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Dr. David Lyon

Dr. David Lyon. Clinical Governance Lead Halton PCT GP Affiliate NPDT. The art of Medicine is to amuse the patient whilst nature cures the disease. Voltaire. TOP. BOTTOM. NSF Recommendations for Those with Established Disease.

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Dr. David Lyon

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  1. Dr. David Lyon Clinical Governance Lead Halton PCT GP Affiliate NPDT

  2. The art of Medicine is to amuse the patient whilst nature cures the disease Voltaire

  3. TOP BOTTOM

  4. NSF Recommendations for Those with Established Disease • Risk factors assessed, documented & advised, especially smoking. • Medication: aspirin, beta blockers, ACEI • Blood Pressure below 140/85 • Blood cholesterol lowered to less than 5mmol/l and LDL-C below 3mmol/l or by 30%

  5. Getting the Ball Rolling • Disease Registers from medication & READ coded entries • Additional Nurse Resource Devolved to Practices • Protocols for Nurse & for Referral to Secondary Care • Computer Templates • Audit Team Geared up to Provide Rapid Feedback

  6. Advantages of Templates • Quicker entry of standard data • Consistent use of READ codes • Display previous recordings • Search for previous interventions • Automatic calculations, e.g. BMI, risk score • Clinician can be reminded of interventions • Easier audit

  7. % Population with IHD Runcorn

  8. % Co-morbidity

  9. Clinical Governance • Protected Time for Regular Team Meetings • Significant Events Premature Deaths New Cancer Cases Unpleasantness In The Waiting Room • Summaries to Clinical Governance Team • SEA News

  10. What Happened • Focus on the facts • No blame • It’s the system • What went well • What was OK • What could have gone better • What should we do next time?

  11. Acute Chest Pain Protocol • Is the patient alert? • Is the patient’s breathing normal? • Is the pain severe? • Is there heart problems or diabetes? • Is it heavy, crushing, pressure or tight? • Is there nausea or vomiting? • Is the patient sweating or clammy?

  12. Acute Chest Pain Protocol • 51 cases in 12 months • 10 (19%) MI 1 had VF within 5 minutes • 7 (14%) crescendo angina • 24 (47%) admitted to rule out MI • 8 (16%) had blood test etc. & discharged • 2 (4%) dysrhythmia • Call to needle time less than 60 minutes

  13. Cardiac Events Castlefields Health Centre

  14. Cardiac Events per Thousand

  15. DEATHS • Practice records • ONS (Office of National Statistics) • Public Health • 3 Character Postcodes • Trend over Time • Twelve Month Periods

  16. At Risk • Other Athersclerotic Disease • Diabetes • Hypertension • Heart Failure • Middle-aged men • Strong Family History • Smoking, Post-menopausal women

  17. Essential Ingredients • Clear evidence and Clear focus • Examples From The Field • Time to consider solutions • Reality of working at ‘street level’ • Systematic recording of information • Rapid feedback • Appropriate resources • Skilled management

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