/ CHHS16/184

Canberra Hospital and Health Services

Operational Guideline

Women’s Health Service Nursing Services

Contents

Contents

Introduction

Scope

Background

Key Objectives

Section 1 – Referral Process into WHS

Section 2 – Registration of Clients

Section 3 – Client Contacts

Section 4 – Documentation

Section 5 – Registered Nurse Scope of Practice

Section 6 – Nurse Practitioner Scope of Practice

Section 7 – Culturally and Linguistically Diverse (CALD) Liaison Nurse Scope of Practice

Section 8 – Management of Pathology at WHS

Section 9 – Clinical Outreach

Implementation

Related Policies, Procedures, Guidelines and Legislation

References

Search Terms

Introduction

This guideline outlines the operational processes applicable to Women’s Health Service (WHS) nurses working within ACT Health.

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Scope

This document is applicable to all nursing staff at Women’s Health Service, ACT Health working within their scope of practice as defined in Sections 5, 6 and 7 of this document.

WHS nurses work in collaboration with the WHS nursing, medical and counselling teams to achieve best outcomes for clients.

Registered Nurses (RNs) must have completed the Family Planning NSW Reproductive and Sexual Health Clinical Accreditation Program (RSH-CAP) or equivalent prior to undertaking any tasks that relate to sexual and reproductive health care delivery.

Eligible Clients of WHS

WHS sees women of all ages who have significant difficulties accessing health services due to the impact of:

  • violence
  • abuse or neglect
  • identifying as being of Aboriginal or Torres Strait Islander origin
  • language or cultural barriers
  • homelessness or risk of homelessness, for example, staying in a refuge or couch surfing
  • mental health issues
  • substance abuse issues
  • disability
  • sexual identity issues
  • 25 years and younger
  • financial hardship, for example, being subjected to economic abuse or limited access to health services due to financial reasons.

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Background

WHS nurses provide universal and opportunistic screening to women. Each consultation is approached with respect and sensitivity, recognising that women’s past lived experiences influence their health and wellbeing. WHS nurses have a heightened awareness of the cues that women may exhibit of past-trauma during a consultation and provide care accordingly.

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Key Objectives

To ensure consistent and evidenced based service delivery by WHS nurses within ACT Health.

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Section 1 –Referral Process into WHS

1.1 Self-Referral

The majority of clients self-refer to nursing services within WHS. ACTPAS referrals are created by the administrative team when the client books an appointment or attends a drop-in appointment.

1.2 Assisted Referral

Assisted referrals are those referrals where the client is assisted in making an initial appointment by another service, a family member or friend. Although this is not the preferred mode of entry, it is recognised that at times it assists access.

1.3Inter-professional Referral

Other professional team members within WHS, may make an internal referral to any of the nurses within WHS, using the Request for Service form, which can be found on in the ACT Health Clinical Record Forms Register, Barcode 25062. The referring clinician creates a new referral in ACTPAS which includes the name of the service the client will be referred to; the referring person and also completes the WHS criteria tab on eligibility. A client’s verbal agreement to this internal referral must be obtained.

1.4Closing ACTPAS Referral

Once an episode of care is complete, it is the responsibility of the clinician to close the ACTPAS referral. The episode of care is deemed complete when all care needs are completed and if necessary duty of follow-up care has been transferred to another health professional.

1.5 Intake Statistics Sheet

All new Interprofessional referrals are documented on the Intake Stats sheet, which is located on Q:\CY&W\WomHlthServ\Service Delivery\Client Information\Intake. The exception to this rule is interprofessional team members to WHS RN Well Women Clinics. The appointment outcome should be noted on the Intake Stat Sheet after the completion of the initial appointment.

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Section 2 – Registration of Clients

2.1 New Clients

A clinical record is created by the administrative team at WHS for each new client. New clients complete the ACT Health, Client Registration Form WHS prior to being seen by the clinician. The WHS administrative team will request the client complete this form initially, and every 12 months thereafter. The client will receive a copy of the ACT Health brochures, Australian Charter of Healthcare Rights and the ACT Health, Health Records (Privacy & Access) Act 1997. It is the responsibility of the administrative team at WHS to provide the client with these brochures.

2.2 Returning Clients

It is the responsibility of the administrative team at WHS to locate the clinical record for the client and request the client complete a new Client Registration Form. A new ACT Government Health Directorate, Consent to Collect and/or Share Personal Information is completed and signed every 12 months. It is the responsibility of the health professional first seeing the returning client to ensure a new Consent to Collect and/or Share Personal Information is signed by the client and health professional.

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Section 3 – Client Contacts

3.1 Clinical Face-to-Face and Phone Contacts

Evidence of clinical face-to-face contact is noted in the Record of Care section of the clinical record in the progress notes, and is recorded in ACTPAS. The clinician seeing the client is responsible for doing this.

Evidence of phone contact regarding a clinical issue only (not rescheduling) is noted in the clinical record in the progress notes, and recorded in ACTPAS. Attempts by the nurse to contact the client may be noted in the clinical record in the progress notes, but are not recorded in ACTPAS.

3.2 Appointments

The RN has two types of booked appointments available. The first is the Well Women’s Appointment, which is a general preventative health screen, including cervical screening. This appointment is booked for 60-minutes. The second is a more opportunistic and client-specific consultation to consider preventative health with screening and for health coaching. This can be booked for 30- or 60-minutes, depending on the client’s clinical need(s). There also is the opportunity for clients to attend RN drop-in appointments, in which health issue(s) are identified, triaged, referred and managed. Screening and health coaching are also available during these appointments.

The Nurse Practitioner (NP)initial clinic appointment isbooked for 60 minutes, with follow-up appointments of either 30-minutes or 60-minutes, depending on the client’s clinical need(s). The NP has 30-minute drop-in appointments available on each clinical day.

3.3DidNot Attend (DNA) Booked Appointments

New clients to WHS who do not present for their initial appointment do not receive a DNA letter. Returning clients, or clients where a clinical issue may be noted in their clinical record, receive one DNA notification letterif there is evidence in the file that it is safe to sendmail to their place of residence. This safety precaution relates to the high proportion of WHSclients who are impacted upon by violence, abuse andneglect.

Where the NP receives an assisted referral from another health care provider, a courtesy letter is sentto the referrer, if the client DNA’s theinitial appointment.

3.4 Indirect Contacts

Indirect contacts must be documented in both the clinical progress notes as well as in ACTPAS. Indirect contacts include activities that relate to clinical care, however do not include the client specifically. Examples include, referral letters, support letters, collaboration and case conferences with other professionals.

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Section 4 – Documentation

4.1 Women’s Health Assessment Form

The WHS Women’s Health Assessment form is an approved clinical form used by the RNto both guide and document the clinical consultation during a Well Women’s Clinic appointment. It is located on the ACT Health clinical forms register. The ACT Health Progress Notes may be used for all other documentation purposes.

4.2 Care Plans

Ideally all WHS clients will have a care plan developed in collaboration with the client and health professional(s) involved. There are however times when a client is only seen as a one-off episode of care, and in these instances the care plan may not be completed. The ACT Health Service / Care Plan, Barcode 65000 is a generic care plan that meets the needs of WHS clients.

4.3 Request for Service

The WHS Request for Service form is used to documentinternal interprofessional referrals and key clinical information. The referring health professional or WHS Intake worker completes this form. It is located on the ACT Health clinical forms register. The completedRequest for Service form is put into the Intake Folder for review by the Intake Team.

4.4 Handouts

Due to the diverse health issues of the WHS client population, a number of external evidence based resources are used. All are from reputable and evidenced based. A full list of the clinical resources used to both guide clinical practice and of reputable and evidence based handouts for clients, is available in the WHS Essentials of Care document.

4.5 Culturally and Linguistically Diverse (CALD)Project Management Plan

The CALD Liaison Nurse (CLN) has developed a project management plan. This plan has been approved bythe Director, Women Youth and Children Community Health Programs. This plan is saved:Q:CH\CY&W\WomHlthServ\Service Delivery\FGM-CALD project\FGM project plan current\Project Management Plan\Program Management Plan

4.6 CALD/Female Genital Mutilation (FGM) Minutes

Monthly CALD project meetings are held at WHS to discuss project progress. These meetings are attended by CLN, WHS Manager, NP and Office Administrator. The CLN is the chair of this meeting. Minutes are saved: G:\CY&W\WomHlthServ\Operational\Meetings\FGM-WHS Project meetings.

4.7 CALD Progress Reports

The CLN provides six monthly progress reports to the Manager, WHS and Director, Women Youth and Children Community Health Programs. These are saved: G:\CY&W\WomHlthServ\Service Delivery\FGM-CALD project\FGM project plan current\Progress Reports

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Section 5–Registered Nurse Scope of Practice

WHS RNmust completethe Family Planning NSW Reproductive and Sexual Health Clinical Accreditation Program (RSH-CAP) or equivalent prior to undertaking any tasks that relate to sexual and reproductive health care delivery.

5.1Referral Processes by WHS RN

5.1.1 Clients of Women’s Health Service

WHS RN will refer allclients whose history, assessment, clinical examination findings or pathology result(s) suggestan abnormal symptom/issueto a NP and/or Medical Officer (MO).

Procedure:

  • The need for medical review will be fully explained and the client will be informed of the referral process.
  • The client will be encouraged to take responsibility for her own health care by making an informed decision considering her needs.
  • A copy of the referral letter will be kept in the client’s health record.
  • The referral letter will be faxed to the client’s nominated general practitioner (GP) and/or given to the client to take to her GP onthe day of her consultation.
  • If the client does not have a specific GP, but rather attends a general practice, or ‘silo model’ medical centre, the referral letter will be faxed to thepractice.
  • All faxes require receipt of confirmation and/or phone call to the practice to confirm receipt.
  • Assistance may be provided to a client without a regularGP to find a GP, or to find a GP that is deemed more appropriate for the clinical issue.
  • Clinical case review of all clients referred to the GP will be discussed with either the NP and/or MO at the WHS Discipline Specific meeting each week.
  • A client, who does not have a GP or identified medical practice, may be referred to the WHS NP and/or MO. A description of the issue for review will be recordedin the progress notes and a Request for Service will be completed. If the RN is at an outreach location, the progress note will be faxed to WHS to be placed on the woman’s file.An appointment will be made at the initial consultation by the RN or Administration staff, and added to the Intake Stats Sheet.
  • Referral to a public hospital outpatient clinic (i.e. emergency department or Canberra Sexual Health Clinic) is appropriate ifthe RNdetermines the medical nature of the issue is highly acute, and thereis no option for medical review by client’s own GP, general practice, other local GP, or WHS NP or MO within an appropriate timeframe.
  • If the RNis concerned about the most appropriate medical management plan for the client, the RNcan discuss this with the WHS NP or MO. If the WHS NP or MO is not available, discussing with another doctor, whether community based or hospital based, would be appropriate.

5.1.2 Clients of Canberra Hospital & Health ServicesAlcohol & Drug Program

A Memorandum of Understanding between WHS and ADP has been signed and aligns with the following procedure.

WHS RN will refer all clients of the Alcohol and Drug Program (ADP) who do not have a regular GP, and whose Pap smear result is abnormal and requires gynaecology review to the WHSNP or MO.

Procedure:

  • The procedure for follow-up of symptomatic clients will be the same as described in 5.1.1 with the following additions:
  • The WHS RN will copy pathology results to the most recent ADP prescribing doctor
  • Pap smear recalls will be documented and stored in Q:\CH\CY&W\WomHlthServ\Service Delivery\Client Information\Recall\ADP Recalls.

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Section 6 – Nurse Practitioner Scope of Practice

The WHS NP’s scope of practice is primary health care. A copy of the NP’s most recent Nurse Practitioner Clinical Practice Guidelines, can be found on the ACT Health website>Health Professionals>Nursing and Midwifery Office>Nurse Practitioners>Nurse Practitioner Information.

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Section 7– Culturally and Linguistically Diverse (CALD) Liaison NurseScope of Practice

The CLN plans and delivers health promotion initiatives to CALD women and provides training around CALD issues to health professionals.

The CLN works with CALD communities to identify and address women’s health issues in a culturally appropriate and sensitive manner. The framework that guides this work is The ACT Health Multicultural Framework and The Ottawa Charter for Health Promotion. The CLN uses a community development model to empower and enable communities to increase control over and improve their own health.

The targeted communities are those affected by female genital mutilation/cutting (FGM/C).

Bicultural Worker Role

Bicultural Workers (BCW) work specifically with people or communities with whom they share similar cultural experiences and understandings, and use their cultural skills and knowledge to negotiate and communicate between communities and service providers.

The BCW will assist the CLN at WHS to:

  • Better understand and work more effectively with people from specific CALD backgrounds
  • Better meet the health education needs of the specific CALD community
  • Liaise and develop rapport with the specific CALD community
  • Actively promote the CALD health promotion project to the specific CALD community
  • Recruit members from specific CALD communities to participate in focus groups/community consultations
  • Conduct/facilitate focus groups/community consultations with women from the specific CALD communities
  • Assist with piloting health promotion sessions
  • Review resources to inform the specific CALD community of women’s health issues
  • Facilitate culturally appropriate health promotion sessions.

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Section8 – Management of Pathology at WHS

8.1 Pathology Tests permitted to be ordered by RN at WHS

Note: The RN who is ordering the test is responsible for follow up of results

List of Pathology Tests:

  • Chlamydia and gonorrhoea PCR – endocervical swab, vaginal swab or first void urine, ano-rectal swab
  • HIV antibody
  • Syphilis EIA
  • Hepatitis B surface antibody, surface antigen, core antibody
  • Hepatitis C antibody
  • Pharyngeal PCR for gonorrhoea if sex industry worker
  • Pap Test
  • Thin Prep and HPV DNA Test of Cure when indicated
  • High vaginal bacterial culture swab (M,C & S) when symptomatic of vaginal discharge and prior to treatment for gonorrhoea
  • Test of Cure, Test of Re-infection and Contacts: testing for chlamydia, gonorrhoea, mycoplasma genitalium following treatment, and for asymptomatic contacts.

Serum BHCG Testing conducted by WHS RN

RN working in WHS is permitted to order serum BHCG in the following clinical situations:

  • Urine BHCG equivocal
  • Client is unable to void, and has a delayed menses of ≥ 7 days
  • Urine BHCG negative, and delayed menses of ≥ 2 weeks
  • Urine BHCG negative, with signs and symptoms of pregnancy, such as:
  • Missed period
  • Sore breasts
  • Nausea and/or vomiting.

8.2 Specimen Management at Outreach Locations

  • Specimens are labelled using the client’s full name, DoB and postcode.
  • Specimens are transported back to WHS.
  • The RN will give the files to the administrative team to make up files and labels.
  • Once the file has been processed, client identification labels are placed on the specimens, medical records, and pathology forms.
  • If necessary, call ACT Pathology courier to collect late pathology specimens.

8.3Processing Pathology Results at WHS

Results faxed to WHS from ACT Pathology

  • Positive results for notifiable sexually transmitted infections (STIs)are usually faxed prior to the issue of a final printed copy.
  • Administration staff place any faxed result at the front of client’s file and give the file to a RN who will:
  • Enter the result in the client’s file
  • Provide the file to the NP or MO and notify them of the resultor, in their absence, ensure that appropriate management is initiated.
  • The clinician will plan and document further management.

Results phoned through to WHS from ACT Pathology

  • Urgent pathology results, including positive results for notifiable STI, may be phoned through to WHS by laboratory staff prior to issue of a printed result.
  • Nursing or Medical Staff are to take the call, and after confirmation of the client’s name, URN number and date of birth:
  • Enter the result in the client’s file, documenting;
  • Date and time of phone call
  • Result
  • Site of infection
  • Name and extension number of person giving result.
  • Provide the file to the NP or MO and notify themof the resultor, in their absence, ensure that appropriate management is initiated.
  • The NP or MOwill plan and document further management.

Initial review of all final paper copy results