Associate Professor Lisa Hui is undertaking leading maternal health research at Northern Health.

Lisa’s research aims to study the effect of blood thinning medications on placental health, and the release of cell-free DNA from the placenta.

“We’re interested in this research question as many women are now using a revolutionary new prenatal screening test based on detecting placental DNA in the mother’s blood to detect fetal chromosome conditions. It has become apparent that women who are on blood-thinning medications are more likely to have a failed result because it somehow interferes with release of DNA from the placenta.”

Lisa and her team will be conducting experiments in the reproductive health bio-bank located at the Northern Centre for Health Education and Research (NCHER).

“We’re so excited about this project because it’s the first project that will be produced from our bio-bank, which we have established with the support of Northern Health and the University of Melbourne,” she said.

“I’m working with a reproductive health scientist, Associate Professor, Natalie Hannan from University of Melbourne, so we’ll be building up this bio-bank resource, build up research here in the laboratory and further promote research in women’s health at the Northern,” she said.

“So it’s sort of the flagship pilot project, and we’re hoping the bio-bank will lead to much more research here, particularly translational research which will be relevant to discovering treatments for pregnant women and babies.”

Lisa’s experiments will involve using placenta cultured cells to understand why blood thinning medications might affect how placentas develop and release DNA.

“One of our hypotheses is the reason there’s less DNA released is because the placental cells are actually healthier and not dying and turning over as quickly. We know that cell-free DNA is released when a cell dies so we’re hoping that by studying these cells in the lab, we might be able to discover any therapeutic or beneficial effects of these medications on placental growth,” she said.

“And if that’s the case, there’s potential for some of these medications to be used for prevention of pregnancy-related complications that are due to an unhealthy placenta.”

For the wider community, Lisa’s research may ultimately mean healthier pregnancies for women due to “prevention of severe complications like preeclampsia and fetal growth restriction, which are major causes of ill health in babies and pre-term birth.”

“We will also be studying newer medications that aren’t in current use in pregnancy, so we hope they may have some novel therapeutic role in pregnancy,” she added.

Lisa acknowledges the support she received, not only in the small research grant provided by the Northern Health Foundation, but also from Northern Health.

“The research grant is really crucial to getting our research underway here because it will help fund costs of the laboratory, medications and the collection of samples. We’ll be having a medical student help us with the project next year and we’ve had a student this year do a lot of the pilot work, so the small research grant helps fund these activities,” she said.

“Separate to the small research grant, Northern Health have also agreed to fund a halftime research midwife to support the recruitment of patients and the collection of samples for the bio-bank over the next five years, so it’s a huge undertaking.”

As Operations Director for Specialist Clinics, Carolyn Downing oversees our clinics at both Northern and Broadmeadows Hospital, as well as Craigieburn Centre.

She sees her role as supporting the teams for great patient care, and, with over 200,000 presentations to the clinics, to make sure “we get our patients to the right place at the right time”.

She started at Northern Health as a Registered Nurse in her graduate year in 1998 and soon realised Emergency Department (ED) nursing was her calling.

She completed her Graduate Certificate of Emergency Nursing while working in our ED, and then the Graduate Diploma Nursing Program here. Carolyn has also recently completed her Master’s in Public Health Management.

Over the years, she has seen the community physically grow and watched the complexity of presentations get higher.

“The complexity of our care is that the more our community grows and diversifies, the more services we need to offer, resulting in more patients coming to us for care,” Carolyn says.

She picked Northern for her graduate nursing as, at that time, “it was the only hospital that offered a stint in ED – which was where I wanted to be always, pretty much!”

“I got to meet a lot of the awesome ED nurses and really confirm this is what I wanted to do. I worked really hard to make sure I was welcomed back the year after!”

“At that time, there were only six applicants taken each year and it was a tough battle to get those roles, so it was really great when I got that role and was able to work with Annabel.”

Annabel Milonas is the Clinical Nurse Coordinator who oversees the postgraduate programs across Northern Health.

Carolyn says Annabel essentially taught her the extra knowledge that made her a certified Emergency Nurse.

“Annabel wasn’t just a teacher – she was my mentor in all facets, as all of us were relatively new to nursing and trying to have a life and study AND balance shift work.”

Besides Annabel, Carolyn also points to the senior nurses on the floor as big influences.

Carolyn says that good nurses generally do really well and make good choices, when thrown in the deep end.

“The true gold comes when you actually have the knowledge to back up the instincts that allow you to make and take the next step to being a better nurse – a more well-rounded nurse,” says Carolyn of the Postgraduate Nursing Program.

“It’s knowing why we do what we do, but also understanding that we can always improve.”

“I think that nurses who are attracted to ED, there is something in us that likes that unknown quantity – that every day is going to be different.”

She says her postgraduate education provided a framework to make good risk-based decisions with whatever is in front of her – “knowing that my decisions each day will be different, based on the different scenarios placed in front of me – such as staffing levels and the complexity of the patient.”

Carolyn is unequivocal in her support of the postgraduate certificate program. She says the nurses are really well supported by a wonderful group of educators, in addition to teams on the wards that want them to grow as nurses and be successful.

“Besides, Annabel is still there and continues to be a wonderful teacher and mentor!” adds Carolyn.

Applications for our Postgraduate Nursing Program are open 5 – 25 August 2019. Click here for more information. 

Northern Health is marking Dying to Know Day in the Northern Hospital foyer today, to change the stigma around talking about death by activating conversations and curiosity.

We welcomed Mr Andrew Giles, Federal Member for Scullin, to Epping Gardens Heritage Care and Northern Hospital.

While talking to one of our patients at Epping Gardens, Mr Giles said how important it is to have respectful care at the end of life.

“It’s important to have these conversations – it’s about the dignity for everyone. It means a lot to me to be able to talk to palliative care patients and understand their needs,” he said.

Bridget Senior, End of Life Nurse Lead, said this is a national initiative which has been running for around six years.

“The aim is to promote conversation about death, dying and bereavement. Today, we have representatives from advance care planning, organ and tissue donation, how to make a will, a coroner, social work, palliative care and community palliative care,” she said.

St Monica’s College STEAM team and their teacher Natalie Ilsley created the ‘Tree of Life’ activity for Dying to Know Day to promote conversation with staff and the community about what is important to them at end of life.

“The community wrote their wishes on the leaves that the STEAM class made and stuck it on the branches of the tree they created. It was a great discussion point throughout the day with the main focus being around the importance of family at the end of life,” Bridget said.

Jeff Vasquez from the Victorian Coroner’s Office said this is the first time a hospital has invited him to an event of this kind, emphasising that some people might have troubles around organising funerals and that all cultural sensitivities are carefully considered.

“This is the first invitation we received this year and we gladly accepted, as we are trying to increase our community engagement. It’s important for the community to know more about the coroner process. We are planning more roadshows in the community and I am glad Northern Hospital is the first place we visited,” he said.

Displays and information was provided by various teams including Social Work, Chaplaincy, Aboriginal Support Unit, Advance Care Planning, Organ Donation, TALS, Donate Life and Banksia Community Palliative Care.

The ‘Dying to Know’ initiative aims to encourage death literacy and provide a space to talk about end of life plans.

Dr Barbara Hayes recently spoke at the launch of two Office of the Public Advocate Guides on medical treatment decision making at the Carers Victoria, Dementia and Family Carers Conference. Launched by Colleen Pierce, Public Advocate from the Victorian Office of the Public Advocate, the guides cover five areas that relate to making medical treatment decisions for a person who lacks medical decision making capacity – to consent to their own treatment.

The areas covered are medical decision-making framework, the role of the medical treatment decision maker, using advance care directives, using the form, ‘What I understand to be the person’s preferences and values’ and medical treatment plans.

Dr Hayes chaired a Department Health Human Services, Working Group that developed resources for people who lack capacity to do advance care planning.  The Guides were some of the resources developed and have now been adopted by the Office of the Public Advocate.

Dr Hayes explains: “There is a clinician guide:  ‘A clinician’s to guide medical decision making:  for when the person lacks capacity to undertake advance care planning’. There is also a consumer guide, aimed at those who will need to make medical decisions for another person who is no longer able to make them for themselves, titled ‘A medical treatment decision maker’s guide: for when the person lacks capacity to undertake advance care planning’.”

Dr Hayes speaking at the launch said: “I was very pleased to be part of this work that addressed an area not covered by written Advance Care Directives alone.”

Barbara explains that many people choose not to write an Advance Care Directive. “Instead, they may have done oral Advance Care Planning, communicating their preferences and values to their Medical Treatment Decision Maker who must apply that knowledge to any decision.”

“The Guide for Medical Treatment Decision Makers helps those in that role better understand their obligations and how they should make decisions, recognising how hard it can sometimes be to make decisions for another. The Guide for Clinicians brings together the legal, the clinical, and the personal aspects of substituted medical decision-making, helping the clinician to better understand their role and responsibilities, and how to facilitate this decision-making.”

The Guides reflect experiences and teaching already in place by the Advance Care Planning Program at Northern Health. The program has been a leader in Victorian Advance Care Planning, with many other health services adopting the Northern Health ‘Advance Care Planning in 3-steps’ approach. This developed from research identifying the importance of a values-based approach to Advance Care Planning, particularly when our community is so culturally and religiously diverse.

“We needed an approach that was respectful of and captured that diversity. The three steps use the ACP mnemonic: Appoint Another; Chat and Communicate; and Put it on Paper, ” says Barbara.

Dr Hayes also has an extensive experience as a Palliative Care Doctor at Northern Health, and although not working clinically, Dr Hayes continues to be involved in research and teaching. This includes: trialling the NH Care of the Dying Patient Plan; supervising Registrar research exploring issues related to diagnosing dying, understanding of dementia and knowledge of the Medical Treatment Planning and Decisions Act; a study looking at RACF patients who die within 24hrs of transfer; an NHMRC study led by A/Prof Kwang Lim at Melbourne Health that aims to improve palliative care for residents in Aged Care Facilities and uses a RACF Goals of Care developed by Dr Hayes in collaboration with NH Aged Care clinicians; and the Melbourne Ageing Research Collaborative’s end-of-life care research.

Copies of ‘A clinician’s to guide medical decision making’ are available here and ‘A medical treatment decision maker’s guide’ here and at the Northern Hospital Library.

Over the last financial year, again we’ve experienced strong growth in our services with emergency department presentations up 8.4% and hospital admissions up 4.6%.

At the beginning of this new financial year, we’ve needed to focus on our budgets to plan our activities and operations to support this continued growth.

As a significant public health care provider, we are entrusted with hundreds of millions of taxpayer dollars each year to deliver patient care. It’s our responsibility to ensure that these resources are spent wisely.

I believe that there is still significant waste across our services that we need to address. We need to look in each of our areas to ensure that the work practices are appropriate and that we are eliminating waste – freeing up resources to maximize patient care and to live within our means.

I encourage you to share ideas within your wards and departments and speak with your Directors when you need support.

As an example – we have been hearing for months about the shortage of IV/syringe pumps across our sites. Each day at the Safety Huddle, we were told there were not enough available. Last week I walked around Northern Hospital and found that numerous pumps were locked away in ward cupboards. Software built within the pumps confirmed that over 100 pumps in clinical areas were not being used.

I encourage everyone to be considerate of others by sharing equipment that’s not in use.

Northern Health Payroll – My Pay

This week we have completed transitioning Payroll from Melbourne Health to Northern Health with minimal disruption.  This is a significant change for Northern Health that will provide improved quality and efficiency, as well as a better service for staff. Congratulations to the People and Culture and Finance teams for all the planning and work in making the change so successful.

I hope you all have a great week ahead.

Northern Health is celebrating World Breastfeeding Week with a foyer display and an afternoon tea held today at Ward 11.

World Breastfeeding Week encourages mothers to breastfeed to help their baby grow healthy and strong.

“We understand while breastfeeding is natural for the baby, sometimes mothers may need more support, so this week is a great opportunity to raise awareness of Northern Health’s Specialist Breastfeeding Clinic and the support services available to mothers within the northern community”, said Natalie Mckell, Clinical Coordinator, Domiciliary and Lactation.

The Specialist Breastfeeding Clinic provides information, assistance, education, reassurance and counselling on breastfeeding and infant feeding issues.

“Northern Health has four lactation consultants available to assist mothers and staff with breastfeeding issues, and mothers needing additional support and advice are able to see a lactation consultant as an outpatient after being discharged from hospital,” she added.

Mothers can discuss any questions about infant feeding, breastfeeding, sleep patterns and settling techniques, or any other aspects of parenting.

“Our midwives and lactation consultants work hand in hand with our families to support successful breastfeeding outcomes,” Natalie added.

The Specialist Breastfeeding Clinic also holds breastfeeding classes on alternate Wednesday and Friday at Northern Hospital Epping and alternate Thursday at Craigieburn Centre.

Grateful for the care James Furletti received at Northern Hospital Epping after being diagnosed with bowel cancer, he wanted to say thank you by donating a gold nugget to the Northern Health Foundation.

“My experience here was unbelievable, I had really good care. I couldn’t be any happier,” he said.

He came to Northern Health late September last year, and had bowel surgery in October.

“I had surgery and then spent some time in the Intensive Care Unit. The care was just fantastic and I feel really good now,” he said.

The doctors here saved my life and I wanted to show my appreciation to the hospital by giving a nugget. The doctors said the Foundation can receive a gift of that kind and I was happy to donate,” he added.

Jimmy, as he prefers to be known as, started looking for gold in 2006. His son in law gave him a gold detector and after finding the first nugget, he has been looking ever since all over Victoria, but mostly around Bendigo.

“I would like to see the money from this gold spent on oncology. It’s not worth millions, but can help someone,” he added.

James in now nearly 80 years old and plans to keep looking for gold, at least once a week.

“I can’t wait to get out in the bush again. I spend around 8 hours a day in the bush and it’s something I enjoy doing.”

Choosing Wisely is a global initiative aimed at reducing unnecessary tests, treatments and procedures and empowering consumers to ask questions about their healthcare management. Northern Health joined the year-long Choosing Wisely Victorian Collaborative in July 2018.

Northern Health implemented several projects to address these objectives including reducing CT Pulmonary Angiograms (CTPAs), coagulation studies and ultrasounds unnecessarily ordered.

Sandy Ayoub, Project Manager for this initiative, says Choosing Wisely is a simple, broad and extremely valuable concept in healthcare.

“We are always looking to be more efficient, and that is the primary object of Choosing Wisely.”

“By implementing evidence-based practice to reduces unnecessary tests and treatments, we can reduce waste and financial burden on patients and the organisation, as well as avoid unnecessary stress on patients. It’s a no-brainer,” Sandy said.

Among the significant achievements was a 32% reduction in unnecessary coagulation studies and a 36% reduction in unnecessary CTPAs ordered in our emergency department. This has doubled the percentage of appropriately ordered CTPAs scans from 29% to 64%.

Sandy also explained how the NPS MedicineWise 5 Questions empowers patients to ask questions about their tests, treatments and procedures.

“Clinicians appreciate this because it promotes conversations between the patient and clinician,” she said.

“It has been a great experience to see how Choosing Wisely can improve clinical practice and it’s exciting to think of all the different areas which would benefit from Choosing Wisely,” she added.