PERIOPERATIVE PRACTICE
healthcare – health ‘outcomes’ will improve.
• Every service will have been put on a solid basis for the long term, with access as local as possible.
• Specialist hospital care in centres of excellence will match the best.
• TheNHS will work with relevant agencies to ensure people’s transport needs to hospitals are addressed.
• The best possible communication links will give clinical staff fast, safe and secure access anywhere inWales to the information needed to help patients.
• TheNHS will publish information on the performance of major services in terms of safety, care outcomes and patients’ views.
“We are trying to create dialogue with patients, to encourage them to accept some responsibility for their own health. We are saying: ‘the NHS is there to care for you when you need it, but what are you doing?’” As part of this shift in emphasis, there is now a drive to ensure that every time a patient comes into contact with the health service, healthcare professionals take the opportunity to discuss patients’ ‘responsibilities’ – such as giving up smoking and alcohol during pregnancy, for example. “We have to stop being embarrassed
about having these discussions,” she commented.
1000 Lives Plus Prof. White highlighted some key healthcare campaigns inWales, which could provide an opportunity for shared learning across the UK, including the 1000 Lives Plus initiative. The patient safety campaign saved more than 1000 lives and reduced harm by around 50,000 incidents, in just two years, and has now been rolled out further. The aim is to cut out waste, harm and variation – ultimately reducing incidence of harm, reducing hospital stay and ensuring services are more efficient. The improvement methodology used is: ‘Plan, Do, Study, Act’.
“This involves starting small and local,
getting staff together to establish how a problem may be addressed; collecting data to see what is working and what is not, then spreading the practice,” Prof. White explained. The initiative uses care bundles to
standardise improvement – including the peripheral venous cannulae care bundle to reduce infection, ‘SKIN’ care bundle for reducing pressure ulcers (Surface, Keep Moving, Incontinence, Nutrition), and stroke care bundle to reduce disability. The bundles have revolutionised care in Wales Prof. White revealed.
52 THE CLINICAL SERVICES JOURNAL
‘As more and more people live to anolder age, we are going to have to get a grip onhow we care for patients with dementia in the acute sector.’
For example, the number of central
venous catheter (central line) related blood stream infections has fallen to a rate of less than one case per 1000 catheter days in 17 intensive care units across the country. This average rate has been maintained for three years and some units have gone more than two years without a central line infection. (Source:Welsh Healthcare Associated Infection Programme.) A focus on preventing infections caused
by peripheral venous cannulas (PVCs) and urinary catheters has also proven successful. A ‘spot audit’ in Prince Philip Hospital, Llanelli, found that on the clinical decisions unit there were 20 patients and only one had a PVC. Of the 28 patients on the surgical ward, none had a PVC in place. Neither ward had catheterised patients. Previously both wards had high levels of PVC and catheter use. A zero tolerance approach to pressure
ulcers and the implementation of the SKIN bundle is also continuing to deliver significant results, with many hospital wards acrossWales going more than a year without a single incident.
Learning disability Another important development, highlighted by Prof. White, included the introduction of the Learning Disability care bundle aimed at protecting vulnerable patients in hospital. The development followed the death of a patient with learning difficulties at a hospital inWales. While the patient’s operation was deemed a success, he later
died from neglect after being transferred to the ward. The tragedy prompted a review of how vulnerable patients are cared for, looking at the individual needs of patients with complex cognitive disabilities. “One approach doesn’t fit all for these vulnerable patients,” Prof. White asserted.
Transforming Theatres Other important aspects of the 1000 Lives Plus initiative include a focus on ‘Transforming Theatres’. Every Health Board inWales has signed up to the programme, which was launched in September 2010. There are four key areas, which focus
on: • Patient experience and outcomes. • Safety and reliability of care. • Team performance and staff wellbeing.
• Value and efficiency.
Guidance on these initiatives and other tools can be found at:
http://www.1000livesplus.wales.nhs.uk The WHO Surgical Safety Checklist is
also a vital part of Transforming Theatres, along with the drive to ensure pre- and post-surgery team briefings/de-briefings. “Briefings improve communication
and make the whole process more efficient. It is a valuable use of theatre time,” Prof. White commented. There are also efforts to de-clutter the
theatre environment; reduce stock levels; improve recycling and procurement; identify and address ‘glitches’ in a positive
NOVEMBER 2012
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