two years of call 4 concern (c4c): patient and relative activated critical care outreach dr. mandy...
DESCRIPTION
Background Josie King Lewis BlackmanTRANSCRIPT
Two years of Call 4 Concern (C4C): patient and relative activated critical care
outreach
Dr. Mandy OdellNurse Consultant, Critical Care
BACCN conference 2012
Call 4 Concern (C4C): patient and relative initiated Outreach
Presented at the BACCN conference in 2010
Background
Josie King www.josieking.org
Lewis Blackmanwww.lewisblackman.net
Why use it?
‘If I would have been able to call a rapid response team, I believe Josie would be here today,’ says Sorrel King.
Helen has “not a shred of doubt” that a rapid response team would have saved her son.
Over a 6 month period (Sept 09 – Mar 10), all patients, and their relatives, transferring out of the intensive care unit (ICU) to the wards were given access to using the C4C service:
- feasibility
- resource
- value
- outcome
Pilot
Development
• Rolled out across all wards
• Maternity
• Paediatrics
Results
Category CCO response to C4C
1 Critical clinical intervention, and/or re-admission to ICU
2
2 Clinical intervention such as pain relief. 2
3 Investigative intervention, such as ordering or speeding up investigations
3
4 Liaising with medical team to get clarification and communication with family/patient
3
5 Re-assurance to patient/family 2
Issues highlighted during the study
• It is relatives more than patients that engage with the C4C process and raise concerns
• Making sure the right people get the information
• Access to calling systems needs to be improved
• Addressing concerns with ward teams
• Reassuring patients and relatives about ongoing care
• CCO able to cope with demand (but will need reassessing when rolled out)
“It was reassuring to know it (C4C) was there”
“You feel so vulnerable when you leave ICU to go to the ward”
“I tried not to be concerned but in my heart I was frightened”
“I put all my efforts into worrying rather than concentrating on getting better”
“…when I raised the issues with her team, they heard but didn’t seem to listen…”
“If I hadn’t had C4C I would have had to find another way to voice my concerns: taking time and draining energy when you have little of both”
What they said..
Nursing Times & Health Service Journal March 2011
Patient Safety: Intensive and Critical Care
Just amazing!
Huge potential to be developed further
We should all be doing this
This is very good practice
Critical Care Outreach
0
100
200
300
400
500
600
700
800
900
1000
2010/11 588 702 580 613 581 576 692 694 803 714 663 662
2011/12 790 773 741 696 825 719 735 850 832 865
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Monthly referrals to Outreach
C4C – 147 calls received
Trust wide since end of April 2011
0
10
20
2010 2 0 0 6 3 3 4 6 7 11 5 12011 4 3 3 3 7 13 6 11 1 11 12 82012 17 3
Jan Fe Ma Apr Ma Ju Jul Au Se Oct No De
147 calls
97 patients
34 had prior involvement with ICU
17 “other” calls
7 calls from Obstetrics 3 calls from Paediatrics
1 pt had 9 C4C, and 7 OR calls
Clinical Concern 50
(2 ICU admissions)Communication 35
Reassurance / Support 26
Other 17
General nursing / ward care 10
Discharge Planning 9
Total 147
“Other” calls
Relatives stuck in lift…
Mum phoned from Mumbai – her son was admitted with a “broken leg” she is unable to track him down…
Found relatives outside of Recovery in distress – pt had been in recovery for > 6 hours: described ward staff us “unhelpful & rude”, not providing any information…
Lost filling…
Wife unable to visit husband (in-patient) due to fractured ankle – now in rehab. Very concerned & distressed…..
Ongoing issues
- Posters, poster boards & DVD
- Feedback from patients & relatives
- Introduction into Paediatrics & Obstetrics
- Any ideas???
Any questions?
