Innovation Support Scholarship Winners 2011

 

Evaluating the Integration of Genetic Counselling services into Multidisciplinary Clinical Teams

Team Leader: Dr Anne Ronan Clinical Lead General Service, Hunter Genetics

As genetic knowledge improves and genetic testing becomes available for more conditions, more clinical services will be in the position to offer genetic testing for their clients. Genetic testing can assist clinical management and provide risk information to the extended family. Genetic Counsellors have strong clinical and counselling skills that allow them to support and educate patients during the testing process and co-ordinate cascade testing for family members.

A Genetic Counsellor already functions within the Paediatric Respiratory Team providing support, education and co-ordinating genetic testing for families with a child diagnosed with Cystic Fibrosis or at increased risk due to results of Newborn Screening for Cystic Fibrosis. Similar services would be helpful to patients within other paediatrics services such as the Baby Hearing Clinic as well as within adult cardiac and neurology clinics.

This project trialed the introduction of Genetic Counsellor Led services to the Paediatric Baby Hearing Clinic and evaluated acceptance of this service by patients and fellow health professionals. Feedback from this trial will be informative in the implementation of similar services with other health teams.

Eating Matters: Protected Mealtimes and Help with Eating

Team Leader: Allison Fraser, Research and Development Dietitian

Malnutrition is a common condition at John Hunter Hospital (prevalence 36%). However, in common with international and Australian experience, malnutrition is poorly recognised and therefore, not treated; as well NHMRC evidence based recommendation A indicates that nutritional status deteriorates during the course of hospital admission.

Aim: To bring best practice patient centred nutrition care by the whole multidisciplinary team to two medical wards at John Hunter Hospital (wards J3 and F2).  Specifically, the project aimed to build capacity using an interdisciplinary approach to:

  1. support patient nutritional status by early problem identification and inpatient management including discharge planning; and

  2. prevent decline in patient nutritional status using recognised strategies to improve mealtime environment such as protected mealtimes and targeted feeding assistance. 

 

Allison_Frazer[1].jpg          Alison Fraser

 

 

Scott_Nightengale[1].jpgDr Scott Nightingale, Michael DiRienzo, Deirdre Burgess and Liz Notaras

 

​Enhancing uptake and effectiveness of enteral nutritional therapy in children and adolescents with active Crohn’s disease

Team Leader: Dr Scott Nightingale Staff Specialist Paediatric Gastroenterologist, Kaleidoscope

Crohn’s disease (CD) is the commonest form of inflammatory bowel disease (IBD) in childhood, and is a chronic (often lifelong) disease characterised by gastrointestinal inflammation of unknown cause.  Approximately one quarter of all people who develop CD will do so during childhood and adolescence.  CD in childhood is often more aggressive than that in adults and adversely affects normal growth and development of affected children.  Furthermore, there is often a significant psychological impact for both the child/adolescent and their families, affecting family and peer relationships, quality of life and subsequently, adherence to therapy. 

There is strong evidence from randomised controlled trials that exclusive enteral nutritional therapy (EEN, ie taking only a diet of a low-residue formula and no other foods) for a period of around 2 months is as effective as therapy with corticosteroid drugs in achieving disease remission in children with active Crohn's disease1.  Additional benefits of EEN are improvement in growth parameters, nutritional status, and avoidance of the significant toxicity associated with corticosteroid drugs.  Despite the equivalent efficacy and additional benefits, uptake and completion of EEN therapy is low in paediatric gastroenterology units worldwide.

Aim: To develop and implement an effective, sustainable multidisciplinary approach to enhancing uptake and effectiveness of EEN therapy in children and adolescents with active CD within our service.  We anticipated that this would improve a range of multidimensional outcomes for these children and adolescents as well as their families.

J2 Eating Disorder Inpatient Program

Team Leader: Anjanette Casey Acting HNE AHS Eating Disorder Co-ordinator

Kaleidoscope and Child and Adolescent Mental Health Services (CAMHSs) are collaborated to implement a pilot integrated medical/mental health model of care, based on the adolescent J2 ward of John Hunter Children’s Hospital. This is commenced in Feb 2011. Previous to this, treatment was been segregated into either medical or psychiatric domains (either being treated in J2 with minimal psychiatric care or in NEXUS with minimal medical involvement), with neither receiving care in line with best practice. There was no facility to provide shared care of these clients in a way that recognised the importance of both their medical and psychiatric needs in a co-ordinated consistent way.

Aim: To comprehensively evaluate the effectiveness of a regionally-based, integrated medical/mental health pilot adolescent inpatient eating disorders program. Long term changes the program aimed to work towards included:

  • improved outcome for patients

  • improved satisfaction from patients and parents/carers of adolescents with an eating disorder

  • improved satisfaction and confidence from staff who work in the J2 eating disorder program

  • improved communication and satisfaction from those who refer clients to the program (including GPs and other service providers)

Considering the high prevalence of eating disorders and the associated cost to patients, their families and to the health system, exploration of effective ways of treating patients with an eating disorder in regional and rural settings is important. The pilot program may prove to be a useful model of care for inpatient treatment in other regional and rural areas in Australia.

 

A_Casey[1].jpgDr Dinesh Aryia, Anjanette Casey, Michael DiRienzo and Dr Bruce Whitehead

 

 

Too_Many_Beers[1].jpg 

Bob Pearce, Sheridan Briggs, Dr Chris Jenkins, Dr Carolyn Hullick, Scott McLachlan

Clinical pharmacy identification and intervention for medication issues for community dwelling older patients in the Emergency Department. “Too many Beers”

Team Leader: Dr Christopher Jenkins, Staff Specialist, Division of Emergency Medicine, John Hunter Hospital

Elderly patients may present to the Emergency Department (ED) for a non medication related problem. Whilst the presentation is not directly related to medication, medication may be a factor. Falls, pain and constipation are examples where medication contributes. The Pharmacist was only in the ED one day per week. It was been identified that intensive Pharmacist review and intervention would decrease morbidity and mortality related to medications by reducing and rationalizing medication use. By increasing the amount of Pharmacist time spent in the ED and targeting the resource based on screening, we aimed to close this gap.

Aim: To improve the long term outcomes of patients presenting to the Emergency Department by reducing medication misadventure using the services of an experienced Clinical Pharmacist.

Clinical pharmacist review: A randomised controlled trial

 

Implementation of an Interdisciplinary Functional Circuit Group on the Rehabilitation Unit at The Maitland Hospital

Team Leader: Kate Brown Occupational Therapist TMH Rehabilitation Unit

Patients in the Rehabilitation Unit at The Maitland Hospital received one-to-one therapy sessions to work towards achieving their rehabilitation goals.

Aim: To increase the amount and frequency of therapy received by patients on the Rehabilitation Unit by running a regular functional circuit group. This therapy group provided patients with the opportunity to engage in goal-directed functional task practice, facilitated by members of the multidisciplinary rehabilitation team including Nursing, Occupational Therapy & Physiotherapy.

Kate_Brown[1].jpgRenae Galvin, Michael DiRienzo and Kate Brown

Congratulations to all the scholarship winners for 2011