Programme

Registration and refreshments

Opening remarks from the Chair

Developing the competencies to recognise and respond to acutely unwell patients in hospital

• Recognising the scale of the problem – responding to the evidence of sub-optimal care
• Defining the professional Chain of Response to the deteriorating patient that the Competency Framework is built around
• Exploring the collaborative competencies required to effectively maintain the Chain of Response and ensure the safety of patients 
• Understanding how the Competency Framework relates to nursing roles
• Implementing the Competency Framework – using the Framework to provide consistent standards for staff involved in the management of the acutely unwell patient

Exploring the Patient Safety First intervention – Reducing Harm from Deterioration

• Preventing harm and reducing in-hospital cardiac arrest through earlier recognition and treatment of the deteriorating patient
• Background to the intervention:
• The National Confidential Enquiry into Patient Outcome and Death
• The 2007 NPSA Report
• The NICE guidance
• The Safer Patients Initiative 
• A practical guide to implementing an improvement programme
• Making the business case for investment in nursing to address patient safety issues

Case study: Implementing the Reducing Harm from Deterioration intervention

• Ensuring that all patients in acute settings have their physiological observations taken and recorded
• Training staff to have the competencies required to undertake observations, understand their clinical relevance and how they should appropriately respond
• Using physiological track and trigger tools to monitor patients
• Developing a graded response strategy for at risk patients and putting an escalation protocol in place to support it
• Using communication tools to safeguard the deteriorating patient

Question and answer session

Morning refreshments

Improving the quality of physiological observations to better enable the recognition and rapid treatment of the deteriorating patient

• Ensuring that physiological observations have a higher priority and are seen as a core element of the nursing role
• Making sure that practitioners undertaking observations have the competencies required to accurately record and understand them 
• Addressing raining and development issues
• Assessing competence and improving the safety of nursing care
• HCAs: Delegation and accountability
• Record keeping and documentation issues
• Electronic measurement versus a return to traditional physical measurement – have we deskilled a generation of nurses? 

Recognising and responding to deterioration

• What are the early warning signs of physiological deterioration that nurses should be watching out for?
• Evaluating the range of physiological track and trigger systems that
• Analysing the deteriorating patient care pathway – picking up unusual patterns and preventing avoidable mortality
• The role of the nurse in identifying and escalating the care of deteriorating patients and ensuring that all staff are aware of their role within the graded response system
• Exploring the role of critical care outreach and understanding the criteria for admission to critical and intensive care units
• Examining the evidence for investing in rapid response teams

Question and answer session

Lunch

Case study: Using Failure to Rescue as an indicator of nursing quality

• An update on the development of quality indicators for nursing practice
• Exploring the opportunities and challenges of measuring Failure to Rescue as a nursing indicator
• Reducing mortality from Failure to Rescue:
• Carrying out rapid route cause analysis to identify where there has been sub-optimal care
• Tools that can reduce Failure to Rescue on the wards
• Transforming hospital culture and techniques that can identify and respond to patients at risk of deterioration
  

Case study: Using a communication framework at handover to improve patient outcomes

• Recognising that the increasing acuity and complexity of patients needs represents a challenge to busy ward staff
• Undertaking a Plan, Do, Study, Act (PDSA) cycle for the introduction of communications tool
• Exploring the use of the SBAR communications tool
• Using SBAR to provide a clear structure to handover, improve the quality of information given and dramatically reduce the time taken
• Using SBAR to help deliver the following outcomes:
• An 11% reduction in hospital mortality
• A 65% reduction  in adverse events
• An 8% reduction in cardiac arrests

Question and answer session

Afternoon refreshments

Case study: Improving the detection of deterioration through patient and relative initiated critical care outreach

• Describing a multi-faceted approach to detecting deterioration through early warning scoring, critical care outreach and a surviving sepsis campaign
• Demonstrating the positive impact of the different approaches through audit and evaluation
• Introducing the innovative approach of Call 4 Concern (C4C), a patient and relative initiated critical care outreach service
• Evaluating the effect of C4C on patients, relatives and staff

Case study: Enhancing collaborative working to reduce the number of cardiac arrests

• Implementing cultural and organisational change to improve the recognition and management of deterioration
• Demonstrating how frontline staff can develop innovative solutions to organisational problems
• Undertaking a Breakthrough Series collaborative based on the Institute for Healthcare Improvement (IHI) model to engage staff to change to change their clinical area
• Exploring the IHI approach to safety improvement
• Changing the culture to one where cardiac arrests are seen as ‘never events’
• Delivering a 32% reduction in cardiac arrest