Velindre Cancer Centre

1. Velindre Cancer Centre 11th May 2010

2. Velindre Cancer Centre Our Aims • To understand mortality in cancer patients and set appropriate measures • To reduce harm in cancer patients within our care by 5%

3. Content Area Drivers Interventions Tests of change Measurement On To continue with Oncology Trigger Tool audits Spread OGTT to other Oncology Centres Undertake case note review of 50 patients to establish triggers To develop a trigger tool for oncology ambulatory/day care treatment settings Improve General Care within inpatient areas To reduce incident of pressure sores and falls Implement skin bundle and risk assessments To reduce harm by 5% Spread Releasing time to care to remaining inpatient wards Spread regular review processes to all wards VCC custom measures: To ensure that regular opioid analgesia is being administered as prescribed To ensure the effectiveness of breakthrough pain relief To determine an early indicator of opiate toxicity in patients Continue with audit and analyse results. Develop action plan including education. Present at CPT meeting Medicines Management Establish thrombosis group and partake in collaborative. Introduce LMWH to all appropriate inpatients To improve the incident and risk of thrombosis in cancer patients Improve compliance with antimicrobial policy Audit of antibiotic usage Infection Implement care bundle for UTI’s Reduce incidence of UTI’s

4. Content Area Drivers Interventions Tests of change To investigate the use of HSMR in an oncology treatment setting Arrange workshop with relevant parties to explore further. Review VCC coding practice for palliative care To analyse cancer survival outcomes by tumour or sub-tumour site All Clinical Process Teams to agree one survival measure for tumour group Measurement To implement systems for mortality case note reviews To reduce mortality by ? To audit patient deaths within 30 days of commencing chemo Develop and implement action plan sharing results with other centres to promote learning across boundaries Chemotherapy / Cytotoxic Drugs RRAILS Spread Sepsis 6 and care bundle approach to all ward areas Spread education sessions and lessons through Critical Care Lead

5. Our Content Areas • Measurement • Medicines Management • Care of Inpatients including rapid response to acute illness • Infection Control • Harm from chemotherapy

6. MEASUREMENT Harm Oncology Global Trigger Tool • 15 months of Data • Downward trend noticed over recent months • Next steps: Share tool with other Cancer Centres and Local Health boards Fig 1. showing VCC’s average Adverse event rate at 103.3

7. MEASUREMENT Harm Development of Trigger Tool for Oncology Daycase Treatments Current assessment methods for daycase related harm include: • Incident reporting • SCIF Fig 2. shows a breakdown of events identified by module. The modified tool including specific Oncology triggers (module O) has allowed VCC to see a true reflection of the harm caused to oncology patients. We now want to emulate this for the daycase patients.

8. MEASUREMENT Mortality • To investigate the use of HSMR in an oncology treatment setting review VCC coding practice for palliative care • To analyse cancer survival outcomes by tumour or sub-tumour site All Clinical Process Teams to agree one survival measure for tumour group • To implement systems for mortality case note reviews To establish a system for regular mortality reviews

9. MEDICINES MANAGEMENT • Identifying measures appropriate for improvement in a Cancer Centre Pain Control measures include: 1. Ensuring that regular opioid analgesia is being administered as prescribed 2. Effectiveness of breakthrough pain relief 3. Determining an early indicator of opiate toxicity in patients

10. Early indications of opiate toxicity in patients • Baseline data on number of patients affected by opioid toxicity • 57 patients were identified as having received opiate medication during the month of September 2009. • Notes were obtained for 43 patients. • 9 patients were identified as being highly likely or definitely opiate toxic by 1 or more investigators. • The notes were then assessed for chronological and clinical data from the notes/drug charts/ISCO as to the sequence of events. • Thus approximately 20% of patients have had signs of opioid toxicity during the data collection period. Although this figure will not reach zero, it is considered too high. • Palliative care and Pharmacy have discussed and a preliminary action plan developed

11. Rapid Response to Acute Illness • Adaptation of the National Sepsis Six Screening tool for Oncology • Standardised patient care with the Survive sepsis care pathway • Introducing MEWS chart Future Plans • Ensure sustainability • Fully embed use of Sepsis Screening tool and pathway within the chemotherapy ward • Roll out to other inpatient ward areas in Velindre Cancer Centre

12. Rapid Response to Acute Illness • Lessons Learnt • Start small and use the PDSA methodology to test change • Involvement of a wider multidisciplinary team to develop documentation • Involving clinical champions has been an essential element of implementing change and embedding a new culture at ward level. • The need for a comprehensive evaluation mechanism at the beginning of the project. • The need for ongoing communication of information to all stakeholders. Above: results from April’s chart checker audit completed on the pilot ward.

13. INFECTIONS Continue with successful interventions like the Hand Hygiene audits on all wards. Results displayed for staff and patients in ward areas and in main hospital entrance promoting an open and honest approach to reducing hospital acquired infections. Use of “days between” safety cross on all wards Praise for Hand Hygiene champions and successful awareness days Right: data from October 08 to March 10

14. Infection – focus for 1000 Lives plus • To continue with existing measures • Improve compliance with antibiotic prescribing policy Custom measures now added to the extranet and data collected from May 10 • Reduce incidence of UTI’s

15. LEADERSHIP Patient Involvement • Patient Chair, Lesley Radley not only chairs Velindre’s 1000 Lives Project Board but also our Patient Liaison Group. Lesley provides an invaluable patient opinion to all areas of Velindre’s 1000 Lives work. • Develop patient involvement with all aspects of the 5 year programme

16. PATIENT STORIES Develop the current patient story work to include: • Regular training sessions for Velindre staff • Patient and Staff stories used proactively throughout the organisation • Support a centralised all Wales story depository

17. Reducing Surgical Complications Successful implementation of the WHO safer Surgery Checklist Above: The Velindre surgical team Right: achieving 100% compliance with the WHO checklist

18. Contact Leads

19. CELEBRATING SUCCESS! “Velindre Cancer Centre has been a committed organisation within the 1000 Lives Campaign from the start. You have developed a good structure to deliver the quality and safety including strong leadership in all content areas” Dr Jonathon Gray, organisational briefing April 2010