Velindre Cancer Centre

11th May 2010

Velindre Cancer Centre Our Aims

• To understand mortality in cancer patients and set appropriate measures

• To reduce harm in cancer patients within our care by 5%

Infection

Improve compliance with antimicrobial policy

Reduce incidence of UTI’s

Audit of antibiotic usage

Implement care bundle for UTI’s

To reduce harm by 5%

Medicines Management

VCC custom measures:To ensure that regular opioid analgesia is being administered as prescribedTo ensure the effectiveness of breakthrough pain reliefTo determine an early indicator of opiate toxicity in patients

To improve the incident and risk of thrombosis in cancer patients

Establish thrombosis group and partake in collaborative.Introduce LMWH to all appropriate inpatients

Continue with audit and analyse results.Develop action plan including education.Present at CPT meeting

Content Area Drivers Interventions

Improve General Care within inpatient areas

To reduce incident of pressure sores and falls

Tests of change

Spread Releasing time to care to remaining inpatient wards

On To continue with Oncology Trigger Tool audits

Spread OGTT to other Oncology Centres

Measurement

To develop a trigger tool for oncology ambulatory/day care treatment settings

Undertake case note review of 50 patients to establish triggers

Implement skin bundle and risk assessments

Spread regular review processes to all wards

To implement systems for mortality case note reviews

Chemotherapy / Cytotoxic Drugs

To audit patient deaths within 30 days of commencing chemo

Spread Sepsis 6 and care bundle approach to all ward areas

RRAILS

To reduce mortality by ?

To analyse cancer survival outcomes by tumour or sub-tumour site

To investigate the use of HSMR in an oncology treatment setting

Measurement

Content Area Drivers Interventions Tests of change

Arrange workshop with relevant parties to explore further.Review VCC coding practice for palliative care

All Clinical Process Teams to agree one survival measure for tumour group

Develop and implement action plan sharing results with other centres to promote learning across boundaries

Spread education sessions and lessons through Critical Care Lead

Our Content Areas• Measurement• Medicines Management• Care of Inpatients including rapid

response to acute illness • Infection Control• Harm from chemotherapy

MEASUREMENT Harm

Oncology Global Trigger Tool

• 15 months of Data• Downward trend

noticed over recent months

• Next steps: Share tool with other Cancer Centres and Local Health boards

Adverse event rate per 1000 patient daysVelindre Cancer Centre

0.020.040.060.080.0

100.0120.0140.0160.0180.0200.0

Sep-

08

Oct

-08

Nov

-08

Dec

-08

Jan-

09

Feb-

09

Mar

-09

Apr-

09

May

-09

Jun-

09

Jul-0

9

Aug-

09

Sep-

09

Oct

-09

Nov

-09

Dec

-09

Jan-

10

Rat

e

Values Average (103.3)

Fig 1. showing VCC’s average Adverse event rate at 103.3

MEASUREMENT Harm

Development of Trigger Tool for Oncology Daycase Treatments

Current assessment methods for daycase related harm include:

• Incident reporting • SCIF

Events by moduleVelindre Cancer Centre from Sep 08 to Jan 10

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O G L M I

Module codeN

umbe

r

Fig 2. shows a breakdown of events identified by module. The modified tool including specific Oncology triggers (module O) has allowed VCC to see a true reflection of the harm caused to oncology patients. We now want to emulate this for the daycase patients.

MEASUREMENT Mortality• To investigate the use of HSMR in an oncology

treatment setting review VCC coding practice for palliative care

• To analyse cancer survival outcomes by tumour or sub-tumour site

All Clinical Process Teams to agree one survival measure for tumour group

• To implement systems for mortality case note reviews

To establish a system for regular mortality reviews

MEDICINES MANAGEMENT• Identifying measures appropriate

for improvement in a Cancer Centre Pain Control measures include:

1. Ensuring that regular opioid analgesia is being administered as prescribed2. Effectiveness of breakthrough pain relief3. Determining an early indicator of opiate toxicity in patients

Early indications of opiate toxicity in patients

• Baseline data on number of patients affected by opioid toxicity • 57 patients were identified as having received opiate

medication during the month of September 2009.• Notes were obtained for 43 patients.• 9 patients were identified as being highly likely or definitely

opiate toxic by 1 or more investigators.• The notes were then assessed for chronological and clinical

data from the notes/drug charts/ISCO as to the sequence of events.

• Thus approximately 20% of patients have had signs of opioid toxicity during the data collection period. Although this figure will not reach zero, it is considered too high.

• Palliative care and Pharmacy have discussed and a preliminary action plan developed

• Adaptation of the National Sepsis Six Screening tool for Oncology

• Standardised patient care with the Survive sepsis care pathway

• Introducing MEWS chart

Future Plans • Ensure sustainability• Fully embed use of Sepsis Screening

tool and pathway within the chemotherapy ward

• Roll out to other inpatient ward areas in Velindre Cancer Centre

Rapid Response to Acute Illness

Rapid Response to Acute Illness

• Lessons Learnt• Start small and use the PDSA

methodology to test change• Involvement of a wider

multidisciplinary team to develop documentation

• Involving clinical champions has been an essential element of implementing change and embedding a new culture at ward level.

• The need for a comprehensive evaluation mechanism at the beginning of the project.

• The need for ongoing communication of information to all stakeholders.

April Anaysis of Chart Checker data

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Documentation Observationrecordings

Use of EWS 24 hour balance Referrals Patient Weight%

co

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Apr week 1

Apr week 2

Apr week 3

Apr week 4

Above: results from April’s chart checker audit completed on the pilot ward.

INFECTIONSContinue with successful interventions like the Hand Hygiene audits on all wards.

Results displayed for staff and patients in ward areas and in main hospital entrance promoting an open and honest approach to reducing hospital acquired infections.

Use of “days between” safety cross on all wards

Praise for Hand Hygiene champions and successful awareness days

Right: data from October 08 to March 10

Infection – focus for 1000 Lives plus• To continue with existing measures• Improve compliance with antibiotic

prescribing policy Custom measures now added to the extranet and data collected from May 10

• Reduce incidence of UTI’s

LEADERSHIPPatient Involvement • Patient Chair, Lesley Radley not

only chairs Velindre’s 1000 Lives Project Board but also our Patient Liaison Group. Lesley provides an invaluable patient opinion to all areas of Velindre’s 1000 Lives work.

• Develop patient involvement with all aspects of the 5 year programme

PATIENT STORIESDevelop the current patient story

work to include: • Regular training sessions for

Velindre staff• Patient and Staff stories used

proactively throughout the organisation

• Support a centralised all Wales story depository

Reducing Surgical Complications

Successful implementation of the WHO safer Surgery Checklist

Above: The Velindre surgical team

Right: achieving 100% compliance with the WHO checklist

Contact LeadsInterim Chief Executive Alun Lloyd

Ex Dir Nursing Diane Smith

Medical Director Peter Barrett-Lee

Chairman Ian Kelsall

Director of Cancer Services Andrea Hague

Patient Chair Lesley Radley

Director of Operations Lisa Miller

Patient Safety Coordinator Debbie Bainbridge

Critical Care Nurse Ceri Stubbs

Senior Infection Control Nurse Gail Lusardi

Chief Pharmacist Bethan Tranter

Clinical Change Facilitator Carol Jordan

Project Officer Helen Jolley

CELEBRATING SUCCESS!

“Velindre Cancer Centre has been a committed organisation within the 1000 Lives Campaign from the start. You have developed a good structure to deliver the quality and safety including strong leadership in all content areas”

Dr Jonathon Gray, organisational briefing April 2010