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 6 th March from 6pm 7.45 pm at the Boardroom, Royal Marsden Hospital London SW3 Action Note Present Jeremy Cordingley (Chair) RBH - Royal Brompton and Harefield Hospitals NHS Foundation Trust Andrea Blay Chelsea and Westminster NHS Foundation Trust Sohan Bissoonauth Hillingdon Hospital NHS Foundation Trust Merlyn Marsden Imperial College Healthcare Trust all sites Ganesh Suntharalingam North West London Hospitals Trust both Sites Tricia Mukherjee North West London Hospitals Trust Northwick Park Hospital site Anil Jaggernath North West London Hospitals Trust both Sites Jacek Borkowski North West London Hospitals Trust Central Middlesex Anthony Bastin Royal Brompton and Harefield Hospitals NHS Foundation Trust Lauren Maher Royal Brompton and Harefield Hospitals NHS Foundation Trust Linsey Christie Trainee - Royal Brompton and Harefield Hospitals NHS Foundation Trust Heather Spurgeon The Royal Marsden NHS Foundation NHS Trust Pascale Gruber The Royal Marsden NHS Foundation NHS Trust Jeremy Brown NHS Blood and Transplant Veronica Marsh Trainee The Lister Hospital Angela Walsh Critical Care Network Gezz Van Zwanenberg Critical Care Network Apologies for absence Doris Doberenz ICHT CXH, Julie Oxton - ICHT St M, Fionna Moore LAS, Gary Wares RMH, Craig Brown RBHT, Barbara Walczynska WMUH, Ruth Griffin THH, Steve Brett ICHT, Andrew Hartle ICHT, Tessa Longney WMUH, Krysruna Koniecczko NWLHT, Roseanne Meacher ICHT, Jane Marie Hamill CW, Jonathan Handy CW, 1. Welcome Who When Jeremy Cordingley welcomed all members to the Network s Joint Clinical Forum Board. 2. Apologies Who When Apologies for absence were noted (See above). 3. Agree the notes of the last meeting held on 11 th December 2013 Who When The notes of the Network Joint Clinical Forum Board meeting held on 11 th December 2013 were agreed. 4. Matters arising not on the agenda Who When 4.1 Nurse vacancy rates GVZ shared the nurse vacancy returns collected in October 13. JC asked if there were any barriers to recruitment that the Network might look at. Members felt that issues (such as jobs freeze) were not within Network influence. At the SAHF critical care meeting, using nurse vacancy rates and agency usage as one of the pressure indicators during SAHF transition in NWL had been discussed. 4.2 Network Patient safety work for GS fed back from the Network Event in Dec 13 proposing a small task group to develop further patient safety work for the Network in /15. Ward round checklists and daily goals sheets were two of several themes from the Network Event. It was agreed that these would be looked at first by the group. Expressions of interest to be part of the group were invited. GS informed the JCFB that he now sat on the ICS standards and safety committee. 4.3 London Senate feedback JC and reported back from the last London Clinical Senate which had had a Primary Care focus. The Network would continue to ensure attendance (which may vary from the Network depending on subject matter). June Page 1 of 6

2 4.4 London Networks The NWLCCN has been consulted on establishing Critical Care Networks in other parts of London. These would be on a sector level (NWL, NC&E and South). It was agreed that the Network and members would offer support wherever possible to the new Networks being developed. 4.5 Critical Care National Clinical Reference Group (CRG) JC reported back from the recent national CRG meeting. There had been a presentation on the AE emergency care standards by Professor Jonathan Wenger (which had not included consultation with critical care up to this point). There were numerous recommendations from this report that could impact upon emergency and critical care services. It was felt that locally, in NWL, the SAHF reconfiguration of services was already looking at many of the issues contained in the report. The CRG had discussed a 5 year plan for what critical care might look like including a lengthy debate about elective surgical patients. Many of the members at the National CRG reported that patients may be cancelled as the level 2 or 1 beds were often filled with emergencies. Going Also discussed for feedback to the CRG in terms of examples were Enhanced recovery area for Bariatric patients at CW. These patients are looked after by bariatric surgeons, whereas the level 1 area is managed by medical teams. Concerns about medical cover for areas where post-surgical patients stayed after the hours of operating Elective surgical centres with a thorough planned transfer protocol in situ The selection and pre-operative process for determining patients for surgery Outline of monitoring and nursing requirements for enhanced recovery areas Models of post op HDU for some surgical patients JC thanked members and would summarise for next national CRG meeting Adult Critical Care National Service Specification DRAFT The DRAFT Adult Critical Care National Service Specification was now anticipated for public consultation in May/June. Consultation would be for 12 weeks. Currently the National CRG Chairs were speaking with the Joint body for clinical commissioning groups to try and ensure that the same specification applied regardless of who commissioned the care (SC or CCG). It was agreed that the Network would inform our 8 CCGs locally once the consultation DRAFT had been made available. ICNARC JC also reported that Richard Mills (CEO ICNARC) had attended the National CRG. CRG/ICNARC had agreed 9 measures for the national dashboard and 7 were part of ICNARC dataset and would be made public. These currently included; Delayed discharge, night time discharges, readmission within 48 hrs. non-clinical transfers, SMR at different risk bands. Direct unit submissions to dashboard would be proportion of electives cancelled (due to no ICU bed), repatriation delays greater than 48 hours. Non-members of ICNARC could defer membership and submission of data for a year. There was discussion about how ICNARC had been selected and also concerns raised around the cost of joining (e.g K for one Trust). Others reported that in discussion with ICNARC they would be allowed to dictate timeliness of reports in the future. Return of information/data and timeliness of reporting from ICNARC had always been a serious issue. It was agreed that inviting CEO of ICNARC to next JCFB meeting to discuss these issues would be beneficial. 1. Agree reporting system to Network for to see trend within organisations and send to Network to report monthly for critical care transition period under SaHF changes 2. Set up patient safety group with pilot of ICU checklist across NWL. GS 3. to Invite Richard Mills ICNARC to speak / attend JCFB in June 4. Any members with models of enhanced level 1 care areas to share these with Network - all 5. Network to share final draft service specification and consultation response with CCGs - JC June June April Page 2 of 6

3 5. Update from each site/member Who When General/ patient pathways ICHT Remains very busy with over 100% occupancy at both CXH and Hammersmith. Repatriation outside London challenging so independent ambulance services have been utilised. Nurse vacancy rates decreasing due to international recruitment drive. Chelwest New Burns ITU has now opened with 4 beds (from 2). General ICU remains busy. Hillingdon 3 weeks into NEWS launch across trust which is well. Unit is very busy with several long term patients, including 1 pt. in for over 3 months (plan now in place for moving patient to a long term ventilation bed at Lane Fox unit). NHSBT 18% increase in donation rates London wide with over 1000 donors last year. Royal Marsden remains 16 running at 90% capacity. Sutton site also 90%. - difficulties recruiting nurses Royal Brompton last 3 weeks fully occupied with high numbers of ECMO patients, including some from other regions. Challenging nurse staffing levels as ECMO patients require higher nurse patient ratio. National surge in ECMO activity due to an increase in H1N1 which is now starting to settle. No reported repatriation difficulties. NWLHT Currently working through changes in the emergency pathway and the effect on critical care. Both sites running at capacity. CMH ED planned to close in July. Challenges around bed base and capacity and provision of services on the CMH site. Local risk analyses being undertaken as services cease on site and potential impact to critical care. ce the NWLHT decisions about the sequence of services changing and relocation of bed base are made these will be notified to the Network. These issues have been added to the actions / risk considerations for transition. 6. SAHF 26 February discussion and follow up Who When 6.1 Draft action list for sign off An outline of the Network meeting with SAHF Team members was given by JC. e of the key outcomes from the meeting was about getting the capacity assumptions accurate and supplying the right data to support the SAHF team. The Network action list was shared and members were asked to review their Trust OBC submissions in the light of emerging clinical models and anticipated capacity. The early warning of rising pressures monitoring mechanisms as NWL moved into transition were discussed and added to the Network action list. April 6.2 Volunteers for outline business case assessments Volunteers were invited to support clinical review of individual critical care chapters in Trust OBCs. Anyone wanting to volunteer to contact the Network. 6.3 Critical care occupancy calculation It was noted that there might be potential for variation between capital submissions made under SAHF regarding critical care requirements in Trusts, and capacity/service assumptions. SAHF assumptions were based on Trusts absorbing a one for one migration of critical care beds in NWL. Members were asked to clinically engage with their own Trust submissions to SAHF clarifying the planning assumptions around capacity. 6.4 Monitoring data for early warning during transition The early warning of rising pressures monitoring mechanisms as NWL moved into transition were discussed and added to the Network action list. 6. Agreed action notes to distribute and share with SaHF leads and group members 7. Unit leads to clinical engage with Trust submissions (OBC critical care modelling) - all 8. GS working up the summary capacity grid and letter/summary. 9. to contact SELEOC regards transfer protocols and process in place and patient selection criteria 10. requested volunteers for OBC considerations for the SAHF team and would out too May Page 3 of 6

4 7. Winter pressures Who When 7.1 Delayed discharge/transfer to specialist sites Any patient in critical care areas (patients at L2 or L1) awaiting access to specialist beds longer the 24 hours after acceptance should be escalated via Trust management to management was reiterated. Also to inform the Network. 7.2 Step down from critical care reported shared a snapshot of the daily number of patients awaiting step down from ICU using the pathways DOS entries from Acute Trusts. Members that submitted to ICNARC were asked to look at their reported delayed discharges and feedback issues arising. 7.3 Pathways DOS critical care bed page GVZ reported that showing the critical care bed state on had helped clinicians regarding what was being reported on bed availability. This was echoed by MM who had used the information recently and was thankful to the Network for facilitating access to the bed state whilst awaiting login details. - registration problems had been reported back to the national user group. Searches available include national Paediatric bed availability, whilst ECMO and Burns bed pages were being finalised. Critical care bed page for London is still being populated by EBS from the phone calls to units. Units were again encouraged to request their login detail. Members were reminded to go to the Network website and access the critical care bed page and then request a login account. Confirmation would be issued by LAS EBS (who manage the pathwaysdos registration of accounts). Units were reminded that reporting of CRITCON, patients awaiting step down from critical care and ED pressures were all shown on this platform and that during times of pressure and surge these pages would be used by NHSE and others to support maintaining business continuity in patient care. ICHT commented that it was really helpful to be able to see what was happening and really useful could also see what ED were reporting. 7.4 ECMO update National ECMO picture was reflected in the update from RBHT The Network ECMO film for clinicians about referral and transfer retrieval process was planned for filming in April 14 and would be available later in. 11. Escalate via management route any delays in specialist access to beds. Inform Network if continued delay. 12. Units requested to share ICNARC reports and delayed discharge data with Network- Aw to request data from Imperial and Ealing and WMUH 8. NICE CG 83 Rehabilitation after Critical Illness Who When 8.1 Data progress SUS data was being looked at to determine the numbers of critical care survivors in NWL for a specific period. This data would then be used to inform a number of work programmes in the Network. 8.2 Care planning Progress was being made with the care planning templates for GPs reviewing critical care survivors. LM had drafted the first edit of a checklist prompt for GPs which was being refined before Dr Mo Ali would then add into the ICP work programme for /15. Next meeting of the rehab group with ICP and Dr Mo Ali was planned for May Admission and discharge template notifications AB and SB had drafted up admission and discharge notification templates which were being tested with local GPs using the NHS mail to fax system. There was also discussion about a draft rehabilitation prescription from the National CRG which had been circulated via the national managers group. Page 4 of 6

5 13. Network co-development group continue to work with ICP and review data to then select pilot cohort 14. GVZ / to liaise with ICP to design care planning template for GPs 15. AB and SB preparing admission/ discharge notification templates these for testing with GPs 16. to fax via NHS mail testing GVZ 9. NICE CG 50 - NEWS Who When 9.1 Education Training packs AB reported on the progress to date of the Network NEWS faculty. Education packs for observers and responders were now being reviewed and refined online by the Network s NEWS faculty. The training also included behaviours and barriers as well as the how to and why related to NEWS. ce refined the education packs would be available to all to support education and training locally about NEWS. A film outline was being developed as an additional training resource. An opportunity to pilot the education materials was being explored with RNOH who are looking to implement NEWS in the forthcoming months with support from across the Network. 9.2 Specialist NEWS AB also reported that at CW they were about to audit the NEWS in the burns patient population. 9.3 National Outreach forum The NORF had now published standards and competencies for the provision of outreach services. This was available via the NORF website. 17. GVZ to load draft slide packs into drop box for review by Network NEWS faculty for feedback at next JCFB 18. Film outline and workup to commence GVZ/JO 19. Network to liaise with RNOH NEWS implementation team 20. Network wide common audit criteria to be set - Network NEWS group 10. Information and Quality Who When 10.1 Peer review from ICS This item was deferred to next meeting Summary collection of quality standards shared a rough draft of her work underway mapping the London quality standards for critical care, the adult service specification for critical care, the standards for general surgery and the ICS standards in relation to the Network Quality Measures and work areas. This was aimed at i) Seeing the plethora of standards ii) Arriving at a picture of any gaps iii) confirming where the Network already had work or data/measures/ work streams in place Members agreed that this complex piece of work was commendable and very useful Critical Care patient transfers Transfer data was shared including; Transfers from individual sites ( clinical, capacity, intra clinical, intra capacity repats) Neuro transfers Renal transfers 3 years of comparison of the number of patient transfers by level of care A one page at a glance summary of transfers for the year by referring trust /destination from the Network so that Network incoming and out CC patient moves could be seen 21. units to be aware of the impact of London and National standards and timeframes outlined by JC 22. Ensure transfer documentation returned to the Network all 23. to consider writing up for Network publication - Page 5 of 6

6 11. Workforce Who When 11.1 GMC workforce planning This item was deferred to the next meeting as GS had to leave Annual Transfer Training Faculty meeting The next annual meeting is planned for 12 th June. Arrangements for the day were being finalised and a report would be submitted to the JCFB for agreement of the 14/15 work plan. Transfer training courses 11.3 GVZ reported on the development of HDU and ED specific transfer training courses. These were adapted from the Network Transfer training course and were being tested at one site. 24. Finalise Network Transfer faculty Annual Meeting 12th June VTBC 25. GVZ to agree agenda with JMH and then circulate details 26. Transfer training course dates on Network website all unit leads to advertise dates locally 12. EPRR for info Who When Burns Service 12.1 reported on work in progress with the Burns Network lead, burns surgeon and ICM lead looking at Burns surge for ITU level patients. A series of meetings had been held and work was in progress on the surge and escalation pathways for this service. 13. AOB and date of next meeting Who When 13.1 Network Office reported that Ealing CCG would be vacating its current premises and relocating. After reviewing the planned location, the network office would not be able to operate within the planned working environment. NHS estates have been approached to explore what options for accommodation in NWL were available. The CCG has offered an alternative office which would be reviewed as well. Other offers of accommodation were welcome for consideration too. Criteria had been developed and it was hoped to avoid any significant cost for accommodation (given the end to prioritise network funds for useful products AB reported that the POPPI study was a Psychological intervention study involving ICU nurses and was starting in the near future. Anyone interested could apply for inclusion in the study. 27. Review options for Network accommodation for /GVZ to visit Martin house feasibility and functionality 29. Any offers of potential accommodation from members to /GVZ Date of next meeting Network Joint Clinical, Forum Board Boardroom 6pm Wednesday 11 th June Charing Cross Hospital Dates for the diary Network Joint Clinical, Forum Board 6pm Thursday 25 th September Royal Marsden Hospital Boardroom Network Event Day Thursday 4 th December - ROSL Network Joint Clinical, Forum Board 6pm ROSL Thursday 4 th December Page 6 of 6