Clinical Matters Newsletter - July 2020 28 Jul 2020
Welcome to the July 2020 Edition of Clinical Matters!
In this issue...
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New Telestroke Service for BOPDHB
BOPDHB has subscribed to the afterhours telestroke service from the Waikato Hospital Neurology Department. This will facilitate specialist input to make urgent time-critical decisions about reperfusion treatment (thrombolysis and/or clot retrieval) from a remote stroke expert. Experience from other centres in New Zealand and overseas has shown that the use of an afterhours telestroke service increases the number of people treated with thrombolysis, and also reduces the 'door-to-needle' times which is essential as thrombolysis treatment is extremely time critical. This is awesome for Bay of Plenty and has been a long time coming!
From a primary care perspective there is no real change.
Pressure Injury Prevention Resources
Kia ora koutou,
The pressure injury team is excited to announce the release of the new 'No Pressure' pressure injury prevention resources, in both online and printed formats.
These new resources were largely developed out of conversations with the New Zealand Wound Care Society (NWCS), who had a vision to create a nationally consistent set of prevention resources. We'd like to thank them for the time they have put into this process.
Following the initial development with NZWCS, the resources have been through a thorough review process, including feedback from DHBs, the Ministry of Health and HQSC, and importantly, from people at risk of pressure injuries. The feedback from all of these groups was hugely valuable in refining the resources and ensuring they would be well understood by the people who need the information the most.
The full set of resources are:
For the public:
- Preventing pressure injuries leaflets –
Printed - English, Hindi, Maori, Samoan, Simplified Chinese, Tongan
Online - English, Arabic, Burmese, Hindi, Korean, Maori, Punjabi, Samoan, Simplified Chinese, Spanish, Tagalog, Tokelauan, Tongan, Traditional Chinese, Tuvaluan -
Preventing pressure injuries posters –
Printed and Online - Bed & Chair
For clinicians:
All printed & online
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Preventing pressure injuries poster – health professional focus
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Pressure injury classification chart
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Guiding principles for pressure injury prevention and management in NZ (2017)
ORDERING RESOURCES - FREE
Each DHB will have the ability to order the printed resources online through the ACC ordering platform: http://acc-connect.youtopiatechnologies.com/.
It is also possible to access versions to print or that are intended to be viewed on a device at www.nzqcs.org.nz/pressureinjuries.
If you have any questions about ordering these resources, or would like other digital formats, please email us at pressureinjuryprevention@acc.co.nz.
Please feel free to share this information with stakeholders you engage as part of your pressure injury programmes (for example district nursing, Allied Health, rehabilitation facilities, community providers). They are also able to order the new resources
Successful School-Based Rheumatic Fever Prevention Programme for Māori in EBOP
One of our Whakatāne paediatricians, John Malcolm, along with Opotiki GP Jo Scott-Jones, DHB doctor Megan Tozer and others including Sandra Innes-Smith, have published an article on School-based Streptococcal A Sore Throat Treatment Programme in Māori. Click here to read the abstract and full article pdf or here for the weblink. Well done!
Dispensing Update from PHARMAC 9 July
- PHARMAC is going to remove most of the temporary restrictions on dispensing medicines that we put in place to manage supply during COVID-19. This will happen at 11:59pm on Friday 31 July 2020
- From 1 August, pharmacist will be able to dispensing three months' supply of most medicines. Some medicines will remain on monthly dispensing where there are continuing problems with supply:
- Oral contraceptives will continue to be restricted to three-month dispensing
- Medicines that were on monthly dispensing before 27 March 2020 will continue to be dispensed monthly
- In addition, 16 medicines will remain on monthly dispensing due to supply issues. The list is available on our website
- PHARMAC is removing the dispensing restrictions for most medicines because following consultation with suppliers, distributors and wholesalers, we are confident that there is sufficient stock in New Zealand of most medicines. However, COVID-19 continues to disrupt supply chains and manufacturing overseas so we are continuing to apply temporary restrictions on dispensing to some medicines, including oral contraceptives.
- There is no need for New Zealanders to stockpile medicines at home. PHARMAC works closely with suppliers to ensure that every New Zealander has access to the medicines they need.
See our website pharmac.govt.nz/dispensing for further information for prescribers, pharmacists and patients.
Mini-ACE has now Replaced MoCA as NZ's Recommended Screening Tool for Cognitive Impairment
The MoCA test will no longer be free to use from 1 September 2020.
Mini-ACE (Mini-Addenbrooke's Cognitive Examination) is now the recommended screening tool for cognitive impairment in New Zealand
HealthPathways will reflect this change from 1 September 2020
Online training for the use of the Mini-ACE will be available on regional DHB and Ministry of Health learning platforms from 1 August 2020.
Click here for further details
HDC Case - Recognition and Treatment of Sepsis
Source: Health and Disability Commissioner
Health and Disability Commissioner Anthony Hill today released a report finding a general practitioner (GP) and a District Health Board (DHB) in breach of the Code of Health and Disability Services Consumers' Rights (the Code) for failing to appropriately recognise and treat a woman's presentation of sepsis.
A woman in her seventies went to a medical centre with a leg wound. A nurse saw her first, noted low blood pressure, low temperature and confusion and asked the GP to review the woman. The GP considered the woman had an infection but was otherwise well. He prescribed antibiotics and told her to seek medical attention if her condition worsened. The GP did not take her blood pressure and did not realise it was low.
The woman attended the emergency department (ED) of the public hospital later that day, where there was a delay in her being seen. She was eventually diagnosed with septic shock and was admitted to the intensive care unit.
Mr Hill considered that the GP failed to give adequate consideration to those risk factors which indicated sepsis, including low blood pressure.
"As a consequence of these failures, the opportunity was missed to identify and access treatment for [the woman's] sepsis at an earlier time," Mr Hill said.
Mr Hill was also critical of the DHB for not having appropriate systems for triage, resulting in the woman being triaged incorrectly and a delay in her receiving treatment. Mr Hill acknowledged the pressures of a busy ED but said, "[A] busy environment under pressure does not remove the obligation to provide appropriate services, and does not remove provider accountability for ensuring appropriate steps are taken."
The full report for case 18HDC00793 is available on the HDC website
Midland HealthPathways Update
New pathways for GPs on HealthPathways
The following pathways are now live on our HealthPathways site for you to use:
- Cough in children
- Pertussis (Whooping Cough)
And remember there is up-to-date info on all matters Covid-19 for primary care on Health Pathways, including national as well as local information.
HealthPathways is a collection of management guidelines specifically tailored to primary care. Our GP Liaison team is in the process of 'localising' these pathways to the Bay of Plenty, i.e, making them relevant to GPs and other primary care providers specifically in the Bay of Plenty. You'll find valuable pointers on History, Examination, Treatment and of course when and how to refer patients on to other services. These pathways will, over time, be replacing the Bay Navigator pathways.
Dr Chris Tofield, Dr Dan Jackson, and Dr Paula Taylor
Click here to email the Bay Navigator team
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