1. AGED CARE COLLABORATIVE August-December 2008

2. Participants Cally Meynell (DON Hibiscus House Nursing Centre) Dr Ali Kalahdooz Amanda Heyer (Speech Pathologist)

3. Plan-Do-Study-Act 1 Change Principle  Establish a system for creating, validating and updating a register of patients  Be systematic and proactive in managing care Description  To determine whether or not recommendations get followed within the RACF and to assist this by improving speed of transfer of information from progress note documentation to care plan and dietary profile. Plan  Learn to use the link in the computer system that transfers information from progress note onto care plan and dietary profile. To do an audit at the lunch time meal 1 x week for a period of 1 month.

4. Plan-Do-Study-Act 1 cont’d Do  Computer system learnt and utilitised after clinical assessment of resident in Hibisicus House. Procedure for computer documentation put into a flow chart. Cally Meynell conducted the lunchtime audits. Study  Being able to access the link to the care plan and dietary profile means that this change of dietary information is actioned at the time of assessment and there is no delay in transfer of this communication.  Cally found that the key issues when doing the audits were that the thickened fluids were sometimes only one consistency of thick rather than the 3 different levels and that there was some confusion between the staff members with terminology e.g. soft vs vitamised vs minced moist. Act  Full colour charts have been posted up in the kitchenettes next to dining room and in main kitchen. Continue to audit once a month.Full page instructions on mixing thickened fluid using a jug have been put in the main kitchen.

5. Plan-Do-Study-Act 2 Change Principle  Be systematic and proactive in managing care.  Adopt a multi-skilled, multi-agency approach to ensure effective coordination of care of patients. Description  To liase with RACF and GP to ensure item 731’s occur in a timely fashion. Plan  To create a list of conditions pertaining to Speech Pathology that would warrant an item 731 referral as a quick reference for nursing staff and doctors.

6. Plan-Do-Study-Act 2 cont’d Do  List was put in doctor and nurses communication book at Hibiscus House. Study  There was one new item 731 generated in this reporting period. This was following a call from one of the GP’s servicing the facility who was currently not using item 731’s. Act  Continued monitoring of number of item 731’s generated and an electronic version of the list made available for all the other participant groups in the collaborative to use at their facility.

7. List of appropriate referral for Speech Pathology services using item 731 Acute CVA for swallowing (<6 months post with early discharge from rehab) CVA with dysphasia (expressive and receptive language difficulties) Neurological condition resulting in speech/language difficulties e.g.tumour, progressive aphasia Parkinson’s- requiring assessment and/or treatment of dysarthria (slurring), dysphonia (voice), and dysphagia (swallowing). PEG removal – changing someone from PEG fed to oral fed Communication devices e.g. for Motor Neurone Disease, Multiple Sclerosis or similar degenerative condition which renders a person unable to communicate especially in the presence of good cognition.

8. Plan-Do-Study-Act 3 Change Principle  Involve patients in developing and delivering their care.  Adopt a multi-skilled, multi-agency approach to ensure effective coordination of care of patients. Description  To create a DVD of oromotor exercises for residents to do in their daily exercises to maintain swallowing and speech functions. Plan  To develop a DVD and distribute this to Diversional Therapy staff at Hibiscus House and Villa Serena to implement, then have residents complete a survey on DVD.

9. Plan-Do-Study-Act 3 cont’d Do  DVD was presented 4x week over a 3 week period at Hibiscus House. It was run once at Villa Serena as they had troubles finding time in their activities calendar in November. Study  5 participants filled in feedback forms from Villa Serena and 9 from Hibiscus House. Exercises easy to follow = 7SA, 3A, 4N. Exercises increased awareness of lip and tongue movements = 4SA, 6A, 3N, 1D. Will you continue to do exercises = 6SA, 5A, 3N. Was this an effective way of accessing Speech Pathology services = 4SA, 7A, 3N. Act  DVD’s may be an effective way for resident’s to access general Speech Pathology information and would be a useful option for education.

10. Overall impression of Collaborative Great networking opportunity. As a team you get more follow through of each plan. Challenged me to create resources that ordinarily I would never have thought I had the time to do. Increased awareness of Speech Pathology services in facility and with Doctors I worked with.