Mental health

PHN Discussion Paper #2 – Mental Health notes a key role for Primary Health Networks in realising effective and lasting improvement in mental health outcomes, through adopting a person-centred approach in service design and enabling integration across service providers in local health systems. The 2014 National Mental Health Commission report noted that “They (PHNs) can work in partnership and apply targeted, value-for-money interventions across the whole continuum of mental wellbeing and ill-health to meet the needs of their communities.” Notwithstanding this, there are challenges and barriers to be resolved in order to effect meaningful and sustainable improvement in mental health outcomes and health system performance.  Further exploration of the challenges and barriers is warranted in order to enable PHNs to deliver on their objectives.&nbsp

Primary Health Network critical success factors

The Primary Health Network (PHN) program has the potential to make a significant positive difference in health outcomes for all Australians. PHN Discussion Paper #1 - Primary Health Network Critical Success Factors reflects on the lessons learnt from previous organised primary health care models in Australia, considers the factors that are essential for PHNs to create true public value, and identifies some key issues which PHNs and the Government need to address to ensure that PHNs are given every opportunity to succeed

Catholic Hospital Ethics

This is the final Report of the Commission on Ethical and Religious Directives for Catholic Hospitals - a study commission established by the Catholic Theological Society of America in June, 1971. Publication of the Report, which is not an official position of the CTSA, was accepted by the CTSA Board of Directors on September 1, 1972. This study is not presented as the final word on codes of ethics for Catholic hospitals, but is proposed as a moral theological rationale for understanding the purposes and functions of a set of ethical directives in Catholic hospitals, and as a basis for dialogue, reresearch, and the revision and interpretation of policies. Reactions to the Report are welcomed. As the list at the end of the Report indicates, it is the work of an eminent group of scholars with special insights into medicine and ethics; they in turn consulted others of equal competence in their fields. Since the directives were approved by the bishops in November, 1971, a number of diocesan meetings have been held to discuss the code. As more meetings are convened, the Linacre hopes to keep its readers up-to-date on the resulting dialogue

Pathways to reform - health funding and the reform of Federation

INTRODUCTION The Centre for Health Economics Research and Evaluation (CHERE) has been commissioned by the Australian Healthcare and Hospitals Association (AHHA) to write two papers as part of the Association’s series on Pathways to Reform. The series will contribute to public debate during the development of the Australian Government’s White Papers on Reform of the Federation, and Reform of Australia’s tax system. This is one of two papers produced by CHERE – the other considers policy options for the new Primary Health Networks (PHNs). This paper examines the financing of Australia’s health care system. It describes the sources of revenue that pay for health care services and products. In doing so, the paper discusses the extent to which Australia’s health care funding arrangements support the efficient and equitable delivery of health care services. In particular, we examine these issues in light of the changing demographic nature of the Australian population which will have substantive implications for the financing, demand and delivery of health care services in the future. The paper seeks to address the question of how (rather than how much) we raise our health care revenue and whether the sourcing of revenue has an impact on the performance of the health system

Neonatology Clinical Guidelines

Cleft lip and palate results from failure of normal orofacial development in weeks 6 to 12 of embryonic life. The incidence is 1:1000 Caucasian births and higher in Asian populations. It is more common in males and can be associated with other anomalies. All infants born with a cleft lip and palate should be assessed within the first 48 to 72 hours of life. The aim of treatment is to: • Promote normal facial appearance with the assistance of pre-surgical orthopaedic treatment. Infants will be assessed and if required fitted with a plate and bonnet and strapping. Surgical repair of the lip occurs at approximately 3 months and repair of the palate at 9 months. • Educate parents to specific care requirements of the plate, strapping and feeding to ensure optimal growth and development • Admission is usually 4 to 5 days and parents should be resident with the infant for that time. TRANSFER Contact the Cleft Clinic Coordinator on 9340 8573 and Ward 6B (9340 8448) regarding plan for transfer. Assessment of the cleft will only be made Monday to Friday. Admission is to educate parents about specific care of the infant so infants can generally stay with their mother at referring hospital over the weekend or until the mother is well enough to accompany the infant, usually at 24 to 48 hours of age. If the infant has a cleft lip only and is feeding well and gaining weight, it may not need to be transferred, but the Cleft Co-ordinator must still be notified (9340 8573) to organise assessment and follow up. Notify the Cleft Coordinator on admission to 6B to enable coordination of the Cleft Team: Plastic Surgeon, Dentist and CleftPals support group (at parents ’ request)

CVAD’S ARE INDICATIONS FOR:

Infant’s with difficult peripheral IV access To provide long-term venous access for parenteral nutrition (PN). To provide a safer route of administration for hyperosmolar fluids / drugs, less risk of extravasation. For the concurrent infusions of medications, inotropes / locally toxic solutions and concentrated glucose solutions. Non tunnelled, peripherally (percutaneously) inserted central venous catheters (PICCs) are easier to maintain than short peripheral catheters, with less frequent site rotations, infiltration or phlebitis noted. They have fewer mechanical complications such as thrombosis or extravasations. Multilumen CVADs permit the concurrent administration of various fluids, medications and haemodynamic monitoring among critically ill infants. Multilumen catheters are associated with an increased risk of infection because of increased trauma at the insertion site and multiple ports increase the frequency of CVAD manipulation. Tunnelled catheters provide vascular access to patients requiring prolonged intravenou

From Ovid to Covid: The metamorphosis of Advanced Decisions to Refuse Treatment into a safeguarding issue

Purpose This paper aims to examine Advance Decisions to Refuse Treatment (ADRTs) in the context of the COVID-19 pandemic. We consider the development of ADRTs, the lack of take up and confusion among the general public, clinicians and health and social care staff. Design/methodology/approach The paper is a conceptual piece that reflects on ADRTs in the particular context of COVID-19. It considers professional concerns and pronouncements on ADRTs. Findings ADRTs have a low take up currently. There is misunderstanding among public and professionals. There is a need for raising awareness, developing practice and a need to allay fears of misuse and abuse of ADRTs in clinical, health and social care settings. Originality This paper is original in considering ADRTs as a safeguarding issue from two perspectives: that of the person making the ADRT and being confident in respect for the decisions made, and of clinicians and other professionals being reflexively aware of the need to accept advance decisions and not acting according to unconscious biases in times of crisis. Practical implications We make recommendations that reflexive training and awareness becomes the norm in health and social care, that reform of ADRTs is undertaken to prevent misunderstandings and that the person becomes central in all decision-making processes

Exploring key risks in the medical admissions process

AbstractThis study investigated the hospital admission process in relation to two areas associated with known patient related risks, venous thromboembolism (VTE) risk assessment and medicines reconciliation in an English teaching hospital Acute Medical Unit (AMU). National guidance was available at the time of the study for both of these aspects of care. Government targets with associated financial penalties were set for VTE risk assessment in 2010, there were no similar targets for medicines reconciliation.NHS ethics approval was granted. A novel mixed methodology was used involving direct observations of the patient admissions process, interviews with staff and an audit of case notes. Data were collected over four one-week periods between 2009 and 2011, 36 staff were observed admitting 71 patients, 44 staff were interviewed (25 VTE, 19 medicines reconciliation) and 930 sets of case notes were audited.The observations showed that at the start of the study guidance was rarely followed for both VTE risk assessment and medicines reconciliation. Staff were unaware of its existence and ignorant of the both the associated risks and the level of guideline compliance within the organisation. There were low levels of compliance with local and national VTE guidance until national financial sanctions were introduced when significant increases in the rates of both VTE risk assessment and appropriate prescribing of prophylaxis were seen, however inappropriate prescribing also rose. Observations showed poor medication history taking and prescribing practices, during the study the proportion of items with a prescribing error increased, however the interviews showed that staff did know how to establish an accurate medication history and were aware of the potential problems.A national financial sanction was associated with the effective implementation of VTE guidance however it remains to be seen whether standards can be maintained in a complex high pressure environment. Organisations must also be aware of the potential for unexpected adverse outcomes. Prescribing errors may be reduced if a mechanism can be found to ensure that theoretical knowledge is routinely translated into practice, however greater pharmacy involvement before the admission prescription is written should also be considered