NORTH SHORE HOSPITAL News
Planning to End Well
North Shore Hospital intensive care nurse Peter Groom knows what his parents want at the end of their lives.
Recently they filled out advance care plans, detailing when they want medical intervention, when they just want to be made comfortable and where they would prefer to die.
“They were very keen to get what they think down,” says Peter.
Peter asked them to complete the plans after training in advance care planning.
Advance care planning helps patients to record their wishes about not just what they want to happen once they have died, but also while they are dying.
Peter often sees extremely ill patients who can’t talk for themselves. “We have no way of asking, ‘Is this what you want? Do you want aggressive treatment?’”
Advance care plan training gives health professionals the skills to have those “difficult conversations” with patients while they still can.
“If you tell them they are going to deteriorate, they won’t fall apart. That’s what they want to know. You are giving them choice.”
This year Peter had just this conversation with one patient who had been admitted to intensive care several times.
“I spoke to him to find out what he wanted, and it wasn’t to come to hospital. But the nursing home was terrified he was going to pass away.
“The patient wanted to be in the rest home. He wanted all the therapy the rest home could offer, but if that didn’t work, he accepted that entirely.”
Once the patient recorded his advance care plan, everyone was relieved, says Peter. “The nurses and the healthcare staff at the rest home felt supported that they didn’t have to ring the ambulance but could ring the GP. The GP knew exactly what the patient wanted, which was clearly documented.”
And the patient? “Actually, he said to me ‘I won’t be seeing you again!’”
Lakeview wows award judges
North Shore Hospital’s new Lakeview extension has won an important national architectural award – the Property Council’s special purpose property award.
At the awards ceremony, Lakeview beat buildings such as the Viaduct Events Centre and IBM’s Auckland data centre.
Judges said the $53.5 million, 4923sq m building created “an integrated and exceptionally efficient emergency care centre”. They also said it “ensured significant improvement to service delivery and patient satisfaction”.
In submitting Lakeview for the award, Klein Architects emphasised its green features, which include collecting rainwater and using heat from the chillers to heat water.
Building Lakeview began in 2009. It was fully opened last November.
Leading a life-saving revolution
Waitemata DHB is leading the way in a life-saving revolution.
Our intensive care and high-dependency units have gone more than 160 days without one case of the often fatal bloodstream infection central line-associated bacteraemia, or CLAB. We’re among the first DHBs in New Zealand to do so.
And it’s because of a checklist, a ready-assembled equipment pack, teamwork and attention to detail.
“I’m really proud of the way the ICU team has embraced this,” says ICU consultant Ywain Lawrey.
Central lines are catheters that go in large veins of seriously ill patients to deliver life-saving medicines, manage fluid levels and aid blood monitoring. But they often cause CLAB, which kills up to half the patients who get it.
However, it was accepted as an “unfortunate consequence of what we do”, says Ywain – until overseas hospitals showed they could cut rates by up to 95% by strictly enforcing best practice.
“One of the biggest barriers to doing this consistently was not having all the equipment you needed at the start of the procedure,” says Ywain.
Last year, Waitemata and Counties Manukau DHBs put together a central line pack, including gown, hat, mask, gloves, antiseptics and everything needed to insert a central line. The Ministry of Health has adopted that pack as the national standard.
Waitemata’s ICU also developed checklists – every time doctors insert central lines, a nurse observes, making sure they follow the protocol.
“A lot of the focus has been on accepting that checklists have a role in medicine, and in empowering nurses to ensure the doctors are doing this – and stop them if they are not,” says Ywain.
It has, says consultant physician Hasan Bhally, been a real team effort.
“If we can prevent one case of CLAB by putting the right processes in place, it’s absolutely a worthwhile thing.”
For more information visit our website www.waitematadhb.govt.nz