Download April 2013 - Gippsland Health Alliance Member

NEWSLETTER
Issue No 14—April 2013
www.gha.net.au/grics
INSIDE THIS ISSUE:
Prostate Cancer
Roadshow
2
GRICS Strategic Plan
3
MDT and CHARM
4
GRICS Breast Cancer
Conference
5
Upcoming Mee'ngs
5
Conference
Presenta'ons
6
Stomal Online
Package
7
Management of
Febrile Neutropenia
8-10
Melanoma Project
and HHF ICT Project
11
Adolescent and
Young Adult News
12
Lymphoedema
Prac''oners
13
Out and About—
14-15
Health Professionals
Consumers
16-17
GRICS
Postal Address:
PO Box 424
Traralgon Vic 3844
Website:
www.gha.net.au/grics
Phone Number:
5128 0138
Fax Number:
5128 0198
Victorian Integrated Cancer Services Inaugural Conference 2013
Connec.ng care, driving best prac.ce and improving pa.ent outcomes
We are delighted to invite you to a=end the Inaugural Victorian Integrated Cancer
Services conference to be held at Rydges Melbourne (on Exhibi'on Street) from
13- 14 May 2013. This inaugural conference of the nine Integrated Cancer Services
will be a forum for showcasing exci'ng work and developments across all aspects
of cancer care in Victoria.
The ICS are formal partnerships between health services that were formed in 2005
and represent Victoria’s cancer clinical network. The ICS aim to work with
consumers, clinicians and health service managers to improve the planning and
delivery of cancer care so that it is coordinated, appropriate and effec've.
This two day conference will feature pa'ent focused, system focused and
innova'on streams.
Invited speakers include:
Phyllis Butow
NHMRC Senior Principle Research Fellow at the School of Psychology, University of
Sydney NSW
Chan Chea
Consumer, Southern Melbourne Integrated Cancer Services
Jon Emery
Winthrop Professor of General Prac'ce at the University of Western Australia
Anna Ugalde
Centre for Pallia've Care St Vincent’s Hospital Melbourne
Kerry Reid Searl
School of Nursing and Midwifery CQUniversity Queensland
Beth Wilson
Consumer Former Victoria’s Health Services Commissioner
To register and see the final program go to www.vics2013.org
Page 2
Issue No 14—April 2013
www.gha.net.au/grics
The Prostate Cancer Rural Educa.on Roadshow
Gippsland Regional Integrated Cancer
Services (GRICS) is proud to be working
with the Prostate Cancer Founda'on of
Australia (PCFA) to bring the prostate
cancer rural educa'on road show to
Bairnsdale on Wednesday the 28th of
August 2013.
GRICS was formed through a division of
the Department of Health in 2004. The
aim of GRICS is to work in collabora'on
with health services throughout
Gippsland to con'nually improve the
service outcomes and experience of
pa'ents across the Gippsland region.
GRICS key areas of interest include
improving care coordina'on, suppor'ng
mul'disciplinary care, implemen'ng
suppor've care approaches and reducing
unwanted varia'on in care.
In April 2012 the PCFA introduced the
posi'on of a prostate cancer specialist
nurse into Gippsland located at Latrobe
Regional Hospital. Kelly Koschade is now
coming up to her first year in the posi'on.
Kelly plays an integral role in educa'ng
and suppor'ng men and their families
through varying aspects of their cancer
journey. Kelly provides men with a central
point of contact where they can have
their ques'ons and concerns heard and be offered expert support and advice.
Together GRICS and the PCFA are excited to be involved in the delivery of the prostate cancer educa'on
road show in Bairnsdale to both health care professionals and the general public. This will be an opportunity
not to be missed as the relevant informa'on will be provided from experts and specialist alike in the field of
prostate cancer including a medical oncologist, urology surgeons and specialist care nurses. Further
informa'on regarding the general outline of topics to be covered, 'ming of the sessions and venue loca'on
are s'll to be confirmed. You will be updated with this informa'on in the near future.
Un'l then if you have any ques'ons or queries regarding the prostate cancer educa'on road show please
don’t hesitate to contact either Tennille Lewin at [email protected] or on (03) 5128 0138 or Kelly
Koschade on (03) 5173 8713.
Page 3
Issue No 14—April 2013
www.gha.net.au/grics
GRICS Strategic Plan
GRICS is currently working to develop their Strategic Plan for 2013-15. This work will clearly define the
direc'on for GRICS over the next three years as we con'nue to work towards enhancing and improving
cancer care across the Gippsland region.
Seeking input from our stakeholders into the forma.on of the GRICS Strategic Plan is an important part of
this process.
GRICS believes stakeholder input is cri'cal to ensure the priori'es of our Strategic Plan are relevant,
meaningful and connected to the direc'ons and aspira'ons of our primary stakeholders and broader
community.
Why is a Strategic Plan important?
The priori'es defined within the Strategic Plan will outline the key themes and major focus areas for GRICS
over the period 2013-2015. These priori'es will form the founda'on of how GRICS con'nues to engage with
and strengthen exis'ng rela'onships with its stakeholders, pursue new partnerships as well as deliver on key
service improvement objec'ves for regional cancer pa'ents over this period.
What informa.on are we seeking?
We are working to ensure the Gippsland plan is based on a thorough understanding of what is most
important to our region as well as the environmental factors that influence how we operate.
In par'cular, we need to take into account the specific and unique strengths, issues, challenges and
opportuni'es relevant to Gippsland in the provision of cancer care and support services.
We also wish to obtain input about the rela've importance and priority of ac'on areas across a range of key
themes rela'ng to how GRICS operates in strengthening rela'onships, building capacity and connec'ng care.
How can you help?
Taking 20 minutes to consider your thoughts and perspec'ves to the ques'ons in a survey would be greatly
appreciated.
A copy of this survey is available by contac'ng GRICS on 03 5128 0137 or alternately email Enza Wright at
[email protected].
The informa'on obtained from this survey process will be integrated with the work done to date in
establishing key direc'ons of the Strategic Plan.
Responses to the survey will be collated and reported to GRICS by stakeholder group only. Please note, all
responses to the survey will remain anonymous and confiden'al.
What is the comple.on date of the survey?
All responses to the GRICS Strategic Plan survey must be received by close of business 24th May 2013.
Page 4
Issue No 14—April 2013
www.gha.net.au/grics
Mul.-disciplinary Team Mee.ngs
Mul'disciplinary care has seen a significant amount of change over the past six months and will con'nue to do so
in the future. The surgical MDC mee'ng that is hosted weekly at Latrobe Regional Hospital has recently seen the
introduc'on of a Quality and Governance commi=ee that now meets bi-monthly. This commi=ee is chaired by
the GRICS Medical Director, Dr John Scarle= and is made up of key stakeholders from all relevant disciplines. The
commi=ee members from key disciplines including pathology and radiology are focussed on iden'fying areas for
improvement and undertaking projects to con'nually strive for best prac'ce when providing mul'disciplinary
care to pa'ents in Gippsland. The achievements of this commi=ee so far include increasing the length of the MDC
mee'ng to an hour every week which allows for a larger number of pa'ents to be thoroughly discussed, the
number of pa'ents able to be presented each week has increased to ten. Another achievement of the commi=ee
includes the proficient flow of pa'ent informa'on required for appropriate decision making. For pa'ents with
breast cancer this has been significantly improved with the implementa'on of data sharing processes between
BreastScreen Victoria and Regional Imaging Limited. This model of quality improvement will soon be introduced
to the lung MDC hosted at Central Gippsland Health Service (CGHS).
The lung MDC hosted at CGHS with the help of Patricia Minter, Cancer Liaison Project Officer (a GRICS funded
posi'on), has also had a significant number of changes recently. The lung MDC has increased its frequency to
meet twice a month to be able to keep up with the number of pa'ents being referred into the service. The lung
MDC has also recently engaged the regular a=endance of a pallia've care consultant and pathologist to ensure
that lung cancer pa'ents in the region have access to mul'disciplinary care that provides a standard of care that
meets best prac'ce standards. The pa'ent management system used across the region for the administra'on of
the MDC mee'ngs is currently undergoing an in-depth review with the hope that an extensive upgrade of the
programs capabili'es, user ability and data repor'ng will be able to be undertaken by the programing company.
This will enable improved management of pa'ents across varying MDC’s held in the region to improve pa'ent
care planning and follow up management .
CHARM
CHARM is an electronic chemotherapy prescribing program that has been funded by GRICS and the Department
of Health. The project will be undertaken by the Gippsland Health Alliance (GHA) and implemented in all five
chemotherapy day units in Gippsland. The ini'al stages of CHARM are well under way with the project manager
from GHA (Herman Lau) and a member of the GRICS team (Tennille Lewin) a=ending the CHARM Health project
officer training in Brisbane over three days in early February. Since their return from the training they have
completed workflow process mapping of the five sites across the disciplines of administra'on, nursing, medical
and pharmacy to allow for future state workflows to be developed with the inclusion of CHARM.
Many key stakeholders have already been engaged in the ini'al stages of the project, although their involvement
will increase over the period of the project. The next vital steps in the project include developing clinical advisory
groups for each of the above men'oned disciplines to undertake extensive review of how CHARM is going to be
used across the region. There will be plenty of opportunity for all relevant health sites to be involved in the
implementa'on of this project and the team is excited to be working with the experienced staff to get the most
out of this program.
The implementa'on of CHARM aims to improve pa'ent safety around the administra'on of chemotherapy,
improve medica'on safety for staff and pa'ents alike as well as streamline processes throughout Gippsland to
ensure that evidence based prac'ce is achieved in all areas of chemotherapy administra'on. GRICS would like to
thank all stakeholders involved in the project to date.
Page 5
Issue No 14—April 2013
www.gha.net.au/grics
GRICS Breast Cancer Conference
The GRICS Breast Cancer Conference held on 22 February 2013 was a great success based on the very posi've
feedback received from registrants. A total of 115 health professionals a=ended, represen'ng 26 health services
across Gippsland. Speakers covered a diverse range of topics from diagnosis through to pallia've care. Thank you to
the speakers: Dr Meenakshi Padmanabhan, Dr Phillip Jayasurya, Mr Cyril Tsan, Mr Eldon Mah, Dr Sachin Joshi,
Dr Mahshid Jalilian, Maree O’Connor, Dan Mellor, Natalie Goroncy, Liz Crocker, Dr. Carrie Lethborg, Michelle
McKimmie and Jenny Turra. Displays provided by Smith and Nephew, Amgen, Breast Cancer Network Australia,
BreastScreen Victoria and Breacan added another dimension to the conference and registrants made the most of
having the opportunity to talk to representa'ves from these organisa'ons. Other organisa'ons kindly provided plenty
of show-bag reference materials. Registrants enjoyed the opportunity to network in the spacious areas of the Esso
BHP Billiton Wellington Entertainment Centre in Sale. GRICS would like to thank everyone who supported the
conference.
Below: Mr Eldon Mah, Mr Cyril
Tsan and Mr David Chan
Above: Laura Flahavin and
Miriam Newman with Yvonne
and Ben from Smith & Nephew
Above: Fiona McRae from BreaCan
with Catherine Enter, McGrath Breast
Care Nurse
Upcoming Mee.ngs
May 2013
Every Friday
7.45am to GRICS Surgical MDT mee'ng—Tutorial Room One Monash Building Latrobe
8.30am
Regional Hospital—video conference available
Tuesday 7th
and 21st
8.00am to Lung MDT mee'ng Central Gippsland Health Service Tele health room Monash
8.45am
Building—video conference available
Thursday 9th
5.30pm to GRICS Haematology MDT mee'ng—Tutorial Room One Monash Building Latrobe
6.30pm
Regional Hospital—video conference available
June 2013
Every Friday
7.45am to GRICS Surgical MDT mee'ng—Tutorial Room One Monash Building Latrobe
8.30am
Regional Hospital—video conference available
Tuesday 4th
and 18th
8.00am to Lung MDT mee'ng Central Gippsland Health Service Tele health room Monash
8.45am
Building—video conference available
Thursday 6th
5.30pm to GRICS Haematology MDT mee'ng—Tutorial Room One Monash Building Latrobe
6.30pm
Regional Hospital—video conference available
Page 6
Issue No 14—April 2013
www.gha.net.au/grics
Conference presenta.ons
14th Na.onal Breast Care Nurse Conference
Kerrie Missen, GRICS Cancer Services Improvement
Coordinator presented at the 14th Na'onal Breast Care
Nurse Conference on 28 February 2013. The presenta'on
provided the audience with informa'on on the
lymphoedema project undertaken by GRICS between
2010–2012. This project resulted in 12 Gippsland health
professionals trained as Level 1 Lymphoedema
prac''oners, one prac''oner trained at Level 2, and the
implementa'on of the GRICS Lymphoedema Prac''oner
Network, to provide ongoing support to all Lymphoedema
Prac''oners in Gippsland.
If you would like more informa'on on this project please
contact GRICS.
Kerrie Missen, Louise Cristofaro and Spiridoula
Galetakis at the Victorian Integrated Cancer
Services display at the conference.
Survivorship Conference
Michelle McKimmie, GRICS Cancer Services Improvement Coordinator, presented two posters at the
Survivorship Conference in Adelaide on 2-3 February 2013. The first poster presented on behalf of GRICS and
Gippsland Lakes Community Health was 'tled ‘Addressing the needs of survivors with lymphoedema - a transferrable model for providing lymphoedema services in a regional context’ provided informa'on on the lymphoedema
project, in the context of survivorship. The second poster presented on behalf of GRICS was 'tled ‘Engaging with
Survivors—A Regional Par'cipa'on Strategy’.
If you would like a copy of the Lymphoedema handout please contact Kerrie Missen at GRICS on
[email protected] or 0351 280062 or a copy of the Engaging with Survivors handout please contact Michelle
McKimmie at GRICS on [email protected] or 0351 280059.
39th AASTN Conference
Hobart was the des'na'on for Linda Raymond when she presented on
behalf of GRICS, Latrobe Regional Hospital and Central Gippsland
Hospital at the 39th Australian Associa'on of Stomal Therapy Nurses
Conference on 22 March 2013. The 'tle of Linda’s presenta'on was
‘Mee'ng the challenge to educate non-stomal therapy nurses (NSTNs)
on stoma care’, which described the project to develop the on-line
self-directed stomal therapy care learning package. The presenta'on
generated a lot of interest from the audience.
As a result of this presenta'on, GRICS was contacted by a stomal
therapist from a health service in Brisbane, who thought the package
was “brilliant” and intends to u'lise the package in this Queensland
health service.
You can access this package easily – please refer to the following page
for further details.
Linda Raymond presen+ng at the
AASTN Conference
Page 7
Issue No 14—April 2013
www.gha.net.au/grics
Self-directed learning package
available on-line!!!
Care of the Faecal or Urinary Stoma
Gippsland Regional Integrated Cancer Services (GRICS) and Nurse and Midwife
Educa'on Gippsland in conjunc'on with Latrobe Regional Hospital (LRH) and Central Gippsland Health Service (CGHS)
would like to remind people that this learning package is available on-line.
It can be accessed via: h=p://www.onwebfast.com/drug/login.htm
Self Directed Learning Packages ‘Stomal Care’
(If you have any problems accessing this site, please contact your Nurse Educator)
General access to the tutorial only, and not the competency, is available via the
GRICS Website: www.gha.net.au/grics
This package has been wri=en by LRH and CGHS Stomal Therapy Nurses for NON Stomal Therapy Nurses and other
health professionals. It will help you to trouble-shoot some of the more common issues associated with stomas.
•
How to get the ‘right fit’ of an appliance
•
Allergies and sensi.vi.es
•
Excoria.on
•
Ulcera.on
•
Irregular shape
•
Hypergranula.on
•
Stenosis
•
Fungal infec.on
•
Hernia.on
•
High or Low Output
For more informa'on go the GRICS Website: www.gha.net.au/grics or contact GRICS on 03 5128 0138.
Links to the learning package have also been established on the Australian Government Cancer Learning website
h=p://www.cancerlearning.gov.au/find/colorectal_ts.php#management_and_support_aTer_and_between_treatment
and the Australian Associa.on of Stomal Therapy Nurses website
h=p://www.stomaltherapy.com/reference_materials.php
Change and disadvantage in regional Victoria: an overview
Prepared by: The Policy and Strategy, Department of Planning and Community
Development (DPCD). May 2011
Five reports providing an overview of disadvantage within each of Victoria’s regions
including Gippsland are available. Each report contains maps of disadvantaged
suburbs and towns and accompanying informa'on that describes the popula'on
makeup of those towns.
The separate region reports are available on the DPCD website:
h=p://www.dpcd.vic.gov.au/home/publica'ons-and-research/urban-and-regionalresearch/Regional-Victoria/chnage-and-disadvantge-in-regional-victoria
Page 8
Issue No 14—April 2013
www.gha.net.au/grics
Immediate Management of Febrile Neutropenia / Neutropenic fever
Febrile neutropenia is a medical emergency. Pa'ents receiving cancer treatment who develop a
temperature of 38O or higher and/or develop shivers or shakes and begin to feel unwell must go to their
nearest hospital emergency department immediately via ambulance. This can be life threatening and has to
be taken very seriously.
GRICS provides Gippsland Chemotherapy Units with Febrile Neutropenia Alert Cards to provide to pa'ents
receiving chemotherapy. Pa'ents should carry this card with them at all 'mes and provide it to health
professionals whenever seeking treatment because they are feeling unwell.
The following informa'on was obtained on 3 April 2013 from eviQ - hEps://www.eviq.org.au/Home.aspx
For pa.ents receiving treatment for cancer
What are the signs and symptoms of infec'on? The signs and symptoms of an infec'on may include:
•
a temperature of 38oC or above
•
chills or shakes, unusual swea'ng
•
cough with yellow or green coloured sputum, shortness of breath
•
sore throat, sores in your mouth
•
redness or swelling on your skin (par'cularly around a central line)
•
loose or liquid bowel mo'ons
•
passing more urine than normal or a burning feeling when passing urine
•
blood or discharge in your urine
•
discharge from your eyes or ears
•
vaginal discharge and/or itching
•
flu-like symptoms such as body aches and feeling 'red
If you develop an infec'on when your neutrophil count is low, it can be life-threatening and needs to be
taken very seriously.
Even if you feel well and you
o
• develop a temperature of 38 C or higher and/or
• develop shivers or shakes or begin to feel unwell
Go to your nearest hospital emergency department immediately via an ambulance. It could be
life-threatening and has to be taken very seriously.
When you arrive at the hospital it is important to tell them the following:•
that you have cancer
•
the date of your last treatment
•
highest temperature you have had in last 24 hours
•
any chills/shakes
•
any other symptoms
•
any drug allergies (especially to an'bio'cs)
Page 9
Issue No 14—April 2013
www.gha.net.au/grics
Immediate Management of Neutropenic Fever
ID: 000123 (V.2)
Approved: 20 May 2011
Last Modified: 29 Oct 2012
Review Due:01 Jun 2013
Immediate management of neutropenic fever for health professionals
Please ensure that all relevant staff within your health service are aware of these current clinical prac'ce guidelines. As these
guidelines are subject to change please refer to eviQ - hEps://www.eviq.org.au/Home.aspx for up-to-date informa'on.
This document was developed from the Australian consensus guidelines for the management of neutropenic fever in adult
cancer pa'ents1 , with an aim to standardise the clinical approach to the management of neutropenic fever. Implementa'on of
these guidelines requires considera'on of local factors.
Defini.on of Neutropenic Fever
For the purpose of this document neutropenic fever is defined as:
•
temperature of at least 38.3°C (or at least 38°C on two occasions) and neutrophil count of less than 0.5 x 109 cells/L, or
less than 1.0 x 109 cells/L and predicted to fall to lower than 0.5 x 109 cells/L
Note:
•
pa'ents with neutropenic sepsis may present with haemodynamic compromise without fever (e.g. if elderly, or on
steroids)
•
neutropenic sepsis with or without fever is a medical emergency
•
all clinical signs indica'ng sepsis need to be acted upon immediately
•
the administra'on of empiric an'bio'cs should not be delayed in order to perform blood cultures
Any delay in the commencement of an.bio.cs may cause increased morbidity and mortality
Management
All pa'ents presen'ng with fever following chemotherapy should be managed as if they have neutropenic fever and receive empiric an'bio'cs without wai'ng for laboratory confirma'on of neutrophil count. This management may be modified if neutrophil
count and func'on are found to be adequate.
Time to first dose:
•
pa'ents with features of systemic compromise (such as hypotension, hypoxia, confusion, major organ dysfunc'on)
should receive an'bio'cs within 30 minutes of presenta'on aTer the immediate collec'on of blood cultures and administra'on of fluid support (grade C)*
•
clinically stable pa'ents should receive an'bio'cs within 1 hour of presenta'on aTer appropriate cultures have been
taken (grade C)*
•
administra'on of an'bio'cs should not be delayed by the conduct of laboratory or radiological inves'ga'ons (grade C)*
* Refers to the levels of evidence and grades of recommenda'ons used in the published guidelines
Refer to flow diagram for more informa'on regarding ini'al pa'ent evalua'on and risk assessment.
Step 1: Perform sep.c workup
Blood cultures and other tests:
•
1 set (aerobic and anaerobic bo=les) from each lumen of CVAD (if in situ)
•
1 set from peripheral blood
•
full blood count with differen'al white cell count
•
electrolytes, urea and serum crea'nine
•
liver func'on
•
mid stream urine /catheter specimen urine
•
sputum (if clinically indicated)
•
faeces (if clinically indicated)
•
swab of central venous catheter exit site
•
swab of any other suspicious wounds/focal lesions
Chest x-ray (if unavailable s'll proceed to step 2 and ensure arrangements for CXR have been made)
DO NOT WAIT FOR RESULTS
Page 10
Issue No 14—April 2013
www.gha.net.au/grics
Immediate Management of Neutropenic Fever (con+nued)
Step 2: Commence empiric an.bio.c therapy (doses are for normal renal func.on)
Pa.ent group
Pa.ents without features of systemic
compromise
(Beta-lactam monotherapy is
recommended unless allergy to the
recommended agent/s
Recommenda.on (grading and level of evidence)
No penicillin allergy:
Piperacillin-tazobactam 4.5 g IV 6–8 hourly (grade A) OR Cefepime 2 g IV 8 hourly
Other reasonable choice for monotherapy is ce7azidime 2 g IV 8 hourly (grade A)
Non-life threatening penicillin allergy (rash):
Cefepime 2 g IV 8 hourly (grade C)
Other reasonable choices for monotherapy are ce7azidime 2 g IV 8 hourly or meropenem
1 g IV 8 hourly (grade C)
Life-threatening (immediate) penicillin allergy or beta-lactam allergy:
Aztreonam 1-2 g IV 8 hourly OR ciprofloxacin 400 mg IV 12 hourly (expert opinion)
+ vancomycin 1.5 g IV 12 hourly (if CrCl >90 mL/min) OR 1 g IV 12 hourly (if CrCl
60-90 mL/min)†*
Pa.ents with systemic compromise
(The combina'on of a beta-lactam an
'bio'c with an aminoglycoside is the
regimen of choice)
As for pa.ents without features of systemic compromise (expert opinion) (see above):
+ gentamicin 5 to 7 mg/kg ideal body weight IV once daily, adjusted to level
+/– vancomycin 1.5 g IV 12 hourly (if CrCl >90 mL/min) OR 1 g IV 12 hourly (if CrCl 60-90
mL/min)†*
Pa'ents with celluli's, obviously infect- As for pa.ents without features of systemic compromise (see above):
ed vascular devices, or MRSA carriers
+ vancomycin 1.5 g IV 12 hourly (if CrCl >90 mL/min) OR 1 g IV 12 hourly (if CrCl
with extensive skin breaks/
60-90 mL/min)†*
desquama'on
Pa'ents with features of abdominal or
perineal infec'on
As for pa.ents without features of systemic compromise (see above):
+ metronidazole 500 mg IV/PO 12 hourly if receiving cefepime, ceTazidime or
ciprofloxacin first-line (grade D) Alterna+vely, piperacillin-tazobactam or meropenem will
provide adequate anaerobic cover, if required (grade B), other than for suspected or
proven Clostridium difficile-associated diarrhoea or coli+s
© Internal Medicine Journal 2011
*Clinicians caring for a pa+ent with immediate hypersensi+vity to one beta-lactam who have subsequently tolerated an alterna+ve
suitable an+pseudomonal beta-lactam agent may elect to administer this second agent under careful supervision.
†Refer to the Therapeu+c Guidelines version 14 for dosing guidance. For vancomycin, individual ins+tu+ons may use alterna+ve
loading-dose protocols
Note: Recommenda+ons for individual an+bio+cs may not align directly with the Therapeu+c Goods Administra+on (TGA)
approved indica+ons. Therefore, following these recommenda+ons may lead to off-label use of some agents.
Summary
•
beta-lactam monotherapy, such as piperacillin-tazobactam (Tazocin® ) or cefepime, is the empiric therapy of choice for all
clinically stable pa'ents with neutropenic fever
•
an an'pseudomonal beta-lactam an'bio'c plus gentamicin is recommended for pa'ents with systemic compromise. All pa'ents in sep'c shock should receive an'bio'cs within 30 minutes of presenta'on, and all other pa'ents within 1 hour
•
vancomycin is not recommended as ini'al empiric therapy unless there is systemic compromise or an approved indica'on
for its use
This is ini.al immediate therapy only and subsequent treatment should be based on clinical findings
and at the discre.on of the trea.ng clinician
References
1.
Tam CS, O'Reilly M, Andresen D et al. 2011 " Use of empiric an.microbial therapy in neutropenic fever". Intern Med J.
Jan;41(1b):90-101 - Link to external ar.cle
eviQ version 1.4.0
Page 11
Issue No 14—April 2013
www.gha.net.au/grics
Melanoma shared care, a tripar.te approach for survival, the pa.ent, their GP and their specialist.
This project is a collabora'on between the Victorian Melanoma Service, Alfred Health; Melanoma Pa'ents Australia, Gippsland Regional Integrated Cancer Services and SMICS. It aims to develop a model for long term care of survivors of malignant melanoma
which incorporates pa'ent self-management; general prac'ce/specialist shared care; con'nuous suppor've care screening;
pa'ent and family centred long term care planning; and electronic reminders.
The project has now received ethics approval and has commenced par'cipant recruitment. The project team have been preparing
various tools and documents including:
•
•
risk stra'fied pathways
data collec'on tools
•
recruitment processes
•
•
pa'ent informa'on
primary care educa'on.
For further informa'on please contact: Colleen Berryman, Cancer Service Improvement Coordinator,
SMICS on 9928 8599 or [email protected].
These project teams have the opportunity to meet with the other survivorship project funding recipients through an established
Community of Prac'ce (CoP). This is a valuable opportunity to learn of each other’s successes and challenges in implemen'ng
survivorship programs to improve the long term well-being of pa'ents who have undergone treatment for a cancer diagnosis and
their families.
The Health and Hospitals Fund (HHF) REGIONAL ICT mul.disciplinary mee.ng tender consulta.on
In 2010 the Department of Health, Cancer Strategy and Development (DH, CS & D) secured $2.5 million from the Australian
Government Health and Hospitals Fund (HHF) regional cancer centres funding to develop an informa'on communica'on technology
(ICT) strategy.
Dr Stephen Vaughan was engaged through HumeRICS by the DH, CS & D to consult with regional ICS regarding informa'on
communica'on technology (ICT) requirements. In March 2012, a report containing recommenda'ons for regional cancer ICT was
completed. The report iden'fied development of a mul'disciplinary (MD) team mee'ng ICT solu'on as the major priority. The DH,
CS & D aims to support Mul'disciplinary (MD) teams across the regions by providing an effec've mee'ng management soTware
solu'on to assist mee'ng prepara'on, documenta'on, communica'on, and team linkage. The DH, CS & D will undertake an open
tender process to select a vendor to provide a suitable ICT solu'on.
A recently completed project that involved a rigorous tender process provided the
Southern Metropolitan Integrated Cancer Service (SMICS) project team with the
experience and skills to develop tender documenta'on. This experience resulted in
the selec'on of SMICS to develop the required tender documents for the DH, CS & D.
SMICS conducted two consulta'ons in each of the regional ICS to develop:
•
a business requirements document (BRD)
•
all other tender documents required by DH, CS & D.
Consulta'on one provided detailed informa'on about the project and the opportunity
to discuss the expecta'ons of the second consulta'on with regional ICS managers,
directors and ICS mul'disciplinary project team members. Following the first
consulta'on, regional ICS managers and directors completed an on-line ques'onnaire, stakeholder analysis, IT environment diagram
(interfaces) and MD team mee'ng administra'on flow diagram. Then each regional ICS was responsible for engaging their
stakeholders, arranging a mee'ng/s for the second consulta'on and providing informa'on required for the second consulta'on. The
purpose of the second consulta'on was to engage with regional ICS stakeholders to:
•
discuss the soTware solu'on business requirements provided in the ques'onnaire responses and stakeholder ideas
•
finalise the soTware solu'on business requirements from a regional perspec've, highligh'ng any real or poten'al risks
•
discuss and finalise the regional IT environment (interfaces)
•
discuss and finalise the MDT mee'ng administra'on workflow.
GRICS and the HHF Regional MDM ICT project team wishes to sincerely thank those members of staff whom a=ended either of the
consulta'ons. The informa'on provided to the project team has enabled them to develop the documents required by the
Department of Health, Cancer Strategy and Development to tender for a vendor to provide a mul'disciplinary team mee'ng ICT
soTware solu'on.
Page 12
Issue No 14—April 2013
www.gha.net.au/grics
AYA Oncology News Update—Exercise Programs: once treatment has finished
The Flinders Centre for Innova'on in Cancer recently held its inaugural Cancer Survivorship Conference in South Australia. A highlight
of the conference was the focus on physical wellbeing and the importance of exercise following a cancer diagnosis.
It is well recognised that cancer and its associated treatments can bring about physical and psychosocial side-effects that impact upon
ones physical func'on and quality of life. Exercise rehabilita'on programmes have shown to be safe, feasible and effec've. Benefits
may include;
•
Improved muscle strength and endurance
•
Reduce cancer related fa'gue
•
Improve bone density and joint range of mo'on
•
Maintain / improve a healthy body weight
•
Increase cardiovascular and respiratory func'on
•
Lower levels of stress and anxiety
•
Improved func'onal capacity
•
Decrease re-occurrence of certain cancers
All these outcomes can assist one during the recovery process and reduce common side effects of treatment such as fa'gue, nausea,
anxiety, depression and muscle weakness. Exercise can also facilitate a healthy and ac've lifestyle and when combined with good
nutri'on provide the plaaorm to allow one to integrate back into their daily life, peer groups, work and school life.
Types of exercise programmes:
Physical ac'vity can take on many forms such as walking, running, swimming, and aerobics. It can also include;
•
Group based exercise undertaken in a gym or community centre
•
Home based exercise programmes that have been specifically designed by an Exercise Physiologist.
•
Compe''ve sport
•
Incidental ac'vity – small amounts of ac'vity over the course of the day
•
Outdoor recrea'on such as hiking
What you are able to do will depend on your current fitness level, treatments undertaken, and what your goals are.
Where to from here?
Exercise is permi=ed during and aTer treatment for cancer but it must be medically safe to do so. Cancer and its treatment can
cause contraindica'ons to exercise. Ask for medical consent from either your GP or oncologist prior to undertaking a new
programme.
It may also be a good idea to consult an Exercise Physiologist, or Physiotherapist before star'ng a new exercise programme. This will
allow for proper screening and assessment and will provide you with the right advice and guidance to ensure that your exercise
program is safe and successful.
If you have any ques'ons please feel free to contact
Andrew Murnane, Exercise Physiologist, ONTrac at Peter Mac Victorian Adolescent & Young Adult Cancer Service
[email protected]
A new ini.a.ve available to all young people who have had a diagnosis of cancer regardless of treatment
loca.on: Cer.ficate I in Voca.onal Prepara.on
ONTrac at Peter Mac Victorian Adolescent and Young Adult Cancer Service in partnership with Murray Mallee Training Company
(MMTC) is offering an accredited training program for young people who are experiencing, or have experienced cancer. The
Cer'ficate I in Voca'onal Prepara'on is designed to provide training for young people to enhance their con'nued educa'on and
employment prospects. It has a focus on orienta'on to work op'ons and prepara'on for further educa'on and training. Individual
plans will be developed for each young person to meet their voca'on needs and ensure training goals are achieved.
Contact:
Nicole Edwards, Educa'on & Voca'on Advisor, ONTrac at Peter Mac ph 9656 1744, [email protected]
Page 13
Issue No 14—April 2013
www.gha.net.au/grics
Gippsland Lymphoedema Prac..oners Network Mee.ng
The GRICS Gippsland Lymphoedema Prac''oners Network Mee'ng commenced in August 2012 and had
its third mee'ng in April 2013. Mee'ngs are well a=ended and the number of members is increasing, as
more Gippsland health professionals are trained as lymphoedema prac''oners. The network is open to all
qualified Gippsland lymphoedema prac''oners, levels 1 and 2, working in the public and private sector.
Educa'on is provided as an adjunct to most mee'ngs. At the April 2013 mee'ng, the members endorsed a
brochure for Gippsland pa'ents and the community to create awareness of lymphoedema. An informa'on
sheet for Gippsland GPs and health professionals, on the availability of lymphoedema prac''oners in
Gippsland health services was also endorsed at this mee'ng. The pa'ent brochures and informa'on sheets
will be made available throughout Gippsland in the near future.
The topic of the educa'on session at the April 2013 network mee'ng was ‘Lymphoedema and Wound
Management’, presented by Marianne Cullen, Gippsland Regional Wound Consultant, from Latrobe
Community Health Service. Thank-you Marianne for the excellent workshop.
Monitoring for the Early Detec.on of Breast Cancer Related
Lymphoedema—Posi.on Statement
Approved by the ALA Na+onal Council October 2012
The Australasian Lymphology Associa'on (ALA) endorses the need to monitor for the early
detec'on of lymphoedema following breast cancer treatment. The early detec'on and
management of sub-clinical lymphoedema may reduce the long term physical, func'onal
and psychological effects caused by a later diagnosis and delayed management of the condi'on.
The ALA endorses the use of bioimpedance spectroscopy (BIS) as a validated and reliable tool to enable early
detec'on of breast cancer related lymphoedema (BCRL) of the arm.1,2
This posi'on statement has been developed by the Australasian Lymphology Associa'on (ALA) to provide an
Australasian perspec've and to promote consistency in the monitoring for early detec'on of breast cancer
related lymphoedema. The importance and benefits of early diagnosis of lymphoedema for medical prac''oners is
explained on the ALA website www.lymphoedema.org.au.
The ALA acknowledges the posi'on statement of the Na'onal Lymphedema Network: “Screening and Measurement
for the Early Detec'on of Breast Cancer Related Lymphedema” updated April 2011 www.lymphnet.org.
1.
2.
Czerniec SA, Ward LC, Refshauge KM, Beith J, Lee MJ, York S, et al. Assessment of breast cancer-related arm lymphedema--comparison of
physical measurement methods and self-report. Cancer Invest. 2010 Jan;28(1):54-62.
Hayes S, Janda M, Cornish B, Babstu=a D, Newman B. Lymphedema secondary to breast cancer: how choice of measure influences diagnosis,
prevalence, and iden'fiable risk factors. Lymphology. 2008 Mar;41(1):18-28.
Page 14
Issue No 14—April 2013
www.gha.net.au/grics
OUT & ABOUT—HEALTH PROFESSIONALS
Living with Cancer Educa.on Program
Facilitator Update
Based on demand GRICS is working with the Cancer Council Victoria to provide a Traralgon facilitator update. The
revised ‘Living with Cancer Educa'on Program’ will be presented at the workshop. For all LWCEP facilitators who wish
to con'nue delivering the program, it is necessary for at least one representa've from your organisa'on to a=end
one of the update days, to ensure you are delivering the most up to date program and have access to current
resources. We will also be looking at the Survivorship module, having a presenta'on by Dr Leisel Fitzgerald (filmed)
and then spend some 'me sharing experiences and planning for programs in 2013.
Date:
Time:
Venue:
8th May 2013
10.00am – 2.00pm
Latrobe Valley Community Mental Health Service Building 3 - Conference Room 1 & 2
Washington Street Traralgon
For further details or to register please contact:
•
Michelle McKimmie or Enza Wright—Phone 5128 0138 OR
•
Michelle Meachen LWCEP Program Manager Phone: 03 9635 5312 or 13 11 20 [email protected]
CuNng cancer risk in mental health
This four hour workshop is aimed at mental health professionals and community workers who want to update their
skills and knowledge about early detec'on strategies and ways to minimise cancer risk. It aims to give par'cipants
the skills and knowledge required to discuss cancer preven'on with individual clients and groups.
Topics include:
Current cancer sta's'cs: pa=erns of incidence and mortality in Victoria
Risk factors: including modifiable and non-modifiable (e.g. obesity, alcohol consump'on, smoking)
Cut your cancer risk strategies including an overview of the current Na'onal cancer screening.
•
•
•
A free workshop for health professionals and community workers working in mental health
Date:
Wednesday 29th May 2013
Time:
10am—2pm
Venue:
Latrobe Valley Community Mental Health Service Conference Building 3 – Conference Rooms 1 & 2
Washington Street Traralgon
Register online:
www.cancervic.org.au/for-health-professionals/training_courses_and_educa'on/preven'on-mental-health
For further informa'on, contact:
Rachel Mulqueeney, Community Health Professionals Coordinator
Phone: (03) 9635 5424; Email: [email protected]
Page 15
Issue No 14—April 2013
www.gha.net.au/grics
OUT & ABOUT—HEALTH PROFESSIONALS
May 2013
2nd and 4th
May
Australian Prac.ce Nurses Associa.on Na.onal Movers and Shakers Conference Pullman
Melbourne Queens Road Albert Park. The program will feature a wide range of
interna'onal and na'onal speakers addressing primary health care and the future direc'on
of nursing. Whilst the Movers and Shakers Conference will primarily focus on furthering
clinical skills it will also provide personal and professional development for a=endees
13—14 May
Victorian Integrated Cancer Services Inaugural Conference 2013 Rydges Hotel Exhibi+on
Street Melbourne This two day conference will feature pa'ent focused, system focused and
innova'on streams. For registra'ons or further informa'on www.vics2013.org.au
Wednesday
22nd
6.00pm to Adolescent and Young Adult Pallia.ve Care—Dr Rachel Hughes, Adolescent and Young
8.00pm
Adult Pallia've Medicine Fellow at ONTrac at Peter Mac, will present on providing
pallia've care for adolescents and young adults with cancer. Free session—supper will be
provided. Mary Sargeant Educa+on Centre West Gippsland Healthcare Group Warragul
Registra.ons: Online registra'ons at h=p://www.trybooking.com/CSAK
Videoconferencing of this presenta.on will be available to health services in Gippsland.
Please contact the Gippsland Regional Pallia.ve Care Consor.a (GRPCC) to arrange.
More details: Judy Coombe, GRPCC, [email protected] or 03 5623 0684
(Tuesday and Thursday only). This forum is an ini'a've of ONTrac at Peter Mac, the
Gippsland Region Pallia've Care Consor'um and the Gippsland Medicare Local.
A=endance at this forum a=racts CPD and CNE points.
July 2013
14—16 July
ANZUP Cancer Trials Group Limited 2013 Annual Scien.fic Mee.ng Gold Coast Conven+on
and Exhibi+on Centre Advancing genitourinary cancer care through research and
collabora'on Further informa'on: go to www.anzup.org.au
25—26 July
11th Biennial Na.onal Rural Remote Social Work Conference
‘Diversity in Rural and Remote Communi'es: Responding to Challenges and Opportuni'es’
RACV Resort Inverloch. Further informa'on www.aasw.asn.au/events/category/vic
Mar'n Butler [email protected] Olga Gountras [email protected]
Later in the year
27 September
Allied Health Symposium Gippsland 2013 Innova.ve Prac.ce: Sustainable Allied Health
Workforce Monash University Gippsland Campus This bi-annual Gippsland Allied Health
Symposium provides an opportunity for par'cipants to share ideas, exper'se and
experiences around important areas of allied health prac'ce, professional development
and research. The focus of the 2013 Gippsland Allied Health Symposium is ‘Innova+ve
Prac+ce: Sustainable Allied Health Workforce’. Further informa'on: Please contact Deanna
Korab, Department of Health, via email at [email protected] or on
(03) 5177 2592
12—14
November
COSA’s 40th Annual Scien.fic Mee.ng Adelaide Conven+on Centre
Registra'on and abstract submissions are now open www.cosa2013.org . The theme for
COSA’s 40th ASM “Cancer Care Coming of Age” will highlight geriatric oncology, and
disease themes will concentrate on gastro-intes'nal cancers and encompass gastric,
oesophagus and hepatobiliary tumours which are oTen neglected at major mee'ngs, as
well as colorectal cancer. A draT program is available at
h=p://www.cosa2013.org/program/
Page 16
Issue No 14—April 2013
www.gha.net.au/grics
The GRICS Consumer Reference Group
The GRICS Consumer Reference Group has now progressed into the third year with membership growing and
commitment and enthusiasm remaining strong.
At the end of each year GRICS undertakes an evalua'on of the Consumer Reference Group. A snapshot of the findings
from 2012 evalua'on include;
100% of respondents either strongly agreed or agreed that they were;
•
Sa'sfied with their level of involvement with GRICS
•
Kept well informed while working with GRICS
•
Supported by GRICS in their consumer role
•
Not financially disadvantaged par'cipa'ng with GRICS
•
Able to be accommodated for their individual circumstances
•
Provided with adequate opportuni'es to contribute
•
Provided with educa'on at the mee'ngs that supported the work of the Consumer Reference Group
•
Sa'sfied with their role within the Consumer Reference Group and that the role was meaningful and met their
volunteering needs
The work undertaken within the GRICS Consumer Reference Group was presented in a poster at the Flinders Centre
for Innova'on in Cancer Survivorship Conference in Adelaide in February 2013.
In 2013 GRICS has engaged the Health Issues Centre to undertake an independent review of our consumer
engagement performance against current na'onal and Victorian standards, best prac'ce and benchmarks in health
services.
Co Managers
Kylie Halsall
[email protected]
5128 0075
Administra.ve Officer
Enza Wright
[email protected]
5128 0138
Cancer Service Improvement Coordinator
Peter Kevekordes
5128 0137
[email protected]
Cancer Service Improvement Coordinator
Michelle McKimmie
5128 0059
[email protected]
Cancer Service Improvement Coordinator
Kerrie Missen
5128 0062
[email protected]
Cancer Service Improvement Coordinator
Tennille Lewin
5128 0147
[email protected]
Cancer Data and Informa.on Analyst
Jody Neal
5128 0139
[email protected]
Louise Cristofaro
[email protected]
5128 0142
Page 17
Issue No 14—April 2013
www.gha.net.au/grics
OUT & ABOUT—CONSUMERS
Support Group Facilitator Update
Loss and Grief
Following on from a very successful support group facilitator update ‘Listen and Refer” in 2012, GRICS has invited the
Cancer Council Victoria to host another session this year focusing on Loss and Grief.
This is a free workshop open to all Cancer Support Group leaders, co-facilitators and consumer advocates.
Date:
Tuesday 7th May 2013
Time:
10am—3pm
Venue:
Latrobe Valley Community Mental Health Service, Building 3 – Conference Rooms 1 & 2,
Washington Street Traralgon
For further details or to register please contact:
•
Michelle McKimmie or Enza Wright—Phone 5128 0138 OR
•
Amanda Spillare Program Manager Cancer Informa'on and Support Service Cancer Council Victoria
Phone: 03 9635 5396
Mee.ng Informa.on for 2013
Time:
Place:
10am to 12.00pm
Gippsland Disability Advocacy Inc 8 Hopetoun Avenue Morwell
There may be 'mes in your role as a carer for someone with a disability, chronic
“Working to build a Regional Support illness, aged frailty, or mental illness, when you may feel overwhelmed and
Network for unpaid family
alone. That need not be the case! There are others out there just like you,
carers in all of Gippsland”
with whom you can share your experiences.
GCA’s Carer Support Group (CSG) was formed to meet the needs of unpaid carers. It seeks to enable carers—those who
give so much to others—the opportunity to enjoy friendship, and the support they deserve, from others who understand what they’re going through. We offer a sympathe'c, non judgemental ear.
Some'mes, a CSG mee'ng includes a guest speaker, or ac'vity. Some mee'ngs are more like social ou'ngs and may
take place in other loca'ons. If we have your email address, we can keep you posted on what’s happening for each
mee'ng. Otherwise, we recommend that you ring prior to the mee'ng for details.
Because we want members to get the most from the CSG we welcome your input. So please, feel free to let the
coordinator know what your interests are, as it may help us to plan future ac'vi'es. For further informa'on contact
Dot Kitwood on 0402 457 241, email: [email protected] or go to the
website: www.gippslandcarers.org
Mee'ng dates for the remainder of 2013 are as follows:
•
22nd May 2013
•
26th June 2013
•
24th July 2013
•
•
25th September 2013
•
23rd October 2013
•
27th November 2013
•
We look forward to seeing you!
28th August 2013