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Regional Activity

Each regional group will report their current clinical effectiveness activity on these pages.

Northern & Yorkshire
Last updated 20/03/02

West Yorkshire Metropolitan Ambulance Service NHS Trust (www.wymas.co.uk)

Collaborative Patient Report Form
Tees, East & North Yorkshire Ambulance Service NHS Trust (TENYAS) together with North East Ambulance Service NHS Trust (NEAS) are working jointly on a collaborative Patient Report Form (PRF). Since the merger of the three services in TENYAS there was a need for a single PRF to allow for trust-wide audit. NEAS use the same scanning system as TENYAS and have donated the design of their PRF to be used jointly with TENYAS. This will allow for cross-trust comparison of clinical audit data including collaborative projects. It is hoped that other services in the region will be interested in this initiative to produce a region-wide PRF.


CLINICALLY Speaking’ - Newsletter
North East Ambulance Service NHS Trust …… December 1999 Issue 1

Welcome, introduction, and aims
First issue of Newsletter to be produced quarterly. The intention of this Newsletter is to encourage discussion amongst those involved in pre-hospital care. Reports will cover findings and developments in other ambulance services including those abroad. Topics will be welcomed for inclusion.

INTRAVENOUS PRE-HOSPITAL FLUID ADMINISTRATION
Dr Tom Clarke, Medical Director discusses the controversial problems surrounding the use of fluids and which intravenous fluid to use, crystalloid or colliod. He also queries how much intravenous fluid should be administered and when they should be used. The article further discusses the shelf life of these fluids and user-friendliness of the packaging systems.

CLINICAL AUDIT
George Marley, Clinical Development Manager discusses the benefits of Clinical Audit. His article covers all aspects of ‘Improving patient care’ and how this is being achieved. Audit covered: Patient Report Forms, Head Injuries and the Glasgow Coma Scale, Chest Pain, Cerebro-vascular accidents and Oxygen Therapy, On-Scene Times for Trauma and finally Future Developments.

CLINICAL GOVERNANCE
(Clinical Quality Improvement) – In practice. By Colin Cessford, Quality & Risk Manager
This article covers the significant impact upon the future direction of the NHS Trusts through Clinical Governance.and its more meaningful interpretation of ‘Clinical Quality Improvement’. Items included are: ‘Clinical Audit’, ‘Clinical Incident Reporting’ and ‘Communications Strategy’
Members of staff appointed into the role of Operation Clinical Governance, their areas of coverage together with the roles involved are given by Paul Richmond, Darlington A&E (one of the five operational representatives on the committee). He also invites feedback on such diverse items as the use of Hypostop in diabetic patients and Post Proficiency or Re-qualification courses.

SURVEY OF OPERATIONAL STAFF ON THE USE OF HYPOSTOP – OCTOBER 1999
S.O.T.S.Birdsey, Clinical Governance Rep Central Division.
This survey covers personal experience, remarks by colleagues and the appropriateness of the current protocol concerning Hypostop together with the results of the survey, the findings and the conclusion.

May 2000 – Issue 2

The second issue of ‘Clinically Speaking’ opens with the subject ‘Variations to Clinical Practice’ written by Dave Hodge, Director of Clinical Standards and Quality.

Dave Hodge lists three central prinicples - identifying, assessing and controlling risks as the key issues to continuous quality improvement to clinical practice. Recognition of support for staff when reporting risks or near misses and the importance of developing a more tolerant and understanding culture. This has resulted in the development of a procedure ‘Variations to clinical practice’ aimed as a positive step to building a supportive environment and assisting the delivery of a clinical service in circumstances that are often difficult and complex.

CLINICAL PROTOCOL HANDBOOK - NEAS ISSUE TWO
Positive feedback was received covering the Clinical Protocol Handbook launched in April 1999 and, as a result, a newly redesigned (small enough to fit into uniform pockets) and updated version was circulated in May 2000. New additions to the book include: ‘Paediatric treatment protocols & procedures’ and ‘Recognition of Death protocol.’ Following the success of this handbook, plans to introduce a Technician book have resulted.

CVA AND OXYGEN THERAPY RE-AUDIT RESULTS
Following George Marley’s article on Clinical Audit (Issue 1) the results of the re-audit have been published. Comments are requested on why 34.5% of patients were not given oxygen.

RE-DESIGN OF THE PATIENT REPORT FORM (PRF)
George Marley also provides information on a User Satisfaction Survey of all A&E Departments served by the NEAS and the benefits of the new electronic data collection system.

THE LIGHT AT THE END OF A PRF
Eric Vincent and Trevor Kennington – Clinical Audit Department have written an article on the strengths and weakness of the PRF. Data collection through the PRF is seen as essential for training and also as a valuable data source for research and development activity. Anomalies in the completion of PRF’s are listed with the reminder that the PRF is a legal document which can be disclosed to the patient or their solicitor.

USER SATISFACTION – SURVEY
Results of a survey to (1) establish opinions held by A&E staff regarding the quality of patient care provided by emergency ambulance crews, (2) to determine the usefulness of PRF’s and (3) to identify problems with NEAS protocols has been written by I Ehrman & C Parker. The survey covers 14 A&E departments served by the NEAS.

PRE-HOSPITAL USE OF GTN
This article, written by Dr M S Farrer, gives the benefits of effective blood levels of GTN in suspected cases of acute myocardial infarction.

RECOGNITION OF DEATH
Following consultation with the Coroners in the NEAS area, the Northumbria Police, Durham County Police and the staff, the NEAS will soon be introducing a Policy regarding the implementation of a formal ‘Recognition of Death Policy’.

CLINICAL ACTION LOG ANALYSIS
Pie charts illustrating the reporting of clinical incidents through a clinical incident reporting system have been produced by Colin Cessford, Quality & Risk Manager. The data covers the period 1st January 2000 to 8th March 2000.

FREQUENTLY ASKED QUESTIONS
Dr T Clarke – Medical Advisor has put together an article which list frequently asked questions and their answers.. These Questions include: Sodium Chloride Flush, Fluid presentation in 500 ml bags, Burns dressings, Laryngoscope covers and finally Stiffneck ‘Select’ cervical collars.

SURVEY OF OPERATIONAL STAFF ON THE USE OF HYPOSTOP – DEC 99 – JAN 00
As a follow-up to the first issue of ‘Clinically Speaking’, S.O. T.S. Birdsey, Clinical Governance Rep North Tyne Div. writes further on his survey into the use of ‘Hypostop’by operational staff. In this edition he has now published the findings which cover the Protocols, the Method adopted to obtain the relevant information, the Results, Discussion and Conclusion together with Recommendations.

BYPASSING THE NEAREST CASUALTY
This article, by Gary Malloy, Divisional Officer, Northumberland Division, relates to the HC 78/45 policy modification which gives NEAS authorisation, where locally agreed, to bypass the local A&E Department and transport a patient to definitive care. Probable future modifications to the policy will also include patients over 12 years of age as a result of staffing changes at Hexham General Hospital and a report from the Royal College of Paediatricians. Your views on this proposal are welcomed.

Further information regarding any of the above topics can be obtained from:
North East Ambulance Service – Ambulance Headquarters, Scotswood House, Amethyst Road, Newcastle Business PRK, Newcastle upon Tyne NE4 7YL Telephone (0191) 273 1212 Fax: (0191) 273 7070