Nurse Liaison Group Meeting

MINUTES

Date: Monday 4 September 10.00 am – 2.00 pm

Location: Shamrock House, Rm 1, Gr Fl, 81-83 Molesworth St , WELLINGTON

Apologies :

Anne O'Connell, ACC

Barry Ayling, Nursing Council of NZ

Mark Jones, Ministry of Health

Marion Clark, Nursing Council of NZ

Suzanne Rolls, NZ Nurses Organisation

Chrissie Cope until 11.30am

1. Attendance and Introductions

Welcome to Glenys Best from Counties Manakau, representing District Nursing Service. Also, welcome to Michael Geraghty from Auckland Hospital , representing College of Emergency Nurses NZ .

Members of the group introduced themselves and identified where they work and what organisation s/he represents.

2. Minutes Agreed and Matters Arising

Minutes from 12 th June agreed.

Pip Rutherford commented that there are 26 Nurse Practitioners (NP) in the country. The NP status has been around for the past 5 years with Nurses applying for NP status in a staggered approach. Pip requested that a meeting be arranged by ACC to include Jenny Carryer, NZNC, and to look at pricing at the NP level. Each NP has a specific scope of practice. Kevin Morris indicated that ACC is not in a position to determine specifically what a NP is able to do. Michael is interested in being involved in this kind of group if one occurs.

Anne O'Connell has previously explained the legislation and outlined the process that would be part of any proposed change (see minutes dated 6 March 2006, item 11)

3. Discharge Guidelines – Ruth Taka, ACC

The following handouts were circulated to the group:

•  Draft Guidelines for District Health Board ACC Patient Discharges – Consultation 2006 (Power Point Presentation)

•  Draft Guidelines for District Health Board ACC Patient Discharges – Consultation 2006 (Document)

The following are the main points taken from these:

•  The minimum care requirements for safety would be a baseline

•  Require a smooth transition from hospital to community services

•  The Health and Disability Standards were looked at when developing these guidelines

•  Reduce length of stay while controlling risk

•  DHB's, ACC and Ministry of Health have been involved

•  Discharge Planning starts on acute admission and includes the assessment of essential personal cares, transfers, food/hydration and oversight safety

•  The effective and timely lodgement of claims is an important point

•  ACC705 – used for early notification of complex cases on Admission and Referral for home based rehabilitation on discharge

•  Those who sign the ACC45 form should really take the responsibility that they are happy to be the contact person for that particular case

•  Page 8-9 – Discharge Processed of the document may be useful in the DHB setting as it outlines scenarios

•  Draft Guidelines for District Health Board ACC Patient Discharges – Consultation 2006; this is a shared document between ACC and the DHB's

•  The document needs to include Pharmaceuticals and requires minor word changes, otherwise it is pretty much in the agreed format and content

•  Currently there is a working party to look at the implementation phase of this project. There will be local meetings held to present the final version and to reinforce the packages of care (as at past meetings there was decreased awareness of packages of care)

Comments from the group:

Pip Rutherford indicated that it was good to see two different organisations coming together. It would be a good idea to have Discharge Planners at the DHB's who are funded by ACC and DHB's and assist with triage.

Ruth indicated that there are no plans to reinstate ACC case management into the hospital environment. Kevin indicated that a while ago there were ACC Case Managers in hospitals and they were withdrawn due to staff providing a health service rather than an ACC focus. There may be a chance that may come back, with a shared funding scenario. Marguerite agreed with the case management model on site.

Michael Geraghty commented that Clinicians may be reluctant to complete forms. Ruth replied that it is up to the DHB's to decide what works best for them in terms of completing these forms

Questions:

Q. At what point do you see that a claimant is no longer on ACC?

A. Kevin replied that there is no clarity regarding the cut off point from ACC back to Health. There is a grey area between ACC and Health. ACC is defined by the legislation.

Q. What percentage of injuries that come through the hospital system are classed as complex?

A. Ruth indicated that there are no figures available but it would not be a major percentage.

4. Pain Management – Linda Shepherd, ACC

Linda circulated a handout to the group titled “ACC Pain Management Services”. The following are the mains points from her discussion:

•  There are a number of contracts under the Pain framework

•  History – a few years ago, with a Healthwise restructure, the Pain Portfolio was moved to the Social & Vocational Team. In 2004 there was a BRC survey which highlighted two important issues; one being Pain and the other Claimant Needs. In 2005, a Programme Manager was dedicated to look after the Pain Portfolio

•  1 April 2006 – Go Live of the Pain Service Specifications. This involved service evaluation, a working party (with internal and external members from urban and rural environments), experienced providers as well as newcomers. There was a 6 week stint of interviewing and finding out about current services and needs. There was a lot of qualitative information, with quantative information from the ACC data warehouse

•  This occurred in a phased approach:

•  Short Term – April 2006 – Go Live of the contracts (training for ACC staff as well as providers was undertaken)

•  Medium Term – Interventional Pain

•  Long Term – Further future development of the service

•  ACC is currently involved in service development with the involvement of external stakeholders that provide interventional pain management

•  A Pain Focus Group comprising of a Psychologist, Physio, Occupational Therapist, Musculoskeletal Specialist and a Nurse, have all been heavily involved. There are no consumers as it is still in the design stage, but Linda does have a couple of consumers ear marked when it is appropriate to include them

•  Currently the contract does not include Nurses. A paper has been written to the Senior management group at ACC with a proposal

Question:

Q. What is the feeling of alternative medicine for pain management?

A. There are 14 treatment providers and not all are registered under the HPCA Act. Alternative pain management – only if they are registered providers with ACC.

5. Social Rehabilitation Assessment – Glenda Foster, Kelly Chal and Alison Hearn, ACC

Social Rehabilitation has 2 purposes:

•  Additional treatment necessary under the Community Nursing Contract
•  Determine if Social Rehabilitation Entitlements are required e.g. consumables

The following are the main points from this discussion:

•  ACC recognises that the dual purpose of the contract is not laid out well
•  The branches do not always provide details regarding the reason for the referral on the form which is an issue
•  Complex Assessment will always have a nursing component.
•  Generic assessment may be done by a Nurse, OT or Physio
•  There was a recommendation that consideration be given to the development of a separate referral form for Nurses to be used in relation to a Community Nursing service
•  Chrissie Cope suggested for future development a “suite of service specifications” could be developed with each service specification relating to a particular area of expertise; e.g. wound, Traumatic Brain Injury
•  As assessor should consider any pre-existing conditions and complete a thorough assessment rather than just agreeing to the need for further treatment
•  The contract refers to an assessment tool; however, there is no such assessment tool at this time. Pip offered to find out whether she is able to obtain a copy of the Western Australia Silver Chain Wound Assessment and share this with ACC
•  The contract also states that a “full physical assessment” is required. The wording needs to be reviewed at the next service evaluation as it implies a complete physical assessment which is not entirely appropriate in some situations. A suggestion was made that it could state “holistic nursing assessment”. The flow chart relating to this service may need to include the process involved with the claimants that are under the Community Nursing Contract, who require a social rehab assessment

The next service review is due at the end of 2007; however, in the mean time, it may be appropriate to develop a letter to clarify issues around the contract to allow providers to work better under the contract. Alison Hearn undertook to oversee this. Pip Rutherford offered to post this letter on the website once it became available.

6. Provider Development – Patricia Logan and Samantha Hutcheson

Patricia has attended previous meetings and has discussed the ACC Return to Work Guidelines. This was designed for GP's as under the legislation they can only sign claimants off work. However, Return to Work Guidelines will be made available for members of the Nurse Liaison Group as well as the Physiotherapy Liaison Group.

Provider Development will be running a programme on Pain once the Traumatic Brain Injury work is completed.

The Pain Programme will focus on the diagnosis of persistent pain and how to manage it. There is a Clinical Net Group which includes Nurse's, GP's, Specialists, Physios and Pharmacists.

Pip Rutherford indicated that she was concerned that NP's are not able to sign claimants off work. Patricia indicated that ACC must work within the legislation.

Pip also indicated that a work force development submission (by Jenny Carryer) was made to ACC in the past and there has been no response. It was requested that this submission be forwarded by Pip to Chrissie Cope.

The development of a DVD on cultural competence is currently being developed with Samantha as Project Manager. There are 9 modules (8-10 minutes each), which consist of:

•  Introduction
•  Why there is a need for Cultural Competence
•  Effective Communication
•  Pronunciation
•  Whanau
•  Tapu
•  Ethnicity
•  Death
•  Professional Development

At the end of each module there will be a discussion section. The aim is to launch this at the Pacific Region Indigenous Doctors Congress (PRIDC) in early December, with a release in February 2007.

Marguerite Besier indicated that the NZOHN Association would be interested in the DVD when it is released. Students may be interested also.

The target audience for this DVD is practicing health professionals

There is a clinical reference group where members comment on material produced by the Provider Development Unit. Feedback is welcomed via email. There will be work completed on material relating to Occupational Hearing Loss and neck Sprain.

Most of the material is available on the ACC website under the Providers/Resource section

Pip mentioned that she values the work/development that is produced by ACC around culture and guidelines.

7. Assistant Corporate Medical Advisor/Branch Medical Advisor – Margaret Macky, ACC

Margaret briefed the group on her background and role at ACC.

She would like to see some consistency with messages that are sent from the BMA's throughout the country.

Margaret advised she is happy to be contacted with any queries that the group may have. She can be contacted via email at: Margaret.macky@acc.co.nz

Occupational Disease

Schedule 2 (automatic cover). ACC is interested in promoting the understanding of occupational diseases as some claimants may be missing out on entitlements due to the lack of awareness. Project work will be done over the next 12-24 months. As information is spotlighted, it will become available on the ACC website. The Provider Development Team will be involved in the design of printed material.

Occupational Stress

It has been identified that stress is a hazard but this is not covered under the ACC Act as an injury. If an ACC45 form was completed for work related stress, this would not be an accepted claim under the legislation.

The Department of Labour have an interest regarding work related stress.

Nursing Treatment Profiles

The aim of the Nursing Treatment Profiles is to describe a shared understanding within the professional group. It is also used as a guide by Nurses working in areas where they do not have clinical support from their peers/GP.

The document has been peer reviewed by the College of Nurses . The current phase is editing to ensure it has a consistent format and is user friendly. Any repetition in each section will be pulled out and placed at the start or end of the section, so it is not repeated under each injury. This will allow the document to be more concise and user friendly.

Treatment of burns will need to reflect recent guidelines that have been developed and signed off and about to be published.

It is hoped to have the final draft ready for the next NLG meeting in December.

8. Other Business

•  There was a request that the ACC CEO, Dr Jan White, be invited to the next NLG meeting
•  A question was asked if representatives from the MOH and Nursing Council will still attend the NLG meetings, as they had regularly in the past. Chrissie will check with both organisations
•  Chrissie also suggested that Sunita Goyal, ACC Pharmaceutical Advisor, be invited to meet with the group

 

Next NLG meeting is on the 4 December 2006.

Action Items: