Delivering Clinical Improvement for Patient Safety. Eddie Docherty Consultant Nurse for Acutely Unwell Adults Susan Hannah Practice Development Lead - Clinical Improvement. Mortality Case Note Review. Modified Early Warning Scoring Admission to HDU Unusually high DNAR orders
Consultant Nurse for Acutely Unwell Adults
Practice Development Lead - Clinical Improvement
Modified Early Warning Scoring
Admission to HDU
Unusually high DNAR orders
Review of complex patients over weekend and holiday periods
End of life care
Development of appropriate action plan
50 consecutive deaths
IHI 3x2 matrix
GTT applied to box 4 patients
Review of additional diagnostic groups
Cardiac Arrest Review
Outcome Primary Driver Secondary Driver
Emergency Response Team created
Testing of process for call and referral
Complete. Live service testing May 2010
Spread June 2010.
Measure use and type of calls.
‘Back to Basics’ programme across
the organisation over next 12 months.
Measure compliance with MEWS & SBAR
using SPSP approach -Sustainable spread.
What did we need the team to do?
Who should be on the team?
How do we get the team to the patient- right patient & right time?
How do we test it?
How do we evaluate it?
How do we sustain?
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 mins or request ERT activation
Contact Patients own team, develop a continuing
plan of care
Activate the 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
ERT Activation and feedback Pathway
* Dial 0 Switchboard and ask them to fast page the Emergency Response Team
Board level engagement
Operational team- nurse consultant, 2 medical consultants & consultant anaesthetist –influencing & engagement
Team member engagement- ownership and “marketing”
Medical staff- non threatening, integrative
WARD BUY IN- small cycles of change , test, retest, systems & PEOPLE
AND PROVING IT
one patient & one nurse- one area - one week
Situation - identified need to improve MEWS, communication and escalation, staff awareness of safety issues .
Background - available data highlights areas for improvement in current practice through SBAR, Safety Briefs
Assessment – measuring and testing change via audit and PDSA methods provides evidence of improvements and supports sustainability
Recommendation – an approach to achieving sustainable improvements in practice with empowered, skilled staff who perform at an optimal level to reduce risk and ensure patient safety
Early recognition of deteriorating patientsComplete and accurate MEWS and action plan recordingRegularity of observations according to clinical concernNursing staff escalation to medical staff where expectedAppropriate response of medical staff to MEWSConsistent approach to documentation of decision making
What do we need to improve?
Model focuses on a facilitated approach to driving improvements through clinical supervision and 1:1 approach to supporting ward staff
Identified first four wards - testing a variety of approaches to implement all aspects of improvement through involving staff in processes (audit, improvement methodology, using data for change)
Supporting staff to understand and engage with SPSP work and relating this to other key drivers within the organisation
Building on Success Through Integration
Scottish Patient Safety Programme
Leading Better Care
Healthcare Associated Infection
Releasing Time to Care
Rights Relationships & Recovery
Joanna Briggs Initiative (JBI)
Engaging with and involving all staff in developments – very busy acute ward environments
Tailoring facilitation to implement SBAR and Safety Briefs
in specific clinical environments – testing a variety of approaches
Resource intensive – dedicated facilitation for each ward required
to achieve sustainability
Ensuring an individualised approach while keeping a firm view on the desired outcomes within acceptable timescales
What changes are we going to make based on our findings?
Build in Quality Assurance Processes
Know exactly what we aim to achieve and how we will do it
Improvement Programme and developed spread plan
What were the results?
Measure and evaluate implementation
Early Days yet.....