Implementing PEWS. With Peter Lachman, Nikki Davey and The NHS

Transcription

1 Implementing PEWS Sebastian Yuen Consultant Paediatrician, George Eliot Hospital, Nuneaton Fellow, NHS Institute for Innovation and Improvement ( ) With Peter Lachman, Nikki Davey and The NHS Institute

2 Overview PEWS implementation in The Royal Free Hospital The NHS Change Model

3 The NHS Change Model

4 PEWS is Recommended By: CEMACH NCEPOD NHS Institute NHSLA NICE NPSA RCN RCPCH

5 PEWS Project Steps Strong Leadership 2. Build the team 3. Clarify the aim and vision 4. Implement change: Model for Improvement 5. Design (localise, improve) the PEWS Form

6 PEWS Project Steps 6. Train staff in QI and PEWS 7. Measure & display effectiveness of PEWS 8. Communicate & engage all staff 9. Enhance Sustainability 10. Spread to other areas

7 1. Leadership Vision Strategy Communication Listen Be authentic Humility Respect Courage

8 "Change will not come if we wait for some other person or some other time. We are the ones we've been waiting for. We are the change that we seek

9 2. Build The Team: Who? Executive Sponsor Lead Paediatrician Lead Nurse / Matron Improvement Advisor Clinical Champions Administrator

10 2. Build The Team: How? Stakeholder mapping Network Treat followers as equals WIIFM (What s in it for me)? Expect challenge: know the evidence Walk the talk Focus and Commitment

11 "Leaders are visible, have a vision and share it, often"

12 3. Clarify Aim & Vision Create a sense of urgency (drivers for change) Align with strategic objectives SMART aim: Days between crash calls to 365 within 1 year Develop compelling vision Carefully limit scope Check readiness for implementation

13 Vision Build compelling shared vision of outcome This comes from all staff, not top-down What will PEWS look like on a good day? What difference will we feel / hear / see? Describe in present tense Make it something exciting!

14 Vision For PEWS Defines the ideal future situation It guides and encourages the organisation What do we want PEWS to look like in the future? So easy to use - my mother could do it! I use it because it works I trust it It saves me time and helps me with patient assessment It improves situation awareness and reduces harm

15 Sense of Urgency Create a Sense of Urgency Why do we need to do this, now? Respond to: o Complaints o Incidents o Patient story o Tight deadline

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17 It was a question of jump or fry, so we jumped

18 4. Implementing Change The Model for Improvement o Rapid start o Evolution, not revolution o Builds will and engagement Driver Diagram: Overview of programme

19 Model For Improvement Model for improvement What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in the improvements we seek? Aim: how much, by when? k Measurement Frontline staff suggest innovative ideas to overcome problems Act Plan Test ideas before implementing. PDSA Cycles are mini-audits Study Do The Improvement Guide: A practical approach to enhancing organizational performance (2 nd Edition 2009) Gerard J. Langley, Kevin M. Nolan, Thomas W. Nolan, Clifford L. Norman, Lloyd P. Provost

20 Record physiological observations competently PEWS Guideline Recording Observations Training Eliminate preventable harm due to deterioration in children Identify early signs of deterioration Respond rapidly to deterioration Calculate PEWS accurately Use PEWS to improve Situation Awareness Follow PEWS Escalation Plan reliably Use SBAR Communication Tool PEWS Form PEWS Training Ward Whiteboard PEWS Handover SBAR Handover SBAR Training

21 5. Design PEWS Form PEWS forms & literature reviewed Started with Brighton, then Cardiff & GOS Multiple versions Led by users Implement as only observation chart

22 The PDSA Cycle Act How will we test what we have learned? Start planning the next cycle Study Complete the analysis of the data Compare data to predictions Summarise what was learned Plan Objective Questions and predictions (why) Plan to carry out the cycle (who, what, where, when) Plan for data collection Do Carry out the plan Document problems and unexpected observations Begin analysis of the data

23 PDSA Cycle Template

24 Testing: Start Small 1 patient 1 nurse 1 doctor 1 day Testing: All

25 Start Next Tuesday! Year Quarter Month Week Day Hour What tests can we complete by next Tuesday?

26 PEWS Cycles 1-9 A P S D S D A P S D A P A P S D Result: Increased buy-in from stakeholders Cycle 9: PEWS design simplified Tests increase from all Cycle 6-8: Design of PEWS form improved. Tests similar to Cycle 1 Cycle 5: PEWS form now incorporated into observation form Cycle 2-4: Design of PEWS form improved. Tests similar to Cycle 1 Cycle 1: First draft of modified Brighton PEWS 1 nurse, 1 child, 1 shift

27 Multiple PEWS Cycles Format of PEWS Usability Testing Link to SBAR & handover Change Concepts Addition of section to audit action & added to safety briefing

28 PDSA PEWS Forms

29 PDSA PEWS Forms

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32 Observation Charts Transformed

33 6. Train staff in QI and PEWS Model for Improvement & PDSA Cycles Measurement for Improvement PEWS SBAR (RFH & NHSI DVD) How to measure vital signs Recognition of the sick child Remember new, night & temporary staff!

34 "Some is not a number. Soon is not a time." IHI 100,000 Lives Campaign

35 7. Measurement Process Measures Outcome Measures Crash Calls Transfers to PICU Balancing Measures Review missed cases, deaths, incidents

36 PEWS Process Bundle

37 Measurement

38 Measurement: Process

39 Measurement: Outcome Interval between Crash Calls on The Royal Free Paediatric Ward

40 8. Communicate Frequently every opportunity! Match your message to this audience Tell patient stories Ask questions with genuine curiosity Listen! Posters announcing: PEWS is coming! Explain why (rational / evidence / emotional) Celebrate success!

41 Capture Learning PDSA Forms Diaries Cameras Share Learning with Staff Families Executive sponsor Network Spread Learning: Measures, Posters, Stories

42 Engagement

43 Engagement The team must want to implement PEWS They cannot be forced to do it Listening, trusting and empowering are key Communication in different ways is crucial Important to continue to engage the team It must make their lives better It must be easy to try and easy to do

44 Sustainability

45 9. Enhance Sustainability Handover SBAR Safety Briefing Resuscitation scenarios Audits The Productive Ward Ward whiteboard Mandatory training Induction Involve parents Quality dashboard

46 PEWS-SBAR Handover Sheet

47 Patient Status At A Glance

48 PEWS-SBAR Card 1

49 PEWS-SBAR Card 2

50 Spread of Innovation

51 10. Spread Emergency Department Paediatric Neurological PEWS Form Neonatal PEWS Form Spread in UK Spread via Partners in Paediatrics Spread via the NHS Institute Spread to Slovenia and Uganda

52 Rigorous Delivery Week Team Meetings Core Team Setup Meeting Review Meeting Review Meeting Plan Next Steps Measures Pre-measures PDSA PEWS Form PDSA 4 PDSA 5 Training Project Team All Staff New / Temporary Staff Comms Project summary to team PDSA summary after each cycle Launch to all staff PEWSletter 1: Why PEWS? PEWSletter 2: What is PDSA? PEWSletter 3: Why Measure? PEWSletter 4: Progress PEWSletter 5: Next Steps Launch PEWS Week

53 All truth passes through 3 stages: 1 st it is ridiculed. 2 nd it is violently opposed. 3 rd it is accepted as being self-evident.

54 #SocialEra @RCPCH_President LinkedIn: The Running Horse Group

55 Paediatric QI Resources RCPCH Quality Improvement and Patient Safety series: 3. The Running Horse Group on LinkedIn: 4. Institute for Healthcare Improvement 5. Patient Safety First Campaign 6. The Health Foundation

56 Learning Points Implementation more important than the tool Align with priorities & other projects Co-produce from the beginning Executive leadership support essential MfI enables rapid start & builds will PDSA Cycles maximise learning Measurement helpful, but must lead to action Engage all team-members, often