1. Welsh Ambulance Services NHS Trust.......................................................................................................................................................................................................... Insert name of presentation on Master Slide Welsh Ambulance Services NHS Trust Presenters: Welsh Ambulance Services NHS Trust 11th May 2010

2. Welsh Ambulance Services NHS Trust.......................................................................................................................................................................................................... Insert name of presentation on Master Slide Introduction First ambulance service in the world to take part in 1000 Lives Campaign Development of new Ambulance Patient Safety Prompt Tool (APSPT) & other measures Interest expressed by New Zealand and Scottish Ambulance Services Interest from University of Manchester Involvement with 1000 Lives continues to spread throughout Trust

3. Welsh Ambulance Services NHS Trust.......................................................................................................................................................................................................... Insert name of presentation on Master Slide MORTALITY TARGETS Reducing Harm and Measuring Effectiveness Utilise Patient Safety Prompt Tool  Percutaneous Infusion  Pre Hospital Thrombolysis Improve:  Peak Expiratory Flow  Pain scores  O 2 administration  Target vehicle cleanliness  Spread structured handover via SBAR  Turnaround at A&E  Domestic abuse handover Mangage Acute Coronary Syndrome Improve Infection Control Improve Clinical Communication Interventions Leadership Medicines Management  Warfarin awareness  Green bag Campaign  Spread access to Naloxone  Walkrounds  Patient Stories Reducing Falls in Intermediate Care  Falls Pathways

4. Welsh Ambulance Services NHS Trust.......................................................................................................................................................................................................... Insert name of presentation on Master Slide Manage Acute Coronary Syndrome Percutaneouse Infusion (PCI) – Development of care pathways for direct admission of appropriate ACS patients Pre-hospital Thrombolysis – Monitored locally & regionally against national targets

5. Welsh Ambulance Services NHS Trust.......................................................................................................................................................................................................... Insert name of presentation on Master Slide Ambulance Patient Safety Prompt Tool (based on GTT) Collect data from 450 Patient Care Records (PCRs) per month Current data collected for May 09 – Aug 09 Selected top three triggers to target change Started implementing change to improve recording of pain scores - November 09 Spread taking place throughout Carmarthenshire

6. Welsh Ambulance Services NHS Trust.......................................................................................................................................................................................................... Insert name of presentation on Master Slide A1 Lack of condition code or narrative description A2 No record of Primary Survey Minimum – ABCD assessment (values not required) A3 Chest pain/suspected MI – no12 lead ECG or readings recorded A4 Cannulation – unsuccessful and no available access A5 Intubation – unsuccessful A6 Complaints of pain in narrative – no pain score recorded A7 If condition code Stroke or TIA then is FAST test recorded? Medication A8 Glucose administration and no BM recorded A9 No O 2 admin and:  any significant trauma or  GCS below 15 or  O 2 stats below O 2 94% A10 Morphine & Naloxone A11 Vomiting/nausea after morphine and no metaclopramide administered A12 Salbutamol administered, but no PEF taken APSPT – LIST OF TRIGGERS TOP 3 TRIGGERS: 1. A6 2. A12 3. A9

7. Welsh Ambulance Services NHS Trust.......................................................................................................................................................................................................... Insert name of presentation on Master Slide Baseline data showing top Triggers

8. Welsh Ambulance Services NHS Trust.......................................................................................................................................................................................................... Insert name of presentation on Master Slide Implementing Changes (APSPT) 1.A6 – Encouraging staff to record pain scores through education (posters, pain management material on stations) 2.A12 – Encouraging staff to take Peak Expiratory Flow (PEF) readings through education (annual CPD course) 3.A9 – Encouraging staff to administer oxygen, where appropriate through education (annual CPD course)

9. Welsh Ambulance Services NHS Trust.......................................................................................................................................................................................................... Insert name of presentation on Master Slide

10. Target Vehicle Cleanliness 8 week vehicle cleaning trial (PDSA) starting in May within ABM East Clean Your Hands Campaign ongoing New hand cleaning products also being trialled

11. Welsh Ambulance Services NHS Trust.......................................................................................................................................................................................................... Insert name of presentation on Master Slide Improve Clinical Communication - SBAR Handovers taken place between A&E and Ambulance at University Hospital of Wales and Wrexham Maelor Hospital SBAR prompt cards are now being issued to ambulance staff A&E handovers re-commencing and will include Llandough Hospital- then spread

12. Welsh Ambulance Services NHS Trust.......................................................................................................................................................................................................... Insert name of presentation on Master Slide SBAR PROMPT CARD

13. Welsh Ambulance Services NHS Trust.......................................................................................................................................................................................................... Insert name of presentation on Master Slide Improve Clinical Communication - A&E Patient Journey Process mapping exercise of patient journey from ambulance arrival at A&E through to full handover of patient Taking place throughout Wales (Morriston already visited) The aim is to improve hospital turnaround times and patient safety Patient handover & SBAR is included within the evaluation and recommendations.

14. Welsh Ambulance Services NHS Trust.......................................................................................................................................................................................................... Insert name of presentation on Master Slide Leadership 1000 Lives/patient safety update paper submitted at every Trust Board meeting Patient story presented at every Trust Board meeting 1000 Lives measures reported on Trust Dashboard Walkrounds ongoing throughout Wales

15. Welsh Ambulance Services NHS Trust.......................................................................................................................................................................................................... Insert name of presentation on Master Slide Medicines Management - Warfarin From 1 st March 10 – 1st June 2010 Callers accessing NHS Direct Wales who are taking Warfarin are being offered information regarding Warfarin and best practice Callers also receive a questionnaire in relation to their management of Warfarin etc. 7 out of 10 questionnaires have been returned so far

16. Welsh Ambulance Services NHS Trust.......................................................................................................................................................................................................... Insert name of presentation on Master Slide

17. Warfarin Ambulance service have launched a Warfarin/anticoagulant awareness campaign Green bag campaign is also being promoted throughout Trust Promote use of Naloxone for service users, including ambulance EMTs

18. Welsh Ambulance Services NHS Trust.......................................................................................................................................................................................................... Insert name of presentation on Master Slide

20. Reducing Falls Implementation of Falls Pathway for Elderly Fallers Audit taking place to monitor use of pathway

21. Welsh Ambulance Services NHS Trust.......................................................................................................................................................................................................... Insert name of presentation on Master Slide

22. Other Initiatives Implementation of F.A.S.T (test for stroke) Recording of Laryngectomy/ Tracheotomy patient information Development of a nurse triage model for 999 callers who have neither life threatening or serious conditions (category C calls) Domestic Abuse patient handover (included within SBAR) Safe Conveyance of Patients in Wheelchairs Professional Advisory Group/Clinical Advisory Group staff initiatives