Cumbria and Lancashire Abdominal Aortic Aneurysm Screening Programme CLAAASP

Transcription

1 Cumbria and Lancashire Abdominal Aortic Aneurysm Screening Programme CLAAASP ANNUAL REPORT 2015/2016 Prepared by Mrs S Clinton Programme Coordinator / CST 1

2 CLAAASP ANNUAL REPORT 2015/ Foreword 3 2. Introduction 4 3. Contacts 5 4. Programme Background and Delivery Programme objectives 6 Screening pathway Screening outcomes Staff Clinic venues Nurse clinics Programme Performance Statistics and Data Quality Standards and KPI Referrals Self referral report 6. Quality Assurance CST report Datix MDT meetings Programme Board Meetings Training and Development Customer Satisfaction Feedback survey Communications and Publicity Promotion events Health Equity and Equality Nurse Report 21 SITES Acknowledgements References 26 2

3 Foreword Mr Simon Hardy: Clinical Director This is our 3rd year of screening in Cumbria and Lancashire. As the programme matures it is beginning to face new challenges, but our technicians have still managed to complete our cohort on time and on target. A magnificent achievement. They have also been able to scan a further 900 selfreferrals as well! Clearly, our staff are the corner stone of our programme and this year they have worked particularly hard to help our screening patients by training and attending courses to aid their understanding of 65 years old men with learning difficulties. They have successfully liaised with our local learning disability teams to improve the experience and up take of screening within the cohort of the 12,000 men aged 65 years we have screened this year. As the programme matures it will doubtless face many other new challenges but the important facts to remember are that we now have over 330 men in our surveillance programme with known aneurysms and have referred over 50 patients onwards for aneurysm treatment by our Local Vascular Centres. 3

4 Introduction Mrs Susan Clinton: Programme Coordinator / CST I am very pleased to present the third Annual Report for the Cumbria and Lancashire AAA Screening Programme {CLAAASP} The programme covers a large, and often remote, geographical area offering challenges for coordination and planning, particularly in winter months. Despite these challenges the team have delivered a high quality and successful service leading to further increase in uptake. This report looks back over the cohort and highlights our achievements in our third year of screening. It gives us an opportunity to reflect on our outcomes and achievements thus enabling us to further develop and improve. Highlights for the programme during included: Successful accreditation of new screening technicians at Salford University 2 further screening technicians moving into new careers as trainee vascular scientists 100% of cohort with an initial offer of a scan despite high levels of long term sickness within the team >75% with a conclusive test Over 900 self-referrals scanned Training of staff in the needs of patients with learning disabilities Excellent feedback from the annual client satisfaction survey 4

5 Programme Contacts: Administration at Queen Elizabeth Hospital, Gateshead, NE9 6SX Local programme office Preston Business Centre Watling Street Road Preston PR2 8DY Clinical Director: Mr Simon Hardy Consultant Vascular Surgeon, Royal Blackburn Hospital Programme Manager: Mrs Jeanette Bowes Service Line Manager for AAA, Breast and Bowel Screening Services, Queen Elizabeth Hospital Programme Coordinator / CST: Mrs Susan Clinton Preston Business Centre Screening Nurse Practitioner: Mrs Carole Williams Preston Business Centre Admin Coordinator: Chaya Reddy Preston Business Centre Screening Technicians: Rachel Johnson, Julie Kellett, Diane McKay, Joy McMahon, Carl Nightingale, Janet Wignall, Alison Wilks Office Manager: Mrs Allison Wise AAA, Breast and Bowel Screening Services, Queen Elizabeth Hospital 5

6 Programme Background and Delivery Programme Objectives The NHS AAA Screening Programme was introduced after research showed it should reduce the number of deaths from ruptured aneurysms among men aged 65 and over by up to 50%. The overall objectives set out by the National programme are to: Identify and invite eligible men for screening Provide clear, high quality information that is accessible to all Carry out high quality ultrasound on men attending for initial or follow-up screening according to national protocol Identify abdominal aortic aneurysms accurately Minimise the adverse effects of screening, including anxiety and unnecessary investigations Enable men to make an informed choice about the management of AAA Reduction of AAA-related mortality in the population of men aged 65 and over Screening Pathway Operating in line with the Standard Operating Procedures [SOPs] men in their 65 th year registered with a GP in Cumbria or Lancashire are identified by the AAA National database and sent an appointment to attend a screening site local to them. We have a team of 7 qualified screening technicians and 1 nurse practitioner [also qualified to screen] who provide screening clinics in the community-based locations [See page 24 for sites attended] Men over 65 and not previously invited under the programme can refer themselves and these are accommodated within the programme as per SOPs Screening test and outcomes ID is checked 6

7 The screening process and possible outcomes are outlined by the screening technician and informed consent obtained before proceeding An ultrasound scan of the abdomen is performed The aorta is measured according to set criteria and the measurement of the widest point is recorded The gentleman is informed of his result The 5 possible outcomes are categorised as below Normal aorta is < 3cm Most men have a normal result and currently will not be invited for AAA screening again -discharged Small aneurysm aorta is between 3cm and 4.4cm Men found to have a small aneurysm will be invited back for scans every 12 months - surveillance. Medium aneurysm aorta is between 4.5cm and 5.cm Men found to have a medium aneurysm will be invited back for scans every 3 months - surveillance Large aneurysm aorta is 5.5cm or above Men found to have a large aneurysm are referred to a specialist vascular team, at one of the three approved vascular centres in the programme area, to discuss possible intervention referral Non-visualised Occasionally it is not possible to visualise the aorta, due mainly to bowel gas or a high BMI ratio. These men will be offered a re-screen and will be given an early morning appointment in an attempt to reduce bowel gas. If after two appointments the technicians are still unable to visualise the aorta the man is referred for medical imaging. The men identified with an aneurysm at their initial screening test will be given the opportunity to speak to the Screening Nurse Practitioner (SNP) at a time convenient for them. The significance of the result and future management within the programme will be discussed with the gentleman and the nurse will also offer advice aimed at trying to 7

8 slow down the growth of the aneurysm. This includes life style advice such as smoking cessation, healthy diet and exercise regimes. These men will also be seen by the SNP at the next screening appointment. If an aorta measures 5.5cm or above a referral is made within 1 working day to one of three approved vascular centres within the Cumbria and Lancashire region East Lancashire Hospital NHS Trust Lancashire Teaching Hospitals NHS Foundation Trust North Cumbria University Hospitals If the AAA measures 7cm or greater an urgent referral is made. The vascular units will endeavour to see the man in the next available Outpatient clinic. The vascular centres have been assessed by the National Programme and the Vascular Society of Great Britain and Ireland to be able to provide appropriate surgical treatment for open and endovascular repair of abdominal aortic aneurysms. All referrals should be seen within two weeks of the referral being made by the Coordinator and if surgery is indicated following assessment this should be completed within eight weeks of the date of the referral. The performance of the vascular centres is measured against Quality Standards and reported back to the National Office, Regional QA team and Programme Board. Staff There are seven part time screening technicians who run clinics throughout Cumbria and Lancashire on a daily basis. The admin hub is based in the Queen Elizabeth Hospital in Gateshead. The coordinator/cst, admin coordinator and nurse practitioner are based in Preston Venues Screening is carried out currently at 16 locations, utilising Health Centres and Community Hospitals. The programme is continually trying to identify new clinic locations to ensure that screening is provided as locally as possible, particularly in areas where the uptake rates are below the programme or national average. 8

9 Nurse clinics All men identified with an aneurysm at their initial screening test will be given the opportunity to speak to the nurse practitioner. A telephone appointment is made for the man before he leaves clinic. The significance of the result and future management within the programme will be discussed with the man and the nurse will offer advice aimed at trying to slow down the growth of the aneurysm. This will include life style advice such as smoking cessation, healthy diet and exercise regimes. Men under surveillance will then be seen by the nurse at his next screening appointment. Programme Performance Statistics and Data Quality Standards and KPI 01/01/ /06/2016 In cohort data taken from SMaRT database total subjects Service Spec Report Count Percentage Subjects with insufficient contact details to make an offer % Subjects offered screening who are tested % Measurement of <3.0cm and discharged % Measurement of cm % Measurement of cm 9 0.1% Measurement of 5.5cm or greater referred to Vascular Surgeon 8 0.1% Measurement of <3cm and overridden into surveillance 2 0% 9

10 Self-referral data taken from SMaRT database total subjects /04/ /03/2016 Service Spec Report Count Percentage Subjects offered screening who are tested % Measurement of <3.0cm and discharged % Measurement of cm % Measurement of cm 3 0.3% Measurement of 5.5cm or greater referred to Vascular Surgeon 4 0.4% Performance against the KPI is provided by NAAASP on a quarterly basis. AA1: Completeness of offer Current Provider Eligible Subjects Eligible Subjects Offered Appt with date <= end Q4 % Eligible Subjects Offered Appt with date <= end of Q4 CML_Cumbria & Lancashire AAA Screening Cohort England KPI figures for Quarter 4 (April to March) 2015/16 Referrals There were 21 referrals made during This included 1 false positive All referrals were made within 1 working day and were seen at one of the three validated vascular units. One patient chose another site outside of our area leading to a delay in initial assessment Cohort Complete Numerator Denominator % 10 Subjects referred within one day % 11 Inappropriate referrals % 12 Referrals with a specialist assessment within 2 weeks % 10

11 Self Referral Complete Numerator Denominator % 10 Subjects referred within one day % 12 Referrals with a specialist assessment within 2 weeks % Self-referral report CML Self Referrals April 15 - March 16 The graph shows that there is a good geographic spread of self-referrals although some areas/sites have considerably more than others. In particular Blackpool has again got the highest number with 168 Rossendale was particularly high and this was due to the active involvement of the practice nurse The main source of information is from the GP surgery, leading to 531 self-referrals, which is encouraging. Recommendations from family and friends generated a significant number

12 Self Referrals April 15- March 16- (How did they hear about us) Local/National paper, 2 Pharmacy, 12 Internet, 5 other, 35 Health Promotion, 31 Via E mail, 22 Family /Friends, 250 GP Surgery, 531 Quality Assurance CST report Susan Clinton During the screening year 1695 examinations have been reviewed for quality assurance purposes. This includes: - all aortas measuring 2.8cm and above - random samples of each screener currently 5 examinations every month - surveillance scans - incidental findings - first 100 scans of newly qualified technician - any examination requested by the screener I am pleased to report that performance was good in all areas and overall the number of examinations where the aorta could not be visualised is low. In addition to reviewing images, regular QA 1:1s are held with each technician. This gives the technician and the CST an opportunity to raise issues and discuss their images. 12

13 Each technician is observed every four months during a clinic session. Both the consent and scanning procedures are observed and feedback is given on the same day. At these visits the opportunity is taken to review the suitability of the venue. The staff at the venue are also given the chance to raise any issues. Datix All adverse incidents are reported using the DATIX system and are thoroughly investigated. Incidents are also discussed at the bimonthly MDT meetings Incidents by category for CLAAASP Appointment / list issues, 1 Information technology, 1 Results / investigations issues 1 Moving and handling incident, 4 Patient falls, 1 Communication failure, 2 Relevant datix are also reported via SIAF to the regional QA team for further actions and recommendations 13

14 Multi-Disciplinary Team Meetings [MDT] All members of the local programme are invited to attend an MDT meeting every 2 months. Programme updates are shared and Clinical governance issues are raised and discussed. Programme Board Meetings The management team meet every six months with the Programme Board to discuss and review the programme performance against the national standards. All aspects of the AAA programme are discussed. Training and Development Salford University: 1 technician completed their accreditation 2 experienced technicians left the team to pursue new careers as vascular scientists. This is an excellent opportunity for them and we are confident they will be an asset to the vascular ultrasound service. Study days attended: Sharing Best Practice and Networking Day Birmingham NAAASP May 2015 Improving uptake in screening for people with a learning disability - workshop with screening providers July 2015 Customer Satisfaction Feedback survey During June and September 2015 the technicians handed out up to 40 Satisfaction Surveys at all 16 sites covered by the screening programme In total 448 completed surveys were returned 14

15 Questions were asked about: Waiting times Venue and facilities Staff Appointment times / availability The results have been summarised below Waiting time Local AAA standards dictate men should be seen within 20 minutes of their allocated appointment time. No 1% Yes 99% 434 men (99%) were seen within 20 minutes 3 men (1%) were not seen within 20 minutes 15

16 Venue Location Of Unit Excellent/Good Satisfactory Waiting Rooms Excellent /Good Satisfactory 16

17 Car Parking Facilities Excellent /Good Satisfactory Poor Disabled Access Excellent /Good Satisfactory Poor Staff Staff are expected to maintain a good level of professionalism and administer patient care in a respectable and courteous manner 17

18 The person who performed your scan Good 8% Satisfied <1% Excellent 92% Yes No Satisfied Comments 395 (92%) men rated staff as Excellent 33 men (8%) rated staff as Good 2 men (less than 1%) rated staff as satisfactory Nobody rated staff as poor very friendly and polite Professional and friendly staff Staff were very caring and compasionate Staff were very good Staff explained process well Nice staff Very Professional Staff Friendly and Professional Staff Excellent service Excellent Staff Good staff Efficient staff Very good Could not be improved Keep up the good work Trainee did 1st scan the checked by another Excellent Excellent Good Spot on Very friendly & polite Very comfortable & relaxed Excellent staff Very Good Staff Excellent staff The staff explained the procedure EXCELLENT 18

19 Staff were very helpful Great and super Staff Efficient staff JW was lovely Good Staff Staff very friendly and polite Excellent SATISFACTORY Brilliant Staff Staff treated me with the Utmost courtesy and dignity throughout the whole test EXCELLENT could not be better Very informative First Class Service Couldn t fault the procedure or staff Really Good Appointment times Would you have preferred an evening appointment 4-6pm? Evening Appointment Yes No 19

20 Would you have preferred a Saturday appointment- 9am-2.00pm? Saturday Appointment Yes NO Communications and Publicity Shared Best Practice Events attended by Practice managers Health Equity and Equality The Cumbria and Lancashire AAA screening programme is committed to ensuring the service is available to all eligible men. All sites have been assessed for wheelchair access and gentlemen are asked to contact the screening office if they have any special requirements or require assistance at their appointment. Screening takes place within the prisons of Cumbria and Lancashire with a minimum of twice yearly visits Further health equity and equality work is planned for next year with the aim to address any barriers to assessing the service and to encourage all those eligible to take up the offer of screening 20

21 In particular we will be looking at improving uptake amongst men with learning disabilities We will continue to work with the local teams to identify areas where improvements can be made Nurse Report Carole Williams Nurse Clinics Standard operating procedures recommend that all men with an aneurysm are offered an appointment with a Nurse Practitioner, either before, or at, their first surveillance appointment. Within CLAAASP the gentlemen are offered a telephone assessment shortly after their initial screening test. During this conversation the significance and management of the gentleman s aneurysm is explained and life style advice is offered. The nurse then reviews the gentleman face to face at his next screening appointment. Learning Disability CQUIN The CQUIN aimed to increase the awareness and uptake of Abdominal Aortic Aneurysm (AAA) screening for men with learning disabilities. It aimed to reduce the inequalities for men with a learning disability in accessing the AAA screening offer and the AAA screening process. This was set out to be achieved through four components delivered throughout the year: Quarter one Identification and flagging of men with a learning disability Quarter two Reasonable adjustments for men with a learning disability Quarter three Training and awareness for staff involved in the process Quarter four Evaluation of impact 21

22 In quarter 1 a spread sheet was devised by the admin team in Gateshead to record any gentleman who was known by their GP to have a learning difficulty. In quarter 2 the gentlemen who had been identified as having a learning difficulty were booked an appointment for screening. Reasonable adjustments were made for each gentleman,these adjustments consisted of extra time for their appointments,easy read leaflets being sent with their appointment letters,myself as the nurse or Susan attending as many appointments as we could to be both a support for the gentleman and also to support the staff. Contact with the learning disability teams in each area at the start proved to be hard and there was little information on who to contact in regards to each clinic area however I now have established links with learning disability nurses in some areas through workshops that I attended, these links will prove valuable in future years in the promotion of the AAA screening service in gentlemen with learning disabilities. Training and awareness of staff was completed by quarter 3. All members of the Cumbria and Lancashire AAA screening team were given a workbook to complete which enabled staff to have an understanding of what is meant by a learning disability,what is a reasonable adjustment, the getting it right charter and reports relating to learning disability. I also attended two workshops one to promote the AAA screening service and one to increase knowledge and awareness of access for people with learning difficulties. Quarter 4 was evaluation of impact. 96 gentlemen were identified as having either learning or physical difficulties. In total 46 gentlemen were screened by the AAA service,2 had already had surgery on their aorta,5 had died,1 gentlemen was ineligible as he is due to be screened in the COHORT and 2 gentlemen require further appointments after recently DNA previous appointments. 19 gentlemen had learning difficulties identified. 5 gentlemen were screened and 7 declined screening appointments,3 men had died,1 gentleman is due COHORT , 1 gentleman had had previous surgery on their aorta and 2 gentlemen are awaiting new appointments following previous not attendance. I am hoping that throughout that the gentlemen with learning difficulties are continued to be identified and that the links with the disability nurses will make the AAA screening service an easier service to access for the gentlemen. Identification of new clinic areas to screen in Fleetwood near Blackpool has been identified as an area that would benefit to have a screening clinic. Currently the closest clinic to Fleetwood is Blackpool South Shore; to get to Blackpool from Fleetwood without car transport it would mean taking 2 22

23 trams. I met up with practice nurses in a GP practice based in Fleetwood and they indicated to me that the residents of Fleetwood would not travel to Blackpool and would be more inclined to attend a screening session if it was based in Fleetwood. There are a few sites that have been suggested to approach in Fleetwood which we visit to see if they are suitable to screen in, once a site has been established I will then promote the service in this area to try to increase compliance. Ormskirk - I have visited Hants Lane clinic which was not suitable to be used as a clinic for screening, so this is another area that we will be looking at to find a suitable premises to screen in. Cumbria Clinics Copeland has been identified as a region that would benefit from having a screening clinic, and again I will be looking at potential screening venues in this area. Equality and diversity Alongside increasing the compliance in gentlemen with learning difficulties, there are some areas covering equality and diversity that I would like to try and promote the AAA screening service in,such as Trans gender or who were once male and now registered as female. The travelling population is still an area proving difficult to tackle. I shall try to find new ways to try to increase compliance in this area. Health Promotion Unfortunately due to staffing issues health promotion has been limited as I have had to attend clinics to screen gentlemen, however during I am going to be able to focus on ways to promote the AAA screening service 23

24 Sites Cumbria London Road Carlisle Dalton Health Centre Workington Community Hospital Penrith Community Hospital Kendal Gillinggate Centre Lancashire Accrington Primary Care Centre Barbara Castle Way Eccleston Health Centre Heysham Primary Care Centre 24

25 Minerva Health Centre Padiham Health Centre Rossendale Primary Care Centre Sandy Lane Health Centre South Shore Primary Care Centre St Peters Burnley Yarnspinners Primary Health Care Centre 25

26 Acknowledgements A huge thank you to the fabulous team pictured above! From left to right Janet Wignall, Julie Kellett, Chaya Reddy, Diane McKay, Carl Nightingale, Rachel Johnson, Joy McMahon, Alison Wilks Special thanks to Chaya Reddy for her dedicated work and help with the report References NAAASP - AAA QS report NAAASP Key Performance Indicators (KPIs) Northgate Solutions SMaRT System 26

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