Post on 04-Jan-2016
description
SNAPScottish National Audit Project
CE BucknallChair, Bicollegiate Physicians Quality
of Care Committee, on behalf of project team
SNAP
• Health Foundation funded (EwQ initiative)
• Community acquired pneumonia
• Epilepsy
• Long term aim – a model for quality improvement for medical topics
Epi-SNAPImproving the quality of annual review for epilepsy patients in primary care
Quality of Outcomes Framework awards points for annual reviews which:
Record seizure frequency Undertake medication review
Epi-SNAP: Protocol which targets poorly controlled Guidance for exemption coding Patient information leaflets with Epilepsy
Scotland
Collaborated to adapt SPICE* software epilepsy screens,used by approx 1/3rd of Scottish GP practices
*Scottish Programme for Improving Clinical Effectiveness
Epi-SNAPFirst Seizure Clinics
Problems:poor quality of referrals
poor documentation of driving advice (medicolegal obligation)
Electronic First Seizure Service referral template – forces
referrer to document driving advice
Fast track appointments for professional drivers
Re-audit started 1st October
SNAP-CAP: Care bundle
• key aspects of care, linked to evidence
• delivered by a single team over a short period of time
• Influenced by parallel policy of SPSA & possibility of benefiting from developing experience of hospitals using these
SNAP-CAP
Care bundle of key items1. severity scoring using CURB652. Management guided by severity 3. first antibiotic dose within 4 hrs4. Oxygen saturations ≥ 92% during first 4
hours
Monthly monitoring & feedback Small changes in practice in response
to data, using PDSA technique
Antibiotics within 4 hours
0
20
40
60
80
100
120
minimum
maximum
average
Bundle Compliance
0
20
40
60
80
100
120 D
ec-
06
Fe
b-0
7
Ap
r-0
7
Jun
-07
Au
g-0
7
Oct
-07
De
c-0
7
Fe
b-0
8
Ap
r-0
8
Jun
-08
minimum
maximum
average
Examples of Practice Changes
Having appropriate antibiotics (& formulations) in A&E
Writing up first dose as “once only”
Fast tracking patients for X-ray
System for enabling home Rx of mild CAP cases
Telephone follow-up of discharged patients
Electronic referrals Structured/targetted
annual review
Hyperlinks to Patient information leaflets
SNAP-CAP:practical Epi-SNAP:structural
Challenges
Persuading clinicians that monitoring the process of care is important
Rapid turnover of junior & middle grade staff (4 monthly) Collecting bundle data in real time (Unavoidable) delays involved in consulting with national
bodies (eg electronic referrals, changes to GP data monitoring screens)
Engaging managers in non priority topics In hospital: building useful prompts into systems which
are still largely paper based
SNAP: secondary objectives
• Sharing experience in a network with other HF projects
• Developing professional leaders• Ensuring sustainability – start-up packs,
organisational prompts, long term “home” within quality organisation in NHS in Scotland,
• Identifying problem areas early using a mapping process
Version 6 March 2008
Project: My NAME: DATE OF COMPLETION:
HEALTH FOUNDATION Engaging With Quality Programme Scottish National Audit Project Š
Community Acquired Pneumonia (SNAP-CAP)
Produced by John.Bullivant@bradford.nhs.uk
07775524390
The Matrix identifies ten ke y areas for individual and collective attention in delivering the pr ogramme. In relation to each element try and assess your own perspect ive on the level to which you believe the progr amme or you ha ve progressed. If you feel you have not yet reached basic leve l, mark the NO column. Revisit at regular intervals. Please mark the form with O for current pos ition and draw arrow-- to place you expect to be achieved in next 6 months. Id the project, your name a nd date at top and return to address given in letter or John Bullivant. All return wil l be anonymised for analysis and presentation
Example
planned position in six months FUTURE Progress
Key Elements No
Basic level Š agreement of commitment and direction
Firm progress in development Maturity Š impact achieved and reviewed
1. I believe the overall purpose to improve patient experience in appropriate care setting is being achieved
_
Purpose and best care setting debated and agreed; Priorities expressed
Targets and priorities agreed with stakeholders and plans in place, confidence in delivery
Evidence that targets and priorities are being met and review in place
2. I think our interventions are achieving specific intended outcomes
_
Project has specific outcomes agreed, described & measurable in terms of quality improvement
Plan in place to achieve specific objectives, record and share outcomes
Plan in place to spread experience and knowledge supporting others to improve
3. As a stakeholders to programme I am getting a return on my commitment (ROC) for my organisation / consituency
_ Clarity of who stakeholders are; I have thought about and expressed my expectations on behalf of my organisation or constituency
My expectations have been recognised and either accommodated within the plan, rejected or parked
Individual stakeholder members expectations have been met and shared with their constituency.
4. I think contributors believe the programme is having an impact on clinical practice in Scotland
_ Clear plan in place to influence clinical practice in Scotland. Drivers for change identified
Messages from programme is getting to those people or drivers with influence on clinical practice in Scotland
Clinical practice in Scotland has changed as a result of the programme. Impact on policy achieved
Maturity Matrices have been developed under license from the Benchmarking Institute
now
Royal College of Physicians and Surgeons of Glasgow
Getting started with small number of committed sites & evolvingSimple data entry systems / prompt feedback Collaborating with other agencies & health policy initiatives (Scottish Patient Safety Alliance)Feedback has some impact, but we need to incorporate quality reminders into system of care – not easy in Acute Medicine (paper based system;huge variety of caseload)Different approaches needed for different topics but adapting existing policies & practices to add value in terms of quality is the essence of the model which emerges.
Lessons Learnt