Join Nicole on a Digital Journey around the #GlobalHR Blogger World
Nicole Slater - Quality & Safety, ACT Health - Monitoring the Program and Challenges around...
-
Upload
informa-australia -
Category
Health & Medicine
-
view
314 -
download
1
description
Transcript of Nicole Slater - Quality & Safety, ACT Health - Monitoring the Program and Challenges around...
![Page 1: Nicole Slater - Quality & Safety, ACT Health - Monitoring the Program and Challenges around Implementation](https://reader034.fdocuments.in/reader034/viewer/2022052311/5575d66dd8b42a917e8b4d54/html5/thumbnails/1.jpg)
Nicole Slater – ERDP Program Manager
ACT Health
![Page 2: Nicole Slater - Quality & Safety, ACT Health - Monitoring the Program and Challenges around Implementation](https://reader034.fdocuments.in/reader034/viewer/2022052311/5575d66dd8b42a917e8b4d54/html5/thumbnails/2.jpg)
Background for the Canberra Hospital
• University Affiliated Tertiary Hospital
• 500 beds
• Serves ACT and GSAHS population (660 000)
• 64 000 separations per year
![Page 3: Nicole Slater - Quality & Safety, ACT Health - Monitoring the Program and Challenges around Implementation](https://reader034.fdocuments.in/reader034/viewer/2022052311/5575d66dd8b42a917e8b4d54/html5/thumbnails/3.jpg)
• 17 year old female, presented to Emergency Department
• Diagnosis: Glandular fever and Bilateral Pneumonia
• Admitted to a ward overnight and then deteriorated.
22 Dr reviews but no definitive management plan in 28 hours
No MET call even when vital signs fulfilled MET criteria.
• An unexpected admission and long stay in ICU.
Example in the ACT of cases where Family/ Carer
escalation system could have had a positive
outcome:
![Page 4: Nicole Slater - Quality & Safety, ACT Health - Monitoring the Program and Challenges around Implementation](https://reader034.fdocuments.in/reader034/viewer/2022052311/5575d66dd8b42a917e8b4d54/html5/thumbnails/4.jpg)
Mother’s comment “My daughter was so very ill and I felt completely powerless to have someone, anyone do anything other than simply look at the monitor and walk out of the room and leave me with her. I was anxious and fearful. It was not until I asked “does my daughter have to have a respiratory arrest before someone will do something?” that action was taken”
![Page 5: Nicole Slater - Quality & Safety, ACT Health - Monitoring the Program and Challenges around Implementation](https://reader034.fdocuments.in/reader034/viewer/2022052311/5575d66dd8b42a917e8b4d54/html5/thumbnails/5.jpg)
Australia Council on Health Care Standards
![Page 6: Nicole Slater - Quality & Safety, ACT Health - Monitoring the Program and Challenges around Implementation](https://reader034.fdocuments.in/reader034/viewer/2022052311/5575d66dd8b42a917e8b4d54/html5/thumbnails/6.jpg)
CARE for Patient Safety
Aim To develop an escalation process that
builds upon current communication pathways to allow patients, their families and carers to articulate their concerns over care being delivered.
![Page 7: Nicole Slater - Quality & Safety, ACT Health - Monitoring the Program and Challenges around Implementation](https://reader034.fdocuments.in/reader034/viewer/2022052311/5575d66dd8b42a917e8b4d54/html5/thumbnails/7.jpg)
CARE for Patient Safety
Families and Carers are ideally placed to identify signs of clinical deterioration
They spend more time with the patient and know them best, therefore any subtle changes may be identified early by family and carers
![Page 8: Nicole Slater - Quality & Safety, ACT Health - Monitoring the Program and Challenges around Implementation](https://reader034.fdocuments.in/reader034/viewer/2022052311/5575d66dd8b42a917e8b4d54/html5/thumbnails/8.jpg)
CARE for Patient Safety What is the evidence?
• Overseas experiences
– Condition H(elp) • Josie King
– Call for Concern (C4C)
![Page 9: Nicole Slater - Quality & Safety, ACT Health - Monitoring the Program and Challenges around Implementation](https://reader034.fdocuments.in/reader034/viewer/2022052311/5575d66dd8b42a917e8b4d54/html5/thumbnails/9.jpg)
CARE for Patient Safety
3 Step Process
AIM:
To develop an escalation process that builds upon current communication pathways to allow patients, their families and carers to articulate their concerns over patient’s clinical deterioration.
![Page 10: Nicole Slater - Quality & Safety, ACT Health - Monitoring the Program and Challenges around Implementation](https://reader034.fdocuments.in/reader034/viewer/2022052311/5575d66dd8b42a917e8b4d54/html5/thumbnails/10.jpg)
CARE for Patient Safety Method • Literature Review
• Focus Groups
• Steering Committee - 50% delegates being consumers
• Project Team
• Development of Family Escalation Pathway
• Roll out of ward education
• Deployment of CARE brochures and posters
• Development and delivery of CARE responders education program
• Development of Survey for families and staff
• Developments of Guidelines for CARE responders
![Page 11: Nicole Slater - Quality & Safety, ACT Health - Monitoring the Program and Challenges around Implementation](https://reader034.fdocuments.in/reader034/viewer/2022052311/5575d66dd8b42a917e8b4d54/html5/thumbnails/11.jpg)
Method
• Prospective before and after intervention trial
• Conducted over two, three month periods on three wards.
• Data Collected
Demographic data
Number of MET calls
Number and Reason for CARE Calls
Outcome of Care Calls
Family awareness of CARE escalation pathway
Family awareness of who was caring for them
• Primary Outcome measures:
Incidence of CARE Calls
• Secondary Outcome Measures
Incidence of MET Calls
![Page 12: Nicole Slater - Quality & Safety, ACT Health - Monitoring the Program and Challenges around Implementation](https://reader034.fdocuments.in/reader034/viewer/2022052311/5575d66dd8b42a917e8b4d54/html5/thumbnails/12.jpg)
CARE for Patient Safety
EDUCATION
• Responders
• Team Leaders
• Ward Staff
STEP 3 RESPONDERS
Business Hours
• MET Nurses Business Hours
STEP 3 RESPONDERS
After Hours
• Afterhours CNC’s including weekends & public holidays
• Adult Medical Ward
•Adolescence Ward • Paediatric Ward
Pilot Wards
![Page 13: Nicole Slater - Quality & Safety, ACT Health - Monitoring the Program and Challenges around Implementation](https://reader034.fdocuments.in/reader034/viewer/2022052311/5575d66dd8b42a917e8b4d54/html5/thumbnails/13.jpg)
![Page 14: Nicole Slater - Quality & Safety, ACT Health - Monitoring the Program and Challenges around Implementation](https://reader034.fdocuments.in/reader034/viewer/2022052311/5575d66dd8b42a917e8b4d54/html5/thumbnails/14.jpg)
![Page 15: Nicole Slater - Quality & Safety, ACT Health - Monitoring the Program and Challenges around Implementation](https://reader034.fdocuments.in/reader034/viewer/2022052311/5575d66dd8b42a917e8b4d54/html5/thumbnails/15.jpg)
![Page 16: Nicole Slater - Quality & Safety, ACT Health - Monitoring the Program and Challenges around Implementation](https://reader034.fdocuments.in/reader034/viewer/2022052311/5575d66dd8b42a917e8b4d54/html5/thumbnails/16.jpg)
CARE for Patient Safety
Weekly surveys of patients, families and carers on the process
Survey patient, family or carer in the event of a call
Survey nursing staff on the ward in the event of a call
CARE responder notification
Evaluation
5 calls
4 clinical related calls
1 complaint
All outcomes resolved
Results
![Page 17: Nicole Slater - Quality & Safety, ACT Health - Monitoring the Program and Challenges around Implementation](https://reader034.fdocuments.in/reader034/viewer/2022052311/5575d66dd8b42a917e8b4d54/html5/thumbnails/17.jpg)
CARE for Patient Safety
•Calls consistent with similar programs internationally •Communication pathways improved •Informing patients & families about the process remains a consideration
![Page 18: Nicole Slater - Quality & Safety, ACT Health - Monitoring the Program and Challenges around Implementation](https://reader034.fdocuments.in/reader034/viewer/2022052311/5575d66dd8b42a917e8b4d54/html5/thumbnails/18.jpg)
Calls 2013-2014
6% 3%
8%
19%
3% 3%
44%
14%
Activation by Division
Unknown Other Critical Care Medicine MHJDAS RACC Surgery WY&C
![Page 19: Nicole Slater - Quality & Safety, ACT Health - Monitoring the Program and Challenges around Implementation](https://reader034.fdocuments.in/reader034/viewer/2022052311/5575d66dd8b42a917e8b4d54/html5/thumbnails/19.jpg)
Time of the Day
69%
31%
Calls (n=36) Median time 51 mins
07:00-16:59 17:00-06:59
![Page 20: Nicole Slater - Quality & Safety, ACT Health - Monitoring the Program and Challenges around Implementation](https://reader034.fdocuments.in/reader034/viewer/2022052311/5575d66dd8b42a917e8b4d54/html5/thumbnails/20.jpg)
Caller
28%
23% 20%
20%
6% 3%
Patient Daughter/Son Parent Partner/Husband/Wife Other Sibling
![Page 21: Nicole Slater - Quality & Safety, ACT Health - Monitoring the Program and Challenges around Implementation](https://reader034.fdocuments.in/reader034/viewer/2022052311/5575d66dd8b42a917e8b4d54/html5/thumbnails/21.jpg)
Reason for Calls
33%
28%
14%
14%
11%
(calls n=36)
Communication Complaint Clinical Deterioration Other Pain Management
![Page 22: Nicole Slater - Quality & Safety, ACT Health - Monitoring the Program and Challenges around Implementation](https://reader034.fdocuments.in/reader034/viewer/2022052311/5575d66dd8b42a917e8b4d54/html5/thumbnails/22.jpg)
Team leader Notified Prior
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Yes No
![Page 23: Nicole Slater - Quality & Safety, ACT Health - Monitoring the Program and Challenges around Implementation](https://reader034.fdocuments.in/reader034/viewer/2022052311/5575d66dd8b42a917e8b4d54/html5/thumbnails/23.jpg)
Treating Team Notified Prior
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Yes No
![Page 24: Nicole Slater - Quality & Safety, ACT Health - Monitoring the Program and Challenges around Implementation](https://reader034.fdocuments.in/reader034/viewer/2022052311/5575d66dd8b42a917e8b4d54/html5/thumbnails/24.jpg)
Initial Outcome
Referral to Nursing Staff 36%
Referral to JMO 25%
Referral to Registrar 14%
Nil intervention 11%
Other 8%
Referral to Consumer Engagement
6%
(Calls n=36)
Referral to Nursing Staff Referral to JMO Referral to Registrar Nil intervention Other Referral to Consumer Engagement
![Page 25: Nicole Slater - Quality & Safety, ACT Health - Monitoring the Program and Challenges around Implementation](https://reader034.fdocuments.in/reader034/viewer/2022052311/5575d66dd8b42a917e8b4d54/html5/thumbnails/25.jpg)
Audits
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14
Aware of the program
![Page 26: Nicole Slater - Quality & Safety, ACT Health - Monitoring the Program and Challenges around Implementation](https://reader034.fdocuments.in/reader034/viewer/2022052311/5575d66dd8b42a917e8b4d54/html5/thumbnails/26.jpg)
Audits
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14
Program Explained
![Page 27: Nicole Slater - Quality & Safety, ACT Health - Monitoring the Program and Challenges around Implementation](https://reader034.fdocuments.in/reader034/viewer/2022052311/5575d66dd8b42a917e8b4d54/html5/thumbnails/27.jpg)
Program Continues
• Across all inpatient areas of CHHS
• Recently rolled out across Calvary Healthcare Bruce, ACT.
• Ongoing audit
• Ongoing review of calls and processes
• Plan to expand to other areas such as ED, ICU, Mental Health and Birthing Services.
![Page 28: Nicole Slater - Quality & Safety, ACT Health - Monitoring the Program and Challenges around Implementation](https://reader034.fdocuments.in/reader034/viewer/2022052311/5575d66dd8b42a917e8b4d54/html5/thumbnails/28.jpg)
Challenges • Cultural change in how we do business
• Ensuring 24 hr/7 day per week cover
• Patients receiving the brochure/explanation
• Improving communication for Steps 1 & 2
![Page 29: Nicole Slater - Quality & Safety, ACT Health - Monitoring the Program and Challenges around Implementation](https://reader034.fdocuments.in/reader034/viewer/2022052311/5575d66dd8b42a917e8b4d54/html5/thumbnails/29.jpg)
None of it would have been possible without:
• Sarah Mamootil (Project officer)
• Prof Frank Bowden (Clinical Lead – Family Escalation)
• A/Prof Imogen Mitchell (Clinical Lead ERDP)
• Heather McKay, Alison Kingsbury and Nicole Slater (ERDP Program Managers)
• The Steering Committee- in particular the consumer representatives
• CHHS MET nurses and After hours Clinical Nurse Consultants
• The clinical staff on the pilot wards