Aims, Goals and Measures of the Scottish Patient Safety Paediatric Programme & integration with SPSP

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Aims, Goals and Measures of the Scottish Patient
Safety Paediatric Programme integration with
SPSP
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Why develop a Scottish Patient Safety Paediatric
Programme?

• Successes of the Scottish Patient Safety
  Programme (SPSP).
• Not little adults.
• Programme designed to recognise the unique
  configuration of Scotlands paediatric services.
• 1st country-wide improvement programme for
  paediatric patient safety.
• Extension of SPSP.

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Scottish Patient Safety Paediatric Programme
Driver Diagram
Identify appropriate paediatric aims
Improve outcomes in paediatric healthcare in
hospitals across Scotland by June 2013
Governance structure
Improvement capacity within paediatric community
Align with SPSP
Engage wider stakeholder groups
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SPSPP programme principles

• Adopted SPSP workstreams.
• Inpatient paediatric care (all ages).
• Aims
• paediatric evidence-base
• best in class
• linked to measurable outcomes.
• Dynamic improvement programme.
• Relevant to paediatric hospital care delivered in
  Scotland.

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Scottish paediatric care
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What defines paediatric harm?

• NPSA Review of patient safety for children and
  young people
• difficulty recognising severity of illness
• high rate of medication administration errors
  particularly dosing errors
• lack of integrated approach to childrens risk
  management that incorporates health, education
  and social care
• improve communication and listening skills by
  healthcare professionals, with more effective
  inter-professional communication
• lack of recognition and appropriate management of
  mental health issues in young people
  appropriate environments etc.

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Aim - Scottish Patient Safety Paediatric Programme

• 30 reduction in adverse events by June 2013
• Reliable systems that can measure the application
  of
• best practice and continually improve outcomes
• learning from paediatric mortality review
• improve recognition of the deteriorating child
• reduce healthcare associated infections
• improve paediatric critical care outcomes
• reduce adverse surgical incidents
• improve medicines management processes
  reduced harm from medicines

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Reduce adverse events by 30 by June 2013
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Promote learning from paediatric mortality

• SPSP Aim 15 reduction in hospital mortality.
• HSMR developed for SPSP
• not designed for paediatrics.
• Develop local mechanisms to identify avoidable
  factors within the paediatric programme
• SPSP mortality review tools.
• SPSPP to link to the child young person review
  of serious morbidity and mortality.

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Improve recognition of the deteriorating child

• Aim All children transferred to a higher
  level of care should have a completed PEWS score
  by June 2013.

Percent compliance with early warning score
assessment
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Reliable delivery of evidence-based practice
improved outcomes
Work Stream Process Outcome
Critical Care VAP prevention bundle CVC bundles Daily Goals Reduction in VAPs Reduction in BSIs Improved communication
Paediatric Ward Paediatric Warning Systems Hand Hygiene Safety Briefings Recognition of deterioration Reduction in HAIs Improved communication
Peri-operative On-time Antibiotics Surgical Pause Surgical Site Infections Reduction in surgical incidents
Medicines Management Medicines Reconciliation Dosage calculations Reduction in adverse drug events
Leadership WalkRounds Safety strategic priority Culture of Safety
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Reliable delivery of evidence-based practice
improved outcomes
Work Stream Process Outcome
Critical Care VAP prevention bundle CVC bundles Daily Goals Reduction in VAPs Reduction in BSIs Improved communication
Paediatric Ward Paediatric Warning Systems Hand Hygiene Safety Briefings Recognition of deterioration Reduction in HAIs Improved communication
Peri-operative On-time Antibiotics Surgical Pause Surgical Site Infections Reduction in surgical incidents
Medicines Management Medicines Reconciliation Dosage calculations Reduction in adverse drug events
Leadership WalkRounds Safety strategic priority Culture of Safety
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SPSP reliable application of central line
insertion bundle
Central Line Bundle Compliance
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SPSP linking process compliance to outcome
Central Line Bloodstream Infection Rate
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Decreasing PICU Catheter-Associated Bloodstream
Infections NACHRIs Quality Transformation
Efforts

• In contrast with adult ICU care, maximizing
  insertion-bundle compliance alone cannot help
  PICUs to eliminate CA-BSIs. Instead, the main
  drivers for additional reductions in pediatric
  CA-BSI rates seem to be issues surrounding daily
  maintenance care for central lines.

Margolis et al, (2010) Decreasing PICU
Catheter-Associated Bloodstream Infections
NACHRI's Quality Transformation Efforts
Pediatrics (125) 206-213 (NACHRI - National
Association of Children's Hospitals and Related
Institutions)
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Leadership to support Scottish Patient Safety
Paediatric Programme

• SPSPP integrated component of NHS boards patient
  safety programme by June 2011.
• Walkrounds, by NHS Board senior team.
• Actionable items - for paediatric wards.

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Medicines Management CCHMC reducing harm
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SPSP Peri-Operative - SSI bundle compliance
Percent on-time prophylactic antibiotic
administration
Trend in data
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SPSP Peri-Operative outcomes using data for
improvement
Percent surgical patients developing surgical
site infection
12-2007 Wd Nurses start 30 day f/up not ICN
4-2007 Start testing SSI bundle Wd 16
6-2007 Implement SSI bundle Orthopaedics
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Scottish Patient Safety Paediatric Programme

• Appropriate, timely and reliable evidence-based
  care - linking process to outcome.
• Focus on delivering child family centred-care.
• Promotes effective and collaborative
  multi-disciplinary team working.
• Leadership, infrastructure culture that
  supports safety quality.
• Paediatric workforce - capacity capability.

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Sharing collaboration across paediatric wards,
hospitals NHS Boards
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Scottish Patient Safety Paediatric Programme

• getting it right every time for every child in
  Scotland