Prepared by Rebecca Kemp

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NSW Amputee Update
Prepared by Rebecca Kemp February 2006
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Update of Progress in Implementation of Review
Recommendations

• CGRG Achievements
• Guidelines for Amputee Care
• Rigid Dressing Guideline
• Outcome measures for ALS clinics

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Clinical Guidelines Reference Group

• Convened in May 2005 to to advise the NSW Health
  Department on the development of clinical
  guidelines for amputee care in NSW and benchmarks
  for quality care.
• Consisted of experts in the field of amputee care
  with representatives from rural metro,
  paediatric adult, professional consumer,
  upper lower limb.
• Over seven meetings discussed the eight Review
  recommendations related to amputee care the
  ALS.
• Tenure of the CGRG is complete and the objectives
  have been achieved.

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Achievements

• Recommendation 1 (Guidelines for integrated
  amputee care)
• Consistent minimal level of care throughout NSW.
  
• Allow each area to improve on their present
  performance.
• Are distributed to all stakeholder groups for
  comment and consideration.
• Recommendation 2 (Surgical representation)
• Representative from the Royal Australasian
  College of Surgeons has supported all decisions
  made by the CGRG and provided invaluable advice
  from the surgical standpoint.

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• Recommendation 3 (Rigid Dressings)
• Recommended the use of rigid removable dressings
  in the acute post-operative management of lower
  limb amputees.
• A policy guideline is in the final draft stage
  and a training program for staff is being planned
  to accompany its publication.
• Recommendation 4 (Mechanical Interim Prostheses)
• Lower limb trial at John Hunter and Westmead
  Hospitals.
• Aim is then to implement these programs in all
  hospitals performing amputations.
• Presently providing upper limb prostheses made by
  prosthetists instead of O.T.s at Prince of Wales
  Westmead.

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• Recommendation 6 (Quality management)
• Mapping exercises have been conducted to evaluate
  present services in NSW prior to advising
  changes. The results are being analysed
  currently.
• Data collection sheet included in rigid dressing
  guideline.
• AusTOMS outcome measure for upper limb clients.
• Minimum data set and benchmarking system.
• Recommendation 10 (Surgery)
• Strong support for this recommendation that
  amputations are performed or supervised by senior
  surgeons experienced in amputation surgery.

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• Recommendation 11 (Surgical support of ALS model)
• The representative from the Royal College of
  Surgeons has supported the recommended amputee
  service model.
• Recommendation 13 (Pre-amputation consultation)
• Supported by the CGRG.
• Included in the NSW Health Guidelines for
  Amputee Care.
•  
• The Amputee Advisory Committee (previously
  the PAC) will supervise the conclusion of those
  projects initiated by the CGRG which have yet to
  be concluded.

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NSW Health Guidelines for Amputee Care

• Being distributed to all stakeholder groups
  AHS, professional organisations, consumer
  groups, amputee interest groups, members of AAC
  and CGRG.
• Closing date for comments and suggestions is 14
  April 2006.

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Rigid Dressing Guideline

• Developing a training program to accompany the
  publication of the guidelines.
• Testing some training in St Vincents Hospital in
  Sydney in March.
• Use of data collection sheet even if rigid
  dressings arent used.

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Outcome Measures

• Introduction of five outcome measures to the ALS
  outpatient clinics - Locomotor Capabilities
  Index
• - Timed Get Up Go (physio)
• - K-classification (prosthetist)
• - Satisfaction with Prosthesis measure
• - SMAF functional outcome measure (physio)
• Intend to provide training to all clinics.
• Views on abilities of admin staff to perform LCI
  Satpro.