The Lone Ranger – Maintaining staff safety

Prepared by Claire Blackburn

The Sydney Childrens Hospital Network Randwick and Westmead

SCHN CAPAC

The SCHN: who are we

• In July 2010 the Sydney Childrens Hospital Network (SCHN) was established.

• This joined The Childrens Hospital at Westmead and the Sydney Childrens Hospital (Randwick) together.

• The Childrens Hospital at Westmead is located West of Sydney Metro and the Sydney Childrens Hospital is located South East of Sydney Metro.

• The SCHN has both paediatric Tertiary and Quaternary facilities.

Comparison of Australia and New Zealand Children’s Health Services

Organisation Separations Bed Days ED Presentations ED Admissions

Sydney Children's Hospitals Network 44497 136790 85162 19577

Royal Children's Hospital, Vic. 34070 98735 67573 13272

Starship Children's Hospital, NZ 27629 81626 31861 16785

Royal Children's Hospital, Qld. 20668 48435 28989 6817

Child Youth & Women's Health Service, SA 18632 51431 42638 9472

Princess Margaret Hospital, WA 16629 45281 61283 8806

John Hunter Children's Hospital, NSW 7907 27197 18378 5035

Source: Data drawn from Women’s and Children’s Hospitals Australasia Reporting 2011/2012

Definition

Community Acute and Post Acute Care (CAPAC) services including Hospital in the Home (HITH) are defined as acute hospital substitution and/or hospital avoidance services.

This means if this service wasn’t offered the child would be

admitted to or stay in hospital. Ongoing community nursing is excluded.

The aim is to provide multidisciplinary care to allow the

patient to be managed in their own home.

CAPAC: Then

• 2008 The Children’s Hospital at Westmead opened CAPAC. On a 12 month trial

• Initial models were CF and Eczema

• Established with a Nursing Unit Manager, 1 FTE Physiotherapist and 1.6 FTE Registered nurses

• The evaluation after 12 months highlighted high levels of satisfaction

• Cost equal to inpatient services

• But families needed flexibility with visiting times including afterhours and models of care needed to expand

CAPAC: Now

• Network service, one management structure including a NUM and part time Staff Specialist

• Located within both hospitals

• Dedicated Models of care, using the hospital avoidance or substitution

• Treating paediatric patients who live with a hours drive of either hospital

Service Description

SCH CHW

RN/CNS 1.47 FTE RN/CNS 4.2 FTE

Physio 1.32 FTE

CNE 0.30 FTE

Admin 1.0 FTE

Staff Spec 0.2 FTE

Operational hours Virtual Beds SCH 0830-1700 2

CHW 0730-2130 8

Background to project

• In 2010 the CAPAC service was allocated enhancing funding.

• The aim was to increase the HITH activity.

• For many of our families evening visits would suit them.

The Project!!

Let the journey begin

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Aim

To have a system that can help protect staff working alone outside the hospital, especially after dark or on weekends/Public holidays

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Nature and extent of the problem

The plan to extend CAPAC service hours potentially increased the risk to staff who are alone out in the community after dark and on weekends.

With more staff joining the team and the department’s hours being extended, safety risks were significantly increasing.

Staff reported feeling unsafe going out into the community into potentially risky situations out-of-hours without a system in place, which could closely monitor their safety.

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The project meets a major objective of any health care

system, which is to ensure its staff members’ safety at all times. The system reduces the risk of harm to staff by having early notification of potentially risky situations and promotes a safer environment for staff 24 hours a day.

Strategic importance

Planning & implementing solutions

Staff identified risk

factors

CHW managers busy

Difficulty in contacting

hospital

Policy allows for no

supervision

Entering homes at

night

More family members in

homes

CAPAC extending

hours

Delays in getting help if in a

potential risk

environment

Some suburbs more

unsafe than others

First visit after dark

Seen sitting in car with

light on

Uniforms identify us as

hospital staff

Mapping ideas, risks and current issues with procedure

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Planning & implementing solutions • Develop the team and gain support from CHW Program Chair and

Executives

• Project Sponsor Dr Bruce Lord Program Chair

• Monthly reports to sponsor and brief to the executive

• Review hospital policy on home visiting

• Survey staff pre and post implementation

• Seek alternative solutions to monitor staff safety

• Network with other community services to discuss management of staff safety

• Educate staff on new system

• Trial new system

• Evaluate changes

• Report to the executive

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Outcomes & evaluation Project Plan, implementation and evaluation

Education

How to

monitor staff Trial &

outcomes

Evaluation Policy review

Review of ways to monitor

and manage staff safety.

Other community services

contacted and information

shared.

Review included double

staff visiting, no first visits

after hours, use of security

staff, use of a computer

operated system.

Policy reviewed and updated to

incorporate the changes required for

community visits out of hours.

Policy title changed to risk

management, rather than home

visiting.

All staff in CAPAC have read and

agree to practice according to the

policy

Staff in-serviced on Lone Worker Program.

Education on monitoring own safety and

changes to policy.

Two week trial of lone worker system.

Evaluation by CAPAC staff was very positive all staff felt

more safe when out visiting. The system was easy to use and

cost effective.

Cost was only $1 per day of use.

Staff surveyed

Marked increase in staff feeling safe.

Efficiency of system

Time saving

Staff satisfaction increase

Cost effective

Communication with staff

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Sustaining change • The Lone Worker Service has now been incorporated into

the CAPAC orientation program and all new staff are appropriately educated before using the system for the first time

• Staff have been using the Lone Worker Service for all shifts since 2010.

• The guidelines for using the speed dial feature are in the folder taken out on home visits and the response centre procedure is very user-friendly.

• Staff are all conscious of the need for safety, especially as they go into homes alone at all times of the day and evening.

Lessons learned

• That staff safety can be improved when providing care in the community.

• The importance as health managers to act on the concerns of staff before problems occur.

• When developing a service think of all potential risks and embrace the opportunities that present themselves.

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Transferability and Future Scope

• This program could be implemented to promote staff safety in other hospital departments and services where staff leave the hospital during their working hours or work in isolation.

• The Lone Worker is a cost effective method of monitoring staff safety outside of the hospital environment.

Claire Blackburn

Nursing Unit Manager|SCHN CAPAC- Hospital in the Home - Randwick & Westmead

Email: Claire.Blackburn@health.nsw.gov.au

Tel: 02 9845 3857

Mobile: 0409 830 213