Molesworth Street Wellington
Prepared by Pip Rutherford NP
June 11 th 2007
Review of minutes from previous meeting.
- Nursing treatment profiles due to be commented on by mid June
- Burns Guidelines will be released in July at GP conference and also national guidelines will be on the New Zealand Guidelines Group website
- ACC does not provide pamphlet holders for their printed material
- Funding for psychology. ACC will only fund if a mental in jury is result of a physical injury for example would not fund of work related stress. Psychologist needs to be ACC approved for funding
Treatment Injury
Presentation on treatment injury Rachel Taylor and Karen Williams (ACC). Medical misadventure was amended to treatment in jury in 2005. An update on treatment injury claims was provided for last 2 years since the new system was started.
Exclusions are:
- When an outcome or event is a necessary part or consequence of treatment
- Is the result of unreasonable with-holding of consent by patient
- Where the claim is based on treatment not getting the desired results
- Where event is related to resource decision e./g waiting lists
- Significant contribution of underlying health conditions.
Claims to ACC for treatment injury are increasing (now over 10,000) and a possible reason is that evidence of medical misadventure is no longer required. Nurses can lodge claims and it will be processed more quickly if ACC45 form and ACC2152 TI claim forms are both sent at once. 56% claims have been accepted and the median decision time is only 13 days. The top nursing related claims are pressure areas, skin damage, (from removing plaster or tapes) haematoma, allergic reaction. Claims can be retrospective to 1974. Acc suggest that poor documentation by nurses and others makes claims difficult for them when health records are reviewed.
Claims related to drugs include dispensing errors, IV cannulation problems, reactions, and infection. GP practice top 4 are allergic/adverse reaction, infection, anaphylaxis and perforated eardrum from syringing.
Acc collects data on national harm notifications and the top 3 are bowel perforation, (usually secondary to colonoscopy) CVA, blindness and visual disturbance. They think their data will be useful for organisations to plan future audits and practice reviews
Disposition Tool, developing a sorting tool for after hours interface between DHBs and Primary Care A&M.
Dona Shiell
Expert advisory group developed and it was found that there is huge variation in needs, between city, rural and regional areas. Funding, cost, staff shortages and convenience have been considered and the process is not a triage assessment process to inform treatment options. Rather it is a filtering process so the right care is given in the right place.
Current systems include:
- ED which does not provide ongoing care
- Primary Health is ideal for many cases. Staff shortages in primary care is an issue after hours
- A & M Clinics providing after hours service for GPs. They have issues around financial sustainability. Sometimes co-located with other services
Five principles are:
- Primary care is the main service that will meet long term needs of patients
- Patient will get ongoing care from primary sector as much as possible
- People will not be denied access to services
- After hours primary care and ED are compatible and will overlap, but are different services
- Access to appropriate services will be improved
New strategies will include a sorting tool, phone help-line, patient education and to treat only what is needed at the time of visit.
Return to work project.
Noeleen Hill explained the pilot where an occupational health nurse is involved in some cases to speed up return to work. Two pilots one in Hastings and one in Christchurch , Is aimed at pts who are off work for more than 7 days but not for long term. Numbers in pilot are low as patient consent is required. After injury a patient is referred to an occupational health nurse to see if early return to work is possible. May be able to access new support such as transport to and from work. Project will be re-evaluated in December 2007
Home Based Rehabilitation project.
Home based Rehabilitation (Long term clients) and Community Nursing (short term clients) have now separated into different units. Entry to the Home Based Rehab programme is via the current assessment process. ACC can assist with things like child care, home help, claimant training costs, RN services.
Primary Health Care Strategy. Verna Smith
Injury prevention not well utilised in Primary Health arenas. Community based health promotion is being explored with a collaborative group being developed to address work-force shortages, poorly co-ordinated patient care, silo mentality of health professionals, rural setting challenges, aging population, using advanced web technology. |
