Achieving High Reliability in Healthcare Aneurin Bevan Health Board

National Learning Event – 8th November 2012

ABHB Vision

The vision statement for Aneurin Bevan

Health Board is:

• Working with you for a healthier community

• Caring for you when you need us

• Aiming for excellence in all we do

ABHB – Achieving High Reliability in Healthcare – Nov 2012

ABHB Aims – Reducing

Mortality and Harm

• Aim: To have a RAMI in line with top

performing UK organisations and eliminate

seasonal and weekly variation in RAMI by

June 2013

• Aim: To establish the Global Trigger Tool as a

measure of patient harm and reduce adverse

events per 1000 patient days to 10 by June

2013

ABHB – Achieving High Reliability in Healthcare – Nov 2012

CHKS Risk Adjusted

Mortality Index (2012)

Mortality & Harm Group overview of:

• RAMI, Mortality Rate, Raw Mortality

• 30 day condition specific mortality (MI,CHF

#NOF,Stroke,Septicaemia,Pneumonia)

• Drill down to specific areas of work eg.

Pneumonia, Sepsis

Mortality Reviews

• At RGH & NHH , plans to spread to YYF

• Global review of all deaths at NHH

• Engaging with individual consultants

• Testing condition specific reviews in

RGH (Sepsis)

ABHB – Achieving High Reliability in Healthcare – Nov 2012

Adverse Events per 1000

Patient Days

ABHB – Achieving High Reliability in Healthcare – Nov 2012

GTT currently carried out

in RGH and NHH.

Harm study carried out at

both sites

ABHB – Achieving High Reliability in Healthcare – Nov 2012

ABHB – Achieving High Reliability in Healthcare – Nov 2012

• The 1000 Lives Steering Group

– representation from all Divisions and

Localities

– aims to embed the priorities for reducing

mortality and harm

• receives presentations from each of

the mini-collaborative areas

– embeds the spread of interventions in the

Divisions and Localities

– measurement system for all the

interventions, ABHB-wide.

• New priorities/drivers to reduce

mortality/harm

– identified through triangulating data from

concerns, mortality review and CHKS data

– interventions developed for further change

Priorities for Reducing

Mortality and Harm

• MEWS to NEWS

• MEWS in the Community

and Mental Health

• RRAILS and SEPSIS

• Fractured Neck of Femur

• Falls in Hospital

ABHB – Achieving High Reliability in Healthcare – Nov 2012

Taking the Driver Diagram

Forward

Aneurin Bevan Continuous Improvement • Core business of

healthcare is to deliver high

quality, safe and reliable

services

• is the ABHB centre

for improvement which will

seek to achieve the above

by developing a culture of

quality improvement where

innovation and creativity

are valued

It will do this by:

• Identifying, developing and

supporting leaders

• Training the workforce in

improvement methodologies

• Supporting ABHB and

divisional improvement

projects

• Resourcing best practice

ABHB – Achieving High Reliability in Healthcare – Nov 2012

Aneurin Bevan Continuous Improvement • will pull together existing

work such as ‘Every day counts

for Megan’, 1000 Lives Plus

• Project alignment with Health

Board and National priorities

Divisional project agendas driven by

clinical teams supported by:

• Quality improvement training

• Support for project design

• Coaching leaders

• Resourcing best practice

• Timely meaningful data

Structure for

• Director – Dr Danny Antebi

• Programme Manager

• 4 Workstream Leads

– Leadership

– QI Training

– Project Support

– Resourcing best practice

• team of Associates and

Affiliates

ABHB – Achieving High Reliability in Healthcare – Nov 2012

100,000 Bed Days:

Everyday counts for Megan

Guiding Principles

• People who don’t need to be

admitted to hospital receive

their care in community

settings

• People who need to go into

hospital receive safe,

effective care as quickly as

possible

• People who are ready to

leave hospital are supported

to return home safely, and

without delay

ABHB – Achieving High Reliability in Healthcare – Nov 2012

QI programme contributing bed days 100KD initial scope

1000 Lives +

Safe Timely Return Home (STRH) √

Fractured Neck of Femur (NOF) √

Hospital Acquired Infection (HAI) √

Enhanced Recovery After Surgery (ERAS)

√

Chronic Conditions – Cardiac Failure

√

Chronic Conditions – Diabetes

Chronic Conditions – Chronic Airways Disease

Frequent Service Users

Gwent Frailty Programme

Safe Timely

Return Home

Wards

C4E & C4W

Driver

Diagram

Patient Centred

Care

Patients with dementia

Operational

efficiency

Patient safety

Patient & family engagement in

discharge planning process

Admission avoidance e.g. dementia

without physical ill health

Bed our outliers on the gastro unit

Management of Mental capacity

Identify patients who should not be in

hospital

Bed our admissions on the gastro wards

Improve planning work with

community/social services

Streamline referral processes e.g. to

therapies

Improve our MDT planning & comms

processes

Engagement with community services

for patients with alcohol related

problems e.g. alcohol induced dementia

Staffing levels appropriate to acuity

Ensure patients get the right

investigations at the right time

Inappropriate patient transfers to non

specialist ward areas

Manage patients as Virtual IPs where

tests & investigations can be done as

OP

Identify patients who should not be in

hospital

Patient/family experience feedback on

discharge planning process

Nursing handover – improve comms

e.g.

Implement PSAG & PfEP

Morning board rounds

Nurse on each ward round

Senior medical presence on ward

everyday – review job plans

Shift allocation of nurses

Staff education on discharge planning,

LA services & CRT function

Discharge planning from Day 1

Clinical

Effectiveness

Everyday counts for Megan: Safe

Timely Return Home (STRH)

• Targetted bed day

reductions on acute and

community wards using a

CI approach

• 2 Year roll-out of

Learning Sets across

30 wards

• 200 staff actively

engaged

• Supported by

• Piloting on 6 community/

unscheduled care wards

• Ward focussed priorities

eg. repatriation of

patients to ward

ABHB – Achieving High Reliability in Healthcare – Nov 2012

Patient and Family Centred Care - Overview

• Programme working with the Kings Fund and Health Foundation

• Improvements are based on the patient’s experience of care rather than our view of their experience

• Patient shadowing is the core method for understanding the patient’s experience of care

• Used IHI Model for Improvement to implement changes

• Working on fractured neck of femur and diabetic foot care experiences

• A Guiding Council, chaired by the executive sponsor, oversees the work in the care experiences

• A Working Group for each care experience is taking forward the work in each care experience

Diabetic PFCCTeam

Patient and Family Centred Care – Next Steps

• Working Groups need to:

• undertake more patient shadowing to understand current patient care experience

• Develop vision for ideal patient care experience

• ensure that membership covers the whole patient care experience

• Develop driver diagram to identify from differences between current and ideal care experience, the primary drivers they will work on, and the actual changes they will make

• Determine the measures that will be demonstrate the improvements made

• Launch Event in early November to:

• Build teams in fractured neck of femur and diabetic foot

• Introduce the concept of PFCC to wider group of stakeholders

• Share learning from recent learning set with the Kings Fund

• Have expert tuition from Faculty member of the Kings Fund

#NOF PFCCTeam

Patient Stories –

Progress • Task and finish Group

established with multidisciplinary membership from across ABHB

• Consent forms developed and agreed including a consent form to collect staff stories

• How to guide developed

• Database established

• 35 stories currently loaded to database

• Staff and equipment resources mapped across ABHB

• Divisional leads for patient stories established .

Patient Stories-

Next steps

• Continued recording of stories

• Development of the database to include clear

classifications to allow effective search for

and use of the stories

• Development of a patient Experience web

page –consider including stories

• Framework for feedback to story teller to be

agreed.

1000 Lives Plus

Mini-

Collaboratives

Aneurin Bevan

Health Board

RRAILS

Team Members

Rapid

Response to

Acute Illness

Learning Set

(RRAILS)

• Linda Alexander – Clinical Lead

• Jan Barrett – 1000 lives coordinator

• Rachel Oliver – Outreach RGH

• Emma Bennett – Outreach RGH

• Alisa Jones – Outreach RGH

• Chris Howells – Outreach RGH

• Karen Lewis – Outreach NHH

• Linda Meek – Outreach NHH

• Sally Copner – Senior Nurse NHH

• Rebekah White – Outreach NHH

• Lilibeth Delarama – ANP YAB

• Coral Cole – ANP YYF

Progress implementing NEWS

• NEWS implemented across 3 acute hospitals

• NEWS being piloted in 1 community hospital

• NEWS being implemented older adult mental health 1 site

• NEWS to be piloted in Newport community resource team

RRAILS Progress & spread -

Sepsis bundle

RRAILS Progress

• Deteriorating Patients Group overview

• Organisational review of NEWS ( Documentation, communication, response and escalation, relationship with T,C, priority within organisation, night cover in response sick patient)

• One observation chart across all acute sites.

• NEWS part patient planning boards

• Pilot work being done looking at more detailed outcome data relating to patients admitted to ITU with SEPSIS: timeliness of referrals to outreach, sepsis six bundle compliance on wards and patient outcome.

• Sepsis audit being part mortality review by medical director

• Continual assessment cardiac arrest data

• Promoted sepsis – world sepsis day stand nursing conference, and on intranet.

RRAILS Progress COMMUNITY HOSPITALS • YAB community hospital pilot

for NEWS • Sirhowy ward is the pilot with

buy in from the ANP’s ward staff, senior nurse and Dr Janker.

• Staff training took place in July 2012, and the pilot commenced August 2012.

• Sirhowy are still piloting as per doctors request, but initial feedback is positive.

MENTAL HEALTH (NEWS)

• NEWS training for Older Adult Mental Health In-Patient services was rolled out in August 2012 in YYF. It remains a part of a much broader module that deals with the monitoring of physical illness in the older adult with mental health problems

Community Resource Team Newport •Piloting NEWS within a community setting to assess its effectiveness in supporting the admission, assessment and decision making process for patients who are accepted and treated through the Newport Community Resource Team. •NEWS training commenced Sept 2012

RRAILS outcomes Cardiac Arrest Data

ABHB - Number of Cardiac Arrest Calls per 1000

Patients Discharged

0

2

4

6

8

Jul-10

Sep-10

Nov-10

Jan-11

Mar-1

1

May-1

1

Jul-11

Sep-11

Nov-11

Jan-12

Mar-1

2

May-1

2

Jul-12

Time

Car

diac

Arr

est

Cal

ls/1

000

Dis

char

ged

Nevill Hall Hospital Royal Gwent Hospital

NHHAverage Score for patients

with Sepsis,MEWS 4=NEWS 6

16/0

7/20

12

18/0

6/20

12

21/0

5/20

12

23/0

4/20

12

26/0

3/20

12

27/0

2/20

12

30/0

1/20

12

02/0

1/20

12

05/1

2/20

11

07/1

1/20

11

10/1

0/20

11

10

9

8

7

6

5

4

3

2

1

Week

Indi

vidu

al V

alue _

X=6.799

UCL=9.871

LCL=3.726

10/10/2011 06/02/2012

Average News Score for Patients With Sepsis

16/0

7/20

12

18/0

6/20

12

21/0

5/20

12

23/0

4/20

12

26/0

3/20

12

27/0

2/20

12

30/0

1/20

12

02/0

1/20

12

05/1

2/20

11

07/1

1/20

11

10/1

0/20

11

16

14

12

10

8

6

4

2

0

Week

Nu

mb

er

_X=5.04

UCL=10.25

LCL=-0.17

10/10/2011 13/02/2012

Number of patients with Sepsis triggered

Number of patients with

Sepsis triggered (NHH)

Percentage favourable outcomes after 24 hours

NHH

from Oct 2011 to Aug 2012 - All Wards

0

20

40

60

80

100

120

10

/10

/20

11

10

/11

/20

11

10

/12

/20

11

10

/01

/20

12

10

/02

/20

12

10

/03

/20

12

10

/04

/20

12

10

/05

/20

12

10

/06

/20

12

10

/07

/20

12

10

/08

/20

12

Weeks

% c

om

pli

an

ce

NHH % favourable

outcome >24hours

RRAILS Barriers • To look at concerns raised by the outreach teams re pressures which have

affected the commitment they can make to auditing and teaching

• To look at concerns raised by ward staff re amount training they need for all collaboratives but the pressures do not allow them the time to attend

• Understand impact of change in ANP hours at RGH on response to patients triggering.

• Engagement Dr’s in escalation and response.

• YAB Dr’s raised concern re impact 24/7 working directive coming in with regards to responding to patients causing concern.

• Look at how data is collected via nursing metrics.

• A&E – Review data collection methods eg. safety briefing or Symphony.

RRAILS Next Steps • Support wards in implementation phase to increase spread sepsis bundle.

• Look at implementing sepsis bags in each area.(Initial meeting taken place with pharmacists and microbiologist )

• Continue to audit progress and sustainability and feed back to relevant committees (Q&PT Safety, 1000 lives steering group, deteriorating patient group, PNF scheduled and unscheduled care)

Intelligent Targets For Dementia

Content 1 Memory Assessment

• 6 Dementia Co-ordinators and 1 specialist nurse young on set dementia appointed June 2011

• Redesign of CMHT services to create capacity for a standards based pathway (Primary care screen, pre-diagnostic counselling, standard cognitive assessment, post diagnostic counselling and information, signposting including 3 sector dementia agencies, Alzheimer Society Information Pack ).

• Standards based Memory Assessment Service Record

• 11 New and redesigned clinics across ABHB at the next meeting

• Training resources and train the trainer skills

• Feedback surveys.

• Health social care Integration at MAS clinical level

Content 2 – General Wards

• Pilot wards C7E and 3.2 , are developing suitable care pathways, the identification of delirium and dementia and the use of ‘’this is me” mechanism of knowing the life history and preferences

• Bespoke training learning events, supported by Mental Health general hospital Liaison Nurses, clinical lead and lead nurse.

• Sustained reduction in falls, patient and carer satisfaction

• Dementia friendly improvements with ward signage

• Y Bannau in Brecon has now completed its initial audit

• Identifying wards for further spread 2 wards st Woolos, preparations at YYF, NHH, CCH.

• Failure free activity developments, rummage box.

Intelligent Targets For Dementia

Content 3 – Community Care (inc.Care Homes)

• Audits of prescribing Newport, Caerphilly and Torfaen.

• PDSA - Audit tool adjusted to include MCA and alternative interventions.

• Medicines management department undertaking care home medication audit in South Powys

• Guidance sheet on anti-psychotic prescribing now in use in all areas

• Guidelines on “Managing behaviour that Challenges” and alternative interventions developed.

• “anti-psychotic” leaflet for patients and carers developed and now in use in pilot areas

• Checklist compiled as per NICE –SCIE guidelines for initiation and review of antipsychotics in dementia patients.

• Medicine’s management anti-psychotic work and this Driver. Joint database being developed.

• Audit of psychotropic medication completed in care homes in Monmouthshire

Content 4 – Support for Care Givers

• The UK Carers’Survey in all Boroughs

• A Carer led development of a care pathway for carers

• “Psychological Therapies for Carers” course is run in Blaenau Gwent and Caerphilly and is being spread to South Monmouthshire

• Guidelines on “Managing Behaviour that Challenges” and alternative interventions developed

• Audit of carers views of the service being undertaken in Blaenau Gwent

• Direct Payments accesses improved in Blaenau Gwent through

• Carers information/training being rolled out across ABHB in conjunction with the Alzheimer’s Society.

Content 5 - improve quality of care in NHS dementia inpatient units

• Pathway for first 48 hours of admission devised ready for piloting

• ABHB mental health Physical health assessment policy under review Policy linked through CTP board and CTP pathway for Physical assessment inpatients

• Dementia Palliative Care Pathway learning and discussion groups

• Life history books being used in pilot areas where a life history book has not been instigated earlier in Dementia care pathway

• Dementia care pathway in draft

• Carers satisfaction survey will be used on the three pilot wards. Process to simplify align FOC Transforming care and Int targets relatives questions

• Ward at St Woolos Dementia Care Mapping observation audit. Deci audits practice on all wards.

• Protocol for anti psychotic prescribing to be introduced on St Pierre Ward, Chepstow piloted at Powys wards, ready for evaluation.

• Therapeutic activities CST & opportunity groups at Ysbyty’r Tri Cwm

• Failure Free Activity opportunity school project St Pierre Ward, CCH

• Evaluation measures group convened for Failure Free, modified CST

• OT led Free Activity level at baseline audit devised.

• Dementia Friendly Environment Baseline audit (Kings Fund) Now incorporated into 6 monthly HEB improvement process..

• Training team multi agency reference group initiated to take forward dementia care training, mediums of learning and support the development of the curriculum

• Utilising the Transforming Care organized ward and FOC opportunity to deliver and drive the Int Targets for dementia.

Intelligent Targets For Dementia

Driver 1: Tier 2 to improve specialist advice & support to primary care, including pre-referral advise & shared care arrangements

Bundle: consultancy, liaison, supervision, training, signposting, information.

Improvements:

• Variety of information on ABHB Intranet

• Designated contacts established and advice available

• Training work group set up and training strategy developed – 4 levels of training, Msc Mod

• DVD “Introduction to Eating Disorders” in development

• Patient and carer information group established – development of a wide range of material for professionals, patient’s and carers.

• Designated contacts to be established within new Primary Mental Health Care teams

• Training to be provided to new PMHCT.

• Data collection tool developed to record advice provided.

Improving Treatment for Eating

Disorders

Driver 2: improved assessment care co-ordination & interventions forTier 2

• Improvements:

• Wide range of material available on Intranet

• Guidelines and prompt sheets for assessment and care planning developed

• Audit tool to measure compliance of standards set within driver

• Epex system input codes developed to capture monthly data (to be converted into run charts)

• Fortnightly SCEDS meetings and monthly supervision available from Tier 2 lead

• Designated contacts per tier 2 team – resource witin the team

• Transition arrangements for CAMHS established

• Patient held record developed (optional)

• ED Training strategy

• Patient and carer information group established

• DBT, psycho-education groups established

• Tier 2 and 3 clinicians trained in specialist interventions e.g. DBT, CBT-e, MET, IPT

• Tier 2 care pathway

• Fortnightly SCEDS meetings

• Patient and carer representatives on all sub groups e.g. training, information.

• Foundation of nursing Patient First bursary secured to develop services for severe and enduring eating disorders

• Working with Nicola Gray to develop WARRN risk assessment and management training module

Improving Treatment for Eating

Disorders

Improving Treatment for Eating

Disorders Driver 3: improved provision of tier 3

specialist eating disorders service

• Improvements

• Tier 3 team fully established; Clinical

lead, specialist clinician, OT, Dietitian,

Tier 2 lead, administrator

• Tier 3 clinicians received additional

training; DBT, CBT-e, IPT, MET

• Number of groups developed; DBT,

SEED, Nutrition, psycho-education

• Transition arrangements with CAMHS

• Interface with Tier 4 service

• Regular SCEDS meetings with Tier 2

• Patient and carer involvement

Driver 4: improved acute medical in-patient

care for patients with anorexia

• Medical refeeding bed identified in NHH.

• Training provided to ward staff

• Tier 3 team to visit any inpatients daily.

• Links established with dietitians

• Challenges

• Small number of admissions unable to compile run charts.

• Implementation and monitoring team in place and will continue to work on improving the provision against the re-feeding bundle.

• High cost Low volume specialist provision

• In view of the National challenges facing this driver a national group is to be convened to undertake an option appraisal for Wales.

Depression

Depression target goal

“To improve detection, assessment and

treatment of depression in hospital

population”

High levels of co-morbidity in long term

conditions, targeted conditions are:

• diabetes

• coronary conditions

• neurological conditions

• respiratory conditions

• Cancer

Pilots completed in Weight Management

and Cancer Services

Patients screened for signs of depression

ABHB – Achieving High Reliability in Healthcare – Nov 2012

Depression – Pilot services Head and neck cancer pilot

• Patients screened using cancer

specific ‘Distress Thermometer’. The

multidisciplinary team decided to

screen all patients at the pre-treatment

clinic.

• In May 2011 no mood screening

routinely took place in the Head and

Neck cancer clinic.

• In May 2012 56 patients were

screened.

Hearty Lives Torfaen Weight

Management Service

• All patients attending the weight

management group screened pre and

post group. The numbers screened are

10 patients per month.

• 210 patients have been screened in

2011-2012. Of these patients 30%

screened positive for possible

depression and 70% were already being

prescribed antidepressant medication.

(These groups overlap.)

ABHB – Achieving High Reliability in Healthcare – Nov 2012

210

147

63

0

50

100

150

200

250

total anti dep positive

number of

patients

0

56

0

10

20

30

40

50

60

2011 2012

Patients

screened

Depression

Difficulties

• Staff confidence - fear of uncovering

need they can’t meet

• Environmental – no privacy

• Indentifying appropriate place in care

pathway - e.g. In acute setting mood

screening complicated by

understandable distress/acute

exacerbation/fatigue

• Insufficient specialist resources

(liaison/clinical psychology time) to

deliver screening as separate activity

Success

• Where mood/psychosocial needs

screening occurs as part of holistic

assessment approach

• Target embedded in teams’ core activity

and owned by service rather than seen

as something someone else does

• Clear onward referral routes

• Where right person asking at right time

(someone who knows patient)

• Hospital patients are community

patients and some may be better

screened when in community.

ABHB – Achieving High Reliability in Healthcare – Nov 2012

Learning from ABHB pilots has contributed to 1000lives+ review of

depression target. Review currently underway

Catheter Associated Urinary Tract

Infection

ABHB – Achieving High Reliability in Healthcare – Nov 2012

Aim

09.10.12

Implementation of

bundle and full data

collection

Baseline data

collection

Achieve

consistent 95%

compliance

with the

maintenance

care bundle for

urethral

catheters.

NHH: embedded on

Ward 4/1,Ward 4/2,

Ward 4/4, Ward 4/3-

All 4 wards doing data

inputting.

Ward 1 /2 baseline

data collection

robust-

Ward 2/4-

established

Ward 3/1-

fragmented

A&E-Insertion bundle

in progress. Audit

tool being trialled.

Baseline data started

OSU 2012

COMM hospitals

Redwood- Embedded. Gwanywn- Embedded.

Pursuing data inputting processes for both areas

Insertion bundle

sticker being put onto

Ormis for orthopaedic

theatre St Woolos

Education

commenced on1 /2

and 2/4 Start baseline line –

Sept 12

Fields N/H (Npt)

collecting baseline

data.

RGH: embedded on

Ward C7E/CCU/critical

care - Ward

C5W/B3/D3W-

embedded.

D2West- early

implementation

July2012

N/H: Bank House N/

H – needs revisiting

and process re-

established

Intended spread

•Maintenance bundle

Embedded across 12

wards in acute and

community settings

•Initial work being

undertaken in care homes

•Spread to 7 additional

wards

•Insertion bundle being

tested in A&E

•Short term catheter days

as outcome measure

•Poster presented to

International Forum in

Paris last year

ABHB – Achieving High Reliability in Healthcare – Nov 2012

Catheter Associated Urinary Tract

Infection

0

50

100

150

200

250

0%

20%

40%

60%

80%

100%

120%

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun

Jul

2010 2011 2012

Cath

ete

r D

ays

% C

om

plian

ce

NHH % CAUTI Bundle Compliance & Short Term Catheter Days

% Total Compliance

Median

short term catheter days

0

50

100

150

200

250

300

350

0%

20%

40%

60%

80%

100%

120%

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul

2011 2012

Cath

ete

r D

ays

% C

om

plian

ce

RGH % CAUTI Bundle Compliance & Short Term Catheter Days

% Total Compliance

median

Short Term Catheter Days

PVC – Care Bundle Organisation

Spread 01.08.12 Implementation of

bundle and full data

collection

Implementation of

bundle

Achieve

consistent 95%

compliance with

the insertion &

ongoing care

bundle for

peripheral

venous catheters

NHH: Insertion

CCU, 1/2, ITU, 4/1, 2/3, main

theatre, x-ray

Rapid response Blaenau

Gwent

C5W, D1W/MAU,

MAX FAX, Main

Theatre

C7W starting 01.07.12

YYF - Theatres

NHH: Ongoing

CCU, ITU, 1/2, 4/1, 2/3

Rapid response Blaenau

Gwent

Delivery/Maternity

service ongoing training

A&E

C5W, C7E, D6E, D6W,

D7W, D1W/MAU,

MAX FAX,

C7W starting 01.07.12

YYF – ward 2/3

RGH: Insertion

OSU theatre,

HDU/ITU, CAU, CCU/D3W,

MDCU, embedded

RGH: Ongoing

Ward D7E, OSU, B6N, D3W,

CCU, ITU, HDU embedded

Intended spread

Maternity Services

teaching in progress

D5E starting Aug

Eye ward/theatre Aug

Delivery/Maternity

service ongoing training

Ward 4/3

Maternity Services

teaching ongoing

D5E starting Aug

Eye ward/theatre Aug

C7E starting Sept

A&E meeting sept

• Insertion Bundle

implemented across 10

wards

•Bundle introduced to

theatres and measured

via ORMIS

•Maintenance bundles

implemented across 12

wards

•Plans in place to

spread to maternity

•MSSA outcome

measure shows

reduced MSSA on

wards where PVC

bundle has been

implemented

PVC - Outcome Data MSSA BACTERAEMIA

(All Wards)

Apr 2011 - current

0

2

4

6

8

10

12

Apr-11

Jun-11

Aug-11

Oct-11

Dec-11

Feb-12

Apr-12

Jun-12

Aug-12

RGH NHH ABHB Linear (ABHB)

MSSA BACTERAEMIA

(PVC Bundle Wards)

Apr 2011 - current

0

1

2

3

4

5

6

Apr-11

Jun-11

Aug-11

Oct-11

Dec-11

Feb-12

Apr-12

Jun-12

Aug-12

Sch

Unsch

F&T

Linear

(Sch)

Mouthcare Team

Rhiannon Jones

Vicki Jones

Katrina Rowlands

Cheryl Hucker

Denise Ewens

Helen Roberts

Janice Thomas

John Hampton-Saunders

Laura Thompson

Linda Western

Mary Hopkins

Robert Taylor

Sally Copner

Sharan Sharman

Tracey Partridge-Wilson

Kate Hooton

Rachel Fletcher

Step one

Mouth care risk assessment

Step two

Choose care plan A, B or C

Step three

Document daily mouth care

Mouthcare for Adults

in Hospital

Urgent referral

to

medic/dentist

Dental

treatment

on

discharge

Mouthcare

Pilot Wards

St Woolos Hosp - Gwanwyn Ward

Rehabilitation

Nevill Hall Hosp - Ward 3/3

Surgical Ward

Royal Gwent Hosp - Ward D5W

Surgical Ward

Llandrindod Wells Hosp - Clywedog Ward (Mental Health) Older Adult Assessment Unit

Nevill Hall Hosp

Intensive Care Unit

Structure

•ABHB Mini collaborative meetings set

up

•Executive Lead – Denise Llewellyn,

Director of Nursing

•Clinical Lead – Rhiannon Jones

(Assistant Director of Nursing)

supported by Vicki Jones (Clinical

Director Dentistry)

•MDT team membership

•Mini-Collaborative called ‘Open Wide’

Mouthcare Achievements

• Training delivered to most ward areas

• Wards have documentation – Assessment Tool & Care Plans

• Equipment obtained via ORACLE

• All wards have commencement plan

• Poster exhibited at ABHB nursing conference

• Mouthcare symbols added to PSaaG database

• Baseline data collected via Fundamentals of Care Tool

• Discussed supplies with hospital shop

• In discussions with Datix Manager regarding recording of lost dentures

Next Steps

• Liaise with Pharmacy regarding high fluoride toothpaste

• Developing PGDs for mouthwash & high fluoride toothpaste

• Measurement process

• HCSW to join mini-collaborative

Transforming Care Team Members

• ABHB Project Lead

• Rhiannon Jones (ADN)

• Transforming Care Facilitators

• Ann Price

• Carol Hadfield

• Karen Smith

• Elaine Ward

• David Timmins

• Sue Pearce

• Mary Hopkins

• Rachel Lee

Driver Diagram • To roll out Transforming Care across all

wards in ABHB

• Primary drivers to include: – Staff Well Being – To use a range of tolls that

demonstrate staff engagement, experience and team spirit

– Efficiency – Evidence an increase in the time

RN spend with patient in direct care to

improve quality of service

– Safety – Use of Safety Crosses to

demonstrate improvements in safe and

reliable care

– Patient Centeredness (Experience of Care) –

to evidence patient experience and achieve

target of 95%

Transforming Care

Project Plan • Launched in ABHB in May

2012

• Executive Board Sign up

• Link with NLIAH to Roll out Transforming Care across all wards by December 2011

• Project Lead Established

• Lead Facilitator Created

• Facilitators Established for each divisions

• Education for facilitators undertaken with NLIAH

• Education planned for all wards by December 2011

Transforming Care Progress Achievements

• ABHB late to start programme but have progressed to meet targets set

• Education rolled out to all wards within ABHB by June 2012

• All wards have started Transforming

• Departments have also been included (Radiology / CCU / A&E)

Barriers

• Leadership Development

• Teamwork Development

•

• Staffing Issues (Sickness/absences)

• Senior Nurses Engagement

• Senior Nurse Education

Transforming Care - Data • All wards are now ‘Transforming’

• Patient experience is being collated and displayed

• Ward B7 achieving 95%, previously not seeking feedback

• Ward 4-1 achieving 100 % for past 2 months

•

• Core Measures are being collated & displayed

• Direct Care Time increases

• Ruperra Pre 315 Post 59 %

• Ebbw pre 48% Post 56%

• Ward D5 east 9 months without patient fall

• Ward C4 West 388 days with MRSA & 148 days without HAPU

• Well organised ward Work stream (WOW)

• Cost savings from a WOW (D4 West)

• Ward D4 West 164.00 for 1 cupboard

• Ward 2-1 320.00 for 1 room

• Intentional Rounding

• Audits of call bells are showing improvements since implementing

• ICARE intentional Rounding Tool (EBBW introduced ICARE April 12, calls reduced by 100 per week)

Next Steps •Continue to transform on all wards across ABHB

•Spread of Transforming Care across departments

•Create depth of evidence to demonstrate improvements

•Educational programme for Senior Nurses

Improving the Reliability

of TIA Services

Progress Compliance monitoring continues.

No Target % set by WAG presently.

Telephone referral system commenced August 2012 and improvements in complying to high risk patient review noted.

At RGH, hot slot appointments created to increase clinic availability.

At NHH – developing system to expedite appointments for high risk patients.

Acute Stroke Bundles

Outcomes

% compliance with First Days bundle

Stroke patients

from May 2010 to Oct 2012

0

10

20

30

40

50

60

70

80

90

100

04

/05

/20

10

04

/06

/20

10

04

/07

/20

10

04

/08

/20

10

04

/09

/20

10

04

/10

/20

10

04

/11

/20

10

04

/12

/20

10

04

/01

/20

11

04

/02

/20

11

04

/03

/20

11

04

/04

/20

11

04

/05

/20

11

04

/06

/20

11

04

/07

/20

11

04

/08

/20

11

04

/09

/20

11

04

/10

/20

11

04

/11

/20

11

04

/12

/20

11

04

/01

/20

12

04

/02

/20

12

04

/03

/20

12

04

/04

/20

12

04

/05

/20

12

04

/06

/20

12

04

/07

/20

12

04

/08

/20

12

04

/09

/20

12

04

/10

/20

12

Weeks

% c

om

pli

an

ce

Compliance: 90%

Reason for failure: 1 patient out of 9 failed to get to ASU < 24 hours

Solution implemented: Ongoing discussion with bed-management

Nevill Hall

% compliance with First Hours bundle

Stroke patients

from May 2010 to Oct 2012

0

10

20

30

40

50

60

70

80

90

100

04

/05

/20

10

04

/06

/20

10

04

/07

/20

10

04

/08

/20

10

04

/09

/20

10

04

/10

/20

10

04

/11

/20

10

04

/12

/20

10

04

/01

/20

11

04

/02

/20

11

04

/03

/20

11

04

/04

/20

11

04

/05

/20

11

04

/06

/20

11

04

/07

/20

11

04

/08

/20

11

04

/09

/20

11

04

/10

/20

11

04

/11

/20

11

04

/12

/20

11

04

/01

/20

12

04

/02

/20

12

04

/03

/20

12

04

/04

/20

12

04

/05

/20

12

04

/06

/20

12

04

/07

/20

12

04

/08

/20

12

04

/09

/20

12

04

/10

/20

12

Weeks

% c

om

pli

an

ce

% compliance with First 3 Days bundle

Stroke patients

from Apr 2010 to Oct 2012

0

10

20

30

40

50

60

70

80

90

100

26

/04

/20

10

26

/05

/20

10

26

/06

/20

10

26

/07

/20

10

26

/08

/20

10

26

/09

/20

10

26

/10

/20

10

26

/11

/20

10

26

/12

/20

10

26

/01

/20

11

26

/02

/20

11

26

/03

/20

11

26

/04

/20

11

26

/05

/20

11

26

/06

/20

11

26

/07

/20

11

26

/08

/20

11

26

/09

/20

11

26

/10

/20

11

26

/11

/20

11

26

/12

/20

11

26

/01

/20

12

26

/02

/20

12

26

/03

/20

12

26

/04

/20

12

26

/05

/20

12

26

/06

/20

12

26

/07

/20

12

26

/08

/20

12

26

/09

/20

12

Weeks

% c

om

pli

an

ce

% of patients admitted to co-located beds (ASU) within 24 hours of admission

Stroke patients

from Apr 2010 to Oct 2012

0

10

20

30

40

50

60

70

80

90

100

26

/04

/20

10

26

/05

/20

10

26

/06

/20

10

26

/07

/20

10

26

/08

/20

10

26

/09

/20

10

26

/10

/20

10

26

/11

/20

10

26

/12

/20

10

26

/01

/20

11

26

/02

/20

11

26

/03

/20

11

26

/04

/20

11

26

/05

/20

11

26

/06

/20

11

26

/07

/20

11

26

/08

/20

11

26

/09

/20

11

26

/10

/20

11

26

/11

/20

11

26

/12

/20

11

26

/01

/20

12

26

/02

/20

12

26

/03

/20

12

26

/04

/20

12

26

/05

/20

12

26

/06

/20

12

26

/07

/20

12

26

/08

/20

12

26

/09

/20

12

Weeks

% p

ati

en

ts

Royal Gwent Hospital

Stroke Rehabilitation Bundles - Data

2 (iii) Percentage of patients who have access to all relevant specialist interventions

from May 2011 to Aug 2012

0

20

40

60

80

100

120

19/05

/11

02/06

/11

16/06

/11

30/06

/11

14/07

/11

28/07

/11

11/08

/11

25/08

/11

08/09

/11

22/09

/11

06/10

/11

20/10

/11

03/11

/11

17/11

/11

01/12

/11

15/12

/11

29/12

/11

12/01

/12

26/01

/12

09/02

/12

23/02

/12

08/03

/12

22/03

/12

05/04

/12

19/04

/12

03/05

/12

17/05

/12

31/05

/12

14/06

/12

28/06

/12

12/07

/12

26/07

/12

09/08

/12

Weeks

% p

atie

nts

4 (i) Percentage of patients who are given a reliable point of contact

from Jul 2011 to Jul 2012

0

20

40

60

80

100

120

06/0

7/11

20/0

7/11

03/0

8/11

17/0

8/11

31/0

8/11

14/0

9/11

28/0

9/11

12/1

0/11

26/1

0/11

09/1

1/11

23/1

1/11

07/1

2/11

21/1

2/11

04/0

1/12

18/0

1/12

01/0

2/12

15/0

2/12

29/0

2/12

14/0

3/12

28/0

3/12

11/0

4/12

25/0

4/12

09/0

5/12

23/0

5/12

Weeks

% p

atie

nts

3 (iii) Percentage of patients who receive appropriate intensity of rehab provided

0.00

20.00

40.00

60.00

80.00

100.00

120.00

19/11/1

1

26/11/1

1

03/12/1

1

10/12/1

1

17/12/1

1

24/12/1

1

31/12/1

1

07/01/1

2

14/01/1

2

21/01/1

2

28/01/1

2

04/02/1

2

11/02/1

2

18/02/1

2

25/02/1

2

03/03/1

2

10/03/1

2

17/03/1

2

24/03/1

2

31/03/1

2

07/04/1

2

14/04/1

2

21/04/1

2

28/04/1

2

05/05/1

2

12/05/1

2

19/05/1

2

26/05/1

2

02/06/1

2

09/06/1

2

16/06/1

2

23/06/1

2

30/06/1

2

07/07/1

2

14/07/1

2

21/07/1

2

28/07/1

2

04/08/1

2

11/08/1

2

18/08/1

2

Data

Median

YAB

Compliance rate for bundle 4

from Mar 2011 to Jul 2012

0

20

40

60

80

100

120

23/03/1

1

06/04/1

1

20/04/1

1

04/05/1

1

18/05/1

1

01/06/1

1

15/06/1

1

29/06/1

1

13/07/1

1

27/07/1

1

10/08/1

1

24/08/1

1

07/09/1

1

21/09/1

1

05/10/1

1

19/10/1

1

02/11/1

1

16/11/1

1

30/11/1

1

14/12/1

1

28/12/1

1

11/01/1

2

25/01/1

2

08/02/1

2

22/02/1

2

07/03/1

2

21/03/1

2

04/04/1

2

18/04/1

2

02/05/1

2

16/05/1

2

30/05/1

2

13/06/1

2

Weeks

% p

atie

nts

YYF

St Woolos

County

Acute Stroke, Rehab and TIA

• Barriers • Lack of clarity of some rehab bundle measures has highlighted risk of

inconsistent reporting between units. Overcome by setting up working group which agreed guidelines

• Acute: Site capacity issues impacting on transfer of patients to ASU.

• TIA: Delayed referrals from GP into TIA service. Inconsistent accuracy of dataset analysis not reflecting service provided. Presently under investigation with DSU.

• Next Steps • TIA: Consistent Seven day service

• Acute: Direct admission to ASU.

• Life After stroke – new programme area launched 2012

• ABHB Stroke Delivery Plan being finalised, with revised membership of Stroke Board and associated Work Stream groups

Torfaen Community Falls Prevention Exec lead, Jan Smith

Clinical lead, Dr Usman, Kitson & Rahman

Governance Link, Kate Hooton

Mulitidisciplinary Team Members:

• Clare Younger, Torfaen Falls Co-ordinator

• Debbie Povey, Falls Specialist Nurse

• Diane Nelson, Falls Administrator

• Nicola Jeffries, Support & Well-being

Worker

• Debra Williams, Support & Well-being

Worker

• Jaqueline Hull, Support & Well-being

Worker

• Karen Minton & Andrea Shelford, Senior

Physiotherapists

• Chris Davis, Senior Occupational

Therapist

Torfaen Community Falls Prevention

Achievements so far

• Progress/Improvements made on falls service integration within Community Resource Team

• Excellent Patient Satisfaction

• 20% annual increase in number of falls referrals

• Reduction in reported fractures

• Decrease in lengths of stay

4 (i) % patients who receive a review of compliance with the plan

Falls

from Apr 2011 to Oct 2012

0

20

40

60

80

100

120

Apr

2011

May

2011

Jun

2011

Jul

2011

Aug

2011

Sep

2011

Oct

2011

Nov

2011

Dec

2011

Jan

2012

Feb

2012

Mar

2012

Apr

2012

May

2012

Jun

2012

Jul

2012

Aug

2012

Sep

2012

Oct

2012

Months

1 (i) % patients who complete the initial screening using an agreed tool

Falls

from Apr 2011 to Oct 2012

0

20

40

60

80

100

120

Apr

2011

May

2011

Jun

2011

Jul

2011

Aug

2011

Sep

2011

Oct

2011

Nov

2011

Dec

2011

Jan

2012

Feb

2012

Mar

2012

Apr

2012

May

2012

Jun

2012

Jul

2012

Aug

2012

Sep

2012

Oct

2012

Months

4 (iii) % patients who have an updated or closed plan as appropriate and update the falls log

Falls

from Apr 2011 to Oct 2012

0

10

20

30

40

50

60

70

80

90

100

Apr

2011

May

2011

Jun

2011

Jul

2011

Aug

2011

Sep

2011

Oct

2011

Nov

2011

Dec

2011

Jan

2012

Feb

2012

Mar

2012

Apr

2012

May

2012

Jun

2012

Jul

2012

Aug

2012

Sep

2012

Oct

2012

Months

1 (i) % patients who complete the initial screening using an agreed tool

Falls

from Apr 2011 to Oct 2012

0

20

40

60

80

100

120

Apr

2011

May

2011

Jun

2011

Jul

2011

Aug

2011

Sep

2011

Oct

2011

Nov

2011

Dec

2011

Jan

2012

Feb

2012

Mar

2012

Apr

2012

May

2012

Jun

2012

Jul

2012

Aug

2012

Sep

2012

Oct

2012

Months

Torfaen Community Falls Prevention

Barriers

• Reduction in Falls Team members

• Increase in the number of referrals received since Frailty

commenced.

Next Steps

• Improved Service Integration

• Improved outcomes

• Overcoming barriers to maintain a gold standard falls service

• Managing demand

• To develop a more robust evaluation and follow-up system.

Transforming Maternity Services

Progress Made

Implementation & Spread of Sepsis Six

Plus Two across the Service – Proforma

updated and ratified.

Streamline Data Gathering Processes to

Improve Process & Outcome Measures in all

Areas - Improve Data Accuracy & Ownership

Team Leader Agreement - Triage, RGH –

Extract Data from Admission Assessment

Documentation (Use for cross reference) –

Input data directly onto spreadsheet

Spread Care Bundles to all areas

throughout the Division - RGH - Triage, DAU,

Ward B4 & Main Delivery Unit - NHH - DAU,

Ward 1/2 & Main Delivery Suite

Data Collection different in some areas

Triage, RGH - All Admissions Data - Ward B4

Snapshot Data

Whiteboards - In all areas, sharing evidence

& information

Mini Collaborative

Team Members

Anju Kumar

Deb Jackson

Anurag Pinto

Caroline Davis

Claire Roche

Debbie Pimbley

Gwyneth Ratcliffe

Helen Erasmus

Louise Taylor

Matt Turner

Mike Byrne

Sajitha Parveen

Rachel Fletcher

Suzanne Hardacre

Tim Watkins

Liz Smith

Jayne Beasley

What are we trying to achieve?

OVERALL AIM:

To improve experience and

outcomes for mothers,

babies and their families

within Maternity Services

Reduce mortality and harm by improving

the recognition and response to the

acutely deteriorating woman.

Reduce mortality and harm from venous

thromboembolism in pregnancy and the

postnatal period.

Achievements To Date

MEOW’s Charts in use across maternity services.

Admissions, Recognition & Response Bundles -

Working well on B4 and AAU at RGH - note service

change - Working well in NHH DAU - note service

change - Senior Midwifery Manager to meet with B5

Manager and Birth Centre Manager plan roll out -

Senior Midwifery Managers to meet to discuss roll

out of all care bundles to 2/1 in NHH.

Sepsis Six Plus Two Bundle - Sepsis Six tool

adapted for maternity - In use on B4 and AAU plan

roll out to Labour ward in RGH.

Quality & Patient Safety Improvement &

Measurement department involvement - Local

meeting set up to validate data - A3 Structured

Progress Report followed by CG day presentation.

% compliance with admission Bundle by month

Triage

0%

20%

40%

60%

80%

100%

120%

Jul 1

2

Aug 1

2

Sep 1

2

Oct 12

% c

om

plia

nce

% compliance with admission Bundle

Numbers of multidisciplinary reviews by month

Triage

0

20

40

60

80

100

120

140

Jul 1

2

Aug 1

2

Sep 1

2

Oct 12

Nu

mb

er

Numbers of multidisciplinary reviews

% compliance with admission bundle by month

DAU NHH

0%

20%

40%

60%

80%

100%

120%

Jan 1

2

Feb 1

2

Mar

12

Apr 1

2

May

12

Jun 1

2

Jul 1

2

Aug 1

2

Sep 1

2

Oct

12

% c

om

plia

nce

% compliance with admission bundle

Number of multidisciplinary reviews by month

DAU NHH

0

1

2

3

4

5

6

7

8

Jan 1

2

Feb 1

2

Mar

12

Apr 1

2

May

12

Jun 1

2

Jul 1

2

Aug 1

2

Sep 1

2

Oct

12

Nu

mb

er

Number of multidisciplinary reviews

Implementation Plan/Next Steps

- Spread Bundles utilising experiences

from pilot areas

- More work needed to capture VTE

Outcome Data

- Severe Sepsis Mortality Rate - Needs to

be established

- Stillbirth Audit planned to establish

Management and Rate

Barriers

- Resources/Staffing Issues

- Education

- Engagement

- Change Environment

Strengths

- The group are enthusiastic and committed to the collaborative

- Both Midwifery and Obstetric staff have embraced the care bundles

- The venous thromboembolism risk assessment document has been successfully

implemented

- The sepsis care bundle has been successfully implemented in all high risk areas

- The admissions, recognition and response care bundles have been successfully

implemented and well received by staff working within the pilot areas

- Maternity services have attended all webex sessions relating to the mini

collaborative

Evidence of Progress

Process of inputting

data electronically on

Triage RGH is going

well

Admission Bundles

going very well

(Evidence shows this)

Staff Comments

Additional Data

Collection required

(Why? What will it

achieve?)

No extra resource

available to gather

this evidence

Transforming Maternity

Services

ERAS – Colorectal, Orthopaedic,

Urology, Gynaecology Project Board/Clinical Leads

Mrs Judith Paget – Deputy Chief Executive.

Mr Peter Lewis – Divisional Director

Mrs Clare Walters – Divisional Nurse

Sr Carole Berger – ERAS-ANP/Lead Nurse.

Mrs Alison Shakeshaft – Clinical Dir.of Therapies

Mrs Rachel Fletcher - Q&PS Improvement Mgr.

Colorectal

Mr Gethin Williams –Colorectal Surgeon

Dr Aida Nadra –Anaesthetist.

Dr Andy Bagwell – Anaesthetist

Mr A Chokkalingham –Colorectal Surgeon.

Sr Mandy Watkins – Colorectal

Dr K Jenkins – Anaesthetist

Orthopaedics Mr W Mintowt-Czyz –Orthopaedics Mr Gordon Gillespie – Orthopaedics Dr Victor Francis –Anaesthetist. SCP Ruth Jenkins – Orthopaedics Mr Robin Rice –Orthopaedics Dr David Lacquiere –Anaesthetist. Mr Y Nathdwarawala – Orthopaedics Urology Mr Adam Carter –Urology Surgeon. Dr Matthew Colmslee –Anaesthetist Sr Janet Marty – Urology Gynaecology

Mr El Hamamy – Gynaecology

Dr Woolard – Anaesthetist

Colorectal (All elective major

bowel surgery)

NHH = 2 Consultants.

Laparoscopic and Open

surgery.

RGH = 5 Consultants.

2 Laparoscopic and all Open

surgery.

‘Spin off’ audits of paralytic ileus

being undertaken

Dis

ch

arg

e b

un

dle

P

ost o

pe

rative

bun

dle

I

ntr

aop

era

tive

bun

dle

Im

me

dia

te b

un

dle

Length of Stay

Orthopaedic (All elective primary hip & knee

replacement)

NHH = 4 Consultants.

OSU = 5 Consultants

RGH = 4 Consultants.

Trauma(# NOF) All Consultants both

sites, on call.

• D7E commenced in RGH

• Prospective data collection will

commence in the next month.

• Bundle compliance has also improved.

• Numbers of participating surgeons has

increased

• Ward reorganisation is planned to

facilitate the DOSA patients and

release the dining room facility

Achievements

• Trauma pathway under development

and benchmarking taking place

• Trial Joint Schools in NHH for Primary

Knee replacements first and now for

Primary Hips and Knees.

• Patients and their partners are

educated through an ERAS

framework and prepared for their

surgical journeys.

• Excellent feedback has encouraged

further bookings.

• Outcomes for these patients will be

audited to assess their usefulness

in the programme.

Dis

ch

arg

e b

un

dle

P

ost o

pe

rative

bun

dle

Pe

ri-o

pe

rative

bun

dle

p

reo

p a

ssessm

ent b

un

dle

Length of Stay

ERAS T&O data

– pilot

consultant

ERAS Urology (Radical Prostatectomy,

Cystectomy, Nephrectomy)

• RGH – 3 Consultants

• Live data collection will

commence on C7W in the next 2

months.

• Urology has trialled anaesthetic

changes and ward education

underway. Data collection tools

are in progress and

implementation imminent.

Achievements

• Urology staff will write their own

information leaflet

• Producing ‘How to’ guide in

conjunction with Swansea

• LOS for small cohort of

cystectomy patients reducing

• PDSA to production of a

anaesthetic ‘recipe’ for major

complex surgery.

Gynaecology (Total abdominal Hysterectomy) NHH pilot commences autumn 2012, 1 Consultant, 1 procedure.

Barriers • New workstream

• One of many

• Time to complete paperwork over

care

• Need for continuing education to

encourage a sound knowledge base

that will allow ERAS to become

nursing and medical custom and

practice and not diminish.

Next Steps • Real time measurement and feedback

to clinical hubs

• 2 study days planned – 1 in NHH and 1

in RGH. To facilitate the wards and

increase availability we will repeat the

morning session in the afternoon.

• Education , Education, Education ..for

all.

Further Achievements • ERAS presented to at the Nursing Conference.

• MDT education – ERAS education for Occupational Therapy

• ERAS presented to Orthopaedic / General study day

• ERAS update for primary care

• Several patients available to participate in patient stories.

Enhanced Recovery After Surgery

Hospital Acquired Thrombosis

• Dr S Noble

• Dr S Lewis

• Leeanne Larcombe

• Sue Hanson

• Denise Cressey

• Sam Jones

• Dr G Robinson

• Kate Hooton

• Rachel Fletcher

ABHB VTE Rate

% ABHB HAT Rate (% DVT/PE of discharges/deaths/daycases

unvalidated by casenote review)

0.00%

0.10%

0.20%

0.30%

0.40%

0.50%

Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11

unvalidated HAT rate

Hospital Acquired Thrombosis - Achievements

• Medical and Surgical Risk Assessment tool incorporated into clerking packs at RGH and NHH

• Risk assessment tools for Mental Health and Obstetrics devised

• Risk assessment tools incorporated into policy for surgical thromboprophylaxis

• HAT rate being devised to be circulated to divisions

• Pharmacy working with frontline clinicians to embed risk assessment tools ie. Increase of 0-80% use of RAT in OSU (joint replacement surgery)

• Links made to Enhanced Recovery After Surgery work

• Evidence submitted to Welsh Government Health & Social Care Committee one day inquiry into VTE

Hospital Acquired Thrombosis

• Regular data and feedback to

– HAT steering group

– Thrombosis Committee

• HAT Rate incorporated into regular QI

report to Q&PS Committee

Primary Care

Collaborative

• Focus on LVSD

• GP Lead – Dr Alun

Edwards

• Initial scoping paper

approved

• Support from PCQIS

and NLIAH and ABHB

Q&PS Dept

Next Steps

• Recruiting practices

• Initial Learning Set early

next year

• Programme to run for

one year

ABHB – Achieving High Reliability in Healthcare – Nov 2012