1. Welcome and Introductions JPJ welcomed members to the meeting and thanked them for their attendance. JPJ asked members to introduce themselves.

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1 SOUTH WALES CRITICAL CARE NETWORK SOUTH EAST WALES SERVICE IMPROVEMENT GROUP Minutes of the meeting held on Wednesday 14th September 2011 in the Resource Room, Critical Care Department, UHW Present: Dr Jack Parry-Jones (JPJ) - Network Lead Clinician - Chair Zoe Goodacre (ZG) - Network Manager Julia Jayne (JJ) - Network Information Analyst Ifor Evans (IE) - Network Manager Mid & West Dr Anton Saayman (AS) - Cardiff & Vale ULHB Gemma Ellis (GE) - Cardiff & Vale ULHB Jessica Castle (JC) - Cardiff & Vale ULHB Orla Morgan (OM) - Cardiff & Vale ULHB Carole Jones (CJ) - Cardiff & Vale ULHB Richard Lee (RL) - Cardiff & Vale ULHB Helen Watkins (HW) - Cardiff & Vale ULHB Dr Tamas Szakmany (TS) - Cwm Taf LHB Andrew Hermon (AH) - Cwm Taf LHB Dr Steve Edwards (SE) - Aneurin Bevan LHB Mary McKerrow (MM) - Aneurin Bevan LHB Linda Alexander (LA) - Aneurin Bevan LHB Sally Copner (SC) - Aneurin Bevan LHB In Attendance: Justine McCarthy (JM) - Network Administrator 1. Welcome and Introductions JPJ welcomed members to the meeting and thanked them for their attendance. JPJ asked members to introduce themselves. Action Apologies for Absence Apologies for absence were received from:- George Findlay (GF) Paul Frost (PF) Chris Morgan (CM) 2. Minutes of the Meeting held on 8 June 2011 Members agreed that the minutes of the previous meeting to be a true and accurate record subject to the following amendment:- Attendance Mr Richard Lee Matters Arising End of Life Care ZG updated the group on progress developing an All Wales End of Life Pathway for Critical Care. She noted that a draft All Wales proposal had Network SIG Minutes 14/09/ of 5 SEW Critical Care Network

2 been produced and sent out for consultation. The development was being led by clinicians in North Wales who would be taking the next steps to completion. It was planned that the final pathway would go to an All Wales End of Life conference in November before rolling out across Wales. 3.2 Upper GI Clinical Model Implementation Plan Following the last meeting of the SIG, JPJ informed the group that he had recently contacted Judith Paget, Director of Planning ABHB to discuss the Service Level Agreement between LHBs in South East Wales for long term patients. The SLA includes 40 bed days per year for all upper GI patients requiring critical care. It was agreed that JPJ would circulate the SLA to the group for information. JPJ All Wales Critical Care Advisory Group JPJ informed the group that the AWCCAG are due to meet on the 15 September 2011 and agreed to feedback at the next meeting SIG meeting due to take place in December JPJ asked group members if they had any issues they would like to raise at AWCCAG Medical Staffing JPJ informed the group that the network teams were reviewing the All Wales Quality Requirements with particular to medical staffing. GE confirmed that the Senior Nurse Forum will be reviewing the nursing standards on behalf of the networks. JPJ agreed to circulate a draft once this had been completed. GE to feedback JPJ 4. Network Board ZG updated the group on progress made to date following discussions that took place at the South Wales Critical Care Network Board meeting held on 18 May ZG noted that the Networks work programme and aims and objectives have been agreed and at the Boards request have been formatted into a driver diagram to illustrate outcomes. ZG formally thanked members for their help in providing the Network with supporting documents and information for the Network Board. JPJ updated the group on work being carried out to design a referral pathway for patients with Cardiogenic Shock needing cardiac care. The project is being led by Dr Christine Weaver and the first meeting is due to take place on 22 September Feedback awaited from CW GE informed the board that the South East Wales Senior Nurse Forum has now regrouped and linked in with the Mid & West Senior Nurse Forum. The forum will, amongst other topics look into advanced nursing roles to cover tasks that were previously medical responsibilities and nursing competencies. GE noted that all critical care senior nurses along with Velindre are invited to attend an annual Senior Nurse Forum meeting. Hayley Ellis-Evans is regularly attending the South East Wale Senior Nurse Forum to provide a link between the two regions within the Network. Network SIG Minutes 14/09/ of 5 SEW Critical Care Network

3 5. Mid & West Service Improvement Group Feedback The group received an update on the Mid and West Service Improvement Group. IE noted that the first Mid and West Service Improvement Group had taken place in June 2011 where the group agreed frequency of the meetings, membership and TOR. As the South East Wales Service Improvement Group has progressed in developing guidelines and pathways in many areas including head injury and clinical governance IE noted that the Mid and West region were keen to adopt pathways already developed by the South East subject to some amendments to fit the M&W region. Although M&W will be adopting pathways from the SE, IE noted that his region wanted to establish and develop their own guidelines and pathways. IE highlighted the areas that M&W SIG wanted to carry out work on, these were:- Admission and Discharge Discharge summaries NICE 83 Nurse led weaning Hypothermia for cardiac arrest IE asked the group if they were happy to share the work already carried out with the M&W region. The group agreed they were for pathways and protocols developed in south East Wales to be shared with Mid & West. 6. Clinical Governance JPJ asked those present if there were any clinical governance incidents from which colleagues across the Network could learn. Cardiff & Vale OM highlighted key patient and medical clinical governance issues for Cardiff and Vale. These were: Prescriptions (infusions) JC mentioned specific lessons learnt around pre filled Heparin syringes. Pressure sores Unit has rolled out guidelines in February 2011 and is currently carrying out work to raise awareness amongst staff. Staff Assault Maxillo facial patients OM noted that all clinical incidents are recorded by staff involved and sent to the practice educator to collate in an electronic format for information. Cwm Taf AH highlighted key clinical governance issues for Cwm Taf. These were: Delayed discharges Pressure sores Infections (any infection acquired whilst on the unit) ABHB SC noted key clinical governance issues for Nevill Hall. These were: Network SIG Minutes 14/09/ of 5 SEW Critical Care Network

4 Pressure sores (acquired prior to being admitted on to unit) Blood transfusion from Orthopaedics Abusive patients Needle sharp incidents (doctors) LA noted key clinical governance issues for Royal Gwent. These were: Pressure sores (acquired prior to being admitted on to unit) Skin bundle and audit in place. ENT patients Infection control (c.diff) Accidents/ personal injury Bariatric patients (lifting) Blood transfusion incident Medication Errors The group agreed that a generic format would be used by each Health Board to report clinical governance issues to the Network. The group agreed to adopt Cwm Taf Health Boards template for future reporting and AH agreed to circulate to all. AH also agreed to circulate a template for reporting medication errors. AH AH Current and Future Work Programme Feedback from Current Working Groups Head Injury The group received the final draft of the South East Wales Critical Care Network Head Injury Pathway for information. It was noted that the Pathway would be sent out to all consultants shortly and the group could access the document on the South Wales Critical Care Network website. Emergency Planning and Pandemic Influenza JPJ informed the group that the All Wales Critical Care Winter Pressures Workshop due to take place 27 th September. The session will bring together speakers from Public Health, Critical Care Clinical Practice and diagnostics in the run up to final planning for Winter Pressures in 2011/ Equipment Standards ZG updated the group on discussions that took place at the Equipments Standards Group meeting held on 7 September She noted that the group had discussed issues around equipment costs and standardising equipment for units. ZG also noted that the group are in the process of developing a proposal highlighting the benefits of Health Boards sharing equipment particularly equipment used for bariatric patients. The SIG supported the proposal and it was agreed that any comments would be forwarded on to JPJ, ZG or Sarah Beuschel, Equipment Standards Group chair. Future Work Programme Audit of Tracheostomy Care Network SIG Minutes 14/09/ of 5 SEW Critical Care Network

5 7.2 GE informed the group of a proposed study of knowledge of the All Wales Tracheostomy guidelines planned in conjunction with MA Broad, Physiotherapy, Cardiff & Vale Health Board. This would be a one day perspective study of all staff on duty on the nominated day. GE and MA were still working on the methodology and further information will be given at a future meeting. WORKSHOP SESSION 8. Engagement with the Network The group discussed individual Health Board engagement with the Network. JPJ invited group members to suggest areas in which it would be useful for the Network to support units. None were raised at the meeting but members were free to submit any to JPJ outside the meeting. 9. Audit of Renal Admissions The group discussed renal patients who require transfer to the renal unit in Cardiff. It was agreed that the number of referrals needed to be audited and would be brought back to the next meeting. 10. Any Other Business No items of any other business were received. DATE OF THE NEXT MEETING Wednesday 7 th December :00am Post Graduate Centre, Royal Glamorgan Hospital Network SIG Minutes 14/09/ of 5 SEW Critical Care Network

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