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Scottish Patient Safety Paediatric Programme – Tests & Measures. Combined Child Services, NHS Grampian. Testing & Implementing Surgical Briefing Paediatric Trigger Tool PEWS PVC Bundle Medicines Reconciliation Safety Briefing Hand Hygiene SBAR. Measuring Surgical Briefing

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scottish patient safety paediatric programme tests measures

Scottish Patient Safety Paediatric Programme – Tests & Measures

Combined Child Services, NHS Grampian

current position
Testing & Implementing

Surgical Briefing

Paediatric Trigger Tool

PEWS

PVC Bundle

Medicines Reconciliation

Safety Briefing

Hand Hygiene

SBAR

Measuring

Surgical Briefing

Paediatric Trigger Tool

PEWS

PVC Bundle

Medicines Reconciliation

Safety Briefing

Hand Hygiene

Current Position
paediatric global trigger tool
Paediatric Global Trigger Tool

RACH Adverse Event Rate 2010

Team & Process

  • Identified core review group: Prof of surgery, Clinical Nurse Manager, Patient Safety Co-ordionator, Senior Charge Nurse.
  • Tested note review, amended form and re-tested. Training session provided by SPSP Programme Manager.
  • Note reviews now carried out monthly and reported internally and on Extranet.
  • Including all Paediatric admissions in our sample and not just those over 24hr stay.

Learning so Far

  • Consensus between reviewers is very good.
  • Large number of the triggers relate to early warning data missing or incomplete.
  • Have feedback other learning points via the Clinical Teams who have taken action.

Note reviews carried out 3 months later to ensure closed cases.

slide4

SBAR

Change 1: Tested SBAR in HDU ward

for communication between medical and

nursing staff when telephoning. Posters

Developed to facilitate education of staff on

the tool.

Change 2: Tested SBAR for transfer of

patients from HDU to other wards. This

facilitated HDU to begin their testingon

handover back to the general wards.

Change 3: HDU using SBAR to structure

nursing handover and linked with safety

briefing. Results have shown decreased

handover time and improved

communication.

Change 4: SBAR implemented on surgical

ward by Consultant as the method of

communication re patient’s status, actions,

treatment plan on the ward round. Staff

view is that process is succinct.

Change 5: NHSG Inter-hospital transfer

SBAR is being adapted and tested to fit

Child Health.

Change 6: SBAR used by senior nurses in

RACH as structure for formal reports.

safety brief
Safety Brief

Change 1: Adult pilot sites shared their safety briefing form and process with Child Health. V1 of form tested by SCN as part of handover in one team of medical ward. Changes made to process and form and continued testing and then implementing with one team.

Change 2:Testing then spread to other medical team.

Change 3: Implemented in medical ward on a daily basis. Learning shared with HDU.

Change 4: Begun testing in HDU 1-3-5 all and now implemented.

Change 5: Spread to other areas

medicines reconciliation examples of tests changes
Medicines ReconciliationExamples of tests/changes

Change 1: V1 of form tested with 1 doctor, then tested with 1 nurse as either professional my collect medication details. Changes made to layout.

Change 2:V2 including the introduction of insulin box tested 1,3 then required alterations highlighted

Change 3: V3 tested also extensive discussion relating to children who have no regular medicines. To complete a form or not?

Change 4: V4 created including a box to identify if the child is on no regular medicines. This is currently in use across PAU

Change 5: V5 in progress need to reintroduce continue column in the reconciliation section. To be tested by Tuesday!

medicines data
Medicines Data
  • Identification of sources is the only reason that not 100%
  • Clarity on sources
  • Feedback to individuals
  • Once 100% spread to rest of medical unit
  • Engagement of Surgical staff
perioperative
Perioperative

Change 1: Began testing the perioperative briefing, pause and debriefing process.

Change 2:Tested posters to convey process for safety checks. Large surgical pause posters in each theatre to act as prompt for the process.

Change 3: Checklist developed to capture data on briefing, pause and debrief. Tested and implemented.

Change 4: Measuring compliance with the process from January 2010. Improvements noted in both briefing and pause compliance. Further work required on debriefing elements.

Change 5: Now working on other perioperative measures.

perioperative data
Perioperative Data

Next step to work on debriefing

pews implementation
PEWS Implementation

Change 1: Document piloted and evaluated in A&E and Paediatric Assessment Unit (PAU). Found to conflict with Manchester Triage System.

Change 2: Frequent education sessions for medical and nursing staff looking at evidence base and practical uses.

Change 3: Implemented across RACH and Dr Gray’s Hospital Elgin.

Change 4: Compliance monitoring commenced in the Surgical Unit.

Change 5:Compliance monitoring now in PAU, Medical and Surgical Units.

next steps for pews
Next Steps For PEWS
  • Reprinting of PEWS charts to incorporate: -
        • Signature for ownership
        • Area to record actions and reviews
  • Review of compliance measuring to: -
        • Ensure usefulness of data
        • Ensure accurate use of measuring tool
objectives method of pvc audit
Objectives & Method of PVC Audit

Objectives

  • Identify the time and date of insertion
  • Measure the duration that PVC was in place
  • Document the rationale and reasons for insertion
  • Identify the reasons for accessing the PVC
  • Check dressings were intact and met agreed standards
  • Establish if PVC removed when there was extravasation or inflammation

Method

  • Pilot undertaken Feb 2010
  • Audit undertaken May 2010
  • 75 completed data collection forms returned
results
Results

Insertion Site

49%

29%

8%

5%

3%

4%

1%

PVC Inserted

49%

21%

15%

8%

5%

1%

results16
Results

Reason for Access

97% of inserted PVC were accessed

37%

38%

34%

29%

21%

16%

8%

< 72 hrs

Length of Time Inserted

No

Response

> 72 hrs

results17
Results

PVC Dressings

81% Intact

41% IV 3000

48% Tegaderm

1% Pink Elastoplast Tape

Resiting of PVC

  • Phlebitis scoring tool used with the questionnaire
  • 11% (8) resited
    • 3 cases of extravasation
    • 4 cases of dislodged PVC
    • 1 case removed by patient
action plan
Action Plan
  • Results shared locally at ward and with wider NHS Grampian
  • Presented at multidisciplinary audit meeting to facilitate discussion and gain agreement on our local plan for the Paediatric PVC Care bundles
  • Will be using PDSA approach and gathering local ward data but plan to repeat hospital wide audit next year
  • Share results with wider SPSP Paediatric community at LS7
next steps
Next Steps
  • PVC Bundle
  • Safety Briefing across Child Health
  • Debriefing element of perioperative work
  • Reliable system for inputting data and reporting