Health Foundation Safety Improvement in Primary Care SIPC

1. Health FoundationSafety Improvement in Primary CareSIPC

2. SIPC1 Aims To enable 80 Primary Care teams to: 1. Identify and reduce risk and harm to patients 2. Improve reliability of care for patients • On High Risk Medications • With Heart Failure

3. Why ? • Link to SPSP • SIGN Guidance • Long Term Conditions • GP Contract • Not done well

4. Heart Failure • Reliable care via bundles • Trigger Tool • Patient Involvement /Experience • Safety Culture

5. Knowledge • Harm - trigger tool • Culture – Climate Surveys • Reliability - Bundles • Patient Involvement • What to spread ? contract • National Priority • Oversubscribed

6. Breaking News “Improving Quality in Primary Care” August 2010 NHS Scotland will “Design and implement a Patient Safety Programme in Primary Care”  " Guided by outputs  from SIPC”

7. Model for Improvement

8. To improve, quality, safety and reliability of care for patients with Left ventricular Systolic Dysfunction What - Outcomes: Reduce rates of admission of patients with LVSD by 20%Reduce rates of readmission of patients within 30 days in patients with LVSD by 20%By When:By May 2012 95 %Compliance with Bundle of care Aim Primary Driver Secondary Drivers (Areas of focus) (Measurements of Success) B Blocker prescribed B Blocker to target doese Functional Assessment -NYHA Pneumococcal Vaccine Written info -signs and symptoms of exacerbation/ Measured by trigger tool 20% Reduction in harm Improve Patient Experience Defined by focus group or other tools

9. List of Interventions Echo NYHA Use of ACE Use of B-Blockers Warfarin if AF Vaccines Self management

10. LVSD Bundle Current use of licensed B Blocker Bisoprolol, Carvedilol and Nebivolol  B blocker prescribed at target or max tolerated dose Functional Assessment Documented - NYHA recorded in last year Self management - Recorded that patient given information about the recognition of worsening of heart function/condition and/or LVSD Immunise Appropriately - Pneumococcal vaccine given

11. Crude Baseline data B Blocker 70% B blocker at target dose 32% Pneumococcal 71% NYHA 55% Patient information – 42% All 5 - 30%

12. Small tests of change

13. Left Ventricular Systolic Dysfunction Guidance • Diagnosis • Investigations • Coding • Interventions • Titrating drugs • Patient Leaflet • Referral criteria

14. Template

15. Leaflet What is Left Ventricular Systolic Dysfunction (LVSD)? Left Ventricular Systolic Dysfunction (LVSD) is a term to describe when there is evidence that the pumping effect of the heart is reduced. “Left” refers to the side of the heart that is affected. The word “Ventricular” refers to the chamber of the heart that is affected. “Systolic” refers to the phase of the heart beat where the blood is being pumped maximally from the heart. “Dysfunction” simply means that the heart is not working optimally.

17. Patient Group Plenty of Positive feedback ! • “Aftercare and follow up for test results was excellent at Stirling Royal Rehab Well done!” Commonest challenges Difficulties on discharge from hospital • Confusion re pills “I had a bag full of drugs to take. I've not a clue what they are for” • Lack of follow up after release from hospital Communication “Lack of communication between GP/Hospital/Patient” Self care - Unclear/ variable self help/ education Carers/Relatives Lack of info/ support

18. Practice Group • What information, if any, have you received from your GP Practice about your heart? • Has anyone at your GP Practice adequately discussed/explained the medication that you take to manage your heart condition? • How confident do you feel about managing your condition at home? • How confident do you feel about recognising when your condition is worsening and what you should do about it? • What do you feel about the care you receive from your practice? • What is your experience of accessing your usual GP or a GP or nurse that knows you at the practice? • If you have been admitted to hospital with your heart condition what do you think about the follow up care you received from your practice after being discharged? • Is there anything healthcare providers could do differently that would help you to manage your Heart Condition?

19. Shared care

20. Communication

21. Heart FailureRecorded in most recent letter Investigations completed 10% NYHA 90% Use of ACE 75% Use of B-Blockers 60% Anticoagulation if in AF 87% Pneumococal Vaccs 5% Influenzae Vaccs 20% Management of Exacerbations 30% Patient education and self management 50% All Criteria 0%

22. Actions carried out by Primary Care as recommended by clinic 66%

23. Structured Outpatient letter SBAR

25. Actions carried out by Primary Care as recommended by clinic 96%

26. Qualitative FeedbackHeart Function team Initially time consuming Quick to update Excellent summary Spread

27. Feedback Primary Care Thanks for the opportunity to feedback. My immediate reaction was  "If only more letters could be like this!!“ “Looks very GP friendly –i.e. simple. I like the clear instructions on what to do next “

28. Opportunities for synergies • Establishing the diagnosis - LVSD • Interventions same • Handover at Discharge – IHI Guide • Guidance for GPs – skill them up • Don’t clog your clinics • Structured communication • Shared Patient information

29. Questions/ Comments