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Systems Thinking

Systems Thinking. A novel approach to the management of a CW patient. Systems thinking. Reacting to a specific outcome or event may contribute to the development of unintended consequences More holistic approaches are required which do not concentrate on analysis of only part of the system

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Systems Thinking

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  1. Systems Thinking A novel approach to the management of a CW patient

  2. Systems thinking • Reacting to a specific outcome or event may contribute to the development of unintended consequences • More holistic approaches are required which do not concentrate on analysis of only part of the system • Systems thinking has been used as an approach to problem solving by viewing “problems” as parts of an overall system • Necessary so that isolated actions taken within the context of part of the system do not upset the equilibrium

  3. Demographics • “ Fred” . Aged 43 years. From Kilmarnock • Multiple admissions to with recurrent chest pain. Over 70 in 2years. Always via NHS 24/ SAS. • Risk factors- known IHD, coronary artery stents, type 2 DM and hypertension. • Also involved with CMHT- “ anxiety and depression”

  4. Medication • Amlodipine 10 mg, bisoprolol 10mg, ramipril 5 mg BD, ISMN 60 mg OD, Atorvastatin 40 mg • Metformin 500mg TDS, Gliclazide 80 mg BD • Asprin 75 mg OD , Clopidogrel 75 mg BD • Duloxetine 90 mg OD • Ranitidine 150 mg BD, Lactulose and Senna • GTN

  5. CMHT • 10+ admissions to Ailsa • Currently “open” to a CPN. • Discharged from consultant psychiatrist • No actual diagnosis despite 2 volumes of case notes • “A wee bit suicidal” • Sociodomestic issues

  6. Meeting • No triggers to chest pain identified- however note times of the week when admitted • Non adherent with medication • ? Role of mood • Social circumstances • Physical examination.

  7. What can the CW do? Anybody?

  8. What happens when he is admitted? • Always after 5pm or at weekends • Majority of the time- IV opiate • Usually gets boarded • In for 2-3 days • Why?

  9. Hospital • Looked at 2 volumes of casenotes with Acute medicine consultant- recent ETT • Rationalised drugs • Discussed with cardiology- “ nothing wrong with his heart” • Identified that his normally abnormal ECG triggered a clinician to give IV opitae

  10. Plan • Plan in AE to direct clinician to best plan of action • Despite history if ECG is the same as previous not for IV opiate • To be kept in CDU. No bloods/CXR. 12 hourly troponin and discharge

  11. Ambulance Service • Meeting with Area Services Manager • Information available in their software • Delighted for help

  12. NHS 24 • Referred to Cauldicott Guardian

  13. CMHT • Meeting with CPN’s • Information now in FACE software detailing usual presentation and management plan. • Decision to be taken by most senior CPN on duty during out of hours

  14. Now? Adherent with simpler medication regime “What’s the point of going in if all I get is co-codamol?” “Can I get Viagra- I am seeing a woman from the pub”

  15. Questions?

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