Member stories

Donna’s story

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Donna von Blanckensee – CEO CD Program Development
RN, Cert IV TAE, Grad Cert Advising on Chronic Disease Self-Management, Diploma Management

As a registered nurse and CEO of C D Program Development I am privileged to work with primary health care nurses and organisations across Australia, and while the location and size of primary health care organisations may vary, the dedication and commitment to improved patient outcomes and the strengthening of the primary health care team by nurses remains consistent.

In my work within the primary health care setting I continue to witness primary health care nurses increasingly step into leadership roles, roles that are resulting in new and innovative ways of meeting the increasing demands of the primary health care arena. In my role as CEO of CD Program Development I am able work with primary health care organisaitons and their nurses to design and implement patient management strategies that are resuting in more patients screened, identified and effectively managed with regard to their specific health care needs as well as raise the profile of the primary heath care nurse.

One of the many highlights during the last 12 months has been continuing to work with APNA to deliver part of the Foundations of General Practice Nursing workshops held in Adelaide, SA. I was again able to share valuable content, as well as my own passion and enthusiasm for primary health care with a room full of nurses new to general practice nursing. I always leave these workshops feeling confident that primary health care nursing is experiencing new levels of professionalism which will ultimately result in improved patient outcomes.

Member stories

Carolyn’s story

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Carolyn Lally – General Practice Nurse, Virginia Medical Centre, Virginia, South Australia

I have enjoyed working as a primary health care nurse for around seven years, most of it at Virginia Medical Centre in semi-rural location north of Adelaide. I chose to move to general practice as a lifestyle change after many years in a variety of clinical and research positions around Australia – I just wish I had made the change sooner!

Catching up with fellow general practice nurses at education events had highlighted the need for more support for nurses who often feel isolated within their own practice and unsure of where to go for guidance. In early 2014 I started collecting email addresses with the plan to initiate a Nurse Network. A group of four nurses then met over dinner and planned our initial meeting, which was held in August 2014. Early on we approached APNA and came to be part of the Nurse Connect initiative, along with other groups Australia-wide. APNA has been very supportive of the coordinators, who were able to travel to Melbourne in February 2015 to share our ideas and learn some new skills to assist with setting up our networks.

Our group has been highly successful, with 16-30 nurses attending each meeting, and over 70 nurses having attended at least one meeting. We meet every six weeks, and enjoy roundtable discussions and guest speakers on topics that the group has chosen. Although we are well supported by APNA and the Northern Health Network (NHN) – who kindly provide us with a venue, catering and admin support, our group is independent and has evolved to meet its own demands. Our network is very dynamic and feedback so far has been very positive.

What’s your experience with nurse networks in your area? We would love to hear your story.

If you are interested in being involved in a nurse network see here.

Items considered for removal from the MBS – the first 23

The first collection of MBS items facing elimination has been released by the MBS Review Taskforce, seen to be “no longer part of contemporary clinical practice”. The 23 items were claimed 52,500 times in 2014-15 at a cost to the government of $6.8 million.

Six clinical expert groups produced this list, and a further 80 groups will draft their own lists of items deemed to be obsolete in the coming months.

Consultation is currently being undertaken on these 23 items.

  1. Intravenous pyelography, with or without preliminary plain films and with or without tomography
  2. Graham’s Test (cholecystography), with preliminary plain films and with or without tomography
  3. Pelvimetry, not being a service associated with a service to which item 57201 applies
  4. Bronchography, 1 side, with or without preliminary plain films and with preparation and contrast injection
  5. Vasoepididymography, 1 side
  6. Peritoneogram (herniography) with or without contrast medium including preparation – performed on a person over 14 years of age
  7. Venography
  8. Glycerol induced cochlear function changes assessed by a minimum of 4 air conduction and speech discrimination tests (Klockoff’s tests)
  9. Glossopharyngeal nerve, injection of an anaesthetic agent
  10. Cryotherapy to nose in the treatment of nasal haemorrhage
  11. Turbinates, cryotherapy;
  12. Division of pharyngeal adhesions
  13. Postnasal space, direct examination of, with or without biopsy
  14. Larynx, direct examination of the supraglottic, glottic and subglottic regions, not being a service associated with any other procedure on the larynx or with the administration of a general anaesthetic
  15. Larynx, direct examination of, with biopsy
  16. Larynx, direct examination of, with removal of tumour
  17. Biliary manometry
  18. Gastric hypothermia by closed circuit circulation of refrigerant for upper gastrointestinal haemorrhage
  19. Gastric hypothermia by closed circuit circulation of refrigerant in the absence of upper gastrointestinal haemorrhage
  20. Sigmoidoscopic examination with diathermy or resection of one or more polyps where the time taken is less than or equal to 45 minutes
  21. Sigmoidoscopic examination with diathermy or resection of one or more polyps where the time taken is greater than 45 minutes
  22. Treatment of habitual miscarriage by injection of hormones each injection up to a maximum of 12 injections, where the injection is not administered during a routine antenatal attendance; an
  23. Bronchospirometry, including gas analysis

Would the removal of these items from the MBS impact your work, or your colleagues work, in primary health care?

Are there items you think could be optioned for removal during this process that shouldn’t be?

AMA’s Position Statement on nurses in general practice

Earlier this week the Australian Medical Association (AMA) published a position statement on nurses in general practice – General Practice Nurse Position Statement 2005. Revised 2015 (see here). This document is a revision of the original statement which was published 10 years ago.

This position statement came as a surprise to APNA, and as the peak professional body representing nurses working in primary health care including general practice it is disappointing we were not consulted in this process. Karen Booth, our President, has now written to the AMA’s President to express our concern around this.

While there are some positive statements about nurses contained in the position statement, it also contains a number of inaccuracies, such as outdated nurse data and a misunderstanding around nurse scope of practice. We have provided this feedback to the AMA and we hope the position statement will be amended.

It is important the role of the primary health care nurse working in general practice is clearly understood by fellow health professionals. Your experience, unfortunately, tells us that this is not the case – in the last APNA salary and conditions survey you told us that only 23% of GPs had a full understanding of nurse scope of practice in general practice and, more worryingly, 4% of GPs had no understanding of scope whatsoever. This lack of understanding is one of the many barriers faced by nurses working in the general practice setting.

Does the AMA’s position statement just add to this lack of understanding? What does the profession need in order to change attitudes and perceptions? Let us know your thoughts.

New Atlas plots variation in healthcare across Australia

On 26 November the Australian Commission on Safety and Quality in Health Care (ACSQHC) launched the first Australian Atlas of Healthcare Variation (see here). The Atlas highlights the variation in healthcare provision across Australia, and importantly highlights the potential overuse of procedures, medication and interventions.

Key highlights of the Atlas are as follows:

  1. Antimicrobial dispensing – significant variation across the country, with the highest rate of total antimicrobial dispensing (Campbelltown, NSW) being almost 12 times more than the area with the lowest rate (Tiwi Islands/ West Arnhem). WA stands out as being more successful than other parts of the country in keeping rates of antimicrobial dispensing relatively low. Internationally, Australia has a very high rate of antimicrobial dispensing (more than twice the rates of the Netherlands for instance)
  2. Diagnostic interventions – wide variation of particular interventions across the country (an example being colonoscopies where the highest rate was 30 times that of the lowest).
  3. Surgical interventions – wide variation across the country (for example women living in regional areas of Australia were over five times more likely to undergo a hysterectomy or endometrial ablation than those living in metropolitan areas)
  4. Interventions for mental health and psychotropic medicines – the greatest variation was seen in in dispensing of prescriptions for psychotropic medicines for those aged 17 years and under (for example the number of prescriptions for attention deficit hyperactivity disorder (ADHD) medicines in the area with the highest rate was 75 times more than in the area with the lowest rate)
  5. Opioid medicines – a wide variety of rates of prescriptions for opioids across the country (the number of prescriptions dispensed was more than 10 times higher in the area with the highest rate compared to the area with the lowest rate)
  6. Interventions for chronic diseases – reflective of the generally poorer health status of indigenous Australians, hospital admission rates for asthma, COPD, heart failure and diabetes-related amputations were markedly higher in remote areas of Australia.

What variations in healthcare provision have you seen or experienced? We would love to know.

The impact of asthma in Australia

A report recently issued by Deloitte Access Economics (commissioned by Asthma Australia and the National Asthma Council Australia) details the financial impact of asthma in Australia. The report (see here) is extremely comprehensive.

Some of the key points in the report are as follows:

  • There is estimated to be 2.4 million Australians with asthma in 2015
  • The prevalence of asthma in Australia is around 10%
  • Australia has the second highest prevalence of asthma among OECD countries – New Zealand has the highest at 14% and Korea the lowest at 1%
  • Australia’s high prevalence of asthma may be due to the variability of weather in Australia and the high prevalence of allergenic risk factors, including natural events such as thunderstorms and winds that distribute allergenic pollen, grasses and particles
  • The direct healthcare costs of asthma in Australia total $1.2 billion.

Some interesting food for thought for nurses.

Medication administration by nurses

APNA often receives enquiries around medication administration by nurses in general practice.

The difficulty in answering these questions lies in the fact that each state and territory has its own drugs and poisons legislation, with different guidelines for rural and remote areas and for certain sectors of the healthcare worker community. APNA recommends nurses check with their local authority on questions around drug and poisons.

We’re interested in your experiences. To start the discussion, we thought it would be helpful to share a typical enquiry we receive around medication administration.

Q. What should I do when a patient brings a prescription medicine dispensed from the pharmacy (e.g. a vitamin B12 injectable supplement) in to the practice for me to administer?

A. To answer this question, our discussion would address the following:

  • As with all procedures, consider what is within your individual scope of practice: what are you educated, authorised and competent to perform?
  • We normally discuss the way in which the prescribing GP might document the medication order for nursing staff in the patient’s clinical notes (i.e. this might coincide with writing the prescription or the GP may prefer to see them again on the day of administration).
  • We ask nurses to ensure the order is written and provides all of the required information, including authorisation for the nurse to administer the medication (i.e. dose, how often, pre and post follow up if required).
  • Verbal orders can be difficult to manage when there is only one nurse in the practice and should be reserved for urgent situations – discuss with your practice team how this might be managed.
  • We like to discuss the need for nurses to have a good understanding of the drugs they are administering. What are the potential side effects? Has the medication been stored appropriately prior to presentation? Is any pre-administration care required? What follow up is required? Is this a cytotoxic drug? If so, what appropriate measures need to be put in place to be able to administer this safely and within legislation in your practice?
  • We always recommend you refer to the ‘6 Rights’ of medication administration (or the 8 rights, if you prefer to include right reason and right response):
    • Right drug – check the order, medication and expiry date. If you don’t have another nurse to check the order and the medication, we recommend you check with the GP. Note that nursing students are NOT able to check medication with you.
    • Right individual/patient – use a minimum of two identifiers. Ask the patient to identify themselves by name and date of birth. Ask them for their understanding of the medication you are about to administer, and deliver medication information. If there is an alert on the patient file that there is a person with a similar name in your practice please use normal processes to provide additional checks.
    • Right dose – check the order and confirm appropriateness of the dose using a current drug reference. If necessary, calculate the dose and have another nurse or the GP calculate the dose as well.
    • Right time – check the frequency of the ordered medication. Double-check you are giving the ordered dose at the correct time. Confirm when the last dose was given. Confirm whether follow up or examination is required prior to or post medication being administered. Place a recall or reminder for next dose or follow up.
    • Right route – again, check the order and appropriateness of the route ordered. Confirm the patient can take or receive the medication by the ordered route.
    • Right documentation – document administration AFTER giving the ordered medication. Using the clinical software, you may develop ways to consistently document the medication administration which includes information about the drug, expiry date, time, route, site of injection, and any other specific information as necessary (e.g. any pathology test or observation which needs to be checked before or after giving the drug).

Have you developed an easy process in your practice to improve medication management that you would like to share? We would love to hear from you.

APNA informs Inquiry into chronic disease management and prevention in primary health care

On Thursday 1 October I appeared at the House of Representatives Standing Committee on Health’s Inquiry into Chronic Disease Prevention and Management in Primary Health Care, representing the primary health care nursing profession.

As the peak body for primary health care nurses, it was a pleasure to work with a group of our colleague nursing organisations (CATSINaM, ACMHN, MCaFHNA and ACN).

General practitioners continue to advocate their role as gatekeepers for real reform. It is time to challenge the role all healthcare professionals provide as part of a multidisciplinary team.

At APNA, our vision is to support the views of our membership to contribute to a healthier Australia and healthier communities.

Nurses at the frontline are well qualified to take an active role in primary health care as we are active in all areas of the community, the cities, the country and our islands, and we continue to develop long term relationships with the people in our care.

In my address to the Inquiry I highlighted the need to support:
–  recruitment and retention of primary health care nurses in the workforce
–  nurses transitioning into primary health care nursing
–  the nurse clinic model as a successful method of dealing with chronic and complex diseases and the coordination of care.

As your president and also an independent representative of the Primary Health Care Advisory Group, I felt well qualified and well positioned to speak on behalf of nurses in our sector and our members.

APNA is commencing work to deliver significant projects including:

>  Transition to Practice Program – which will directly support the recruitment and retention of nurses in all areas of primary health care

>  Nurse Demonstration Projects – established in multiple regions directly informed by health population needs

>  Education and Career Framework – to support the career trajectory available to primary health care nurses

>  Chronic Disease and Healthy Ageing Workshops – innovative face to face professional development for nurses in primary health care.

These important long term projects will be run in collaboration with the Department of Health to directly benefit recruitment and retention of nurses in primary health care and to support the Government’s initiative of population health driven chronic disease management and healthy ageing.

Our APNA projects promote a broader model of healthcare, providing the right care at the right time, keeping people out of hospital and caring for them on their return to their homes and communities.

The current environmental and political focus is well and truly focused on health reform. This is a time of change, challenge, and considered action and responsiveness from your peak body. APNA will be flexible and dynamic and continue to drive the agenda on your behalf. It is vital your voice is heard so we can best represent your position. Please continue to communicate your views with us at policy@apna.asn.au.

Our role has been recognised as the peak body for nurses in primary health care nurses and we are confident the Federal Government is listening and will make changes based on our submissions and direct feedback.

Kind regards,

Karen Booth

Read our full submission here.

Read the transcript of the Parliamentary Inquiry hearing here.

MBS Review: Benefiting you

Of the more than 5500 Medicare items, 70% of them have remained unchanged and unassessed since they were introduced.

The purpose of the Medicare Benefits Schedule (MBS) Review is to align the list of services funded by the Australian government with contemporary clinical practice. The Review will focus on whether patients are being offered the right service at the right time for the right reason, and whether it will provide them with a health benefit. And yes, it is aimed at enabling Medicare and our health system to sustain itself in the future, for a future population.

A broad consultation of clinicians, consumers and stakeholders has been promised, and individuals can have a say through the online consultation hub.

At APNA we believe this is a priority for the primary health care sector, our members and the Australian public. Primary health care nurses are in the perfect position to ensure we are supporting the delivery of modern, patient-focused care.

As your President, I encourage you to stay active and engaged in the ongoing review of the MBS.

The increase in public health spending is in proportion the rising costs of chronic disease and an ageing population – two areas APNA is heavily focused on – and this will continue to swell if we fail to review regularly to test the response against the demand of the Australian population health needs.

Investing in primary health care and prevention is the smart fiscal move, to keep people well and out of hospital.

Hear the reasoning behind the Review from Chair Professor Bruce Robinson.

And Health Minister Sussan Ley writes It’s time to fix our healthcare system for doctors and patients.

Removal of healthy kids check from MBS

From 1 November 2015, Medicare benefits for the pre-school healthy kids check (including the nurse item #10986) will no longer be available. See here for the MBS notification.

The Australian Government has cited a lack of evidence around the current system providing a higher quality service and the increased annual cost of delivering pre-school health checks as factors behind its decision to remove the healthy kids check MBS items.

The four year old health check remains a recommended child health assessment, which can still be undertaken in general practice settings using time and complexity based MBS items #23, #36, #44 (and the Aboriginal and Torres Strait Islander health assessment item #715). The health checks can also be undertaken by State and Territory funded infant health clinics, where available.

With these changes in mind there is debate around whether the rebates for these consults accurately reflect the work required to undertake a comprehensive childhood health assessment or support the non face-to-face work undertaken outside of the consultation.

  • Do you believe there will be a change in your health assessment rates for children in your area as a result of the Government’s decision?

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