1. Developing the evidence-base
Wednesday 22nd December 2010
Developing the evidence-base
Dr Alan Willson, 1000 Lives Plus Director
Insert name of presentation on Master Slide

2. Where are we now Maintenance Areas:
Reducing Healthcare Associated Infections – hand hygiene compliance; Compliance with local antimicrobial use policy;
Improving Medicines Management – A reduction in INR >5 and INR >8 in hospital and community settings;
Improving Critical Care – central line and ventilator bundles;
Reducing Surgical Complications - Normothermia; appropriate pre-operative hair removal;
WHO Surgical Checklist;
Improving the Reliability of Acute Stroke Care;
Preventing Hospital Acquired Thrombosis;
Maintenance Areas – mini-collaboratives completed and now supported through webex, teleconferences, meetings and mandatory reporting for some areas.

3. Ongoing Areas:
Mental Health – Identifying Depression in Hospital Settings, Improving Dementia Care, First Episode Psychosis;
Reducing Mortality and Harm;
Enhanced Recovery After Surgery (ERAS);
Rapid Response to Acute Illness (RRAILS);
Reducing Catheter Associated Urinary Tract Infections;
Reducing Harm from Falls in the Community;
Improving Care for Chronic Heart Failure Patients;
Stroke: Improving Early Rehabilitation Following Stroke;
Stroke: Improving the Reliability of Transient Ischemic Attack (TIA) Services;
Transforming Care;
Transforming theatres.

4. Tools for improvement:
Leading the Way to Safety and Quality Improvement;
A Guide to Mortality Measurement;
Intelligent Targets for Wales;
Learning to Use Patient Stories;
Using the Model for Improvement;
How to Use Trigger Tools;
Reducing Patient Identification Errors;
Safe Communication - SBAR and Safety Briefings.

5. Potential development – worked up:
Starting soon:
Improving Maternity Services;
Reducing Harm from Acute Coronary Syndrome;
Improving Medicines Management – Psychotropics;
Reducing Harm from Peripheral Venous Cannula.
Potential development – worked up:
Reducing Harm in Primary Dental Care;
Improving care for patients with learning disabilities: Directed Enhanced Service – the Learning disabilities annual health check;

6. Potential development – not worked up:
Reducing C. difficile;
Chronic Conditions Management
Primary Care;
Chronic obstructive pulmonary disease (COPD).
Supporting the development of:
A campaign to reduce domestic violence;
Wales eye health improvement programme;
Using the Model for Improvement within Smoking Cessation (in early discussion).

7. Where we want to be Two stage process:
Public Health Wales literature review of evidence and proposals put to the Board.
Topic/speciality specific steering group established to review proposed interventions.

8. Public Health Wales: Criteria
What is the gap between current health and healthcare outcomes (including avoidance of harm) when Wales is compared with best standards achieved internationally?
What is the scale of the problem?
What are the strongly evidence based interventions which have been shown to improve these outcomes?
What is the likely impact of these outcomes if they were fully implemented in Wales?
Knowledge of the power of the intervention and current extent of implementation in Wales required.
Focus on benefit to people – end to end care rather than episodes in individual sectors.

9. Questions for steering group to advise Board
Is the intervention relevant and achievable in Wales?
What timeframe will be required?
Are there links with national/local priorities?

10. Way Forward Continue with maintenance and tools
Complete ongoing areas and those starting soon
Ratify the areas worked up
Apply the process to future new areas

11. Applying the 2 stage process: the Learning disabilities annual health check
Is the aim clear?
Are there measures?
What are the interventions?
Have we addressed the criteria?