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Dr. David Lyon. Clinical Governance Lead Halton PCT GP Affiliate NPDT. The art of Medicine is to amuse the patient whilst nature cures the disease. Voltaire. TOP. BOTTOM. NSF Recommendations for Those with Established Disease.

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Dr. David Lyon

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Dr. David Lyon

Clinical Governance Lead

Halton PCT

GP Affiliate NPDT


The art of Medicine is to amuse the patient whilst nature cures the disease

Voltaire


TOP

BOTTOM


NSF Recommendations for Those with Established Disease

  • Risk factors assessed, documented & advised, especially smoking.

  • Medication: aspirin, beta blockers, ACEI

  • Blood Pressure below 140/85

  • Blood cholesterol lowered to less than 5mmol/l and LDL-C below 3mmol/l or by 30%


Getting the Ball Rolling

  • Disease Registers from medication & READ coded entries

  • Additional Nurse Resource Devolved to Practices

  • Protocols for Nurse & for Referral to Secondary Care

  • Computer Templates

  • Audit Team Geared up to Provide Rapid Feedback


Advantages of Templates

  • Quicker entry of standard data

  • Consistent use of READ codes

  • Display previous recordings

  • Search for previous interventions

  • Automatic calculations, e.g. BMI, risk score

  • Clinician can be reminded of interventions

  • Easier audit


% Population with IHD Runcorn


% Co-morbidity


Clinical Governance

  • Protected Time for Regular Team Meetings

  • Significant EventsPremature DeathsNew Cancer CasesUnpleasantness In The Waiting Room

  • Summaries to Clinical Governance Team

  • SEA News


What Happened

  • Focus on the facts

  • No blame

  • It’s the system

  • What went well

  • What was OK

  • What could have gone better

  • What should we do next time?


Acute Chest Pain Protocol

  • Is the patient alert?

  • Is the patient’s breathing normal?

  • Is the pain severe?

  • Is there heart problems or diabetes?

  • Is it heavy, crushing, pressure or tight?

  • Is there nausea or vomiting?

  • Is the patient sweating or clammy?


Acute Chest Pain Protocol

  • 51 cases in 12 months

  • 10 (19%) MI 1 had VF within 5 minutes

  • 7 (14%) crescendo angina

  • 24 (47%) admitted to rule out MI

  • 8 (16%) had blood test etc. & discharged

  • 2 (4%) dysrhythmia

  • Call to needle time less than 60 minutes


Cardiac Events Castlefields Health Centre


Cardiac Events per Thousand


DEATHS

  • Practice records

  • ONS (Office of National Statistics)

  • Public Health

  • 3 Character Postcodes

  • Trend over Time

  • Twelve Month Periods


At Risk

  • Other Athersclerotic Disease

  • Diabetes

  • Hypertension

  • Heart Failure

  • Middle-aged men

  • Strong Family History

  • Smoking, Post-menopausal women


Essential Ingredients

  • Clear evidence and Clear focus

  • Examples From The Field

  • Time to consider solutions

  • Reality of working at ‘street level’

  • Systematic recording of information

  • Rapid feedback

  • Appropriate resources

  • Skilled management


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