NSF Recommendations for Those with Established Disease Risk factors assessed, documented & advised, especially smoking. Medication: aspirin, beta blockers, ACEI Blood Pressure below 140/85 Blood cholesterol lowered to less than 5mmol/l and LDL-C below 3mmol/l or by 30%
Getting the Ball Rolling Disease Registers from medication & READ coded entries Additional Nurse Resource Devolved to Practices Protocols for Nurse & for Referral to Secondary Care Computer Templates Audit Team Geared up to Provide Rapid Feedback
Advantages of Templates Quicker entry of standard data Consistent use of READ codes Display previous recordings Search for previous interventions Automatic calculations, e.g. BMI, risk score Clinician can be reminded of interventions Easier audit
What Happened Focus on the facts No blame Its the system What went well What was OK What could have gone better What should we do next time?
Acute Chest Pain Protocol Is the patient alert? Is the patients breathing normal? Is the pain severe? Is there heart problems or diabetes? Is it heavy, crushing, pressure or tight? Is there nausea or vomiting? Is the patient sweating or clammy?
Acute Chest Pain Protocol 51 cases in 12 months 10 (19%) MI 1 had VF within 5 minutes 7 (14%) crescendo angina 24 (47%) admitted to rule out MI 8 (16%) had blood test etc. & discharged 2 (4%) dysrhythmia Call to needle time less than 60 minutes
At Risk Other Athersclerotic Disease Diabetes Hypertension Heart Failure Middle-aged men Strong Family History Smoking, Post-menopausal women
Essential Ingredients Clear evidence and Clear focus Examples From The Field Time to consider solutions Reality of working at street level Systematic recording of information Rapid feedback Appropriate resources Skilled management