Deteriorating Patient

The NHS is standardising the assessment of acute-illness severity using the physiological ‘track and trigger’ National Early Warning Score (NEWS) system to identify patients at risk of deterioration.

This is a key step in the identification of patients with sepsis and the AHSN NENC will build on the work already done in the region to support the widespread adoption of NEWS in all healthcare settings to allow a common language to communicate, risk and the need for appropriate escalation of care.

Completed Projects

Please find below a selection of projects which are now complete:

Can a robust implementation of the AMBER Care Bundle, Deciding Right and Palliative intervention improve Advance Care Planning, Patient Experience, greater patient safety and an improved plan of care for patients who have an uncertain recovery and a life limiting illness?

Project lead: Mr John Sheridan (North Tees & Hartlepool NHS Foundation Trust)

North Tees & Hartlepool NHS Foundation Trust are looking at whether a robust implementation of the AMBER Care Bundle, Deciding Right and Palliative intervention improve Advance Care Planning, Patient Experience, greater patient safety and an improved plan of care for patients who have an uncertain recovery and a life limiting illness?

Patients who have an uncertain recovery due to underlying frailty or disease burden often utilise secondary care due to lack of appropriate care planning. Whilst there are tools and guidance available they are rarely effectively linked or used in a collaborative approach into an integrated package that allows for greater planning and improved patient safety, experience and care. The lack of effective care planning in this client group is seen as a significant patient safety issue, in relation to inappropriate readmissions into secondary care when the patient has a clear preference in regards to their preferred place of care or death.

With a focus on empowering and enabling clinical teams to undertake effective use of the AMBER Care Bundle and adopt greater partnership working when arranging and developing transfers of care. As the Bundle is a hospital tool the FT are working with GSTFT in its use and approach, whilst making a strategic link to the use of Deciding Right, Advance Care Planning, Escalation decisions and patient safety. The collaborative use of these tools and policies will be audited and presented to the trust board and key stakeholders with key evidence in relation to the effectiveness of the project.

Programme Lead: Jonathan Murray

The Acute Kidney Injury programme initially promoted consistent management of Acute Kidney Injury (AKI) across all Trusts within the North East and North Cumbria.

This programme raised awareness of patient safety risks associated with delayed AKI recognition and the adverse outcomes associated with this syndrome to over 1000 staff across all the trusts in the region. An independent Clinical Informatics company that collects clinically important data across many hospital Trusts throughout England noted a 36% reduction in AKI cases within the surgical wards at South Tees NHS Foundation Trust that coincided with the onset of this AKI programme. Furthermore, this significant reduction in AKI cases has been sustained after completion of the programme in this Trust, suggesting a cultural legacy of sustained AKI awareness. This programme was highly commended at the national Patient Safety Awards in July 2017 and the team have been approached by teams elsewhere in the country who have expressed interest in adopting their programme, including North West Coast, London and Oxford AHSNs.

The AKI programme is now focused on developing strategies to support AKI detection and management by Primary Care teams across the region, in order to reduce patient harm due to AKI in the community. Central to this aspect of the project, is the aspiration to harmonise AKI aftercare through good transitional care across hospital and community services. So far 12 CCGs are involved and over 600 staff has been trained. As part of this phase of the programme, 4 Primary Care Practices from the region are collecting AKI data which has contributed to the development of a national Primary Care AKI toolkit formulated in collaboration with the Royal College of General Practitioners.