1. MCQIC: Phase 2 Prepared by: Bernie McCulloch
(with lots of help from Dr. Linda Clerihew )

2. Overview Current state
What has worked, what hasn’t, suggestions for future
What should MCQIC Paediatric Care look like going forward
Opportunity to feed in views to inform future state

3. Deteriorating Patients
SPSP
Update 11th May
PSHKI
Deteriorating Patients
Person Centred Care
Human Factors

4. Paediatric Serious Harm Key Index
Serious Safety Events
Serious Medication Event
Unplanned admissions to PICU
Central Line Blood Stream Infections
VAP
Child Protection
Apply to all units
All apply across whole patient journey
ICU only ?
Long term vent in community
At first ICU – DGH & now homecare teams

5. Deteriorating Patients
PEWS
Sepsis
Watchers Bundle
National
Embedded

6. Person Centred Care Family Child Staff
What Matters to Me
Family
Improvement Trees
Staff
Safety briefs, Effective handovers,
Structured ward rounds
Embedded

7. HUman factors
their influence of disruption and distraction, for example on performance and susceptibility to error.

10. Pros Cons Opportunity VERDICT ?
PSHKI – applicable to all areas, not just large units & PICUs
Low numbers
acute hosp based programme
i.e. within our sphere of influence
Lots of Data – process
& outcome at board level
Unique National Programme
Cons
Difficulty aggregating data as more & more measures are reported o in more areas
Don’t see the whole journey of the child, no joined up transitions,
Limited National aggregation Variance in reporting with programme change in 2013/14
Consensus takes time
Opportunity
Focus on common errors: medication, periop safety
Focus on other issues –medicines, periop safety
flow, readmissions, QI within speciality networks
Consolidate
Aggregate
International Sharing

11. International Sharing
USA measures
Adverse drug events (ADE)
Catheter-associated urinary tract infections (CAUTI)
Central line-associated blood stream infections (CLABSI)
Injuries from falls and immobility
Obstetrical adverse events (OBAE)
Peripheral intravenous infiltration and extravasations (PIVIEs)
Pressure ulcers (PU)
Surgical site infections (SSI)
Ventilator-associated pneumonia (VAP)
Venous thromboembolism (VTEmm
Scotland as a country is leading the way
On the tipping point of demonstrating good national outcome data

12. So What about social care integration?............

14. MCQIC & SPSP Maternity Neonatal Reducing harm from key Indicators
The Integration Question ?
MCQIC & SPSP
Maternity
Smoking ?Obesity,
Neonatal
Reducing harm from key Indicators
Deteriorating Patients
Morbidity Mortality
Paediatrics
Mental Health CAMHS -Eating disorders, suicide
Primary Care: Dentistry
HAI & Medicines
(Acute Adult) Mental Health, Primary Care, HAI, Medicines
Key areas for focus determined by speciality
Generic Improvement Activity:
Leadership, Culture, Safety Briefs, Human factors, Huddles, etc

15. MCQIC
Diabetes

16. Healthcare associated harm but across the whole journey”
The Future
“Outcomes for children in the UK are poor – focus needs to be on sphere of influence, not sphere of concern
Healthcare associated harm but across the whole journey”
Dr. Linda Clerihew
National Clinical Lead McQIC Paediatric Care
“ I believe this is about becoming better at what we have already agreed,
Identifying how to link with other groups to agree paediatric specifc priorities “

17. The Future Continue measurement plan
Ensure reliable measurement/ reporting
therefore aggregation of data
Greater focus on medicines harm
high risk meds (e.g gentamicin & acute kidney injury), prescribing, administration and med reconciliation
Consider Scotland as pilot for a 'decision -making tool ' that RCPCH have been working on “Paediatric Care on Line”
Perioperative safety
Child Protection measure to be agreed

18. ? A role for MCQIC sharing QI methodology
The Future
? A role for MCQIC sharing QI methodology
with the other specialist services NDP networks
- Asthma, Diabetes, Epilepsy, Neurology, Oncology etc
Encourage disease specifc teams to work on their priorities
(top causes of admissions would identify priorities)
Deteriorating patient & integration with HDU network
Readmissions & Flow e.g. looking to decrease asthma related deaths and readmissions with better discharge planning/interval management etc.
Reducing unnecessary hospital attendances

19. DISCUSS