Cumbria and Lancashire Abdominal Aortic Aneurysm Screening Programme CLAAASP ANNUAL ...

26 Pages·2016·1.3 MB·English

Cumbria and Lancashire Abdominal Aortic
Aneurysm Screening Programme
CLAAASP

ANNUAL REPORT
2014/2015
Prepared by Mrs S Clinton
Programme Coordinator / CST
1
CLAAASP ANNUAL REPORT 2014/2015

1. Foreword 3
2. Introduction 4
3. Contacts 5
4. Programme Background and Delivery
 Programme objectives 6
 Screening pathway
 Screening outcomes 7
8
 Staff

 Clinic venues
9
 Nurse clinics

5. Programme Performance
 Statistics and Data – Quality Standards and KPI 9
 Referrals 10
 Self – referral report 11

6. Quality Assurance
 CST report 12
 Datix 13
 MDT meetings 14

 Programme Board Meetings
15
 Training and Development

7. Customer Satisfaction
 Feedback survey 15
 DNA CQUIN 20

8. Communications and Publicity
 Promotion events 21
 Staff survey 22

9. Health Equity and Equality
 Nurse Report 22

SITES 24

10. Acknowledgements 26

11. References 26

2
Foreword
Mr Simon Hardy: Clinical Director

This is our second year of the aortic aneurysm screening programme in Cumbria
and Lancashire.
I am pleased to be able to report that we now have over 220 people in our on-going
surveillance programme. Furthermore, in this cohort, we have referred 6 people for
surgery in the arterial centres in our region.

The Screening Service is developing nicely. It has moved to new office premises at
the Preston Business Centre. In addition we have continued to develop our facilities
by providing new screening venues such as opening the service up at the Gillinggate
centre in Kendal. Staff too are an important part of our service and I would
particularly like to welcome our new nurse practitioner Carole Williams and admin
co-ordinator Chaya Reddy.

Finally, I’d like to thank our programme coordinator Susan Clinton for all her valuable
hard work in ensuring that the programme continues to meet the high standards we
set in our 1st year as we screened the 10,000 men from Cumbria and Lancashire this
year. We can look forward to this coming year with confidence in the service we
provide.

3
Introduction
Mrs Susan Clinton: Programme Coordinator / CST
I am very pleased to present the second Annual Report for the Cumbria and
Lancashire AAA Screening Programme {CLAAASP}
The programme covers a large geographical and often remote area offering
challenges for coordination and planning, particularly in winter months, but despite
these challenges the team have delivered a high quality and successful service.
This report looks back over the 2014-15 cohort and highlights our achievements in
our second year of screening.
It gives us an opportunity to reflect on our outcomes and achievements thus enabling
us to further develop and improve.
Highlights for the programme during 2014-15 included:
 Successful reaccreditation of screening technicians at Salford University

 2 screening technicians moving into new careers as trainee vascular
scientists

 100% of cohort with an initial offer of a scan, >75% with a conclusive test

 Over 1100 self-referrals

 Appointment of a new nurse practitioner who has taken the lead in promoting
the service and in establishing links with GPs to try and improve on our
uptake even further

 Appointment of an administration co-ordinator to assist the coordinator in
Preston – the main admin team are based in Gateshead so having a local
team has helped in the smooth running of the service

 Involvement in local screening service promotion events

 Moving into new premises at Preston Business Centre

 Excellent feedback from the annual client satisfaction survey

4
Programme Contacts:
Administration at Queen Elizabeth Hospital, Gateshead, NE9 6SX
0191 445 2554
Email: [email protected]
Local programme office
Preston Business Centre
Watling Street Road
Preston
PR2 8DY
01772 214407
Clinical Director: Mr Simon Hardy
Consultant Vascular Surgeon, Royal Blackburn Hospital

Programme Manager: Mrs Jeanette Bowes
Service Line Manager for AAA, Breast and Bowel Screening Services,
Queen Elizabeth Hospital

Programme Coordinator / CST: Mrs Susan Clinton
Preston Business Centre

Screening Nurse Practitioner: Mrs Carole Williams
Preston Business Centre

Admin Coordinator: Chaya Reddy
Preston Business Centre

Screening Technicians:
Rachel Johnson, Julie Kellett, Diane McKay, Joy McMahon, Carl Nightingale, Janet
Wignall, Alison Wilks

Office Manager: Mrs Allison Wise
AAA, Breast and Bowel Screening Services, Queen Elizabeth Hospital

5
Programme Background and Delivery

Programme Objectives

The NHS AAA Screening Programme was introduced after research showed it
should reduce the number of deaths from ruptured aneurysms among men aged 65
and over by up to 50%.
The overall objectives set out by the National programme are to:
 Identify and invite eligible men for screening
 Provide clear, high quality information that is accessible to all
 Carry out high quality ultrasound on men attending for initial or follow-up
screening according to national protocol
 Identify abdominal aortic aneurysms accurately
 Minimise the adverse effects of screening, including anxiety and unnecessary
investigations
 Enable men to make an informed choice about the management of AAA
 Reduction of AAA-related mortality in the population of men aged 65 and over

Screening Pathway

Operating in line with the Standard Operating Procedures [SOPs] men in their 65th
year registered with a GP in Cumbria or Lancashire are identified by the AAA
National database and sent an appointment to attend a screening site local to them.
We have a team of 7 qualified screening technicians and 1 nurse practitioner [also
qualified to screen] who provide screening clinics in the community-based locations
[See page 24 for sites attended]

Men over 65 and not previously invited under the programme can refer themselves
and these are accommodated within the programme as per SOPs

Screening test and outcomes
 ID is checked
 The screening process and possible outcomes are outlined by the screening
technician and informed consent obtained before proceeding
 An ultrasound scan of the abdomen is performed
6
 The aorta is measured according to set criteria and the measurement of the
widest point is recorded
 The gentleman is informed of his result

The 5 possible outcomes are categorised as below
Normal – aorta is < 3cm
Most men have a normal result and currently will not be invited for AAA screening
again -discharged
Small aneurysm – aorta is between 3cm and 4.4cm
Men found to have a small aneurysm will be invited back for scans every 12 months
- surveillance.
Medium aneurysm – aorta is between 4.5cm and 5.cm
Men found to have a medium aneurysm will be invited back for scans every
3 months - surveillance
Large aneurysm – aorta is 5.5cm or above
Men found to have a large aneurysm are referred to a specialist vascular team, at
one of the three approved vascular centres in the programme area, to discuss
possible intervention – referral
Non-visualised
Occasionally it is not possible to visualise the aorta, due mainly to bowel gas or a
high BMI ratio. These men will be offered a re-screen and will be given an early
morning appointment in an attempt to reduce bowel gas. If after two appointments
the technicians are still unable to visualise the aorta the man is referred for medical
imaging.

The men identified with an aneurysm at their initial screening test will be given the
opportunity to speak to the Screening Nurse Practitioner (SNP) at a time convenient
for them.
The significance of the result and future management within the programme will be
discussed with the gentleman and the nurse will also offer advice aimed at trying to
slow down the growth of the aneurysm. This includes life style advice such as
smoking cessation, healthy diet and exercise regimes.
These men will also be seen by the SNP at the next screening appointment.
7
If an aorta measures 5.5cm or above a referral is made within 1 working day to one
of three approved vascular centres within the Cumbria and Lancashire region
 East Lancashire Hospital NHS Trust
 Lancashire Teaching Hospitals NHS Foundation Trust
 North Cumbria University Hospitals

If the AAA measures 7cm or greater an urgent referral is made. The vascular units
will endeavour to see the man in the next available Outpatient clinic.
The vascular centres have been assessed by the National Programme and the
Vascular Society of Great Britain and Ireland to be able to provide appropriate
surgical treatment for open and endovascular repair of abdominal aortic aneurysms.
All referrals should be seen within two weeks of the referral being made by the
Coordinator and if surgery is indicated following assessment this should be
completed within eight weeks of the date of the referral.
The performance of the vascular centres is measured against Quality Standards and
reported back to the National Office, Regional QA team and Programme Board.

Staff
There are seven part time screening technicians who run clinics throughout Cumbria
and Lancashire on a daily basis.
The admin hub is based in the Queen Elizabeth Hospital in Gateshead.
The coordinator/CST, admin coordinator and nurse practitioner are based in Preston

Venues

Screening is carried out currently at 16 locations, utilising Health Centres and
Community Hospitals.

The programme is continually trying to identify new clinic locations to ensure that
screening is provided as locally as possible, particularly in areas where the uptake
rates are below the programme or national average.

8
Nurse clinics

All men identified with an aneurysm at their initial screening test will be given the
opportunity to speak to the nurse practitioner. A telephone appointment is made for
the man before he leaves clinic.

The significance of the result and future management within the programme will be
discussed with the man and the nurse will offer advice aimed at trying to slow down
the growth of the aneurysm. This will include life style advice such as smoking
cessation, healthy diet and exercise regimes.
Men under surveillance will then be seen by the nurse at his next screening
appointment.

Programme Performance

Statistics and Data – Quality Standards and KPI

In cohort data taken from SMaRT database total subjects 12137
01/01/2014-30/4/2015
Service Spec Report Count Percentage
Subjects with insufficient contact details to make an offer 34 0.3%
Subjects offered screening who are tested 9024 74.4%
Measurement of <3.0cm and discharged 8916 98.8%
Measurement of 3.0-4.4cm 93 1%
Measurement of 4.5-5.4cm 6 0.1%
Measurement of 5.5cm or greater referred to Vascular Surgeon 5 0.1%

Self-referral data taken from SMaRT database total subjects 1165
01/04/2014-31/03/2015
Service Spec Report Count Percentage
Subjects offered screening who are tested 1126 96.7%
Measurement of <3.0cm and discharged 1105 98.1%
Measurement of 3.0-4.4cm 18 1.6%
Measurement of 4.5-5.4cm 2 0.2%

9
Performance against the KPI is provided by NAAASP on a quarterly basis.

AA1: Completeness of offer

Current Provider Eligible Eligible Subjects % Eligible Subjects
Subjects Offered Appt with Offered Appt with
date <= end Q4 date <= end of Q4
CML Cumbria & Lancashire AAA Screening Cohort 12013 12010 99.98%
England 294368 286535 97.34%

KPI figures for Quarter 4 (April to March) 2014/15

Referrals
There were 6 referrals made during 2014-15
All referrals were made within 1 working day and were seen at one of the three
validated vascular units

Quality Standards: Referrals Q1-Q4 2014-15
Report run 14/04/2015

Complete
Cohort
Numerator Denominator %
5.3 Subjects referred within one day 6 6 100.00%
6.1 Appropriate referrals 6 6 100.00%
7.1 a Referrals with a specialist assessment within 2 weeks 6 6 100.00%
7.1 b Referrals with a specialist assessment within 8 weeks 6 6 100.00%
7.1 c Referrals operated on within 8 weeks 3 6 50.00%

10