Care of Burns in Scotland ANNUAL REPORT 2015/16 Lead Clinician: John Kinsella Programme Manager: Alison Gilhooly
Contents Care of Burns in Scotland... i ANNUAL REPORT 2015/16... i Contents... ii Executive summary... 1 Introduction... 2 Aim/ Purpose/ Mission Statement of network... 2 Report against Workplan... 3 Plans for the year ahead... 4 Network governance... 4 Appendix 1: Detailed Description of Progress over Reporting Period (2015-16)... 5 Appendix 2: Detailed Workplan 2016-17... 8 Appendix 3 Workplan description/key... 11 Appendix 4: Network Steering Group membership... 12 Appendix 5: Finance... 14
Executive summary The network continues to work to improve the care of patients who have received a burn injury; with the completion of the psycho-social training programme in 2015, patients are being treated in wards where all levels of staff have an improved awareness of their psycho-social needs. A new website has been designed to provide better access for clinicians and patients alike. Further work is planned to improve the accessibility of burn care guidelines and protocols in 2016-17. Since establishment of the network, clinicians working in burn care have noticed a reduction in patient numbers, confirmed by national admissions data and Scottish Fire & Rescue statistics. This highlighted concerns around the sustainability of the current service delivery method. In September 2015 the National Planning Forum (NPF) endorsed proposals for a review of burn care services in Scotland. The Network has a significant role in supporting the review, primarily in gathering evidence to inform recommendations on future service provision. This is anticipated to be a significant piece of work for network members in the next reporting period. With an improved data set recorded on the Clinical Audit System for all centres, the network will now engage with ISD to access wider health information for patient mapping and to ensure that all appropriate burn patients who meet COBIS criteria are included. 1
Introduction The NMCN for Care of Burns in Scotland (COBIS) was launched in April 2007. It aims to fulfil the core principles for networks outlined in policy documents including the Better Health, Better Care and CEL 29 (2012) Managed Clinical Networks: Supporting and Delivering the Healthcare Quality Strategy. The steering group has representatives from each profession involved in burn care, and patients, across Scotland. The mission of the NMCN is to ensure that patients who suffer serious burn injury in Scotland: Are treated at an appropriate centre Are transported safely and expeditiously to that centre Receive a high standard of care irrespective of where they live Since designation in 2007 the network has developed care protocols for both paediatric and adult burns patients, established a skin bank for Scotland and worked with the national disaster planning group to ensure that burns care requirements are included in any plans. This year, COBIS proposed a review of burn services in Scotland, as a result of the data being gathered by the network and concerns raised regarding training opportunities and the ability to gain and retain experience in burn care. This will be a significant piece of national work requiring extensive input from the network in 2016-17. Aim/ Purpose/ Mission Statement of network The purpose of the network is to enhance the delivery of care to patients (adults and children) who have suffered a severe burn injury. The network aims to: Optimise the level of support for patients adults and children as well as their families and carers Support the establishment and maintenance of a skin bank (both autologous and allogenic) to ensure there is safe and satisfactory supply of skin allografts that have been stored and processed in accordance with all the appropriate regulations Initiate and maintain training and educational events to meet the skill requirements of those involved in the treatment and care of burned patients Ensure that there is a comprehensive plan in place in Scotland to deal with large numbers of burn victims, which may arise from an adverse event resulting in multiple casualties Establish and maintain a database of complex burn injury in Scotland Set up mechanisms to regularly audit outcome of burn treatment against nationally agreed standards of care Establish a website to provide guidance and access to national protocols for those managing burn injuries in Scotland, as well as patients and carers, which will also be accessible to the general public for information purposes. 2
Report against Workplan COBIS has accomplished the majority of the planned activities this year, including delivering an annual education event, continued progress with data gathering, initiating a major national review of burn services and provision of psychosocial training. The 2015 annual conference included talks from a former Glasgow Royal Infirmary patient and Dr Yvonne Wilson from Birmingham Children s Hospital. The former patient spoke about his experience following a burn injury, which received excellent feedback, and the network is now considering how to include the patient voice in events on an ongoing basis. Dr Wilson presented on the management of severe burns in children and fluid resuscitation from the perspective of a hospital managing larger numbers of paediatric burns than Scotland s hospitals. The conference was well received by attendees, with some suggestions for topics for the 2016 event, for which planning is underway. Dr Charlotte Gilhooly, data lead, has worked with some trainee doctors to improve the quality of the data held on the COBIS data system by gathering missing data from the 6 burns centres. This has involved visiting each of the centres to review other data sources for patients admitted with a burn injury to complete the dataset for patients with incomplete data recorded on CAS, and to gather information on patients who had not been entered on CAS. Ensuring that the network holds a full dataset will help to ensure that the review of burn services is underpinned by accurate information. In the Steering Group meeting of November 2014, concerns were raised about the small and decreasing number of patients, and the ability to maintain training and experience in managing burn care in smaller centres. ISD data on hospital admissions for burn/corrosions and Scottish Fire & Rescue statistics both show a decline in numbers of burn injuries. While COBIS data shows a small increase, this is likely to be due to improved reporting since the implementation of CAS. The network produced a proposal to review burn services, and on 23 rd September 2015 this was presented to the Directors of Planning meeting and subsequent National Planning Forum meeting, who agreed that the review should go ahead. The review group has now been established, and preparation is underway for their first meeting on 10 th May 2016. The review of burn services will require significant involvement from COBIS in 2016-17, with a lot of data and information required from across the network. The Better Together Patient Innovation and Experience Fund provided funding for a two year project to implement and evaluate psychosocial training across the four main burn centres in Scotland. The training was developed by the London and South East Burns Network in conjunction with Changing Faces with the aim of increasing psychological awareness amongst burns staff. The training has now been completed, with an aim to increase the confidence staff have in addressing psychosocial needs in their services as well as increasing their knowledge of the importance of psychosocial care for recovery. Staff found the training enjoyable and highly relevant, and it is hoped the training might be rolled out further. Discussions are currently underway to determine suitable delivery of training options. A sub-group has also been formed within the network for communications and stakeholder engagement, representing a major step forward for a network with a hard to reach patient and family group and a very extensive group of clinicians who have the potential to be involved in burns care at some level. This group has agreed a communication strategy for the network that will help inform the work plan for 2016-17 and develop stakeholder engagement. 3
The network website has been re-developed, with the aim of making network information more accessible. The website can be found here: www.cobis.scot.nhs.uk. Plans for the year ahead As detailed previously, the network will be involved in supporting a review of burn services in Scotland, and this forms a significant amount of the work planned for 2016-17. The communications and stakeholder engagement sub-group have come forward with a number of ideas of how the network can improve access to network expertise for regional hospitals. This includes revising burn care protocols to produce consistent guidance for paediatric and adult care and producing posters that can be displayed in emergency departments. A plan is to be developed for the ongoing delivery of psychosocial training. The initial round of training was successfully delivered funded by Better Together, and it was agreed that there would be ongoing training requirements, as staff needed refresher training, or new staff started working in burn care. The network will work with ISD team edris to access wider NHS and national records data to audit COBIS data. This will ensure that current data is as accurate as possible to support the review of burn services. Network governance As of 1 st April 2014 COBIS is under the management of the National Network Management Service in National Services Division. Through the management structure and terms of reference for the network Steering Group and sub-groups, COBIS meets the core principles of managed clinical networks as set out in CEL (2012) 29. Workplans and reports are published on the network website, and any documents produced by the network are publically available for clinicians and patients to view. 4
Appendix 1: Detailed Description of Progress over Reporting Period (2015-16) Number SMART Linked Dimensions of Quality Planned start/ end dates Detailed Plan Available / Owner Description of progress towards meeting objective as at 04/02/2016 Anticipated Outcome RAGB status 2014-02 Progress and develop skin camouflage skills through training from Changing Faces 1,3,5,6 01/02/2013-13/11/2015 Sharon Ramsay Update presented to Education Event on 13/11/2014. Nurse training forms part of nurse s personal development plan, rather than network plan. All burn care staff will be aware of the skin camouflage service available. B 2014-04 Develop patient questionnaires, on patient experience and expectations (linked with review) 1,3,5 01/04/2015-31/12/2016 John Kinsella / Alison Gilhooly closed to allow for proper planning as part of burn service review. The network will gain a better understanding of patient needs, and how to configure services to meet those. Closed 2015-01 Review of care protocols 2,3,4,5,6 01/05/2015 31/03/2016 John Kinsella On going, complete by end May 2016 Protocols will be based on latest evidence R 5
Number SMART Linked Dimensions of Quality Planned start/ end dates Detailed Plan Available / Owner Description of progress towards meeting objective as at 04/02/2016 Anticipated Outcome RAGB status 2015-02 Ensure audit data is complete for all centres 3,4,5,6 01/04/2015 30/09/2015 Charlotte Gilhooly / Alison Gilhooly Dr Gilhooly has worked with a student to gather audit data for all centres, although some data is still missing. A report on the data has been produced. The network will have access to accurate data to evidence their work. B 2015-03 Continue benchmarking activity use data gathered for Scottish Service to benchmark against available information from other countries 3,4,5,6 01/04/2015 31/03/2016 John Kinsella / Charlotte Gilhooly Benchmarking process continuing with improved data and cleaning of databases. Main challenge has been some missing data and method of classifying lengths of stay in national audits. Initial results for presentation at the COBIS Education Event, and International Society for Burn Injuries 2016. The network will know how Scotland fares against other countries data. B 6
Number SMART Linked Dimensions of Quality Planned start/ end dates Detailed Plan Available / Owner Description of progress towards meeting objective as at 04/02/2016 Anticipated Outcome RAGB status 2015-04 Support the initiation of a review of Burns Services in Scotland (commissioned by the National Planning Forum) 1,2,3,4,5,6 01/10/2015 30/09/2016 John Kinsella/ Alison Gilhooly The National Planning Forum commissioned the review proposed by COBIS at their meeting on 23/09/2015 A review of burn services will be underway, with initial data available and meetings planned. B 7
Appendix 2: Detailed Workplan 2016-17 Number SMART Linked Dimensions of Quality Planned start/ end dates Detailed Plan Available / Owner Description of progress towards meeting objective as at 04/02/2016 Anticipated Outcome RAGB status 2015-01 Review of current care protocols to ensure they meet current evidence. 2,3,4,5,6 01/05/2015 31/05/2016 John Kinsella On going, complete by end May 2016 Patient care protocols will be based on latest evidence, improving patient outcomes for NHS Scotland. G 2016-01 Support a review of burn services in Scotland, providing evidence as required by the Expert Review Group. 1,2,3,4,5,6 01/04/2016 31/12/2016 John Kinsella/ Alison Gilhooly Services will be planned on a sustainable and optimised way for Scotland. G 2016-02 Carry out gap analysis of care protocols and develop network look for 2,3,4 01/04/2016 31/03/2017 Communi cations Group/ Alison Burn survivors throughout Scotland will be treated G 8
Number SMART Linked Dimensions of Quality Planned start/ end dates Detailed Plan Available / Owner Description of progress towards meeting objective as at 04/02/2016 Anticipated Outcome RAGB status protocols (i.e. similarities read across between adult/paediatric protocols) Gilhooly according to easilyunderstood evidencebased care protocols. 2016-03 Further develop communications strategy in order to map stakeholders, agree and establish methods of communicating with stakeholders 1,2 01/04/2016 31/03/2017 Communi cations Group/ Alison Gilhooly Network will have improved understandin g of stakeholders needs and ability to meet these. G 2016-04 Develop plan for ongoing delivery of psychosocial training, as rolled out through Better Together funding 1,3,5 01/04/2016 31/03/2017 Rebecca Crawford Improved psychosocial care delivered by all staff working in burn care. G 2016-05 Work with edris to review COBIS 4 01/04/2016 Charlotte Improved data G 9
Number SMART Linked Dimensions of Quality Planned start/ end dates Detailed Plan Available / Owner Description of progress towards meeting objective as at 04/02/2016 Anticipated Outcome RAGB status data against NHS Scotland data to ensure accuracy. 31/03/2017 Gilhooly available for audit and reporting. 10
Appendix 3 Workplan description/key Please develop and update the table below to include the network s designation objectives and related agreed annual objectives. When planning for the year ahead, please consider the standard statements in the guidance section to inform the development of annual network objectives. RAG status key RAG status RED (R) AMBER (A) GREEN (G) BLUE (B) Description The network is unlikely to achieve the objective/standard within the agreed timescale There is a risk that the network will not achieve the objective/standard within the agreed timescale, however progress has been made The network is on track to achieve the objective/standard within the agreed timescale The network has been successful in achieving the network objective/standard to plan The Institute of Medicine s six dimensions of quality are central to NHS Scotland s approach to systems-based healthcare quality improvement, therefore objectives should be linked to these dimensions: Person-centred: providing care that is responsive to individual personal preferences, needs and values and assuring that patient values guide all clinical decisions; Safe: avoiding injuries to patients from healthcare that is intended to help them; Effective: providing services based on scientific knowledge; Efficient: avoiding waste, including waste of equipment, supplies, ideas, and energy; Equitable: providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location or socio-economic status; and Timely: reducing waits and sometimes harmful delays for both those who receive care and those who give care. 11
Appendix 4: Network Steering Group membership Name: Organisation/ Division: John Kinsella (Chair) Charlotte Gilhooly Hilal Bahia Jacqui Bellew Roxanna Bloomfield Rebecca Crawford Michaela Davies Julie Freeman Mike Fried Murray Geddes Roselynn Kennedy Alex Lambah Susan Lundie Breeda McCahill Joanne McPeake Rob Murray Lead Clinician, NHS Greater Glasgow & Clyde Contact: john.kinsella@glasgow.ac.uk Consultant in Anaesthesia, NHS Greater Glasgow & Clyde Consultant, Plastic & Burns, NHS Lothian Ward Manager, NHS Greater Glasgow & Clyde Consultant in Anaesthesia and Intensive Care, NHS Grampian Clinical Psychologist, NHS Greater Glasgow & Clyde Consultant Plastic Surgeon, NHS Grampian Paediatric Anaesthetist, NHS Lothian Consultant in Anaesthesia & Critical Care Medicine, Burns Unit, NHS Lothian (resigned from group April 2015) Clinical Lead for Critical Care, St John s, NHS Lothian (replacing Mike Fried) Lead Nurse, Burns & Plastics, NHS Greater Glasgow & Clyde Consultant Plastic Surgeon, Ninewells Hospital Dundee Senior Charge Nurse, NHS Tayside Burns Nurse, NHS Greater Glasgow & Clyde Senior Staff Nurse, Glasgow Royal Infirmary, NHS Greater Glasgow & Clyde Changing Faces Representative 12
Name: Organisation/ Division: Christina Porter Senior Charge Nurse, NHS Lothian Sharon Ramsay Paediatric Nurse Specialist, NHS Greater Glasgow & Clyde Thomas Reekie Research Fellow, Glasgow University Alison Scott Telford Theatre Nurse, NHS Lothian Christine Smith Plastic Surgery Nurse, NHS Lothian Mark Stevenson The Scottish Burned Children s Club (The Burns Club) Ian Taggart Consultant Plastic Surgeon, NHS Greater Glasgow & Clyde Stuart Waterston Consultant Plastic Surgeon, NHS Tayside Stuart Watson Consultant, NHS Greater Glasgow & Clyde Daniel Widdowson Consultant Plastic Surgeon, NHS Lothian Steering Group Secretariat: Name: Alison Gilhooly Liz Blackman Robina Collins Gavin Moir Organisation/ Division: Programme Manager (PM), National Network Management Service, NHS NSS Contact: alison.gilhooly@nhs.net Senior Programme Manager, National Network Management Service, NHS NSS Programme Support Officer (PSO), National Network Management Service, NHS NSS IT Programme Support Officer (PSO), National Network Management Service, NHS NSS 13
Appendix 5: Finance Description Amount Network Meetings/Catering 118.20 Education Event 313.86 Poster/postcard printing 16.16 Better Together Travel (agreed support) 445.30 TOTAL 894.12 14