In keeping with Cobram District Health’s commitment to respecti ng and valuing Australia’s First Peoples, we would like to acknowledge the traditi onal lands of the local Aboriginal people and pay our respects to Elders both past and present.Cobram District Health is committ ed to providing quality health experiences for all people from culturally and linguisti cally diverse backgrounds and

minority groups.

Quality Account2018-

2019

Wayne Gainger says the cardiac rehab classes at the Moira Community Rehabilitati on Centre has got him moving again.

“Bett er than sitti ng in front of the TV and feeling sorry for myself. I had a crook valve and the operati on was really

long, but these classes have really helped get me moti vated. I’m taking it slowly but I’d like to get down

to Thompsons beach and walk along the river down there. Thats my goal.”Cardio rehab is just one of the many classes off ered to our community to get well and get acti ve. To access rehab classes contact Community Health on 5871 0777(opt5). Our recepti on staff will guide your enquiry. Some consumers may need to be referred by their GP or hospital.

www.cobramdistricthealth.org.au

Cobram District Health has been working closely with Numurkah District Health Service and Nathalia District Hospital under a shared services model across the three organisati ons. During the year, a second stage of community engagement took place on the proposal to join the three health services as ‘NCN Health’ in 2019. We thank the community for their valuable input into the proposal. An independent Due Diligence Report found no major issues of concern on the proposal to join services, which will improve access to care for local communiti es. The proposal was endorsed by the three Boards in April and approved by the Minister for Health in June 2019.

Mental health services were increased through the ongoing partnership between Cobram District Health, Numurkah District Health Service, Nathalia District Hospital and Yarrawonga Health. New Psychological Therapy Services and Mental Health Clinical Care Coordinati on for residents of Moira Shire have been funded by Murray Primary Health Network.

Cobram District Heath conti nued to parti cipate in the Respiratory Project – a grant funded partnership project that aims to improve lung health and reduce

Partnering With Our Community

Getting Moving Again

CEO & Chair Report

avoidable hospital admissions due to lung disease. It focuses on providing Pulmonary Rehabilitati on in four health services: Cobram, Yarrawonga, Nathalia and Numurkah.

Our Community Health Team began a 5 year collaborati on with researchers from Deakin University to undertake a ‘whole of community’ project to encourage the uptake of healthier food and exercise opti ons for our children.

The Urgent Care Centre conti nued to work with Numurkah, Nathalia and Kyabram Health Services to strengthen the capacity of our Urgent Care Centre. “Choose Well Feel Bett er” funded by Bett er Care Victoria and the specialist telehealth facility “My Emergency Dr” were introduced to help your visit to our Urgent Care Centre result in the best possible outcome.

CobCAB: Cobram District Health have been working in close partnership with Cobram Community House to purchase and resource an all-abiliti es bus to transport residents of Irvin House and local community groups to att end community events. The project is an exciti ng initi ati ve to improve social connectedness in our local community.

We are delighted to present the 2018-2019 Quality Account to our community. The report details a range of informati on about the care our organisati on provides and focuses on the quality and safety of that care.

This has been a busy year for Cobram District Health as we conti nued to deliver high quality services and work in close partnership with a range of organisati ons to meet the needs of our local community.

During the year, Cobram District Health reestablished a clinical governance system focusing on quality, safety and conti nuous improvement. We maintained accreditati on for the health service and successfully achieved accreditati on for the Commonwealth Home Support Program. We also had a support visit from the Aged Care Quality Agency and maintained our aged care accreditati on.

The health needs of our local community are at the centre of our planning, with our staff providing over 50,000 appointments annually. We delivered services from prenatal to residenti al aged care on-site along with home and community based services off -site through our District Nursing, Home Care Packages and Community Health teams. Our clinics provided comprehensive medical and dental care, with over 35,000 appointments annually.

This year has seen major infrastructure projects completed, such as the mechanical, electrical and airconditi oning upgrade over the whole site, and planning and detailed design work commenced for the $1.9 million upgrade to Irvin House. We acknowledge the hard work and dedicati on of all of our staff and would like to thank our volunteers, Consumer Advisory Committ ee and our Hospital Auxiliary for their ti me and commitment. I look forward to your feedback on this report and our services. This is the fi nal Quality Account for Cobram District Health. Next year we will report as NCN Health.

Jacque Phillips OAM Chief Executi ve Offi cer

Dale Brooks Board Chair

All incidents reported in our health service are given a score of 1, 2, 3 or 4. These scores measure the impact on the pati ent, client or resident as a result of the incident. Incident Severity Rati ng 1 (ISR1) is the highest or most severe impact; and Incident Severity Rati ng 4 (ISR4) is a ‘no harm’ or a ‘near miss’ incident. This year we had one ISR1 incident at Cobram District Health. A full root cause analysis and clinical review was conducted. There were no shortcomings in the care or clinical processes identi fi ed and the staff were found to have provided the best possible care in the circumstances.

We had 18 ISR2 incidents. The majority of these were due to presentati ons at our Urgent Care Centre. We respond to almost 5000 UCC presentati ons every year. All presentati ons are triaged by the nurse on duty. The pati ent may not have had an adverse event, but a facet of their conditi on was serious enough to trigger an ISR2 report. (An adverse event is an incident occurring in a health service that resulted in harm to a person receiving care)

We take these incidents very seriously and have been working hard this past year to review our escalati on of care processes, and strengthen our reporti ng processes.

We have introduced a dedicated weekly CARE meeti ng to make sure all incidents are reviewed in a ti mely manner, and that recommended acti ons are followed through on. We have built staff capacity through extra emergency care training and introduced a telehealth service, My Emergency Doctor, to support the triaging nurse.

We also established a new Morbidity and Mortality Committ ee, which involves the Director of Medical Services, General Practi ti oners, the Nurse Unit Managers, the Director of Clinical Services and the Quality Coordinator. This committ ee reviews all serious incidents and makes recommendati ons for acti on and improvement and is also charged with ensuring the recommendati ons are implemented.

12 Acute BedsOperati ng Theatre & Day Procedure Unit

EndoscopyGeneral SurgeryOrthopaedicsMinor Gynaecology

Palliati ve CareTransiti onal Care BedsUrgent Care CentreRadiology

Hospital

Irvin House

Community Health

Superclinic

Moira CommunityRehabilitation Centre

29 High Care Beds1 High Care Respite Bed

Community Aged CareAllied Health ServicesDistrict NursingHospital in the HomeChronic Disease ManagementHealth Promoti on

GP ClinicVisiti ng Medical SpecialistsDental ClinicPathologyMidwiferyPracti ce Nurses

Individual & Group Rehabilitati onMulti disciplinary Team

Safer Care Through Constant Review

Training for Success

Our Services

Cobram District Health Victorian Target

75%85%

Very positive response to questionson discharge care

Cobram District Health parti cipates each month in the Victorian Healthcare Experience Survey (VHES) This survey provides very important informati on on our pati ents’ experiences. In 2018/2019 some of the areas we targeted are:

Victorian Health Care Experience Survey

As a result of the closer cooperati on between the three health services, this year Cobram District Heath commenced holding orientati on days in conjuncti on with Numurkah and Nathalia Health Services. New employees from each site were brought together within their fi rst weeks of commencement to complete training and educati on to their new roles.

Apart from learning about policies, procedures and systems to ensure they are supported over their employment with CDH, this sharing of resources allowed more opportunity for staff to meet workers from each campus. The feedback from the groups run has been overwhelmingly positi ve.

This has also allowed us to really up the ante on the provision of face to face training. It has proved much more cost eff ecti ve to engage specialist trainers , with staff completi ng Strengthening Hospital’s Response to Family Violence, Bullying and Harassment training in 2018/9.

Occupati onal Violence and Aggression:In 2019 CDH had a focus on occupati onal violence and aggression, and ran workshops across the year. The focus was on understanding occupati onal violence and agression and supporti ng staff to de-escalate situati ons, and to ensure they stay safe. Staff have also been encouraged and supported to ensure all episodes are reported, so that staff can be supported as each incident is investi gated.

Bullying and Harassment:HR on Track provided a series of workshops to increase the understanding around bullying and harassment. The introducti on of stronger, clearer policies and procedures saw an increase in staff understanding of and confi dence in reporti ng incidents related to bullying and harassment.

Cobram District Health Victorian Target

Positive patient experience

95%97%

What you told us:

Discharge informati on not clear enough.

Pati ent wanted feedback acknowledged regarding care.

Pati ents not always aware of the Urgent Care Centre fee for doctors.

Discharge documentati on project commenced. Discharge check-list reviewed.Multi disciplinary team involved with families and carers to discuss relati ves needs at home.Post discharge phone calls introduced.

Introduced a Welcome to the Urgent Care Centre Important Informati on Sheet which includes doctor’s payment arrangements.Educati on provided to doctors, nurses and administrati on staff .

Pati ent communicati on white boards in rooms redesigned to capture daily care planning acti viti es.Pati ents informed regarding how to escalate care concerns.Educati on provided to staff and doctors.

What we did:

Expert AdviceFor people living with a disability, the simplest things can become an obstacle when accessing our health service. From the location of parking spots to the slope of a footpath to the height of the handsoap dispenser to the position of the toilet paper - the way a health facility is organised can have a significant impact on equity of access. At Cobram District Health we have a variety of buildings, old and new, some with significant legacy issues for people living with a disability. Some problems are very expensive to resolve and some are just a case of changing how we arrange the furniture or how we do things.

But where to start? What would make the most difference to our patients and consumers? To sort the priority list we needed some expert help. So we put together a disability access consumer working group, and enlisted the help of three of our volunteers with a variety of disabilities. With their help, we worked through the list of identified barriers to access and got them to tell us what would make the most difference to them. Along with representatives from the maintenance and corporate services department, they spent several days touring the facility and coming up with solutions. The working group assigned a priority to each project, based on the lived experience of our expert panel of volunteers. We took into account the risk of injury and the degree of inconvenience.

Some solutions were very cheap, such as establishing wheel chair parking spots in the waiting room areas. Others required scheduling maintenance resources, such as shifting the disabled carparks outside the Moira Community Rehabilitation Centre closer to the front door, and some required capital planning, such as the new handrail outside pathology.

The Consumer Advisory Committee are responsible for monitoring the progress on the Disability Access plan and we look forward to a more accessible service in the future. The Disability Working Group will collaborate on our new disability action plan for 2020 and if you have suggestions for how we can make our service easier for you to access, or would like to be participate in the working group then contact the Volunteer Coordinator on 5871 0777.

Consumer feedback provides valuable information on the standard of client satisfaction and allows Cobram District Health an opportunity to improve upon all aspects of our service. Consumer feedback brochures are available in all 6 of our customer service areas. You can also send your feedback by email to admin@ncnhealth.org.au or you can use the feedback form on our website or even give us a phonecall (5871 0777).

Our Community Health team received a complaint regarding confusion over a booked appointment. The client received a letter from our administration team but couldn’t clearly identify who had sent the letter. When they arrived for their appointment no appointment was booked for them.

As a result of this matter being brought to our attention we process-mapped our new appointment process and identified areas that needed improvement. A checklist was developed for staff to use to assist in making sure all steps are followed and clients now receive a phone call and a signed letter confirming their new appointment. The client who made the initial complaint was very pleased to hear their complaint had instigated changes to help make our process more effective.

Another way you can give us your feedback is through Patient Opinion Australia which is a website where you can share your opinion safely and anonymously. Just Google Patient Opinion Australia and get started. Its easy to use, with no log in required. How it works:1. Share your story of using a health service2. Patient Opinion sends your story to staff so that

they can learn from it3. You will get a response4. Your story might help staff to change the way we

provide servicesEvery single post, large or small, will be seen by our CEO, Jacque Phillips, and your issue will be communicated directly to the department that needs to know. We aim to acknowledge all posts within 48 hrs. Some issues may be hard to solve and others easy, but rest assured we will keep you in the loop through the safe, anonymous space of Patient Opinion Australia. Cobram District Health is lucky to be only one of eight health services chosen to trial this new platform by Safer Care Victoria.

Your Feedback matters

Beryl Reynolds is 95 years old and she has had more than a few setbacks. Like a broken hip - twice! - but she is not going to let that or anything else get in the way of her independence. And with a caring relationship with her home care Case Manager Tess Lane, she has been able to not only recover from those set backs, but to thrive as well.

“It’s hard when you have no relatives nearby to help,” says Beryl. “I have been with Cobram District Health Home Care program for 15 years now and I can say that Tess has taken so much off my shoulders, because when I have no one else to turn to, she is always there. My home care takes me shopping and helps me with the cleaning but they do so much more than that. They have helped with the transition care at home. They would come and help me with exercises and the district nurses came to help me with some wounds on my leg that wouldn’t heal. If I am feeling a bit shaky and have to get a taxi, the home care package will even pay for that. I am very active in the community. I find that having home help has not made me more dependent at all. In fact the opposite. It has allowed me to keep my independence.“

Tess helps her make the most of her package, advising her about some entitlements she may not have been aware of, such as maintaining her car. She qualifies for this assistance because it allows her to get out and about in the community for social events. Tess brings her experience to all sorts of problems Beryl has to face, like arranging bills and getting things repaired.

Our case managers like to take a holistic approach to our patients, involving families wherever

possible. “It’s a gradual process of building up trust with the client,

and getting everyone involved - on the same page. We

just go that extra mile in a way that the out

of town providers, with such high client ratios, are simply not able to do.”

Interested in finding out about

your homecare options? Ph 5871

0777 today (opt 5)

Keeping My Independance

Case study

Patient Opinion Australia

FeedbackreceivedJuly 2018 -June 2019

119Compliments

56Complaints

What you told us:

Nicer napkins for Irvin House meals.

More activities in theIrvin House gardens

Waiting on the phone for the Medical Clinic was too long

Residents now enjoy cloth napkins at every meal

We established separate external phone lines for medical and dental clinics

Kitchen staff and residents planted herbs together.

What we did:

Cobram District Health identi fi es that failure to recognise and appropriately manage deteriorati ng pati ents is a contributi ng factor in many adverse events in hospitals and health care organisati ons. The essenti al elements of the Escalati on of Care System include:

OBSERVATIONObservati on charts with standard criteria that easily identi fy pati ents that may be deteriorati ng for Clinical Review and Rapid Response. If a pati ent is deteriorati ng we can alert other staff to help.

A case review of a pati ent presenti ng to the Urgent Care Centre with burns identi fi ed a need to provide broad educati on to staff around how to respond and support a pati ent with complicated burns. Improvements have been the development of a burns kit in the Urgent Care Centre and the delivery of increased educati on to staff around early identi fi cati on of the risks associated with burns.

Educati on with a focus on the use of facilitated simulati on in the Urgent Care Centre has also enabled staff to undertake clinical review and refl ecti on of clinical practi ce in the early recogniti on of clinical deteriorati on and escalati on of care processes.

A fundamental principle of good medical care is to involve the pati ent/consumer in care decisions. In a busy hospital environment this can be challenging. But with a small change to the way we do things we are trying to acti vely involve the pati ent in the conversati on about their care.

Acti ons we have taken are to include the family wherever possible in the clinical bedside hand over. Another acti on is to bring pati ent feed back to the clinical beside handover. Rather than recording pati ent feedback only in a writt en form, we have found that if we verbally bring that feedback to the clinical bedside handover, we can not only resolve the concern quickly and effi ciently, involving the whole care team, but we can also involve the pati ent directly.

Through these small changes we have been able to improve our response ti me to pati ent concerns and this year we have met and /or exceeded our goals for overall pati ent experience.

Escalation of Care

Continuous ImprovementListening to the PatientExperience

TheDental Team

at Cobram District Health

Have you ever wondered why you need to fi ll in a medical history form at the denti st? It may seem very trivial (and we also someti mes hear ‘annoying’ and ‘unnecessary’) to you, but medical history informati on needs to be accurate, for your own sake.Our Dental Clinic has combined

recent pati ent feedback and legislati ve requirements to produce a streamlined and

easy to use document.The medical histories are so we are aware

of any health changes you may have had or new medicati on you may be on. Medical history

forms include questi ons about dental history, lifestyle (such as smoking, high sugar intake or fl ossing habits),

and family medical history. This history, combined with the results of your initi al clinical examinati on, will help us to assess

your immediate dental-care needs and help recommend the best treatment approach, while also minimising any risks to you.

Please be assured that all your informati on is kept strictly confi denti al and is not used outside the dental practi ce without your permission. We encourage pati ents to come in 10 minutes early to their appointments so they can fi ll out their medical forms without cutti ng into their appointment ti me. So thank you for your pati ence when we ask you to fi ll in a Medical History - we have your best interests in mind!

Have you ever wondered why?

CERSClinical Emergency Response System (CERS): is an established procedure for escalati on of Clinical Care or Rapid Response.

EDUCATION:Educati on for clinical staff to reinforce their skill in recognising and responding to pati ents who are clinically deteriorati ng.

EVALUATION:Conti nuous Quality Improvement including auditi ng, and review of all occurrences of escalati on.

REACHThe process for pati ents and/or their families to raise their concerns about changes in their medical conditi on.

R: You may recognise a worrying change in your conditi on or in the person you care for.

E: Engage (talk) with the nurse. Tell them your concerns.

A: If you are sti ll concerned - Act - speak up

C: Call the Nurse in Charge and request a “Clinical Review.” This should occur within 30 minutes.

H: Help is on it’s way

Midwife Care provides family-centred maternity services to our local community in conjuncti on with a women’s birthing hospital. Midwife Care is located within the Cobram District Health Medical Clinic and provides collaborati ve support between General Practi ti oners, Midwives, delivering hospitals, Maternal Child Health and other support services.

Antenatal care is off ered to women as part of the shared care program with Goulburn Valley Health and North East Health Wangaratt a. This enables women to book into either hospital to deliver without having to travel to see a midwife. Low risk women can then conti nue to see the Midwife or GP for their care in the Cobram area. This allows families to develop a relati onship with the Midwives who provide individual pati ent-centred care, evidence-based informati on, educati on and emoti onal support during their pregnancy journey.

All women who deliver and have their postnatal care in a public hospital are also off ered domiciliary care at home by the Midwife Care team. This includes Goulburn Valley Health, Northeast Health Wangaratt a, Yarrawonga Health, Echuca Regional Health and Albury Wodonga Health.

A breastf eeding Educati on and Support service is also off ered with one Midwife being an Internati onal Board Certi fi ed Lactati on Consultant. This service can be on site, in the home, or on the telephone.Women can access the Antenatal service with a pregnancy referral from any local Doctor and the Midwives will happily answer any queries or concerns. If not able to assist they will refer families to the appropriate service. Some of these services may include drug & alcohol, QUIT, counselling, mental health, housing, parenti ng, & pregnancy support services.

In the last fi nancial year the Midwife Care team have provided care & support services for:• 80 new antenatal clients & families booked

to deliver at Northeast Health Wangaratt a & GVHealth

• 29 Discharge planning and educati on sessions• 100 standard low risk antenatal visits• And 117 Domiciliary home visits following birth.• Breastf eeding educati on and support has also

been off ered when necessary.The Midwife Care service operates on a Monday, Wednesday and Friday (not public holidays) and is provided by 4 experienced Midwives; Jacquie, Sarah,

Kylea and Rebecca.

Midwife Care

A New Kind of Reality

The Nati onal Aged Care Quality Indicator Program is a voluntary program that provides a set of measures used to evaluate and report on the care given in Residenti al Aged Care homes. The set includes fi ve measures.

Pressure injuries are an area of skin and underlying ti ssue that has been damaged due to unrelieved pressure. Stage 4 pressure injuries are the most serious and we had zero injuries per 1000 bed days. We had 0.19 Stage 3 injuries per 1000 bed days, which is below the State-wide average. Over 2018/19 we have achieved a sharp reducti on in Stage 1 (0.48) and Stage 2 (0.29) pressure injuries per 1000 bed days through strategies such as pressure relieving devices and new protocols for the ongoing monitoring of residents by staff .

Staff have been working closely with our GPs to reduce the numbers of medicati on which residents are taking. Over the last quarter of reporti ng the use of 9 or more medicati ons has reduced by 30% to 5.76 per 1000 bed days. This is similar to the State-wide average.

Aged Care Indicators

Saving your life. - Our wonderful Ladies Auxiliary with the $15,000 defi brillator that they have fundraised for.

For the Teddy Bear Hospital in 2018 we invited 140 local prep aged children to bring their favourite teddy bear or toy to visit Cobram District Health to parti cipate in the Teddy Bear Hospital program. The children took part in acti viti es that included a dental check-up and doctor visit for their teddy bears,

Teddy Bear Hospital

a look inside a local ambulance and a healthy eati ng session with our dieti ti an Caitlyn Cormick. They also parti cipated in a fun outdoor acti vity that encouraged their toy or Teddy bear to exercise!

The Teddy Bear Hospital is a joint program developed by the University of Melbourne in conjuncti on with the Royal Children’s Hospital. It aims to desti gmati se the medical health services available in Australia and encourage children to feel welcome in the local health service.

Cobram District Health partnered with Dementi a Australia to run workshops for families, residents, volunteers and staff to help them bett er understand how to care for the growing number of Australians suff ering from a form of dementi a.

The second largest cause of death for Australians, dementi a, refers to a group of cogniti ve conditi ons such as Alzheimer’s, Vascular Dementi a, Dementi a with Lewy bodies or Alcohol Related Dementi a to name a few. Dementi a educati on was well att ended by staff . The families, volunteers and carers workshop was also well received, with people learning how to engage with someone with dementi a, strategies to have a “good visit” and how to recognise the behaviour changes that are caused by the underlying disease. Virtual reality technology was also used to give staff a chance to experience fi rst hand what it feels like to have dementi a. The Dementi a Project ran for two months, providing an opportunity for everyone to gain skills and build awareness.

Staff used virtual reality technology to gain an insight into the experience of someone living with Dementi a.

Pressure Injuries:

Multiple Medications

0.00

1.00

2.00

1 2 3 4

Our Pressure Injuries Stage 1

Our Rate State Rate

0.00

10.00

20.00

1 2 3 4

Our Falls

Our Rate State Rate

0.00

10.00

1 2 3 4

Our 9 or More Medications

Our Rate State Rate

0.00

0.50

1.00

1 2 3 4

Significant Weight Loss >3kgs

Our Rate State Rate

0.00

1.00

2.00

1 2 3 4

Our Pressure Injuries Stage 1

Our Rate State Rate

0.00

10.00

20.00

1 2 3 4

Our Falls

Our Rate State Rate

0.00

10.00

1 2 3 4

Our 9 or More Medications

Our Rate State Rate

0.00

0.50

1.00

1 2 3 4

Significant Weight Loss >3kgs

Our Rate State Rate

Rate

per

100

0 be

d da

ysRa

te p

er 1

000

bed

days

Cobram District Health Victorian Target

75%88%

patient’s perception of cleanliness

Tell us what you thought of our Quality Account. Did you read it in the paper?Would you prefer an electronic copy?

What is the most important part of our health service to you? Email us on feedback@

cobramdistricthealth.org.au

What did you think?

In 2019 our health service began working with Deakin University on a project to improve health and wellbeing outcomes for children under 12 in our community. This project has involved schools, family support agencies, local businesses children and community members.

Research from Deakin University has shown that the causes of poor eati ng choices and lower childhood acti vity are complex and diff erent for every community. There is easy fi x for this issue. Each community requires a tailor made soluti on that addresses the parti cular dynamics at play in that community. It’s not about one soluti on but lots of soluti ons working together to lower the obstacles to healthy eati ng and to encourage physical acti vity for our children. A series of community consultati on forums were initi ated in March of 2019, using a community ‘cause and eff ect’ mapping process to build a picture of the many complex factors at play.

Cobram District Health and Deakin University will work together over the next fi ve years to develop this map, and with local community members and groups to develop and implement local ideas and soluti ons to create healthy lives for our children

Meeting Your NeedsThe Dignity of RiskIn order to improve service experience and outcomes we are constantly reviewing our practi ces and programs. The Community Health Integrated Program guidelines require our service to ensure we are meeti ng the needs of people in our community who live with chronic disease and children, parti cularly vulnerable children.

Early Intervention with Speech Pathology The 2018 Australian Early Development Census on children in their fi rst year of school revealed that the Moira shire had a large number of children (15%) who were vulnerable in the area of language and cogniti ve skills. We now off er a dedicated paediatric speech pathology service for preschool aged children living in our community.

Wait times for PodiatryOur Community Health Podiatry service is an excepti onally busy service, seeing upwards of 70 clients a week. Feedback from clients indicated that our wait ti me for appointments was becoming a problem. In order to best meet our community needs we implemented the following:

• Referrals for clients with Chronic Disease Management Plans are now only accepted for clients in Cobram District Health’s catchment area

• Increased the number of hours of Podiatry available to the community each month.

These changes have made a small but signifi cant diff erence in the wait ti mes our clients are experiencing.

PrivacyFeedback from the 2018 Community Health VHES indicated that at ti mes our clients were not given enough privacy at our recepti on desk. All clients are asked to take a seat on arrival and only one client at a ti me is called to the desk to arrange further appointments and payment. There is also a sign in our recepti on areas asking our clients to respect each other’s privacy.

Targeting servicesTo ensure we are able to provide a high quality service to people with chronic disease and health conditi ons and minimise wait ti mes for appointments we have limited our referral acceptance to clients residing in our immediate hospital catchment area. This decision was directly based on feedback from our clients. This has minimised the wait ti me for appointment parti cular in areas of high demand including Diabetes Educati on and Podiatry.

Healthy Choices for Children

Increasing ImmunisationRates for Residents:

Infecti on Control took over the management of the program this season. One gap identi fi ed was that doctors would do a round on a certain day and would only immunise the residents directly in their care. Any new residents could possibly be missed. Changes to the program were made so that immunisers now go into Irvin House on May 1 and immunise all residents. Any new residents are noti fi ed to Infecti on Control and immunisati on is arranged. We have also introduced a program to ensure that all residents have the pneumococcal and shingles vaccine where indicated for their age. Most people in aged care are prett y happy to be immunised, provided they and their families are well informed. Vaccinati on has oft en already been discussed with their GP’s before they have gone into care.

In the last twelve months Cobram District Health has had no incidents of Staphylococcus Aureus infecti on. The nati onal benchmark rate is 2 per 10,000 occupied bed days.

Our rates of signifi cant weight loss (greater than three kilograms in three months for a resident) stands at 0.19 per 1000 bed days which is well below the State-wide average rates of 0.88 per 1000 bed days. Our unplanned weight loss rates (any resident who lost weight three months in a row) at 0.96 were also very low.

It should be noted that this greater att enti on to fall recording and preventi on strategies has resulted in an increase in recorded fall numbers at 10.7 per 1000 bed days which is slightly higher than the State- wide average of 8 per 1000 bed days. However we are confi dent that there has not been an increase in damaging falls and it has led to an increase in resident quality of life.We aim for zero fracture from falls. Our rate, at 0.29 per 1000 bed days, is lower than the state average

Residents are encouraged to conti nue to be as mobile as possible. Maintaining mobility is important for resident wellbeing and residents have the right to take reasonable risks that are essenti al for their dignity and self-esteem and they should not be impeded by excessively cauti ous caregivers. This concept is called the dignity of risk. In line with this we adopted a zero use of physical restraint policy in 2018/19.

Many falls in a health care setti ng happen in the vicinity of the bed and we have adopted new strategies to reduce the severity of falls that our residents experience. We have installed a number of low-low beds and introduced the use of sensor equipment which noti fi es staff that a resident positi on has changed. Crash mats have been purchased which are placed on the fl oor for residents who are at risk of rolling from bed.

We have also improved the way we record, analyse and respond to resident falls. All falls, including rolls from bed with nil injuries, are now reported. We also have looked at ways to disguise doors to prevent falls in parti cular areas where residents experience dementi a related visual hallucinati ons. Falls are individually reviewed and strategies adopted to ensure best outcomes for residents.

Pressure Injuries:

Falls

0.00

1.00

2.00

1 2 3 4

Our Pressure Injuries Stage 1

Our Rate State Rate

0.00

10.00

20.00

1 2 3 4

Our Falls

Our Rate State Rate

0.00

10.00

1 2 3 4

Our 9 or More Medications

Our Rate State Rate

0.00

0.50

1.00

1 2 3 4

Significant Weight Loss >3kgs

Our Rate State Rate

0.00

1.00

2.00

1 2 3 4

Our Pressure Injuries Stage 1

Our Rate State Rate

0.00

10.00

20.00

1 2 3 4

Our Falls

Our Rate State Rate

0.00

10.00

1 2 3 4

Our 9 or More Medications

Our Rate State Rate

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Aged Care Indicators

• Our GP’s, Nurses, Specialists Dentists and Allied Health Professionals service over 50,000 appointments per year.

• Cobram District Health uses only accredited interpreter services. Services can be booked in advance, or on short notice through the Victorian Interpreting and Translating Service.

Did You Know?

Wound Awareness

The health system occupies a unique position in our lives. We all end up in the health system at some point and so it is only appropriate that we should all have a say in how it is run. The volunteers who serve on our many subcommittees all bring their unique perspectives and skills to it. From the Board to the Clinical Governance Committee to the Finance, Audit and Risk Committee, Cobram District Health has been well served by the professionalism and dedication of those community members that have volunteered their professional skills to the organisation.

The Consumer Advisory Committee is a sub-committee of the board, whose special charter is to offer a consumer’s perspective to the decision making process. We have a vibrant and active committee with a current membership of ten.

The last year has been one of sweeping change at CDH as we prepared for the joining of the three health services. The Consumer Advisory Committee had oversight of many of these change processes, from the adoption of the new Clinical Governance Framework - “Excellent Care Every Time” to a major electrical and mechanical upgrade to the continuous stream of improvements to our IT and communications facilities. They reviewed documents. They reviewed feedback on the service and recommended staff for commendations. They reviewed consumer compliments and complaints. They established a Disability Access Working Party, consisting of Cobram District Health staff and consumers living with a range of disabilities, to review and prioritise the disability access audit.

Through this engagement we have been able to achieve significant progress on the task of retrofitting existing buildings, by prioritising the areas that make the most difference to consumers with disabilities. They have been there at the Dementia workshop as and attended the Moira Shire Disability Advisory Committee.

We thank the committee for their service and look forward to working together in the New Year.

Good community health care is all about team work. This case study shows that coordinating services in

a small rural town like Cobram can make sure that the client feels cared for every step of the way.

About 2 years ago, a community member from Barooga noticed some deficit in one of his legs. Following consultation with a local GP, he was referred to our Community Health service to

have a leg brace crafted by our physiotherapist. The brace was somewhat helpful, but the client’s

condition continued to deteriorate, resulting in referral by the GP onto Neurologists in both Melbourne and Shepparton, where Motor Neuron Disease (MND) was diagnosed early this year.The client was again referred to our Community Health Service and the Intake Team care-coordinated services that included support to access My Aged Care, access to our Occupational Therapist service, continence support, dietitian and district nursing. Family Care was also accessed to provide funding for pressure care cushions, and respite care for 2 weeks. Following ongoing significant falls in his home, further intense support from our Occupational Therapist and Intake Team was provided, including home visits and coordination of services through MND NSW, which resulted in a wheel chair, hoist and a new bed. Ongoing support was provided by our District Nurse team, until the family came to a point of crisis when the client and his wife were unable to manage transfers from the chair to the bed. The District Nurses continued to support the client and made further contact with the GP. This resulted in admission to the acute ward, where the patient remained for 8 days. Unfortunately the patient became unwell, and was transferred to GVH with a suspected heart attack. The patient remained in GVH for some time, which became quite difficult for his wife to see him. On reviewing options for permanent care, the patient’s wife attended an information evening hosted by Mogg Osborne on accessing aged care. The patient’s wife spoke highly of the evening as it was helpful to meet the Nurse Unit Manager for Irvin House and talk about questions and options. The family then met with our finance team, who supported the family with all the relevant contracts and paperwork.

Now a resident in Irvin House, he describes the care as marvelous. Now he and his wife don’t have to worry about transfers, and are very relieved to be receiving great care in Irvin House. The Occupational Therapist has still been heavily involved, coordinating the transition from MND NSW to MND VIC and facilitating the appropriate equipment to support the resident’s needs.

The resident has become actively involved in the grammatical checking of the newsletters and has expressed interest in being involved on committees, from a consumer perspective.

Nearly half a million Australians suffer from chronic wounds, and their treatment, if not carefully managed, can cost up and above $10,000 per patient, with a total cost to the health system of $3 billion dollars.

Mrs Murial Bach had a persistent wound on her lower leg this year. With wound care provided by the District Nursing team in conjunction with her local Doctor she has recovered much faster. Muriel is so pleased the nurses can visit her in her home. The nurses work in with Muriel to enable her to still be active in the community and to make sure she can still attend her various social outings.Chronic wounds can be caused by many factors, including poor circulation, diabetes, cancer or life style choices like smoking and poor diet. If your wound is not healing, it is important to act sooner rather than later. You can contact your local medical clinic or self refer straight to the District Nursing team. The Cobram District Health District Nursing team are very well educated in wound treatment. Every second month they meet with Gabrielle Munro, the West Hume Region Wound Consultant. Gabrielle is the driving force behind upskilling of District Nurses in the region and keeps them informed about the latest research and wound product knowledge. 40 % of the clients that the District Nurses attend are wound related, so it certainly pays for the team to keep up their skills up to date. If you have a wound please do not hesitate to contact the Cobram District Health District Nursing team on 58710917.

Congratulations to our vaccination hero Jeanette Mellier, Infection Control Coordinator at Cobram District Health. We scored in the top ten health services in the state for our vaccination program, achieving a 96% coverage of staff and 100% of all our Aged Care Residents! That knocked our 80% mandated service vaccination goal out of the park!

It is a testament to Jeanette’s persistence, resilience and flexible methodology. Here she is pictured with our new grounds and maintenance trainee Michael Duggan. Why is this important to you? It is all part of keeping you, our consumers, and our staff safe by making sure that cross infection of the Flu is kept to a minimum.

Caring can be Complex:

Local Immunisation Hero

Consumer Advisory Committee

We think that

the 2019 People Matt er Survey

shows that Cobram District

Health is headed in the right directi on.

Our People Matter2019

11%Increase in

Intention to Stay31%

Increase in Senior Leaders provide

clear strategy and direction

4% Increase in

Surveyparticipation

13% Decrease in Bullying &

Harrasment

75% score for

Patient Safety Culture

12% Drop in work related stress

8% Increase in Employee

Engagement

www.cobramdistricthealth.org.au

If I can tell people anything it would be this…..If you are even thinking of how to help our community—Volunteer at Irvin House!

My name is Kay Kelly and I fi rst came to Irvin House in Oct 2015. My husband Bryan was in Shepparton Hospital. He had a severe stroke on July 30th at home. We were told we had to fi nd care for him. Aft er my fi rst visit to Irvin House, my mind was put at rest!

In subsequent visits I found the staff very happy to answer my queries. Then on Dec 7th 2015 Bryan was transported from Shepparton Hospital to Irvin House.Nett a, Janett e and Jo met us and made Bryan actually smile! He immediately took to Jo. I think her atti tude and loud voice reminded him of me.

My family have always been made very comfortable when visiti ng. We have all enjoyed 3 wonderful Christmas parti es as well as all the other special events.Bryan thoroughly enjoys his outi ngs in the bus—Morning Melodies at the Barooga Sporti es being one of them. Aft er visiti ng Bryan here and enjoying both the residents and the staff , I enquired about being a volunteer.

This is one of the most enjoyable and sati sfying ti mes of my week. Mostly my ti me is spent with Jo and Tania and also with Jade in the Diversional Therapy room, however my skill is chatti ng and this I do with the residents. If I can tell people anything it would be this…..If you are even thinking of how to help our community—Volunteer at Irvin House!

Come along to meet Michelle or Janett e at Irvin House in O’Dwyer Ave and have a chat!

Volunteering at CDH

Celebrating NAIDOC

Kellie Butler is a volunteer member who sits on the Consumer Advisory Committ ee at Cobram District Health.She started volunteering as a way to give back to the community and fi nds her “ability to help people and the community” the most rewarding part of her role.When Kellie isn’t volunteering, you can fi nd her working as a visitor informati on services offi cer, helping out tourists and people new to the community.Thank you Kellie and all of the volunteers out there for all that you do! Your hard work and dedicati on is what makes our small but wonderful community go round!

Irvin House in Cobram and Pioneer House in Numurkah proudly celebrated NAIDOC with Yorta Yorta Elder Aunty Faye Lynam and family. Around sixty residents, family, volunteers, staff and friends at each site listened as Aunty Faye shared her story of growing up in this area, of her struggles to reunite herself with her family aft er her forced removal from her family at aged 8 years old, and the long path back to eventually fi nding her family and taking her place as an elder in Yorta Yorta culture. A journey that included fostering some 40 children over her lifeti me! Aunty Faye has a passion for her culture and for sharing it with all of us. We enjoyed the traditi onal dances performed by her grandchildren Jaella, Ethan and Paiton, who were accompanied by their Uncle Sonny on didgeridoo.

Aft erwards we shared a BBQ lunch with traditi onal damper cooked in dripping just like in the old days!

Keeping Everyone in the Loop

During 2019, our Home Care Package program parti cipated in a Quality Review against the Commonwealth Home Care Standards.

During our visit the assessors noted that the budget statements we provide to our Home Care Package clients were not itemised and were not displaying the dates that each service was provided. In order to meet this parti cular standard, itemised statements are essenti al, so we immediately made contact with our Home Care Package soft ware provider and we were able recti fy this without delay.

All clients within our Home Care program are now receiving itemised monthly budget statements outlining the expenditure recorded against their package for the month.

Making Sure The Price is Right Kay & Bryan’s Story

Feedback from previous staff surveys indicated that some staff were unclear how to report concerns they may have regarding programs and services off ered by our health service.

Throughout the past year we have focussed on increasing our staff ’s knowledge of our incident reporti ng system and the importance of this informati on to the quality of our service

Case StudyStaff provided feedback that our previous home visit risk assessment document wasn’t providing them with enough informati on to make an informed decision about the appropriateness of conducti ng a home visit. In consultati on with key staff we undertook an extensive review of the assessment form and implemented a more detailed form and process to ensure our staff can gather all the informati on required to safely plan a home visit.