Scottish Intensive Care Society
Audit Group Newsletter

December 2009

WardWatcher Upgrade (2008 Version)

WardWatcher (2008 version) has now been installed in all areas. Remember there is a HELP button on every screen, click on this to get definitions for every mandatory field.

Work in progress: the wardwatcher manuals are currently being updated. These will include sections on searching, reporting, interpreting data and a new staff induction pack. Watch out for these early next year.

WardWatcher survey

Results from our recent WardWatcher survey show that senior staff are accessing information on the audit and data via reports, the website, newsletters and Annual conference. As you can see from graph 1 below, this reduces significantly for staff nurses and support workers.

SICSAG continue to train staff locally to raise awareness of the audit and ensure data is of high standard, please contact Angela if you would like training in your hospital.

Any other ideas on how we can reach more staff?

Graph 1:Questions about general awareness of SICSAG and whether reports, website etc have been accessed

Nurse User Group

The first Nurse user group will be on the 19th January 2009 at Stirling University Management Centre. Places are limited to one nurse per unit; please speak to your charge nurse if interested.

The agenda includes sessions on: SICSAG update, Data quality, Interpretation of data, searching and reporting in wardwatcher, using data effectively at a local level.

Data Quality

In January we started prospective case note validations in ICU to highlight the quality of data entered into WardWatcher. The overall data quality is very good but there is always room for improvement!

Remember!!

History Page

  • If unsure of the definitions for the chronic health conditions (Past Medical History), click on the HELP button on this screen to check. The definitions are very precise and if you can’t find written evidence (case notes, charts, GP letter etc) that they meet the criteria then enter no.

Severity of illness page

  • Only laboratory blood results, taken in the first 24 hours in ICU, should be used for U and E and FBC bloods.
  • When recording lowest and highest respiratory rate, this should be the TOTAL of any set breaths and spontaneous breaths if patients are ventilated on SIMV or similar.
  • Make sure the GCS is documented in the patient notes. Only information recorded in patients’ notes should be entered into wardwatcher.

Case note validation will start in HDU next year.

Reports

Monthly ‘real time’ reports will start in HDU in February.

Have you had a look at the 2009 report? You can find it on the website www.sicsag.scot.nhs.uk. Please send any comments back to angela.kellacher@nhs.net so we can ensure we report the data you find most useful.

HAI Surveillance in ICU

22/24 ICU and combined ICU/HDUs are now collecting data on VAP, Blood stream infections and CVC related infections. Nineteen of these units are collecting this data through WardWatcher.

Health Protection Scotland (HPS) and SICSAG will publish a combined National report next summer, following validation of data by HPS.

Combined Critical Care Conference

Thanks to everyone who attended the September conference. The combining of the Audit, Trials group and Evidence based medicine conferences proved very popular with delegates.

H1N1

All hospitals with ICUs have had temporary units set up on WardWatcher to allow data collection on all patients if Critical Care services need to be increased.

Questions on H1N1 may also have been added to your discharge or research page of WardWatcher.

Both measures should allow you to monitor the effect of the predicted increase in activity of your unit/hospital over the winter.

New Units

  • Western Isles Hospital, Stornoway HDU
  • Monklands Medical HDU
  • Royal Infirmary Edinburgh Ward 105 (Level one)

Queen Margaret Hospital and Victoria Hospital Kirkcaldy Medical HDUs will join the audit in January 2010.

ADHOC Requests

SICSAG have dealt with over fifteen requests for National data over the last year and have 8 more requests outstanding. Each request is followed up after a year and we plan to have a section on the website with a ‘library’ of publications or presentations which were produced with the help of SICSAG data. Look out for this next year.

Scottish Patient Safety Programme: update

Scottish Patient Safety Programme logo

The Scottish Patient Safety Programme (SPSP) continues to work closely with NHS Board programme managers, executive sponsors and frontline teams to support implementation of the programme. Frontline staff within each participating NHS board play a key role in testing and implementing interventions in 5 work streams, including Critical Care. 

SPSP supports Boards in a number of ways including, site visits and conference calls.  Conference calls give frontline teams direct access to each other, senior experts in the field and faculty through regular work stream-specific calls.  Site visits allow teams the opportunity to meet with faculty in their own environment and provide the opportunity for faculty to see first hand what is working well and how NHS boards are integrating the programme locally. 

In addition, to site visits and conference calls, SPSP provides networking events and Learning Sessions.  Our fifth learning session took place on 16 & 17 November 2009 with over 700 delegates attending.  Our learning sessions provide an opportunity for multidisciplinary teams to come together, with faculty and other NHS Board teams, to share successes to-date, learn from each other, problem solve challenges and build on learning to-date, through a series of workshops, storyboard presentations, plenary presentations and informal discussions.  Our sixth learning session will take place on Tuesday 4 & Wednesday 5 May 2010 at the SECC.

All 14 territorial NHS Boards and the Golden Jubilee National Hospital taking part have been testing and implementing changes from the five work streams, and an increasing number of NHS Boards are beginning to see statistically significant improvement in their measures using run chart rules.  Examples of significant improvements were highlighted in the following measures:

  • Critical care teams with significant time since last central line infection,
  • 603 Leadership Walk rounds have been completed since January 2008,
  • Reduced ventilator associated pneumonia rates,
  • Reduced staph aureus bacteraemia rates, and
  • Reduced clostridium difficile associated infections.

The success of SPSP is dependent on building sustainability by embedding methodologies into the everyday practice, and effective integration and alignment of SPSP and other national work will contribute to this aim.  Scoping to incorporate the patient safety quality improvement methodology into paediatric, primary care and mental health services is underway.

For further information on Scottish Patient Safety Programme please contact:

Jane.murkin@nhs.net (National Coordinator)
0131 623 4317

Finally, the SICSAG team would like to wish you
a merry Christmas and a happy new year!