ED Safety Checklist Masterclass Presentation
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The full presentation from the first ED Safety Checklist Masterclass hosted by the West of England Academic Health Science Network
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ED Safety Checklist Masterclass Presentation
- 1. ED Safety Checklist Masterclass Monday 25th April 2016
- 2. Welcome & Introduction Deborah Evans, Managing Director, West of England AHSN
- 3. The West of England Academic Health Science Network We are delivering positive healthcare outcomes by • driving the development and adoption of innovation • supporting the adoption and spread of evidence-informed practice • and making a meaningful contribution to the economy.
- 4. The West of England Academic Health Science Network
- 5. Academic Health Science Networks As the only bodies that connect NHS and academic organisations, the third sector and industry, we are catalysts that create the right conditions to facilitate change across whole health and social care economies, with a clear focus on improving outcomes for citizens.
- 6. Academic Health Science Networks
- 7. Academic Health Science Networks
- 8. Academic Health Science Networks
- 9. The ED Safety Checklist The Why! Dr Emma Redfern, ED Consultant University Hospitals Bristol
- 10. The Problem Patient safety in the urgent care environment, particularly at handover and during crowding Delays in recognition and treatment of severe illness and deterioration A staffing crisis and reliance on agency staff. Human factors in urgent care
- 12. Where’s Wally?
- 13. Safer Transfers of Care
- 14. There’s Wally!
- 15. The ED Safety Checklist The What! Alex Hastie & Caroline Clark ED Safety Checklist Project Nurses University Hospitals Bristol
- 16. PDSA Cycles The PDSA cycle is shorthand for testing a change by developing a plan to test the change (Plan), carrying out the test (Do), observing and learning from the consequences (Study), and determining what modifications should be made to the test (Act).
- 17. • A comprehensive list of essential components of care, prioritised according to required completion time • Incorporating elements to improve not only safety but patient experience through their ED journey. • A multidisciplinary tool to provide safe, timely emergency care What is the ED Safety Checklist?
- 18. • Feedback from ED Team • Review of Clinical Incidents • Review of complaints • Inclusion of information from nursing indicators How was it conceived?
- 19. • Focused on hourly themes Vital signs, NEWS, pain scoring • Frontloading of investigations • Promotion of care pathways • Early identification of required referrals onto specialist teams What does it comprise of?
- 20. • Checklist pilot trial • Checklist roll out • Reformation of ED Safety Checklist Team • Collection of multi-sourced feedback How was it implemented?
- 21. • Fluctuating enthusiasm from a large team • Timing • Correlation between checklist uptake and department acuity • Varying attitudes from different staff groups • Data collection What problems did we face?
- 22. • Length of Stay • Outliers • ED Targets – 4 hour breaches, nurse indicators • Mortality • Clinical Incidents • Patient Experience How did we measure our success?
- 23. • Introduction of CQuin • Staff group specific, multi source feedback • Shop floor champions • Senior support • SWAS involvement • Continued indicator audit • Shift from monthly to daily uptake auditing How did we maintain our results?
- 24. Within the Department Business as normal Continued auditing Shop floor champion Outside the Department Collaboration between other trusts National dissemination What next for the project?
- 25. • Structured introduction • Designated team • Specific staff group engagement • Multidisciplinary involvement • Shopfloor champions • Daily and monthly auditing • Set targets What have we learnt?
- 26. The ED Safety Checklist The How! Ellie Wetz, Patient Safety Improvement Lead West of England AHSN
- 27. The ED Safety Checklist Toolkit • Developed to support the implementation of the ED Safety Checklist at adopting trusts. • Guidance not mandate!
- 28. The ED Safety Checklist Toolkit Toolkit Structure: 1. About the ED Safety Checklist 2. Form your team 3. Organise your ED 4. Agree your measures Appendixes
- 29. The ED Safety Checklist Toolkit 1. About the ED Safety Checklist • Local Fields • Baseline Data • Comprehensive review of ED clinical incidents • ‘Best Practice’ Fields • Vital signs taken and NEWScore calculated regularly • Front loading of investigations i.e. imaging, bloods
- 30. The ED Safety Checklist Toolkit • PDSA • Helps teams plan • Test on small scale • Review • What works? What doesn’t? • QI Toolkit http://www.weahsn.net/ what-we-do/skills-knowledge- development/improvement-resources-and-tools/the- improvement-journey/
- 31. The ED Safety Checklist Toolkit Project Logic Model • Inputs • Activities • Outputs • Outcomes • Impact
- 32. The ED Safety Checklist Toolkit 2. Form your team • Local Implementation Team (LIT) • Existing ED Staff • Lead Nurse • Lead Consultant • Audit Coordination Nurse/Data Analyst • Other key stakeholders
- 33. The ED Safety Checklist Toolkit • LIT fortnightly meetings • Agenda • Project documentation • Risk & Issue Log
- 34. The ED Safety Checklist Toolkit 3. Organise your ED • How will you print, store and restock the ED Safety Checklist? • ED Safety Checklist Training • Real-time feedback • NEWS Training
- 35. The ED Safety Checklist Toolkit 4. Agree your measures • How do we know a patient safety intervention has a positive impact? We measure it! • Baselining • KPI’s & Dashboards • Life System Platform • Evaluation
- 36. The ED Safety Checklist Toolkit Appendixes • ED Safety Checklist http://www.weahsn.net/what-we-do/enhancing-patient-safety/ • SHINE 2014 Final Report • QI Resources http://www.weashn.net/what-we-do/skills-knowledge- development/improvement-resources-and-tools/the-improvement- journey/ • Research Papers
- 37. Q & A General Discussion Chaired by Deborah Evans, Managing Director, West of England AHSN
- 39. The Interface with the Ambulance Trust Phil Cowburn Acute Care Medical Director South Western Ambulance Service NHS Foundation Trust Consultant in Emergency Medicine University Hospital Bristol
- 40. NEWS?
- 41. Emergency Department • Increased demand • “Winter Pressures” • Lack of discharges • Poor flow • Exit block • Crowding
- 42. Effects on Ambulance Service • Crews tied up • Hours lost • Poor performance • Delayed response times • Undifferentiated risk in community
- 43. Who’s Caring for Patients in the Queue?
- 44. Care of Queue ED at Bristol Royal Infirmary – University Hospitals Bristol NHS Foundation Trust – Adult only ED 2012 Retrospective review of ED notes and PCF 100 consecutive queuing patients over 2 week period
- 45. Care of Queue Patient care responsibility of ambulance Trust Clinical SOP requiring minimum 15 minute observations Increased frequency if clinically indicated
- 46. Care of Queue
- 47. Care of Queue
- 48. Care of Queue Number of Sets of Observations Compared to Time Queuing 0 5 10 15 20 25 30 <30 30-59 60-89 90-119 >=120 Time in Queue (minutes) NumberPatients 0 1 2 3 >=4
- 49. What was really happening in the Queue
- 50. Queue Events 6 CVE – Average age 76 – All queued > 75 minutes – No CT < 60 minutes 4 # NoF – Average age 87 – All queued > 90 minutes – No X-Ray < 60 minutes
- 51. Queue Events 4 Serious Incidents Missed MI – Deteriorated in queue, moved to resus, arrest, RIP OD self discharged – No capacity assessment or mental health matrix # dislocation ankle with critical skin – Queued 3 hours, reduction >6 hours post injury – Plastics referral
- 52. Who Owns this Risk?
- 53. Late Night Chat Acute Gold • We’re full • We’re not performing • Stop bringing patients • I need nurses and beds • We’re unsafe • We want a divert • We’re un-safer than you • We might close Just shut the doors and don’t let ‘em in Ambulance Gold • Everyone is full • We’re not performing • Start taking the patients • I need crews • We’re unsafe • No-one will take a divert • We’re un-safer than you • You can’t close Push ‘em through the doors and go
- 54. Risk Reduction Improve quality care Get basics right Work together Grassroots
- 55. ED & Queue Which patients are sick? Which patients are deteriorating? Which patients have time critical conditions ?
- 56. Birth of The ED Safety Checklist
- 57. Better NEWS
- 58. NEWS
- 59. How NEWS might help? Potential for ambulance service to – Prioritise HCPC calls – Assist on decision making to discharge – Define & communicate pre-alerts
- 60. Transforming Urgent and Emergency Care Service in England Safer, Faster, Better: Good Practice in delivering urgent and emergency care NHS England August 2015 “All adult patients should have a NEWS established at time of admission.” “Where patients experience long waits, their NEWS should be recorded, pain assessed and managed and essential care given.”
- 61. Ambulance Service Electronic Care System & ePCR
- 62. WEAHSN supported Roll out & incorporation of NEWS into ePCR Auto calculates ED can see all information Including NEWS Part of executive summary Aim to incorporate SHINE Checklist
- 63. Working Together Adoption and spread -safer transfers of care
- 64. Measuring the Impact of the ED Safety Checklist Kevin Hunter, Patient Safety Programme Manager, West of England AHSN
- 65. Baseline Data • Understanding your current standards of care • Case note review • Suggested 20 notes per month • 1 year of data • Performance against Key Performance Indicators • Data input sheet provided in Toolkit • Serious Incident Review • Common themes Inform local checklist & PDSA
- 67. Key Performance Indicators • Suggested 5% ED Safety Checklist audited per month (at UHB: 200 per month) • <50% complete – not valid • Basic clinical care • Pathways • Patient experience • Local KPIs to reflect local checklists
- 69. Key Performance Indicators 1. Red: <49% 2. Amber: 50% - 79% 3. Green: >80% 40.00% 50.00% 60.00% 70.00% 80.00% 90.00% 100.00% Pain scoring at triage and analgesia given Nov 13 - May 15 Pain - Pain score & triage Pain - Analgesia IntroductionofEDSafety Checklist
- 70. What is the ‘Life’ System? • A web based platform designed to assist front line staff running Quality and Safety improvement projects • It has been developed as part of the PSC in partnership by SeeData and South West AHSN • Regional subscription model – Free for our members to use • Supports team working and collaboration – an open and transparent culture • Ability to view projects on the system from across the country • Able to seek assistance and support from other users • Gives a regional overview of improvement activity
- 71. The Principles Life has been build by SeeData and South West AHSN on a set of principles that are designed to support continuous improvement: • All users agree that the information they add to the system can be viewed (with limitations able to be set) • The system is not designed to collect detailed information on users, organisations or patients • The system will make minimal use of mandatory fields to encourage flexible use • The information collected is only to support improvement and is never to be used for performance management
- 72. Login Page
- 73. Front Page – My Projects
- 75. All Projects
- 76. Project General Info Tab
- 77. Project Driver Diagram Tab
- 79. Project Change Ideas Tab
- 80. Project PDSA Tab
- 81. Project SPC Chart Tab
- 83. Connect Module - Discussions
- 84. Resources Module
- 86. Users List
- 91. Participating AHSN’s in ‘Life’: • West of England • South West • Wessex • Kent, Surrey and Sussex • UCLPartners • Oxford • West Midlands • East Midlands • Eastern • North West Coast.
- 92. Any questions then please see Kevin Hunter throughout the day or email kevin.hunter@weahsn.net To sign up for a user account: https://life.seedata.co.uk/login/ Further Information
- 93. The West of England ED Collaborative Dr Emma Redfern, ED Consultant University Hospitals Bristol
- 94. Participating Trusts • Weston Area Health Trust • North Bristol NHS Trust • Gloucestershire Hospitals NHS Foundation Trust • Great Western Hospital NHS Foundation Trust • Royal United Hospitals Bath NHS Foundation Trust • University Hospitals Bristol NHS Foundation Trust • South Western Ambulance Service NHS Foundation Trust
- 95. West of England AHSN Support • Implementation Toolkit • Financial Award • Band 7 Lead Nurse • 2 days per week for 6 months • 1 day per week for 12 months • Band 4 Data Manager • 1 day per week for 18 months • Conditional on: • Attendance at ED Collaborative Meetings • Submission of KPI Data
- 96. Lesson’s Learnt • Cultural ‘Buy In’ • Executive Teams • ED Medical & Nursing Leads • Local ‘ownership’ of the ED Safety Checklist is important • EDs are structured and staffed in different ways • Success is more likely if adopting Trusts plan their own implementation model
- 97. Interactive Session Chaired by Deborah Evans, Managing Director, West of England AHSN
- 98. Discussion: • Barriers • Challenges • The role of Patient Safety Collaboratives • What other support is needed?
- 99. Next Steps Dr Emma Redfern, ED Consultant University Hospitals Bristol
- 100. • Pledges • Can we form a nation-wide collaborative? • How shall we structure ourselves? • The role of Patient Safety Collaboratives • KPI Data • Life System
- 101. Summary & Close Deborah Evans, Managing Director, West of England AHSN
Notes de l'éditeur
- Patient story
- National relevance Clear demand Need to demonstrate it is transferrable at scale Duty to see if it works – full evaluation required Efficient and effective implementation Drug pharma analogy
- ED crowding is common and leads to delays in: Diagnosis recognition of acute deterioration Instigating correct treatment Can lead to serious clinical incidents Staffing crisis
- National relevance Clear demand Need to demonstrate it is transferrable at scale Duty to see if it works – full evaluation required Efficient and effective implementation Drug pharma analogy
- National relevance Clear demand Need to demonstrate it is transferrable at scale Duty to see if it works – full evaluation required Efficient and effective implementation Drug pharma analogy
- Life is a web platform designed to assist frontline NHS staff in running safety and quality improvement projects. It has been developed as part of the Patient Safety Collaborative in partnership by SeeData Ltd and the South West AHSN. Access to Life is being offered on a regional subscription basis through the AHSN network so they can manage the rollout to frontline staff in their regions. As well as providing individuals the functionality they need to run safety and quality improvement projects, it supports team working and collaboration helping to promote an open and transparent culture towards safety and improvement. As a national system users will be able to view projects from across the country and seek assistance and support from users anywhere in the country. Steering Group made up of AHSN staff for those subscribed to Life system.