Peer Reviewer Major Trauma Network Training

Welcome and Introductions

Aims of the Training To promote understanding of the purpose and implementation of the National Peer Review Programme Enable the cascading of information to support teams within the network

Learning Outcomes By the end of the day you will: understand the principles of the National Peer Review Programme be prepared for the forthcoming peer review and ensure that all good practice is shared understand how to complete a self assessment be able to cascade details of the review to others.

Session 1 The National Peer Review Programme

Our Key Principles Clinically led Focus on coordination within and across organisations - networking Consistency in delivery of programme Driver for service development and quality improvement Quality assurance process for clinical services Peer on Peer User/carer Involvement

Aims of Peer Review To ensure services are as safe as possibleTo improve the quality and effectiveness of careTo improve the patient and carer experienceTo undertake independent, fair reviews of services To provide development and learning for all involved To encourage the dissemination of good practice

Organisation of the Programme Ruth Bridgeman National Director Richard McMahon North Region Quality Director Local Review Units (LRU) x 3 QM & AQM Sally Edwards South Region Quality Director Local Review Units (LRU) x 4 QM & AQM Clinical Leads Julia Hill Deputy Director NVMU Marie Cummins Programme Development Manager

Validated Self Assessment Pre visit Review of Evidence Peer Review Visit All teams complete a self assesment validated by the host organisation All validated self assessments reviewed prior to the visit by the NPRP local review unit Comprehensive visits to all major trauma centres and units The Peer Review Programme

The Peer Review Schedule

Development of the Measures National Guidance Evidence based using agreed national guidance and best practice Expert Group Development of measures is undertaken by an expert group made up of each of key disciplines, patient/carer representation and representing a variety of organisations involved in the pathway Consultation General consultation to gather feedback from the wider community Editing All comments from consultation reviewed by expert group Publication Measures reviewed on a regular basis to take into account changes in national guidance

Major Trauma Measures Pre-Hospital Reception and Resuscitation (Adult, Children,Trauma Units) Definitive Care (Adult, Children,Trauma Units) Rehabilitation (Adult, Children,Trauma Units) Network

Pre Hospital Clinical Governance Triage Tool Enhanced Care Teams Pain Management Administration of Tranexamic Acid Pre Alert and Handover

Reception & Resuscitation Emergency Department (ED) staff –Trauma Team Leader –Training Radiology –CT scanning –Radiology reporting –Interventional Radiology Surgery –Access to theatre –Access to specialist consultants ITU Transfusion

Definitive Care Major trauma leadership and staffing Major trauma pathways Specialist management pathways

Rehabilitation Rehabilitation leadership and staffing Enhanced rehabilitation Specialist rehabilitation pathways Rehabilitation prescriptions Repatriation Psychological support

Network Organisation Network configuration of services Network governance structure Network protocols and guidelines Trauma Audit and Research Network

Development of Clinical Indicators Clinical Indicators are developed in consultation with national clinical groups Data is available from national sources such as national audits - TARN TARN reports are used where available

Completing a Self Assessment

Evidence Documents Quality Measures Report Key Themes

MTC and TU Evidence Documents Operational PolicyAnnual ReportWork Programme Describing how the team functions and how care is delivered across the patient pathway Outlining policies/processes that govern safe / high quality care Agreement to and demonstration of the clinical guidelines and treatment protocols for the team. Summary assessment of achievements & challenges Demonstration that the team is using available information (including data) to assess its own service Workload & Activity Data TARN Local Audits Patient Feedback Work Programme Update How the team is planning to address weaknesses and further develop its service. Outline of the team’s plans for service improvement & development over the coming year Actions resulting from audit and from previous reviews

Network Evidence Documents Operational Policy Annual ReportWork Programme The network’s constitution and how it functions Description of the governance process explaining how the network links to individual services The current clinical and referral guidelines agreed by the network The agreed configuration of services across the network. Summary assessment of achievements & challenges Demonstration that the group is using available information to assess network services, including TARN audit Summary update on implementation of previous year’s work-programme (including progress on implementing actions from previous reviews) Consideration and discussion of performance against clinical indicators How the group is planning to address weaknesses and further develop network services Outline of the plans for network wide service improvement & development over the coming year Should include addressing actions from previous peer reviews where relevant

Demonstrating Agreement Where agreement to guidelines and policies is required this should be stated clearly in the relevant evidence document.

Self Assessment Report Compliance against the measures General commentary based on 4 key themes Identification of –Good practice / significant achievements –Immediate risks / serious concerns –Concerns / Recommendations

Key Themes The following themes should be considered when writing the report

Categorising Review Findings Relates to the service and can be either innovative or common practice undertaken very well Good Practice/ Significant Achievement An issue that is likely to result in significant harm to patients or staff or have a direct serious adverse impact on clinical outcomes and therefore requires immediate action Immediate Risk An issue that whilst not presenting an immediate risk to patient or staff safety is likely to seriously compromise the quality of patient care, and therefore requires urgent action to resolve Serious Concern An issue that is affecting the delivery or quality of the service that does not require immediate action but can be addressed through the work programmes of the services Concern

Self-Assessment – Key Tips Be honest Get the evidence agreed in line with the measures Ensure agreements are documented Don’t let yourself down with poor evidence Establish process for any data requirements Use annual report to focus on outcomes Sell yourself

Using TQuINS Using TQuINS  Secure web based database supporting each stage of the peer review process  Records assessments, compliance with the measures and reports  Provides information for national analysis and reporting  Access to resources  Measures  Handbook  Reports  Training slides

TQuINS Homepage Navigate to TQuINS homepage uk uk Enter your registration details

Pre-visit Review of Evidence Desk top review of validated self-assessment undertaken by the Peer Review Local Review Unit Review accuracy of self-assessmentIdentify areas/issues for clarification at the visitReview shared with reviewers and services

The Peer Review Visit

Who are Reviewers? Multidisciplinary teams of: Service users, clinicians, AHPs, managers, commissioners “Peers are people who have been trained and working in the same discipline as the people they are reviewing” Reviewers will not normally review teams that are part of their own patient pathways

Review Team for MTC 2 consultants from different specialties (ED, T&O, Intensivist.) Rehab specialist Either a trauma coordinator or a paramedic Lay member of local MTC Trust Board National Peer Review team member.

Review Team for TU The network lead clinician The network manager A consultant from another TU in the network A trauma co-ordinator / trauma nurse / rehabilitation specialist from the MTC National Peer Review team member.

The Visit Day

Logistics Rooms –Suitable to enable discussion (not lecture theatre) –Small breakout room for review team Refreshments / Lunch Information –Car parking arrangements –Map / directions –Contact details

Resources Available TQuINS Handbook Slides and packs from today Local review units are able to offer support

Training Organisation training sessions supported by local review units Reviewer training –29 th October: Thistle Marble Arch London –3 rd November: Holiday Inn Bristol Filton –20 th November: Cedar Court Huddersfield –26 th November: Hilton Birmingham Bromsgrove –3 rd December: London TBC

Any Questions? Thank You