Improving Care, Delivering Quality Reducing mortality & harm in Welsh Ambulance Services NHS Trust

Transcription

1 National Learning Session - 10 th June 2011 Improving Care, Delivering Quality Reducing mortality & harm in Insert name of presentation on Master Slide

2 Reducing Mortality & Harm in the Welsh Ambulance Services NHS Trust First ambulance service worldwide to be involved in 1000 Lives work Driver diagram reviewed to reflect new collaborative work and maintenance areas New focus on developing a Pre Hospital Early warning Scoring system through RRAILS Infection Prevention & Control will focus improving infection control arrangements across the Trust Improve survival rates for Acute Coronary Syndrome and Acute Stroke with rapid recognition of presenting conditions

3 Driver diagram Interventions RRAILS Develop and Implement a Pre Hospital Early Warning Scoring System Reducing Harm and Measuring Effectiveness Mortality & Harm Ambulance Patient Safety Prompt Tool (APSPT) Reducing Healthcare Associated Infections Improve Clinical Communication Leadership Acute Stroke Care Reducing Falls in the Community Improve: Pain scores Peak Expiratory Flow O2 administration Asepsis/Peripheral venous cannula insertion Improve rates of vehicle cleanliness IPC on all CPD programmes Spread structured handover via SBAR Turnaround at A&E Call taker to nurse SBAR handover Domestic abuse handover Patient Safety Executive WalkRounds Patient Stories Clinical Model in Control Centres FAST for rapid identification of stroke Blood pressure and blood glucose obtained to eliminate stroke mimics Introduce ROSIER PDSA with ABM East Falls Pathways Referrals by Paramedics and Nurses

4 RRAILS Pre Hospital Early Warning Scoring (PhEWS) Tool The use of an early warning system in the pre-hospital setting could benefit patients when there are capacity problems in accepting Emergency departments. The use of PhEWS will allow patients to be admitted on the basis of clinical priority rather than a first come first served basis. Pre hospital early warning score has been developed and desk top tested using 300 patient care records Sickness within the team has delayed further progress Next steps are to undertake a PDSA to test the tool in the live environment The PDSA will commence within the next 2 months

5 Reducing HCAI Focus over next 12 months zero tolerance to preventable HCAI s, this will be delivered by: Regional implementation of All Wales Dress Code guidance Delivering CPD sessions on Standard IPC precautions to all frontline staff, commenced May 2011 Introduction of ChloraPrep on all vehicles for skin asepsis Monitoring compliance with - hand hygiene, aseptic non touch technique for invasive procedures, appropriate waste disposal, cleanliness of environment, appropriate cannulation All job descriptions for staff who have direct patient care will include IPC responsibilities.

6 Reducing HCAI Peripheral Venous Cannulation Aim to reduce unnecessary cannula insertion and where cannulation is necessary increase first attempt success Circumstances in which intravenous cannula should be inserted are set out in the IHCD paramedic training manual Review of 400 patient care records undertaken where pain scores of 4 or more were present 54% of these patients (n=217) were cannulated and all were appropriate in line with cannulation guidelines 88% of these (n=190) were successfully cannulated at the first attempt Next steps repeat data collection with random sample

7 Improve Clinical Communication - SBAR SBAR introduced into telephone triage service within one clinical contact centre in January SBAR used to frame the handover for high priority calls from call handlers to telephone triage nurses. Aim Timely relevant effective handover of clinical information PDSA developed and baseline data collected. Average handover time 52 seconds prior to SBAR introduction and no evidence of SBAR use

8 SBAR Plan Staff information guide developed and awareness training provided to all call handlers on site. Do Go live date agreed and process introduced. Study Utilisation of SBAR during handover studied via call review process over 4 months February May Results disappointing. Act Further awareness sessions and revision of supporting literature planned

9 SBAR evident in call handler handover process % Jan-11 Feb-11 Mar-11 Apr-11 May-11

10 SBAR PROMPT CARD

11 Utilising SBAR for Domestic Abuse Handovers Following collaborative work with WAG and HBs, Routine Enquiry into Domestic Abuse was introduced into WAST in November The Domestic Abuse Routine Enquiry/HITS screening forms part of the patient assessment for patients meeting the criteria and where it is safe to do so. HITS screening is carried out by Paramedics The results of positive HITS screening form part of the patient handover to staff in A & E Departments. There is an opportunity to utilise SBAR for this handover.

12 Utilising SBAR for Domestic Abuse Handovers In order to review how the pathway is working an audit tool has been developed. A retrospective audit reviewing a random sample of 1000 Patient Care Records selected over a one month period for each of the three regions within WAST will be undertaken in July The inclusion criteria will be: Calls attended by a Paramedic who has undertaken the domestic abuse training Patient attended was aged 16 years or over.

13 Utilising SBAR for Domestic Abuse Handovers The audit criteria will review: Number of HITS assessment recorded on PCR Number of HITS correctly recorded as not appropriate on PCR Where a positive HITS assessment has been recorded on the PCR and patient was not conveyed to hospital the case will be followed up to assess whether patient subsequently made contact with NHSDW and the DA2 assessment was undertaken. The outcome of the assessment will be reviewed. The results of the audit will form baseline information for the Domestic Abuse Project

14 Leadership Trust Target To undertake 2 Executive Walkrounds each month in different locations and service areas. Issues and action plans from WalkRounds presented to Patient Safety & Safeguarding Group for monitoring and to escalate unresolved issues Recent changes following WalkRounds include improved communication with HB s leading to a decrease in the number of cancelled journeys by hospitals using the Patient Care Services Challenges experienced in co-ordinating and sustaining target over past 2 months with no WalkRounds taking place in May Plans back on track for at least 2 WalkRounds/month

15 Patient Stories Patient stories continue to influence service improvements Personal stories about challenges faced by Deaf and Hard of Hearing community in using health services, particularly accessing emergency ambulance service have been shared with staff following focus group discussions Focus group feedback resulted in the development of a Medical Information Card The card is carried by the individual at all times and holds personal and medical details about a person and strengthens communication between front line ambulance staff, patients and public WAST is now part of the national emergency SMS service that enables deaf, hard of hearing and speech impaired people in the UK to send an SMS text message to the UK 999 service where it is passed onto Ambulance control.

16 Clinical Response Model New clinical triage model introduced into Ambulance Control centres where calls that are neither life threatening nor urgent are transferred for a nurse telephone assessment which is commenced within 10 minutes. Provides a high quality clinical service which meets patients clinical needs. Model continually monitored and evolving through review and lessons learnt. Nurses triaging average 62% of callers to a more clinically appropriate outcome. Improved patient safety by nurse assessment identifying patient that may require a more urgent intervention than initial prioritisation suggested ambulance journeys were saved from 1 April 2010 to 31 March 2011 due to the new model in ambulance control rooms

17 Clinical Response Model Calls passed Calls resolved Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11

18 Driver Diagram Research based/ benchmarking Tool development Develop Screening Tool Senior level Approval Peer Input Develop and Implement Falls Referral Process for NHSDW Nurses Training Confirm Referral Pathways Develop Process Training Program Staff engagement Teams accepting referrals Update local services database Acceptance of Referral process Data Collection Paper based for PDSA s Internal Falls register

19 Falls pathway for nurse triage Patients who have fallen and subsequently assessed by NHS Direct Nurses are not currently referred into any falls prevention/ assessment teams across Wales. Patients may benefit from referral to falls prevention/ assessment teams. To utilise the model for improvement approach to facilitate change.

20 What are we trying to Accomplish (AIM)? Development of a Falls Screening Tool. Development of an All Wales referral process for patients who have fallen (and been assessed within NHS Direct Wales). Implement both the Screening tool and the referral process by May 2011 using PDSA framework. Small scale pilot commenced May 2011 with Neath Port Talbot CISS team.

21 How will we know the change is an improvement? Patients will be referred (by NHSDW nurses) to falls teams following nurse assessment. Measures will include :- Number of assessments conducted by nurses relating to falls Number of falls patients where the falls screening tool was used Number of patients actually referred to Falls prevention/ assessment teams

22 Falls Referrals from Paramedics Older people who fall account for approximately 10% of all 999 calls to the Many patients transported to A&E are subsequently discharged without further intervention There is a risk that patients managed at home, without referral into a falls pathway, may re-access the Trust following subsequent falls The Trust has continued to work with colleagues across Wales to further develop referral processes

23 HB areas taking referrals

24 Falls referrals made by Paramedics into established pathways 1200 Number of Referrals across Wales Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11

25 Acute Stroke Care Improve survival rates for Acute Stroke with rapid recognition of presenting conditions and transfer to definitive care Compliance with documenting FAST test on patient care records improved from 35 to 52% following its introduction into training and CPD between April June 2010 To further improve the rates of FAST compliance and transfer patients directly to a stroke team within 60 minutes. Introduce FAST test via telephone assessment at initial point of contact (999) To introduce the use of ROSIER test for stroke patients in the pre-hospital setting (PDSA planned with ABMU East)

26 FAST Compliance Patient Care Records where condition code relates to Stroke/TIA and FAST test documented Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11

27 Contact Information Chris Powell Nursing Practice & Clinical Practice Lead/1000 Lives Plus Key Contact Tel: