1. Prepared by Jenny Tyrrell Nurse Manager Nursing Development & Capability Nursing & Midwifery Directorate October 2012 Grand Rounds via Video Conferencing

2. What are we accomplishing? 1.Critically review case presentations in a interprofessional framework to ↑ awareness & foster development of locally adapted, effective systems of quality & safety controls for better outcomes for patients & staff. 2.↑ learning by allowing reflection on cases that are relevant, practical & respectful of prior knowledge (Adult learning principles ) - everyone learns differing lessons dependant on their level of experience & discipline.

3. Grand Rounds Via Video Conferencing Links 8-9 Rural sites via MHECs or Telehealth Units & teleconferencing Networking without travel Relevant real cases to reflect on their care strategies Multidisciplinary in both discussion & attendance- team work- all health professionals welcome

5. Steps undertaken to implement Acceptance of project from HETI Lead Person assigned EOI from sites & education to sites Webpage development for all presentations & forms Building rapport & Confidence & invite other disciplines to attend ↑ Future scope & sustainability

6. Grand Rounds Via Video Conferencing Sites alternate monthly- offering different cases to reflect & learn from Builds confidence with technology use Builds capability through critical questioning & reflection on real case presentations

7. Presentations 2011 & 2012 20112012  The Devil is in the Detail - Sliding Scale Insulin  Dyspnoea in Palliative Care  Advanced Care Directives  Paediatric Head injury  Pressure Area Prevention  Early Presentation of Chest Pain/AMI  Gun Shot Wound Cardiac Pacing of a Patient in a Rural Setting Management of Haemoptysis A Simple Case of Tonsillitis – not so simple Management of a Patient with Asthma with Laryngeal Stridor A multiservice approach to holistic wound care Head injury management while isolated by floods Paratrooper- Trauma presentation Little Boy Blue- idiopathic VT arrhythmia Tricky Dicky- a collaborative approach to confusion Mrs Bear – go back to basics Is it Dementia or Delirium

9. Continuous Improvement model Started January 2011 → constant improvements Eg –Webpage developed = Access to P.P & forms pre presentation –Mute Button - pre presentation (link)(link) –Presentations recorded →Power points with voice (Link) (Link) –Future scope - other groups expanded

10. Future Scope 3 x Acute hospital groups running each month community lone practitioners monthly Community health centre groups

11. Future Scope

12. Team responsible - Implementation Nursing & Midwifery Directorate Telecommunications team Site Managers CNE-CME’s, CNC -CMC, site teams, acute & community, Dr’s, Ambulance officers & allied health

14. Performance measures used Attendance data Evaluations ↑ capability / confidence -use of Technology Build rapport & participation = ↑ questioning & reflection → practice change ↑ awareness in other models of care, options for presentations – thinking outside the box

15. Evaluation Used to ensure improvements & evidence for accreditation January – August 2011 = evaluation from CETI & MLHD Annually - July 2012 Future – survey monkey?

16. Evaluation July 2012

17. Reflection on Clinical Practice

18. Numbers regarding participation

19. Multidisciplinary team engagement

20. Comparing 2011 results to 2012 Question2011 results2012 resultsImprovement Rate VC technically31% Very good /excellent 77% Very good/ Excellent ↑ 46% Led to reflection on teams clinical practice79% Yes91% Yes ↑ 12% Led to reflection on own clinical practice78% yes92% Yes ↑ 14% How valuable was Grand Rounds 75% very good/excellent 96% very good/ excellent ↑ 21% Participant attending141 participants 200 participants ↑ 59 participants

21. Questions ?

22. Thank you for your time in sharing our exciting news on just some of our initiative's that bring remarkable results