The Scottish Patient Safety Programme

1. The Scottish Patient Safety Programme Improving HSMR in NHS Ayrshire and Arran

2. Improving HSMR in General Ward Back to Basics programme designed to directly support the work of the Emergency Response Team, ensuring that staff are: • Aware of patient safety issues on a daily basis through safety brief ‘huddles’ • Accurately measuring MEWS, identifying and responding to patient deterioration • Escalating patients effectively through SBAR communication at all times

3. Improving HSMR in General Ward • Achieving sustainability and spread • Measuring compliance with MEWS weekly, improvement methodology to drive improvements • Monitoring daily safety briefs to ensure effectiveness and compliance • Evaluating quality of exchange using SBAR for escalation of patient concern and for ward communication between staff e.g. handover/transfer

4. Improving HSMR in General Ward Emergency Response Team Managing the Acutely Unwell Patient Barbara Cowley & Gaynor Campbell ANP Clinical Managers NHS Ayrshire & Arran

5. Improving HSMR in General Ward Emergency Response Team • Team of Doctors and Nurses with advanced life skills • Respond to emergency calls following an acute deterioration in a patients condition • Aim to administer treatment and prevent unexpected ICU admission, cardiac arrest or death

6. Improving HSMR in General Ward Prior to Pilot • Buy in of ANP team • Buy in of Ward team • Switchboard

7. Improving HSMR – LeadershipCall Out Criteria Emergency Response Team callout Criteria – General Ward Area • Airway • Any airway compromise • Breathing • Respiratory Distress/ progressive dyspnoea • Respirations less than 8/min or greater than 30 min(new, persistent) • Sa02 less than 88% on oxygen(new, persistent) • Increase in oxygen requirements to 50% • Circulation • HR >130 or HR< 40 • Blood pressure less than 90mmHg (new, persistent) • Symptomatic dysrythmia • Disability • Acute change in mental state • Decreased responsiveness (new, persistent) • Seizure activity • Exposure • Uncontrolled pain despite treatment • Staff concern e.g. sustained chest pain despite nursing intervention • Uncontrolled bleeding

8. Patient in Cardiac Arrest? Activate the Cardiac Arrest team via 2222 Does the Patient meet the ERT call out criteria or are they triggering a MEWS >4 Patients own team unavailable or unable to attend in 30 minsor request ERT activation Contact Patients own team, develop a continuing plan of care Activate Emergency Response team* ERT team Assess and initiate appropriate intervention Documentation by ERT, follow up protocol activated Contact Patients own team and develop a continuing plan of care

9. Improving HSMR in General Ward During Pilot 3 full ERT activations:all appropriate 2 patients Sepsis 1 patient Acute Coronary Syndrome

10. Improving HSMR in General Ward Post Pilot • Evaluation “There is a feeling of comfort and support knowing there is a team available if we are in trouble.” Senior Charge Nurse “it’s good to know we can get urgent help if things are going wrong” Staff Nurse “The fact you can get advice is great”. FY1 • What could be improved?