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11th May 2010
Velindre Cancer Centre
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%
Content Area
Drivers
Measurement
Interventions
Tests of change
On To continue with
Oncology Trigger Tool
audits
To develop a trigger tool for
oncology ambulatory/day care
treatment settings
To reduce harm
by 5%
Improve
General Care
within
inpatient
areas
Medicines
Management
Spread OGTT to other
Oncology Centres
Undertake case note
review of 50 patients to
establish triggers
To reduce incident of pressure
sores and falls
Implement skin bundle and risk
assessments
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
To improve the incident and
risk of thrombosis in cancer
patients
Improve compliance with
antimicrobial policy
Continue with audit and analyse
results.
Develop action plan including
education.
Present at CPT meeting
Establish thrombosis group and
partake in collaborative.
Introduce LMWH to all
appropriate inpatients
Audit of antibiotic usage
Infection
Reduce incidence of UTI’s
Implement care bundle for
UTI’s
Content Area
Drivers
Measurement
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
To implement systems for
mortality case note
reviews
To reduce
mortality by ?
Chemotherapy /
Cytotoxic Drugs
RRAILS
To audit patient deaths
within 30 days of
commencing chemo
Spread Sepsis 6 and care
bundle approach to all
ward areas
Develop and implement action
plan sharing results with other
centres to promote learning
across boundaries
Spread education sessions and
lessons through Critical Care
Lead
Our Content Areas
• Measurement
• Medicines Management
• Care of Inpatients including rapid
response to acute illness
• Infection Control
• Harm from chemotherapy
•
Next steps: Share tool with other
Cancer Centres and Local Health
boards
Adverse event rate per 1000 patient days
Velindre Cancer Centre
Values
Average (103.3)
Fig 1. showing VCC’s average Adverse event rate at 103.3
Jan-10
Dec-09
Nov-09
Oct-09
Sep-09
Aug-09
Jul-09
Jun-09
May-09
Apr-09
Mar-09
Feb-09
Jan-09
Dec-08
Nov-08
Oct-08
200.0
180.0
160.0
140.0
120.0
100.0
80.0
60.0
40.0
20.0
0.0
Sep-08
Oncology Global
Trigger Tool
• 15 months of Data
• Downward trend
noticed over recent
months
Rate
MEASUREMENT
Harm
MEASUREMENT
Harm
Current assessment
methods for daycase
related harm include:
• Incident reporting
• SCIF
160
140
Number
Development of
Trigger Tool for
Oncology Daycase
Treatments
Events by module
Velindre Cancer Centre from Sep 08 to Jan 10
120
100
80
60
40
20
0
O
G
L
M
I
Module code
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.
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
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
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
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
Rapid Response to
Acute Illness
April Anaysis of Chart Checker data
100
•
•
•
•
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.
90
80
70
60
% compliance
•
•
Apr week 1
Apr week 2
50
Apr week 3
Apr week 4
40
30
20
10
0
Documentation
Observation
recordings
Use of EWS
24 hour balance
Referrals
Patient Weight
Above: results from April’s chart checker audit
completed on the pilot ward.
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
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
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
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
Reducing Surgical
Complications
Successful implementation of
the WHO safer Surgery
Checklist
Above: The Velindre surgical team
Right: achieving 100% compliance with the WHO
checklist
Contact Leads
Interim Chief Executive
Alun Lloyd
Ex Dir Nursing
Diane Smith
Medical Director
Peter Barrett-Lee
Chairman
Ian Kelsall
Director of Cancer Services
Andrea Hague
Patient Chair
Lesley Radley
Director of Operations
Lisa Miller
Patient Safety Coordinator
Debbie Bainbridge
Critical Care Nurse
Ceri Stubbs
Senior Infection Control Nurse
Gail Lusardi
Chief Pharmacist
Bethan Tranter
Clinical Change Facilitator
Carol Jordan
Project Officer
Helen Jolley
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