Inside this issue

In this issue, we celebrate one year of the Critical Care Clinical Network (CCCN), provide QI project updates, profile the Duckett review and Better Safer Care Victoria and pass on updates from our subcommittees. This month we visited the ICU team at Albury Wodonga Health and we are pleased to bring you latest nutritional research.

Upcoming CCCN events • 25 October – CCCN Steering Committee

• 26 October – Albury Wodonga Health ICU visit

• 28 October – Austin Health MET QI project site visit

• 24 November – Latrobe Regional Hospital ICU visit

• 30 November – Workshop 3 QI MET projects

Celebrating one year of the CCCN steering committee The CCCN steering committee has reached its first-year in operation and in that time the network has achieved some great milestones: an inaugural statewide forum, developed the 2016–17 work plan, launched the CCCN website, visited 50 per cent of units (since February 2016), established five subcommittees and begun various quality improvement projects. The steering committee has provided leadership and guided the network to ensure that critical care is positioned for success.

Critical Care Clinical Network newsletter, October/November 2016

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Duckett review: Better Safer Care Victoria On 14 October the Minister for Health and the Secretary for Health released the Duckett review of the department’s quality and safety governance. In this review 179 recommendations were made to the department to improve governance and responsiveness to quality and safety issues. This will have an impact on each clinical network including the CCCN.

The full review is available via this link:

https://www2.health.vic.gov.au/hospitals-and-health-services/quality-safety-service/hospital-safety-and-quality-review

In response to one of the Duckett review’s recommendations, head of unit obstetrics at Monash Health, Professor Euan Wallace, will begin as CEO of the newly created Office for Safety and Quality Improvement (OSQI) in January 2017. It is anticipated that Safer Care Victoria, a part of OSQI, will also start in early 2017. A summary of the Duckett review is available and attached to the email that accompanies this newsletter.

QI project updates

Inotrope and vasopressin standard protocols

Melbourne Health senior pharmacists Robyn Ingram and Melissa Ankravs are leading a coordinated CCCN-sponsored project to standardise protocols for intensive care units (ICUs). This work will help support clinicians, especially pharmacists, in regional ICU facilities to have access to evidence-based protocols. Currently 10 ICU pharmacists are helping to develop the protocols and, once completed and ratified, these will be centrally available.

Review of PROMPT ICU guidelines Barwon Health intensive care specialist Charlie Cork is identifying the extent to which significant practice guidelines are available to those working in the 12 Victorian ICUs that use the PROMPT document sharing portal. The recommendations included propofol, tracheostomy management, central line management, withholding treatment, asthma management and sedation in non-intubated patients. The findings demonstrated variation across the 12 ICUs and was presented to the CCCN steering committee.

MET/rapid response

Teams are looking forward to the site visit to Austin Health on Friday 28 October and are keen to gain more insights into ways to improve their MET system. Daryl Jones, Carmel Taylor, Maurice Leguen, Sam Radford and Annabel Milonis shared their journey to more engaged units, robust systems, feeding back data to units and education for MET responders. The session will also be offered via webinar for the participating ICUs who cannot make the visit.

Professor Euan Wallace newly appointed CEO of Safer Care Victoria

Subcommittee updates The network has five subcommittees that are working to determine what critical care requirements are in the areas of consumer experience, monitoring (quality and flow), standardised guidelines, MET/rapid response and workforce and culture.

To date all five have completed their first meeting, with each group working through their problem statement and aim. It is anticipated that by February 2017 each group will have recommendations and, where possible, outcomes for the CCCN steering committee.

There are spaces open for ICU staff to join a subcommittee group. Current membership includes:

Priority 1: Consumer experience

Priority 2: Clinical dashboard

Priority 6: Improved flow

Priority 3: Standardised guidelines

Barbara Rozenes David Charlesworth Jill Lamb-Jenkins

Nerina Harley Yahya Shehabi Melissa Ankravs

Kimberley Haines Marcus Kennedy Kate Fetterplace

Michelle Spence Helen McKee Lina Briek

Deb Sage Graeme Hart Nicole Keogh

John Santamaria Tim Leong

Sue O’Sullivan

Priority 4: MET/rapid response Priority 5: Workforce and culture

Priority 6: Improved flow has been merged with priority 2

Warwick Butt Alison Walker

Melissa Richards-West Craig French

Daryl Jones Donna Robertson

Sam Radford Melanie White

Carol McKenzie

Latest research (provided by Eastern Health ICU clinical dietitian Lina Briek) The impact of diarrhoea on a patient’s overall recovery and nutrition status is underappreciated. Diarrhoea in critically ill patients can have a prevalence of up to 95 per cent. Besides the immediate fluid and electrolyte imbalances, severe diarrhoea can also result in risk of skin breakdown and pressure injuries. A review published a month ago (cited below) details possible causes of diarrhoea in critically ill patients and how a deeper understanding of enteral formula compositions and gut function can positively influence bowel function and nutrition.

Source: Brito-Ashurst I, Preiser J 2016, ‘Diarrhoea in critically ill patients: the role of enteral feeding’, Journal of Parenteral and Enteral Nutrition, vol. 40, no. 7, pp. 913–923.

A new term has recently been introduced into the ICU nutrition world – ‘nutrition rehabilitation’. In the article cited below, Massanet and colleagues explore the physiological, anatomical, psychological and environmental factors that influence the start of a patient’s nutrition journey in the ICU. If identified and managed early, the authors argue that restoration and maintenance of homeostasis after severe injury is more likely to occur at a quicker pace. With interesting graphics and practical recommendations, this is a great read to put nutrition into perspective.

Source: Massanet P et al. 2015, ‘Nutrition rehabilitation in the intensive care unit’, Journal of Parenteral and Enteral Nutrition, vol. 39, no. 4, pp. 391–400.

Food for thought Did you know that propofol is a lipid solution containing 1.1 kcal/mL, which is more than what full-fat milk provides at 0.62 kcal/mL?

Source: Mike L 2010, ‘Propofol-related infusion syndrome’, Nutrition Issues in Gastroenterology, Series #81, Practical Gastroenterology, pp. 16–19.

Site visits On Wednesday 26 October I visited the ICU team at Albury Wodonga Health to learn more about the innovative, challenging and resilience of a regional unit. The team has made some great progress over the years and continue to strive for excellence. It was also great to spend time with clinical nurse educator Holly Clarke on their QI MET project.

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Critical care consulting from 15,000 km away Sydney’s Macquarie University is connecting critically ill patients in the United States to night-time carers in Australia.

The Daily Telegraph recently reported that US medical staff, based here, are involved in a pilot study to that is providing remote overnight care for patients some 15,000 km away Atlanta, Georgia during the Australian daytime.

Using remote technologies, the Sydney-based clinicians actively monitor their US-based patient’s heart rate, oxygen saturation, blood pressure and other vitals. If they detect any change in the patient’s condition, they immediately alert night duty staff by the patient’s bedside in Atlanta.

For Victoria, while remote technologies could never replace direct patient care, schemes like this could greatly improve patient outcomes in rural areas, while also saving time and money.

Read the full article online at <http://www.dailytelegraph.com.au/news/nsw/medical-technology-allows-doctors-in-australia-to-monitor-health-of-patients-in-atlanta-georgia/news-story/b4e08f5a460ddbdf84e53854c5f5b71f>.

Sector news • David Charlesworth recently resigned as the network chair to pursue private practice at Peninsula Health. David

has made a significant contribution to the network over the past two years.

• Melbourne Private nurse unit manager Simone Murphy is moving on and Fiona Williams will be acting from 29 October.

Contact us Monica Holdsworth, Program Manager

Monica.holdsworth@dhhs.vic.gov.au or criticalcare@dhhs.vic.gov.au

Albury Wodonga Health ICU NUM Helen McKee and Director Charles Mashonganyika

Phone: 9096 5621

To receive this publication in an accessible format phone 9096 5621, using the National Relay Service 13 36 77 if required, or email <criticalcare.clinicalnetwork@dhhs.vic.gov.au>.

Authorised and published by the Victorian Government, 1 Treasury Place, Melbourne.

© State of Victoria, Department of Health and Human Services, October 2016

Available at <www2.health.vic.gov.au/hospitals-and-health-services/quality-safety-service/clinical-networks/clinical-network-critical-care>.