Prepared by Rebecca Kemp February 2006

1. NSW Amputee Update Prepared by Rebecca Kemp February 2006

2. Update of Progress in Implementation of Review Recommendations CGRG Achievements Guidelines for Amputee Care Rigid Dressing Guideline Outcome measures for ALS clinics

3. 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.

4. 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.

5. 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.

6. 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.

7. 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.

8. 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.

9. Rigid Dressing Guideline • Developing a training program to accompany the publication of the guidelines. • Testing some training in St Vincent’s Hospital in Sydney in March. • Use of data collection sheet even if rigid dressings aren’t used.

10. 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.