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Health Foundation Safety Improvement in Primary Care SIPC. SIPC1 Aims. To enable 80 Primary Care teams to: 1. Identify and reduce risk and harm to patients 2. Improve reliability of care for patients On High Risk Medications With Heart Failure. Why ?. Link to SPSP SIGN Guidance

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Health foundation safety improvement in primary care sipc l.jpg

Health FoundationSafety Improvement in Primary CareSIPC


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SIPC1 Aims

To enable 80 Primary Care teams to:

1. Identify and reduce risk and harm to patients

2. Improve reliability of care for patients

  • On High Risk Medications

  • With Heart Failure


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Why ?

  • Link to SPSP

  • SIGN Guidance

  • Long Term Conditions

  • GP Contract

  • Not done well


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Heart Failure

  • Reliable care via bundles

  • Trigger Tool

  • Patient Involvement /Experience

  • Safety Culture


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Knowledge

  • Harm - trigger tool

  • Culture – Climate Surveys

  • Reliability - Bundles

  • Patient Involvement

  • What to spread ? contract

  • National Priority

  • Oversubscribed


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Breaking News

“Improving Quality in Primary Care” August 2010

NHS Scotland will

“Design and implement a Patient Safety Programme in Primary Care”

 " Guided by outputs  from SIPC”



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To improve, quality, safety and reliability of care for patients with Left ventricular Systolic Dysfunction What - Outcomes: Reduce rates of admission of patients with LVSD by 20%Reduce rates of readmission of patients within 30 days in patients with LVSD by 20%By When:By May 2012

95 %Compliance with Bundle of care

Aim Primary Driver Secondary Drivers

(Areas of focus) (Measurements of Success)

B Blocker prescribed

B Blocker to target doese

Functional Assessment -NYHA

Pneumococcal Vaccine

Written info -signs and symptoms of exacerbation/

Measured by trigger tool

20% Reduction in harm

Improve Patient Experience

Defined by focus group or other tools


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List of Interventions patients with

Echo

NYHA

Use of ACE

Use of B-Blockers

Warfarin if AF

Vaccines

Self management


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LVSD Bundle patients with

Current use of licensed B Blocker Bisoprolol, Carvedilol and Nebivolol 

B blocker prescribed at target or max tolerated dose

Functional Assessment Documented - NYHA recorded in last year

Self management - Recorded that patient given information about the recognition of worsening of heart function/condition and/or LVSD

Immunise Appropriately - Pneumococcal vaccine given


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Crude Baseline data patients with

B Blocker 70%

B blocker at target dose 32%

Pneumococcal 71%

NYHA 55%

Patient information – 42%

All 5 - 30%



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Left Ventricular Systolic Dysfunction Guidance patients with

  • Diagnosis

  • Investigations

  • Coding

  • Interventions

  • Titrating drugs

  • Patient Leaflet

  • Referral criteria


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Template patients with


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Leaflet patients with

What is Left Ventricular Systolic Dysfunction (LVSD)?

Left Ventricular Systolic Dysfunction (LVSD) is a term to describe when there is evidence that the pumping effect of the heart is reduced. “Left” refers to the side of the heart that is affected. The word “Ventricular” refers to the chamber of the heart that is affected. “Systolic” refers to the phase of the heart beat where the blood is being pumped maximally from the heart. “Dysfunction” simply means that the heart is not working optimally.


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Patient Group patients with

Plenty of Positive feedback !

  • “Aftercare and follow up for test results was excellent at Stirling Royal Rehab Well done!”

    Commonest challenges

    Difficulties on discharge from hospital

  • Confusion re pills “I had a bag full of drugs to take. I've not a clue what they are for”

  • Lack of follow up after release from hospital

    Communication “Lack of communication between GP/Hospital/Patient”

    Self care - Unclear/ variable self help/ education

    Carers/Relatives Lack of info/ support


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Practice Group patients with

  • What information, if any, have you received from your GP Practice about your heart?

  • Has anyone at your GP Practice adequately discussed/explained the medication that you take to manage your heart condition?

  • How confident do you feel about managing your condition at home?

  • How confident do you feel about recognising when your condition is worsening and what you should do about it?

  • What do you feel about the care you receive from your practice?

  • What is your experience of accessing your usual GP or a GP or nurse that knows you at the practice?

  • If you have been admitted to hospital with your heart condition what do you think about the follow up care you received from your practice after being discharged?

  • Is there anything healthcare providers could do differently that would help you to manage your Heart Condition?


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Shared care patients with


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Communication patients with


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Heart Failure patients with Recorded in most recent letter

Investigations completed 10%

NYHA 90%

Use of ACE 75%

Use of B-Blockers 60%

Anticoagulation if in AF 87%

Pneumococal Vaccs 5%

Influenzae Vaccs 20%

Management of Exacerbations 30%

Patient education and self management 50%

All Criteria 0%





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Qualitative Feedback 96%Heart Function team

Initially time consuming

Quick to update

Excellent summary

Spread


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Feedback Primary Care 96%

Thanks for the opportunity to feedback.

My immediate reaction was  "If only more letters could be like this!!“

“Looks very GP friendly –i.e. simple. I like the clear instructions on what to do next “


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Opportunities for synergies 96%

  • Establishing the diagnosis - LVSD

  • Interventions same

  • Handover at Discharge – IHI Guide

  • Guidance for GPs – skill them up

  • Don’t clog your clinics

  • Structured communication

  • Shared Patient information



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