Clinical Matters Newsletter - September 2020 24 Sep 2020
Welcome to the September 2020 Edition of Clinical Matters!
In this issue...
Let's do this Together - Pressure Injury Prevention and Management Course
Did you that in 2019, 63% of pressure injuries were community acquired? Of which 9% were stage 3 or stage 4 pressure injuries...(Source: BOP DHB discharge coding data)
Learn how to identify, stage and educate patients and their family-whānau in pressure injury prevention and management by taking our FREE Pressure Injury Prevention and Management Course on Te Whāriki ā Toi (Bay of Plenty District Health Board training site)
Let's do this together....
- Te Whāriki ā Toi - Pressure Injury Prevention and Management course. Visit https://tewharikiatoi.ac.nz/login/index.php
Kaupapa Māori Community Nursing Service, Māori Health Gains and Development
Please advise all Māori patients of the option of the Māori Health Community Nursing Service available out of the Bay of Plenty District Health Board.
All referrals will be triaged via Bay of Plenty Care Co-ordination Centre but for those who have chosen to be considered for the Kaupapa Māori service, the referral will be sent to Māori Health Gains and Development for community care that is delivered with an emphasis on tikanga and kawa.
This aligns strategically and ethically with Te Toi Ahorangi 2030 and He Korowai Oranga
- All patients who identify as Māori who require community nursing care
- Patient condition cannot be managed by patient's attendance at a general practice
- Limited mobility or lack of transport precludes attendance at GP or clinic
Service provided included but are not limited to:
- Weekend care - Māori Health Services works collaboratively with District Nursing Services to ensure that the patient has access to weekend care.
- Currently we work with District Nursing Services around ACC patients. Māori Health community nursing services is working to be able to take this cohort of patients
- Individual assessment
- There are no exclusion criteria
- All tangata whenua should be given the option of a Māori Health service to provide their care
When it is not possible, options will be discussed with the patient on alternative providers.
No more 'Discharge Summaries'
When looking at CHIP from the 29th of September, you will see the heading 'Transfer of Care' This will have replaced the term 'Discharge Summary,' and more accurately reflects the purpose of these documents
Accelerated Silicosis Pathway Assessment
The Ministry, WorkSafe and ACC have been working collaboratively with health professionals in the national Dust Diseases Taskforce to understand and respond to the emerging risk to engineered stone workers of exposure to respiratory crystaline silica (RCS). RCS can cause accelerated silicosis, a potentially serious lung disease. This has been seen overseas in those working with artificial or engineered stone found in composite benchtops used in kitchens, bathrooms and laundries.
We are providing you an update to let you know that from the beginning of September 2020, a pathway is in place to support the delivery of consistent prevention, assessment and treatment services across the country. We are asking you to share this information with your staff and contractors so they are aware of this in case they are approached by people who may need to be assessed for possible accelerated silicosis.
If workers are at risk of developing disease due to exposure to RCS, they can go through a pathway for assessment, diagnosis and support. This is attached to your reference, along with guidance to support GPs and other medical practitioners in assessing a patient. Information is available on the Ministry’s website, and a Silica Exposure HealthPathway has also been developed to enable general practice teams to access information most needed at the point of care (registered users can access the new pathway on the Canterbury Community HealthPathways site).
To provide further information for health professionals, the Royal New Zealand College of General Practitioners is hosting a webinar on Tuesday 8 September from 7-8pm with an expert panel to discuss any questions or queries you may have. You can register: https://rnzcgp.zoom.us/webinar/register/WN_rp3OkWpSRGyhcIvZ93pYpw.
This week, WorkSafe inspectors will begin visiting businesses and workers known to work with engineered stone. An estimated 530 people are currently working with engineered stone in New Zealand. WorkSafe will undertake a phased approach to visiting workplaces to manage the number of people accessing health assessments in a coordinated way. They will be encouraging people who have worked with engineered stone for at least six months in the last 10 years to visit their GP for assessment.
ACC will assess a person if they meet the accelerated silicosis exposure threshold and ACC eligibility criteria.
There is more information about accelerated silicosis exposure threshold on the following websites:
- Ministry of Health: https://www.health.govt.nz/silicosis
- WorkSafe New Zealand: www.worksafe.govt.nz/dust
- ACC: www.acc.co.nz/silicosis
And in these documents:
HDC Case: Delayed Diagnosis of Breast Cancer
The Office of the Health and Disability Commissioner today released a report finding a general practitioner (GP) in breach of the Code of Health and Disability Services Consumers' Rights (the Code) for missing an opportunity to diagnose breast cancer.
A woman in her twenties visited her GP with blood stained nipple discharge from her left breast. She had finished breastfeeding her first child six months earlier. Her GP referred the woman for an ultrasound scan, which was reassuringly normal. The GP instructed a practice nurse to contact the woman to let her know the scan was normal, and to come back if she had any concerns.
About eight months later, and two days after she had given birth to her second child, the woman came back for further review. Her breast was rock hard and tender, and the GP prescribed antibiotics for possible mastitis (inflammation of the breast). However, the symptoms did resolve and the GP sent an urgent request for an ultrasound scan, which confirmed the diagnosis of breast cancer. The woman sadly died three years later.
Former Commissioner Anthony Hill was critical that the GP did not refer the woman to a breast surgeon after her ultrasound scan, as required for a red flag symptom of unilateral blood-stained nipple discharge. He considered that the omission was a missed opportunity to diagnose and treat the woman's cancer at an earlier stage.
"The inescapable fact is that [the GP] should have referred [the woman] to a breast surgeon after her scan regardless of the scan results, because of the unilateral blood-stained nipple discharge, yet she did not," Mr Hill said.
"The failure to do so led to [the woman] being informed that her results were fine and that no scheduled follow-up was required, and placed the onus on [the woman] to follow up if she had further concerns, which was inadequate advice in the circumstances."
Mr Hill recommended that the GP's medical centre conduct an audit of 10 randomly selected patients with a coded diagnosis of a breast symptom in the past year to ensure that the care undertaken is consistent with current guidance, and provide evidence of the steps it has taken to ensure a more robust safety-netting and follow-up process for high-risk patients. He also recommended that the GP apologise to the woman's husband.
The full report for case 19HDC00988 is available on the HDC website.
New Community Care Coordination (CCC) eReferral Live From Wednesday 30th September
Not sure who to refer your patient with short-term health needs to? Do they need input from multiple allied health and nursing services?
A new Community Care Coordination (CCC) eReferral will be available from Wednesday 30th September.
The Community Care Coordination centre provides a single point of access, navigation and coordination for people requiring DHB community based short term health and enablement services across the Bay of Plenty.
Services with the CCC may connect to include, but are not limited to:
- District nursing - which includes Regional Māori Health kaupapa District Nursing
- Community geriatric service - which includes specialist geriatric nursing, occupational therapy, physiotherapy, social work
- In Home Falls Prevention programme - Body in Motion
- Community Allied Health - occupational therapy, physiotherapy, social work, speech and language therapy
- Short-term home-based support services - includes personal care and home-help services, usually provided for a maximum of 6 weeks to enable a client's return to previous functioning
- CCC can also link in with other community-based services that may be helpful in addressing your patient's needs.
The team of care coordinators includes Nursing and Allied Health professionals and provides a 6-day service
Midland HealthPathways Update
No new pathways this month for GPs on HealthPathways
And remember there is up-to-date information 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, Dr Joe Bourne, and Dr Rachel ShoulerBack to latest