Clinical Matters Newsletter - October 2021 28 Oct 2021
Welcome to the October 2021 Edition of Clinical Matters!
In this issue...
Local Version of National COVID Clinical Guidelines Now Available
Our DHB is pleased to be able to share with you the locally adapted version of the national COVID clinical guideline which is now available on the Microguide antimicrobial app. This has been the result of hard work by a group of BOP staff to convert the original guide, written by the clinical teams at Counties Manukau, into a format that you can easily access and take in bite-sized friendly pieces, containing locally relevant information and links, with updated details on the available drugs and how to use them (Thanks and absolute credit for this BOP work to: Finn Coulter, Leah Chen, Johnnie Walker, Massimo Giola, Jean-Pierre Meyer). The content has benefitted from the experience of colleagues who looked after COVID patients in the UK. The guide is a combined effort across Bay of Plenty and Lakes and can be accessed from either DHB. It will be update as things change. In addition, there is also an adapted version of the Counties Manukau guidance on COVID in pregnancy.
Some of you may already have Microguide loaded on your phone. If so, the guide will update itself next time you open it whilst connected to wifi. If you don't already have it, search under "Microguide," in your app store and download it for free. We have found the update to be a little temperamental! You will need to be in good wifi signal and it seems you need to have completed your profile details on your role and organisation - if you swipe to the right, the options appear that allow you to go in and update your profile. Don't get confused by the lack of information in the paediatric section or links to international guidelines - they are actually empty but will have content in the near future.
If you prefer to access the guide on a PC or are struggling with the app you can get to it at Adult Antimicrobial Guide (microguide.global). It opens in a mobile friendly mode so it can still be read on a phone. Whichever way you use it, rotate your phone sideways to fit on the whole page.
Resuscitation Skills/Immediate and Advanced CPR Courses 2021
Please click here for a list of available CPR training courses for 2021 and contact details for our trusted Resuscitation officer Andy Davies
MRI Scanner for Whakatāne
Pete Chandler, CE of BOPDHB is excited to announce, alongside Bay Radiology Limited General Manager Mr Steve Harris, that an MRI scanner is to be installed in a facility built on the Whaktāne Hospital Campus. The privately owned MRI facility will have internal Hospital access for inpatient and emergency patient transfers and independent parking access for Outpatients, Private and ACC patients.
Eastern BOP residents currently have to travel to Tauranga for their MRI appointments. This new MRI service is required to meet the growing need of the EBOP community, and will significantly reduce barriers for patients accessing this service. The DHB recognises there is unmet demand for MRI scanning for patients living in the Eastern BOP, and that by having an MRI scanner facility located in Whakatāne, demand will increase over the next few years.
BOPDHB and Bay Radiology Limited have a long-standing relationship, of more than 30 years, and continue to work cooperatively in the provision of a range of imaging services to both the Western Bay and Eastern Bay communities. Historically, this relationship has allowed community access to the latest imaging technologies and was a significant contributing factor to enabling the provision of an MRI service in Whakatāne in the near future. The facility design is progressing well, and it is hoped that this facility will be operational by late 2022.
Gynae Threshold Change
As of Monday 18/10/21, the threshold for gynaecology referrals will change to decline grade 3 referrals.
You can access gynaecology guidelines via Midland HealthPathways.
Update to Special Authority Terms for Ferinject
Some versions of Medtech are displaying out-of-date information about the special authority terms for ferric carboxymaltose (Ferinject).
Please be aware the most recent terms include a provision that applications can be made by any medical practitioner (e.g. a GP) on the recommendation of an internal medicine physician.
Death Certificates - Frailty Can Now be Listed as the Cause of Death
‘Frailty of old age’ can be entered as the sole entry in line1a of a medical certificate of cause of death (MCCD) in limited circumstances.
This diagnosis refers to a gradual multi-system decline in function over a period of several months or years that is attributable to atrophic degenerative changes of aging, in the absence of any specific organ system disease. It applies to patients aged 80 years or older whose declining function has been appropriately clinically assessed over a period of time for specific organ system disease before death. The diagnosis 'frailty of old age' should not be used as a substitute for a more specific diagnosis (if there is one), and should not be used in part 1a. if the deceased suffered from an acute illness (e.g. pneumonia), or trauma prior to death.
Any chronic medical conditions that contributed to the deceased’s steady decline, (for example chronic ischaemic heart disease, dementia, or cerebrovascular disease), should be entered in Part 2 of the MCCD, along with the time interval in brackets after each condition. The most serious of these medical conditions should be entered first in Part 2.
The purpose of this guideline is to provide a suitable option for medical practitioners and nurse practitioners to use when completing the certificate of cause of death for an elderly frail patient who has died suddenly, apparently of natural causes, but the exact cause of death cannot be ascertained without an autopsy. Too many deaths of this nature are being reported to the coroner contributing to the burden of deaths awaiting the coroner’s attention, unnecessary use of pathology services to identify the exact causes of deaths of elderly people from natural causes, and contributing to the distress of whānau waiting to arrange funerals or tangihanga for their loved ones.
This guidance is now on the Ministry of Health’s website and is effective immediately. Please feel free to circulate it to any other medical practitioners, nurse practitioners and medical referees you are in contact with. It will also be available on the Death Documents website via a link to the Ministry of Health webpage.
Health SURV Codes Are Now Available for Practices and Clinicians
The Ministry of Health SURV codes are now available for practices and clinicians to view on Te Manawa Taki | Midland Community HealthPathways on the following COVID-19 pathways:
- COVID-19 Requests and Local Processes
- COVID-19 Testing
- COVID-19 Assessment and Management in ARC
They are under Key Links on the right-hand side of the screen and are directly linked to the Tāmaki Makaurau | Auckland Region who are updating them regularly from the MoH.
Grand Round via Zoom - Assisted Dying Service - Tuesday 2 November 2021
Where: Tauranga and Whakatāne - Via Zoom https://bopdhb.zoom.us/j/85884799114?pwd=S3dDeW5mWFgrMmNCc2tvVXMxOEtMUT09
When: Tuesday 2 November 2021 – 12:30-13:30
Details: On 7 November 2021, The End of Life Choices Act 2019 will become law following the 2020 public referendum. This will allow the provision of Assisted Dying Services as an option for people with a terminal illness who meet eligibility criteria.
Regardless of our own personal beliefs about Assisted Dying, we must be prepared to respond with respect and compassion if assisted dying is raised by a patient and it is important for all staff to understand their legal obligations in this area.
Update and Q&A Session.
Assisted dying is a sensitive topic and may be difficult for some people. If reading this information has raised some distressing feelings for you, please know there is support available. You can call or text 1737 for free to speak to a trained counsellor at any time.
Health Reform Roadshow in Tauranga 16 November
From 2 November, the North Island leg of the Health Reform roadshow will begin.
Given the changing nature of the COVID-19 outbreak, it is anticipated that the majority – and potentially all – of these events will need to be held as virtual-only sessions.
These details will be confirmed next week the registration invites are sent out.
The Department of the Prime Minister and Cabinet (DPMC) thanks those of you who have already been in touch and encourages you to please keep the questions, feedback, insight and suggestions coming.
The vision of a system that delivers pae ora healthy futures for all can only be realised with your support.
As with the South Island schedule, it is anticipated the Minister of Health, and also a number of Māori Health Authority and Health NZ Board Members will attend many of the events.
The confirmed North Island dates – start times, online links and venues will be confirmed next week:
|Tues 2 Nov||Napier|
|Wed 3 Nov||Tairawhiti|
|Mon 8 Nov||Hamilton|
|Tues 9 Nov||Matamata|
|Wed 10 Nov||Te Kuiti|
|Thurs 11 Nov||Taupo|
|Mon 15 Nov||Whakatane|
|Tues 16 Nov||Tauranga|
|Wed 17 Nov||Hutt Valley|
|Fri 19 Nov||Auckland|
|Mon 22 Nov||MidCentral|
|Tues 23 Nov||Whanganui|
|Thurs 25 Nov||Waitemata|
|Fri 26 Nov||Counties Manukau|
|Tues 30 Nov||Capital & Coast|
|Fri 3 Dec||New Plymouth|
|Mon 6 Dec||Wairarapa|
|Fri 10 Dec||Northland|
For more general information about the reforms, visit the dedicated reform website www.futureofhealth.govt.nz. Here you can find background information about the health reforms, links to receive regular news and updates, and also a copy of the slide pack that is being used in the roadshows to date.
On behalf of the Health Reforms Transition Unit.
Midland HealthPathways Update
New pathways for GPs on HealthPathways
The following pathways are now live on our HealthPathways site for you to use:
- Cognitive Impairment
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, and Dr Paula TaylorBack to latest