1. Powys teaching Health Board
11th May 2010
Powys teaching Health Board
Presenter: Dr Brendan Lloyd

2. Our 1000 Lives Plus achievements
Opportunities for new work:
Merger
Extend across primary, secondary, community care and voluntary sector
Demonstrate success in rural setting
Mandatory measures are already in the bag:
WHO checklist – full implementation in Powys theatres
Surgical hypothermia – already eliminated in Powys theatres
Acutely ill patient – all patients now on “track and trigger” form. Real-time monitoring of ward acuity.

3. Mortality in Powys Jan-Dec 2008 1431 Powys residents died.
in our hospitals
43% in other providers
Hospitals
Death Certification Pilot
Data: C. Jarrett, Death Certification Project, Clinical Governance Powys THB

4. Mortality and HSMR: Hereford

5. Area: Mortality, HSMR & Palliative Care
Aim
Drivers
Interventions
Tests of Change
HSMR data features in all Quality Reports
Collect HSMR data from both Welsh & English providers – monitor through Quality & Safety committee
Provide assurance to Board regarding HSMR of provider hospitals
Work with partners to achieve targets in HSMR reduction
Mortality
HSMR
Palliative Care
Continue participation in DH Death Certification Pilot
Increase choices for Powys residents in line with Last Days of Life – aim 10%
Improve quality & choices for Powys residents
Increase choices available to Powys residents through extended palliative care, nursing and social service teams
Patient and relative survey on availability of appropriate choices
Create “pull” system in line with “Setting the Direction” to enable best treatment

6. Area: Pressure Ulcer Aim Drivers Interventions Tests of Change
Percentage of care settings using standardised clinical assessment tool – aim for 95%
Improved clinical assessment of skin integrity in all care settings
Implement a standardised clinical assessment tool for risk of pressure ulcers in all care settings
Percentage of patients with completed assessment tool outlining level of risk of pressure ulcer – aim for 95%
Reduce number and severity of pressure ulcers across hospital, community and care home sector
Percentage of clinical areas using pressure ulcer care bundle
Aim for 95%
Improved clinical care of patients at medium and high risk of pressure ulcers
Implement a pressure ulcer care bundle that can be used in various settings
Compliance rate of pressure ulcer care bundle – aim for 95%
Incidence of pressure ulcers; and days between pressure ulcers – aim for 50% improvement
Improve whole systems care – incorporating community hospitals, community and care homes
Establish a mini- collaborative across Health & Social Care within Powys to link together differing areas of practice
Number of mini-collaborative meetings (include virtual meetings/audio etc); aim for 3 in 2010

7. Area: Catheter Acquired Urinary Tract Infection
Aim
Drivers
Interventions
Tests of Change
Percentage of clinical areas using clinical decision making guide (aim for 100% in all areas)
Implement a clinical decision making guide regarding rationale for insertion of urinary catheters
Improved clinical decision making regarding insertion of urinary catheter
Percentage of patients with urinary catheter with completed decision making guide indicating catheterisation
Reduce rate and number of catheter acquired urinary tract infections across hospital, community and care home sector
Establish a standardised approach to catheter storage and identification of device of choice
Compliance with standardised catheter identification and storage
Improved clinical care of patients requiring urinary catheter
Percentage of clinical areas using urinary catheter care bundle
Implement a urinary catheter care bundle that can be used in various settings
Compliance rate of urinary catheter care bundle
Improve whole systems care – incorporating community hospitals, community and care home
Number of mini-collaborative meetings (include virtual meetings/audio etc); aim for 3 in 2010
Establish a mini- collaborative within Powys to link together differing areas of practice

8. Area: Medicines Management
Aim
Drivers
Interventions
Tests of Change
Identify high risk medicines in Powys
Increase compliance with local formulary for high risk medicines – target 85%
Appropriate use of high risk medicines
Implement NPSA/NICE guidance
Percentage of NICE/NPSA guidance audited within 12 months of introduction – 50%
Reduce iatrogenic harm due to medicines
Communication of patient medication list
Implement electronic discharge/transfer medicines lists (IHC)
Percentage of medicine lists included in patient discharges & transfers
Implement effective medicines reconciliation on admission
Extend to all Powys wards
Errors in prescribing and administration
Number of systems installed in Powys hospitals within 12 months
Implement electronic transcribing and/or prescribing system in Powys hospitals (IHC)

9. Area: QI Development Aim Drivers Interventions Tests of Change
Develop a Faculty across Health & Social Care supported specifically by Lives Plus
Number of staff who have received Advanced Quality Improvement Training – aim for Faculty of 10 by end of 2010
Integrated working across Health & Social Care
Reduce Patient Harm and Improve Care through elimination of interface problems between primary care, community hospitals, DGH and Social Services
Implement programme of Quality Improvement Learning facilitated by NLIAH
Key learning points identified and published in academic journal with links to Welsh University
Community Teams delivering “Setting the Direction”
Develop partnership with Institute of Rural Health (IRH) identifying key learning from QI in rural environment
Series of Action Learning Set meetings every 8 weeks; aim for 3 in 2010
Improve Quality Improvement Capacity in Organisations
Action Learning Sets:
British Association of Medical Managers and NLIAH – develop with leaders across Health, Social Care & Voluntary Sector

10. Thank You

11. Thank You