Aims, Goals and Measures of the Scottish Patient Safety Paediatric Programme & integration with SPSP

1. Aims, Goals and Measures of the Scottish Patient Safety Paediatric Programme & integration with SPSP

2. Why develop a Scottish Patient Safety Paediatric Programme? • Successes of the Scottish Patient Safety Programme (SPSP). • Not little adults. • Programme designed to recognise the unique configuration of Scotland’s paediatric services. • 1st country-wide improvement programme for paediatric patient safety. • Extension of SPSP.

3. Scottish Patient Safety Paediatric Programme Driver Diagram Identify appropriate paediatric aims Improve outcomes in paediatric healthcare in hospitals across Scotland by June 2013 Governance structure Improvement capacity within paediatric community Align with SPSP Engage wider stakeholder groups

4. SPSPP – programme principles: • Adopted SPSP workstreams. • Inpatient paediatric care (all ages). • Aims: • paediatric evidence-base; • ‘best in class’; • linked to measurable outcomes. • Dynamic improvement programme. • Relevant to paediatric hospital care delivered in Scotland.

5. Scottish paediatric care

6. What defines paediatric harm? • NPSA “Review of patient safety for children and young people” • difficulty recognising severity of illness; • high rate of medication administration errors – particularly dosing errors; • lack of integrated approach to children’s risk management that incorporates health, education and social care; • improve communication and listening skills by healthcare professionals, with more effective inter-professional communication; • lack of recognition and appropriate management of mental health issues in young people – appropriate environments etc.

7. Aim - Scottish Patient Safety Paediatric Programme 30% reduction in adverse events by June 2013: Reliable systems that can measure the application of best practice and continually improve outcomes: learning from paediatric mortality review; improve recognition of the deteriorating child; reduce healthcare associated infections; improve paediatric critical care outcomes; reduce adverse surgical incidents; improve medicines management processes & reduced harm from medicines;

8. Reduce adverse events by 30% by June 2013

9. Promote learning from paediatric mortality • SPSP Aim: 15% reduction in hospital mortality. • HSMR developed for SPSP: • not designed for paediatrics. • Develop local mechanisms to identify avoidable factors within the paediatric programme: • SPSP mortality review tools. • SPSPP to link to the child & young person review of serious morbidity and mortality.

10. Improve recognition of the deteriorating child Aim: All children transferred to a higher level of care should have a completed PEWS score by June 2013. Percent compliance with early warning score assessment

11. Reliable delivery of evidence-based practice – improved outcomes

12. Reliable delivery of evidence-based practice – improved outcomes

13. SPSP – reliable application of central line insertion bundle Central Line Bundle Compliance

14. SPSP – linking process compliance to outcome Central Line Bloodstream Infection Rate

15. Decreasing PICU Catheter-Associated Bloodstream Infections: NACHRI’s Quality Transformation Efforts “ In contrast with adult ICU care, maximizing insertion-bundle compliance alone cannot help PICUs to eliminate CA-BSIs. Instead, the main drivers for additional reductions in pediatric CA-BSI rates seem to be issues surrounding daily maintenance care for central lines.” Margolis et al, (2010) Decreasing PICU Catheter-Associated Bloodstream Infections: NACHRI's Quality Transformation Efforts Pediatrics (125) 206-213 (NACHRI - National Association of Children's Hospitals and Related Institutions)

16. Leadership to support Scottish Patient Safety Paediatric Programme • SPSPP integrated component of NHS board’s patient safety programme by June 2011. • Walkrounds, by NHS Board senior team. • Actionable items - for paediatric wards.

17. Medicines Management CCHMC – reducing harm

18. SPSP Peri-Operative - SSI bundle compliance Percent on-time prophylactic antibiotic administration Trend in data

19. SPSP Peri-Operative outcomes – using data for improvement Percent surgical patients developing surgical site infection 12-2007: Wd Nurses start 30 day f/up – not ICN 4-2007: Start testing SSI bundle – Wd 16 6-2007: Implement SSI bundle – Orthopaedics

20. Scottish Patient Safety Paediatric Programme • Appropriate, timely and reliable evidence-based care - linking process to outcome. • Focus on delivering child & family centred-care. • Promotes effective and collaborative multi-disciplinary team working. • Leadership, infrastructure & culture that supports safety & quality. • Paediatric workforce - capacity & capability.

22. Sharing & collaboration across paediatric wards, hospitals & NHS Boards

23. Scottish Patient Safety Paediatric Programme “getting it right every time for every child in Scotland”