Mortality and harm reduction in Welsh Ambulance Services NHS Trust

Transcription

1 25 th November 2010 Mortality and harm reduction in Welsh Ambulance Services NHS Trust Insert name of presentation on Master Slide

2 Introduction First ambulance service in the world to take part in 1000 Lives Campaign Organisational commitment to reducing avoidable harm Development of an Ambulance Patient Safety Prompt Tool (APSPT) & other measures Interest expressed by New Zealand and Scottish Ambulance Services and University of Manchester Involvement with 1000 Lives continues to spread throughout Trust with Executive leads for each work area

3 Driver diagram Management of Acute Coronary Syndrome Interventions Percutaneous Infusion Pre Hospital Thrombolysis Utilise Ambulance Patient Safety Prompt Tool (APSPT) Improve: Pain scores Peak Expiratory Flow O2 administration Reducing Harm and Measuring Effectiveness Improve Infection Control Improve Clinical Communication Target vehicle cleanliness Spread structured handover via SBAR Turnaround at A&E Domestic abuse handover Leadership Walkrounds Patient Stories Medicines Management Reducing Falls in Intermediate Care Warfarin awareness Green bag Campaign Spread access to Naloxone Falls Pathways

4 Management of ACS (Acute Coronary Syndrome) Percutaneous Infusion (PCI) Where pathways exist, patients identified as suitable are transferred directly for PCI. The Trust continues to collaborate with Cardiac Networks and Health Boards in the development of a primary PCI model.

5 Ambulance Patient Safety Prompt Tool (ASPST) Data collected from 150 records/month per region (3) over 6 month period to identify top three triggers for potential harm. Findings identified: 1. Pain: Complaints of pain in narrative but no pain score recorded 2. PEFR: Salbutamol administered but no peak expiry flow taken (PEFR) 3. O2: No oxygen therapy administered and: Any significant trauma GCS below 15 or O2 sats below 94%

6 Baseline data showing selected triggers x3 Pain PEFR O2

7 Implementing Changes (APSPT) 1. Pain Encourage and educate staff to record pain scores through education (posters, pain management material on stations) 2. PEFR Encourage and educate staff to take Peak Expiratory Flow (PEF) readings through education (annual CPD course) 3. O2 - Encourage and educate staff to administer oxygen, where clinically appropriate through education (annual CPD course)

8 Ambulance Patient Safety Prompt Tool Audit Results A random audit of 150 Patient Records per Region (3) was undertaken following awareness/education sessions. Over a 5 month period: The recording of Pain Scores improved by 10% The recording of PEFR readings improved by 33% Oxygen administration rate remained unchanged.

9 Next steps Review Trigger Tool data collection strategy to ensure timely data collection Encourage local ownership by identification of Champions in each Region Enhance spread throughout localities

10 Improve Clinical Communication - SBAR SBAR now a component of Paramedic CPD training SBAR prompt cards used by staff Snapshot audits of the utilisation of SBAR for handovers at identified Accident & Emergency Departments commenced. Findings shared with locality managers to inform practice Plans to introduce SBAR into telephone triage service within one clinical contact centre, PDSA developed and baseline data currently being collected. Plan to spread to all clinical contact centres.

11 SBAR PROMPT CARD

12 Leadership Target - Patient story presented at every Trust Board meeting: compliance with target 100%. Patient Safety paper presented to each Trust Board Meeting. Target 2 Executive Walkrounds completed each month: compliance with target to October %.

13 Medicines Management Warfarin Pilot From 1 st March 1st June 2010 callers accessing the service with an information need or medicines enquiry, and identified as taking Warfarin, were offered written information regarding Warfarin and best practice (n = 13). A follow up questionnaire was sent to identify whether the information increased patients existing knowledge. 46% of respondents indicated that the Warfarin Information Sheet increased their existing knowledge. Interest from health focus groups and GP s suggested that the initiative should be widened within the Trust and also piloted within a General Practice.

14 Medicines Management Warfarin Pilot The Warfarin Information Sheet has been reviewed by the Trust s Partners in Healthcare network readers panel and amendments made following feedback. The information sheet has been sent to the all Wales Medicines Strategy Group for endorsement and the all Wales Prescribing Advisory Group for information. Next Steps Widen the inclusion criteria for all patients identified as taking Warfarin who contact the Trust. Pilot the information sheet within an identified GP practice with support from the Community Health Council.

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16 Insert name of presentation on Master Slide

17 Reducing Falls in Intermediate Care 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 National Service Framework (NSF) for Older People and evidence offered by the National Institute for Health and Clinical Excellence (NICE) suggest that many of the elderly fallers attended to by WAST should be referred to alternative care pathways.

18 Reducing Falls in Intermediate Care The Trust currently refers into Falls Referral Pathways in: Anglesey Cardiff & Vale Carmarthenshire Powys Wrexham Swansea (from Dec2010) Conwy & Denbighshire Anglesey (from Jan 2011) Flintshire Neath Port Talbot A clinical audit of patient referrals into falls pathways is in progress

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