Inpatient care and inpatient experience of adults with ulcerative colitis in the UK [Presenter / title] [Date of presentation]

Slides:



Advertisements
Similar presentations
Hip fracture NICE quality standard March 2012 ABOUT THIS PRESENTATION:
Advertisements

For the Healthcare Provider
Mapping Diabetes against the needs for London
Acknowledgements RHH ED staff Safety and Quality Unit RHH for their participation and valuable contribution Next Steps It is envisaged over the next 12.
Adult IBD Services in the UK
Introduction to ‘Immediate management of delirium care bundle’ and change package Karen Goudie, Clinical Advisor a Michelle Miller, Improvement Advisor.
Improving inpatient care for people with diabetes at the Royal Berkshire NHS Foundation Trust: The Think Glucose Project Naseem Sohpal.
The Health Roundtable 3-3b_HRT1215-Session_MILLNER_CARRUCAN_WOOD_ADHB_NZ Orthopaedic Service Excellence – Implementing Management Operating Systems Presenter:
Inpatient care and inpatient experience of young people with ulcerative colitis in the UK [Presenter / title] [Date of presentation]
Shaping a service Colin Hughes Consultant Nurse - Older People (Mental Health) Chesterfield Primary Care Trust.
The National Mastectomy and Breast Reconstruction Audit Key findings of the Third Annual Report Slides produced by the MBR Project Team. © The National.
(Date of presentation) (Name of presenter) UK IBD audit Biological therapies audit 2014 Comparison of (Your site name) results against the national results.
Reviewed process for follow up appointments for interpreters Review of information for patients regarding financial process & appointment letters for private.
Training Module 2: Respondent Eligibility Criteria.
Clinical Unit of Health Promotion WHO Collaborating Centre for Evidence-Based Health Promotion in Hospitals Quality tools and Health Promotion Implementation.
Satbinder Sanghera, Director of Partnerships and Governance
MUST and BAPEN Nutrition Screening Week 2010.
CRISIS MANAGEMENT AT THE MANAGED CLINICAL NETWORK.
1 Final Version© Ipsos MORI Final Version Evaluation of Adult Cancer Aftercare Services Quantitative and Qualitative Service Evaluation for NHS Improvement.
© Copyright, The Joint Commission Advanced Certification in Heart Failure Measures Pilot Test Training Part I: Monday, November 14, 2011.
Management of Adults with Diabetes undergoing Surgery and Elective Procedures UHL Guideline – April 2013 The aim of the guideline is to improve standards.
Acute Quality Standards Dan Beckett Acute Physician CMO Advisor for Acute & General Medicine.
The PAN-Care Project Development and testing of a comprehensive care planning service to enable patients with end stage pancreatic cancer die at home Department.
Learning Disability Services Acute Health / Community LD Team Partnership Working & Service Delivery Tameside Hospital NHS Foundation Trust in conjunction.
25 January 2013 Dr Ian Arnott UK Inflammatory Bowel Disease (IBD) audit Audit of inpatients with ulcerative colitis 1st January 2013 – 31st December 2013.
Inpatient care and inpatient experience of adults with ulcerative colitis in the UK Dr Deepak Kejariwal Consultant Physician Aug 2014.
JCUH NICE MSCC Guidelines Compliance audit Ruth Mhlanga Senior Specialist Physiotherapist Oncology and Haematology.
The 2002 Commonwealth Fund International Health Policy Survey Adults with Health Problems The Commonwealth Fund Harvard University School of Public Health.
A Regional Approach to Improvement Julie Branter Associate Director for Clinical Governance and Patient Safety 21 September 2010 South West Strategic Health.
Improving the quality of medical and surgical care NCEPOD SEPSIS STUDY.
RAPID RESPONSE TEAM NEWPORT Service Provision and Referral Criteria.
Scottish Patient Safety Programme – Pharmacist Engagement Gordon Thomson Arlene Coulson Shadi Botros.
End of Life Care At the West Suffolk Hospital
Fresh Approaches to Patient Education Susan Savastuk MEd, BSN Stroke Program Coordinator Neuroscience Institute Bloomington Hospital Bloomington, IN 1.
Date of presentation Name of presenter UK IBD Audit 3 rd Round Comparison of (Your Site Name) results against the National Results for Clinical Audit of.
[Enter date of presentation] [Enter name of presenter] National audit of adult IBD service provision Organisational audit.
DVT Prevention and Anticoagulant Management
Hospital Operational Standards Jennie Hall, Chief Nurse Dr Ros Given-Wilson, Medical Director Martin Wilson, Director of Delivery and Improvement.
(Date of presentation) (Name of presenter) UK IBD audit Biological therapies audit 2014 Comparison of (Your site name) results against the national results.
Date of presentation Name of presenter UK IBD Audit 3 rd Round Comparison of (Your Site Name) results against the National Results for Clinical Audit of.
Older People’s Services The Single Assessment Process.
Date of presentation Name of presenter UK IBD audit 3rd round Primary care questionnaire.
Level 6 Discharges from Bradford Teaching Hospitals: Destination and Survival Dr Kath Lambert SpR in Palliative Medicine BRI.
Best Practice in End of Life Care:
1 Hinchingbrooke Health Care NHS Trust CQC report October 2015 Inspection Chair: Helen Coe Team Leader: Fiona Allinson Quality Summit 2 February 2016.
 Friends and Family Test (FFT) -single question ‘would you recommend…’  The Adult National Inpatient Survey (AIPS) - AIPS uses validated questions based.
NHS West Kent Clinical Commissioning Group West Kent Urgent Care DRAFT Strategy Delivering a safe and sustainable urgent care system by
National Audit of In-patient Falls 2015 Presenter / title Date line Comparison of (Your site name) results against the national results for the 2015 National.
Cardinia-Casey Community Health Service (CCCHS) Partnership Development with Casey Hospital Michael Jaurigue Senior Clinician Physiotherapist Belinda Ogden.
The National Emergency Laparotomy Audit Dave Murray National Clinical Lead
(Date of presentation) (Name of presenter) UK IBD audit Biological therapies audit 2015 Comparison of (Your site name) results against the national results.
Development of a Community Stroke Rehabilitation Team “meeting the need” NHS Blackburn with Darwen Tracy Walker Team Leader.
(Date of presentation) (Name of presenter) UK IBD audit Biological therapies audit 2015 Comparison of (Your site name) results against the national results.
Peer Review for Paediatric Diabetes Ruth Bridgeman.
Alcohol dependence and harmful alcohol use NICE quality standard August 2011.
The Next Five Years.  No national service framework  Patchy quality of care  Over 200,000 patients  Not topical  Lack of evidence for commissioning.
POMH-UK Topic 2e supplementary audit Screening for metabolic side effects of antipsychotic drugs in patients under the care of assertive outreach teams.
(Date of presentation) (Name of presenter) UK IBD audit Biological therapies audit 2016 Comparison of (Your site name) results against the national results.
Biological therapies audit 2016
National audit of adult IBD service provision
National audit of paediatric IBD service provision
Patient Medical Records
J.Livie1, E.Goodall1, M.Wilson2,C.Payne2 Department of Surgery2
Symptom Management: Terminal Agitation J28 & J29
Introduction Where did it come from? Started approximately 5 years ago
Neuro Oncology Therapy Update
Principal recommendations
Chemotherapy Services in England: Ensuring quality and safety
Principal recommendations
2016 NCPES Inpatient and day case adult cancer patients, discharged from hospital 01/04/16 – 30/06/16 Sent postal questionnaires Oct’16 – March ’17 National.
Presentation transcript:

Inpatient care and inpatient experience of adults with ulcerative colitis in the UK [Presenter / title] [Date of presentation]

Introduction to the IBD programme ‘Improving the care of people with IBD’ Five elements, 2012– Inpatient care (1 Jan – 31 Dec 2013) Assesses the treatment that a patient receives when admitted to hospital. Each hospital participating in the audit collects information on the first 50 patients admitted with ulcerative colitis in Inpatient experience (1 Jan 2013 – 31 Jan 2014) Assesses the quality of patient care. Each patient included in the inpatient care audit is given a questionnaire when they leave hospital. They can comment on the care that they received and how this made them feel. 3.Biological therapy audit (continuous audit) Collects information about treatment, delivery, disease activity and quality of life in patients who are prescribed infliximab or adalimumab for IBD.

Introduction to the IBD programme ‘Improving the care of people with IBD’ Five elements, 2012– Organisational audit and quality improvement tool IBDQIP (1 Feb – 31 March 2014) A web-based self-assessment that enables hospitals to measure their organisation of care compared with national service standards. The tool identifies areas for improvement and facilitates change. 5.Quality improvement: peer support visits A series of visits where hospitals are paired up and meet to compare results and identify methods for improving the quality of care for patients. The IBD programme team supports the clinical teams to share best practice and explore new ways of working.

Methodology Prospective patient identification Ulcerative colitis (UC) Reduced dataset Up to 50 audited admissions per site Inclusion criteriaExclusion criteria Patients admitted for treatment or surgery for UC (including newly diagnosed patients) Primary reason for admission was not for treatment of UC Patients any ageA day case (for an infusion, endoscopy or day surgery procedure) Patients admitted for longer than 24 hours If the patient stayed overnight but was discharged within 24 hours of admission Multiple admissions included

Participation in inpatient care 1 January 2013 – 1 December % (154/162) adult trusts/ health boards that were eligible to take part 190 hospital sites took part 4359 admissions were audited [Your site’s number of admissions]

Key indicators for inpatient care Key indicators round 4National resultsYour site results Mortality – death during admission 0.85% (37/4359) % (n/N) Previous admission in the past 2 years (among emergency and planned admissions for active UC and restricted to first admission only) 31% (854/2778) % (n/N) Active UC admissions and no UC medication on admission (excludes new diagnoses) 11% (352/3065) % (n/N) Seen by IBD nurse (among emergency admissions) 49% (1657/3410)% (n/N) Stool samples sent for SSC and CDT (among emergency admissions where the patient had diarrhoea) SSC: 80% (2060/2565) CDT: 76% (1940/2565) SSC: % (n/N) CDT % (n/N) Your site level data for this table can be found in your local site report (Section 2, Table 3)

Key indicators round 4National resultsYour site results Positive stool sample SSC: 3% (57/2060) CDT: 4% (79/1940) SSC: % (n/N) CDT: % (n/N) Nutritional screening during admission a 82% (3566/4359) % (n/N) Seen by a dietitian during admission a 40% (1449/3635) % (n/N) Prophylactic heparin prescribed (excluding elective surgical admission) 90% (3560/3952) % (n/N) Ciclosporin/anti‐TNFα prescribed following failure to respond to corticosteroids Ciclosporin: 22% (268/1226) Anti‐TNFα: 42% (519/1226) Ciclosporin: % (n/N) Anti‐TNFα: % (n/N) a Excludes from the denominator admissions that were not applicable to the question Key indicators for inpatient care Your site level data for this table can be found in your local site report (Section 2, Table 3)

Key indicators round 4National resultsYour site results Response to ciclosporin / anti-TNFα treatment a 80% (627/780) % (n/N) Surgery during admission among non‐elective surgical admissions 12% (442/3784) % (n/N) Bone protection prescribed when discharged home on steroids 74% (2553/3448) % (n/N) Medication(s) not started or increased in the clinic appointment prior to admission. Includes: 5‐ASA, steroid, topical or immunosuppressant therapy (among admissions where the patient had active UC at their last clinic appointment and were not admitted to hospital) 42% (556/1329)% (n/N) Key indicators for inpatient care a Response to treatment is defined as not having had surgery and not having died during admission Your site level data for this table can be found in your local site report (Section 2, Table 3)

Key indicators round 4National resultsYour site results No steroid-sparing therapies tried for patients on steroids >3 months (National data table Q6.2.2 d) 22% (151/684) % (n/N) No treatment provided for iron deficiency (National data table Q6.3.3) 56% (783/1406)% (n/N) Key indicators for inpatient care Your site level data for this table can be found in your local site report, within the national data table (from page 23). Individual question numbers are provided below

Outcomes of treatment escalation in UC

Inpatient care audit recommendations 1.All outpatients with UC should have their disease activity accurately assessed (eg using symptoms and faecal calprotectin), and treatment should be initiated or escalated in those with active disease. Early intervention may prevent admission. 2.All patients with a new diagnosis of UC, those for whom the use of anti‐TNFα is considered and those requiring additional information should be seen by an IBD nurse during admission. 3.IBD services should ensure that inpatient IBD care provided by the IBD nurse is appropriately resourced in line with IBD Standard A1 (1.5 whole‐time equivalent nurse per 250,000 population). 4.All IBD patients admitted to hospital should be weighed and their nutritional needs assessed, in line with IBD Standard A10. 5.Bone protection should be prescribed to all patients with UC who receive corticosteroids.

Inpatient care audit recommendations 6.Heparin should be given to all patients for whom it is not contraindicated, to reduce the risk of thromboembolism. 7.All patients on steroids for longer than 3 months should be considered for steroid‐sparing agents such as azathioprine. 8.Anaemia should be actively investigated, and the cause should be identified and treated appropriately. 9.Further national audit in IBD should be commissioned.

Participation in inpatient experience 1 January 2013 – 31 January /162 (95%) trusts/health boards 190 hospitals 1687 questionnaires returned (1550 included in national analysis) Your site’s number of questionnaires returned

Key indicators round 4National resultsYour site results Overall how would you rate the care you received? Excellent = 47% (690/1475) Excellent = % (n/N) Did you have confidence and trust in the doctors treating you? Yes, always = 75% (1098/1470) Yes, always = % (n/N) Did the patient receive a visit from a specialist nurse? No = 28% (417/1471) No = % (n/N) Was the patient visited by a dietitian? No = 62% (915/1476) No = % (n/N) Were you ever in pain? Yes = 78% (1154/1478) Yes = % (n/N) Do you think the hospital staff did everything the could to control your pain? Yes, definitely = 66% (763/1148) Yes, definitely = % (n/N) Key indicators for inpatient experience

Key indicators round 4National resultsYour site results In your opinion how clean was the hospital room or ward you were in? Very clean = 62% (914/1473) Very clean = % (n/N) How would you rate how well the doctors and nurses worked together? Excellent = 40% (584/1472) Excellent = % (n/N) Did a member of staff tell you about any danger signals you should watch out for after you went home? No = 33% (477/1466) No = % (n/N) Do you feel that you received enough information from the hospital on how to manage your condition after your discharge? Yes, definitely = 47% (683/1454) Yes, definitely = % (n/N) Would you recommend this hospital to your family and friends? Yes, definitely = 62% (910/1465) Yes, definitely = % (n/N) Key indicators for inpatient experience

Patient experience across core domains of acute inpatient care

Inpatient experience quotes

Inpatient experience recommendations 1.All UC inpatients should receive input from specialist multidisciplinary teams with experience of managing such complex disorders. This will maximise the opportunity for provision of consistent and coordinated care. 2.Local IBD teams should consider whether the general nursing staff have sufficient awareness and knowledge of IBD, and initiate appropriate educational interventions and care pathways to support high‐quality nursing. The routine involvement of specialist IBD nurses in the day‐to‐day care of IBD patients at ward level is seen as a potential driver to improve the overall experience of nursing care. 3.All admitted patients with active UC require routine documentation of nutritional intake and weight. Nursing care plans should identify nutrition as a key element of day‐to‐day care. Food provided should be appropriate to patients’ dietary needs. Standard A5 of the IBD standards 1 states that access to a dietitian should be available to all IBD patients. 1 IBD Standards Group. Standards for the healthcare of people who have inflammatory bowel disease (IBD Standards), 2013 update.

Inpatient experience recommendations 4.Ward medical and nursing teams should review their local policies and current practice with regard to the frequency and effectiveness of pain assessment and provision of analgesia. 5.Discharge policies for IBD patients require local review to ensure that patients receive high-quality pre‐discharge information regarding medication, self‐care and follow‐up plans. In particular, improvements are needed in the provision of information about potential drug side effects and the warning signs of which to be aware after discharge.

Your three key areas for local change Local key area identified What action is needed to facilitate this change? Who will be responsible? How and when will you review this action? 1. Treatment of anaemia Write local treatment algorithm and circulate to MDT Consultant gastroenterologist and IBD nurse Sep

Acknowledgements Thank you to all the hospital-based staff who contributed towards case note retrieval and data collection, and distributed the inpatient experience questionnaires. For further information, contact