5 March 2010

A new Clinical Advisory Panel (CAP) at Pact is a place for clinicians and other key staff to discuss issues facing Pact from a clinical perspective.

Pact CEO Louise Carr asked clinician educator Kate Wilsher to set up CAP last year, following the Deloitte review of the organisation. The aim is to take advantage of the knowledge people within Pact have.

CAP first met in August and now meets every two months, coinciding with the Promt (Pact Regional Management Team) meetings held in Dunedin which bring regional managers Jackie Kruger (Southland) and Helen Porter (West Coast) to the city.

Kate says a variety of topics are covered: "pretty much we talk about things that people think are important within Pact."

The terms of reference say that the purpose is: to discuss prioritise and recommend Pact’s working requirements, from a clinical perspective, based on our mission and vision. They also say it is a forum to:

• engage in the clinical aspects of work at Pact;

• be an internal mechanism for reviewing practice in the field of mental health and intellectual disability within a community context;

• engage all clinicians at Pact; and,

• debate and discuss current practice, issues, celebrations, scopes of practice, philosophical points of interest etc.

Kate says medication is often discussed because it is a big issue at Pact, with most clients taking some form of medication.

She says CAP has discussed whether non-clinical staff should give the epilepsy drugs, rectal diazepam and buccal midazolam.

"The alternative to not doing it is waiting maybe half an hour for an ambulance to come. So we discussed whether it is all right to have non-clinical staff trained to do those things. Out of that came some specifications on what needs to be done in certain circumstances."

She says there is a Pact Otago client who has diabetes and needs his blood monitored four times a day including once at night, meaning it is not practical to have a nurse come to do it.

"So it makes sense for support staff to be trained in doing it themselves and plus he knows them. They’ve been doing it for a long time. If the staff weren’t able to do that then he simply wouldn’t be able to live there. He would need to go to a place where there were nurses."

Another client has a peg feed, meaning he is tube fed – something which again, requires training for staff. Kate points out these are the sorts of thing family members would do if the person was living with their family.

"I think that’s the tack we’ve taken. They’re not difficult things; they’re important to know how to do. I think just about every staff member can handle them with the correct training. The same with the administration of the rectal diazepam and the buccal midazolam. Everybody’s capable of doing that. It does enable people to live in a normal home rather than a hospital setting."

Another medication issue is what happens when people come to Pact for crisis respite from the hospital – their medication should be blister-packed.

"We need to talk to the district health boards [DHBs] to make sure that the person comes with the blister packs, which sounds a small thing, but it’s a fairly big thing when they come in the middle of the night."

Another item discussed last year was whether Pact is getting all the information from DHBS and needs assessment teams for new clients.

"We agreed there needed to be a process in place whereby support workers are provided with all they need to know about the client."

Two others issues discussed at CAP are the development of a risk management plan assessment and de-escalation skills assessment of all staff.

Kate says issues pop up in the course of people’s work and they can bring those to the CAP to discuss.

If CAP discusses anything it feels needs to be escalated then they will recommend things to Pact’s executive team.

Kate ways she has enjoyed the meetings and found them "really useful."

She says she views the panel as a safeguard to ensure Pact is doing what it needs to be doing within the law and auditing and funding requirements.

"And that we’re obeying the code of rights at the most basic level I think."