mortality and harm reduction in welsh ambulance services nhs trust · insert name of presentation...
TRANSCRIPT
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Mortality and harm reduction in Welsh
Ambulance Services NHS Trust
25th November 2010
Welsh Ambulance Services NHS Trust
Introduction• First ambulance service in the world to take part in 1000
Lives Campaign
• Organisational commitment to reducing avoidable harm
• Development of an Ambulance Patient Safety Prompt Tool (APSPT) & other measures
• Interest expressed by New Zealand and Scottish Ambulance Services and University of Manchester
• Involvement with 1000 Lives continues to spread throughout Trust with Executive leads for each work area
Welsh Ambulance Services NHS Trust
Driver diagram
Reducing Harm and
Measuring Effectiveness
Utilise Ambulance
Patient Safety Prompt Tool
(APSPT)
Percutaneous Infusion
Pre Hospital Thrombolysis
Improve:
Pain scores
Peak Expiratory Flow
O2 administration
Target vehicle cleanliness
Spread structured handover via SBAR
Turnaround at A&E
Domestic abuse handover
Management of Acute
Coronary Syndrome
Improve Infection Control
Improve Clinical
Communication
Interventions
Leadership
Medicines Management Warfarin awareness
Green bag Campaign
Spread access to Naloxone
Walkrounds
Patient Stories
Reducing Falls in
Intermediate CareFalls Pathways
Management of ACS
(Acute Coronary Syndrome)
Percutaneous Infusion (PCI)
Where pathways exist, patients identified
as suitable are transferred directly for
PCI.
The Trust continues to collaborate with
Cardiac Networks and Health Boards in
the development of a primary PCI model.
Ambulance Patient Safety
Prompt Tool (ASPST)
• Data collected from 150 records/month per region (3) over 6
month period to identify top three triggers for potential harm.
Findings identified:
• 1. Pain: Complaints of pain in narrative but no pain score
recorded
• 2. PEFR: Salbutamol administered but no peak expiry flow
taken (PEFR)
• 3. O2: No oxygen therapy administered and: – Any significant trauma
– GCS below 15 or
– O2 sats below 94%
Welsh Ambulance Services NHS Trust
Welsh Ambulance Services NHS Trust
Baseline data showing
selected triggers x3
Pain PEFR O2
Welsh Ambulance Services NHS Trust
Implementing Changes (APSPT)
1. Pain – Encourage and educate staff to record pain scores through education (posters, pain management material on stations)
2. PEFR – Encourage and educate staff to take Peak Expiratory Flow (PEF) readings through education (annual CPD course)
3. O2 - Encourage and educate staff to administer oxygen, where clinically appropriate through education (annual CPD course)
Welsh Ambulance Services NHS Trust
Ambulance Patient Safety
Prompt Tool Audit Results
A random audit of 150 Patient Records per Region
(3) was undertaken following awareness/education
sessions. Over a 5 month period:
The recording of Pain Scores improved by 10%
The recording of PEFR readings improved by 33%
Oxygen administration rate remained unchanged.
Welsh Ambulance Services NHS Trust
Review Trigger Tool data collection strategy to ensure timely data collection
Encourage local ownership by identification of ‘Champions’ in each Region
Enhance spread throughout localities
Next steps
Welsh Ambulance Services NHS Trust
Improve Clinical Communication
- SBAR
• SBAR now a component of Paramedic CPD training
• SBAR prompt cards used by staff
• Snapshot audits of the utilisation of SBAR for handovers at identified Accident & Emergency Departments commenced. Findings shared with locality managers to inform practice
• Plans to introduce SBAR into telephone triage service within one clinical contact centre, PDSA developed and baseline data currently being collected. Plan to spread to all clinical contact centres.
Welsh Ambulance Services NHS Trust
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SBAR PROMPT CARD
Welsh Ambulance Services NHS Trust
Leadership
Target - Patient story presented at every Trust Board meeting: compliance with target 100%.
Patient Safety paper presented to each Trust Board Meeting.
Target – 2 Executive Walkrounds completed each month: compliance with target to October 2010 100%.
Welsh Ambulance Services NHS Trust
From 1st March – 1st June 2010 callers accessing the service with an information need or medicines enquiry, and identified as taking Warfarin, were offered written information regarding Warfarin and best practice (n = 13). A follow up questionnaire was sent to identify whether the information increased patients existing knowledge.
46% of respondents indicated that the Warfarin Information Sheet increased their existing knowledge.
Interest from health focus groups and GP’s suggested that the initiative should be widened within the Trust and also piloted within a General Practice.
Medicines Management
Warfarin Pilot
Welsh Ambulance Services NHS Trust
The Warfarin Information Sheet has been reviewed by the Trust’s Partners in Healthcare network readers panel and amendments made following feedback.
The information sheet has been sent to the all Wales Medicines Strategy Group for endorsement and the all Wales Prescribing Advisory Group for information.
Next Steps
Widen the inclusion criteria for all patients identified as taking Warfarin who contact the Trust.
Pilot the information sheet within an identified GP practice with support from the Community Health Council.
Medicines Management
Warfarin Pilot
Welsh Ambulance Services NHS Trust
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Welsh Ambulance Services NHS Trust
• Older people who fall account for approximately 10% of all 999
calls to the Welsh Ambulance Services NHS Trust
• Many patients transported to A&E are subsequently
discharged without further intervention
• There is a risk that patients managed at home, without referral
into a falls pathway, may re-access the Trust following
subsequent falls.
• The National Service Framework (NSF) for Older People and
evidence offered by the National Institute for Health and
Clinical Excellence (NICE) suggest that many of the elderly
fallers attended to by WAST should be referred to alternative
care pathways.
Reducing Falls in
Intermediate Care
Welsh Ambulance Services NHS Trust
Reducing Falls in
Intermediate Care
The Trust currently refers into Falls Referral Pathways in:
Anglesey Powys
Cardiff & Vale Wrexham
Carmarthenshire Swansea (from Dec2010)
Conwy & Denbighshire Anglesey (from Jan 2011)
Flintshire
Neath Port Talbot
A clinical audit of patient referrals into falls pathways is in
progress
Contact Information
Chris Powell
Nursing Practice & Clinical Practice
Lead/1000 Lives Plus Key Contact
Tel: 07872415430