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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

Dr. David Lyon

Clinical Governance Lead

Halton PCT

GP Affiliate NPDT



TOP cures the disease

BOTTOM


Nsf recommendations for those with established disease
NSF Recommendations for Those with Established Disease cures the 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
Getting the Ball Rolling cures the disease

  • 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
Advantages of Templates cures the disease

  • 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



Co morbidity
% Co-morbidity cures the disease


Clinical governance
Clinical Governance cures the disease

  • Protected Time for Regular Team Meetings

  • Significant Events Premature Deaths New Cancer Cases Unpleasantness In The Waiting Room

  • Summaries to Clinical Governance Team

  • SEA News


What happened
What Happened cures the disease

  • 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
Acute Chest Pain Protocol cures the disease

  • 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 protocol1
Acute Chest Pain Protocol cures the disease

  • 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 per thousand
Cardiac Events per Thousand cures the disease


Deaths
DEATHS cures the disease

  • Practice records

  • ONS (Office of National Statistics)

  • Public Health

  • 3 Character Postcodes

  • Trend over Time

  • Twelve Month Periods


At risk
At Risk cures the disease

  • Other Athersclerotic Disease

  • Diabetes

  • Hypertension

  • Heart Failure

  • Middle-aged men

  • Strong Family History

  • Smoking, Post-menopausal women


Essential ingredients
Essential Ingredients cures the disease

  • 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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