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Hunter New England Health Service
Minutes of HNEAHS Diabetes Clinical Stream Leadership Group Meeting
MEETING:
HNEAHS Diabetes Clinical Stream Leadership Group Meeting
DATE:
19 August 2011
PRESENT:
Sham Acharya (chair), Scott McLachlan, Jane Kerr Janine Briginshaw, Carolyn Bailey, Phil Way, Lisa Craig, Melba Mensch, Rosalie
Arnold, Lynne Gilks, Robyn Beach, Margaret Lewis, Louise Saville, Ivy Semple, Penny Cummings (Leadership Group trainee).
Lin Perry, Janet Dunbabin (attended to present at 2pm).
APOLOGIES:
Nicole Martin, Candice Dahlstrom, Vicki Holliday.
TIME COMMENCED: 14:00
ITEM
NO.
TOPIC
TIME COMPLETED: 16:00
MINUTES: Margaret Lewis
DISCUSSION
1
Welcome
2
Confirm minutes Previous minutes from 17 June 2011 confirmed by Carolyn.
3
Business
arising from the
previous
minutes
ACTION / DECISION
RESPONSIBILITY
/ TIMELINE
Sham and other
members to provide
feedback on the
resources directly to
Dr Perry.
Sham
All members
Sham Acharya welcomed members at all locations and Dr Lin Perry and Janet
Dunbabin, who attended to get feedback on the YOuR Diabetes Project.
3.1 Feedback from Stream members on the disseminated YOuR Diabetes
Project resources
Lin Perry gave a brief overview and update on the YOuR Diabetes Project
and asked for feedback on the Insulin Pump resources. Sham advised that
he was seeking comment from the diabetes medical staff, and advised that for
routine pump management during non diabetes related admissions,
Specialists do not get involved. There are insufficient specialist resources to
see all pump patients routinely during inpatient stay. It is assumed that
education occurs prior to and at the time of the pump start. Therefore, simple
steps and precise guidelines are needed to facilitate consistent information
delivery. Carolyn suggested inviting feedback from other groups such as the
Hospital Peak Forum and Emergency Stream, but Sham feels it would be
better to develop a final draft first before inviting comment. Lin agreed, and
added that if the Stream is not happy with the draft, it is pointless taking it to
other user groups. The Project Steering Committee plans to meet next week,
Sham to continue to
update members.
Sham
Sham to update on
progress at next
meeting
and the discussion of the redesign issues for the project will commence.
3.2 Update on Chronic Disease Management system (acceptance testing
phase)
Sham has not heard from the CDMS team about current progress, but a glitch
has occurred and they are still at this stage requesting information. We should
expect a delay of several months.
3.3 Approval for Stream to authorise CPGs – progress with Hypoglycaemic
CPG and Standing order for Glucagon
The Diabetes Stream has been granted approval to authorise area-wide
guidelines. The Standing Order for the administration of glucagon has been
sent to the Quality Use of Medicines Committee and has been approved with
minimal amendment. Both of these documents will be put on the guideline
website with a link to them from the Diabetes Portal (Collaborative Space).
Sham asked that we ensure the documents are clearly marked as relating to
adults, not paediatric patients.
Sham
Finalise both
documents and add
to HNELHD website
Sham to circulate
DKA audit data
Distribute a save the
date email, then
follow with flyer and
registration details
Sham advised the DKA audit is complete and he will share these results with
the Stream group. There is a need for wider consultation with paediatric
clinicians, and with all physicians in all hospitals in the development of the
DKA guideline, and this may take 6 months to complete.
3.3 Planning for 2011 Diabetes Education Forum
Two 2 day forums, held over Friday and Saturday at Newcastle and also at
Tamworth will be offered at a later date, with different topics over the two
days, so that participants can choose to attend either or both days. Lisa and
Scott White from GP Access have organised the date and venue for
Newcastle (21 and 22 October at Newcastle Town Hall), and will organise
CPD points, catering, flyer and distribution to GPs and process registrations,
and welcoming on the day. Robyn and Sham will finalise the content, invite
clinician input and produce the final program, distribute the flyer to relevant
HNELHD staff and evaluation of the forum. Need to ensure the content and
delivery style is appropriate for HNE Health clinical staff and for GPs and
Practice Nurses. The Tamworth forum will be organised after a review of the
Newcastle forum, and will involve input from clinicians in the northern part of
HNE Health, and perhaps other GP Divisions. Once the program has been
finalised, the flyers and registrations will be distributed to relevant HNE Health
clinical staff and forwarded to Lisa to distribute to general practices.
Rosalie &
Margaret
Sham
Robyn & Lisa
Update at next
meeting
Carolyn offered to fund half of the cost of the Newcastle forum. Sham says we
need to ensure paediatric clinicians are involved. It is to be badged as a joint
venture of HNE Health and GP Access.
3.4 HOLD OVER TO NEXT MEETING: Diabetes workforce update, Staff
Specialist support for Tamworth and Armidale
3.5 Discussion of proposed KPIs on the Diabetes Stream 2011-12
Operational Plan
Sham said it is a difficult task to know what KPIs to set, particularly at primary
care level – easier to set the acute level KPIs. Robyn has met with Scott
White from GP Access about Health Pathways and he advised that the GPs
have already met with Clinical Innovations and that the GPs are very keen.
Lisa says there are big opportunities for collaboration and she has spoken to
Karen Kelly who suggested CNCs and Nurse Practitioners be involved in
general practice training. Sham said that there has been progress made on
referral protocols, but there is a need to work on discharge back to GPs from
specialists.
Phil advised to restrict the KPIs to things that we can actually measure. Down
the track we should be able to collect annual cycle of care, HbA1c etc, but
Sham says that this data is not passed across from general practice. The UK
has a framework and the GPs are expected to send data about proportions of
patients completing cycles of care, etc to a central database. Lisa advised
that this information is currently available. Suggestion that the KPI be that
"GP data is fed to HNELHD”. Jane asked if all GP Divisions hold reports on
this data. Lisa advised that she can access this, as it is on the public record.
Suggested that a letter be sent to the other GP Divisions to advise them that
we are seeking this data.
Sham & Robyn
Send letter to GP
Divisions re KPI data
(annual care cycle)
Put minutes on portal
Put TOR on portal
Margaret
Margaret
Margaret
3.8 Member feedback from Diabetes Portal (Collaborative Space) on MyLink
Margaret invited feedback on the portal. Suggested to put the meeting
minutes on the portal to encourage Leadership Group members and other
staff to visit the portal to access them.
3.9 Review of membership and roles and Stream activities
Terms of Reference have been updated, agreed by members and signed by
Sham. Some Leadership Group members to attend meetings only when they
have a contributory role. The new TOR reflects this.
Robyn recently visited Tamworth, Taree and other sites and reports that staff
in these areas are very keen and want to be involved in policy development
and standardising protocols, though there is a certain lack of knowledge
about what the Stream does. Robyn says they should be part of the Stream
Leadership Group to contribute to decisions about the direction in which we
are heading. We need to tap into this enthusiasm, but also work through
priorities with these staff.
There was a suggestion that there could be a strategic group and an
operational group within the Stream, attending alternate meetings. Phil
reiterated that Stream activities are open to anyone in the area, and that the
Leadership Group is small by design and that the role of the group is to direct
where the Stream is heading. He congratulated Robyn for arranging to meet
the staff across the area, and agrees that we need to grab these interested
people now. Jane advised that different streams and networks do things in
different ways. The Vascular Network actively targets people as required, and
that this is very effective. Janine believes there is good support of the Stream,
in her experience, and that we need to continue to promote it.
Phil is also working on the alignment of CNCs, Nurse Practitioners and allied
health staff to the Streams, with the aim of them seeing it as their role to be
part of these groups. He is having discussions with Kim Nguyen. There was
agreement that with the new generalist staff, and new clinical nurse educators
coming on board, it is imperative to provide them with appropriate education.
Carolyn agrees that the Leadership Group should be kept reasonably small,
and that to form working groups, appropriate staff should invited to contribute
for a defined, time-limited period for a particular Stream activity.
Phil advised that in order to not lose the opportunity Robyn has reported, an
invitation to be involved in specific projects should be sent to these staff to
ask which they would like to contribute to. Robyn agreed to write these invites
as soon as possible. Sham said that at the end of their contribution, we
should send them a letter of appreciation.
3.10 Opportunity to offer discounted ComDIAB training
Carolyn reported that Lyn Boylan contacted her regarding an Australian
Diabetes Council (ADC) program targeting practice nurses and community
nurses to develop their skills to run groups. Carolyn proposes to offer this to
HNELHD staff, and has sourced funding for the program which ADC is
Invite targeted staff
across the area to
contribute to Stream
activities
Rosalie and Melba to
review course content
Robyn
Carolyn to progress
with Lyn Boylan
Carolyn to continue to
provide info on this
Rosalie & Melba
offering at a reduced cost. Carolyn proposes the Stream endorses it, and that
staff be cherry-picked to attend the program. Subsequently, with their
manager’s support, they could offer groups over the following year, with
checks to ensure they have the skills and time to run these programs in the
community. Melba questioned what the nutrition component would be, and
the quality of the information staff would then impart, reminding us that the
dietitians have recently standardised patient information across the area.
Rosalie and Melba agreed to review the content. Suggested they could run
groups for people with pre-diabetes, but that complex patients may not be
suitable. Carolyn reminded that we will never have enough Credentialed
Diabetes Educators and though we do not want to offer substandard
programs, as long as they fall within agreed principles and guidelines, there
should be no risk involved. Many people are offered nothing at all now.
Louise says their generalist nurses already wear many hats, (eg.
immunisation, otitis media screening etc.) and is concerned they are asked to
take on more and more. Lisa says that is where general practice staff can fill
the gaps. Carolyn believes that chronic disease resource staff would be ideal
candidates for this training, as they often deal with diabetes clients and they
are doing their best to care for them.
Carolyn
Carolyn
3.11 Referral system for GPs and clinician to clinician - consistency across
the area
Melba advised that not all staff are aware of standardised referrals and that
the level of information received varies. Carolyn advised that next year, 80
different pathways to care based on New Zealand clinical guidelines,
including diabetes care, are to be developed. Carolyn believes that the
Stream is the group to work on this. Lisa says also the e-health and
electronic referral systems and smart referrals are all tied in with this initiative.
4
Standing Items
4.1 Update on National Health and Hospital Reform progress
Scott reported that the full context of the changes, particularly in regard to the
workforce portfolio and HR/industrial relations, is not yet known. However, most of
Population Health and Planning will be under the HNELHD, with public health,
screening etc transferring to NSW Health. Nursing and allied health and clinical
services such as imaging are also returning to HNELHD, as is IT. Pathology will be
a part of a unit stretching from northern Sydney to the Queensland border. The new
Board was established at the end of June, with one new member, and Michael
Dirienzo wants to have the management structure settled as soon as possible.
There has been much speculation in the media and a fair amount of concern
regarding the changes, with the downscaling of NSW Health, and some functions
Scott to provide
update next meeting
Scott
directed to one of the four pillars. Some senior executives have voluntarily moved
out of HNELHD positions due to inaction in advising what is to happen to their
positions. The new structure is far more certain for HNE Health than for other
areas.
The Hunter Urban and Northern Inland Medicare Locals are up and running, and
committees are to be finalised soon. Graeme Kershaw is the transition manager of
the Northern Inland Local. The Community Health Peak Forum met this morning
and a plan for interfacing with these Medicare Locals was drawn up. The GPAC
meeting in two weeks will help advance collaboration. The Medicare Locals are
likely to have huge expectations lumped on them, particularly with regard to after
hours programs. Lisa advised that the contract with the Commonwealth is ready to
be signed, and that she has heard that the after hours services are not to be
affected. Scott advises to ‘watch this space’.
4.2 Vascular Network activities and updates
Jane is asking for assistance from all the Streams in the Vascular Network around
the issue of capacity building among the generalist workforce. The Network needs
to know what basic skills, knowledge and competency to perform tasks the
Streams broadly want their generalist nursing staff to have. Stream member input
will be very important to inform skills training. Jane asked Robyn to drive this by
inviting input from members.
A second Vascular Network initiative is to develop a directory of primary prevention
program information that can be offered to patients. These may include SNAPIF
initiatives, or programs conducted by other organisations such as the Heart
Foundation.
Jane also advised that a NHMRC research proposal was submitted, but was not
successful in first round offers. Sham feels we can incorporate initiatives from our
Stream into the Network and that Jane, Robyn, Sham and Margaret should meet to
discuss opportunities. Lisa advised that GPs do not have a directory of primary and
secondary prevention programs, but that they would find this particularity useful.
Carolyn advised Jane to speak to Karen Gillham from Population Health, as they
have a database of primary prevention activity. Jane clarified that it should be a list
of what everyone should be able to do. Carolyn says that Fiona Hodgson has a
document from New Zealand containing core capabilities for generalist staff around
diabetes care, such glucometer reading, HbA1c. The Stream could consider
endorsing this and building the capability.
Robyn to invite input
to create a list of
expected
competencies.
Robyn to invite all
members
Members to provide
feedback to Jane re
any
primary prevention
All members
activities or programs.
Jane to ask Karen
Gillham for an
existing directory of
primary prevention.
Carolyn to circulate
the NZ core capability
document
Jane
Phil to check with
POC that BGL meters
are within their scope
Phil to send
Innovations Support
Group info to group
Carolyn
Add optometrist
project to the Op
Plan.
Sham says that currently glucose meter standardisation and processes is a limiting
factor. Phil commented that the Point of Care group is assessing standardisation
across the area, so we need to make sure the blood glucose machines are part of
this. Sham advises that there is also no standardised blood ketone testing policy.
Phil
4.3 GP Division Update
Phil reported that the Innovations Support Group is now using a systematic
approach and he says not just GPs and doctors, but also allied health, nurses etc
will be involved to ensure the patient gets the best care. Phil says it is a project
centered around GNC and GP Access initially, and then after a year it will be rolled
out when the system and protocols are worked out. Phil to send the info about this
to distribute to the group to advise what is happening.
Sham has been representing the retinal screening group in Clinical Innovations. He
reported on a pilot project on eye health using NDSS data: Who is doing eye
checks, are eye specialists involved? This needs to go to the Ethics committee
and it will be a while before the project commences. Currently data is not centrally
collected and data pooled. Sham reported on a second small project in Newcastle
with the optometrists who are qualified to do retinal screening, but not all do.
Results from screening that is done are often not shared. The project aims to
identify ten to fifteen optometrists and at get them, upskill them and then patients
can be advised which optometrists have been trained. Assessments are covered
by Medicare, so no cost involved. Carolyn says some optometrists do not bulk bill
and that we need to be careful about endorsing particular clinicians. Sham says It
is the optometrists’ society that will compile the list, and that we would then make
this available to the patient. This project is happening without funding, all done with
goodwill. Phil says that this project should be added to the Operational Plan.
5
New business
5.1 As the next scheduled meeting clashes with the Education Forum in Newcastle,
the meeting will be cancelled. However, if staff are available to meet in the
afternoon/evening after the forum, this can be arranged.
6
Business
without notice
Nil
Phil
Phil
Advise members if
meeting after the
forum
Sham
7
Correspondence
Next meeting
The next meeting is FRIDAY 16 DECEMBER 2011, 2:00pm – 4:00pm
The next scheduled meeting on 21 October coincides with the Diabetes Education Forum in Newcastle, so this meeting will be
cancelled. The final meeting for the year will be 16 December.
Minutes confirmed by S Acharya (Chairperson) on 25 August 2011