We are driving work around four national priorities, including leading the national delivery of COPD and ELC:
- Chronic Obstructive Pulmonary Disease (COPD) care bundle – the care bundle describes six high impact actions to ensure the best clinical outcomes for patients admitted with Chronic Obstructive Pulmonary Disease.
- Emergency Laparotomy care bundle – improve standards of care for patients undergoing emergency laparotomy surgery, reduce mortality rates, complications and hospital length of stay, while encouraging a culture of collaboration and embedding QI skills to ensure sustainability of change.
- PReCePT – helping to reduce cerebral palsy in babies through the increased antenatal administration of magnesium sulphate (MgSO4) to mothers during preterm labour. For every 37 women in preterm labour that receive the £1 individual dose of MgSO4, a baby born with cerebral palsy is prevented. With the project in its second year, we expect to reach and sustain a >85% uptake of eligible women over the year.
- Emergency department safety checklist – the checklist helps to standardise and improve the delivery of basic care, including the assessment of vital signs and level of pain in the first hour of admission in emergency departments, leading to escalation of concerns in a timely manner.
KSS Patient Safety Improvement Programme (PSIP) is leading the national roll out of the Chronic Obstructive Pulmonary Disease (COPD) care bundle. COPD admissions account for around 45,000 bed days per year in KSS hospitals, and in 2014 the KSS AHSN Respiratory Network recognised that there was room for improvement in care of hospitalised COPD patients.
It worked on a programme to increase the number of patients receiving a discharge care bundle, with the main change to practice being a way for acute respiratory teams to identify patients admitted with Acute Exacerbation of COPD and pro-actively deliver the elements of the discharge bundle.
The bundle is made up of six elements:
- Inhaler technique checked and corrected if necessary
- Patient provided with written information and action plan
- Prescribed ‘Rescue Pack’ on discharge
- Referred to smoking cessation if appropriate
- Assessed for, and referred for, pulmonary rehabilitation
- Appropriate follow-up arranged.
KSS PSIP is supporting the spread and adoption of the care bundle for COPD patients across England.
Find out more about the work of the KSS AHSN Respiratory Network.
COPD DISCHARGE CARE BUNDLE DASHBOARD
As part of the National Patient Safety Improvement Programme’s COPD Discharge Bundle adoption and spread work, this dashboard aims to support effective delivery of the COPD Discharge Care Bundle.
This work supports improvement in the care of hospitalised COPD patients, reducing variation and ultimately improving patient safety and care on discharge. The dashboard provides insight into discharge care bundle delivery.
Emergency Laparotomy (EL) is a major surgical procedure, with 30,000 to 50,000 performed every year in the UK. However, around 15% of patients are reported to die within 30 days of surgery. Over 25% of patients remain in hospital for more than 20 days after surgery, costing the NHS over £200m a year.
KSS PSIP is leading the national roll out of the EL care bundle approach, which includes the involvement of consultant surgeons, anaesthetists and intensivists from the time of the patient presenting to hospital, throughout the patient’s time in the operating theatre and beyond. The bundle elements are:
1. Use of an Early Warning Score (EWS) or lactate to identify patients most at risk for deterioration and the delivery of prompt resuscitation for these patients
2. Use of a sepsis screening tool to identify septic patients and treatment with Sepsis Six
3. Definitive surgery within six hours of decision to operate for patients categorised as Level 1 and 2a in urgency
4. Appropriate dynamic fluid resuscitation and optimisation using goal-directed fluid therapy
5. Postoperative critical care (Level 2 or 3) for all patients
6. Consultant delivered care throughout the perioperative journey.
The care bundle was developed by the Emergency Laparotomy Collaborative (ELC) – go here to find out more about the ELC and its work.
PRevention of Cerebral Palsy in Pre-Term Labour (PReCePT) was developed by the West of England AHSN in collaboration with University Hospitals Bristol NHS Foundation Trust, and involved both patients and staff. This evidence-based, cost-effective project was designed to help reduce cerebral palsy in babies through the increased antenatal administration of magnesium sulphate (MgSO4) to mothers during preterm labour, costing from £1 per individual dose.
Between 4,000 and 5,000 babies are born before 30 weeks’ gestation in England per year and stand to benefit from full national roll-out of the PReCePT programme.
The aim of the programme was to ensure that at least 85% of all eligible mothers are receiving magnesium sulphate across all maternity units in England by 2020. All 10 acute trusts in the KSS AHSN region have successfully met the national targets and the KSS AHSN Patient Safety Improvement Programme (PSIP) continues to support the maternity units in our region in embedding this practice.
ED SAFETY CHECKLIST
The Emergency Department (ED) Safety Checklist aims to standardise and improve the delivery of basic care in EDs. Developed by West of England AHSN’s ED Collaborative, the ED Safety Checklist has been shown to improve:
- Resilience in EDs during periods of crowding
- The safety and clinical outcomes for patients accessing the emergency care system
- ED performance against Best Practice Tariffs
- Standardisation, and demonstrate improvements in patient safety and care.
By systemising the observations, tests and treatments required by patients in a time-based sequence, the checklist makes it clear what has been done and what needs to be done.
Its use results in improved outcome for patients and a reduction in system risk, as well as serving as an aide-mémoir for busy staff. Any doctor, nurse, bank or agency staff can join the department and provide the right care by providing this structure.