jane motley & annabel milonas - northern health - enhancing quality care: implementation of a 2...

Northern Health Demographic

Australian Safety and Quality in Healthcare Commission recommendations 2012

Standard 9 working group

Implementation of a 2 –Tier Patient Escalation System and a Track and Trigger Observation Chart into an Acute Healthcare Setting: Impact on Care and Lessons Learned!

Annabel Milonas, Jane Motley, Narkita Van Ekeren Northern Health Victoria

About Northern Health a community of over 580,000 people

located in one of Melbourne's most significant growth corridors

local population is expected to grow by

64% or an additional 128,569 people by 2031.

5 campuses

primary, secondary and some tertiary services

emergency , intensive care, acute

medical, surgical, maternity services,

sub acute, palliative care and

aged care.

DETERIORATION! “the act or process of becoming

worse!

Northern Health Patient

What is the Best Practice Experience?

Committed team leader

Dedicated Standard 9

working committee

A robust 2 Tier Rapid Response Escalation

system

Track and Trigger

Observation Chart

Recording of 6 core

physiological observations Family

Escalation

Advanced Care

Planning /Consumer

Engagement

The Way We Were View video

Unpicking the Process PreMET escalation criteria not in existence, so no

escalation for abnormal observation

BP >200mg is a preMET escalation call

PreMET paged unit response within 15 minutes

No ability to modify abnormal parameters for a patient based on individual clinical state.

Must review modifications of patient escalation parameters within 72 hours

Unpicking the Process Patient has chest pain which was previously MET criteria Now preMET criteria and notification to nurse in charge Nurse records baseline observations (T, BP, HR) Nurse records 6 core physiological parameters Decides most likely heartburn. Individual clinical decision

making Discourages individual interpretation of observations Mylanta given to patient Nurse initiated care with no medical attention discouraged

Unpicking the Process

Nurse unclear which medical team to page

Workforce education mandatory for escalation process as part of staff induction

Medical review would have escalated care to MET call and Intensive Care clinicians if patient deteriorated further.

No clear documentation of process

Escalation event forms recorded for every escalation event

Unpicking the Process

No clear observation monitoring plan for patent

Frequency of observation monitoring plan introduced as part of observation track and trigger chart

No consistent or standardised data collection of this event

Riskman Q Escalation templates developed for all escalation events. Analysis and reporting capability

The Chart

The Chart

Core Observation Recording

Observation Chart Frequency of Monitoring Plan

Northern Health Escalation Calls Jan 2013-July 2014

57

108

199 194

270

245

284

243

300

400

467

371

421 442

537

85

121 116 136

188

153 147 153

186

147 150 127

117

148

173 169 162 181

210

16 12 16 11 21 25 20 18 28 19 13 15 11 19 27 25

12 25

38

0

50

100

150

200

250

300

350

400

450

500

550

600

Jan-13 Feb-13

Mar-13

Apr-13 May-13

Jun-13 Jul-13 Aug-13

Sep-13

Oct-13 Nov-13

Dec-13

Jan-14 Feb-14

Mar-14

Apr-14 May-14

Jun-14 Jul-14

Nu

mb

er

of

Call T

ota

ls

Month

CLINICAL DETERIORATION CALLS

Pre MET

MET calls

Code Blue

Organisational wide rollout

Pre MET Trial commence

Engaging the right people

Appointing a leader with the ability to influence Identifying and

Escalating risks

Celebrating successes

Checking in with the commission

Delegation task that match skill sets

Our keys to success and lessons learnt!

Effective communication

Setting a clear vision

Regular monitoring

Sustainability!

The NH Deteriorating Patient in The Future

Timely management of clinical deterioration

Effective rapid response through analysis of data

Family escalation

Clinical Deterioration Education to workforce

Workforce feedback of individual performance

Enhanced response team skills

References Australian Commission on Safety and Quality in Health Care (ACSQHC) (2011), National Safety and Quality Health

Service Standards, ACSQHC, Sydney.

Australian Commission on Safety and Quality in Health Care(2010). National Consensus Statement: Essential Elements for Recognising and Responding to Clinical Deterioration. Sydney, ACSQHC.

http://www.safetyandquality.gov.au/

http://www.safetyandquality.gov.au/our-work/recognition-and-response-to-clinical-deterioration/

http://www.safetyandquality.gov.au/wp-content/uploads/2010/01/R2-ORC-April-2012.pdf

http://www.safetyandquality.gov.au/our-work/recognition-and-response-to-clinical-deterioration/observation-and-response-charts/