Welsh Ambulance Service NHS Trust PDF
Preview Welsh Ambulance Service NHS Trust
National Learning Session - 10th June 2011 Improving Care, Delivering Quality Reducing mortality & harm in Welsh Ambulance Services NHS Trust Insert name of presentation on Master Slide Reducing Mortality & Harm in the Welsh Ambulance Services NHS Trust • First ambulance service worldwide to be involved in 1000 Lives work • Driver diagram reviewed to reflect new collaborative work and maintenance areas • New focus on developing a Pre Hospital Early warning Scoring system through RRAILS • Infection Prevention & Control will focus improving infection control arrangements across the Trust • Improve survival rates for Acute Coronary Syndrome and Acute Stroke with rapid recognition of presenting conditions Welsh Ambulance Services NHS Trust Driver diagram Interventions RRAILS Develop and Implement a Pre Hospital Early Warning Scoring System Mortality & Harm Improve: Ambulance Patient Safety Pain scores Prompt Tool (APSPT) Peak Expiratory Flow O2 administration Asepsis/Peripheral venous cannula insertion Reducing Harm and Reducing Healthcare Improve rates of vehicle cleanliness Measuring Associated Infections IPC on all CPD programmes Effectiveness Spread structured handover via SBAR Improve Clinical Turnaround at A&E Communication Call taker to nurse SBAR handover Domestic abuse handover Leadership Patient Safety Executive WalkRounds Patient Stories Clinical Model in Control Centres Acute Stroke Care FAST for rapid identification of stroke Blood pressure and blood glucose obtained to eliminate stroke mimics Reducing Falls in the Introduce ROSIER PDSA with ABM East Community Falls Pathways Referrals by Paramedics and Nurses Welsh Ambulance Services NHS Trust RRAILS – Pre Hospital Early Warning Scoring (PhEWS) Tool • The use of an early warning system in the pre-hospital setting could benefit patients when there are capacity problems in accepting Emergency departments. The use of PhEWS will allow patients to be admitted on the basis of clinical priority rather than a ‘first come first served’ basis. • Pre hospital early warning score has been developed and desk top tested using 300 patient care records • Sickness within the team has delayed further progress • Next steps are to undertake a PDSA to test the tool in the live environment • The PDSA will commence within the next 2 months Welsh Ambulance Services NHS Trust Reducing HCAI • Focus over next 12 months zero tolerance to preventable HCAI’s, this will be delivered by: • Regional implementation of All Wales Dress Code guidance • Delivering CPD sessions on Standard IPC precautions to all frontline staff, commenced May 2011 • Introduction of ChloraPrep on all vehicles for skin asepsis • Monitoring compliance with - hand hygiene, aseptic non touch technique for invasive procedures, appropriate waste disposal, cleanliness of environment, appropriate cannulation • All job descriptions for staff who have direct patient care will include IPC responsibilities. Welsh Ambulance Services NHS Trust Reducing HCAI – Peripheral Venous Cannulation • Aim – to reduce unnecessary cannula insertion and where cannulation is necessary increase first attempt success • Circumstances in which intravenous cannula should be inserted are set out in the IHCD paramedic training manual • Review of 400 patient care records undertaken where pain scores of 4 or more were present • 54% of these patients (n=217) were cannulated and all were appropriate in line with cannulation guidelines • 88% of these (n=190) were successfully cannulated at the first attempt • Next steps – repeat data collection with random sample Welsh Ambulance Services NHS Trust Improve Clinical Communication - SBAR • SBAR introduced into telephone triage service within one clinical contact centre in January 2011. • SBAR used to frame the handover for high priority calls from call handlers to telephone triage nurses. • Aim – Timely relevant effective handover of clinical information • PDSA developed and baseline data collected. • Average handover time – 52 seconds prior to SBAR introduction and no evidence of SBAR use Welsh Ambulance Services NHS Trust SBAR • Plan – Staff information guide developed and awareness training provided to all call handlers on site. • Do – Go live date agreed and process introduced. • Study – Utilisation of SBAR during handover studied via call review process over 4 months February – May 2011. Results disappointing. • Act – Further awareness sessions and revision of supporting literature planned Welsh Ambulance Services NHS Trust SBAR evident in call handler handover process 60 50 40 30 % 20 10 0 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Welsh Ambulance Services NHS Trust SBAR PROMPT CARD Welsh Ambulance Services NHS Trust ............................................................................................................. .................................................................................. Insert
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