MCQIC: Phase 2 Prepared by: Bernie McCulloch (with lots of help from Dr. Linda Clerihew )

Overview Current state What has worked, what hasn’t, suggestions for future What should MCQIC Paediatric Care look like going forward Opportunity to feed in views to inform future state

Deteriorating Patients SPSP Update 11th May PSHKI Deteriorating Patients Person Centred Care Human Factors

Paediatric Serious Harm Key Index Serious Safety Events Serious Medication Event Unplanned admissions to PICU Central Line Blood Stream Infections VAP Child Protection Apply to all units All apply across whole patient journey ICU only ? Long term vent in community At first ICU – DGH & now homecare teams

Deteriorating Patients PEWS Sepsis Watchers Bundle National Embedded

Person Centred Care Family Child Staff What Matters to Me Family Improvement Trees Staff Safety briefs, Effective handovers, Structured ward rounds Embedded

HUman factors their influence of disruption and distraction, for example on performance and susceptibility to error.

Pros Cons Opportunity VERDICT ? PSHKI – applicable to all areas, not just large units & PICUs Low numbers acute hosp based programme i.e. within our sphere of influence Lots of Data – process & outcome at board level Unique National Programme Cons Difficulty aggregating data as more & more measures are reported o in more areas Don’t see the whole journey of the child, no joined up transitions, Limited National aggregation Variance in reporting with programme change in 2013/14 Consensus takes time Opportunity Focus on common errors: medication, periop safety Focus on other issues –medicines, periop safety flow, readmissions, QI within speciality networks Consolidate Aggregate International Sharing

International Sharing USA measures Adverse drug events (ADE) Catheter-associated urinary tract infections (CAUTI) Central line-associated blood stream infections (CLABSI) Injuries from falls and immobility Obstetrical adverse events (OBAE) Peripheral intravenous infiltration and extravasations (PIVIEs) Pressure ulcers (PU) Surgical site infections (SSI) Ventilator-associated pneumonia (VAP) Venous thromboembolism (VTEmm Scotland as a country is leading the way On the tipping point of demonstrating good national outcome data

So What about social care integration?............

MCQIC & SPSP Maternity Neonatal Reducing harm from key Indicators The Integration Question ? MCQIC & SPSP Maternity Smoking ?Obesity, Neonatal Reducing harm from key Indicators Deteriorating Patients Morbidity Mortality Paediatrics Mental Health CAMHS -Eating disorders, suicide Primary Care: Dentistry HAI & Medicines (Acute Adult) Mental Health, Primary Care, HAI, Medicines Key areas for focus determined by speciality Generic Improvement Activity: Leadership, Culture, Safety Briefs, Human factors, Huddles, etc

MCQIC Diabetes

Healthcare associated harm but across the whole journey” The Future “Outcomes for children in the UK are poor – focus needs to be on sphere of influence, not sphere of concern Healthcare associated harm but across the whole journey” Dr. Linda Clerihew National Clinical Lead McQIC Paediatric Care “ I believe this is about becoming better at what we have already agreed, Identifying how to link with other groups to agree paediatric specifc priorities “

The Future Continue measurement plan Ensure reliable measurement/ reporting therefore aggregation of data Greater focus on medicines harm high risk meds (e.g gentamicin & acute kidney injury), prescribing, administration and med reconciliation Consider Scotland as pilot for a 'decision -making tool ' that RCPCH have been working on “Paediatric Care on Line” Perioperative safety Child Protection measure to be agreed

? A role for MCQIC sharing QI methodology The Future ? A role for MCQIC sharing QI methodology with the other specialist services NDP networks - Asthma, Diabetes, Epilepsy, Neurology, Oncology etc Encourage disease specifc teams to work on their priorities (top causes of admissions would identify priorities)   Deteriorating patient & integration with HDU network Readmissions & Flow e.g. looking to decrease asthma related deaths and readmissions with better discharge planning/interval management etc. Reducing unnecessary hospital attendances

DISCUSS