timboon and district healthcare service report …...2013-2014 quality of care report 1 we are...

12013-2014 quality of care report

quality of carereport

Timboon and District Healthcare Service

2013

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2 Timboon & District Healthcare Service – In partnership with Our Community

VisionTo be a leader in rural health care providing a consumer centred, multi-disciplinary service, responding to the needs of our community.

MissionTo provide a consumer-centred, multi-disciplinary, quality healthcare service working collaboratively within the regional health system to promote and provide for a comprehensive range of services supporting health and wellbeing throughout the continuum of life via centre and community-based models of care.

Back cover: Geoff Drayton and his daughter Linda Berry with great grandaughter Ella Drayton

1 Welcome

2 Our Rural Health Service

3 Overview of Our Services to the Community

5 Standard 1: Governance for Safety and Quality in Health Service Organisations

11 Standard 2: Partnering with Consumers

20 Standard 3: Preventing and Controlling Healthcare Associated Infections

22 Standard 4: Medication Safety

23 Standard 5: Patient IdentificationandProcedure Matching

25 Standard 6: Clinical Handover

26 Standard 7: Blood and Blood Products

28 Standard 8 Preventing and Managing Pressure Injuries

29 Standard 9 Recognising and Responding to Clinical Deterioration in Acute Health Care

30 Standard 10 Preventing Falls and Harm from Falls

Preparing this ReportTimboon and District Healthcare Service’s Quality of Care Report has been compiled from contributions by a diverse group of staff dispersed throughout the organisation with input from volunteers and community members. We are confident that this report gives a comprehensive overview of our services provided to consumers throughout 2013-2014.

contents

ValuesAccountable Accountable We show pride, enthusiasm and dedication in everything that we do. We ensure quality patient care and use resources appropriately. We accept professional responsibility for all our decisions and actions.

Excellence We create opportunities for education and are committed to continuous development. We enable everyone to make knowledge-based decisions for service excellence.

Respectful We consult and collaborate with others and respect the diverse knowledge and skills of our partners, working as a team we ensure the best inter-professional patient care. We are courteous and respectful to patients, families and each other.

Integrity We engage others in a respectful, fair and ethical manner,fulfillingourcommitmentsasprofessionalsandemployees. We ensure the highest degree of dignity, equity, honesty and trust.

Compassion We will accept people as they are and display kindness and sensitivity to them.

Number of Community Health Clients by Township

Timboon /Nullawarre 461

Scotts Creek 30

Port Campbell / Princetown 74

Peterborough 30

Cobden / Simpson 333

Camperdown 35

Terang / Corangamite North 4

Colac Otway Shire 6

Moyne Shire 10

Warrnambool 6

Other Victoria including Melbourne 8

Not Stated 34

Timboon /Nullawarre 275

Scotts Creek 29

Port Campbell / Princetown 47

Peterborough 21

Cobden / Simpson 99

Camperdown 2

Terang / Corangamite North 4

Colac Otway Shire 10

Moyne Shire 18

Warrnambool 17

Other Victoria including Melbourne 9

Interstate / Overseas 5

Number of Inpatients by TownshipCommunity Health Clients by Township

Timboon /Nullawarre

Sco2s Creek

Port Campbell / Princetown

Peterborough

Cobden / Simpson

Camperdown

Terang / Corangamite North

Colac Otway Shire

Moyne Shire

Warrnambool

Other Victoria including Melbourne

Not Stated

Inpa%ent Numbers by Township

Timboon /Nullawarre

Sco2s Creek

Port Campbell / Princetown

Peterborough

Cobden / Simpson

Camperdown

Terang / Corangamite North

Colac Otway Shire

Moyne Shire

Warrnambool

Other Victoria including Melbourne

Interstate / Overseas


We are delighted to present the 2013-2014 Quality of Care report for Timboon and District Healthcare Service. At Timboon and District Healthcare Service, our patients, residents and clients are the focus of everything we do. Staff and patients are constantly reminded of our commitment to this through our values of Accountable, Excellence, Respectful, Integrity and Compassion.

Timboon and District Healthcare Service has an ongoing commitment to improving and enhancing the quality and safety of the healthcare we provide to our diverse community. This report outlines what we have done over the past year to meet the National Standards for high quality, safe healthcare that have been developed by the Australian Commission on Safety and Quality in Health Care and incorporated into the Australian Council on Health Care Standards (ACHS) accreditation requirements. It is with great pleasure that we can relate Timboon and District Healthcare Services’ success in the review undertaken by ACHS in August 2013 that led to us achieving a very satisfying result across the organisation including 17 Met with Merit acknowledgements, recognising the dedicated work by all our staff and volunteers.

In this regard, we aim to constantly improve our services to ensure that we continue to provide quality healthcare outcomes for all patients, residents, clients and their families. Our staff are passionate about the quality of care provided and this is reflected in our vision and values. Every day our staff demonstrate their Respect, Compassion, Integrity, Excellence and Accountability skills as they strive to achieve ‘Excellence in healthcare’.

Timboon and District Healthcare Service is committed to consumer participation. We have an active Community Participation in committees and we regularly review feedback from patients. We exist to provide you with the best possible care, and what you tell us matters. By listening to feedback, we have been able to make changes to what we do and how we do it. It is an essential component in our quality management process.

This Quality of Care Report is a means through which we can inform the community about our various services – Primary care services, Acute hospital services, Residential Aged Care, Urgent care and Community services.

The report contains information on standards and benchmarks and how Timboon and District Healthcare Service measures up against those requirements. It also highlights many of the projects and activities we have undertaken over the past 12 months to enhance the quality of care provided at Timboon and District Healthcare Service. Most importantly, this report contains many interesting stories on the people who use our services and on the staff who provide the care to our patients. I hope you enjoy reading them as much as we enjoy sharing them with you.

Gerry Sheehan Chief Executive Officer

John Renyard Chair Board of Management

Board of Management Chair John Renyard (left) with CEO Gerry Sheehan.

welcome



Our Rural Health Service

VICTORIA

Peterborough

Nullawarre

Timboon and District Healthcare Service provide services within the southern half of the Corangamite Shire and the south eastern section of Moyne Shire. Key towns within the catchment area include Timboon, Cobden, Simpson, Nullawarre, Port Campbell, Princetown and Peterborough.

This area comprises a catchment population of approximately 7700 with 50.1% male and 49.9% female. The age demographics of the catchment largely mirror that of Victoria as a whole but unlike many small rural communities, we do not have a larger than average aged population. Our catchment has a high percentage of 10-14 year-olds, as well 45-49 year-old residents, with lower numbers of 20-24 year-olds. Our future projections are for a rapidly ageing population. Within the population 0.1%, or seven individuals, are of Aboriginal of Torres Strait Islander descent, 7.5% of our population were born overseas, with 0.2% stating that they do not speak English well. The top three birthplaces outside Australia were United Kingdom, New Zealand and the Netherlands. A total of 42% of residents currently own their homes outright, 30% are in the process of purchasing their homes and 22% are renting their homes either publicly or privately.

Our social demographic SEIFA index of disadvantage is 986, which is

higher than other areas in regional Victoria but lower than average for both Victoria and Australia. The Timboon and district area has 3% unemployment. Timboon and District Healthcare Service is an integrated health service administered under the multi-purpose service model of care for rural health services.

Timboon and District Healthcare Service provides acute, residential and community aged care and a comprehensive suite of primary care services. Acute and residential aged care services are provided within 14 flexible beds and a 6 day-stay bed complex with an operating theatre suite and urgent care centre. Primary care services are provided both in house within the community health services wing and externally through community outreach programs. The Timboon and District Healthcare Service jointly manage the Timboon Medical Clinic and contract General Practitioners, these facilities being adjacent to the Health Service.

Timboon and District Healthcare Service is a partner in the Corangamite Health Collaborative with Terang, Cobden and South West Healthcare Camperdown Campus. The model aims to coordinate service provision across the Corangamite Shire improving workforce and service opportunity in a collaborative approach.

ABOuT TIMBOON AND DISTRICT

Our catchment area of the southern half of the Corangamite Shire extends from Cobden in the north to the Great Ocean Road coastline, which encompasses the tourist icon of the Twelve Apostles. The area provides diverse employment through a range of primary industries, with dairying being most predominant along with tourism along the coast. Timboon, although a small town of some 1000 provides a service hub for the southern part of the catchment and Cobden serves the northern most section of the catchment area.


Overview of our services to the communityURGENT CARE CENTRE Timboon and District Healthcare Service operate a 24-hour, seven-day-a-week urgent care centre. Acute clinical staff have provided care to 2599 patients who have presented to the urgent care centre in the past 12 months. This equates to 7.1 patients per day. Acute ward nursing staff work collaboratively with our general practitioners, nurse practitioners and ambulance officers to meet patient care needs in the areas of assessment, consultation, treatment and referral.

ACUTE CARE Acute care services at Timboon and District Healthcare Service have remained active over the past 12 months with nursing/medical staff caring for 524 admissions. The average length of stay per admission is currently 2.65 days. Of the 524 admissions, the three permanent general practitioners and nursing staff cared for 94% of patient presentations at the healthcare service, with 6% of patient presentations requiring transfer to a higher level of care (intensive, coronary or specialist referral) at a regional or metropolitan hospital.

MATERNITY SERVICES In July 2013 an 18 month moratorium was put on birthing services at Timboon and District Healthcare Service due to reduced birthing numbers creating concerns regarding quality of care, whilst consultation occurred on its feasibility. During this time, Timboon and District Healthcare Service created a Community Midwife position. A visiting obstetrician is available through the Monthly Outreach Obstetrician Clinic - On Site for those women referred by the midwife or general practitioner and collaborates with the midwifery team in planning client management. A total of 181 visits were provided in antenatal and domiciliary care.

GENERAL SURGERY AND DIAGNOSTIC PROCEDURES Visiting medical and surgical specialists provide quality care for our community catchment and surrounding areas. Our communities receive significant physical, mental, social and financial benefits by having access to expert specialist services close to home. An investigative procedure or non-urgent surgery was provided to 195 patients

PALLIATIVE CARE During 2013/2014 a new clinical care pathway for palliative care has been implemented. This pathway ensures that care is delivered efficiently and effectively with the patients consent and joint goals are achieved.

RESIDENTIAL AGED AND RESPITE CARE Timboon and District Healthcare Service dedicate 4 beds to high care residents and 3 beds towards respite. There were a total of 8 residents and 47 respite clients who were accommodated during the past 12 months. This equated to 98% occupancy of available bed days of permanent high aged care and 92% occupancy of respite care bed days, both high and low care. Respite client placement is coordinated through the Respite Barwon South West and Carelink Service and we work in association with the Regional Aged Care Assessment team to make sure clients are appropriately assessed prior to access to aged care services.

HOME AND COMMUNITY CARE SERVICES The Home and Community Care program provides care and support services to frail older people, younger people with disabilities and their carers residing in the community, allowing them to remain in their home in a supported environment rather than a premature or inappropriate

admission to long term residential care. The program continues to ensure community care workers have the most up to date information and knowledge to pass onto their consumers. This occurs via fortnightly one on one support meetings and quarterly whole of staff meetings where new information, challenges, OHS, client and worker wellbeing is discussed.

ASSESSMENT AND CASE MANAGEMENT An increased emphasis on assessment, case management and goal centred care planning utilising the Active Service Model has occurred during the past twelve months. All 331 Home and Community Care Assessment clients have an assessment plan that meets this model. Clients are reviewed on a 3, 6 or 12 monthly basis depending on their level of need. All new clients have also had a more vigorous home visit safety screening to ensure worker safety.

DISTRICT NURSING During 2013/2014 the District Nursing Service experienced a busy year with 1953 hours of service, to 209 clients, providing professional assistance for a wide range of needs. These services include assessment, pathology collection, disease education, health promotion and hygiene assistance. Some people need help for a short time after an injury or hospital stay, with 20% of our visits for postoperative wound care. We gained a 90% satisfaction rate from our client satisfaction survey at the end of 2013.


PLANNED ACTIVITY GROUPS AND NATIONAL RESPITE CARERS PROGRAM

The Planned Activity Groups operate twice weekly at Timboon and Cobden and provide an opportunity for older members of the community to socialise and participate in a range of activities and outings while encouraging participants to remain active and involved. This year there has been an emphasis on making necessary paperwork more efficient and thus enabling the implementation of goal directed care planning to promote group members independence. The five hour program also offers carer respite, funded by the National Respite Carers Program, on Fridays in Timboon.

FITNESS AND REHABILITATION PROGRAMS A total of 15 weekly classes are offered to the community of Timboon through the Exercise and Rehabilitation Program. With a particular emphasis on supporting older adults, the aims of the program include maintaining and improving participants’ strength, mobility, falls risk, balance and encouraging social connectedness. Programs include Tai Chi, Strength Training, Balance Plus, Gentle Exercise, Stepping Stone, Heartmoves and Rehabilitation. Classes for pre and post natal women are also offered.

COMMUNITY HEALTH SERVICES A range of staff and contracted Allied Health services are provided to the Timboon and district community. They are an integral part of the multi-disciplinary team approach providing services to both inpatients and community clients. Their role includes clinical treatment, education and health promotion.

In the 2013/2014 year there was a decision to increase services and directly employ allied health staff. This allowed greater flexibility, waiting list

management and allows Timboon and District Healthcare Service to respond to community needs. The positions of Physiotherapist, Dietician and Speech Pathologist are now employed full time by Timboon and District Healthcare Service. Also during the 2013/2014 year there has been part time recruitment of Social Work, Youth work and Health Promotion which had been vacant for varying lengths of time.

Due to the increased workforce and demand of clients requiring multiple services and thus client management, the employment of a Primary Health Access Advisor has occurred. This position is the first point of contact for any allied or community health appointment/services. This is to ensure that the clinician has all the information required prior to appointments but most importantly it ensures the consumer receives the service that is most appropriate.

HEALTH PROMOTION PROGRAM Health Promotion programs have played a key role in health prevention in the Timboon and district community during 2013/2014. Our focus has been on the two key health determinants of Obesity and Mental Health. The rates for these two determinants within the Corangamite catchment are well above the State averages. Timboon and District Healthcare Service continues to work in partnership as part of the Heart of Corangamite Network whose major focus is on reducing early childhood obesity and increasing physical activity. This network continues to drive health promotion activities which are delivered within the school, early childhood and the wider community. Successful activities have included ‘the food revelation’, healthy eating at school and cooking for one.

Timboon and District Healthcare Service is currently embarking on a staff health and wellbeing program which hopefully, when completed, will be rolled out into the wider community workforce in following years.

YOUTH PROGRAM Youth Services continue to be an important part of our community health focus. Timboon and District Healthcare Service filled this position partway through the year and services have focused on supporting students at school but also youth in our community and catchment. There have been some very successful events for youth within the shire and we look forward to improving these over the coming years. Some of the successful events have included holiday movie nights, drama and building resilience programs.

ORAL HEALTH PROGRAM Timboon and District Healthcare Service offers a holistic Oral health program, this includes public dental which is offered on a weekly basis to all health care card holders and provides a preventative and general dental treatment as well as a referral service. This service is provided by South West Healthcare Dental Program. A private dental service is provided by Dr. Donna Mercado on a fortnightly basis. This service continues to be very valuable to community’s oral health needs. To meet oral health prevention needs, the ‘Smiles 4 Miles’ program continues to be provided to all Kindergartens and Childcare Services within the Timboon district. This program includes parent and child education on oral health and direction to available dental programs.

Overview of our services to the community


Compliance with Victorian Clinical Governance Policy Framework

Standard 1: Governance for Safety and Quality in Health Service Organisations

The governance of clinical care occurs within the context of the broader governance of the health service board of management and includes the areas offinancialandcorporatefunctions,settingstrategicdirection, managing risk, improving performance and ensuring compliance with statutory requirements.

Governance of an organisation occurs at all levels and requires a program of review and improvement of internal processes and outcomes at every level from the board, the executive staff, the management team, clinicians and non-clinical staff.

The clinical governance framework focuses on the domains of quality and safety and includes:

• Consumer participation;

• Clinical effectiveness;

• An effective workforce, and;

• Risk management.


Health Service Accreditation

Type of Accreditation Outcome

Australian Council of Healthcare Standards (EQuIP National)

Community Care Common Standards

(Home and Community Care)

National Respite for Carers Program (NCRP)

Full accreditation status received – four (4) years provided in 2013 until 24 October 2017

• Periodic Review in 2011;

• Supported Self-Assessment in 2012 endorsed ongoing accreditation;

• A self-assessment, across all Functions, Standards and Criterion was submitted in October 2012;

• Organisational Wide Survey conducted against EQuIP National in August 2013. Timboon and District Healthcare Service obtained full accreditation and met all mandatory and developmental standards in this accreditation process. We received:

Satisfactorily Met – Actions required have been achieved

Met with Merit – In addition to achieving actions required, measure of good quality and a higher level of achievement are evident.

• In August 2013 the Service’s HACC programs were surveyed against the National Community Care Common Standards; a self-assessment was completed in preparation for the survey;

• The last assessment undertaken against National Community Care Common Standards occurred in 2009 with a rating of 19.20 out of 20;

• Results from August 2013 assessment demonstrated that Timboon and District Healthcare Service met all 3 Common Care Standards.

• The Commonwealth Department of Health and Ageing reviewed the NRCP program last in 2009;

• The programs successfully met the standards at the time of the review;

• An Accreditation survey was undertaken by the Commonwealth Department of Health & Ageing in October 2013 against the National Community Care Common Standards;

• Results from October 2013 assessment demonstrated that Timboon and District Healthcare Service met all 3 Common Care Standards.

Standard SM MM Total OverallStandard 1 47 6 53 MetStandard 2 11 4 15 MetStandard 3 37 4 41 MetStandard 4 37 0 37 MetStandard 5 9 0 9 MetStandard 6 11 0 11 MetStandard 7 23 0 23 MetStandard 8 23 1 24 MetStandard 9 20 0 20 MetStandard 10 18 2 20 MetTotal 236 17 253 Met


This committee is used to assist Timboon and District Healthcare Serviceinfulfillingitsresponsibilityfor ensuring the continuous provision of high quality and safe patient care.

The Committee operates in accordance with Timboon and District Healthcare Service’s strategic direction and the safety, quality and risk management system which forms our quality and risk management

framework. The committee meets bi-monthly as a subcommittee of the Board of Management. During the year four Quality and Risk management meetings occurred.

Timboon and District Healthcare Service decided to adopt the RiskManQ Management system during the 2011/2012 year.

The RiskManQ Management system enables the reporting and capturing of reactive risk management practices of incident management and complaints reporting along with the proactive risk and quality planning activities. The benefits to the organisation of the RiskManQ system have enabled decreased time from incident to report, easier reporting and analysis plus a single system for risk management,

incident management, feedback and quality reporting.

In July 2013, an evaluation of the RiskmanQ system was conducted to see how staff were managing and if further education in the RiskmanQ system was necessary. Results from the evaluation indicated the following improvements were necessary:

• To provide all new staff with login and password to the RiskmanQ system - this has been rectified with staff notification to the quality coordinator during the orientation process

• To have a RiskmanQ update at annual mandatory training updates – RiskmanQ has been added to the mandatory training calendar

• To provide training to staff in each area of RiskmanQ via organisation Education Calendar

To continue to monitor and review clinical services a clinical governance framework was established.

Clinical Governance is a framework through which organisations are accountable for continuously improving the quality of their services and

safeguarding high standards of care, by creating an environment in which excellence in clinical care will flourish. This framework is supported by a clinical governance committee which meets monthly focusing on clinical review, policy review, innovation and compliance with ACHS EQuiP National Standards.

The Board Quality and Risk Management Committee

RiskManQ System

Clincial Governance


My Experience with Timboon and District Healthcare Service– Nancy Johnson – Board MemberBefore moving to Timboon, my family and I lived a very nomadic life, living in ten locations in ten years, including Port Hedland, Broken Hill and London. I have held various accounting and finance roles with BHP Billiton and CMA-CGM. We moved to the region for my husband’s work, with the plan of living in Warrnambool and only staying 18 months. On discovery of Timboon our plans have definitely changed. Five years later our two children attend Timboon P12 School; we have built a house and have been welcomed as members of the community. I have held positions on committees including the Timboon and District Kindergarten and two playgroups. I regularly assist at Timboon P12 School and am currently the Chair of the Corangamite Shire Council Audit Committee.

My first experience with Timboon and District Healthcare Service was two weeks into my life in Timboon. Taking my 14 month old son, who was struggling to breathe with asthma, to the hospital on a Saturday night. I was not sure whether they would be able to assist. I was relieved to find very helpful and caring nursing staff and a doctor on call. When approached a year later to become a member on the Board I was honoured to join and give back to the community that was so welcoming to my family and I. Being a stay at home mum, joining the Board gave me a great opportunity to use my financial knowledge and experience.

Working with fellow Board Members I have embraced the opportunity to continuously improve the organisation. As a Board we have great breadth and depth of knowledge and experience. There is a high level of respect amongst Board Members and I believe we always conduct ourselves with integrity and with the interests of the community at heart. In the current

political and fiscal environment it is always a challenge to meet the budgetary constraints and manage strategic, operational and clinical risk whilst maintaining and maximising the welfare of the community.

As a member of the Board I don’t see my role to be any more important to the success of Timboon and District Healthcare Service than that of the other 186 active volunteers. We, as an organisation, are very lucky to be a part of such a committed community. I think it is important that the Healthcare Service always strives to achieve the

best healthcare facilities possible for the community.

The last four years on the Board have been a very rewarding and enjoyable experience. I am looking forward to the future of Timboon and District Healthcare Service. The organisation has an exceptional team of employees that all show an outstanding commitment and enthusiasm to ensuring that Timboon and District Healthcare Service can be all that it can be and more.

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Clincial Governance

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Timboon and District Healthcare Service verify the credentials of all registered practitioners annually through public access websites and via staff presentation of their registrations.

As of 30 June, 2014:

• All registered and enrolled nurses had registration through AHPRA;

• All allied health staff were appropriately registered through AHPRA;

• All medical staff were appropriately credentialed and registered through AHPRA;

• All staff had a police check.

Staff Credentialling

During 2013/2014 the ‘whole-of-staff’ meeting (which was initiated during 2011 and is held bi-monthly) continued to occur.

This meeting enables the Chief Executive Officer, Directors and staff to communicate and discuss relevant Timboon and District Healthcare Service business.

Timboon and District Healthcare Service had six ‘whole-of-staff meetings’ during 2013/2014, with an average attendance of 27% of staff.

This equated to 30th July 2013 - 29 staff 8th October 2013 - 22 staff 3rd December 2013 - 21 staff 4th February 2014 - 22 staff 1st April 2014 - 23 staff 3rd June 2014 - 29 staff.

Minutes of these meetings are displayed in the staff tea room and emailed to staff, for those unable to attend.

Timboon and District Healthcare Service have many staff who have served the Healthcare Service for many years.

Staff recognised for reaching milestones in the 2013/2014 financial year includes:

Monica Easterbrook - 35 years Amanda Nash - 30 years

The People Matter Survey measures a range of aspects of workforce culture and climate in the Victorian public sector.

The survey focuses on employees’ perspectives on the application of the public sector values and employment principles. The survey also measures other aspects of the workplace such as job satisfaction and workplace wellbeing. This survey is completed by the organisation every second year.

Results of our last survey concluded:• Our staff consider human rights

when making decisions and providing advice,

• Understand how the Charter of Human Rights and Responsibilities applies to their work,

• Staff felt the organisation provides high quality services to the Victorian community,

• Staff felt comfortable in reporting any patient safety concerns,

• Staff indicated that they don’t see gender as a barrier to success,

and• Staff received help and support

from other members of their workgroup.

Future Improvement opportunities have been identified around issues which include:• Feedback,• Bullying, and• Commitment and Retention.

General Staff Meeting

Service Awards

People Matter Survey


At Timboon and District Healthcare Service we are committed to providing a high quality of care to our consumers.

To help us to evaluate our progress clients are asked to give feedback via our concerns and compliments process. There are a number of ways to make a suggestion, share an idea or make a complaint regarding our level of care and services.

Feedback, good and bad, from consumers provides unique information about their needs and the quality of care and services that they receive. “Concern or Compliments Forms” are available throughout the facility. They can be found in the Acute Hospital at the Nurse’s Station, at the Front Reception and regularly provided to our community clients.

The forms are part of a brochure explaining the processes. The brochure was reviewed in July 2013 with the assistance of a group of consumers. They suggested some changes to make the brochure more useful and we have since had those redeveloped to include all of the suggested changes.

Have Your Say

“What a fantastic place to be sick, the staff are excellent, service is great and food fantastic.”

“During my most recent stay in your hospital, I was most favourably impressed by the standard of care.”

“We would like to say a big thankyou to the wonderful staff, the nurses for their visits and the meals on wheels, it is all a good help.”

Compliment and Complaint data presented by months for 2013 -2014 financial year, the high number of complaints in December, January and February was due to our home maintenance staff leave over the Christmas holiday period and reduced lawn mowing capacity.

Compliment / Complaint Data

My Experience with Timboon and District Healthcare Service– Kate Sloane, Nurse PractitionerThe Nurse Practitioner model commenced at Timboon and District Healthcare Service in June of last year. It had been identified that there was a gap in service provision as the General Practitioners were no longer available to cover the Urgent Care Centre at all times after hours. The model was developed with the financial support of the Department of Health, through their Nurse Practitioner program.

Two experienced Emergency Nurse Practitioners are providing a locum service which covers some of these gaps. The Nurse Practitioners see patients who present to Urgent Care, and care for the inpatients in the ward. In many cases patients are able

to be treated in Timboon and then discharged. The Nurse Practitioners have admission privileges at Timboon and can admit, if necessary. If the patient requires transfer to higher level care this is able to be arranged as normal.

The Nurse Practitioners are able to prescribe some medications, and order x-rays and pathology tests. They are able to undertake procedures such as suturing and plastering, and can refer on to specialists if necessary. They do not replace the need to have General Practitioners but are able to offer an adjunct that enhances the emergency care provided at Timboon and District Healthcare Service. They

work closely with the Timboon General Practitioners and Registered Nurses who have been very supportive of the initiative.

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Our catchment is located in an area in which less than 2% of our population is of Aboriginal and Torres Strait Islander descent.

Regardless of this we make sure all community members have access to appropriate services. Our Cultural Diversity Plan ensures we are creating a welcoming environment and providing cross-cultural training for healthcare service staff. During planning and evaluation of our services we ensure cultural needs of the organisation are assessed and met.

We embrace cultural diversity which ensures we tailor our services to meet the needs of all the community irrespective of cultural background. Although only 5.2% of our communities were born overseas compared with 22% nationally, we view it as important to have actions in place to ensure we are able to accommodate particular health needs if they present to our healthcare service.

During 2013/2014 our Diversity Plan has focused on:

• Clients from Culturally and Linguistically Diverse (CALD) backgrounds, implementing an updated interpreter policy and process accessible to all staff.

• Goal directed care planning for clients accessing our services.

• Ensuring regular publications continue to be published and communicated to all consumers.

• Employment of a Primary Care Access Worker who assists each client entering the organisation and ensuring that their needs are met.

Our Cultural Diversity Plan

Standard 2: Partnering With Consumers

• Timboon and District Healthcare Service works closely with the South West Primary Care Partnership. During the 2013-2014 year, Timboon and District Healthcare Service’s Director of Clinical Services attends this Partnership.

• Timboon and District Healthcare Service uses a variety of approaches to record and report on consumer, carer and community participation to the wider community including the annual Quality of Care Report, newspaper articles, Monthly What’s On, Quarterly Newsletter, Timboon and District Healthcare Service website, Timboon and

District Healthcare Service brochures and posters and via the Quality and Risk Management Meetings.

• Timboon and District Healthcare Service has a cultural responsiveness plan that meets the six minimum reporting requirements.

• Timboon and District Healthcare Service has systems, processes and structures in place to consult and involve consumers, carers and community members - these include consumer Board representatives, strategic plan, consumer, carer and community participation policy,

executive reporting on consumer participation to the Chief Executive Officer, participation in the Victorian Experience Survey, consumer involvement in Quality and Risk Management Meetings and consumer involvement in the development of all consumer resources developed by Timboon and District Healthcare Service.

• Timboon and District Healthcare Service is developing capacity of staff to support consumers, carers and community participation, this has included the Board Chairman, staff, consumer representatives attending education in consumer participation.

Timboon and District Healthcare Service demonstrates a commitment to consumer, carer and community participation appropriate to its diverse communities.

Target Score

75% 75%

Numerator – The number of strategies implemented 6

Denominator – The eight specified strategies required 8

Consumer, Carer and Community Participation– Doing it with us not for us: Strategic Direction 2012/2013


My Experience with Timboon and District Healthcare Service– Sharon Gaut, Consumer RepresentativeI am city born and bred, but the reason I am a ‘country’ girl now is not by accident but by conscious choice.

The outstanding drawcard to a rural life for me is the sense of community and the all-encompassing blanket of protection and involvement that affords us all – something far less evident in city life. The value of community is often taken for granted or assumed but it is worth zillions and is something very special and worth fighting for. Community is about friendship, compassion, participation, working together, security, achievement, involvement and looking out for others. Without the pull of this community, little towns and rural communities would struggle to exist, let alone grow and prosper.

As we all know, a huge part of community is volunteering. The work of volunteers keeps the wheels of the community turning. I recognise that each of us needs to contribute in some way, large or small, to keep our community functioning. Over my years in the Timboon district, I have been a volunteer in a variety of capacities. Through organisations like sporting clubs, the kinder, school, Landcare, anti-cancer and CERT, I have been fortunate to have been able to assist our community at a volunteer level. Although my life is still very busy with family and farming, my family has grown past the kinder and almost past the school stage, therefore I am beginning to find time to dedicate to other organisations and the Timboon and District Healthcare Service is one of these.

Our hospital is an integral part of our community and something of which we can all be proud. Community members’ input into all aspects of hospitals is becoming recognised as more and more important. This

community involvement is part of the hospital’s success as a well managed, highly effective organisation. My small contribution is as a consumer representative on the Quality and Risk Management Committee. This committee reports and openly discusses all things relating to the risks and quality of services provided with complete transparency. The community, as a whole, should take

comfort to know that each and every incident in the day-to-day running of the hospital and its various services, no matter how minor, is discussed at length with complete honesty, and always to conclusion of how improvements can be made.

We have a great Health Service of which we all need to be grateful of and therefore all need to be involved in.

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Being A Consumer Representative

12


A Client Journey through the Rural Health Care System– Pat DelaneyMr Patrick (Pat) Delaney was transferred from South West Health Care to Timboon and District Healthcare Service following his initial treatment for a fractured femur. On arrival at Timboon, Pat required full assistance for all his care needs. As Pat’s health and healing progressed, Pat was referred for a Physiotherapy assessment and treatment to support progress to weight bearing and ambulating. Pat was also referred to the Dietician to assess and ensure his nutritional needs were being met.

All staff focused on a person centred care approach. Person centred care is treatment and care provided by health services that places the person at the centre of their own care and considers the needs of the older person’s carers. This approach encouraged Pat to attend to as much of his care as he could, promote his independence and ultimately the confidence he needed to return home. This being a wish for Pat and his family.

Whilst recovering in the hospital Pat had daily physiotherapy, attended the gentle exercise program and also attended the Timboon Adult Planned Activity Group for social stimulation. Planning for Pat’s discharge saw the introduction of a Webster pack for medications to enable Pat to manage his own medications once at home. Pat was also referred for an Occupational Therapy assessment. This assessment occurred prior to discharge at Pat’s home in consultation with Pat’s family. It was determined that home modifications

were necessary to ensure Pat’s safety.

Prior to Pat’s discharge from hospital Pat had some initial day leave and an overnight stay to ensure his safety at home. With successful leave, Pat was discharged from hospital and received initial Post Acute Care Services. Home

and Community Care services are now being provided and have included the installation of a personal alarm.

The services provided to Pat support his family’s caring role and ultimately have met Pat’s goal to return home and maintain his independence.

Pat

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2. Consumers, and, where appropriate, carers are involved in informed decision-making about their treatment, care and wellbeing at all stages and with appropriate support.

13


0% 0% 5% 7%

73%

15%

Involvement decisions overall care n=41

poor

Fair

Good

Very Good

Excellent

Not Applicable

The Victorian Patient Satisfaction Monitor Wave Reports help to identify strategies that can improve services and patient satisfaction.

Unfortunately for the last Wave of this report in Dec 2013 Timboon and District Healthcare Service did not have enough respondents who completed the survey for a meaningful result.

To replace this survey Timboon and District Healthcare Service completed an internal audit of its consumers.

3. Consumers, and, where appropriate, carers are provided with evidence-based, accessible information to support key decision-making along the continuum of care.

Target Score Score

85% 100%

Numerator - The number of new information resources produced, revised or adopted over last year which met at least 30 of the 40 items on the Checklist for Assessing Written Consumer Health Information, including at least five items from section D 25

Denominator – The total number of new consumer, carer or community information resources produced, revised or adopted in last year 25

During 2013 the community engagement and communications strategy was evaluated.

Outcomes from the strategy have resulted in the printing of a Timboon and Healthcare Service Quarterly which showcases services, activities and special events. This newsletter is printed and distributed within the ‘Cobden Timboon Coast Times’ each quarter, available at local establishments and electronically

sent to an extensive email distribution list. A monthly ‘What’s On’ is also distributed via the the ‘Cobden Timboon Coast Times’, provided to local establishments and electronically sent to those who have subscribed to receive health service information. Regular ‘good news’ media articles have also been maintained, with at least 3 articles per month printed in the 2013/2014 financial year. The Annual Report is provided to residents who attend the Annual General Meeting or

request a copy. The ‘Quality of Care Report’ is distributed to residents in a community mail-out. The Timboon and District Healthcare Service website focuses on news, publications and service provision.

This evaluation was conducted via two surveys. The initial survey which was sent out in our events update flyer and only gathered 4 responses. A second survey was conducted at Timboon and District Healthcare

Consumer Satisfaction Results

Keeping You Informed

Involvement in decisions about overall care n=25

Respectful, courteous and helpful staff n=25

Involvement in decisions about overall care n=41

0% 4%

24%

20%

52%

0%

Respec&ul, courteous and helpful staff n=25

poor

Fair

Good

Very Good

Excellent

Not Applicable

0% 4%

24%

20%

52%

0%


poor

Fair

Good

Very Good

Excellent

Not Applicable

0% 4%

24%

20%

52%

0%


poor

Fair

Good

Very Good

Excellent

Not Applicable

Inpatient Consumer Results Community Health Consumer Results

0% 0%

32%

16% 36%

16%

Involvement in decision making n=25

poor

Fair

Good

Very Good

Excellent

Not Applicable

0% 0% 2% 5%

81%

12%

Sa#sfac#on with overall care n=41

poor

Fair

Good

Very Good

Excellent

Not Applicable

Respectful, courteous and helpful staff n=41


4. Consumers, carers and community members are active participants in the planning, improvement, and evaluation of services and programs on an ongoing basis.

Target Score Score

75% 100%

Numerator - The number of dimensions or specified activities where consumers, carers and community members are active participants 5

Denominator – The six dimensions or specified activities 5

Service and also in the main street of Timboon. This survey gathered 38 responses. Community Meetings and presentations are evaluated after each occasion. Timboon and District Healthcare Service had implemented all strategies except the Open Day, however the Community Health Building Opening on the 15th August 2013 supported this strategy, enabling the community to view all areas of the hospital.

Results of the survey indicate that the community is very interested in:

• acute and emergency services;• allied health services;• health activities and programs;• special health events;• staff information - who’s who;• planning for future needs; and• how to provide feedback.

The survey results indicated that the useful communication methods included:• What’s On; • Quarterly; and,• Noticeboard.

The survey results indicated that the preferred communication methods included:• What’s On; • Quarterly; and,• Noticeboard.

More than 50% of those surveyed had provided feedback to Timboon and District Healthcare Service in writing. Participants would also like to give feedback via email, phone and in meetings.

• Timboon and District Healthcare Service held an Open Board Meeting in April 2014.

• Timboon and District Healthcare Service have involved consumers in the development of community programs such as the Timboon Community Garden development.

• Timboon and District Healthcare Service have consumers on the Quality and Risk management committee which reviews feedback, complaints and clinical and corporate governance.

• Consumers are involved in the review of the annual Quality of Care Report, review of services as part of community development forums and client experience surveys.

• Consumers and community members are involved in the review of consumer information.

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Timboon and District Healthcare Service and BHP joined forces in May 2014 to bring comedian and author Nelly Thomas to Timboon inafunfillednightoflaughterandentertainment.

This is the 11th year that Timboon and District Healthcare Service has offered it’s very popular ‘Women’s Health Night’ to the community. Speakers are chosen each year following consultation with the women at the conclusion of the previous year’s event.

In 2013 Evaluations strongly focussed on Mental Health. It has consistently been identified as one of the major health issues facing local women as well as the lack of social support/networks outside areas such as kindergarten and school. This is an area that is being worked on by the Community Health Team.

Nelly Thomas is described as one of Australia’s most natural, intelligent comedians as well as being an award winning performer and critically acclaimed author. Prior to her appearance, Nelly was briefed on the relevant issues facing our community

that were identified from the evaluation of the 2013 Women’s Health Night. Her hilarious performance was entwined with many serious health topics, including mental health, obesity, isolation, parenting, relationship issues and violence against women. Nelly had the 110 women present spell bound with her wit and insight into what women want.

Many of the women had travelled quite a distance to attend the evening and by all reports the journey was well worth it.

Women’s Health Night - – A night of laughter at Timboon with Nelly Thomas

“Well done, keep them coming. Always a great night”

“Speaker was excellent”

“A fantastic night, with a magnificent speaker and great friends”

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sThree movie nights have been held in the 2013/2014 year over the holiday break. These are extremely successful nights, as the young people do not have access to a local cinema.

Through consultation with young people at the local school and from research conducted through the Timboon Action Plan, it was clear that film and fun entertainment were high on the preferred list of activities.

Timboon and District Healthcare Service provide milkshakes, popcorn and healthy hot food such as home-made pizza for the young people

during the films. All films to date have been double features, with a combination of new release films and classics from the 1980’s and 1990’s.

The Youth Activities Centre can provide this activity at minimal cost, with a maximum outcome for young people.

Film Nights Support Local Youth


It is our strong belief that the community should have access locally to a high quality healthcare service which includes hospital, aged and community services.

Feedback received from our community allows us to reflect on and strengthen our services and practice to ensure this goal is met.

In summary, approximately 83% of consumers felt that the 2012-2013 Quality of Care Report was

an accurate reflection of Timboon and District Healthcare Services’ activities and achievements, was well presented, easy to read and provided useful information.

All consumers who provided feedback felt that the graphs were easy to understand and that the report was well presented.

Comments from consumers indicated they found the report interesting and were happy with the range of services

provided. Community members liked the human interest stories from staff and clients and would like them to again appear in the next report.

Feedback on 2012-2013 Quality of Care Report

5. The organisation actively contributes to building the capacity of consumers, carers and community members to participate fully and effectively.

Descriptive Reporting

Timboon and District Healthcare Service has 186 registered Volunteers who support our programs and our community members.

We express our sincere appreciation to the valuable group of Volunteers who give their time to assist members of the community via the following programs: • MOW’s Volunteers• Planned Activity Group Volunteers• Community Transport Volunteers

• Friendlies Volunteers• TOPS Opportunity Shop

Volunteers • Consumer Representatives

Timboon and District Healthcare Service Volunteer program underwent a documentation and service review during 2013. Volunteers all received a pack containing personnel documentation as well as volunteer information. This information enables compliance with strict State and Federal government requirements in

relation to volunteer records. Each Volunteer now has a personell file, criminal record checks are monitored and recorded so that Volunteers requiring renewals are contacted for the renewal to occur.

Timboon and District Healthcare Service likes to thank all its very valuable Volunteers for their work and support during the past 12 months.


My Experience with Timboon and District Healthcare Service– Jill MacLeod

Jill MacLeod is one of Timboon and District Healthcare Services’ very valuable volunteers. Jill began volunteering at the Timboon Op Shop in November 2011, soon after its opening.

Jill was diagnosed with Bipolar Disorder 40 years ago and on multiple occasions has incurred lengthy hospitalisations. Jill stated that “it took six months for the initial diagnosis to be made, that was when I lived in Melbourne with my first husband and 2 children.” When Jill was 51, 22 years later, she moved to Timboon and came to love the easy going and friendly population. Since her arrival Jill has been an active member of the Port Campbell Baptist Church and has regularly taught Religious instruction at the Timboon P12 School.

During 2011, Jill had a drastic episode of ill health where she had a long hospitalisation at South West Healthcare, Warrnambool. “On discharge from hospital, I felt more in control of my life and began to believe in my abilities and I wanted to become a member of more social groups,” she said. So Jill chose to become a volunteer at the Timboon Op Shop, attended the Wednesday Better Balance Class at the healthcare service and walked with the Timboon Walking Group on Mondays. Like socialising, exercise can provide many benefits in improving mental health.

Jill said “I chose volunteering at the Op Shop because it is something I can do to give back to the community which has been an incredible support to me.” “I also get benefits from the Op Shop,

I feel useful and valuable being able to provide customers with practical help and /or company, we have some customers who call in every Thursday” she said.

Jill has not required any additional treatment for her Bipolar disorder since November 2011, having not suffered from depression during this time. “I know that my faith and the extra social stimulation that I get from attending the Op Shop and the exercise and walking groups have contributed to my improved health,” she stated.

“We have a lovely group on Thursdays at the Op Shop, we have a lot of fun and have bonded very well,” she said.

Timboon and District Healthcare Service currently has 42 volunteers at TOPS (Timboon Op Shop)

Jill

Mac

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enj

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at T

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Being an Op Shop Volunteer

18


My Experience with Timboon and District Healthcare Service– Una McCullam

Una McCullam lives alone in a rurally isolated area of the Heytesbury Settlement. Una, aged 81, no longer drives her own vehicle, creating an increased load on her family if she wants to get out and about. This means that Una is at a high risk of social isolation. Periods of loneliness or social isolation can have a negative impact on an individual’s physical, mental and social health. Una’s family attends to her needs but they are supported by Timboon and District Healthcare’s Home and Community Care (HACC) program.

Una receives services to assist her in maintaining her independence, remain living in her own home and reduce the impacts of being rurally isolated. The Services include the attendance of a community care worker, three

times per week for personal care and medication management.

In addition to meeting her medical needs, once per week on a Wednesday, Una is collected by her community care worker and driven to Cobden to attend the Planned Activity Group. This group provides Una with a home cooked lunch and social activities with the other Planned Activity Group members. The group often ventures out of Cobden on bus outings for lunch, shopping and entertainment. At the end of the day Una is driven home by a community transport driver.

“I look forward to my trip to Cobden each week to meet with the ladies, I enjoy their company”.

Left:

Una

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Keeping our Clients Out and About

19


Each year, infections associated with healthcare occur in a large number of patients, making healthcare associated infections the most common complication affecting patients in hospitals. In Australia it equates to 1 patient in every 20 develops a healthcare associated infection which will complicate their recovery. At least half of the healthcare associated infections are preventable and involve simple measures which our staff, patients and their families or carers can do to reduce the risk of infections. These include infections control, hand hygiene surveillance and improving the safe and appropriate use of antimicrobials.

Timboon and District Healthcare Service employs infection control nurse, Heather Power to support the organisation in understanding and complying with Standard 3.

Heather is supported by the regional infection control consultants who provide standardised auditing, education and resources to enable our staff to fully understand the importance in reducing the risk of healthcare associated infections.

Over the past 12 months as well as complying with appropriate audits, Heather and Timboon and District Healthcare Staff have maintained excellent results and compliance in the areas of hand hygiene, immunisation, cleaning and food safety.

“We continue to provide all our patients, consumers and staff with handwashing information and supplies to ensure that they understand the importance of hand hygiene in assisting to stop the spread of infection,” said Heather.

The assessment of staff in Aseptic Technique is another method undertaken in reducing the spread of infection in hospital settings. Staff are audited on their technique every 12 months to ensure they are competent and not increasing the risk of spreading infections.

Timboon and District Healthcare Service has policies which provide processes in the case of patients who are admitted with diseases which could be spread via airborne particles for example, influenza. In this instance patients are isolated and staff adhere to additional precautions. Staff are notified during the admission procedure and further via clinical handover.

Timboon and District Healthcare Service is a member of the SWABS (South West AntiBiotic Stewardship) group which has undertaken on audit in the correct prescribing of antibiotics for the organisation. Results obtained found that there has been a 25% improvement in antibiotic prescribing

since the 2012 audit.

Heather stated that, “It is very important for the correct antibiotic to be prescribed, this includes the correct doseage and the prescription provided in the correct timeframe of the illness for antibiotics to be successful in treating a condition. Antibiotics are not appropriate in the treatment of viral conditions . It is necessary that the full course of antibiotics is taken by an individual so that resistant bacteria is not developed.”

“We are also providing our clients and consumers with educational material on minimising spread of infection in the hospital setting,” said Heather.

How We Work Towards Preventing Healthcare Associated Infections

Standard 3: Preventing and Controlling Healthcare Associated Infections

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Infection Control Compliance

HAND HYGIENE

IN PARTNERSHIP WITH OUR COMMUNITY BUILDING A HEALTHY FUTURE INFECTION CONTROL COMPLIANCE HAND HYGIENE

Compliance Rate by Moment and Healthcare Worker – Timboon and District Healthcare Service

Audit Period NHHI Audit Two 2014

Name Correct Moments

Total Moments

Compliance Rate

Lower Confidence Interval

Upper Confidence Interval


51 55 92.7% 82.7% 97.1%

Compliance by Moment

1. Before Touching a Patient 12 15 80% 54.8% 93%

2. Before Procedure 4 4 100% 51% 100%

3. After a Procedure or body fluid exposure risk

2 2 100% 34.2% 100%

4. After Touching a Patient 19 19 100% 83.2% 100%

5. After Touching a Patient’s Surroundings

14 15 93.3% 70.2% 98.8%

Achieved a score of 92.7% in the South West Region Hand Hygiene Audit against a target of 85%.

INFECTION PREVENTION AND CONTROL VICNISS Hospital Required infection rates – Timboon and District Healthcare Service complies with this data collection however

has not had any infections that are included in these categories over the past five years.

STAFF IMMUNISATION Achieved a staff participation rate of 82% for annual flu vaccination a much higher rate than the state indicator target of 60%.

CLEANING SERVICES

Achieved an External Audit Cogent Cleaning score of 99% in June, 14 against an acceptable quality score of 85%.

FOOD SERVICES Achieved certificate of compliance with Food Hygiene Australia’s food safety Audit.

IN PARTNERSHIP WITH OUR COMMUNITY BUILDING A HEALTHY FUTURE INFECTION CONTROL COMPLIANCE HAND HYGIENE

Compliance Rate by Moment and Healthcare Worker – Timboon and District Healthcare Service

Audit Period NHHI Audit Two 2014

Name Correct Moments

Total Moments

Compliance Rate

Lower Confidence Interval

Upper Confidence Interval


51 55 92.7% 82.7% 97.1%

Compliance by Moment

1. Before Touching a Patient 12 15 80% 54.8% 93%

2. Before Procedure 4 4 100% 51% 100%

3. After a Procedure or body fluid exposure risk

2 2 100% 34.2% 100%

4. After Touching a Patient 19 19 100% 83.2% 100%

5. After Touching a Patient’s Surroundings

14 15 93.3% 70.2% 98.8%


INFECTION PREVENTION AND CONTROL VICNISS Hospital Required infection rates – Timboon and District Healthcare Service complies with this data collection however

has not had any infections that are included in these categories over the past five years.


CLEANING SERVICES

Achieved an External Audit Cogent Cleaning score of 99% in June, 14 against an acceptable quality score of 85%.

FOOD SERVICES Achieved certificate of compliance with Food Hygiene Australia’s food safety Audit.

INFECTION PREVENTION AND CONTROL VICNISS Hospital Acquired infection rates – Timboon and District Healthcare Service complies with this data collection however has not had any infections that are included in these categories over the past five years.


FOOD SERVICES Achieved Certificate of Compliance with Food Hygiene Australia’s food safety Audit.

CLEANING SERVICES Achieved an External Audit Cogent Cleaning score of 99% in June 2014 against an acceptable quality score of 85%.



Medicines are the most common treatment used in healthcare and because of this they are associated with higher incidence of errors and adverse events.

Solutions to prevent medication errors are found in standardisation and systemisation of processes as well as improving communication between clinicians and patients, improvements in recording of information and ensuring better access to patient information.

When a medication incident occurs at Timboon and District Healthcare Service it is recorded in the RiskManQ incident system. Each month these incidents are reported to the Clinical Governance Group as well as the bi monthly Board Quality and Risk meeting.

Medication Related Incidents

Standard 4: Medication Safety

TDHS Health Medication Incidents with Harm Average

Target per 1,000 occupied bed days 0.52

2012/2013 0

2013/2014 0

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Patientidentificationandthematchingofapatienttotheirintendedtreatmentisperformedroutinelyinallcaresettings. A risk to patient safety occurs if there is a mismatch between a given patient and components of their care, whether those components are supportive, diagnostic or therapeutic.

Timboon and District Healthcare Service has an overarching policy to guide staff through the processes to ensure thatcorrectpatientidentificationandprocedurematchingiscarriedoutinlinewiththisstandard.WeusetheWorld Health Organisation Surgical Safety Checklist and ensure that correct patient, correct site and correct procedure protocols are adhered to. Auditing of safety checks occurs twice per year.

Patient Identification and Procedure Matching Incident Reporting

Standard 5: Patient Identification and Procedure Matching

During 2013/2014 Timboon and District Healthcare Service had 35 reported medication incidents with 20 being no harm/near miss and 13 being mild. The reported incidents have occurred during staff auditing and checking procedures. This indicates that these procedures are occurring and need to continue to ensure medication policy compliance.

On each occasion a medication incident occurs, the Nurse Unit Manager and clinical team discuss the error and detailed actions are put in place to ensure the safety of the patient, either by additional patient observation or providing the drug when the omission has been recognised if appropriate.

IMPROVEMENTS HAVE INCLUDED:

ANNUAL REVIEW OF MEDICATION MANAGEMENT POLCIES This has ensured that the appropriate legal and safe practice with respect to medication administration practices

within Timboon and District Healthcare Service and outlines the procedure for storage, supply, disposal and security of medications at Timboon and District Healthcare Service. Policies continue to be in line with NSQHS Standard 4, Medication Safety.

CONTINUED ROTATION OF STOCK Rotation of Stock via the introduction of a coloured coding per year to ensure out of date medication is not used and disposed of appropriately and that the drugs closest to expiry are used first to minimise medication waste. This process allows for timely ordering of common medications and reduces the likelihood of overstocking or expired stock on shelves.

ENSURING APPROPRIATE DISPOSAL OF MEDICINES To ensure accountability for all medications and to reduce medication wastage, Timboon and District Healthcare Service developed an appropriate disposal of medications system. This involves a Pharmaceutical Waste Log whereby a record is kept of

drugs and reasons for their disposal. This enables a three-monthly analysis of medication disposal and will enable Timboon and District Healthcare Service to improve pharmacy maintenance.

USE OF TALL MAN LETTERING Timboon and District Healthcare Service continues to use Tall Man Lettering to reduce likelihood of incidents resulting from incorrect provision of medicines of similar names. Tall Man Lettering uses a combination of lower and upper case letters to highlight the differences between look-alike drug names, like fluOXETine and fluVOXAMine, helping to make them more easily distinguishable.

Tall Man Lettering reduces error by warning health care professionals about the risk of confusing a particular medicine name and by helping health professionals to select the right product in electronic systems or from shelves.

When a patient identification and/ or procedure matching incident occurs at Timboon and District Healthcare Service, it is recorded in the RiskManQ incident system.

Each month these incidents are reported to the Clinical Governance

Group as well as the bi monthly Board Quality and Risk meeting.

During 2013/2014 Timboon and District Healthcare Service had 4 reported incidents, these incidents were all identified as near miss/no harm.


Using Patient ID in the Operating Suite

New Process for Community Clients

In the operating theatre there is the potential for the wrong operation to happen on the wrong patient, or the wrong site.

This has been recognised by the National Safety and Quality Health Service Standards who have made recommendations for health services to adhere to. At Timboon and District Healthcare Service we have put these recommendations into practice to ensure that all patients receive the correct procedure.

Our steps begin at pre-admission where the patients are asked to fill in their details on the pre-admission

documentation. This documentation is checked against their referral and consent to be assured that the details such as the patient’s name, date of birth, address and the type and site of the procedure are correct. At the pre-admission interview these details are again checked, including the patient identification number as well as discussing with the patient any significant factors that may affect their surgery.

The checking occurs again on admission to the acute ward at the hospital and again on admission to the operating suite.

When the patient arrives in theatre a “time out” is performed. Time out is where all staff stop what they are doing. Staff are introduced to the patient, the patients identification number, name, date of birth, allergies, consented procedure and site of procedure are all checked before the procedure is commenced. All of this documentation occurs on the surgical safety checklist. Once all documentation matches, the procedure can commence.

In 2013/2014, the Executive teamidentifiedanabsenceofaconsumer/patient centred focus which led to fragmented care, consumers who were poorly informed about their care needs and options, and gaps and/or duplication of services received.

It was identified that there was a need for a more uniform, comprehensive service in order to assist consumers within the Timboon and District. When consumers are engaged, have access to reliable and appropriate information and support, they are better placed to adhere to treatment regimens and manage lifestyle related risk factors, which may lead to better clinical outcomes and better quality of life.

Historically, consumers who required allied health services were required to present to the reception desk, to arrange an appointment and discuss their issues. This often occurred in front of a filled waiting area. The other issue identified was that a consumer might present for podiatry care but have many other health issues not being addressed. This system

appeared to work well for many years, but it was agreed this system did not demonstrate a model of Consumer Directed Care. In March 2014, a new role of Primary Health Access Advisor was appointed.

When a consumer now contacts Timboon and District Healthcare Service, either via Phone or face to face, they speak to the Primary Health Access Advisor. Their current issue is discussed, if for example the person wants to access the Physiotherapist due to joint pain, stiffness and Arthritis, the discussion focuses on making an appointment with the Physiotherapist. The consumer may then be encouraged to consider accessing the exercise groups. The Physiotherapist completes the assessment and develops a support plan which may include a referral to the exercise group coordinator.

The introduction of the Primary Health Access Advisor position has helped to improve the allocation of appointment times for those utilising the Podiatry service. The Podiatrist who attends Timboon and District Healthcare

Service weekly was having concerns about clients attending appointments requiring extensive care but unable to be assisted on the day due to lack of client history information prior to the appointment. The Primary Health Access Advisor manages all new referrals for podiatry to ensure a full history is gathered, what consumables will be required and if the appointment is urgent or requires a wound management plan.

The Primary Health Access Service assists consumers to access Physiotherapy, Exercise groups, Diabetes Education, Dietician support, Women’s Health Services, Occupational Therapy, Speech Pathology, Social Work, Youth Work, Planned Activity Group Program and the Home and Community Care services such as domestic assistance, hygiene assistance, garden and lawn maintenance. The role works with the local medical clinics to manage referrals for services, ensure client details and contact numbers are up to date, and consent is gained for all referrals.


Clinical handover refers to the transfer of professional responsibility and accountability for some or all aspects of care for a patient or patients to another person or professional group. The breakdown in the transferofinformationhasbeenidentifiedasoneofthemostimportantcontributingfactorsinseriousadverse events and is a major preventable cause of patient harm. The implementation of standardised processesforclinicalhandover,improvetheflowofcriticalinformationbetweenhealthcareprofessionals.This ensures patient safety and the continuity of care.

Standard 6: Clinical Handover

Timboon and District Healthcare Service moves towards best practice clinical handover at the bedside – Lynn MarrI would like to introduce myself, I am Lynn Marr, a Registered Nurse at Timboon and District Healthcare Service and I manage the Clinical Handover portfolio. When my children ask me what it was like in the olden days, I cringe. I’m not 153 only 53. Patient handover at Timboon and District Healthcare Service has remained in the back room for years where the nurses huddled together and discussed what they needed to do for each patient for that day. We have now come out of the back room and have moved clinical handover to the patient’s bedside. Nursing care like everything else is constantly changing to ensure that we provide the best care to our patients.

The process involves staff from the current shift handing over to the oncoming shift at each patient’s room. Initially the new clinician is introduced to the patient. Information we include in the handover ranges from their current observations, treatments, investigations, personal care, wellbeing and future appointments. The patients are free to interrupt the handover at any time to provide input and voice any concerns. They state that they enjoy hearing about what has happened during the previous 8 hours.

The patients’ family members or carers are welcome during handover as long as this has been agreed to by the patient. This enables the patient and family the opportunity to discuss their thoughts and concerns. It also

provides the opportunity for them to ask any questions they may have for the staff.

We have found that the patients appear to really appreciate the bedside handover and the ability to have greater discussions with staff around their care.

The standardised ISBAR tool is used by all staff during each handover to ensure a standardised level of information is handed from one clinician to another. The ISBAR tool stands for:• I - Identify the patient• S - Situation, patients current

presenting problems• B - Background, past problems

contributing to the present condition

• A - Assessment, look at the patient from head to toe and identify any problems

• R -Requirements, what tests need to be done in the future and what tests have been done

“Great, positive connection with nurses on duty” John Longmore

“Nice to meet who is coming onto next shift, lovely to chat with the girls.” Kath Trotter

“Good idea, keeps me up to date with my progress. Nice to see who is working the next shift.” Shirley Morgan

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Standard 7: Safe use of Blood and Blood ProductsBlood and blood products are a vital resource, sourced from the Australian and International donor community, and from commercial manufacture.

While the use of blood and blood products can be lifesaving, there are also risks associated with their administration. The standard aims to ensure that safe, appropriate, effective and efficient blood management systems are in place.

These include:• Health service organisations

have systems in place for the safe and appropriate prescribing and clinical use of blood and blood products

• Timboon and District Healthcare Service has clear policies and procedures to ensure that blood and blood products are safely administered to the designated patient when clinical need indicates. These policies were reviewed this year to ensure compliance with NSQHS Standard 7, Blood and Blood Products and the Department of Health Victoria, Blood Matters Program.

• The clinical workforce accurately records a patient’s blood and blood product transfusion history and indications for use of blood and blood products.

• Our Medical Practitioners meticulously determine the clinical need for the patient to receive blood or blood product as it is in such short supply and correct and timely use is paramount. Time is taken to discuss with our patients the need for blood or blood products and in the past two years there has been 100% consent from patients to such care. Staff participate in annual mandatory education online.

• Health service organisations have

systems in place to receive, store, transport and monitor wastage of blood and blood products safely and efficiently.

• Blood is stored in a designated fridge and monitored. All monitoring for the blood fridge will be recorded by the RFID Tag located in the fridge. It is monitored 24/7 by a computer program which sends alerts to the nurses pagers and the maintenance officer via a text message when temperature alerts are outside range. When blood is stored in the blood fridge, the fridge is monitored manually, twice a day at 0800 and 2000 hours and temperatures are recorded.

• Patients and carers are informed about the risks and benefits of

using blood and blood products, and the available alternatives when a plan for treatment is developed.

• Patients are provided with blood safe information verbally by their medical officer and in written form to ensure they are informed about the risks and benefits of using blood and blood products.

During 2013-2014, there were not any incidents where the wrong type of blood was administered to a patient or any adverse reactions to blood and blood products.

We are unwavering in our commitment to ensuring the safety and quality of our care with regard to use of blood and blood products.

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Philip Reardon shares his story on receiving regular blood transfusions It is Friday again and Philip (Phil) Reardon arrives at Timboon and District Healthcare Service from his home in Cobden for his fortnightly blood transfusion. For Phil this involves an overnight stay at Timboon Hospital. Phil was diagnosed with Myelodysplasia. Myelodysplasia affects normal blood cell production in the bone marrow, the bone marrow produces abnormal, immature blood cells called blast cells. These cells fail to mature properly and are unable to work properly. Treatment for Phil’s Myelodysplasia involves fortnightly packed cell transfusions to help promote normal red blood cell production.

Phil’s medical history includes Addisons disease and type 2 diabetes.

On arrival at Timboon and District Healthcare Service and prior to admission, Phil is met by Dr Rouse. “Dr Rouse makes sure I understand what I am having happening, what could go wrong and then I sign a blood transfusion consent, after I do this I complete the book work with the nurses,” he says. Phil then said, “The nurses are great they ask me the same questions each fortnight, they check my identifiers, ask me if I have had any problems, provide me with the pamphlets and then give me the chance to ask questions.”

After all the paperwork is complete, Phil is prepared for his blood transfusion. A cannula is inserted and the blood transfusion begins. The process begins with a saline flush, then the first bag of packed cells, followed by a saline flush, then a second bag of packed cells and a final saline flush. During the transfusion nurses stay with Phil for the first 15 minutes of each packed cell bag of blood monitoring blood pressure, pulse, oxygen levels and temperature every 5 minutes. If all is going well Phil is then monitored every 15 minutes for the first hour and then every 30 minutes until the bag is completed. It generally takes between 3-4 hours for each bag/unit of blood. Timboon and District Healthcare

Service Registered Nurse, Naomi Lewis says, “The first 15 minutes of each transfusion is most risky therefore we increase the monitoring in case there is an adverse reaction.”

Phil says “I have learnt a lot about my blood and my diabetes coming to Timboon and District Healthcare Service, especially that I react differently to each transfusion, I sometimes leave the hospital full of energy and can go home and cook a couple of cakes while at other

times I leave the hospital very tired and want to rest.” “I really enjoy my fortnightly stay at Timboon and District Healthcare Service, I know all the staff by name, I give the nurses a 10 out of 10 and the cleanliness of the bathrooms are a credit to the hospital staff,” he said.

Phil finished the interview by saying “I would also like to give a special thankyou to all the blood donors as my life depends on their life giving donation.”

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Standard 8: Preventing and Managing Pressure InjuriesPressure injuries are localised areas of damage to the skin or underlying tissue, caused by unrelieved pressure or friction. They occur most commonly over bony prominences such as the sacral area (the area at the base or bottom of the spine) and heel, but they can develop anywhere on the body.

While pressure injuries are generally considered to be preventable, research shows that pressure injuries are a major contributor to the care needs of patients within healthcare facilities. Pressure injuries may impact significantly on the length of stay in health services, the cost of care, health outcomes and the comfort and quality of life of the individuals affected. In the majority of cases pressure injuries are preventable.

Standard 8 requires that:

• Health service organisations

have governance structures and systems in place for the prevention and management of pressure injuries. – Developed policy with guidance from regional wound care specialist – Regular audits have been conducted at both the ward and facility level which shows improvement at time of screening by staff.

• Patients are screened on presentation and pressure injury prevention strategies are implemented when clinically indicated. – All acute, aged care and respite patients/clients are screened on admission for the prevention of pressure injuries developing and a skin assessment is conducted daily so that the appropriate pressure reducing aides are

put in place. Permanent aged care clients are then reassessed monthly. – A new wound care chart is currently being trialled in Urgent Care Centre, district nursing and on the ward. This document was adapted from Barwon Health.

• Patients who have pressure injuries are managed according to best practice guidelines. – Staff have been encouraged to complete an online learning package as part of their ongoing education yearly.

• Patients and carers are informed of the risks, prevention strategies and management of pressure injuries. – Adapted an information brochure from Wounds West Victoria- which is given to every patient admitted for 24hrs or more, respite and aged care clients.

Preventing and Managing Pressure Injuries Incident ReportingWhen pressure injury incident occurs at Timboon and District Healthcare Service it is recorded in the RiskManQ incident system. Each month these incidents are reported to the Clinical Governance Group as well as the bi monthly Board Quality and Risk meeting.

During 2013/2014 Timboon and District Healthcare Service had 13 reported incidents relating to skin integrity and pressure injuries. Timboon and District Healthcare Service met the aged care benchmark of between 0 and 0.8% reported pressure injuries per 1000 bed days for 11 out of the past 12 months. The month where the benchmark was not met was due to a patient being admitted for respite with a pressure injury.


Standard 9: Recognising and Responding to Clinical Deterioration in Acute Health CareRecognising that a patient’s condition is deteriorating and responding to their needs in an appropriate and timely way is an essential component of safe and high quality care.

Serious adverse events such as unexpected death and cardiac arrest often follow observable deterioration in the patient’s condition. Early identification of deterioration, followed by prompt and effective action, can minimise the occurrence of these events, and may improve outcomes and lessen the level of intervention required to stabilise patients whose condition deteriorates. There is evidence that the warning signs of clinical deterioration are not always identified or acted on appropriately. The organisation and workforce factors that contribute to a failure to recognise and respond to a deteriorating patient are complex and overlapping. Systems to recognise deterioration early and respond to it appropriately need to deal with all of these factors, and need to apply across a healthcare facility.

This Standard requires that:

Health services use organisation-wide systems consistent with the National Consensus Statement to support and promote recognition of, and response to, patients whose condition deteriorates in an acute health care facility. • To recognise and respond

promptly to situations of deterioration we are using observations charts for adults and children which provide trigger scores

• These charts are called Modified Early Warning Scores (MEWS) and Children’s Early Warning Tool (CEWT)

• A MEWS / CEWT is a simple bedside track and trigger system that is calculated by nursing staff from the observations taken at the bedside. The scores are added to indicate early signs of a patient’s deterioration

• The MEWS / CEWT looks at all the observations together, not just a single observation in isolation. It includes respiratory rate, oxygen

saturation, temperature, blood pressure, heart rate, sedation score and urine output

Patients whose condition is deteriorating are recognised and appropriate action is taken to escalate care. • A MEWS / CEWT is beneficial

as it provides a point in time for communicating changes in a patient’s condition and assist Doctors to prioritise the management of their patients.

• Education of staff in MEWS /CEWT tool

Appropriate and timely care is provided to patients whose condition is deteriorating.• Recommended to determine

a more detailed emergency response team

Patients, families and carers are informed of recognition and response systems and can contribute to the processes of escalating care. • Recommended to develop

educational information for patients, families and carers on clinical deterioration

Recognising and Responding to Clinical Deterioration Incident Reporting

When an incident occurs at Timboon and District Healthcare Service it is recorded in the RiskManQ incident system.

Each month these incidents are reported to the Clinical Governance Group as well as the bi monthly Board Quality and Risk meeting.

During 2013/2014 Timboon and District Healthcare Service had 1 reported incident related to this standard.


Standard 10: Preventing Falls and Harm From FallsFalls and fall-related injury are a significantprobleminAustralianhospitals and residential aged care facilities due to the ageing population, the incidence of falls and the negative impacts of falls at both individual and organisational levels. Fall injuries within hospitals have steadily increased. The impact of falls on individuals is far reaching.

The social impact of reduced independence through fear, the potential for loss of independence and the increased burden on families can be significant. While the risk of falls is well documented for the elderly, falls can occur in all age groups. Therefore, strategies such as screening to reduce falls and harm from falls should not be limited to older Australians.

In the acute hospital setting, fall rates have been reported as ranging from 2–5%. In the sub-acute or rehabilitation hospital setting, over 40% of patients with specific clinical problems, such as stroke, experience one or more falls during their admission. Thus, incident rates vary between wards and departments in hospitals. Injuries result from

approximately 30% of such falls. In residential aged care settings up to 50% of residents experience one or more falls in a 12 month period.

This Standard requires that:

Health service organisations have governance structures and systems in place to reduce falls and minimise harm from falls.• Our health service has a

comprehensive falls prevention policy and a falls prevention focus group to ensure that best practice systems are in place to reduce falls

Patients on presentation, during admission and when clinically indicated, are screened for risk of a fall and the potential to be harmed from falls. • Falls prevention strategies within

our Health Service are extensive. Prevention of falls starts with a screen via the Nursing Clinical Risk Assessment. If a risk is identified then a thorough assessment of the potential for a patient or a resident to fall occurs.

Prevention strategies are in place for

patients at risk of falling.• It is our philosophy, particularly in

aged care that our patients and residents are free to move about but this freedom must come as safely as possible. For this reason we make every attempt to provide an environment free of obstacles, ensure footwear of residents is well fitting and appropriate to the surface they are walking on and, most importantly, that patients and residents can call staff easily when they need help. Clients or patients who are assessed as high falls risk are then monitored closely by staff, they are easily identified by an illuminated light outside their room, orange band on their equipment and a red patient identification bracelet.

Patients and carers are informed of the identified risks from falls and are engaged in the development of a falls prevention plan.• Patients and their carers are

informed by nursing staff of the results of the assessment and preventative strategies are discussed with them.

Falls Incident ReportingDuring the past 12 months Timboon and District Healthcare Service has had 33 falls.

Falls are converted to the benchmark of falls per 1000 bed days with an aim of falling within the benchmark of 3 - 11% falls per 1000 bed days. Timboon and District Healthcare Service managed the benchmark on 8 out of 12 months. The months where we were unable to meet this benchmark were due to single inpatients or

residents with health-related conditions causing them to fall. All of these patients or residents had completed a falls assessment and multifactorial prevention plan.


Better Balance Program - to keep our community healthy and reduce fallsHave you fallen over? As an adult, it can be a frightening as well as a debilitating experience and one that, potentially, can have long lasting effects.

Given this area of concern for our hospital, both in the acute setting and the community setting, a working party was formed by staff to address how well we were supporting our community in the area of falls prevention.

The community health approach was to reinvigorate the Better Balance short course which has been run in the past. National guidelines were used as the starting point to developing the program and a few messages stood out to be followed.• Offer good assessment • Consider all aspects related to falls

prevention, not just exercise!• Hear from experts in the field• Take an individualised approach• Offer ongoing support

The community was invited to attend an “April Falls Day” screening day whereby participants were invited to undergo a 30 minute screening which aimed to identify areas of strength and deficit in their balance. The response was positive and 14 good folk from around the district were put through their paces. From this initial group, 10 people signed up for the 10 week Better Balance course to enhance their skills and understanding of what keeps us on our feet.

Elliot Watts, physiotherapist and Tracey Heeps, exercise program coordinator conducted the 10 classes, which included 60 minutes of specific physical activity to improve leg strength and challenge balance. The group was very responsive to trying new activities, some of which may have appeared odd. Walking along an imaginary tightrope while throwing a ball to oneself isn’t something you do every day, but this skill translates to everyday activities! Standing on a piece of foam with closed eyes is a bit confronting, but it kicks the balance mechanisms into gear! It was great to see people’s skills and confidence grow as the weeks progressed.

After the exercise program, a falls prevention weekly topic was discussed, facilitated by guest speakers.

At the completion of the course, participants repeated some of the tests they did on April Falls Day. The results and outcomes from the course were very positive. All participants felt their balance or physical activity levels had improved. Some participants improved up to 75% on their pre tests and as a group the improvements were approximately 20% across 5 physical balance tests. Importantly, those folk who need further support to stay on their feet are currently accessing services in Timboon and beyond, to make the best of their balance and environments. We thank all the participants for their involvement and

feedback regarding the course and look forward to offering Better Balance in the future.

Comments from Better Balance Participants: • “It was interesting to discover the

strengths and the weakness of my balance, then see them improve!”

• “Staff were professional and most helpful giving concern to each individual”

• “I liked challenging my balance and doing new things”

• “The Home Exercise Program was most beneficial”

• “It was nice to realise that you are not alone!”

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Coping After a Stroke

My Experience with Timboon and District Healthcare Service– Tim and Mavis CouchTim and Mavis Couch live at Curdies River on the outskirts of Timboon. They recently celebrated 65 years of marriage.

In November of 2012 Tim suffered a left cerebrovascular accident (CVA) or stroke resulting in a lengthy stay at South West Healthcare followed by a 12 week Transition Care Program which enabled Tim to return back to his home. At the completion of the Transition Care Program Tim and Mavis required some Home and Community Care (HACC) services for Tim to remain comfortable at home. In June 2014, Mavis became unwell and upon her discharge from hospital, Tim and Mavis’ HACC services were increased for carer sustainability.

Mavis and Tim’s main goal when met by the HACC Assessment Officer was to remain living together in their own home for as long as possible. Services provided through Timboon and District Healthcare Services’ HACC program include:• Meals on Wheels, five times per

week

• Personal Care for Tim, three times per week

• Homecare, once per week• Shopping assistance, once per

week ,• Transport of Tim to the exercise

program, once per week; and• Access for Tim in respite at

Timboon and District Healthcare Service.

Tim and Mavis also have a very supportive family network that provides

additional care to both Mavis and Tim. The benefits to Tim and Mavis in receiving the HACC program is that it allows for more time with their family revolving around family activities, gatherings and quality time together.

“We are very happy and grateful for the services we receive and it enables us to continue to live at home without being a burden on our family”

Suffering From a FallHaving a fall at any time can have significantconsequencesfortheindividual and those caring for them.

For those of us who are over the age of 60 or with other risk factors (illness/disability) there is an increased risk of falls. Falls associated injuries contribute significantly to hospital presentations, and also to injuries that can occur whilst in hospital. This makes our response to improving falls both within the healthcare service and out in the community very important and necessary.

At Timboon and District Healthcare Service we have a policy and procedure in place to decrease the risk of our patients and clients falling. This procedure includes the education of our staff and clients in the ways to prevent falls. The model adopted includes a falls risk screen (Sydney Modified STRATISFY) on admission to the acute hospital ward. This screen gives a level of falls risk rated by low, medium or high as well as identifying a list of precautions to put in place dependent on what level the patient is rated.

If a patient records a medium or high rating they then have a more thorough assessment using the FRAT (falls risk assessment tool). The FRAT was developed by Peninsula Health and we implement this tool for all our falls assessments on our patients. The package educates staff and patients on the interventions that can be put in place to reduce falls risks and any associated problems that might occur.

The effectiveness of these measures are regularly audited, enabling the identification of areas of both success and those which require further work.

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Concerns or compliments

Timboon and District Healthcare Service invites any comment you may have about the care or service provided by our health

service; this provides an opportunity for service improvement.

Concerns or compliments may be directed to the Chief Executive Officer

on 03 5558 6000.

If the matter is not resolved to your satisfaction, the Health Services Commissioner who assists with

complaint resolution, can be contacted on 03 9655 5200.


21 Hospital Road, Timboon, VIC 3268p: (03) 5558 6000 f: (03) 5598 3565 e: [email protected] www.timboonhealthcare.com.au

timboon and district healthcare service report …...2013-2014 quality of care report 1 we are...

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