Presentation on theme: "Version Modifications Author Date 0.1 Draft Initial Draft 0.2"— Presentation transcript:
1 Sample: National Early Warning Score and associated Education Programme Project Plan VersionModificationsAuthorDate0.1DraftInitial Draft0.2Modifications to initial draftAdapted with kind permission of Beaumont HospitalUpdated 23rd May 2012
2 ObjectivesAgreement in principle to the Project Initiation Document (PID)Direction & guidance on some key decisions relating to project scopeMedical leadership to be identifiedHighlight significant service implications associated with NEWS project rolloutIdentification of pilot wards/units/departments√√√√
3 Table of Contents 1. Introduction 2. National NEWS Framework Purpose of the documentProject Context2. National NEWS FrameworkNEWS Framework ObjectivesKey Components of NEWS ProjectNEWS project scopeProject Phasing3. Project ManagementNEWS project structureProject roles & responsibilitiesProject Assumptions4. Project WorkstreamsWork streams overviewNEWS policy & Observation chartEmergency Response System /MET Team Development & Escalation protocolEducation -COMPASS, ViEWS and ISBAR Communication toolEvaluation & Audit5. Project PlanProject Implementation Plan6. Project Assumptions7. Clinical Risk Assessment and KPI’s
4 Purpose of the document The purpose of this document is to set out the terms of reference for a project to deliver the Implementation of NEWS Project in ………………………Hospital through a Project Initiation Document (PID)The document will also outline how the NEWS Project will be managed. The project organisation are also detailed in this document.The PID addresses the following fundamental aspects of the project:What the project is aiming to achieveWhy it is important to meet the stated aimsTo provide a clear and unambiguous view of how the project will be managed and controlledWho will be involved in managing & delivering the project; their roles and responsibilitiesHow and when the arrangements covered in this document will be put into place.This document will be agreed and approved by the NEWS Steering Group as part of the project initiation stageThe Project Manager (………………….) will be responsible for it’s maintenance throughout the project life
5 Project ContextThe National Early Warning Score initiative is a work stream of the Acute Medicine Programme in association with other Clinical Programmes, Quality & Patient Safety, Office of the Nursing and Midwifery Services Director, Clinical Indemnity Scheme, the Assistant National Director, Acute Hospital Services, Integrated Service Directorate, Irish Association of Directors of Nursing and Midwifery (IADNAM) and the Therapy Professionals Committee.International literature identifies that 11% of hospital deaths can be attributed to patient deterioration not recognized or acted upon.National Patient Safety Agency (2007) Patient deterioration not recognized in hospitalized patients.A large proportion of patients who suffer cardiac arrest in hospital have recognisable changes in routine observations during the preceding 24hrs including changes in vital signs, level of consciousness and oxygenation. One study showed that 60% of primary events investigated (deaths, cardiac arrests and unplanned ICU admissions) were preceded by abnormal physiology. (Hillman K.M. et al. “Antecedents to Hospital Deaths”. Intern Med J 2001; 31(6); 343-8)Early recognition of clinical deterioration, followed by prompt and effective action, can minimise the occurrence of adverse events such as cardiac arrest, and may mean that a lower level of intervention is required to stabilise a patient. (Smith GB et al, Resuscitation 2006; 71: 19-28)
6 Project ContextEarly warning scores have been developed to facilitate early detection of deterioration by categorising a patient’s severity of illness and prompting nursing, and other healthcare professionals, to request a medical review at specific trigger points, utilising structured communication tools whilst following a definitive escalation the occurrence of adverse events such as cardiac arrest, and may mean that a lower level of intervention is required to stabilise a patient. plan.Phase 1 of the National Early Warning Score initiative applies to Adult patients in Acute Hospital Services.In April of 2011 HIQA recommended that the HSE should, as a priority, agree and implement a national early warning score to ensure that there is a system of care in place for the prompt identification and management of clinically deteriorating patients.In July, 2011 the National Early Warning Score Governance Group launched the guiding framework and policy for the national Early Warning Score System to recognise and respond to clinical deterioration. This document was updated in January 2011, following a review of the programme, to take account of more recent international research. The Australian Compass Programme (2010) has been selected as the national tool for education on the deteriorating patient which now incorporates the VitalPACTM (ViEWS) scoring parameters (Dec 2011).
7 On March 27th 2012 the National Clinical Programmes formally launched the National Early Warning Score and associated COMPASS Education Programme.HIQA Report 2012The National Early Warning Score (NEWS) should be implemented in all clinical areas providing inpatient care. An emergency department specific system of physiological monitoring and triggered responses comparable to the NEWS should be implemented.‘It is not acceptable that an EWS was not in place given that the Authority had previously recommended in the Report of the investigation into the quality and safety of services and supporting arrangements provided by the Health Services Executive at Mallow General Hospital (2010) that an EWS be implemented in all hospitals in Ireland and that the HSE should ensure a system-wide application and dissemination of this.
8 National Early Warning Score Framework Objectives To improve patient safety and outcomes by :Supporting the implementation of the national standard for recognising and responding to clinical deterioration -the ViEWS system and the associated multidisciplinary educational programme – COMPASS in acute healthcare settingsPromoting more effective inter-professional communication and teamwork by recommending the implementation of the structured communication tool “ISBAR”(Identification; Situation; Background; Assessment; Recommendation)Supporting the development and implementation of appropriate organisational support systems for the early detection and escalation of care of at risk patientsEnabling audit of outcomes and performance comparison between different healthcare facilities8
9 Project Implementation Principles All clinical staff must comply with the national guiding framework and related policies, clinical guidelines, procedures and protocols. Each employee must adhere to their professional scope of practice guidelines and maintain competency, in recognising and responding to patients with clinical deterioration, including the use of the National Early Warning Score System (ViEWS).All staff will be comprehensively trained and supported during the NEWS implementationThe operation of the NEWS will require MDT co-operationWhile aspects of the NEWS may be customised for use in ……………………. Hospital the ViEWS parameters and core objectives of the National Programme will be maintainedAll policies, protocols, documents, forms etc, will be initially developed in draft form, extensively consulted and formally approved by the appropriate body before implementation
10 In Scope\Out of Scope Patients (in scope) All adult in-patients & out patients requiring interventional procedures and sedationAll patients attending AMU/AMAU/MAUED presentations identified as requiring NEWS at triage & all patients identified for admissionAny patient where professional judgement of staff identifies a need to carry out an EWS because of concern re their conditionPatients in a critical care environment (ITU, Recovery Room, CCU) EWS at transfer to wardPatients (out of scope)Palliative care (active end of life care) & routine OPDNot For Resus (NFR) Patients (documented in Patients Chart)Paediatrics, CNUObstetric Patients
11 In Scope\Out of Scope (cont.) Key tasks (in scope)Develop a Hospital wide NEWS PolicyDevelop and implement an Escalation plan & Emergency Response System / Medical Emergency Team (MET) integrating with existing arrangementsReview and design an observation chart incorporating (NEWS) for use in …………………(name of service)Provision of education and training of all clinical staff measuring/interpreting Vital SignsImplementation of the standard communication tool (ISBAR)Implementation of an Evaluation and Audit processDelivery of a comprehensive cross hospital communications planKey tasks (out of scope)Education for undergraduate Nursing students year 1-3 and Medical students
12 Project Management Structure The Project Management Structure will comprise the following components:Oversight (“Steering Group”)Management & Execution - Project Manager and Work stream Leads to work on the Individual work streamsThe Work stream leads will establish their own work stream groups as requiredEach work stream will have a Working Group to support it in its work. The composition of the Working Group will be agreed by the Work stream Lead in conjunction with the Project Manager. It is possible that some Working Groups may provide support to more than one work stream or that individuals may be on more than one Working GroupThe structure and the Roles and Responsibilities are outlined in the following slideThe Steering Group will meet every 6-8 weeks during phase 1 of the project:On the first occasion to approve the Project Initiation Document (including objectives, timelines, etc)On subsequent occasions to get a project progress reports & authorise key stages/ decisions of the projectThe Project Team will meet on a fortnightly basisWork stream and Working Group meetings will occur as required by the Work stream lead
13 Project Roles & Responsibilities Ensure the project is established and appropriately managedProvide overall direction and leadership for the delivery and implementation of the projectEnsure that the project is aligned with Hospital & HSE Strategic objectivesEnsure that the project Manager and Work stream Leads have the staff and other resources to deliver the projectResolve any issues that are escalated from the project Manager and Work stream LeadsEnsure that the project in on target and meets its approved objectivesSign off on key project milestones / deliverablesMonitor for changes in the external environment that may impact on the projectPlay an advocate role across the Hospital for the projectSteering GroupLeads the project on a day-to- day basisEnsures that the overall project is appropriately structured into work streamsDrives overall project plan & project directionMonitors the progress of all work streamsEnsures project meetings with Work stream Leads takes place on a weekly basisDevelops Steering Group Update / ReportEnsures an appropriate stakeholder and cross hospital engagement plan is established and is implementedManages overall project risks and issuesReports to project sponsor on a weekly basisEscalates to Steering Group risk and issues where appropriatePlay an advocate role across the Hospital for the projectProject managerProject TeamWorkstream LeadsResponsible for planning of the projectProvides the relevant leadership & expertise from specialist areasRepresents the interests of stakeholders in Clinical areasIdentifies opportunities in EWS project & takes the lead in implementing theseDirectly works on a work stream tasks on a day to day basisReports on a weekly basis to the project team & communicates all relevant information clearly to the project teamLeads the work stream on a day-to-day basis involving team members as appropriateMonitors the progress of all activities within the work stream plan in conjunction with the project managerDevelops & submits to the project manager a weekly status report on progress during the weekEnsures an appropriate stakeholder and engagement plan is established and is implemented with respect to the work streamLiaises with other key stakeholders as required who impact on the projectInteracts with and involve the project team in the activities of the work stream1313
14 NEWS Project Structure HSENEWS National Steering CommHospitalClinical/ Senior ExecLeadership TeamNEWS Project Steering Group(see next slidefor suggested membership)Hospital PMOAMPSteering CommProject Manager……………………..These are the common roles of people involved in a projectThere may not be a Steering Committee, Advisory Group, or a Project Management OfficeTeam leads will only be appointed to large, complicated projectsThere will ALWAYS be team members, a sponsor, and a project managerNEWS Project TeamWorkstreamGroupsProject SupportQualityAssuranceAdministrativeSupport
15 EWS Project Steering Group as appropriate to hospital (Suggested Membership) ………………….Project Sponsor…………………Clinical Director Medicine…………………Anaesthetist…………………ED Consultant…………………Resuscitation Officer……………….. Consultant (Surgical)………………….Clinical Governance Manager (IQS)………………….ICT Director………………… Financial Controller………………… Practice Development Co-ordinator…………………..Medicine Directorate Nurse Manager………………….Surgical Directorate Nurse Manager………………….Specialist areas Directorate Nurse managers………………….Critical Care Directorate Nurse Manager…………………..Physiotherapy Manager………… Out of Hrs Nursing Representative………………….Associated Third Level Lecturer (Nursing and/or Medical)
16 NEWS Project Phasing :The EWS project will be rolled out in …………………………… on a phased basisPhase 1 of the project (Timeframe) will deliver:Review & design of an appropriate observation chart incorporating ViEWS parameters for use in ……………………………Development of Emergency Response System e.g. MET team integrating with existing arrangements-Development of an NEWS policy incorporating escalation protocol and communication tool (ISBAR)-Train the trainer Programme for identified Medical & Nursing EWS programme trainers-Rollout of COMPASS education programme to clinical staff on selected pilot site(s)- Development of audit tool-Pilot ………………………………..(timeframe)-Evaluation of outcome of pilotPhase 2Hospital rollout to begin ……………………………(tmeframe)Phase 3Implementation of later phases
17 Project Workstreams 17 Project Manager……………………………. NEWS Policy & Obs chartEmergency Response SystemEvaluation & AuditEducationLead: ………..Lead: …………….Lead: Medical /NursingLead:Work stream lead supported by Practice dev, Clinical governance, Medical leadershipObjective: To support the development & implementation of NEWS and related systems into clinical practice in ………………. Hospital.-NEWS policy development-Obs chart /fNEWS sign off- Communication tool signWork stream lead supported by Medical & Nursing MgmtObjective: To design composition of ERS / MET and develop supporting escalation protocol incorporating EWS trigger and communication tool-Escalation protocol agreement-Emergency Response SystemWork stream lead supported by Nurse Education, Practice Development & Medical TutorsObjective: To provide clinical staff with an understanding of the underlying physiology of acutely unwell patients, clear guidelines on the measurement of vital signs & the documentation &, escalation /communication of triggered NEWS to appropriate medical personnelTrain the trainerRollout of COMPASS programme incorporating ISBAR communication tool-Documentation processWork stream lead supported by Clinical Governance & Practice DevelopmentObjective:To develop and implement appropriate evaluation & clinical audit systems to support the continuous quality improvement process in relation to implementation of the NEWS system.Nursing: All inpatient areas Dir repsEDITUOut of hoursClinical GovernanceMedical: Physicians /Surgeons, Critical CareMedicine : as appropriate to hospital Respiratory, Cardiology , otherAnaesthetics, SurgeonsCritical Care NursingOut of Hours NursingICTNCHD TrainersNurse Education/ Practice DevelopmentACLS instructorsIdentified Cnm’s/SN’sAHP’sNursing: Practice dev,Senior Medical supportWard ManagersITU, Audit nurseRTO inputICT17
18 Project Plan - suggest Gannt Chart Use the Implementation Plan provided on the NEWS website below as a guide for the development of a phased roll out of the NEWS in the Hospital.Identifying key milestones, timelines, planning targets – tasks completed, planned etcTask requiring urgent action etc
19 Key AssumptionsSenior Medical & Clinical Managers will support the EWS project implementationMedical and clinical staff will support the practice changes required by the projectBudgetary and other resources including Human resources will be made available to the project and will not impact on timelinesStaff will be released to attend trainingTrainers/Instructors will be released to provide trainingThere will be no delays in getting training for additional ‘Train the Trainer’ staffThe AMP project will support the NEWS project as required.
20 Clinical Risk Assessment and KPI’s Clinical Risk assessment will be key to prioritising areas for immediate implementation of the NEWSIdentification of Key Performance Indicators (KPI’s) to assess performance patient safety and quality of care is recommended.