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Translating a safety programme. The Great Ormond Street experience. Aims of session. A discussion of how GOSH has established an improvement and safety programme. Great Ormond Street Hospital . C ONTEXT Paediatric specialist hospital 120,000 outpatients / year 30,000 inpatient / year
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Translating a safety programme The Great Ormond Street experience
Aims of session A discussion of how GOSH has established an improvement and safety programme
Great Ormond Street Hospital • CONTEXT • Paediatric specialist hospital • 120,000 outpatients / year • 30,000 inpatient / year • 2,800 staff • 16 transformation team staff • 3 Analysts Light therapy for the treatment of rickets in the 1930’s
GOSH 2010 Strategy Working Together
Leadership for safety © GOSH All rights reserved
Developing IDEAS and innovating
The UK Paediatric Trigger Tool Safer Care Programme
Co-production steering group Nicola Davey, Senior Associate, and Dr Robert Varnum, Associate, Safer Care Programme, NHS Institute for Innovation and Improvement Dr Peter Lachman, Consultant for Service Redesign and Transformation Great Ormond Street Hospital for Children Dr Derek Burke, Medical Director, John Reid, Director of Nursing and Dr Janet Cumberland Associate Specialist, Emergency Care, Sheffield Children’s NHS Foundation Trust Co-Production Teams Alder Hey Children’s NHS Foundation Trust Birmingham Children’s Hospital Great Ormond Hospital for Children NHS Trust Royal Manchester Children’s Hospital Sheffield Children’s Hospital The Royal Free Hospital NHS Trust University Hospital Bristol NHS Greater Glasgow Clyde Royal Hospital for Sick Children, Edinburgh
UK Co-production • 9 Hospital worked together to co-produce the tool • The tool was based on the UK Adult GTT, The Canadian Paediatric GTT, The CHCA recommended tools • 3 meetings to work together to debate each trigger • Each team asked to test tool 4 times on 20 sets of notes • At each meeting triggers adjusted or modified • Definitions clarified and refined • Results were then analysed
Creating & Refining a Trigger Tool Adverse event list Trigger long list Alpha version(s) Trigger Tool Beta version Trigger Tool Public version(s) Insert date/time
Alpha testing data analysis Sample characteristics Patients 296 Triggers 503 = 1.70 per case (95 CI 1.5-1.9) Adverse events 127 = 0.43 per case (95% CI 0.3-0.6) ie 43% harm rate
Situation: I am (band X nurse) on (ward X) I am calling about (patient X) The reason I am calling is because I am concerned as the…. (e.g. Resp. is XXX, Pulse is XXX, Temp is XXX, CEWS is XXX) S Background: Patient X was admitted on (date) with (e.g. seizure/chest infection) They have had X operation / procedure / investigation… Patient X’s normal condition is (e.g. alert/drowsy/confused/pain free) Assessment: I think the problem is:….. Or I am not sure what the problem is but patient X is deteriorating Or I don’t know what’s wrong but I am really worried And I have….. - (e.g. given O2/ given analgesia/ stopped the infusion) A B Recommendation: I need you to….. Come and see the patient in the next XXX minutes/hours And is there anything I need to do in the meantime?;…… (e.g. stop the fluid?/ repeat the obs.) R Decision: The recipient agrees with your recommendation The recipient understands the SBAR and you on agree a plan (e.g. and will attend within the next xxx minutes/hours) D Acknowledgement to the Institute of Healthcare Improvement (www.ihi.org/ihi) and to NHS Institute for Innovation and Improvement (www.institute.nhs.uk/safercare)
Peri-operative Care Driver Diagram © GOSH All rights reserved
October © GOSH All rights reserved
Infection driver diagram © GOSH All rights reserved
Infections Dashboard © GOSH All rights reserved
Dashboard medicine management early days © GOSH All rights reserved
Dashboard for the wards © GOSH All rights reserved
Challenges Business case for quality Clinician Engagement Culture change Wiring this into the system