1. Welcome and Introductions DH welcomed members to the meeting and thanked them for their attendance. The group were asked to introduce themselves.

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1 Minutes Service Improvement Group Wednesday 23 August :30am 11:30am room, Life Sciences Hub, Cardiff Attendance Dave Hope - Chair, Network Lead Clinician (Mid & West) Ifor Evans - Network Manager (South East) Sally Heal - Senior Nurse, Aneurin Bevan University Health Andrew Hermon - Senior Nurse, Cwm Taf University Health Piroska Toth- Tarsoly - Clinical Lead, Cwm Taf University Health Greg Ead - Service Improvement Manager Lisa Lewis - Senior Nurse, Hywel Dda University Health Mike Martin - Clinical Lead, Hywel Dda University Health Dale-Charlotte Moore - Directorate Manager, Cardiff & Vale University Health Kate Stephens - Clinical Lead, Aneurin Bevan University Health 1. Welcome and Introductions DH welcomed members to the meeting and thanked them for their attendance. The group were asked to introduce themselves. Lead Apologies for Absence Apologies for absence were received from: Gemma Ellis - Consultant Nurse, Cardiff & Vale University Health Carly Buckingham - Service Deliver Manager, Hywel Dda University Health Maria Hobrok - Clinical Lead, Hywel Dda University Health Babu Muthuswamy - Clinical Lead, Aneurin Bevan University Health Julie Highfield - Consultant Clinical Psychologist, Cardiff & Vale University Health Tamas Szakmany - Network Lead Clinician (South East) Carole Jones - Superintendent Physiotherapist Zoe Goodacre - Transitional Lead & Network Manager (South East) Paul Temblett - Clinical Lead, Abertawe Bro Morgannwg University Health Deborah Dean - Amanda Jackson - Senior Nurse, Abertawe Bro Morgannwg University Health Orla Morgan - Senior Nurse, Cardiff & Vale University Health 2. Minutes of the Meeting Held on 8 February 2017 Members agreed the minutes of the meeting held on 8 February 2017 to be a true and accurate record. 3. Matters Arising Neurosurgery Meetings The last Neurosurgery Mortality and Morbidity meeting took place in June 2017 and gave critical care and neurosurgery colleagues an opportunity to discuss specific patient cases and raise any concerns. The meeting was well received

2 by those who attended and encouraged continued negotiations between critical care and neurosurgery. The next meeting is scheduled in October 2017 and agreed to circulate the date to the group for information. 4. Service Improvement Project AB UHB SH informed the group that with support from WAST, her local unit has successfully been able to provide compassionate extubation at home following the family s request. SH agreed to share information at the next meeting. ABM UHB DH updated the group on projects within ABMU. He noted that ABMU are in the process of developing a Discharge pathway along with an Enablement Pathway. DH agreed to invite.to the next meeting. HD UHB Using slippage from 2016/17 ministerial funding, HDUHB resourced a band 4 physiotherapist to audit falls in critical care and to deliver prescribed physiotherapy treatments. LL agreed to approach Adam Lewis and invite him to next meeting to present the data. CT UHB AH noted that Cwm Taf has now completed a Sepsis Box Trial. Data from the trial will be formally released on World Sepsis Day and AH agreed to present the findings at the next meeting. SH DH LL AH 5. Admission and Discharge Policy DH informed the group that the North Wales Admission and Discharge Policy has been formally adopted by CIIG for implementation across Wales. JM agreed to circulate a copy of the policy to the group for information. JM 6. ISo Neuraxial Connectors and Cross-border Transfers Following recently reported safety issues using ISo Neuraxial connectors on transfers the group were asked if units were transferring patients using the connectors. Members of the group confirmed that no units were using the devices to transfer critically ill patients. 7. Workshops Update Rehabilitation Following the success of the last Rehabilitation workshop it was noted that the Network was in process of organising another workshop on the topic. ZG to provide an update on progress at the next meeting. ZG Life after ITU updated the group on The Life After ITU workshop. The event took place on 11 May 2017 in the Life Sciences Hub, Cardiff and included presentations on follow-up clinics, psychological problems post ITU, data developments and survival analysis. The day was well received by all those attended and reflected in the feedback given.

3 8. VAP Prevention Survey Revision of VAP, WICS. Taking out stress ulcer prophylaxis?? DH informed the group that the VAP prevention survey was now complete. 9. Planned Revision of GPICS At the last CIIG meeting held in June 2017, Dr Chris Thorpe presented that there will soon be a revised version of GPICS published. This will include standards for smaller hospitals as the current standards are unrealistic for many smaller rural hospitals to adhere to. It was noted that once the revised guidance is published, the group will need to discuss and decide how to incorporate the guidance into peer review. 10. Advanced Communication Skills Training The group received feedback on the four Advanced Communication Skills training courses held throughout Wales in 2016/17 and facilitated by the Royal Marsden School. Training sessions are a mixture of theory and practical workshops and were well received by those who attended. Due to the courses success and the likelihood of additional funding being made available from the CIIG slippage asked the group if they d like the Network to organise additional ACST courses throughout 2017/18. The group supported this subject to each course being attended by staff from different Health s. 11. Clinical Governance Each Health were asked to give an overview of any clinical governance cases since the last meeting. ABHB SH informed the group infection control had uncovered a case of stenotrophomonas grown in a communal water machine drip tray and therefore the unit was no longer able to provide patients with cold water. ABMU DH reported a case where a central line had been removed from a patient which caused an air embolism and as a result left the patient disabled. Following the incident nurses are now required to be assessed three times by a trainer removing central lines. CTUHB AH informed the group that a patient had been mistakenly fed in to their left lung using a yellow core flow line ball and as a result the patient died?? AH informed that group that the Health s feeding guideline has been rewritten following the incident and agreed to share with the group. AH 12. Current and Future Work Programme ARDS Audit It was noted that ABHB has recently carried out an ARDS audit in critical care using a template devised by TS. However, four days ago the following guideline was published: An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome. It was noted that TS was in the process of redesigning the audit form to see how ABHB compare to the guidelines in Wales. TS agreed to contact Richard Pugh, Chair of WICSARG (audit and research arm of WICS) to help roll out the audit and template in every Welsh ICU.

4 eicu and Clinical Information System The group received an update on the Clinical Information System project from Greg Ead, Service Improvement Manager. He noted that CIS is at risk due to the delay in starting the procurement process for the project. This was due to a variety of reasons including the establishment of a Project and of a Senior Responsible Officer for the project, engagement from NWIS Procurement team and knowledge and experience gaps in the project team that remain unfilled. explained that a business case for the project needed to be submitted by the end of September 2017 for the project to continue. As a result of the delay in implementing the CIS the CIIG has been left with a significant amount of slippage to spend in 2017/18. Therefore, explained that Health s will be invited to submit bids for a proportion of the underspend to be spent in this financial year. The group expressed their frustration that 95% of the allocated ministerial fund would not be spent this year and that approval of their bids would be delayed due to the timing of SIG meetings with the CIIG. The group was encouraged to draft bids at their earliest convenience in an attempt to speed up the allocation and release of the funds. agreed to senior critical care staff across the six Health s notifying them that slippage funds will be available following the next CIIG in September also agreed to circulate a reminder of what the slippage could be spent on. Follow-up informed the group that the Follow-Up project had now ended. He noted that the project and clinics were well received and that clinics were still ongoing. A pilot study had been carried out and evaluated and agreed to share the results with the group. Peer Review updated the group on progress with carrying out Peer Review of critical care across Wales. He noted that Hywel Dda UHB Peer Review has been completed and a half day session has been scheduled in September 2017 for the Health to look at their action plan and decide how best to take the plan forward. Cardiff and Vale UHB has been reviewed and a draft report has been submitted for comment. ABHB peer review has been scheduled to take place on 14 September 2017 and agreed to provide an update on the review at the next meeting. informed the group that Welsh Government has recently released new guidance on peer review. He noted that a working group has been set up as result to discuss how to incorporate the new guidance into the peer review process. agreed to organise additional peer review training sessions over the next few months and also agreed to request a copy of the Cancer Network action plan and circulate to the group for information. Nutrition Project ALL

5 Item deferred. Delirium No update received. DCM requested clarification on the information the group required and agreed to provide an update at the next meeting. Proning Guidance No update received. It was agreed that Proning guidance would be removed from future SIG agendas and added to SNF for discussion. CVC SOP Item deferred. ZG/ 13. Any Other Business EMRTS 14. Date of the Next Meeting Wednesday 15 November :30am 11:30am Mawr Room, Public Health Wales Office, River House, Cardiff