1. Page 1 Mid and West Wales Critical Care Network Newsletter December 2007 Mid and West Wales Critical Care Network Newsletter December 2007 Role and Structure of Network The Network is overseen by a Network Board. The role of the Board is to plan, organise and deliver effective critical care, working to an agreed service development plan to achieve the critical care quality standards required under WHC(2006)09. The Board is up and running and has met three times. We have agreed our membership, Terms of Reference and Establishment Agreement. We hope to sign a “Governance Framework” at our next meeting. We have also agreed a work plan that is being implemented. There are two sub groups – the Collaborative group and the Resources group. Collaborative Group The Network has established a collaborative group to undertake much of the work agreed upon by the Board. This group has met three times and has discussed, in depth, the draft definitions of cancelled operations, inter-hospital transfers, out of hours discharges and delayed transfers of care. It also agreed to establish the educational workshop for December 12 th (see below). Network Team Ifor Evans has been appointed as Network Manager and he commenced work on October 1st 2007. He is based at the Mid and West Wales Regional Office, Hill House, Picton Terrace, Carmarthen, SA31 3BS and can be contacted on 01267 225264 or ifor.evans2@pembrokeshir elhb.wales.nhs.uk Dr Dave Hope (Consultant in Intensive Care at Morriston Hospital) is the Lead Clinician and Bernardine Rees (Chief Executive of Pembrokeshire and Ceredigion LHBs) is the Chair. Resources Group A resources group has been set up to agree how best to establish the resources spent on critical care. They are currently deliberating whether to use the Trust Financial Returns or a specially designed questionnaire. Dr Dave Hope Ifor Evans Bernardine Rees months to keep you up to date with what’s happening. It will benefit from your input, so if you know of any interesting news or events coming up, please get in touch so I can let everyone know. Welcome Welcome to the first edition of the Mid and West Wales Critical Care Network newsletter. This newsletter will be published every 3

2. Page 2 Mid and West Wales Critical Care Network Newsletter December 2007 NICE Guideline 50 This Guideline sets out the requirements on NHS Trusts to put in place effective systems to enable the early identification of acutely ill patients whose condition is deteriorating and to ensure that an appropriate response is made. Visits Summary During November 2007, Dave Hope and Ifor Evans visited each of the Trusts in the region. The purposes of the visits were:- * to introduce themselves; * to explain the purpose and aims of the critical care network; * to listen to the views, opinions and concerns of staff; * to discuss the completion of the Critical Care Quality Requirements audit and resulting action plans; * to encourage units to share information with the network, especially ICNARC reports; * to discuss the critical care minimum dataset and what feedback people wanted; * to inform staff of the forthcoming educational workshop; * to ascertain progress with implementation of NICE guideline 50 “Acutely ill patients in Hospital – recognition of and response to acute illness in adults in hospital”, and * to inform them that the network wished to undertake a “resource audit” to ascertain the cost of providing critical care. The visits were a resounding success and we were heartened by the enthusiasm of the teams we met. The main findings from the visits were:- The current uncertainty caused by possible Trust reconfigurations is hampering the units’ ability to plan for the future and speedy decisions would be welcome. There was a general consensus that sharing of information within the network was a good idea and to be promoted. A number of units reported difficulties with medical staffing capacity and, to a lesser extent, nursing staff, due to difficulty in recruitment and retention, rising patient expectations and increasing demands being placed upon staff. Critical Care Minimum Dataset (CCMDS) All units are now supplying data to the CCMDS and the hope expressed was that they would receive useful information back as a result, that would help them in improving services. The Trusts are all working towards implementation of this Guideline and are all at different stages of compliance. The implementation of the Guideline is not being led by the critical care units, though all see the need to get involved in the implementation.

3. Page 3 Mid and West Wales Critical Care Network Newsletter December 2007 Education Chris Hancock (NLIAH) submitted a paper to the Network Board highlighting the issues with education and training for critical care. A sub group is to be set up to take forward the issues highlighted in the paper. Chris presented the findings at a workshop to critical care staff throughout the region on December 12 th 2007 (see right). Educational Workshop A successful workshop was held on December 12 th in Swansea. It started with a case presentation on how not to transfer a critically patient, given by Dr Richard Self, Bridgend. This was followed by an informative talk by Dr Ed Farley-Hills on the “Transfer of the Critically Ill” course they run in North Wales. Following vibrant group discussion, it was decided to establish a “Transfer of the Critically Ill” course in the Mid and West Wales region. The first course, to train the trainers, will take place in Bridgend early in the new year. Next, Chris Hancock, Project Manager for the Welsh Critical Care Improvement Programme, presented his findings of a survey of educational needs of nurses. Again this was followed by lively debate about the role of the Network in nurse education. It concluded with an agreement for members from the Network to meet up with representatives from Higher Educational Institutions to discuss developing competencies for critical care nursing and how best these can be achieved. Finally, Dr Dave Hope gave a brief presentation on implementing the NICE Guideline 50 “Acutely Ill Patients in Hospital”. The talk emphasised the need for Trusts to establish a steering group to oversee the implementation of the guideline, undertake a baseline audit and costing, then produce an action plan and finally to re-audit. The importance of involving people throughout the hospital, and not just critical Care personnel, was highlighted. If you would like a copy of any of the presentations or further information, please contact Ifor Evans. Quality Requirements Audit * All of the units have undertaken an audit against the critical care quality requirements. Some of the main findings are: * Not all units have a Critical Care Delivery Group and only one unit has an outreach service. * There are still significant numbers of patients being discharged between 22.00hrs and 07.00 hours. A number of units did not report on this item. * A number of the smaller units do not have haemofiltration facilities. * Whilst a number of units have done work to obtain feedback from patients and visitors, only Carmarthenshire NHS Trust is regularly undertaking patient/relative satisfaction surveys. * Only three units hold regular multidisciplinary team meetings and not all units undertake a regular review of patient outcomes. None review patient outcomes more frequently than monthly. * All units have critical incident reporting systems. * None of the units have all the required policies but they all have them bar two or three. Between the units all policies are covered and therefore if units are willing to share policies, any lack of policies can be easily remedied. * There are still significant numbers of delayed discharges at each unit.

4. Page 4 Mid and West Wales Critical Care Network Newsletter December 2007 Meetings Schedule Future dates/times for Network Board meetings are:- 25 March 2008 (10 am to 12.30 pm) 26 June 2008 (10 am to 12.30 pm) at the Regional Office, Hill House, Picton Terrace, Carmarthen. If you would like further information on any item in this newsletter, please contact Ifor Evans (contact details on Page 1). MERRY CHRISTMAS AND A HAPPY NEW YEAR!