Achieving High Reliability in Healthcare - 1000 Lives Plus · PDF filefor Megan’, 1000...
Transcript of Achieving High Reliability in Healthcare - 1000 Lives Plus · PDF filefor Megan’, 1000...
Achieving High Reliability in Healthcare Aneurin Bevan Health Board
National Learning Event – 8th November 2012
ABHB Vision
The vision statement for Aneurin Bevan
Health Board is:
• Working with you for a healthier community
• Caring for you when you need us
• Aiming for excellence in all we do
ABHB – Achieving High Reliability in Healthcare – Nov 2012
ABHB Aims – Reducing
Mortality and Harm
• Aim: To have a RAMI in line with top
performing UK organisations and eliminate
seasonal and weekly variation in RAMI by
June 2013
• Aim: To establish the Global Trigger Tool as a
measure of patient harm and reduce adverse
events per 1000 patient days to 10 by June
2013
ABHB – Achieving High Reliability in Healthcare – Nov 2012
CHKS Risk Adjusted
Mortality Index (2012)
Mortality & Harm Group overview of:
• RAMI, Mortality Rate, Raw Mortality
• 30 day condition specific mortality (MI,CHF
#NOF,Stroke,Septicaemia,Pneumonia)
• Drill down to specific areas of work eg.
Pneumonia, Sepsis
Mortality Reviews
• At RGH & NHH , plans to spread to YYF
• Global review of all deaths at NHH
• Engaging with individual consultants
• Testing condition specific reviews in
RGH (Sepsis)
ABHB – Achieving High Reliability in Healthcare – Nov 2012
Adverse Events per 1000
Patient Days
ABHB – Achieving High Reliability in Healthcare – Nov 2012
GTT currently carried out
in RGH and NHH.
Harm study carried out at
both sites
• The 1000 Lives Steering Group
– representation from all Divisions and
Localities
– aims to embed the priorities for reducing
mortality and harm
• receives presentations from each of
the mini-collaborative areas
– embeds the spread of interventions in the
Divisions and Localities
– measurement system for all the
interventions, ABHB-wide.
• New priorities/drivers to reduce
mortality/harm
– identified through triangulating data from
concerns, mortality review and CHKS data
– interventions developed for further change
Priorities for Reducing
Mortality and Harm
• MEWS to NEWS
• MEWS in the Community
and Mental Health
• RRAILS and SEPSIS
• Fractured Neck of Femur
• Falls in Hospital
ABHB – Achieving High Reliability in Healthcare – Nov 2012
Taking the Driver Diagram
Forward
Aneurin Bevan Continuous Improvement • Core business of
healthcare is to deliver high
quality, safe and reliable
services
• is the ABHB centre
for improvement which will
seek to achieve the above
by developing a culture of
quality improvement where
innovation and creativity
are valued
It will do this by:
• Identifying, developing and
supporting leaders
• Training the workforce in
improvement methodologies
• Supporting ABHB and
divisional improvement
projects
• Resourcing best practice
ABHB – Achieving High Reliability in Healthcare – Nov 2012
Aneurin Bevan Continuous Improvement • will pull together existing
work such as ‘Every day counts
for Megan’, 1000 Lives Plus
• Project alignment with Health
Board and National priorities
Divisional project agendas driven by
clinical teams supported by:
• Quality improvement training
• Support for project design
• Coaching leaders
• Resourcing best practice
• Timely meaningful data
Structure for
• Director – Dr Danny Antebi
• Programme Manager
• 4 Workstream Leads
– Leadership
– QI Training
– Project Support
– Resourcing best practice
• team of Associates and
Affiliates
ABHB – Achieving High Reliability in Healthcare – Nov 2012
100,000 Bed Days:
Everyday counts for Megan
Guiding Principles
• People who don’t need to be
admitted to hospital receive
their care in community
settings
• People who need to go into
hospital receive safe,
effective care as quickly as
possible
• People who are ready to
leave hospital are supported
to return home safely, and
without delay
ABHB – Achieving High Reliability in Healthcare – Nov 2012
QI programme contributing bed days 100KD initial scope
1000 Lives +
Safe Timely Return Home (STRH) √
Fractured Neck of Femur (NOF) √
Hospital Acquired Infection (HAI) √
Enhanced Recovery After Surgery (ERAS)
√
Chronic Conditions – Cardiac Failure
√
Chronic Conditions – Diabetes
Chronic Conditions – Chronic Airways Disease
Frequent Service Users
Gwent Frailty Programme
Safe Timely
Return Home
Wards
C4E & C4W
Driver
Diagram
Patient Centred
Care
Patients with dementia
Operational
efficiency
Patient safety
Patient & family engagement in
discharge planning process
Admission avoidance e.g. dementia
without physical ill health
Bed our outliers on the gastro unit
Management of Mental capacity
Identify patients who should not be in
hospital
Bed our admissions on the gastro wards
Improve planning work with
community/social services
Streamline referral processes e.g. to
therapies
Improve our MDT planning & comms
processes
Engagement with community services
for patients with alcohol related
problems e.g. alcohol induced dementia
Staffing levels appropriate to acuity
Ensure patients get the right
investigations at the right time
Inappropriate patient transfers to non
specialist ward areas
Manage patients as Virtual IPs where
tests & investigations can be done as
OP
Identify patients who should not be in
hospital
Patient/family experience feedback on
discharge planning process
Nursing handover – improve comms
e.g.
Implement PSAG & PfEP
Morning board rounds
Nurse on each ward round
Senior medical presence on ward
everyday – review job plans
Shift allocation of nurses
Staff education on discharge planning,
LA services & CRT function
Discharge planning from Day 1
Clinical
Effectiveness
Everyday counts for Megan: Safe
Timely Return Home (STRH)
• Targetted bed day
reductions on acute and
community wards using a
CI approach
• 2 Year roll-out of
Learning Sets across
30 wards
• 200 staff actively
engaged
• Supported by
• Piloting on 6 community/
unscheduled care wards
• Ward focussed priorities
eg. repatriation of
patients to ward
ABHB – Achieving High Reliability in Healthcare – Nov 2012
Patient and Family Centred Care - Overview
• Programme working with the Kings Fund and Health Foundation
• Improvements are based on the patient’s experience of care rather than our view of their experience
• Patient shadowing is the core method for understanding the patient’s experience of care
• Used IHI Model for Improvement to implement changes
• Working on fractured neck of femur and diabetic foot care experiences
• A Guiding Council, chaired by the executive sponsor, oversees the work in the care experiences
• A Working Group for each care experience is taking forward the work in each care experience
Diabetic PFCCTeam
Patient and Family Centred Care – Next Steps
• Working Groups need to:
• undertake more patient shadowing to understand current patient care experience
• Develop vision for ideal patient care experience
• ensure that membership covers the whole patient care experience
• Develop driver diagram to identify from differences between current and ideal care experience, the primary drivers they will work on, and the actual changes they will make
• Determine the measures that will be demonstrate the improvements made
• Launch Event in early November to:
• Build teams in fractured neck of femur and diabetic foot
• Introduce the concept of PFCC to wider group of stakeholders
• Share learning from recent learning set with the Kings Fund
• Have expert tuition from Faculty member of the Kings Fund
#NOF PFCCTeam
Patient Stories –
Progress • Task and finish Group
established with multidisciplinary membership from across ABHB
• Consent forms developed and agreed including a consent form to collect staff stories
• How to guide developed
• Database established
• 35 stories currently loaded to database
• Staff and equipment resources mapped across ABHB
• Divisional leads for patient stories established .
Patient Stories-
Next steps
• Continued recording of stories
• Development of the database to include clear
classifications to allow effective search for
and use of the stories
• Development of a patient Experience web
page –consider including stories
• Framework for feedback to story teller to be
agreed.
1000 Lives Plus
Mini-
Collaboratives
Aneurin Bevan
Health Board
RRAILS
Team Members
Rapid
Response to
Acute Illness
Learning Set
(RRAILS)
• Linda Alexander – Clinical Lead
• Jan Barrett – 1000 lives coordinator
• Rachel Oliver – Outreach RGH
• Emma Bennett – Outreach RGH
• Alisa Jones – Outreach RGH
• Chris Howells – Outreach RGH
• Karen Lewis – Outreach NHH
• Linda Meek – Outreach NHH
• Sally Copner – Senior Nurse NHH
• Rebekah White – Outreach NHH
• Lilibeth Delarama – ANP YAB
• Coral Cole – ANP YYF
Progress implementing NEWS
• NEWS implemented across 3 acute hospitals
• NEWS being piloted in 1 community hospital
• NEWS being implemented older adult mental health 1 site
• NEWS to be piloted in Newport community resource team
RRAILS Progress
• Deteriorating Patients Group overview
• Organisational review of NEWS ( Documentation, communication, response and escalation, relationship with T,C, priority within organisation, night cover in response sick patient)
• One observation chart across all acute sites.
• NEWS part patient planning boards
• Pilot work being done looking at more detailed outcome data relating to patients admitted to ITU with SEPSIS: timeliness of referrals to outreach, sepsis six bundle compliance on wards and patient outcome.
• Sepsis audit being part mortality review by medical director
• Continual assessment cardiac arrest data
• Promoted sepsis – world sepsis day stand nursing conference, and on intranet.
RRAILS Progress COMMUNITY HOSPITALS • YAB community hospital pilot
for NEWS • Sirhowy ward is the pilot with
buy in from the ANP’s ward staff, senior nurse and Dr Janker.
• Staff training took place in July 2012, and the pilot commenced August 2012.
• Sirhowy are still piloting as per doctors request, but initial feedback is positive.
MENTAL HEALTH (NEWS)
• NEWS training for Older Adult Mental Health In-Patient services was rolled out in August 2012 in YYF. It remains a part of a much broader module that deals with the monitoring of physical illness in the older adult with mental health problems
Community Resource Team Newport •Piloting NEWS within a community setting to assess its effectiveness in supporting the admission, assessment and decision making process for patients who are accepted and treated through the Newport Community Resource Team. •NEWS training commenced Sept 2012
RRAILS outcomes Cardiac Arrest Data
ABHB - Number of Cardiac Arrest Calls per 1000
Patients Discharged
0
2
4
6
8
Jul-10
Sep-10
Nov-10
Jan-11
Mar-1
1
May-1
1
Jul-11
Sep-11
Nov-11
Jan-12
Mar-1
2
May-1
2
Jul-12
Time
Car
diac
Arr
est
Cal
ls/1
000
Dis
char
ged
Nevill Hall Hospital Royal Gwent Hospital
NHHAverage Score for patients
with Sepsis,MEWS 4=NEWS 6
16/0
7/20
12
18/0
6/20
12
21/0
5/20
12
23/0
4/20
12
26/0
3/20
12
27/0
2/20
12
30/0
1/20
12
02/0
1/20
12
05/1
2/20
11
07/1
1/20
11
10/1
0/20
11
10
9
8
7
6
5
4
3
2
1
Week
Indi
vidu
al V
alue _
X=6.799
UCL=9.871
LCL=3.726
10/10/2011 06/02/2012
Average News Score for Patients With Sepsis
16/0
7/20
12
18/0
6/20
12
21/0
5/20
12
23/0
4/20
12
26/0
3/20
12
27/0
2/20
12
30/0
1/20
12
02/0
1/20
12
05/1
2/20
11
07/1
1/20
11
10/1
0/20
11
16
14
12
10
8
6
4
2
0
Week
Nu
mb
er
_X=5.04
UCL=10.25
LCL=-0.17
10/10/2011 13/02/2012
Number of patients with Sepsis triggered
Number of patients with
Sepsis triggered (NHH)
Percentage favourable outcomes after 24 hours
NHH
from Oct 2011 to Aug 2012 - All Wards
0
20
40
60
80
100
120
10
/10
/20
11
10
/11
/20
11
10
/12
/20
11
10
/01
/20
12
10
/02
/20
12
10
/03
/20
12
10
/04
/20
12
10
/05
/20
12
10
/06
/20
12
10
/07
/20
12
10
/08
/20
12
Weeks
% c
om
pli
an
ce
NHH % favourable
outcome >24hours
RRAILS Barriers • To look at concerns raised by the outreach teams re pressures which have
affected the commitment they can make to auditing and teaching
• To look at concerns raised by ward staff re amount training they need for all collaboratives but the pressures do not allow them the time to attend
• Understand impact of change in ANP hours at RGH on response to patients triggering.
• Engagement Dr’s in escalation and response.
• YAB Dr’s raised concern re impact 24/7 working directive coming in with regards to responding to patients causing concern.
• Look at how data is collected via nursing metrics.
• A&E – Review data collection methods eg. safety briefing or Symphony.
RRAILS Next Steps • Support wards in implementation phase to increase spread sepsis bundle.
• Look at implementing sepsis bags in each area.(Initial meeting taken place with pharmacists and microbiologist )
• Continue to audit progress and sustainability and feed back to relevant committees (Q&PT Safety, 1000 lives steering group, deteriorating patient group, PNF scheduled and unscheduled care)
Intelligent Targets For Dementia
Content 1 Memory Assessment
• 6 Dementia Co-ordinators and 1 specialist nurse young on set dementia appointed June 2011
• Redesign of CMHT services to create capacity for a standards based pathway (Primary care screen, pre-diagnostic counselling, standard cognitive assessment, post diagnostic counselling and information, signposting including 3 sector dementia agencies, Alzheimer Society Information Pack ).
• Standards based Memory Assessment Service Record
• 11 New and redesigned clinics across ABHB at the next meeting
• Training resources and train the trainer skills
• Feedback surveys.
• Health social care Integration at MAS clinical level
Content 2 – General Wards
• Pilot wards C7E and 3.2 , are developing suitable care pathways, the identification of delirium and dementia and the use of ‘’this is me” mechanism of knowing the life history and preferences
• Bespoke training learning events, supported by Mental Health general hospital Liaison Nurses, clinical lead and lead nurse.
• Sustained reduction in falls, patient and carer satisfaction
• Dementia friendly improvements with ward signage
• Y Bannau in Brecon has now completed its initial audit
• Identifying wards for further spread 2 wards st Woolos, preparations at YYF, NHH, CCH.
• Failure free activity developments, rummage box.
Intelligent Targets For Dementia
Content 3 – Community Care (inc.Care Homes)
• Audits of prescribing Newport, Caerphilly and Torfaen.
• PDSA - Audit tool adjusted to include MCA and alternative interventions.
• Medicines management department undertaking care home medication audit in South Powys
• Guidance sheet on anti-psychotic prescribing now in use in all areas
• Guidelines on “Managing behaviour that Challenges” and alternative interventions developed.
• “anti-psychotic” leaflet for patients and carers developed and now in use in pilot areas
• Checklist compiled as per NICE –SCIE guidelines for initiation and review of antipsychotics in dementia patients.
• Medicine’s management anti-psychotic work and this Driver. Joint database being developed.
• Audit of psychotropic medication completed in care homes in Monmouthshire
Content 4 – Support for Care Givers
• The UK Carers’Survey in all Boroughs
• A Carer led development of a care pathway for carers
• “Psychological Therapies for Carers” course is run in Blaenau Gwent and Caerphilly and is being spread to South Monmouthshire
• Guidelines on “Managing Behaviour that Challenges” and alternative interventions developed
• Audit of carers views of the service being undertaken in Blaenau Gwent
• Direct Payments accesses improved in Blaenau Gwent through
• Carers information/training being rolled out across ABHB in conjunction with the Alzheimer’s Society.
Content 5 - improve quality of care in NHS dementia inpatient units
• Pathway for first 48 hours of admission devised ready for piloting
• ABHB mental health Physical health assessment policy under review Policy linked through CTP board and CTP pathway for Physical assessment inpatients
• Dementia Palliative Care Pathway learning and discussion groups
• Life history books being used in pilot areas where a life history book has not been instigated earlier in Dementia care pathway
• Dementia care pathway in draft
• Carers satisfaction survey will be used on the three pilot wards. Process to simplify align FOC Transforming care and Int targets relatives questions
• Ward at St Woolos Dementia Care Mapping observation audit. Deci audits practice on all wards.
• Protocol for anti psychotic prescribing to be introduced on St Pierre Ward, Chepstow piloted at Powys wards, ready for evaluation.
• Therapeutic activities CST & opportunity groups at Ysbyty’r Tri Cwm
• Failure Free Activity opportunity school project St Pierre Ward, CCH
• Evaluation measures group convened for Failure Free, modified CST
• OT led Free Activity level at baseline audit devised.
• Dementia Friendly Environment Baseline audit (Kings Fund) Now incorporated into 6 monthly HEB improvement process..
• Training team multi agency reference group initiated to take forward dementia care training, mediums of learning and support the development of the curriculum
• Utilising the Transforming Care organized ward and FOC opportunity to deliver and drive the Int Targets for dementia.
Intelligent Targets For Dementia
Driver 1: Tier 2 to improve specialist advice & support to primary care, including pre-referral advise & shared care arrangements
Bundle: consultancy, liaison, supervision, training, signposting, information.
Improvements:
• Variety of information on ABHB Intranet
• Designated contacts established and advice available
• Training work group set up and training strategy developed – 4 levels of training, Msc Mod
• DVD “Introduction to Eating Disorders” in development
• Patient and carer information group established – development of a wide range of material for professionals, patient’s and carers.
• Designated contacts to be established within new Primary Mental Health Care teams
• Training to be provided to new PMHCT.
• Data collection tool developed to record advice provided.
Improving Treatment for Eating
Disorders
Driver 2: improved assessment care co-ordination & interventions forTier 2
• Improvements:
• Wide range of material available on Intranet
• Guidelines and prompt sheets for assessment and care planning developed
• Audit tool to measure compliance of standards set within driver
• Epex system input codes developed to capture monthly data (to be converted into run charts)
• Fortnightly SCEDS meetings and monthly supervision available from Tier 2 lead
• Designated contacts per tier 2 team – resource witin the team
• Transition arrangements for CAMHS established
• Patient held record developed (optional)
• ED Training strategy
• Patient and carer information group established
• DBT, psycho-education groups established
• Tier 2 and 3 clinicians trained in specialist interventions e.g. DBT, CBT-e, MET, IPT
• Tier 2 care pathway
• Fortnightly SCEDS meetings
• Patient and carer representatives on all sub groups e.g. training, information.
• Foundation of nursing Patient First bursary secured to develop services for severe and enduring eating disorders
• Working with Nicola Gray to develop WARRN risk assessment and management training module
Improving Treatment for Eating
Disorders
Improving Treatment for Eating
Disorders Driver 3: improved provision of tier 3
specialist eating disorders service
• Improvements
• Tier 3 team fully established; Clinical
lead, specialist clinician, OT, Dietitian,
Tier 2 lead, administrator
• Tier 3 clinicians received additional
training; DBT, CBT-e, IPT, MET
• Number of groups developed; DBT,
SEED, Nutrition, psycho-education
• Transition arrangements with CAMHS
• Interface with Tier 4 service
• Regular SCEDS meetings with Tier 2
• Patient and carer involvement
Driver 4: improved acute medical in-patient
care for patients with anorexia
• Medical refeeding bed identified in NHH.
• Training provided to ward staff
• Tier 3 team to visit any inpatients daily.
• Links established with dietitians
• Challenges
• Small number of admissions unable to compile run charts.
• Implementation and monitoring team in place and will continue to work on improving the provision against the re-feeding bundle.
• High cost Low volume specialist provision
• In view of the National challenges facing this driver a national group is to be convened to undertake an option appraisal for Wales.
Depression
Depression target goal
“To improve detection, assessment and
treatment of depression in hospital
population”
High levels of co-morbidity in long term
conditions, targeted conditions are:
• diabetes
• coronary conditions
• neurological conditions
• respiratory conditions
• Cancer
Pilots completed in Weight Management
and Cancer Services
Patients screened for signs of depression
ABHB – Achieving High Reliability in Healthcare – Nov 2012
Depression – Pilot services Head and neck cancer pilot
• Patients screened using cancer
specific ‘Distress Thermometer’. The
multidisciplinary team decided to
screen all patients at the pre-treatment
clinic.
• In May 2011 no mood screening
routinely took place in the Head and
Neck cancer clinic.
• In May 2012 56 patients were
screened.
Hearty Lives Torfaen Weight
Management Service
• All patients attending the weight
management group screened pre and
post group. The numbers screened are
10 patients per month.
• 210 patients have been screened in
2011-2012. Of these patients 30%
screened positive for possible
depression and 70% were already being
prescribed antidepressant medication.
(These groups overlap.)
ABHB – Achieving High Reliability in Healthcare – Nov 2012
210
147
63
0
50
100
150
200
250
total anti dep positive
number of
patients
0
56
0
10
20
30
40
50
60
2011 2012
Patients
screened
Depression
Difficulties
• Staff confidence - fear of uncovering
need they can’t meet
• Environmental – no privacy
• Indentifying appropriate place in care
pathway - e.g. In acute setting mood
screening complicated by
understandable distress/acute
exacerbation/fatigue
• Insufficient specialist resources
(liaison/clinical psychology time) to
deliver screening as separate activity
Success
• Where mood/psychosocial needs
screening occurs as part of holistic
assessment approach
• Target embedded in teams’ core activity
and owned by service rather than seen
as something someone else does
• Clear onward referral routes
• Where right person asking at right time
(someone who knows patient)
• Hospital patients are community
patients and some may be better
screened when in community.
ABHB – Achieving High Reliability in Healthcare – Nov 2012
Learning from ABHB pilots has contributed to 1000lives+ review of
depression target. Review currently underway
Catheter Associated Urinary Tract
Infection
ABHB – Achieving High Reliability in Healthcare – Nov 2012
Aim
09.10.12
Implementation of
bundle and full data
collection
Baseline data
collection
Achieve
consistent 95%
compliance
with the
maintenance
care bundle for
urethral
catheters.
NHH: embedded on
Ward 4/1,Ward 4/2,
Ward 4/4, Ward 4/3-
All 4 wards doing data
inputting.
Ward 1 /2 baseline
data collection
robust-
Ward 2/4-
established
Ward 3/1-
fragmented
A&E-Insertion bundle
in progress. Audit
tool being trialled.
Baseline data started
OSU 2012
COMM hospitals
Redwood- Embedded. Gwanywn- Embedded.
Pursuing data inputting processes for both areas
Insertion bundle
sticker being put onto
Ormis for orthopaedic
theatre St Woolos
Education
commenced on1 /2
and 2/4 Start baseline line –
Sept 12
Fields N/H (Npt)
collecting baseline
data.
RGH: embedded on
Ward C7E/CCU/critical
care - Ward
C5W/B3/D3W-
embedded.
D2West- early
implementation
July2012
N/H: Bank House N/
H – needs revisiting
and process re-
established
Intended spread
•Maintenance bundle
Embedded across 12
wards in acute and
community settings
•Initial work being
undertaken in care homes
•Spread to 7 additional
wards
•Insertion bundle being
tested in A&E
•Short term catheter days
as outcome measure
•Poster presented to
International Forum in
Paris last year
ABHB – Achieving High Reliability in Healthcare – Nov 2012
Catheter Associated Urinary Tract
Infection
0
50
100
150
200
250
0%
20%
40%
60%
80%
100%
120%
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
2010 2011 2012
Cath
ete
r D
ays
% C
om
plian
ce
NHH % CAUTI Bundle Compliance & Short Term Catheter Days
% Total Compliance
Median
short term catheter days
0
50
100
150
200
250
300
350
0%
20%
40%
60%
80%
100%
120%
Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul
2011 2012
Cath
ete
r D
ays
% C
om
plian
ce
RGH % CAUTI Bundle Compliance & Short Term Catheter Days
% Total Compliance
median
Short Term Catheter Days
PVC – Care Bundle Organisation
Spread 01.08.12 Implementation of
bundle and full data
collection
Implementation of
bundle
Achieve
consistent 95%
compliance with
the insertion &
ongoing care
bundle for
peripheral
venous catheters
NHH: Insertion
CCU, 1/2, ITU, 4/1, 2/3, main
theatre, x-ray
Rapid response Blaenau
Gwent
C5W, D1W/MAU,
MAX FAX, Main
Theatre
C7W starting 01.07.12
YYF - Theatres
NHH: Ongoing
CCU, ITU, 1/2, 4/1, 2/3
Rapid response Blaenau
Gwent
Delivery/Maternity
service ongoing training
A&E
C5W, C7E, D6E, D6W,
D7W, D1W/MAU,
MAX FAX,
C7W starting 01.07.12
YYF – ward 2/3
RGH: Insertion
OSU theatre,
HDU/ITU, CAU, CCU/D3W,
MDCU, embedded
RGH: Ongoing
Ward D7E, OSU, B6N, D3W,
CCU, ITU, HDU embedded
Intended spread
Maternity Services
teaching in progress
D5E starting Aug
Eye ward/theatre Aug
Delivery/Maternity
service ongoing training
Ward 4/3
Maternity Services
teaching ongoing
D5E starting Aug
Eye ward/theatre Aug
C7E starting Sept
A&E meeting sept
• Insertion Bundle
implemented across 10
wards
•Bundle introduced to
theatres and measured
via ORMIS
•Maintenance bundles
implemented across 12
wards
•Plans in place to
spread to maternity
•MSSA outcome
measure shows
reduced MSSA on
wards where PVC
bundle has been
implemented
PVC - Outcome Data MSSA BACTERAEMIA
(All Wards)
Apr 2011 - current
0
2
4
6
8
10
12
Apr-11
Jun-11
Aug-11
Oct-11
Dec-11
Feb-12
Apr-12
Jun-12
Aug-12
RGH NHH ABHB Linear (ABHB)
MSSA BACTERAEMIA
(PVC Bundle Wards)
Apr 2011 - current
0
1
2
3
4
5
6
Apr-11
Jun-11
Aug-11
Oct-11
Dec-11
Feb-12
Apr-12
Jun-12
Aug-12
Sch
Unsch
F&T
Linear
(Sch)
Mouthcare Team
Rhiannon Jones
Vicki Jones
Katrina Rowlands
Cheryl Hucker
Denise Ewens
Helen Roberts
Janice Thomas
John Hampton-Saunders
Laura Thompson
Linda Western
Mary Hopkins
Robert Taylor
Sally Copner
Sharan Sharman
Tracey Partridge-Wilson
Kate Hooton
Rachel Fletcher
Step one
Mouth care risk assessment
Step two
Choose care plan A, B or C
Step three
Document daily mouth care
Mouthcare for Adults
in Hospital
Urgent referral
to
medic/dentist
Dental
treatment
on
discharge
Mouthcare
Pilot Wards
St Woolos Hosp - Gwanwyn Ward
Rehabilitation
Nevill Hall Hosp - Ward 3/3
Surgical Ward
Royal Gwent Hosp - Ward D5W
Surgical Ward
Llandrindod Wells Hosp - Clywedog Ward (Mental Health) Older Adult Assessment Unit
Nevill Hall Hosp
Intensive Care Unit
Structure
•ABHB Mini collaborative meetings set
up
•Executive Lead – Denise Llewellyn,
Director of Nursing
•Clinical Lead – Rhiannon Jones
(Assistant Director of Nursing)
supported by Vicki Jones (Clinical
Director Dentistry)
•MDT team membership
•Mini-Collaborative called ‘Open Wide’
Mouthcare Achievements
• Training delivered to most ward areas
• Wards have documentation – Assessment Tool & Care Plans
• Equipment obtained via ORACLE
• All wards have commencement plan
• Poster exhibited at ABHB nursing conference
• Mouthcare symbols added to PSaaG database
• Baseline data collected via Fundamentals of Care Tool
• Discussed supplies with hospital shop
• In discussions with Datix Manager regarding recording of lost dentures
Next Steps
• Liaise with Pharmacy regarding high fluoride toothpaste
• Developing PGDs for mouthwash & high fluoride toothpaste
• Measurement process
• HCSW to join mini-collaborative
Transforming Care Team Members
• ABHB Project Lead
• Rhiannon Jones (ADN)
• Transforming Care Facilitators
• Ann Price
• Carol Hadfield
• Karen Smith
• Elaine Ward
• David Timmins
• Sue Pearce
• Mary Hopkins
• Rachel Lee
Driver Diagram • To roll out Transforming Care across all
wards in ABHB
• Primary drivers to include: – Staff Well Being – To use a range of tolls that
demonstrate staff engagement, experience and team spirit
– Efficiency – Evidence an increase in the time
RN spend with patient in direct care to
improve quality of service
– Safety – Use of Safety Crosses to
demonstrate improvements in safe and
reliable care
– Patient Centeredness (Experience of Care) –
to evidence patient experience and achieve
target of 95%
Transforming Care
Project Plan • Launched in ABHB in May
2012
• Executive Board Sign up
• Link with NLIAH to Roll out Transforming Care across all wards by December 2011
• Project Lead Established
• Lead Facilitator Created
• Facilitators Established for each divisions
• Education for facilitators undertaken with NLIAH
• Education planned for all wards by December 2011
Transforming Care Progress Achievements
• ABHB late to start programme but have progressed to meet targets set
• Education rolled out to all wards within ABHB by June 2012
• All wards have started Transforming
• Departments have also been included (Radiology / CCU / A&E)
Barriers
• Leadership Development
• Teamwork Development
•
• Staffing Issues (Sickness/absences)
• Senior Nurses Engagement
• Senior Nurse Education
Transforming Care - Data • All wards are now ‘Transforming’
• Patient experience is being collated and displayed
• Ward B7 achieving 95%, previously not seeking feedback
• Ward 4-1 achieving 100 % for past 2 months
•
• Core Measures are being collated & displayed
• Direct Care Time increases
• Ruperra Pre 315 Post 59 %
• Ebbw pre 48% Post 56%
• Ward D5 east 9 months without patient fall
• Ward C4 West 388 days with MRSA & 148 days without HAPU
• Well organised ward Work stream (WOW)
• Cost savings from a WOW (D4 West)
• Ward D4 West 164.00 for 1 cupboard
• Ward 2-1 320.00 for 1 room
• Intentional Rounding
• Audits of call bells are showing improvements since implementing
• ICARE intentional Rounding Tool (EBBW introduced ICARE April 12, calls reduced by 100 per week)
Next Steps •Continue to transform on all wards across ABHB
•Spread of Transforming Care across departments
•Create depth of evidence to demonstrate improvements
•Educational programme for Senior Nurses
Improving the Reliability
of TIA Services
Progress Compliance monitoring continues.
No Target % set by WAG presently.
Telephone referral system commenced August 2012 and improvements in complying to high risk patient review noted.
At RGH, hot slot appointments created to increase clinic availability.
At NHH – developing system to expedite appointments for high risk patients.
Acute Stroke Bundles
Outcomes
% compliance with First Days bundle
Stroke patients
from May 2010 to Oct 2012
0
10
20
30
40
50
60
70
80
90
100
04
/05
/20
10
04
/06
/20
10
04
/07
/20
10
04
/08
/20
10
04
/09
/20
10
04
/10
/20
10
04
/11
/20
10
04
/12
/20
10
04
/01
/20
11
04
/02
/20
11
04
/03
/20
11
04
/04
/20
11
04
/05
/20
11
04
/06
/20
11
04
/07
/20
11
04
/08
/20
11
04
/09
/20
11
04
/10
/20
11
04
/11
/20
11
04
/12
/20
11
04
/01
/20
12
04
/02
/20
12
04
/03
/20
12
04
/04
/20
12
04
/05
/20
12
04
/06
/20
12
04
/07
/20
12
04
/08
/20
12
04
/09
/20
12
04
/10
/20
12
Weeks
% c
om
pli
an
ce
Compliance: 90%
Reason for failure: 1 patient out of 9 failed to get to ASU < 24 hours
Solution implemented: Ongoing discussion with bed-management
Nevill Hall
% compliance with First Hours bundle
Stroke patients
from May 2010 to Oct 2012
0
10
20
30
40
50
60
70
80
90
100
04
/05
/20
10
04
/06
/20
10
04
/07
/20
10
04
/08
/20
10
04
/09
/20
10
04
/10
/20
10
04
/11
/20
10
04
/12
/20
10
04
/01
/20
11
04
/02
/20
11
04
/03
/20
11
04
/04
/20
11
04
/05
/20
11
04
/06
/20
11
04
/07
/20
11
04
/08
/20
11
04
/09
/20
11
04
/10
/20
11
04
/11
/20
11
04
/12
/20
11
04
/01
/20
12
04
/02
/20
12
04
/03
/20
12
04
/04
/20
12
04
/05
/20
12
04
/06
/20
12
04
/07
/20
12
04
/08
/20
12
04
/09
/20
12
04
/10
/20
12
Weeks
% c
om
pli
an
ce
% compliance with First 3 Days bundle
Stroke patients
from Apr 2010 to Oct 2012
0
10
20
30
40
50
60
70
80
90
100
26
/04
/20
10
26
/05
/20
10
26
/06
/20
10
26
/07
/20
10
26
/08
/20
10
26
/09
/20
10
26
/10
/20
10
26
/11
/20
10
26
/12
/20
10
26
/01
/20
11
26
/02
/20
11
26
/03
/20
11
26
/04
/20
11
26
/05
/20
11
26
/06
/20
11
26
/07
/20
11
26
/08
/20
11
26
/09
/20
11
26
/10
/20
11
26
/11
/20
11
26
/12
/20
11
26
/01
/20
12
26
/02
/20
12
26
/03
/20
12
26
/04
/20
12
26
/05
/20
12
26
/06
/20
12
26
/07
/20
12
26
/08
/20
12
26
/09
/20
12
Weeks
% c
om
pli
an
ce
% of patients admitted to co-located beds (ASU) within 24 hours of admission
Stroke patients
from Apr 2010 to Oct 2012
0
10
20
30
40
50
60
70
80
90
100
26
/04
/20
10
26
/05
/20
10
26
/06
/20
10
26
/07
/20
10
26
/08
/20
10
26
/09
/20
10
26
/10
/20
10
26
/11
/20
10
26
/12
/20
10
26
/01
/20
11
26
/02
/20
11
26
/03
/20
11
26
/04
/20
11
26
/05
/20
11
26
/06
/20
11
26
/07
/20
11
26
/08
/20
11
26
/09
/20
11
26
/10
/20
11
26
/11
/20
11
26
/12
/20
11
26
/01
/20
12
26
/02
/20
12
26
/03
/20
12
26
/04
/20
12
26
/05
/20
12
26
/06
/20
12
26
/07
/20
12
26
/08
/20
12
26
/09
/20
12
Weeks
% p
ati
en
ts
Royal Gwent Hospital
Stroke Rehabilitation Bundles - Data
2 (iii) Percentage of patients who have access to all relevant specialist interventions
from May 2011 to Aug 2012
0
20
40
60
80
100
120
19/05
/11
02/06
/11
16/06
/11
30/06
/11
14/07
/11
28/07
/11
11/08
/11
25/08
/11
08/09
/11
22/09
/11
06/10
/11
20/10
/11
03/11
/11
17/11
/11
01/12
/11
15/12
/11
29/12
/11
12/01
/12
26/01
/12
09/02
/12
23/02
/12
08/03
/12
22/03
/12
05/04
/12
19/04
/12
03/05
/12
17/05
/12
31/05
/12
14/06
/12
28/06
/12
12/07
/12
26/07
/12
09/08
/12
Weeks
% p
atie
nts
4 (i) Percentage of patients who are given a reliable point of contact
from Jul 2011 to Jul 2012
0
20
40
60
80
100
120
06/0
7/11
20/0
7/11
03/0
8/11
17/0
8/11
31/0
8/11
14/0
9/11
28/0
9/11
12/1
0/11
26/1
0/11
09/1
1/11
23/1
1/11
07/1
2/11
21/1
2/11
04/0
1/12
18/0
1/12
01/0
2/12
15/0
2/12
29/0
2/12
14/0
3/12
28/0
3/12
11/0
4/12
25/0
4/12
09/0
5/12
23/0
5/12
Weeks
% p
atie
nts
3 (iii) Percentage of patients who receive appropriate intensity of rehab provided
0.00
20.00
40.00
60.00
80.00
100.00
120.00
19/11/1
1
26/11/1
1
03/12/1
1
10/12/1
1
17/12/1
1
24/12/1
1
31/12/1
1
07/01/1
2
14/01/1
2
21/01/1
2
28/01/1
2
04/02/1
2
11/02/1
2
18/02/1
2
25/02/1
2
03/03/1
2
10/03/1
2
17/03/1
2
24/03/1
2
31/03/1
2
07/04/1
2
14/04/1
2
21/04/1
2
28/04/1
2
05/05/1
2
12/05/1
2
19/05/1
2
26/05/1
2
02/06/1
2
09/06/1
2
16/06/1
2
23/06/1
2
30/06/1
2
07/07/1
2
14/07/1
2
21/07/1
2
28/07/1
2
04/08/1
2
11/08/1
2
18/08/1
2
Data
Median
YAB
Compliance rate for bundle 4
from Mar 2011 to Jul 2012
0
20
40
60
80
100
120
23/03/1
1
06/04/1
1
20/04/1
1
04/05/1
1
18/05/1
1
01/06/1
1
15/06/1
1
29/06/1
1
13/07/1
1
27/07/1
1
10/08/1
1
24/08/1
1
07/09/1
1
21/09/1
1
05/10/1
1
19/10/1
1
02/11/1
1
16/11/1
1
30/11/1
1
14/12/1
1
28/12/1
1
11/01/1
2
25/01/1
2
08/02/1
2
22/02/1
2
07/03/1
2
21/03/1
2
04/04/1
2
18/04/1
2
02/05/1
2
16/05/1
2
30/05/1
2
13/06/1
2
Weeks
% p
atie
nts
YYF
St Woolos
County
Acute Stroke, Rehab and TIA
• Barriers • Lack of clarity of some rehab bundle measures has highlighted risk of
inconsistent reporting between units. Overcome by setting up working group which agreed guidelines
• Acute: Site capacity issues impacting on transfer of patients to ASU.
• TIA: Delayed referrals from GP into TIA service. Inconsistent accuracy of dataset analysis not reflecting service provided. Presently under investigation with DSU.
• Next Steps • TIA: Consistent Seven day service
• Acute: Direct admission to ASU.
• Life After stroke – new programme area launched 2012
• ABHB Stroke Delivery Plan being finalised, with revised membership of Stroke Board and associated Work Stream groups
Torfaen Community Falls Prevention Exec lead, Jan Smith
Clinical lead, Dr Usman, Kitson & Rahman
Governance Link, Kate Hooton
Mulitidisciplinary Team Members:
• Clare Younger, Torfaen Falls Co-ordinator
• Debbie Povey, Falls Specialist Nurse
• Diane Nelson, Falls Administrator
• Nicola Jeffries, Support & Well-being
Worker
• Debra Williams, Support & Well-being
Worker
• Jaqueline Hull, Support & Well-being
Worker
• Karen Minton & Andrea Shelford, Senior
Physiotherapists
• Chris Davis, Senior Occupational
Therapist
Torfaen Community Falls Prevention
Achievements so far
• Progress/Improvements made on falls service integration within Community Resource Team
• Excellent Patient Satisfaction
• 20% annual increase in number of falls referrals
• Reduction in reported fractures
• Decrease in lengths of stay
4 (i) % patients who receive a review of compliance with the plan
Falls
from Apr 2011 to Oct 2012
0
20
40
60
80
100
120
Apr
2011
May
2011
Jun
2011
Jul
2011
Aug
2011
Sep
2011
Oct
2011
Nov
2011
Dec
2011
Jan
2012
Feb
2012
Mar
2012
Apr
2012
May
2012
Jun
2012
Jul
2012
Aug
2012
Sep
2012
Oct
2012
Months
1 (i) % patients who complete the initial screening using an agreed tool
Falls
from Apr 2011 to Oct 2012
0
20
40
60
80
100
120
Apr
2011
May
2011
Jun
2011
Jul
2011
Aug
2011
Sep
2011
Oct
2011
Nov
2011
Dec
2011
Jan
2012
Feb
2012
Mar
2012
Apr
2012
May
2012
Jun
2012
Jul
2012
Aug
2012
Sep
2012
Oct
2012
Months
4 (iii) % patients who have an updated or closed plan as appropriate and update the falls log
Falls
from Apr 2011 to Oct 2012
0
10
20
30
40
50
60
70
80
90
100
Apr
2011
May
2011
Jun
2011
Jul
2011
Aug
2011
Sep
2011
Oct
2011
Nov
2011
Dec
2011
Jan
2012
Feb
2012
Mar
2012
Apr
2012
May
2012
Jun
2012
Jul
2012
Aug
2012
Sep
2012
Oct
2012
Months
1 (i) % patients who complete the initial screening using an agreed tool
Falls
from Apr 2011 to Oct 2012
0
20
40
60
80
100
120
Apr
2011
May
2011
Jun
2011
Jul
2011
Aug
2011
Sep
2011
Oct
2011
Nov
2011
Dec
2011
Jan
2012
Feb
2012
Mar
2012
Apr
2012
May
2012
Jun
2012
Jul
2012
Aug
2012
Sep
2012
Oct
2012
Months
Torfaen Community Falls Prevention
Barriers
• Reduction in Falls Team members
• Increase in the number of referrals received since Frailty
commenced.
Next Steps
• Improved Service Integration
• Improved outcomes
• Overcoming barriers to maintain a gold standard falls service
• Managing demand
• To develop a more robust evaluation and follow-up system.
Transforming Maternity Services
Progress Made
Implementation & Spread of Sepsis Six
Plus Two across the Service – Proforma
updated and ratified.
Streamline Data Gathering Processes to
Improve Process & Outcome Measures in all
Areas - Improve Data Accuracy & Ownership
Team Leader Agreement - Triage, RGH –
Extract Data from Admission Assessment
Documentation (Use for cross reference) –
Input data directly onto spreadsheet
Spread Care Bundles to all areas
throughout the Division - RGH - Triage, DAU,
Ward B4 & Main Delivery Unit - NHH - DAU,
Ward 1/2 & Main Delivery Suite
Data Collection different in some areas
Triage, RGH - All Admissions Data - Ward B4
Snapshot Data
Whiteboards - In all areas, sharing evidence
& information
Mini Collaborative
Team Members
Anju Kumar
Deb Jackson
Anurag Pinto
Caroline Davis
Claire Roche
Debbie Pimbley
Gwyneth Ratcliffe
Helen Erasmus
Louise Taylor
Matt Turner
Mike Byrne
Sajitha Parveen
Rachel Fletcher
Suzanne Hardacre
Tim Watkins
Liz Smith
Jayne Beasley
What are we trying to achieve?
OVERALL AIM:
To improve experience and
outcomes for mothers,
babies and their families
within Maternity Services
Reduce mortality and harm by improving
the recognition and response to the
acutely deteriorating woman.
Reduce mortality and harm from venous
thromboembolism in pregnancy and the
postnatal period.
Achievements To Date
MEOW’s Charts in use across maternity services.
Admissions, Recognition & Response Bundles -
Working well on B4 and AAU at RGH - note service
change - Working well in NHH DAU - note service
change - Senior Midwifery Manager to meet with B5
Manager and Birth Centre Manager plan roll out -
Senior Midwifery Managers to meet to discuss roll
out of all care bundles to 2/1 in NHH.
Sepsis Six Plus Two Bundle - Sepsis Six tool
adapted for maternity - In use on B4 and AAU plan
roll out to Labour ward in RGH.
Quality & Patient Safety Improvement &
Measurement department involvement - Local
meeting set up to validate data - A3 Structured
Progress Report followed by CG day presentation.
% compliance with admission Bundle by month
Triage
0%
20%
40%
60%
80%
100%
120%
Jul 1
2
Aug 1
2
Sep 1
2
Oct 12
% c
om
plia
nce
% compliance with admission Bundle
Numbers of multidisciplinary reviews by month
Triage
0
20
40
60
80
100
120
140
Jul 1
2
Aug 1
2
Sep 1
2
Oct 12
Nu
mb
er
Numbers of multidisciplinary reviews
% compliance with admission bundle by month
DAU NHH
0%
20%
40%
60%
80%
100%
120%
Jan 1
2
Feb 1
2
Mar
12
Apr 1
2
May
12
Jun 1
2
Jul 1
2
Aug 1
2
Sep 1
2
Oct
12
% c
om
plia
nce
% compliance with admission bundle
Number of multidisciplinary reviews by month
DAU NHH
0
1
2
3
4
5
6
7
8
Jan 1
2
Feb 1
2
Mar
12
Apr 1
2
May
12
Jun 1
2
Jul 1
2
Aug 1
2
Sep 1
2
Oct
12
Nu
mb
er
Number of multidisciplinary reviews
Implementation Plan/Next Steps
- Spread Bundles utilising experiences
from pilot areas
- More work needed to capture VTE
Outcome Data
- Severe Sepsis Mortality Rate - Needs to
be established
- Stillbirth Audit planned to establish
Management and Rate
Barriers
- Resources/Staffing Issues
- Education
- Engagement
- Change Environment
Strengths
- The group are enthusiastic and committed to the collaborative
- Both Midwifery and Obstetric staff have embraced the care bundles
- The venous thromboembolism risk assessment document has been successfully
implemented
- The sepsis care bundle has been successfully implemented in all high risk areas
- The admissions, recognition and response care bundles have been successfully
implemented and well received by staff working within the pilot areas
- Maternity services have attended all webex sessions relating to the mini
collaborative
Evidence of Progress
Process of inputting
data electronically on
Triage RGH is going
well
Admission Bundles
going very well
(Evidence shows this)
Staff Comments
Additional Data
Collection required
(Why? What will it
achieve?)
No extra resource
available to gather
this evidence
Transforming Maternity
Services
ERAS – Colorectal, Orthopaedic,
Urology, Gynaecology Project Board/Clinical Leads
Mrs Judith Paget – Deputy Chief Executive.
Mr Peter Lewis – Divisional Director
Mrs Clare Walters – Divisional Nurse
Sr Carole Berger – ERAS-ANP/Lead Nurse.
Mrs Alison Shakeshaft – Clinical Dir.of Therapies
Mrs Rachel Fletcher - Q&PS Improvement Mgr.
Colorectal
Mr Gethin Williams –Colorectal Surgeon
Dr Aida Nadra –Anaesthetist.
Dr Andy Bagwell – Anaesthetist
Mr A Chokkalingham –Colorectal Surgeon.
Sr Mandy Watkins – Colorectal
Dr K Jenkins – Anaesthetist
Orthopaedics Mr W Mintowt-Czyz –Orthopaedics Mr Gordon Gillespie – Orthopaedics Dr Victor Francis –Anaesthetist. SCP Ruth Jenkins – Orthopaedics Mr Robin Rice –Orthopaedics Dr David Lacquiere –Anaesthetist. Mr Y Nathdwarawala – Orthopaedics Urology Mr Adam Carter –Urology Surgeon. Dr Matthew Colmslee –Anaesthetist Sr Janet Marty – Urology Gynaecology
Mr El Hamamy – Gynaecology
Dr Woolard – Anaesthetist
Colorectal (All elective major
bowel surgery)
NHH = 2 Consultants.
Laparoscopic and Open
surgery.
RGH = 5 Consultants.
2 Laparoscopic and all Open
surgery.
‘Spin off’ audits of paralytic ileus
being undertaken
Dis
ch
arg
e b
un
dle
P
ost o
pe
rative
bun
dle
I
ntr
aop
era
tive
bun
dle
Im
me
dia
te b
un
dle
Length of Stay
Orthopaedic (All elective primary hip & knee
replacement)
NHH = 4 Consultants.
OSU = 5 Consultants
RGH = 4 Consultants.
Trauma(# NOF) All Consultants both
sites, on call.
• D7E commenced in RGH
• Prospective data collection will
commence in the next month.
• Bundle compliance has also improved.
• Numbers of participating surgeons has
increased
• Ward reorganisation is planned to
facilitate the DOSA patients and
release the dining room facility
Achievements
• Trauma pathway under development
and benchmarking taking place
• Trial Joint Schools in NHH for Primary
Knee replacements first and now for
Primary Hips and Knees.
• Patients and their partners are
educated through an ERAS
framework and prepared for their
surgical journeys.
• Excellent feedback has encouraged
further bookings.
• Outcomes for these patients will be
audited to assess their usefulness
in the programme.
Dis
ch
arg
e b
un
dle
P
ost o
pe
rative
bun
dle
Pe
ri-o
pe
rative
bun
dle
p
reo
p a
ssessm
ent b
un
dle
Length of Stay
ERAS T&O data
– pilot
consultant
ERAS Urology (Radical Prostatectomy,
Cystectomy, Nephrectomy)
• RGH – 3 Consultants
• Live data collection will
commence on C7W in the next 2
months.
• Urology has trialled anaesthetic
changes and ward education
underway. Data collection tools
are in progress and
implementation imminent.
Achievements
• Urology staff will write their own
information leaflet
• Producing ‘How to’ guide in
conjunction with Swansea
• LOS for small cohort of
cystectomy patients reducing
• PDSA to production of a
anaesthetic ‘recipe’ for major
complex surgery.
Gynaecology (Total abdominal Hysterectomy) NHH pilot commences autumn 2012, 1 Consultant, 1 procedure.
Barriers • New workstream
• One of many
• Time to complete paperwork over
care
• Need for continuing education to
encourage a sound knowledge base
that will allow ERAS to become
nursing and medical custom and
practice and not diminish.
Next Steps • Real time measurement and feedback
to clinical hubs
• 2 study days planned – 1 in NHH and 1
in RGH. To facilitate the wards and
increase availability we will repeat the
morning session in the afternoon.
• Education , Education, Education ..for
all.
Further Achievements • ERAS presented to at the Nursing Conference.
• MDT education – ERAS education for Occupational Therapy
• ERAS presented to Orthopaedic / General study day
• ERAS update for primary care
• Several patients available to participate in patient stories.
Enhanced Recovery After Surgery
Hospital Acquired Thrombosis
• Dr S Noble
• Dr S Lewis
• Leeanne Larcombe
• Sue Hanson
• Denise Cressey
• Sam Jones
• Dr G Robinson
• Kate Hooton
• Rachel Fletcher
ABHB VTE Rate
% ABHB HAT Rate (% DVT/PE of discharges/deaths/daycases
unvalidated by casenote review)
0.00%
0.10%
0.20%
0.30%
0.40%
0.50%
Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11
unvalidated HAT rate
Hospital Acquired Thrombosis - Achievements
• Medical and Surgical Risk Assessment tool incorporated into clerking packs at RGH and NHH
• Risk assessment tools for Mental Health and Obstetrics devised
• Risk assessment tools incorporated into policy for surgical thromboprophylaxis
• HAT rate being devised to be circulated to divisions
• Pharmacy working with frontline clinicians to embed risk assessment tools ie. Increase of 0-80% use of RAT in OSU (joint replacement surgery)
• Links made to Enhanced Recovery After Surgery work
• Evidence submitted to Welsh Government Health & Social Care Committee one day inquiry into VTE
Hospital Acquired Thrombosis
• Regular data and feedback to
– HAT steering group
– Thrombosis Committee
• HAT Rate incorporated into regular QI
report to Q&PS Committee
Primary Care
Collaborative
• Focus on LVSD
• GP Lead – Dr Alun
Edwards
• Initial scoping paper
approved
• Support from PCQIS
and NLIAH and ABHB
Q&PS Dept
Next Steps
• Recruiting practices
• Initial Learning Set early
next year
• Programme to run for
one year
ABHB – Achieving High Reliability in Healthcare – Nov 2012