Early Warning Score Archives - Health Innovation West of England

How our Learning Disabilities Collaborative was formed

Posted on June 14, 2021June 9, 2021 by Vanesther Hamer

In this blog to mark Learning Disabilities Week 2021, Dr Alison Tavaré, who is a GP, one of our Primary Care Clinical Leads and South West Clinical Lead for the NHS@home programme, discusses how the idea for the West of England Learning Disabilities Collaborative (WELDC) took shape…

As a GP and a clinical lead at the West of England AHSN I have always had a special interest in the use of NEWS2 (National Early Warning Score) to support clinicians in the early identification and management of the unwell patient. However, the more I used NEWS2 the more I wondered if patients could record observations such as their blood pressure or pulse rate and share these measurements with clinicians to help us decide whether they needed to be seen, and if so by who, and with what urgency. Read more about NEWS2.

Making connections

The idea evolved and I shared it with my brother Ian, and his wife Kate, who are the parents of Toby who has a learning disability and therefore finds it a challenge to tell others when something is wrong. A few months later Toby developed a cough and became very quiet and subdued; while this may not be unusual for many people, for Toby this can be a sign that he is unwell. Kate took a full set of observations, calculated a NEWS2 score of 6 and took Toby to the local emergency department where he was promptly treated for sepsis.

LeDeR (Learning Disability Mortality Review) has identified that not only are people with a learning disability more likely to die of sepsis but on average they die more than 20 years younger than the general population. While this may partly be due to underlying health conditions it is also known that being unable to say you are unwell is another contributing factor.

Sharing Toby’s story

With permission I started to share Toby’s story when I spoke about NEWS2 and soon found there were many others who shared my concern that communication could be difficult if someone who has a learning disability becomes unwell. Anne Pullyblank, the medical director of the West of England AHSN, and I therefore decided to find out if there could be any interest in developing a group where practical ideas and strategies could be shared. We sent a speculative email which immediately generated lots of positive responses, and in 2019 the West of England Learning Disability Collaborative (WELDC) was established. There are now over 300 members from diverse backgrounds and include experts by experience, families, carers and clinicians.

Continuing the WELDC journey

The WELDC has continued to flourish and in the past year alone have delivered webinars on COVID-19, annual health checks, digital solutions and advance care planning. Alongside this there has been lots of sharing of knowledge and expertise and we have even had a question asked in the House of Lords. Most recently we have worked with the NHSE Learning Disability and Autism team to co-create training on ‘soft signs’ and communication which has been delivered to 8000 families and carers.

As there is increasing awareness of the health inequalities experienced by people with learning disabilities, we feel that the WELDC is well placed to support new models of care and look forward to seeing the collaboration continue to evolve and contribute to better outcomes for people like Toby.

Read our new blog: Co-creation in the West of England Learning Disabilities Collaborative: ‘Done with, not to’.

New online video training for care home staff

Wessex and the West of England Academic Health Science Networks (AHSNs), and West Hampshire CCG, funded by Health Education England, have collaborated to produce a series of free videos and e-learning materials to support staff working in care homes to care for residents who are at risk of deterioration.

As recognised in a recent paper supported by North East and North Cumbria AHSN, identifying acute illness, including sepsis, amongst older adults in care homes can be difficult, and opportunities to initiate appropriate care may be missed, if illness is not recognised promptly.

Videos

The short videos describe how to take measurements from residents correctly (such as blood pressure and oxygen saturation), spots the signs of deterioration, and prevent the spread of infection.

You can access them via Health Education England’s e-Learning for Healthcare (e-LfH) Hub, an educational web-based platform that provides quality assured online training content for the UK’s health and care workforce here.

You can also view the full suite of videos on our designated YouTube channel.

Natasha Swinscoe, national lead for patient safety for the AHSN Network says:

“Patient safety is a guiding principle for all AHSNs. Our care homes report highlighted numerous successes that AHSNs have had working with care homes across the country. Collectively, these have the potential to save many lives and tens of millions of pounds. I am excited to see the launch of these videos, which will support care home staff to be trained in a consistent way to recognise and respond to the soft signs of deterioration”.

This is one of a range of tools which AHSNs are supporting to provide training materials to up skill people who work in care homes, which will be published on our website over the coming weeks. This follows the AHSN network report, which highlighted over 30 examples of projects delivered by England’s 15 Patient Safety Collaboratives (PSCs) and the AHSNs which host them, published in September 2019.

Guidance for care home staff to register for an account

To register for e-Learning for Healthcare visit this link.

Select the ‘Register’ button. Select the option ‘I am a care home or hospice worker’ then enter your care home / hospice name or postcode and select it from the options available in the drop-down list. Finally enter your care home / hospice registration code and select ‘Register’. You may need to see your employer to get this code.

If your employer does not have a code, then they need to contact the e-LfH Support Team. The Support Team can either give the employer the registration code or arrange a bulk upload of all staff.

Detailed instructions on how to gain access are available here.

Quick start guide to e-LfH hub is also available here.

Emergency Department Safety Checklist Masterclass

“Checklists are like toothbrushes; everyone wants one, but they don’t want to use anyone else’s!”

On Monday 25 April 2016, the West of England Academic Health Science Network (AHSN) hosted a free masterclass on the Emergency Department (ED) Safety Checklist, piloted at University Hospitals Bristol NHS Foundation Trust (UHB). Delegates were invited from EDs and AHSNs around the country that had expressed an interest in the project.

The masterclass was attended by 22 delegates from 12 different organisations.

Dr Emma Redfern, ED Consultant from UHB, explained why they had developed the ED Safety Checklist: to respond to the challenges of crowding in ED; to be able to quickly assess the sickest patients (by using the National Early Warning Score (NEWS) as an indicator); and to be able to triage according to patient’s needs.

Alex Hastie and Caroline Clark, ED Nurses from UHB, explained how the ED Safety Checklist had been developed. They described the quality improvement methods and the plan-do-study-act (PDSA) cycles employed to test the checklist, and described the benefits they had realised ‘on the shop-floor’:

an aide memoire for basic clinical care,
NEWScores used to differentiate the sickest patients,
a tool for measuring performance in real time
a tool to support staff when they are at full capacity
a tool to resource plan during periods of crowing
a ‘how to’ guide for bank and agency staff unfamiliar with the setting
a reduction in free-text writing in notes which has consequently improved patient contact time.

The West of England AHSN presented the implementation toolkit developed to assist adopting Trusts with how they might introduce the principle of the ED Safety Checklist. We also explored the principle of measurement to prove an intervention has an impact, key performance indicators and the ‘Life’ web-based platform to support quality improvement projects.

Dr Phil Cowburn, Acute Care Medical Director at South Western Ambulance Service NHS Foundation Trust (SWASFT) and Consultant in Emergency Medicine at UHB described the challenges of interfacing the ED Safety Checklist with the ambulance trust, particularly where the responsibility of risk sits for patients waiting to off load into ED in the queue.

Feedback from delegates on the day was very positive and the masterclass was well received. Funding, staff capacity and general ‘intervention fatigue’ were seen as challenges. However, the benefits of the ED Safety Checklist, the improvements to patient safety, improved patient triage, improved patient flow through ED, and improved staff resourcing and management were recognised and agreed across the board.

The slide show from the ED Safety Checklist masterclass can be downloaded here.

A full event write up on the ED Safety Checklist masterclass can be found here.

The ED Safety Checklist Toolkit can be downloaded here.

If you’d like any further information on this programme, please contact ellie.wetz@weahsn.net.

South Western Ambulance Service moves to electronic patient care records

This spring, the South Western Ambulance Service (SWASFT) launched a new electronic Patient Care Record (ePCR) with Weston Area Health NHS Trust – an electronic solution designed by paramedics for paramedics.

19 emergency vehicles have been fitted with the ePCR device and 14 clinical workstations have been installed at five receiving units at Weston General Hospital. 98 SWASFT clinicians have been trained in using the new kit.

This is an exciting development for our ‘Safer Care through Early Warning Scores’ as NEWS (National Early Warning Score) will be automatically calculated, recorded and communicated for all patients using the portable monitoring equipment.

Led by Francis Gillen, Executive Director of IM&T, and clinically managed throughout by Dave Partlow, East Division Clinical Development Manager, SWASFT has over the last three years, worked tirelessly on the development of an Electronic Care System finally fit for a modern 21st century ambulance service.

The ePCR will enhance patient experience, support the decision-making process of frontline clinicians and open up opportunities for the transmission of data being captured to help improve SWASFT’s overall operations.

Background

The ECS has been created in partnership with Ortivus, a leading supplier of mobile solutions for modern emergency medical care. The solution aims to eradicate paper-based data collection, enhance the clinical decision making process and support the provision of ‘right care in the right place at the right time’.

The project was initially part of four work programmes led by Connecting for Health and aimed to provide an electronic solution across the South of England. Although looking in particular at an ambulance based solution, functionality to support further integration at a later stage has been a consideration throughout.

David Partlow says, “We wanted to find a system that is highly configurable by the ambulance service and a solution that is focused on the needs of a modern 21st century ambulance service. We wanted a service driven by the provision of high quality care and the desire to ensure that the patient outcome meets the needs of the individual patient, but is also focused on supporting the clinician in determining the most appropriate pathway and providing care that meets the objectives of the wider urgent care agenda.

How the ePCR was designed

The ePCR has been configured by a small but very dedicated project team in SWASFT. Using a structured model of examination and assessment, the software is configured so as to take the clinician through a structured process, capturing any and all clinical interventions and where possible and appropriate incorporating validated assessment tools to enhance the clinical decision making process. This in turn allows the clinician to use the solution to support
their clinical assessment and ensure that patients are conveyed or signposted to the most appropriate service.

The solution offers full connectivity at a clinical workstation, connecting the individual end user device via the 3G network. This allows the acute trust and other clinical partners to view the appropriate record and provide early indication of potential patients with regards levels of acuity and likely interventions. The solution is expected to provide for full NHS Spine connectivity and therefore supports the Summary Care Record.

Information Governance requirements feature heavily in SWASFTs requirements and there was a clear need for patient identifiable data to be held securely and only made available to those with a clinical need to see it. Data is only held on the end user device during the patient engagement; once closed and signed the data is held securely on a hosted server and cannot be accessed by anyone unauthorized to do so.

The capture and controlled transmission of patient data is available in the form of highly configurable output forms. This can be created and auto populated from data already entered, to enable Falls Referrals, TIA Clinic Referrals, Safeguarding Referrals and other suitable clinical outputs which further enhance the patient outcome and patient
experience.

The device incorporates a web browser, enabling the clinician to view a selection of approved websites such as toxbase, Athens and NICE. The device also holds a number of hard file documents, such as JRCALC, other national and local guidelines, Patient Group Directions and Operational Instructions.

The solution can and will also enable access via web links to the Directory of Services. Crews are often unaware of the options available to them to enhance the appropriateness of conveyance and this will greatly enhance the ability of SWASFT to build on its Right Care agenda, increasing the appropriateness of conveyance and decreasing the numbers inappropriately conveyed to the emergency departments.

What the future holds

The benefits of the device relate to enhancing the patient experience, supporting the decision making process and opening up real opportunities for the transmission of data. But equally important is the data that will be captured by SWASFT in relation to its operations. Such data will enable real opportunities in terms of research in to pre hospital care, research that up to this point has been incredibly onerous and reliant on review of paper based systems.