Velindre Cancer Centre
11th May 2010
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%
Infection
Improve compliance with antimicrobial policy
Reduce incidence of UTI’s
Audit of antibiotic usage
Implement care bundle for UTI’s
To reduce harm by 5%
Medicines Management
VCC custom measures:To ensure that regular opioid analgesia is being administered as prescribedTo ensure the effectiveness of breakthrough pain reliefTo determine an early indicator of opiate toxicity in patients
To improve the incident and risk of thrombosis in cancer patients
Establish thrombosis group and partake in collaborative.Introduce LMWH to all appropriate inpatients
Continue with audit and analyse results.Develop action plan including education.Present at CPT meeting
Content Area Drivers Interventions
Improve General Care within inpatient areas
To reduce incident of pressure sores and falls
Tests of change
Spread Releasing time to care to remaining inpatient wards
On To continue with Oncology Trigger Tool audits
Spread OGTT to other Oncology Centres
Measurement
To develop a trigger tool for oncology ambulatory/day care treatment settings
Undertake case note review of 50 patients to establish triggers
Implement skin bundle and risk assessments
Spread regular review processes to all wards
To implement systems for mortality case note reviews
Chemotherapy / Cytotoxic Drugs
To audit patient deaths within 30 days of commencing chemo
Spread Sepsis 6 and care bundle approach to all ward areas
RRAILS
To reduce mortality by ?
To analyse cancer survival outcomes by tumour or sub-tumour site
To investigate the use of HSMR in an oncology treatment setting
Measurement
Content Area Drivers Interventions Tests of change
Arrange workshop with relevant parties to explore further.Review VCC coding practice for palliative care
All Clinical Process Teams to agree one survival measure for tumour group
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
MEASUREMENT Harm
Oncology Global Trigger Tool
• 15 months of Data• Downward trend
noticed over recent months
• Next steps: Share tool with other Cancer Centres and Local Health boards
Adverse event rate per 1000 patient daysVelindre Cancer Centre
0.020.040.060.080.0
100.0120.0140.0160.0180.0200.0
Sep-
08
Oct
-08
Nov
-08
Dec
-08
Jan-
09
Feb-
09
Mar
-09
Apr-
09
May
-09
Jun-
09
Jul-0
9
Aug-
09
Sep-
09
Oct
-09
Nov
-09
Dec
-09
Jan-
10
Rat
e
Values Average (103.3)
Fig 1. showing VCC’s average Adverse event rate at 103.3
MEASUREMENT Harm
Development of Trigger Tool for Oncology Daycase Treatments
Current assessment methods for daycase related harm include:
• Incident reporting • SCIF
Events by moduleVelindre Cancer Centre from Sep 08 to Jan 10
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O G L M I
Module codeN
umbe
r
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 prescribed2. Effectiveness of breakthrough pain relief3. 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
• 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
Rapid Response to Acute Illness
• 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.
April Anaysis of Chart Checker data
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Documentation Observationrecordings
Use of EWS 24 hour balance Referrals Patient Weight%
co
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nc
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Apr week 1
Apr week 2
Apr week 3
Apr week 4
Above: results from April’s chart checker audit completed on the pilot ward.
INFECTIONSContinue 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
LEADERSHIPPatient 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 STORIESDevelop 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 LeadsInterim 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