PERSONNEL DOCUMENTATION QUALITY ASSURANCE & AUDIT, INSURANCE NORTH WALES CRITICAL CARE NETWORK TRANSFER TRAINING COURSE

PERSONNEL DOCUMENTATION QUALITY ASSURANCE & AUDIT, INSURANCE NORTH WALES CRITICAL CARE NETWORK TRANSFER TRAINING COURSE

Introduction There are currently over 500 Critical Care Transfers carried out in Wales every year. Who conducts these transfers, what training they have received and the quality of care are currently being determined. By defining who should who should undertake this work, the training and competencies required, the quality of transfers should improve.

Introduction Documentation during transfers has previously been poor. The introduction of an All Wales Transfer Form should improve this. Collecting data from these forms allows us to audit the process. Lessons can be learnt which will improve the overall quality of care.

Personnel All critical care transfers should be undertaken by two attendants. Usually a Doctor & a Nurse (or other health professional) Precise requirements depends on clinical circumstance Both should: Be suitably experienced Have received training in the transfer of the critically ill Be willing to undertake the transfer Be able to work independently Be able to work while travelling Be familiar with the patient

Personnel Level 3 Transfers Medical Attendant Should be a senior doctor trained in critical care medicine (In reality most transfers are conducted by trainees) Usually an anaesthetist but could be another critical care doctor with appropriate skills

Personnel Medical Attendant minimum competencies 6 Months experience in critical care medicine Advanced airway skills of Anaesthetic ST3 level or equivalent ALS or ATLS Provider Should be familiar with the transfer equipment and know how to set up and use the transport ventilator

Personnel Assistant Should be a health professional with 2 years experience in a critical care environment (ITU / A&E / Theatres) ITU Nurse A&E Nurse Anaesthetic Nurse ODP They should be: Be willing to undertake the transfer Be prepared to work independently and assist in any necessary procedures Have basic airway skills (Bag & Mask Ventilation) Be an ILS (ideally ALS) Provider

Personnel Both Attendants should be familiar with the transfer equipment: Ventilator Change cylinders & batteries Monitor Know how to set up and use Change batteries Infusion Pumps Set up & change infusion rates Change syringes Change batteries

Personnel Both attendants should be: Familiar with the contents & the layout of the transfer bag Familiar with patient packaging including the use of the transfer trolley Familiar with communication protocols & have contact details for the transferring and receiving units Familiar with handover procedures

Personnel Air Transfers Both attendants must be suitably experienced. The transfer must be conducted by a senior doctor (Consultant / Associate Specialist / Staff Grade) with appropriate critical care experience In addition to the above competencies all personnel must have received specific training in Air Transfer including aircraft familiarisation and safety

Personnel Level 2 Transfers Two attendants should accompany the patient Ideally a Doctor and a Nurse Can vary according to clinical circumstances Medical Attendant Anaesthetist or Doctor with basic airway skills Anaesthetist not required if: No airway problem anticipated Patient is DNAR Intubation & Ventilation of no benefit to the patient Nurse Same requirements as level 3 Transfers

Documentation Continuation of Intensive Care A record of the transfer should include: Patient Demographics Diagnosis Who arranged the transfer Who is accepting the patient Who is accompanying the patient The patients condition prior to transfer Equipment & monitoring used Observations during the transfer Drugs administered Untoward events & how they were dealt with The patients condition at handover Any other relevant information

Documentation All Wales Critical Care Transfer Form Triplicate Form Copies for: White (Top) Copy Stays with the patient Pink Copy is filed in patients notes at transferring hospital Yellow Copy is sent to NWCCN for audit

Documentation

Quality Assurance & Audit Clinical Governance & Patient Safety Yellow copy of Transfer Form sent for audit Task is led by the NWCCN All forms are analysed % Data fields completed (Weighted) Graded as Excellent Good Borderline Poor Uninterpretable All transfers graded as poor are checked by 2 nd assessor

Quality Assurance & Audit Data is analysed and fed back to each Critical Care Network on a monthly basis. Transfers graded poor are fed back directly to the relevant Network for further investigation and any necessary action

Insurance All transfers are not without risk Ambulances or helicopters can be involved in accidents Financial consequences for those involved Current options are: Welsh Risk pool Basic cover & delayed processing Individual Hospital Policies Variable availability & level of cover Membership of ICS or AAGBI includes transfer insurance up to 1million individual cover or 5million per incident. Cover land & air transfers RAF has indemnity for transfer personnel NWCCN looking into All Wales Insurance Policy

Any Questions?

Summary All critical care transfers should be carried out by suitably experienced and trained personnel A comprehensive record of the transfer should be kept All transfers should be audited for quality Data from the audit process should be fed back to each Network as part of the learning process.