Embed Size (px)
Citation preview
Patient Safety: Early Warning Score
Thursday 5 March 2015
WELCOME
@weahsn #earlywarningscore
Welcome & Introduction
Anne PullyblankClinical DirectorWest of England Academic Health Science Network
Colorectal Surgeon NBT
AHSN
A Network of Member Organisations
5 Community Health Services Providers
3 Universitie
s
2 Mental Health Trusts
6 Acute Trusts
1 Ambulanc
e Trust
7 Clinical
Commissioning Groups
How will the AHSN add value?
• Builds on safer Care South West• Collaborative• Across all health system• Add innovation
Wouldn’t it be good if all paperwork was the same?
standardisation
• Education and training• Staff move• Patients move• Communication
NEWS
Across the system
A Common Language
This morning
• The expertise is in the room• Others have done it• Reduce variation• Learn from the best• Innovate-SWAST EPR
This afternoon
• Break out groups• Help to make the plan
What Patient Safety can do for us
Tricia WoodheadAssociate Clinical DirectorWest of England Academic Health Science Network
Patient Safety
What can it do for us
professional, patient, society
First do No Harm
‘Medicine creates evidence as well as being evidence based’ (Berwick)
Three objectives-
1.the outcome
2.the experience
3.the cost
Measure and Monitor Patient Safety
Vincent 2013
Lining up the Potential for Harm
Triggering actionsLatent conditions Unsafe acts or omissions
SAFETY IS NO
ACCIDENT
‘We have to decide to be safe’
Patient Safety ?Is even more complicated
•Standardise the language we all use•All know what the numbers mean•Have safety designed into the journey for patients and professionals•Work together- •For the patient it is ONE SYSTEM
Learning from experience in Scotland
Colin CrookstonPatient Safety ManagerScottish Ambulance Service
@colin_crookston
• 5 million people• £12 billion• 14 Health Boards• 8 Support Boards• Integrated delivery• Moving towards social care
integration• National Ambulance Service
• Over 4,300 Staff ,five territorial divisions covering ALL health boards.
• 150 locations • 650 vehicles• Over 4,000 Air Ambulance
missions per annum • over 1000 volunteers
SPSP – Acute Adult 2008 - 2013
By 2012 SPSP Rescue had achieved traction:
•The outcome measure was crash calls •The focus was largely on the afferent response limb•There was emphasis on Rapid Response Teams•General Ward work included
– Early Warning Scoring– SBAR communications– Safety Briefs
Safety Essentials-Raising the bar
“The emphasis should now shift from testing and spread towards one of sustainable universal implementation which requires different approaches to ensuring and assuring the
continued provision of these interventions as standard work in all clinical areas”
Juran Trilogy
31Juran Trilogy
Early Warning Scores and Sepsis
Raising the bar in 2013 – Deteriorating Patient work stream
• Cardiac Arrest as a largely avoidable harm – a proxy for failed rescue and/or care planning in the general ward setting
• Count all cardiac arrests
• Aim for 50% reduction outside of ED/CCU/ICU
If each step is 80% reliable reliability for whole system is 0.84 = 41%
Rescue is a complex system requiring a sequence of events and interactions to occur reliably, linked by pivotal reliance on communication between and within teams.Only the final step adds value to the patient (or person)
Patient with Physiological DeclinePatient with Physiological Decline
Identification; Decision making and Actions
NEWS, Identification tools with ACP and early and effective
engagement with person and family,
Identification; Decision making and Actions
NEWS, Identification tools with ACP and early and effective
engagement with person and family,
Crucial Lynchpin
End of Life care
includingIntegrated end of life pathway
End of Life care
includingIntegrated end of life pathway
Structured person centred
response to clinical
deterioration
Structured person centred
response to clinical
deterioration
DNAR CPR decisions
Scottish Structured Response (SSR) to triggering patient•Forcing Function for Teamwork•Identifies Key Processes Required •Modification of successful rescue approaches used in Beth Israel Deaconess System and NHS Forth Valley•Require strong team safety culture
Script the Critical Moves
Our Challenge (or one of them)
• Methodology of SPSP has supported universal uptake of EWS – this is good news!
• However, we now have limited standardisation i.e. NEWS
• With the adoption of NEWS by SAS and peripatetic workforce we need to standardise
#AARLSsoutheast
Standardisation
Elevated NEWS is associated with increased levels of adverse outcomes.
Spread
• 4 boards (covering approx 50% of population have now implemented in acute care)
•SPSP actively encouraging further uptake via regular board assessments and clinical leads
•3 boards now planning implementation this year
Interactive Session:Mapping where we are with EWS
Early Warning Scores in the West of England
• Hospitals Wards
• GPs
• Out of Hours Services
• Emergency Departments
• Community Services Mixed
• Mental Health Services
Key Issues
• South West Ambulance Service Trust
• National Early Warning Score (NEWS)
• Situation – Background – Assessment – Recommendation (SBAR)
• Second Order issues e.g. simplifying NEWS
Workshops
Two journeys of introducing NEWS: Gloucestershire Hospitals and the
Royal United Hospital NHS FTs
Andrew Seaton, Director of Safety (Gloucestershire Hospitals)Julian Hunt, Consultant Nurse Critical Care, (Bath)
Anne Plaskitt, Senior Nurse Quality Improvement (Bath)
The Gloucestershire experience…
Timeline• 2001 to 2005 - Introduction of ‘GL EWS’ included
grading of physiological parameters• Progressive development from feedback/audit
• 2010 - Chart revised significantly taking considered best practice from systems already in place in UK
• This included a formal PDSA cycle over time• Small areas, constant feedback, frequent revisions• Final finished chart very similar to eventual NEWS chart• Included introduction of RSVP for use across Trust
• 2012 - Trustwide implementation of Unwell patient / Potentially Deteriorating Patient Plan
• 2013 - Trustwide implementation of NEWS (early adoption)
RSVP Communication Model
• Reason• Summary
• Vital Signs• Plan
Reason – immediately sets tone for what follows
Summary – Must be brief and relevant
Vital Signs – Only those of concern need to be mentioned
Plan – To discuss current plan or formulate a new one
• ‘UP form’• Developed in Oncology• Key areas trial• 2012 - Trustwide
implementation
Benefits • Knowledge it is best evidenced system• Good discriminator of mortality / DCC admission• Most standardised system across UK
• More sensitive - potential to miss fewer patients
• Recommendation for frequency of observations• Not increased resuscitation calls • Not increased ACRT workload unnecessarily• Supports clinical judgement & responsibility not just
‘nursing by numbers’
• Policy compliance - Improved observation recording– From 66% in 2013 to 87% in 2014
Problems• Oversensitivity - frequent alerts (e.g. Respiratory /
Cardiology), with potential for relaxed attitude
• Under sensitivity - especially Renal– Not all risk parameters for deterioration can be included
• Some inaccurate/under scoring (O2 / AVPU)
• Nursing by numbers - If NEWS normal they can’t be ill!• Response guidance principles - some people like to be
told what to do! • Policy compliance 40-55% (some auditor bias) - still
work to be done especially reverse of chart to avoid documented demise and poor escalation/response.
The Bath experience…
Context
• Have used EWS since 2003 – dated system not NICE compliant
• Pressure to migrate to NEWS
• Needed to assess whether Bath EWS and NEWS were essentially the same
• Planned introduction and continued implementation
Comparison of Bath local system and NEWS
• Correlation co-efficient of 0.82 (Spearman’s rho) NEWS/ BEWS
• Confirmation that Acute Kidney Injury and British Thoracic Society guidelines for oxygen administration are potentially problematic.
• Scoring feels rightRater Assessment of NEWS Clinical Response n=100
PDSA for NEWS
Cycle 1: Develop draft of chart with small working group, test on one ward, one nurse, one patient
Cycle 2: Consultation exercise with clinicians –collate initial feedback to inform design-working draft v1
Cycle 5: Limited print run, test for 2 weeks,3 wards
D
A PS
Cycle 7: Launch August 2014
SP
Cycle 6: Proof revised following test on 3 wards. More consultation
Cycle 4: Second consultation with clinicians - feedback to inform design – working draft v2+++
Cycle 3: Test sensitivity of NEWS compared to Bath EWS: inform design of training material
Vital Signs Care bundle
SNOOP stands for:
– Consider Sepsis
– Calculate NEWS
– Consider Oxygenation
– Consider Output of Urine
– Assess for Pain
Top Tips
• Test with enthusiasts for quick wins
• Engage doctors early
• Have most of the chart sorted before introduction, BUT leave obvious mistakes for people to discover and own
• Do not under-estimate implementation goes on for long after the introduction of the chart
• Consider moving to automated vital signs recording / data fusion models as the next step
Is this patient well?
SPCA Presentation
Single Point of Clinical Access and the booking of GP transport with
SWASFT.
Kym Wagstaff Team Manager SPCA06/03/15
Aims and Objectives
• AIM• To show that by embedding the NEWS score within SPCA’s transport
booking system it has become a valuable evidence based tool.
• OBJECTIVES• To give the background of SPCA service• The background of why we implemented the NEWS score• A review of the associated audits and results• Conclusion• The future
Background to presentation
•Current demand within the NHS means everyone is under extra pressure to perform, to reach targets and to provide ‘better’ care.
•As a service, SPCA works closely with other care service providers to ensure that we do provide the ‘best’ care for the patient in getting them to the right place at the right time.
•SWASFT completed an in-service audit of SPCA transport bookings within Winter pressures and its findings suggested that resource management of ambulances could be improved
•Little evidence or research based on the use of NEWS within pre-hospital settings – SPCA setting the standard within Gloucestershire.
Facts about Gloucestershire
• The population of Gloucestershire grew by 5.7% in the 10 years to 2011 (equivalent to 3,200 people a year).
• According to latest estimates from the Office of National Statistics the current population is around 602,000 (as of 2012); and is projected to reach 644,000 by 2021.
• The GP registered population in 2013 was 306, 925 males; and 313, 812 females covered by 87 surgeries.
• The rising trend of older people living alone is also likely to place extra pressure on care provision; with the number of over 65s living alone projected to rise to 41,000 by 2021.
Single Point of Clinical Access
SPCA
• SPCA (Single Point of Clinical Access) was established on 1 st March 2010 as part of GCS (Gloucester Care Services).
• Formal integration of 2 teams; UCRC (Urgent Care Referral Centre) and CMS (Capacity Management Service).
• Objectives of the service cover 2 areas; Capacity Management and Clinical Signposting through identified pathways.
Capacity Management
• Gives SPCA the ability to;
• Support real time capacity and demand throughout the Health and Social Care, Urgent and Emergency systems
• Maintain a live capacity management system• Facilitate timely and appropriate transfers from GHNHSFT and Out of
County acute trusts into Gloucestershire Community Hospitals and reablement beds.
Clinical Signposting through Identified Pathways
Clinical Signposting
• Improve the ability of health care professionals to refer patients to the most appropriate service to meet their (patients’) needs
• Provide a one-stop point of contact to plan an individuals care pathway in the most appropriate and cost efficient manner
• Provide consistent pathway co-ordination to identify relevant service needs
• Provide a consistent high level of clinical telephone triage by highly experienced Band 6 registered nurses to HCP’s in order to place the patient on the right pathway and facilitate the best outcome for the patient and the GP/HCP
• Liaise with other services in assessment, planning, delivery and evaluation of care
• Liaise with SWASFT (South West Ambulance Service Foundation Trust) to secure transport for patients following a clinical discussion with HCP.
Arranging Transport
• Within the current, agreed practice, the following response times have been identified and are used;
• 1 hour response
• 2 hour response GP currently dictates the response time.
• 3 hour response
• 4 hour response
• If a 999 response is required, the GP arranges this from the surgery
• SPCA clinician (at weekends) and administrator (weekdays) contact hub in SWASFT and arrange transport based on populated template in SPCA and standard questions from SWASFT.
SWASFT and SPCA
SWASFT Audit vs SPCA Audit
• SWASFT;
• Completed random sample of 32 calls over 2 month period in May and June 2014 of GP transport cases booked by SPCA.
• Paramedic practitioner looked at calls and processed clinical observations through NEWS system.
• Comparison then conducted of the requested priority (transport) and the clinical signs as indicated by NEWS.
SWASFT Results…NEWS scoreAssigned
At patient within 1 hour 1At patient within 4 hours 8At patient within 1 hour 7At patient within 2 hours 3At patient within 2 hours 3At patient within 2 hours 0At patient within 1 hour 0At patient within 1 hour 4At patient within 1 hour 0At patient within 4 hours 0At patient within 4 hours 2At patient within 1 hour 4At patient within 2 hours 11At patient within 1 hour 2At patient within 1 hour 5At patient within 2 hours 0At patient within 1 hour 3At patient within 1 hour 3At patient within 2 hours 7At patient within 4 hours 3At patient within 1 hour 1At patient within 1 hour 3At patient within 1 hour 1At patient within 1 hour 1At patient within 1 hour 0
Transport Response as requested by SPCA Here you can see the difference in the transport
request time against the assigned NEWS score as given by the clinical observations.
Conclusion: Improvements need to be made in theway ambulance resources are utilised.Could the use of NEWS assist crews in their decisionmaking when requesting ‘back ups’ on scene?
SPCA Audit
• Retrospective audit.
• Mirrored SWASFT audit in time – 2 month period from May and June 2014.
• Looked at bigger sample: 128 transport bookings Countywide, covering all localities within Gloucestershire
• These bookings then reviewed by a clinical practitioner and again clinical observations processed through NEWS system. A comparison of requested priority and clinical signs indicated by NEWS was then conducted.
SPCA Results…
Of the 128 transport bookings, a full set of clinical observations was recorded in just 12 cases (above).As with the SWASFT audit, there is a difference between the GP request for transport and the NEWS score assigned.
Conclusion
•Supported the idea that there was no real evidence based criteria for GP’s requesting the transport times through SPCA.
Changes to be made….
• ‘Quick’ fix solution:• Alterations were made to our template for transport bookings; this
included questions such as;• Can the patient make their own way ?• Does the patient have any relatives / friends who can take them?• Confirm that the patient definitely requires an ambulance?
• Longer term option:• Embedding the NEWS into our clinical referral and transport templates
How did we do this?
• Soft launch started in January 2015• Clinician led in SPCA – simply asking the question below when taking a
referral• Question of ‘has a NEWS score been conducted?’ embedded in to
question set for patient referral• Staff individually trained in NEWS –mandatory E-learning tool / booklet
for support now implemented in our induction program • If GP declines or hasn’t conducted NEWS, looking at capturing why • Matching the ‘clinical triggers’ from NEWS to the transport booking times
in SPCA
National Early Warning Score
PHYSIOLOGICAL PARAMETERS
3 2 1 0 1 2 3
Respiration Rate <8 9 to 11 12 to 20 21 to 24 >25
Oxygen Saturations <91 92 - 93 94 - 95 >96
Any Supplemental Oxygen
Yes No
Temperature <35.0 35.1 - 36.0 36.1 - 38.0 38.1 - 39.0 >39.1
Systolic BP <90 91 - 100 101 - 110 111 - 219 >220
Heart Rate <40 41 - 50 51 - 90 91 - 110 111 - 130 >131
Level of Consciousness A V,P or U
Clinical Response & Transport Request Times for SPCA
Clinical Indicators for NEWS Titrated transport times for SPCA
NEWS ScoreFrequency of Monitoring
identified by NEWSIdentified
Clinical Risk
Transport Response Time
for SPCAComments
1 to 4 minimum 4-6 hourly Low 4 hourConsider use of Non-Emergency
vehicle
5 or more or a score of 3 in one parameter
Increased frequency up to every hour
Medium 2 -3 hourClinical
experience to determine
7 or more Continuous High 1 hour Consider 999 and discuss with GP
Results for January…
•A further 84 bookings (19.2%) were asked for as 4 hour responses but has no NEWS score attached. However, none of these 84 bookings required a trained ambulance crew.•A potential 27% of bookings could have been considered for a non-emergency vehicle to transport patient
Total Transport Bookings 436 31% with NEWS Score
NEWS ScoreTransport Response
Time for SPCAAppropriately
booked transport
1 to 4 4 Hour 7.80%
5 or more / 3 in 1 parameter
2 or 3 Hour 8.20%
7 or more 1 Hour 15%
Results for February…
• A further 72 bookings (15.4%) were asked for as 4 hour responses but has no NEWS score attached. However, none of these 72 bookings required a trained crew as a response.
• A potential 20.6% of bookings could have been considered for a non-emergency vehicle to transport patient
Total Transport Bookings 469 27.5% with NEWS Score
NEWS ScoreTransport Response
Time for SPCAAppropriately
booked transport
1 to 4 4 Hour 5.20%
5 or more / 3 in 1 parameter
2 or 3 Hour 8.50%
7 or more 1 Hour 13.80%
Conclusion
• A positive start considering this was a ‘soft’ launch.
• Helped to reduce the number of ‘unnecessary’ ambulance bookings
• Highlighting the need for further research into the effectiveness of NEWS within this pre-hospital setting.
To the future….
• Still in its infancy with just 2 months of evidence – recognise these are small numbers at the moment
• Further investigation into non-emergency vehicles for transport• ?? Promote the use of NEWS through out the County • Continue to monitor within SPCA and build on our evidence base• Meet with SWASFT at end of April to share findings / discuss impact• Recommendation for SPCA – look at embedding a pain assessment tool
alongside NEWS for patients who score 1-4 but whose pain means that a 4 hour wait would be inappropriate – palliative care / muscular pain
• Constantly looking for opportunities to develop the service that we provide
• Feel free to contact us in 6 months for an update!!!!!
Contacts
•Single Point of Clinical Access, Edward Jenner Court, Brockworth, Gloucester
References
• The Journal of The Health Management Institute of Ireland July 2012
• Smith GB, Prytherch DR, Schmidt P et al. Hospital-wide physiological surveillance – a new approach to the early identification and management of the sick patient. Resuscitation 2006;71:19–28.
• National Institute for Health and Clinical Excellence. Acutely ill patients in hospital. Recognition of and response to acute illness in adults in hospital. NICE clinical guideline 50. London: NICE, 2007.
• Royal College of Physicians. Acute medical care: the right person, in the right setting – first time. London: RCP, 2007
References
• Patterson C,Maclean F, Bell C et al. Early warning systems in the UK: variation in content and implementation strategy has implications for a NHS early warning system. Clinical Medicine 2011;11(5):424–7.
• Smith GB, Prytherch DR, Schmidt P, Featherstone PI. A review, and performance evaluation, of single parameter ‘track and trigger’ systems. Resuscitation 2008;79:11–21.
• Gray, J.T., Challen, K., Oughton, L. (2010) Does the pandemic medical early warning score system correlate with disposition decisions made at patient contact by emergency care practitioners? EmergMed J. 27: 943-7
• Fullerton, J.N., Price, C.L., Silvey, N.E., Brace, S.J., Perkins, G.D. (2012) Is the Modified Early Warning Score (MEWS) superior to clinician judgement in detecting critical illness in the pre-hospital environment? Resuscitation. 83: 557-62
• Royal College of Physicians (2012) National Early Warning Scores (NEWS): Standardising the
assessment of acute-illness severity in the NHS. Report of a working party. London: RCP.
Recognising the deteriorating patient – implementing N.E.W.S
Louise Forrester
Lead Nurse, Nursing Projects
Sally Ashton
Clinical Continuous Improvement Lead.
A single Early Warning Score for the West of
England:5th March 2015
Context• Our organisation• NHS Patient Safety and Quality
Improvement Programme for Mental Health
• Methodology• Physical Health work stream• Data • Learning • Questions
Our Organisational Profile
• 2gether NHS Foundation Trust provides mental and social health care across Gloucestershire, South Gloucestershire and Herefordshire
• We serve around 582,600 people in Gloucestershire and 178,400 people across Herefordshire
• Members of staff are working across all age groups within inpatient, community, primary care and social care.
• Delivering existing clinical services based on individual need rather than age and IQ.
NHS Patient Safety and
Quality Improveme
nt Programme for Mental
Health
Commenced 2011/Revised 2013
Methodology
Measurement
Measurement
Physical health work streams
The N.E.W.S story• AIM - Reduce harm through early detection of clinical
deterioration and timely competent clinical response: 95%, or more, of patients who trigger a clinical alert receive an appropriate response.
• Aim is to embed NEWS into all in patient units across the Trust.
5 x older adult inpatient wards across Hereford & Gloucestershire.
Learning Disability units in Gloucestershire.
136 suite in Gloucestershire.
Recovery Units recently started using NEWS in both Gloucestershire and Herefordshire.
Adult inpatient wards have a plan to use NEWS in trust wide.
The story……2012
• 2012 • Directive to implement NEWS within the Trust.• Challenging!• “Spray and pray” approach not practice development
• Problematic and frustrating for clinicians……
……2013• Linked up with other trusts in South West – we were the
only MH Trust attempting this!• More structured approach through Driver diagram • Enabled us to identify where we were and what next.• Planned pilot using the PDSA cycle – test NEWS out on
one patient one shift with one nurse and grow from there.• Highlighted areas where change was needed to support
implementation eg, training, and data collection to know how we were doing.
• Standardised NEWS tool identified for use• Full set of 6 daily physical observations being completed
for older inpatients
….2014• Data collection becoming more robust – monthly audits for
measurement but still patchy• Simpler audit tool devised and tested – should help data!• NEWS training built into MERT and Clinical Skills training with
eLearning also available• PDSA of “lanyard card” – NEWS/SBARD prompt – funding to
implement this to support ongoing NEWS use• SBARD training being revisited in some areas• Full set of 6 weekly physical observations completed for younger
inpatients.• Full set of 6 daily physical observations completed for older adults.• Evidence of physical observations in care plans on RiO system • Trainers identified to support clinical teams in practice
Data Example – Completed physical observations.
Data Example – Trigger patients receiving an appropriate response
……2015 ….More work to be done…
• Scoring and triggering leading to an appropriate response which includes medics
• When a patient’s condition requires variation in score and trigger - to avoid an unnecessary response
• Clarity through communication – SBARD• Review of training support – March 2015• WEAHSN collaborating to identify a single EWS
supported by SBAR to improve patient safety as interfaces of care across the patch – event March 2015
• Benefits to our service users completing their own physical observations – how might we do this?
“ I just got this information through – I’ll look into it, but it looks like a great example of how NEWS is working!”
Hurrah!
Patient attended clinic for her medication. Physical observations taken at approx. 10:00 hours. Resps 24pm, Sats 91% 02, HR 115bpm, BP 120/72 temp 37.3 Total NEWS score 7. Patient returned to rest on bed, made comfortable in bed, fluids encouraged, patient alert and responsive observed to be coughing a lot. Informed staff grade doctor at about 11:00. He arrived and reviewed patient at about 11:20-impression chest infection.
Learning and themes• Model for Improvement has helped get away from Spray and Pray
approach, and creates local ownership• Variations in practice have been identified.• Measurement is becoming more robust over time – data shows that
MERT calls have reduced at one site since NEWS implementation. • Big cultural/attitudinal shift were physical health is aligned with
mental health – some resistance but changing• More inpatients are having physical health observations completed
and recorded • Training and practice development supports are critical to
implementation and embedding into everyday practice.
Our colleagues: How was it for you?
Describe your role
What has been your story in implementing NEWS?
The challenges and benefits have been……..
Describe what you have learnt along the journey.
Thank you for listening to our story
~Any
Questions?
Human Factors training in communication, team working and
leadership for Support Staff
Sirona Karen Gleave
Jane Hadfield [email protected]
Adults learning at work - lessons
A way to promote behavioural change is to engage people in active learning right from the outset. Adults attending lectures, presentations, and discussions—i.e., learning by listening— typically retain just 10 percent of the material after 3 months.
Learning by doing—taking part in role plays and simulations and practicing techniques in a model setting—boosts retention rates to 65%. When people are then supported to put what they have learned into practice in their workplace, retention can approach 100%. (McKinsey).
Human Factors - aims The overarching aim is to ensure that support staff are enabled to help create and work in environments that optimise their ability to deliver safe, quality, patient care.
The core training is based on how teams communicate and use communication tools such as SBAR. This tool is widely used by organisations in health, and increasingly in social care and is also used by our primary partner universities, so there is baseline awareness which can be built upon in the training using realistic scenarios.
The key to this is not only competence and skills based training but also a focus on ‘non-technical’ or softer skills – Human Factors - Teamwork, Communication and Leadership.
‘Non Technical’ HF?
Teamwork – ensuring that a team understands it purpose, has the skills and abilities to perform its duties, and has the support to do so
Communication – that’s people can communicate with
each other without misinterpretation, that they can act to promote excellent communication using standard approaches whatever their role
Leadership – that provides support and engagement for the team to achieve the goals of the organisation
Human Factors training to support (N)EWS
Further work is required in developing tools such as SBAR and (N)EWS to compliment each other in practice.
Focus on support workers to develop their awareness and understanding and in supporting them in raising concerns/questioning practice.
Developing scenarios and methods to deliver awareness training in different settings – hospital, community, clients own home.
Sirona – our pilot site Virtual Wards - Specific piece of work with Admin staff and GP
receptionists which will develop into a programme for front of house staff in using Communications cascade tools such as SBAR.
Supervisors - training in Sirona to include piggybacking onto other current activities and meetings, aimed at building on current knowledge.
Alignment - Sirona is also a pilot site for the Cavendish Certificate, mapped human factors into the national syllabus and operational plans include HF programme in induction.
NBT Mapped the work into the ‘Foundation in Care programme’ – the
forerunner of the Cavendish Certificate, which is to launch next month.
Programme will build on their welcome and induction programme, core skills in delivering personal care, and the introduction to caring for patients with complex needs, developing insight and understanding into Human Factors, safety, communication skills and working in a team/raising concerns.
The Foundation programme (Cavendish) dovetails with their onward development and Apprenticeship / Diploma.
Some other things we’re working on
Faculty development - sourcing the trainer skills to assist in the programme delivery, by recruiting an experienced
Senior Nurse (ex NBT) who is working in Sirona.We are working to establish how we might develop the faculty to deliver non-technical human factors training at this level as this aspect of the
project will need to be developed further to effect a broader programme roll out.
Preparation for the launch of the Cavendish Certificate following national field work and launch of the Health
Education England Talent for Care strategy
Evaluation and further planning The feedback will be based on qualitative feedback -
what impact they think the training has had on their role? Does it enhance their ability to their job, Does it increase confidence? How often are they using the new skills?
Measure impact and reach by identifying attendance of and training the target group.
Influence programme content and share best practice based on outcomes.
What next?
Influencing –
With our regional and national links, (with Health Education England on the new Talent for Care Strategy, and new Apprenticeship Frameworks, Vocational Education Networks), we will now be looking for ways to influence programme content by sharing this practice once it is implemented and tested/evaluated.
Key messages from pre-lunch workshops
Key messages
Workshop Issue
Change Management story 1. Use of NEWS2. Interpretation
NEWs in primary care 1. Recognise a valuable tool as a supporting mechanism to then clinician’s assessment
2. Common language
Using NEWs in Mental Health 1. Use within care homes/private settings2. Sell the initiative as a valuable tool
staff can see benefit from the outset
How NEWs can help in ED 1. Consistency2. EWS in ED is like a relay race, using the
patient as a baton.
Key messages
Workshop Issue
Human Factors training to support EWS
1. Empowerment & confidence – help find them find a voice
2. Use SBAR and HF training together will make NEWS happen from the frontline
NEWs and Sepsis 1. Escalation process & actions required needs to be clear and context specific.
2. By delivering EWS with a sepsis score we can improve outcomes
Break out session• How would we do this?• What are the challenges?• What are the early priorities?
Break Out Themes
Theme Room
Measurement – How do we know it will be successful? Acer Room
How can EWS follow the patient journey through hospital wards, departments and community services
Elm Room
Setting priorities and early wins Ash Room
Growing clinical and patient champions Sequoia 1a
EWS across the urgent care system Sycamore Room
System wide enablers Sequoia 2
Discussion Points
• What are the issues?
• What are we going to do?
Feedback
Break Out ThemesTheme Key message
Measurement – How do we know it will be successful?
1. Its hard & be clear with outcome2. Share the work we are doing to define the
measures & progress so it’s part of a community.
How can EWS follow the patient journey through hospital wards, departments and community services
1. Passport system (unsure how it will be updated)
Setting priorities and early wins 1. Agreement Trust boards – a single NEWS2. Standardise education package delivered
by AHSN
Growing clinical and patient champions 1. Make it easy – use a card/App2. Link it with Sepsis
EWS across the urgent care system 1. Snap shots will prioritise across urgent care system.
2. GPs are needed!
System wide enablers
Health Community session
• How do we get this working across our system?• What are the priorities?• How does this fit with other work?• How should workstreams be set up?
Discussion Points
• How do we get this working across our system?
• What are the priorities?
• How does it fit with other work?
• How should workstreams be set up?
Next Steps
Next Steps
• Report of event by 23 March
• First Project Team 12 March
• Mobilise Workstreams
• Follow up event Thursday 17 September (venue TBC)
THANK YOU
