1. How to Pass your JAG Visit 10th March 2009

2. Housekeeping Fire Exits Evaluation – forms in packs – please complete
Interactive – please contribute

3. Introducing the team Roland Valori – National Endoscopy Clinical lead
Debbie Johnston – Operations Director, National Endoscopy Programme
Libby Thomson – National Nurse Advisor to NEP

4. Objectives To explain the JAG process
JAG standards – across 4 domains
the JAG visit website
preparing folders
To review the key learning from JAG visits
Questions and close

5. Timetable Outline of the process Audits Environment Waiting lists
Decontamination
Training
Workforce
Summary and close

6. Resources
Resource book
CD – including trainee feedback tool
The team

7. Deadlines for JAG visits
All acute hospital sites (207)
booked for a visit by April 2009 
visited by 31 Dec 2009
All private and community facilities (circa 250)
testing of process completed by 31 Dec 2008
visits completed by 31 December 2010
Northern Ireland
First visits in December 2009
Completed by 31 December 2010

8. Visit statistics - January 2009
Sites
Visited
Full approval
Deferred
To visit
Acute sector
125 91 34 84
Independent 10 2
144
Community 40
Total
137 93
268

9. JAG visit – the visited unit
Stressful
Hard work
Rewarding
Challenging
Exhilarating

10. JAG visit – the visiting team
Hard work
Rewarding
Challenging
Exhilarating
Learn lots

11. Wansbeck and North Tyneside - JAG accreditation visit
I’ve written to Roger separately about the exemplary quality of the process – if only all of the regulatory processes were this good.
The really striking (and humbling) thing though was the way yourself and the whole team have grasped the issue, driven massive improvements in a very short space of time and really transformed the service for patients.
Jim Mackey
Chief Executive

12. JAG accreditation The cost of a visit is currently £7,000/site
These charges cover administration, reimbursement of assessors and travel costs. There is no profit.
Feedback indicates the cost of a visit is more than offset by the benefits of going through the process:
Improved quality of care
New investment for under resourced units
Better recognition within the organisation of what the service provides
Improved staff morale

13. Most common pre JAG and JAG visit challenges
Training
Audits
Decontamination
Sustainability of waits
Environment issues

14. Training
Uniform across all disciplines (medical, surgical, nurse endoscopists)
Identified and empowered single training lead
Trainee feedback

15. Audits
Comprehensive rolling audit programme, supported by an Endoscopy Reporting System

16. Decontamination Non-compliant AERs
Flow of endoscopes (separation of clean and dirty)
Evidence of training

17. Environment
Privacy and dignity
Recovery area

19. Preparing for a JAG visit: Quality, comfort and safety items Collecting and presenting data, ………… and acting on it Roland Valori, March 2009

20. Motivation What motivates you?
What makes your staff prepared to go the extra mile?

21. JAG visits
A tick in the box
Opportunity to create high quality care

22. Audit
Lack of/incomplete audit – a common cause of deferral/delay in approval

23. Clinical data and JAG visits
Requirements for the visit
The ‘doing’
Data presentation

24. Preparing audit reports for a JAG visit
Difficulty E M D
Performance data on all indicators and outcomes
The timescale of each audit
Complete and consecutive data
All endoscopists included for that procedure
Data from other NHS units of each endoscopist
All relevant quality, safety and comfort parameters
A code that can identify every endoscopist
An explanation of anomalies
Data has been shown to all endoscopists
Action agreed with each endoscopist below standard

25. X Preparing audit reports for a JAG visit Difficulty E M D
Performance data on all indicators and outcomes X
The timescale of each audit
Complete and consecutive data
All endoscopists included for that procedure
Data from other NHS units of each endoscopist
All relevant quality, safety and comfort parameters
A code that can identify every endoscopist
An explanation of anomalies
Data has been shown to all endoscopists
Action agreed with each endoscopist below standard

26. X +++ - ++ Preparing audit reports for a JAG visit Difficulty Cost E M
Performance data on all indicators and outcomes X
+++
The timescale of each audit -
Complete and consecutive data
All endoscopists included for that procedure
Data from other NHS units of each endoscopist ++
All relevant quality, safety and comfort parameters
A code that can identify every endoscopist
An explanation of anomalies
Data has been shown to all endoscopists
Action agreed with each endoscopist below standard

27. X +++ - ++ Preparing audit reports for a JAG visit Difficulty Cost E M
Performance data on all indicators and outcomes X
+++
The timescale of each audit -
Complete and consecutive data
All endoscopists included for that procedure
Data from other NHS units of each endoscopist ++
All relevant quality, safety and comfort parameters
A code that can identify every endoscopist
An explanation of anomalies
Data has been shown to all endoscopists
Action agreed with each endoscopist below standard

28. Endoscopy reporting systems
Provide endoscopy reports
Collect data
Provide data reports - badly

29. Resource for data collection
Income for unit doing 5,000 procedures/year: 5,000 x £500 = £2,500,000
0.5% = £12,250
1.0% = £25,000
2.0% = £50,000

30. Effective audit Requires robust processes and IT support
collecting data
clear outputs
regular review
an approach for the disengaged

31. Examples of rolling audit programme

32. Examples
Quality data
Adverse outcomes
immediate
late
Comfort

33. Colonoscopy completion rates

34. Performance comparisons
Comparison of key outcomes
3 quarters
Split between level of training
Allows for quick overview
Nurse and Endo comfort scores

35. The data can then be linked to the patient record in the ERS
Swiftop Zoom
This A5 form follows the patient and is completed by the nursing team. The data is entered into the PAS the next day
The data can then be linked to the patient record in the ERS

36. Comfort of 4/5 versus patient opinion of worse than expected
Apr 07- Apr 08, independent colonoscopies

37. Comfort of 4/5 versus completion rate
Apr 07- Apr 08, independent colonoscopies

38. Completion vs comfort best 2034 Colonoscopies: Jan – Jun 2008
2306 Colonoscopies: Jul – Dec 2008

39. Completion vs comfort 2034 Colonoscopies: Jan – Jun 2008
2306 Colonoscopies: Jul – Dec 2008

40. Immediate adverse outcomes
Immediate outcomes
Adverse Events on swiftop
Highlight worrying trends if exist

41. Late outcome audit system
30 day mortality
8 day re-admission
ERCP 30 day audit
30 day mortality for SEMS
Bleeding / perforation
Audit system
automated endoscopy late outcome audit system
identify patients who have died within 30 days
facilitates the audit of these procedures
All procedures on SwiftOp
All deaths which the trust is notified of by GPs, Coroners, Hospices etc are registered on PAS
Readmissions recorded on PAS
Can produce list of patients from ALL sites who meet audit requirements, displayed in Late Audit System
Cases can be assigned to reviewers, filtered by the reviewer and site
Notes are reviewed and determined if case needs to go to clinical governance review.

42. Preparing audit reports for a JAG visit
Requires robust processes
Collecting data
Process that integrates with working practice
IT system
Clear outputs
Designed to meet GRS standards
Be useful for the user
Regular review
Plan a programme of meetings
Action planning
An approach for the disengaged
Assume there will be a problem
Plan rather than react