ABHB – Clinical Audit Department support for clinicians and the 1000 Lives Plus Programme

Rachel Fletcher

Q&PS Improvement Manager

Aneurin Bevan Health Board

This presentation

A little bit about our story at ABHB

Data - ‘from ward to board’

How do we support this?

Supporting the Maternity Mini-Collaborative

ABHB – Our Story

1998 – Clinical Audit

2007 – Safer Patients Initiative 2

2008 – 1000 Lives Campaign

2010 – 1000 Lives Plus Programme

In the beginning – Clinical Audit StructureCorporate

Medical Director responsible for Clinical Audit

Clinical Effectiveness & Audit Strategy

Rolling Clinical Audit Programme

Clinical Audit Department

Clinical Standards and Audit Group

Divisional

Directorate Audit Leads

Directorate Addit Programmes

Directorate Audit Meetings

Clinical Audit Outcomes– 2009/10 Clinical Audit Report

284 Audits carried out plus locality Audits

61% led to agreed actions/shared learning

28% re-audits – difficult to assess actual improvements across the organisation

Education/professional development of staff, staff appraisal, curriculum vitae

Clinical Audit embedded within organisation

Clinical Audit valuable to create a snapshot of good/poor performance across multiple criteria

What are we trying to

Accomplish?

How will we know that a

change is an improvement?

What change can we make

that will result in

improvement?

The Model for Improvement

Act Plan

Study Do

2007 – Safer Patients Initiative

• Utilises Model for

Improvement to test,

implement and spread

evidence based

interventions

• Aimed at reducing

mortality and harm

• 24 hospitals across UK

• RGH & UHW couplet

What are we trying to

Accomplish?

How will we know that a

change is an improvement?

What change can we make

that will result in

improvement?

The Model for Improvement

Act Plan

Study Do

2007 – Safer Patients Initiative

• Measurement a key

component

• Employs Statistical Process

Control Techniques

Measurement

70

35

0

10

20

30

40

50

60

70

80

Avg

Before

Change

Avg After

Change

Cycle Tim

e (min.)

Results for units 1, 2 and 3

010

20304050

607080

90100

date

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Change

Made

Cycle Time (min.)

010

20304050

607080

90100

date

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Change

Made

Cycle Time (min.)

Unit 1

Unit 3

Unit 2

0

10

2030

4050

60

7080

90

100

date

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Change

MadeCycle Time (min.)

Unit 2

Clinical Audit Data

����

SPC – Run chart data

����

2008 – 1000 Lives Campaign

Extended Safer Patients Initiative work to Wales

Uses Runcharts to measure progress

Aimed to reduce deaths by 1000 across Wales

Aimed to reduce harm by 50,000 episodes across Wales

Across six domains: Leadership, Critical Care, General Wards, Medicines Management, Surgical Complications, Healthcare Acquired Infection

1000 Lives Campaign - Structure

Executive lead for each domain

Led by Assistant Director for Q&PS

1000 Lives Frontline Team Meetings

Clinical Audit Department supporting measurement

Infection Prevention and Control Team support

Extranet Reporting to 1000 Lives Campaign

Regular progress reports to Health Board

1000 Lives Campaign Outcomes – 2009/2010 Clinical Audit Report

143 series reported across 52 measures at either organisational, hospital or ward/theatre level

Statistically significant improvement in

� 61% of outcome measure series

� 64% of process measure series

Reduction in Risk Adjusted Mortality Index

Reduction in infection rates

Runcharts aide real-time understanding of the current status of improvements to patient safety

2010 – 1000 Lives Plus Programme21/4/10 – 1000 Lives Campaign ended

11/5/10 – 1000 Lives Plus Programme launched

Acute Stroke

Stroke Rehabilitation

Transient Ischaemic Attack

Coronary Heart Failure

Depression

Dementia

First Episode Psychosis

Transforming Care

Transforming Theatres

Maternity Services

Pressure Damage

Hospital Acquired Thrombosis

Rapid Response to Acute Illness

Medicines Management

Healthcare Acquired Infection

Acute Coronary Syndrome

Enhanced Recovery After Surgery

Community Falls

Primary Care Collaborative

Eating Disorders

Oral care

Measurement for Improvement‘Cracks’ in the System

Extranet no longer used

Local spreadsheets

Lack of divisional level involvement

No time for full support from Audit Coordinators

External Pressures for change

Pressures for Change

Quality & Patient Safety Committee priorities

Projects must focus on improvement

National Projects

1000 Lives Plus

Patient Experience

Highest risks to patients

So where are we with data?

Boarddata

Frontline data

-Quality Improvement Reports-Aims to reduce mortality and harm-Mortality & Harm Driver Diagrams

-Local 1000 Lives spreadsheets-easy to use-provide run-charts locallyBUT difficult to aggregate data for upwards reporting

ABHB MORTALITY DRIVER DIAGRAM

Reduce

Unexpected

Deaths in order

to have a RAMI

in Line with Top

Performing UTE

Organisations by

June 2013.

Leadership

ICT & Supporting Work

Observation Policy

Primary Drivers Secondary Drivers Action

Prevent Deterioration of Patients

(RRAILS)

(Rapid Response to Acute

Illness)

End of Life Care

Prevent HCAI

Prevent Hospital Acquired

Thrombosis, General and

Maternity

Improve Cardiac

Care

CHF

Acute

Coronary

Syndrome

Stroke

Fractured Neck of Femur

NEWs (and NEOWs and Community

Hospitals)

Appropriate Response to NEWs Triggering

Recognition and Management of SEPSIS

Appropriate DNARs in Place

MRSA

C DIFF

VAP

CVC

SSI, General & Maternity

DVT Risk Assessment

6 Campaign Interventions

Timely Management of TIA

Acute Stroke Care

Early Recovery and Rehabilitation

One NEWS Chart

NEWS Chart signed by trained staff

Appropriate handover/SBAR/ Escalation

Outreach Team

Hospital at Night

SEPSIS 6 Admission, Recognition, Response

SEPSIS Resus Bundle

SEPSIS Management Bundle

Hand Hygiene

Environmental Measures

Antibiotic Stewardship

VAP Bundle

Insertion and Maintenance Bundles

Normothermia

Glycaemic Control

Antibiotic Prophylaxis

Appropriate Hair Removal

Primary Care End of Life Pathway

ABHB Health Community DNAR

Appropriate DVT Prophylaxis

First 3 Hours

First 24 Hours

First 3 Days

First 7 Days

Patient Information

Quality Improvement Report

High Level Data eg. Mortality, infection rates

1000 Lives Plus A3 Reports

Run-charts of outcomes and process measures

Presented bi-monthly to Q&PSC

Leads to questions and drilling down into specific areas

Locally held data - spreadsheets

1000 Lives spreadsheets used at a local level – where improvements happen �

Provide run-charts locally �

Relatively easy to use �

But

Difficult to pull together data from across multiple wards to feed into and gain support from management groups/board

So…data capture needs to:

lead local improvements – owned by frontline clinicians

be at differing levels of organisation eg. Directorate level, Divisional level, Board level to drive improvement

be stored, analysed and fed-back systematically across Health Board

Be supported – support for clinicians to collect and learn from their data

Boarddata

Frontline data

Directorate data

Divisional data

Support & Leader-ship for

work

Data to Directorate Quality Imp./Audit Meetings

Locally held 1000 Lives spreadsheets/audits

Reports to Divisional Quality & Patient Safety Groups

Quality Dashboard of high level measures to Q&PS Committee

Audit Dept Support for data reports

Data – structure/system

What next?

Set up directorate/divisional level regular reports of 1000 Lives Data

Set up an X Drive – to store ‘live’spreadsheets from across ABHB

The future – Nursing Care Metrics dashboard to hold 1000 Lives ward data

How?

Clinical Audit Department workload restructured to incorporate support for 1000 Lives Measurement

New name to reflect this.

Q&PS Improvement & Measurement Department

Working as member of each ABHB mini-collaborative team to support measurement to drive improvement

Working with Divisional Q&PS Groups to regularly receive and discuss 1000 Lives divisional data

Collate data to contribute to Quality Dashboard

So how is Tim supporting the 1000 Lives Maternity mini-collaborative?

Member of the ABHB Maternity Mini-Collaborative – attends meetings

Supports data collection process

Regular liaison with frontline maternity staff

Monthly Feedback of Maternity Mini-Collaborative data to O&GGovernance Group

A3 Reports as part of bi-monthly QIReport for ABHB Q&PS Committee

Monthly Feedback Report

Next Steps- Develop Dashboard/Report of other 1000 Lives Measures to Maternity Governance Group

- Aggregate data to ABHB data

thanks

Rachel.fletcher@wales.nhs.uk

Tim.watkins@wales.nhs.uk