First Annual Report 2013/2014 - Wiltshire · Wiltshire Abdominal Aortic Aneurysm (AAA) Screening...

E:\moderngov\data\published\Intranet\C00001123\M00008738\AI00048058\$mamap4a4.docxShirley Ledingham DOW Programme Co-ordinator

1

The Dorset and Wiltshire Abdominal Aortic Aneurysm

(AAA) Screening Programme

First Annual Report 2013/2014


2

1. INTRODUCTION ....................................................................................................... 6 2. BACKGROUND INFORMATION .............................................................................. 6 2.1 The National AAA Screening Programme objectives ............................................. 6 2.2 The Framework for the delivery of AAA Screening Programmes ........................... 6 2.3 The Screening Pathway ......................................................................................... 7 2.4 Screening Outcomes ............................................................................................. 7 2.5 Summary ............................................................................................................... 9 3. DOW AAA SCREENING PROGRAMME .................................................................. 9 3.1 Implementation ...................................................................................................... 9 3.2 The DOW AAA Screening Programme Team ........................................................ 9 4. PROGRAMME DELIVERY ...................................................................................... 10 4.1 Clinic Templates .................................................................................................. 10 4.2 Identifying Clinic Locations .................................................................................. 10 4.3 Planning and monitoring Programme Delivery ..................................................... 12 4.4 Improving Programme Delivery ........................................................................... 13 4.4.1 Client questionnaires ................................................................................... 13 4.4.2 Feedback from Screening Technicians ........................................................ 13 5. QUALITY ASSURANCE ......................................................................................... 13 5.1 Clinical Governance and meetings ...................................................................... 13 5.1.1 MDT Meetings ............................................................................................. 13 5.1.2 AAA Team Meetings .................................................................................... 14 5.1.3 Weekly meetings.......................................................................................... 14 5.1.4 Programme Board Meetings ........................................................................ 14 5.1.5 South West Managers Meetings .................................................................. 15 5.2 Data Quality and Information Tracking Systems .................................................. 15 5.2.1 Data Quality ................................................................................................. 15 5.2.2 Incidental Findings ....................................................................................... 16 5.2.3 Incidents ...................................................................................................... 16 5.2.4 Complaints ................................................................................................... 17 5.2.5 Risk Assessments ........................................................................................ 17 5.2.6 Vascular Referrals ....................................................................................... 17 5.3 Training and Development ................................................................................... 17 5.3.1 Scanning QA ................................................................................................ 18 5.3.2 Clinical assessment ..................................................................................... 18 5.3.3 Equipment Checks ....................................................................................... 18 5.3.4 CPD ............................................................................................................. 18 5.3.5 Succession Planning .................................................................................... 18 6. PROGRAMME PERFORMANCE ............................................................................ 19 6.1 Statistics and Data ....................................................................................................... 19 6.2 DNA RATES ........................................................................................................ 19 6.3 Performance against National and Quality Standards .......................................... 19 6.3.1 Summary of results .............................................................................................. 20 6.4 Non Visualised Scans .......................................................................................... 21 6.5 Surveillance Clients ............................................................................................. 21 6.6 Ruptures .............................................................................................................. 22 6.7 Vascular Referrals during 1st year of scanning ..................................................... 22 7. COMMUNICATIONS AND PUBLICITY ................................................................... 22 8. HEALTH EQUITY AND EQUALITY ........................................................................ 23 9. ACTION PLAN for 2014/2015................................................................................. 23 10. ACHIEVEMENTS .................................................................................................... 25 11. SUMMARY .............................................................................................................. 25 12. GLOSSARY OF TERMS …………………………………………………………………26

INDEX


3

FOREWORD – Clinical Director Sarah Hulin

It is my very great pleasure to introduce the first Annual Report of the Dorset and Wiltshire Abdominal Aortic Aneurysm (AAA) Screening Programme. Over the past two years, the Dorset and Wiltshire Programme has developed from a few tentative plans with a National imperative, through planning, tendering, and project implementation phases, to a fully-operational and successful screening programme. This has required a truly enormous amount of hard work, and it is difficult not to reduce this Foreword to a long list of grateful thanks. As it is the first report, I am hopeful that I might be indulged with a few very important ones. Without the help and support of Public Health and PCT representatives Rebecca Pearce, John Goodall, and Bex Ward we would never have been able to get the Programme Project off the ground. Without the support, never-ending energy, and sonography training expertise of Linda Harris I would probably have given up, and we would have no screening technicians. Mandy Cripps and Alison Herod at Salisbury Foundation Trust supported us through a difficult tender process. Shirley Ledingham is our project-manager-turned-Programme Coordinator, and without her the programme simply would not exist, much less function as successfully as it does. Initially a Phase Four programme, we were able to bring forward our ‘Go Live’ date into late 2012 following significant planning and training efforts. After twelve months of operation, we have successfully screened our cohort of 65 year old men, offered screening to a large number of self-referred men over 65, run hundreds of community-based screening clinics, successfully dealt with the challenges of staff sickness and turnover, welcomed a new NHSE commissioning team, and still had time to consider how our programme could be improved next year. This, I am sure you will agree, is a credit to the hard work and dedication of the entire screening team. During the past twelve months, we have identified a significant number of men with AAAs in Dorset and Wiltshire. Some of these would undoubtedly have gone undiagnosed until the point of rupture and likely death - this programme has already saved lives. All men identified with AAAs are now under the close surveillance of the programme, and have received counselling regarding both their diagnosis and lifestyle change aimed at reducing cardiovascular morbidity. We are currently liaising with our surveillance clients to arrange a ‘Client User Group’ who will both feedback to the Steering Board, and provide an independent social forum for screened men to raise issues, queries, or concerns about the Screening Programme.


4

As we look forward to the next twelve months, we anticipate further commissioning and funding changes, possible changes to the Programme driven by the National Team, and changes to the delivery of local Vascular services as a result of service centralisation. We are already planning ways in which we can improve access to and experience of our service, and reduce appointment DNA rates. I have complete confidence that the Team will continue to go from strength to strength. It only remains for me to extend my gratitude to the entire Screening Team for their work over the past year. Many thanks, everyone – and ‘Well done’. Sarah Hulin Clinical Director Dorset and Wiltshire AAA Screening Programme Consultant Vascular Surgeon and Network Clinical Lead, Dorset and Wiltshire Vascular Network.


5

EXECUTIVE SUMMARY

1. Report Aim

• An understanding of the National AAA Screening Programme

• An overview of the Dorset and Wiltshire (DOW ) AAA programme set up and early implementation

• A review of the key elements of the first year of programme delivery

• An opportunity to reflect on outcomes and achievements

2. Background Information

• National Screening Programme objectives

• Framework documents = SOPs, Service Specification, Quality Standards and Failsafe Processes

• Screening Outcomes are according to SOPs and Medical Alert cards are given to all DOW surveillance clients

• DOW commenced delivery of the programme in November 2012 following early Implementation project

• The AAA Team is now fully staffed and trained

• Clinic templates established and appointments remain at 10 minutes and this will be maintained

• Site surveys are carried out on all potential clinic venues

• 46 venues are currently being used and many more are being investigated

• Tracking systems and rotas have been implemented to support all aspects of clinic planning

• Client questionnaires have been produced and are currently under review

3. Quality Assurance

• The following regular meetings are held:- MDT, Team Meetings, Meetings with AAA Clinical Director, Vascular

Manager and Co-ordinator, South West AAA Managers

• Tracking systems have been developed for:- Data Quality, Incidental Findings, Incidents, Complaints, Vascular

Referrals and death in programme. Incidents and the Risk log are also maintained on the Trust DATIX system

• The CSTs and screening technicians are fully AAA accredited by Salford University

• A robust system for QA reporting and the provision of feedback from CSTs has been developed

• Equipment checks and processes have been produced by the Medical Physics Department

• CPD activities include:- Opportunities to view open and EVAR surgery. Screening technicians manage a

number of individual projects that will assist the on-going service improvement of the Programme

• Funding has been awarded to support two screeners completing vascular training thus providing a career

progression

4. Programme Delivery

• Reports have been established by the SFT Information Services to support Programme Board requirements

• A Plan of Action is being established to help reduce the DNA rate

• All but two of the quality standards have met the achieved or acceptable criteria There are 109 surveillance

clients (up to 1st April 2014) in the programme

• There have been 2 ruptures and 9 vascular referrals

• A raft of communication and publicity material has been produced and two Events are planned for April and July

2014. The first User Group meeting is expected in September 2014

• An Action Plan to support on-going service development and improvement

5. Health Equity and Equality

• A Health Equity Audit is under consideration and the provision of clinics in Prisons is currently being planned

6. Summary

• During the year 8532 scans were performed, 109 aneurysms requiring monitoring were identified and 9 large

aneurysms were successfully operated on. This has been a very successful 1st year which has established a

solid foundation upon which to safely deliver the AAA Screening Programme.


6

1. INTRODUCTION

This is the first Annual Report of the Dorset and Wiltshire (DOW) Abdominal Aortic Aneurysm (AAA) Screening Programme. The aim of this report is to provide:- • An understanding of the National AAA Screening Programme • An overview of the Dorset and Wiltshire (DOW ) AAA programme set up and

early implementation • A review of the key elements of the first year of programme delivery • An opportunity to reflect on outcomes and achievements • An Action Plan to support on-going service development and improvement

2. BACKGROUND INFORMATION

2.1 The National AAA Screening Programme objectives

The NHS AAA Screening Programme aims to reduce AAA-related mortality among men over the age of 65 by up to 50% through early detection, appropriate monitoring and high-quality treatment. This will be achieved by providing a systematic population-based screening programme for men during their 65th year and, on request, for men over 65 who have not previously been screened. The programme objectives are to:- • Identify and invite eligible men for screening during the year they turn 65. • Provide clear, high quality information that is accessible to all • Carry out high quality abdominal ultrasound scans on those men attending

screening according to national protocol • Minimise the adverse affects of screening, including anxiety and

unnecessary investigation • Identify AAA accurately • Ensure appropriate and effective management of cardiovascular risk factors

identified through screening • Ensure high quality diagnostic and treatment services • Promote audit and research and learn from the results

2.2 The Framework for the delivery of AAA Screening Programmes

In order that a safe and quality assured screening programme can be delivered nationally the following documents provide the overarching framework that must be adhered to:- • The AAA Standard Operating Procedures • The National Service Specification for AAA Screening Programmes


7

• National AAA Service Programme (NAAASP) Quality Standards and Service Objectives

• NAAASP Failsafe Processes • The Vascular Society Provision of Vascular Services document and AAAQIP

2.3 The Screening Pathway

The Dorset and Wiltshire (DOW) AAA Screening Programme operates in line with the Standard Operating Procedures and men in their 65th year, who are registered with a GP in Dorset or Wiltshire, are identified using the AAA National database and invited to attend a scanning appointment. The administrative office for the DOW programme is based at Salisbury NHS Foundation Trust (SFT) and men over 65 years may request an appointment by contacting the Salisbury AAA office. The DOW AAA programme has a team of five fully qualified screening technicians who provide screening clinics in multiple community-based locations across the two counties.

2.4 Screening Outcomes

Based on the results of the AAA scan the outcomes are categorised as follows:- • Normal – aortic diameter < 2.9cm

A normal result means that the aorta is not enlarged. Most men have a normal result and no further treatment or monitoring is required. The screening programme will inform the GP of the results by letter and no further invitations for screening will be provided.

• Small aneurysm found – aortic diameter > 3cm to 4.4cm wide

Men with a small aneurysm are invited back for surveillance scans every 12 months to monitor the size of the aneurysm

• Medium aneurysm found – aortic diameter > 4.5cm to 5.4 cm wide

Men with a medium aneurysm are invited back for surveillance scans every 3 months to monitor the size of the aneurysm Ø Medical Alert Card The DOW programme has developed an information card which is provided to men who have been identified with an aneurysm. The aim was to allow clients or relatives to alert healthcare professionals to their diagnosis:-


8

A new card is provided at each surveillance appointment when the size of the aneurysm and date of the appointment is added by the screening technician.

• Large aneurysm found - aortic diameter > 5.5cm

Men identified with a large aneurysm are offered an early outpatient appointment with a consultant vascular surgeon in their area, to discuss possible treatment and arrange further diagnostic tests as required.

• Non-visualised scan

In some circumstances it is not possible to visualise the aorta, this is normally due to bowel gas or a high BMI ratio. These men will either be offered another appointment for a re-screen on the programme (i.e. for bowel gas) or will be referred by the screening programme to the Vascular Unit at Salisbury Foundation Trust for a medical imaging appointment.

• Incidental Findings The objective of AAA Screening is to identify abnormal aortas only. The DOW programme has developed robust quality assurance processes, carried out by the Programme QA Lead and CSTs, to ensure that scans are checked. If any incidental findings are identified each case is reviewed by the QA lead or CSTs and a supplementary report provided for the AAA Clinical Director who will provide the GP with any recommendations regarding further appropriate action.

• Nurse Assessments

All men identified with a small or medium sized aneurysm are offered an appointment with a Vascular Nurse Practitioner as soon as possible following the scan appointment. The nurse explains the significance of having an aneurysm and explains future management within the programme. In addition she will offer lifestyle advice and provide an essential point of contact. Further nurse appointments are available on request if the man is concerned or anxious about his condition.


9

2.5 Summary

During the year 8532 scans were performed, 109 aneurysms requiring monitoring were identified and 9 large aneurysms were successfully operated on.

3. DOW AAA SCREENING PROGRAMME 3.1 Implementation

Salisbury NHS Foundation Trust was awarded the contract to deliver AAA Screening across Dorset and Wiltshire in 2012. Preparation for implementation was undertaken as a Prince2 Project which was formally initiated in July 2012 and the first clinics were delivered in November 2012.

3.2 The DOW AAA Screening Programme Team

The current DOW AAA Screening Programme Team comprises:- Programme Mrs Shirley Ledingham Co-ordinator Clinical Director Miss Sarah Hulin

Consultant Vascular Surgeon - Dorset & Wiltshire Vascular Network lead

QA Lead Mrs Linda Harris Vascular Department Manager CSTs Ms Susan Richards Mrs Joanne Lee Mrs Vanora Heather Mrs Theresa Fail Programme Ms Andrea Burdus Administrator Admin support Mrs Anna-Marie Sharp Screening Mrs Heidi Andrews Technicians Mr Luke Hart Mrs Libby Lockwood Miss Claire Brown Miss Morgan Ashton Medical Dr Mark Brewin Physics


10

4. PROGRAMME DELIVERY 4.1 Clinic Templates

During early implementation and whilst the screening technicians were gaining experience the clinics were set up with longer appointment slots and more breaks. As we enter our 2nd year of scanning the normal full day clinic template has:-

• 10 minute appointments • 28 cohort scan appointments • 8 DNA rebook appointments • 2 self referral appointments • 3 double appointment surveillance appointments 4.2 Identifying Clinic Locations

Clinic locations are identified across Dorset and Wiltshire, initially these focused on approaching Community hospitals and GP surgeries with a large AAA cohort. As the programme becomes embedded the emphasis is to provide screening in convenient locations for all clients. Site surveys are carried out in order to establish:-

• Key contacts • Availability of rooms • Health and safety requirements • Suitability of premises:- •

o Access and parking o Ground floor clinic rooms or access to a lift o Suitable waiting area o Height adjustable couch and chair o Inclusion of consumables o Ability to store equipment safely on site o Access to the Internet via N3 connection o Staff facilities o Lighting

• Costs • Willingness to scan patients from other surgeries • Formal agreement between parties • Public transport links


11

Clinics are now held in the following locations:-

CLINIC LOCATIONS

Adcroft Surgery

Bere Regis

Beversbrook Surgery

Boscombe and Springbourne MC

Bridport Medical Centre

Canford Health Group Practice

Chippenham Hospital

Corfe Castle Cranborne Practice - Lake Road Surgery Wimborne

Devizes Hospital

Eagle House Surgery

Lilliput Surgery

Malmesbury Medical Centre

Malmesbury Medical Centre - Upstairs - PCT

MELKSHAM

Milborne St Andrew

NewLand Surgery

Orchard Surgery - Christchurch

Peacemarsh Surgery

Penny's Hill

Poole Town Surgery

Purton GP Surgery

Quarter Jack Surgery - Wimborne

Rowden GP Surgery

Savernack

SDH

SDH - Rheumatology

St Albans

St James Surgery, Devizes

St Leonards

Stalbridge Surgery

Swanage Hospital

The Adam Practice

The Atrium

The Dorchester Road surgery

The Hadleigh Lodge

The Harvey Practice

The Village Surgery

Trowbridge Hospital

Wareham Hospital

Wareham Surgery

Westbourne Medical Centre

White Horse Surgery Westbury

Wyke Regis Health Centre

Yetminster Surgery


12

4.3 Planning and monitoring Programme Delivery

In order to ensure that all cohort clients receive an appointment invitation it is essential that this is carefully managed and monitored. The DOW programme consists of three regional areas:- i. Wiltshire ii. Bournemouth and Poole iii. Dorset

In order to fulfil timely surveillance and DNA rebooked appointments, clinics need to be provided accordingly in the relevant locations. This is achieved using a number of tracking systems and reports as follows:- • A “Round” Plan for each region

This tracks individual surgeries and their annual cohort numbers. At the start of the cohort year the expected cohort clinics are allocated for the remainder of the cohort year. This provides the predicted programme delivery.

• Staff timetables Staff timetables are used to inform individual screeners of the agreed booked clinics and also those that are planned many months ahead. These timetables also provide specific information to the screeners about venues and are used to track travel expenses and additional hours.

• Updating the Round plans On a weekly basis a report is generated by the Information Services Department showing the actual number of invites that have been sent, this information is sourced from the NAAASP national database (SMaRT). These details are used to update the Round Plans. This enables the Round Plans to be constantly amended and monitored. Appointments are frequently changed by clients who may decide to delay their scanning appointment or may wish to book at a different location. Weekly updating of these details is a failsafe mechanism for tracking initial invitations. A surveillance report is also generated on a weekly basis and this is also checked against the Round Plans to ensure the timely booking of surveillance appointments as aneurysms continue to be identified throughout the year.

• The clinic booking system A clinic booking system is updated from the Round Plans. This provides the AAA Administrator with the details of where clinics need to be booked onto SMaRT, the screening technicians who will be scanning and which GP surgeries should be used to fill the clinic. The AAA Administrator will also check the surveillance requirements.

• Failsafe

The checking procedures above provide failsafe processes to ensure:- i. Cohort clients will receive an initial invitation


13

ii. Surveillance clients will be offered a timely surveillance appointment

4.4 Improving Programme Delivery 4.4.1 Client questionnaires

Client questionnaires were produced with advice and guidance from the SFT Readership Panel. These are distributed randomly following a scan appointment and analysis of the outcomes undertaken by a screening technician. It is intended that this will become a rotational task for the technicians. The feedback to date has been exceptionally positive, and few changes have been required. A review of the questions is shortly to be undertaken.

4.4.2 Feedback from Screening Technicians

The screening technicians have a set objective to provide feedback following scanning at each new venue they screen at. This is a useful way to capture the views of both the clients and the screeners.

5. QUALITY ASSURANCE 5.1 Clinical Governance and meetings

Clinical Governance is a key element to the delivery of this screening programme and the on-going development of the service and supporting processes reflects this. The following meetings are held on a regular basis:-

5.1.1 MDT Meetings

These are held on a two monthly basis and are attended by:- • The Clinical Director • The Vascular Manager (QA Lead) and/or CSTs • The Vascular Nurse Practitioner • The Screening Technicians • The Programme Co-ordinator • The Programme Administrator

Regular Agenda Items and discussion points include:-

• AAA Programme updates from the Clinical Director • Review and discussion of specific scan images (e.g. Incidental

Findings, bulging and ectatic scans, Vascular Referrals and all scans that the screeners and CSTs have highlighted for MDT discussion)

• Update on Incidents and Complaints • Reports – Aneurysmal growth, overview of activity, non vis scans


14

5.1.2 AAA Team Meetings

These are held on a monthly basis and are attended by:-

• AAA Programme Co-ordinator • Medical Physicist • AAA Screening Technicians • AAA Screening Administrator • A variety of speakers (Health and Safety, Education)

Regular Agenda items include:-

• Individual screener’s projects update (e.g. currently – decontamination protocols, Striving for Excellence Awards, data quality analysis, client questionnaire analysis, associated Trust polices)

• CPD update • RSI – incidents and updates • Process updates (e.g. clinic templates and timings, information from

clinics) • MLE (Managed Learning Environment) – mandatory training update • Cascade Brief (Monthly Trust Newsletter)

5.1.3 Weekly meetings

Weekly meetings are held with the Clinical Director and AAA Programme Co-ordinator and also with the Vascular Manager and AAA Programme Co-ordinator. All and any aspects of the programme are discussed at these meetings.

5.1.4 Programme Board Meetings

These meeting are held quarterly and there is the following representation:- • Screening & Immunisation Manager, BGSW Area Team, NHS England • Screening and Immunisation Coordinator, BGSW Area Team, NHS England • AAA Clinical Director SFT • AAA Programme Co-ordinator • Surgical Directorate Manager SFT • Wiltshire Public Health Representative • Head of Contracts (Deputy Head of Finance) SFT • Vascular Manager SFT • GP Representative • Screening & Immunisation Manager, Wessex Area Team, NHS England • Dorset Public Health Representative • Screening and Immunisation Coordinator, Wessex Area Team, NHS England • Finance Manager SFT


15

All aspects of the AAA programme are discussed at these meetings.

5.1.5 South West Managers Meetings

These meetings are held quarterly and more frequently if required. They are represented by:- • Bristol Bath & Weston AAA Screening Programme • Dorset and Wiltshire AAA Screening Programme • Somerset & North Devon AAA Screening Programme • Exeter and South Devon AAA Screening Programme • Peninsula AAA Screening Programme All aspects of the Screening Programme are discussed and a key element of these meetings is to share experiences and understand how each programme manages the AAA Screening Programme. The group firmly believes in a standardised and collaborative approach and the help and support from this Group has been pivotal to the early development and implementation of the DOW programme. Much benefit has been derived by the opportunity to share lessons learned and best practice from other programmes with a greater experience in the delivery of the AAA Screening Programme. It is intended that a combined approach to programme policies will continue to develop. The RSI Policy, produced by the Exeter and South Devon AAA Screening Programme has been adopted by the Group.

5.1.6 National Clinical Directors Meetings

The programme Clinical Director attends meetings twice yearly, as organised by the National Programme team. Meetings aim to disseminate best clinical practice, discuss individual programme queries, and discuss the future of the National programme. Feedback from meetings is shared at local level with the Steering Board, MDT meetings, and Coordinator meetings.

5.2 Data Quality and Information Tracking Systems

A number of Information Tracking Systems have been developed as follows:-

5.2.1 Data Quality

A Data Quality Tracking System and policy (which has been endorsed by HR) have been implemented. This system uses the information written on the hard copy clinic lists as a failsafe check against data input into the SMaRT database.


16

When the clinic lists are returned to the AAA office the AAA administrator checks the following entries:-

• CONSENTER DOESN'T MATCH

• CONSENT NOT RECORDED

• FAMILY HISTORY/ PREVIOUS SURGERY INCORRECT

• ETHNIC CATEGORY DOESN'T MATCH

• LANGUAGE APPEARS INCORRECT

• SCREENER DOESN'T MATCH

• SCREENER ROLE INCORRECT

• EQUIP ID INCORRECT

• SCREENING EXCEPTION INCORRECT

• SIZE DOESN'T MATCH

• REC'S NOT TICKED

• QA NOT MARKED/ INCORRECT

The relevant screening technicians are informed of any errors and they carry out the appropriate investigation and make the necessary amendments. Analysis of this data is undertaken by the screening technicians and it is planned this will be on a rotational basis. The analysis is a standing agenda item at Team meetings and individual reports are produced for discussion as part of the IPR process.

5.2.2 Incidental Findings

Details of Incidental Findings are maintained and failsafe processes have been implemented that ensure the episode can only be closed following instructions from the Clinical Director.

5.2.3 Incidents

In order that both NAAASP and SFT (Salisbury Foundation Trust) Incident reporting procedures can be followed a simple flow map of the process has been produced. All incidents are reported using the SFT Datix system and a summary tracking system is also maintained by the AAA Programme Co-ordinator. Open Incidents are discussed with the Clinical Director at the weekly meeting, or immediately if appropriate, and actions are agreed at either the AAA Screening Team Meetings or MDT meetings. An incident report is provided for the Programme Board. Summary of Incidents in 1st year of screening:-

Year Date Raised

Datix no Overview of issue

Outcome

2013 20/03/2013 XXXX DQ issue Improved processes produced and implemented


17

Year Date Raised

Datix no Overview of issue

Outcome

2013 01/08/2013 XXXX DQ issue Improved processes produced and implemented

2013 21/11/2013 XXXX Clinical Followed National AAA protocols

2013 05/12/2013 XXXX Clinical Followed National AAA protocols

2014 14/02/2014 XXXX DQ issue Client continue on surveillance programme

2014 24/02/2014 XXXX DQ issue Extra checking period for Screener. Discussed at MDT

2014 26/02/2014 XXXX DQ issue Improved checking Additional checks for screener

2014 06/03/2014 XXXX DQ issue Retraining and improved checking

5.2.4 Complaints

Formal complaints are dealt with by the SFT complaints procedure and are also tracked on the Incident Tracking System. During the first year of scanning there were two complaints. • Client was not informed of a clinic cancellation (due to staff sickness) • Client found the AAA scan to be painful

5.2.5 Risk Assessments

Programme Risk Assessments are managed on the SFT Datix system and a report is generated for discussion at the Programme Board meetings.

5.2.6 Vascular Referrals

Details of all vascular referrals are retained the Data Quality Tracking System. Detailed processes and a checklist have been produced to support the requirements associated with Vascular referrals. A situation report of vascular referrals is provided in the Programme Performance section of this report.

5.3 Training and Development

The DOW programme is fortunate to have the enthusiastic support of an experienced Vascular Unit. The level of knowledge and expertise demonstrated by the screening technicians when they completed their Salford Assessment was commended and this should be attributed, not only to the hard work of the screening technicians, but also the excellent training that had been provided.


18

5.3.1 Scanning QA

In addition to the random QA sampling automatically generated by SMaRT the screening technicians are instructed to request QA on all surveillance scans. They are also encouraged to mark any unusual scans or scans that they would like to discuss further for QA. The CSTs carry out a detailed examination of all QA scans, making both positive and instructive comments. The screening technicians are provided with a hard copy report, downloaded from SMaRT, which they are required to review, act upon and sign and date.

5.3.2 Clinical assessment

In addition to the training and development provided as an integrated part of the QA process, technicians are individually assessed at clinics every four months.

5.3.3 Equipment Checks

The programme is also fortunate to have significant support from Dr Mark Brewin, who has produced a detailed set of processes which the screeners carry out on a monthly basis to check the sonosite performance. Dr Brewin also carries out more in-depth checks of the sonosites.

5.3.4 CPD

CPD is a developing part of the Screening Technicians tasks. They are provided with opportunities to attend Open surgery and EVAR procedures and several have observed these. Currently each technician has the responsibility for delivering a project directly linked to the AAA programme, these include:- • An overview of all the SFT Policies that link to the Screening Programme • A decontamination policy for AAA screening incorporating COSHH and

other relevant Health and Safety requirements • Client Questionnaire analysis • Data Quality analysis

5.3.5 Succession Planning

It has been identified nationally that the lack of job-progression for NAAASP screening technicians has made the post less attractive to potential high-quality applicants. Within the Dorset and Wiltshire programme, efforts continue to be made to ensure that screeners are given the opportunity for continued professional development. The programme Coordinator and QA Lead have achieved the approval of Education funding for two of the existing AAA screening technicians to undertake their PGC and PG Dip in Vascular ultrasound. During the two year training period, these technicians will be able to continue delivering AAA screening on a reduced part time basis whilst completing their vascular


19

training. When fully trained, it is hoped that these technicians will augment staffing levels in the Vascular Unit and will ultimately be able to further support delivery of the AAA Screening Programme in assisting to train additional screeners.

6. PROGRAMME PERFORMANCE

6.1 Statistics and Data

There are a number of useful reports generated from SmaRT and the National team continue to develop and improve the quality and variety of reports available to local programmes. Whilst these reports are being produced the SFT Information Services team have produced uptake and activity reports for discussion at programme Board level. Report available on request.

6.2 DNA RATES

The DOW programme is committed to reducing the existing DNA rate further. Early on in the programme there was concern that clients were not receiving their appointment letters and one of the screening technicians undertook a survey to establish if this was a problem. In line with similar surveys undertaken by other AAA programmes, it was established that the low attendance rate for 2nd DNA rebooked appointments was difficult to improve. A DNA report is currently being produced which will take a holistic review of the DNA issue and outcomes will be added to the Action Plan at 9 below.

6.3 Performance against National and Quality Standards

The table below is the amalgamation of two reports generated from SmaRT (national database) by NAAASP:- • AAA QA report Initial Screens – By Site 2013/2014 • AAA QA report Initial Screens – Nationally 2013/2014 The bottom section provides the Acceptable and Achievable performance standards as defined in the NAAASP Quality Standards and Service Objectives for AAA screening programmes in the NHS.


20

Table 1:-

1.1 1.2 3.1 (a) 3.2 (a)

Total Number of Eligible Patients

Subjects Declined

Ineligible Subjects - Initial

No Post Office Returns

Screen Offered - Initial Screen

Offer Accepted - Initial Screen

Dorset and Wiltshire outcomes

7852 329 (4.19%) 138 (1.73%) 31 (0.39%) 7891 (100.50%) 6693

(84.82%)

National Outcomes

286914 12861

(4.48%) 6891 (2.35%) 888 (0.31%)

288594 (100.59%)

234497 (81.25%)

Quality Standards requirements

Acceptable Not Provided 20% 10% 90% 60%

Achievable Not Provided 5% 5% 100% 85%

Table 2:-

3.3 3.4 4.1 4.4 5.1

Number of Eligible Patients Tested

New appt within 3 months after DNA

Percentage of Offered Subjects Tested

No Patients with

Aorta >= 3cm on initial screen

Non visualised Screens

Dorset and Wiltshire outcomes

6674 (85.00%)

1400 (80.65%)

6674 (84.58%) 73 (0.93%) 229 (3.30%)

National Outcomes

233790 (81.48%)

57739 (78.09%)

233790 (81.01%)

2,943 (1.03%)

3564 (1.49%)

Quality Standards requirements

Acceptable 54% 90% 60% 2.5% to 5% 3%

Achievable 85% 100% 85% 1%

6.3.1 Summary of results

Achievable or acceptable results have been achieved for all but two of the quality indicators. The two indicators that failed to meet the Acceptable level were:- i. Rebooking DNA appointments within 3 months

This was the result of our inexperience at the start of the programme. All DNA appointments are now rebooked the same or the following day of the clinic they failed to attend.


21

ii. Non Visualised Screens - Refer to the Action Plan at 9 below.

6.4 Non Visualised Scans

The graph below shows the number of non visualised scans. The April 2013 increase was as a result of the newly trained screeners becoming independently operational following completion of training. The trend shows a gradual decrease in non vis scans as the screening technicians become more experienced. This graph shows both programme rescreen and medical imaging non vis outcomes.

6.5 Surveillance Clients

• Surveillance Totals

The table below shows the total number of clients on a surveillance pathway at the end of the 1st year. These totals include all surveillance clients who were inherited by the programme and those who have been identified with an AAA at a 2nd or subsequent appointment.

Total AAA Clients on a 12 month surveillance pathway

Total AAA Clients on a 3 month surveillance pathway

TOTAL

92

17

109

Dorset and Wiltshire AAA Screening Programme - Non Vis Scans to April 2014

0

10

20

30

40

50

60

Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14

Number

Count of Subject's Last Name

MONTH


22

• Surveillance Appointments

There have been two breaches in the provision of a surveillance appointment within the four week period. Both these instances were as a result of clients being unable to attend due to ill health.

6.6 Ruptures

There have been two in programme ruptures during the 1st year of scanning. Neither of these clients were on a referral pathway (i.e. the sizes of their Aneurysms dictated that they required on-going surveillance scanning). Full details of these incidents were reported to the National AAA Screening Programme.

6.7 Vascular Referrals during 1st year of scanning

DETAILS NUMBER COMMENTS

Number of Referrals 9

Number Outpatient appointment booked within 2 weeks

8

Number Outpatient appointment booked outside 2 weeks

1 1 x Client requested to delay

Number received surgery within 8 weeks 4

Number received surgery outside 8 weeks

5 2 x Delay due to medical complications 2 x Delay for patient choice 1 x Hospital breach

Number operated at Royal Bournemouth Hospital

7

Number operated at Royal United Hospital Bath

2

7. COMMUNICATIONS AND PUBLICITY

The following table provides details of some of the communications and publicity events that have been done to help promote the programme. It should be noted that publicity has been kept fairly low key in order not to jeopardise the early implementation of the programme due to a potential unmanageable number of self referrals.

TITLE DETAILS

Engaging GPs The AAA Clinical Director had discussions, made presentations and attended meetings with


23

TITLE DETAILS

GPs and CCGs

Engaging GPs Mail shots were sent to all GPs in Wiltshire and Dorset, introducing the programme , providing leaflets and posters and seeking clinic rooms

Early promotion of the programme Leaflets and information sent to local groups including – SFT Volunteers, Friends of SFT and Warminster Hospital, local Golf Clubs, British Legion

Promotion at GP surgeries National poster adapted to be played on TV screens in GP surgeries

Christmas Newsletter to GPs A Christmas Newsletter was sent to GPs, thanking them for their help and providing them with surgery specific reports of AAA scanning outcomes

Christmas Newsletter to Surveillance Clients

A Christmas Newsletter was sent to clients identified with an aneurysm, welcoming them to the programme, providing them with contact details and explaining that a User Group would be set

Dorset and Wiltshire GP Newsletters

AAA Articles were published in regional GP Newsletters

8. HEALTH EQUITY AND EQUALITY The Dorset and Wiltshire AAA Screening Programme is keen to ensure screening is equally available to all eligible men. A health equity audit is being considered in order to help identify health inequalities within the region, so that improved access to the programme can be established. Following discussions with the South West Managers Group and the setting up of a Transgender AAA clinic in Devon, this has resulted in useful team discussions regarding an understanding approach to these clients and the possibility of setting up similar clinics in Dorset and Wiltshire should there be sufficient need.

There are three HM Prisons across Dorset and Wiltshire and plans are underway for scanning to be carried out at the venues.

Further health equity and equality work will be undertaken next year.

9. ACTION PLAN for 2014/2015

Theme Title Plans

Comms Open Days Two open days are planned:- • April 2014 to coincide with Hospital


24

Theme Title Plans

event in Salisbury • July 2014 – to cover Dorset Area

Publicity Press Release Local papers to be given an article following the open day/s

Publicity SFT Members Annual Trust Newspaper

Article prepared to be published. Distribution circa August 2014

Service Improvement

Health Equity and Equality

Contact the Health equity and equality team to establish plan

Service Improvement

User Group Hold first User Group following July 2014 Event. Expected Sept 2014 ( to avoid hols). There are currently 7 named volunteers for this group.

Service Improvement

Client questionnaires

Update and ask more useful questions to help improve the service

Performance Improvement

DNAs Reduce DNA rate – Follow Action Plan in DNA Report – currently under construction

Quality Assurance Processes and Protocols (Local SOPs)

Protocols to support the National framework of documents to be completed and ratified by the Programme Board

Service and Performance Improvement

Increasing number of venues

Improved access to clinic locations

Service and Performance Improvement

Improving directions to some venues

The inclusion of additional maps for some venues

Service Improvement

Integrating with other SFT screening programmes

Collaborative approach to similar issues – travel expenses, Incident Reporting, etc

Service Improvement

Non Vis Scans Reduce number of non vis scans – scanning undertaken by both screeners + continuing development of experience

Service Improvement

Self Referral Cards To be given to self referral clients to hand onto their friends and colleagues

Research AAA UK Growth Study

Awaiting information regarding involvement with this

Service Improvement

Uploading clinic lists and downloading images into SMaRT

Plans are identified to roll out the changes to uploading clinic lists and downloading images in the Summer. This will link with greater working flexibility for the screening staff as they will be able to work remotely.

Service Improvement

Synertec – Offsite printing

Planned implementation late 2014 early 2015.


25

10. ACHIEVEMENTS

The following is a list of key achievements during the first year that AAA Screening was provided by the Dorset and Wiltshire Screening Programme:-

• The Vascular CST team and 5 trainee screening technicians successfully

completed the Salford training • Successfully appointed the AAA administrator • The DOW AAA screening programme commenced on time (six months earlier

than originally planned) • Permanent and appropriate premises were identified and refurbished for the

AAA Screening team • Data and reports – Generation of agreed activity reports by SFT Information

Services • Award of funding to support two of the existing screening technicians to

undertake a PGC and PG Dip in Vascular sonography • Delivery of AAA Screening according to National Requirements

• Processes and systems to support the safe delivery of the key elements of the

programme (and failsafe mechanisms) embedded • Main KPI – invitations sent to 100% of cohort • Excellent feedback from clients

11. SUMMARY

This Annual Report of the Dorset and Wiltshire AAA Screening Programme has endeavoured to provide an understanding of how the programme has developed and been implemented during it’s first year. This has been a busy year with steep learning curves and a lot of hard work by the entire AAA Screening Team. We are now looking forward to all the challenges that our second year in the AAA Screening programme will bring.

Shirley Ledingham Dorset and Wiltshire AAA Screening Co-ordinator July 2014


26

12. GLOSSARY OF TERMS AAA Abdominal Aortic Aneurysm

AAAQIP Abdominal Aortic Aneurysm Quality Improvement Programme

CCG Clinical commissioning groups

COSHH Control of Substances Hazardous to Health

CPD Continuous Professional Development

CST Clinical Skills Trainer

DATIX Incident Reporting Database

DNA Did Not Attend (refers to appointments)

DOW Dorset and Wiltshire Programme

DQ Data Quality

EVAR Endovascular aneurysm repair

HR Human Resources

KPI Key Performance Indicator

MDT Multi Disciplinary Team

MLE Managed Learning Environment

NAAASP National Abdominal Aortic Aneurysm Screening Programme

NHS National Health Service

PCT Primary Care Trust

PG Dip Post Graduate Diploma

PGC Post Graduate Certificate

QA Quality Assurance

RSI Repetitive Strain Injury

SFT Salisbury Foundation Trust

SMaRT AAA National Database

SOP Standard Operating Procedure

First Annual Report 2013/2014 - Wiltshire · Wiltshire Abdominal Aortic Aneurysm (AAA) Screening...

Documents

Transcript of First Annual Report 2013/2014 - Wiltshire · Wiltshire Abdominal Aortic Aneurysm (AAA) Screening...