SNAP Scottish National Audit Project

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SNAP. Health Foundation funded (?300,000 )Community acquired pneumonia Epilepsy ? annual review

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SNAP Scottish National Audit Project

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1. SNAP Scottish National Audit Project CE Bucknall Chair, Bicollegiate Physicians Quality of Care Committee

2. SNAP Health Foundation funded (£300,000+) Community acquired pneumonia Epilepsy – annual review & first seizure clinic referral Long term aim – a model for quality improvement for medical topics

3. EPI-SNAP Aids for GP annual review Triage system to target poorly controlled patients, and those at risk of side effects Adaptations to SPICE screens eLinks to Epilepsy Scotland info leaflets Standardised referral proforma for first seizure clinic Driving advice Professional drivers fast tracked Reducing inappropriate referrals

4. EPI-SNAP lessons Working with other groups/agencies important when dealing with chronic disease monitoring Too early to comment on first seizure clinic project – maybe possible to derive a care bundle of key information needed & monitor this in future

5. SNAP-CAP Care bundle of key items severity scoring using CURB65 Management guided by severity (IV antibiotics if CURB65=3, home Rx if CURB65 0 or 1 and no clinical concerns first antibiotic dose within 4 hrs Oxygen saturations = 92% during first 4 hours (patient information) Monthly monitoring & feedback Changes in practice in response to data

6. 4 sites have already shown some improvement in quality of care Improved CURB65 scoring Antibiotics within 4 hrs Oxygenation Not improved Home treatment for mild pneumonia Information giving to patients/carers

10. Examples of practice changes Having appropriate antibiotics (& formulations) in A&E, so that first dose can be given before transfer to ward Writing up first dose as once only Fast tracking patients for XRay System for allowing home Rx of mild CAP cases Telephone follow up of patients discharged

11. Model for future work Care bundles Regular monitoring of these with timely feedback Rapid response to poor results to change the system of care & promote good practice

12. Care bundles key items, linked to evidence delivered by a single team over a short period of time topics can have two bundles eg relating to initial therapy and discharge arrangements

13. Feedback Person to person – using the post receiving ward round more effectively Paper based – posters showing monthly results Electronic – emails to FY, middle grade docs and consultants

15. Does It Work in Our ICU?

16. Why should physicians get involved now? Fragmentation of care (MMC) has weakened medical teams Consultants have responsibility but no current means of influencing care, other than post hoc changes on receiving ward rounds & general exhortations Opportunity - Patient safety being strongly promoted within Scottish NHS, with IHI as world class partner

17. Model for quality improvement Specialist Societies identify topics and care bundles IHI model of local groups monitoring results & sharing experience more widely PSA collaboration for local data monitoring & changing practice Senior support – medical & managerial Electronic links to training and CPD

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