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|CANDOUR - Issue 15 -
The newsletter of the Joint ASA/JRCALC Clinical Effectiveness Committee and the ASA National Clinical Effectiveness Programme
In this Issue:
Clinical Risk - learning the lessons
Clinical risk is one of the key components of clinical governance and its management is something that should be part of both the organisation's and the individual's day-to-day practice. Learning the lessons from 'near misses', critical/ adverse incidences and clinical audit are an integral part of continuing education and clinical quality improvement for all staff from the frontline to the boardroom. It is a process that protects both the practitioner and the patient enabling standards of practice to continue to improve.
Prior to Ambex 2000 Dr Judith Fisher (Medical Director of Essex Ambulance Service NHS Trust and a member of JRCALC) conducted a survey of all UK ambulance services to ascertain their progress towards implementing systems for clinical governance. The survey highlighted the need for some central guidance on clinical risk management within the ambulance service.
The reasons for this were two fold:
Dr Fisher presented the findings of her survey to the September 2000 meeting of the Joint ASA/JRCALC Clinical Effectiveness Committee where a sub-group was established with the overall objective to look at the key issues of clinical risk and co-ordinate the production of guidance for all UK ambulance services.
An initial meeting was held to identify the key issues where guidance was required and to identify potential resources and references to inform such guidance. Together these will be worked up into a reference pack to be distributed to all ambulance service.
Following lengthy discussions the key issues were categorised under these five headings to form the main body of the reference pack:
ASA Reference Pack for Clinical Risk
There will two common themes, which will run throughout the reference pack, namely -
A. CNST Standards
B. Staff Information Leaflet
C. Standard incident reporting form
D. Sharing best practice
Education needs to be pitched at the level where changes in practice or management are most needed to fulfil the aim of a 'blame free' culture. It is also recognised that the risks to a patient from an ambulance service are part of a wider 'chain of risk' through other sections of the NHS. Communication at handover is an area where specific guidance will be provided given that this is a point where the greatest risks are presented.
If we do not share the valuable lessons we learn every day in our practice we can not improve the service we provide either as an individual practitioner, an organisation or as an ambulance service as a whole. The reference pack currently being pieced together will show how clinical risk management must be part of day-to-day practice for all staff at all levels.
Below are some of the references that will be included in the guidance:
Controls Assurance - NHSE (includes NHSLA
information and CNST standards)
Clinical Governance Support Team - NHS
Clinical Governance Bulletin - Royal Society of
Significant Event Audit - University of Exeter
IN THE NHS'
DEPARTMENT OF HEALTH SPONSORED
The event will be chaired by Neil Mckay, Chief Operating Officer of the Department of Health and Chair of the Corporate Governance Group and speakers will include - the Minister of State for Health, John Denham MP *** the Permanent Secretary/Chief Executive of the Department of Health, Nigel Crisp *** the Director of Clinical Governance, Professor Aidan Halligan *** the Vice Chancellor of Keele University, Janet Finch *** the Director of the Controls Assurance Support Unit, Professor Ellie Scrivens *** the Head of Controls Assurance, Stuart Emslie ********** additional speakers to be announced.
This event will be charged in the sum £99+VAT for NHS delegates and £199+VAT for delegates from other sectors. Any surplus from the funds will be refunded to delegates in the form of training credits for the 2001/2002 training programme.
A limited number of exhibition stand spaces will be available for a charge of £500. Interested organisations, please email [email protected] or fax +44 870 136 0745
On-line booking is available via the Controls Assurance Support Unit site (www.CASU.org.uk) - this is for www users only. NHSweb users should email [email protected] or fax on our dedicated conference fax number +44 870 136 0745.
PAT - Paramedic Audit Tool
With the introduction of Competence Based Training and Assessment system to East Anglian Ambulance Service NHS Trust it has become vital that paramedics and technicians gather evidence of their competence. This evidence will form part of the training portfolio and will be assessed against IHCD and local standards. To ease the logistics of maintaining records a computer based application has been developed by John Morgan, a paramedic based at Saxmundham Ambulance Station. This is his story about PAT
" In November 2000 I attended my Annual Paramedic update. On the agenda was the subject of Registration and the obligation to maintain a Portfolio of skills Usage. What followed was a complicated routine, and it was clear to see that this could be a major headache. Surely there must be an easy way to keep track of all these skill codes, skills, etc etc.
I first looked at designing an Access database, it could do most of what I wanted, but not all. So I decided to write my own program that does everything I want, and just as I want it. As it neared completion I offered it to the East Anglia Ambulance Service NHS Trust - EAAS - who are still evaluating it (at time of submission February 2001).
A major advantage is that the user requires no other program, such as MS Access, which is an expensive piece of software. A lot of people have a PC, but not all have this software, or the patience and knowledge to build a fully fledged data base. Also there is problem that these portfolios require access to confidential information, which really should not be taken away from Trust property.
The Paramedic Audit Tool was completed in December 2000 and released on the web on Christmas day (see link at end).
It has 5 sections, each working in a similar fashion. A screen to view and edit data, one to add data, and one that preview what you are about to add.
The Sections are:
It has a back up facility and few options to turn features on and off.
This release was designed as a preview, an example of what the final could do. There is so little software built for Paramedics its shameful. This version was all my own idea, but I wanted feedback for a better version. My plans for the next version are:
To date there has been over 200 downloads from the site and I have sent out dozens of copies on CD.
There are over 100 registered users.
I will be posting an updated version that fixes a few minor annoyances in the next week or so, these are mainly design issues for people outside EAAS Trust, and I am about to start work on Version 2. "
John Morgan, Paramedic, East Anglia Ambulance Service NHS Trust
PAT - Paramedic Audit Tool can be downloaded for free from the following website, which also lists contact details for John Morgan - http://www.cleversod.clara.net/
Following download you can evaluate PAT for 30 days before registration with John is required.
An NeLH communications area for the Coronary Heart Disease NSF
and CHD Partnership Programme.
The mission of the National electronic Library for Health (NeLH) is to provide easy access to best current knowledge and know-how. This is particularly important in addressing Coronary Heart Disease where the gap between what we know and what we do could be closed with massive benefit resulting.
The National Service Framework for Coronary Heart Disease has been designed to set out a system of care which will close the gap between what we know and what we do, based on best current evidence. The CHD Taskforce charged with the responsibility for implementing the NSF will lead the programme of change and development which will transform prevention, treatment, rehabilitation and care.
The NeLH Virtual Branch Library For Heart Disease will house the evidence base on which policy and its implementation are based, but users of the NeLH have asked for more information about the work of the Taskforces responsible for NHS modernisation, and to do this we are setting up information zones in which the messages from the Department of Health and the Taskforces will be made quickly and easily available, and linked to the Virtual Branch Library for Heart Disease.
We will work with the CHD Taskforce, the Heart Team and the CHD Partnership on a weekly basis to keep you in touch with the implementation of the National Service Framework.
J A Muir Gray, CBE, DSc, MD, FRCP (Glas&Lond)
For more information check out the website at http://www.nelh.nhs.uk/heart/
The National Electronic Library for Health -
Emergency Care branch
The government's Information for Health strategy
announced the creation of a National electronic Library
for Health (NeLH). The aims of the NeLH are to provide
easy access to best current knowledge, to improve health
and healthcare, clinical practice and patient choice.
This should allow any healthcare professional to look
up the latest treatment at his desk or workstation. These
guidelines will have a standard structure and will all
have been peer reviewed. This is without doubt the most
ambitious part of the project and is therefore likely to
be the last component to be completed.
An advisory group is being established which includes representatives of BAEM, the Faculty of A&E Medicine, the Faculty of Emergency Nursing and the Ambulance Service Association.
Dr Matthew Cooke
If you have any comments or wish to contribute to CANDOUR please forward any information to: