North West London Critical Care Network Network Joint Clinical Forum Board

Transcription

1 North West London Critical Care Network Network Joint Clinical Forum Board Action notes of the Network Joint Clinical Forum Board meeting held on 3 rd June 2015 from pm in the Boardroom, Riverside Wing, Charing Cross Hospital Present Jeremy Cordingley Andrea Blay Linsey Christie Ruth Griffin Steve Brett Roseanne Meacher Julie Oxton Fiona Stubbs Melanie Denison Ines Martinez Deirdrie Moran Tariq Husain Mike Dean Liz Staveacre Donna Hall Anthony Bastin Pascale Gruber Gary Wares Alex Sell Suzanne Brompton Barbara Walczynska Duncan Wells Jeremy Brown Angela Walsh Ganesh Suntharalingam Gezz Van Zwanenberg Action Note (Chair) RBH - Royal Brompton and Harefield Hospitals NHS Foundation Trust Chelsea and Westminster NHS Foundation Trust Chelsea and Westminster NHS Foundation Trust Hillingdon Hospital NHS Foundation Trust London North West Healthcare Trust London North West Healthcare Trust London North West Healthcare Trust Royal Brompton and Harefield Hospitals NHS Foundation Trust Royal Brompton and Harefield Hospitals NHS Foundation Trust Royal Marsden Hospital Royal Marsden Hospital Royal National Orthopaedic Hospital West Middlesex University Hospital West Middlesex University Hospital Patient and carer Member NHSBT Critical Care Network Critical Care Network Critical Care Network Apologies for absence Tim Wigmore RMH, Rohit Juneja RMH, Jacek Borkowski CMH, Doris Doberenz ICHT CXH, Elaine Manderson C&W, Fionna Moore - LAS, Robert Broomhead ICHT HH, Melissa Dransfield ICHT HH, Jonathan Handy CW, Maie Templeton- ICHT, Simon Ashworth-ICHT, Eve Corner CW, Julian Letaigne RBHT, Raheela Ajmal-Ali LNWHCT, Rory Skinner LNWHCT, John Vogel LNWHCT, Saraa Al-Mahdi LNWHCT, Keetje Gull RMH, Lorraine Papapvlou RNOH, Pippa Dorney- Kingdom THH, Jamie Zanardo LNWHCT. 1 & 2. Welcome Who When Jeremy Cordingley welcomed all members to the Network s Joint Clinical Forum Board. Apologies for absence were noted (See above) 3. Agree the notes of the last meeting held on 12 th March 2015 Who When 3.1 Correction to the attendance list from the last notes was requested as it currently showed TH as medical lead for network The action notes of the Network Joint Clinical Forum Board meeting held on 12 th March 2015 were agreed Page 1 of 6

2 4. Matters arising Who When ICNARC training feedback from units that attended was that this was a useful training day although a little frustrating as it left many unanswered questions regarding local variation and ability to interrogate data locally for use by members. Seems very fixed way of using and operating the system. There was a known variation in the definition on a capacity transfer. It had previously been confirmed with the CRG in regards to the service specification about the definition of capacity transfer. 4.1 Action list from 12 th March was agreed. 4.2 Main actions from the Network strategy group were outlined and the workforce survey was agreed by members. The letter from Network to NMC regards PIN number delays was also agreed 4.3 Spinal centre access was discussed. Some patients appeared to be in a holding pattern in Gen DHG ICU pending specialist access. It was agreed to draft letter to spec commissioning (Deborah Nicholson) in preparation for this it was agreed to look at telling the patient story. Also mapping the cost of one patient that would illustrate the cost x the number of patients awaiting access at any one time. to raise at London steering group. 4.4 Pan London Steering group TOR were shared with principles for the group and network comments. There were no additional comments from members. There was discussion regards the London Event. It was felt to have been less interactive than anticipated. Very little time for feedback during the day. Some members expressed concerns regards operational vs strategic intentions. Any comments on the TOR to network office by COP 7/7. Action 1. It was agreed to write and invite the new CE of ICNARC to a future JCFB meeting 2. It was agreed that members would update the workforce information to inform Network work regards workforce planning 3. AW to send letter and covering to NMC on PIN numbers and registrations. 4. Spot audit regards spinal and Neuro rehab patients AS, RM, GS, AW agreed to assist 5. Raise issue of spinal provision with SC at NHSE via London steering group 6. Members to comment on TOR for Pan London steering group AW AS,RM, GS 5. National Critical Care Clinical Reference Group- Jeremy Cordingley Who When 5.1 There had been no meeting since the last JCFB. Next CRG meeting Sept The Service Specification was anticipated to be finalised and published in the near future. 5.2 Network data reports from ICNARC documentation required to be signed by each site permitting their data to be used in Network reports was available. It was agreed by members that they wanted to share data at Network level to support transparency. Action 7. AW to send out the ICNARC waivers from ICNARC to each unit lead for clinicians to sign. Sep Update from each site/member Who When RNOH reduction of 2 adult level 3 beds. Based on access as there was capacity within ICU to accept more patients. ICNARC was slow being implemented due to the Trusts software provision. LNWHCT CMH ICU remains open. New CE is looking at feasibility of the site and has already hosted both SAHF and NHSE looking at the critical care capacity at the NPH site. As a Trust (including Ealing) LNWHC T contributing the majority of capacity transfers in the NWLCCN. Additional training in place to support clinical staff and patients in these clinical settings. Harefield Julie Maber has taken over as unit lead from Peter Doyle who has moved into more senior Trust role. 6 extra beds have received planning permission but no building started yet. ICNARC challenges similar to others with regards the software updates required. RMH Discussions about expanding ward bed capacity to enable better flow. Page 2 of 6

3 Chelwest Merger with WMUH 1 st Sep Critical care configuration and integration meetings have already started. ICNARC at Chelwest now in place but no additional funding for admin had been sourced. This was being looked at. Access to Putney rehab beds was an issue.. Anticipating further changes to hospital at night including roles of FY1 and FY2 physician s assistants. These were noted WMUH - Recent reduction in activity, new CE wants integration discussion and work early. Patients and carers updated on the life saver pitch and working with the clinical teams on rehabilitation work. Reiterated the my name is campaign and to me not about me principle for clinical staff working with critically ill patients. ICHT all 4 ICUs remain busy. CQC - ICU revisit anticipated Jan Action plan in place and being implemented. CXH 6 HDU Neuro beds will improve capacity for Neuro patients. There was also planned work looking at improving capacity across all three sites and a critical care strategy. Hillingdon Split rota 1:7 (moving to 1:8 later in the year) about to start. ICNARC data was now being collected as of 1 April Pippa Dorney-Kingdom is the new unit manager. ICU strategy group had initial meeting to discuss how best to expand. Current footprint now part of the Trust risk register as not meeting building regs compliance as well as other upcoming standards including service spec and GPICs. RBHT busy. Capacity remained ok. Surjeet Kaur retiring and Jo Tillman from the RLH to be new ICU matron (Sept). NHSBT consent at 54.7% from 51.5% of all requests however 42 donations fewer compared with last year. Discussion with units about new strategies to address this. Discussed the DONATE education resource aimed at Healthcare professionals and providing resources for educating staff about the subject of donation. Also aimed at giving families the best possible experience right info at the right time in order to help families make informed choice for agreeing donation. LNWHT activity remains high at Northwick Park site with capacity at CMH being used to manage flow. Evidence in the Network transfer data (already shared with unit lead at LNHW & TCCDG) of capacity transfers from NPH to CMH. Also evidence of capacity transfers from Ealing to other sites including NPH. Impacting on capacity. It was understood that the CCGs would be asking the Network to review services on the CMH site again to confirm that the original action plan was in operation. There was also the potential to look at CMH as a resource to the Network for specific patient pathways all of which was part of the work ongoing at LNWHT. 7. Shaping a Healthier Future (SAHF) Who When Maternity - There was discussion about closure and moving of maternity services from Ealing hospital with regards impact on the critical care element of any modelling that might have been carried out. It was agreed that leads would check what activity if any had been anticipated on their site and let the network know if any concerns. Sep Information and Quality Who When Information, Quality and Patient Safety Network Quality Measures 8.1 Q all sites, TH at LNWHT asked for clarification and change in two items that AW had transposed. Report showing Q1,2,3&4 for all sites (raw data) were shared at the meeting. Members accepted the QM report for Critical Care Patient Transfers - Network data Total critical care transfers data shared showed that there were 537 documented inter hospital transfers (L3, L2, L1) This was a rise compared with 393 in Page 3 of 6

4 8.3 Capacity transfers data shared showed that of the 537 total transfers documented 115 were for capacity reasons. This was a rise from where out of the total 393, 50 were capacity. It was noted that the majority of capacity transfers were from Northwick Park to Central Middlesex ICU in order to maintain flow and capacity at NPH. Also it was noted there were a significant number of transfers out of Ealing hospital. These points needed to be incorporated into the capacity and capability planning of LNWHT going forward. There were 5 transfers that were captured by EBS that were not documented by Network documentation. 8.4 Specialist transfers Neuro transfers = 70, an increase on the preceding year. Renal transfers from critical care to ICHT = 40. ECMO retrieval data was shared showing the Team from RBH had undertaken 39 ECMO retrievals 8.5 Transfer incidents of the 537 documented transfers there were total 41 Incidents (9 where 2 incidents occurred during the same transfer). Two main themes from this reporting period being equipment and organisational, specifically ambulance delays / issues / problems. incidents had been looked into locally and learning shared across the network via the transfer training course + Trust Critical Care delivery Groups. In addition several incidents specifically to do with LAS had been escalated to CE LAS. On each occasion what was clear was that the vocabulary used in contacting LAS and requesting either Critical or Immediate transfers was crucial. Senior unit leads medical and nursing were asked to remind all grades and staff that the set vocabulary was essential. calls to LAS are recorded and transcripts can be requested. On the occasions that this was requested there was clear difference between the agreed vocabulary and the clinicians making the call. 8.6 Transfer documentation the distribution of the 2015 transfer documentation reflecting the new Network office address was underway and anticipated to be completed by end June Patient Transfer Safety developments 8.7 Intra-hospital transfer form Implementation update reported back from several sites that were using the Network intra hospital transfer form. There was interesting data showing the amount of time in hours that staff were off the unit escorting patients to CT scan etc. (1 unit showed 87 hours of staff time off the unit in 3months). One aspect of the data that the Network transfer faculty would be looking at was that there were no recorded incidents across any of the sites. This seemed unlikely and further work into this was planned. Version 2 of the form would be distributed and placed on the network website after the Network Transfer faculty meeting It was agreed that all sites would implement the intra hospital transfer form and data from these would be collected locally for use and sent on a quarterly basis to the Network for aggregation and sharing at JCFB. 8.8 Network Transfer App The App is progressing and content is being created from existing material being used on the transfer training. There had been discussion and agreement to make the App pan London in terms of utility and contact details for all critical care units in London were being sought for inclusion. Initial issue of the prototype of the App is planned for September 2015 with full launch planned for the Network Event in December. 8.9 Network Transfer bag The modified Delphi process used had produced a list of items which had been photographed in sections (Airway, Breathing etc.) and these were now being agreed to determine the numbers of each item. It was agreed to pilot the bag contents in 3 sites and then to have the bag designer develop the bag and contents. The key concepts (from the faculty) including the patient specific pocket (for equipment relating to the patient being transferred), at a glance checking and being able to secure the bag and access in the ambulance. Pilot was anticipated to be complete by Sept with the planned demonstration of the bag and contents in December at the Network Event. Actions 8. members to publicise Critical and Immediate transfer vocabulary and Ambulance flowchart requesting locally 9. Version 2 of the Network Intra hospital transfer form to be distributed post transfer faculty meeting Units to feedback on implementation and data sharing of intra hospital transfers at JCFB to ALL ALL Jun 15 July 15 Sep 15 Page 4 of 6

5 liaise with local teams regards this. 11. App development team to provide content by end of July to liaise with developers 12. Transfer bag pilot to be implemented once content agreed Aug 15 Sep NICE CG 83 Rehabilitation after Critical illness Steve Brett Who When NICE CG 83 Rehabilitation after Critical illness - Dr Mo Ali (GP) & Dr Steve Brett 9.1 Network rehabilitation film update The filming of an educational film to support care planning of critical care survivors in NWL was scheduled for It was anticipated that this would be edited by end Sep There was also on-going work to establish the pilot of care planning by GPs of critical care survivors. Electronic notification testing via workflow from ICU to GPs had been encouraging and more testing was planned. 10. EPRR Inc. business continuity and surge Who When EPRR Inc. business continuity and surge 10.1 BAXTER supply chain failure colleague pumps an update was given about the management of supplies and variation in stock that was being experienced in NWL. As large users of the Baxter lines, Trusts in NWL were being assisted in their access to stock to maintain supply to patents. DH was leading on this work with support locally from North West London CCN. SB/ MO Jun15 Sept Surge Capacity It was agreed that for winter, a request of Surge Capacity numbers would be helpful Ambulance capability tool It was reported that the tool which had been put together as part of the Olympic resilience work had been confirmed for accuracy of contact numbers and capability in June Since that time there were some changes in the independent ambulance provider world. Staff were reminded that the tool was a guide in the event of an independent ambulance being required and that all arrangements should be made in line with local trust policy and existing contracts. The Network was working with one trust who was experiencing difficulty with their provider and the collection tool used to collate the capability tool was being used to support on-going work by facilities management. Actions 13. Any unit experiencing supply chain difficulties to contact Network 14. Units to review their surge capacity plans 15. Unit leads to review their PTS or HDU contracts where applicable and in needed contact Network for additional intelligence regards independent ambulances Ongoing Ongoing 11. Network administration update Who When Network administration update work plan the final work plan was issued and would be reviewed by JCFB and Network strategy group Peer review Following discussion GS agreed to draft an outline proposal and plan regarding Peer Review in NWL Network governance review Network feedback to NHSE attached there was discussion about the time taken to complete this and also the potential impact upon the Network work plan. Members agreed that that the work plan was the priority for Network and that demands for extra information needed to be light touch Annual report drafting schedule was discussed 11.5 To note that all data assurance review was taking place at Imperial supported by the Network, CCG and Trust Independent sector protocol it was agreed that the offer in principle letter to the independent sector to be members of the Network was agreed. GS Sept 15 Actions 16. The updated work plan was confirmed 17. The Network feedback to NHSE was agreed 18. The CCMDS data assurance review taking place was noted Page 5 of 6

6 19. AW to proceed with independent sector protocol AW Sept AOB and date of next meeting Who When Gary Wares Regional Advisor requested that the Network support his work looking at Workforce Planning and numbers of consultants and nurses in post and in the training pipeline to understand the future requirement and any shortfalls / pinch points. There was discussion that this matched the Network work plan around workforce. This would also inform the Network event in December. Action 20. It was agreed to liaise with GW and design specific questions that would inform workforce work stream Network Joint Clinical Forum Board next meetings Wednesday 23 rd September 2015 The Royal Marsden Boardroom pm Thursday 17 th December 2015 combined with Network Event ROSL pm Transfer Training Dates ( supported by Network wide faculty) for 2015 Unit leads were asked to book dates into off duties and faculty were asked to look at availability and confirm Tuesday 9th June 2015 Northwick Park Hospital (Local) Tuesday 28th July 2015 Royal Marsden Hospital (Network wide) Friday 14th August 2015 Royal Marsden Hospital (Network wide) Tuesday 8 th September 2015 West London University Thursday 17 th September 2015 RBHT Harefield Hospital (Local) Tuesday 22nd September 2015 St Mary's Hospital (Local) Tuesday 6th October 2015 Northwick Park Hospital (Local) Tuesday 10th November 2015 Royal Marsden Hospital (Network wide) Page 6 of 6