1. South East Wales Critical Care Network Challenges Ahead

2. Presentation Overview 2 nd Strategic Framework 2008-2011 Key issues for Critical Care in SE Wales How can you become involved?

3. 2 nd Strategic Framework Ministerial letter issued 27 th August 2008 1 st priority – full compliance with Core Quality Requirements Delayed Discharges Local Delivery Plan by each organisation (20 th October) Network Level Delivery Plan (end November) Quarterly monitoring by Regional Offices starting December 08 Annual report on performance by end April

4. Aim 1 - High quality critical care for adults Full participation in ICNARC – October 08 Capacity Assessment (incl DTOC) – Nov 08 Network level Action plans – Nov 08 Regular audit against Quality Requirements Patient and public engagement programme Key Quality indicators NICE Guidance CG50 and CG56

5. Aim 2 – Improved efficiency & effectiveness by modernising and standardising practice All Wales Transfer and Transport Evidence base and guidance for elective surgical admissions Critical Care Minimum Data set Performance Monitoring framework Common costing framework Currency to aid planning & delivery Longer term strategic information technology base

6. Aim 2 contd. Workforce development framework Evidence base best practice & new technology Care bundle compliance 1000 Lives interface Service Developments & Senior appointments Quality Requirements “Core” and “priority” Specialist weaning & progressive care for long term ventilation Organ donation Taskforce recommendations

7. Key issues for SE Wales Network Gaps against Quality Requirements Delayed Transfers of Care Outreach Policies and procedures Equipment – potential for saving Emergency Planning & Flu Pandemic Renal patients NICE Guidance CG50 and CG56

8. Transfers & Transport North Wales Network - All Wales Guidelines Drafts have been widely circulated SEWCCN Small Task & Finish group Audited equipment and transfers Wider group now required with all units and stakeholders to:- Plan and organise transfer system in the region Review audit of transfers Transfer training Nursing Reps already nominated. Medical Reps required from Gwent & Cwm Taf

9. Outreach Senior Nurse forum developed the core principles of an Outreach Service Service model and specification NHS Trusts – service development/business cases SEWCCN Task & Finish group Reps required – Medical & Nursing. 2 Physio reps already nominated

10. Flu pandemic planning a priority Regional approach required and common use of ICU beds National guidance available North Wales Network already developing guidance and plans SEWCCN Working Group Emergency Planning & Flu Pandemic

11. Head Injury – CG56 Severe Head Injury pathway for patients requiring critical care Management of severely brain injured patients who remain in the local ICUs Repatriation North Wales Network examples Neuroscience Review http://new.wales.gov.uk/topics/health/news/neuroscience/?lang=en http://new.wales.gov.uk/topics/health/news/neuroscience/?lang=en SEWCCN Working Group

12. Acutely Ill – CG50 Trust priority across acute care but implications for critical care Interface with Outreach group Interface 1000 Lives campaign National and local work in progress NICE CG50 Compliant ICU Discharge summary SEWCCN Working Group

13. Policies & Procedures Critical Care Operational PolicyYYNYNN Admission policyYYYYYY Discharge policyYYYYYY Escalation policyNYYYNY Admin of IV drugsNNYYYY Admin of inhaled drugsNNNNY Admin of drugs by other routesNNYYY Assessment and management of tracheostomyYYYYYY Assessment and management of patients with communication difficultiesNNNYNY Assessment and mgt of dysphasic patientsNNYYNY Communication with ICU ConsultantNNNNNY Communication with the critical care serviceNNNNNY Provision of info to patients/relativesYYYYYY Induction of new staffYYYYYY Transfer of patients in or out of the unitYYYYYY Use of all invasive monitoringYYNYN use of all invasive proceduresYYNYY Assessment and support of nutritionYYYYY Identification of critically ill on wards protocolNNYYNY Protocol for critical care to be notified of all level 1 patientsNNYYN Moving patients between dependenciesNNNYN

14. Short Lived Policy Groups Common Standard across the region, best practice for local implementation Admission & Discharge (already started) Assessment & management of Tracheostomy ITU Follow Up Management of Delerium

15. Patient & Public Involvement All Wales Critical Care Advisory group recommendations: Each unit must have a strategy/plan for the involvement of patients & carers Non prescriptive but action appropriate to local issues Plans to be submitted to Network & 6 monthly progress reports All Wales PPI questionnaire to support consistency

16. How can you become involved? Service Improvement group consists of 12 people Knowledgeable and experienced staff within the service Working groups Balance of professions and across region Work acknowledged within the Network Process – to Service Improvement Group and endorsed by Network Board Agree with each group a “leader”

17. Working Groups - Nomination forms Transfers & Transport Outreach Emergency Planning & Flu Pandemic Head Injury – CG56 Acutely Ill – CG50 Admission & Discharge policy Assessment & management of Tracheostomy policy ITU Follow Up policy Management of Delerium policy