jane motley & annabel milonas - northern health - enhancing quality care: implementation of a 2...
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Jane Motley & Annabel Milonas presented this at the 2014 Managing the Deteriorating Patient Conference. The conference discussed the latest strategies to recognise and respond to the acute patient in clinical deterioration. You can find out more about next year's conference at http://bit.ly/1sjQubiTRANSCRIPT
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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
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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.
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DETERIORATION! “the act or process of becoming
worse!
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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
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The Way We Were View video
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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
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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
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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
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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
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The Chart
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The Chart
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Core Observation Recording
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Observation Chart Frequency of Monitoring Plan
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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
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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!
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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
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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/