Annual Report and Accounts 2012/13 - Royal Devon & Exeter Hospital

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4. Annex C
Royal Devon and Exeter NHS Foundation Trust
Quality Report 2012/13
National Clinical Audit /
Confidential Enquiry Title
The Management of
Severe Sepsis and Septic
Shock in Adults in the
Emergency Department
(ED)
Consultant Sign Off
National UK Epilepsy
(NASH)
Myocardial Ischaemia
National Audit Project
(MINAP)
Acute Stroke (Stroke
Improvement National
Audit Programme SINAP/
Sentinel Stroke National
Audit programme SSNAP)
Intensive Care National
Audit & Research Centre
(ICNARC) Case Mix
Programme
National Confidential
Enquiry: Cardiac Arrest
Study, Time to Intervene
Actions
In order to improve the timeliness of antibiotic prescribing and urine output measuring the
following actions are planned:
• Sepsis checklist to be triggered on the diagnosis of sepsis – unified protocol with acute
medicine
• More nursing staff to be requested, especially in majors where there are delays to
antibiotics.
As the RD&E were high performing in this audit there are few actions required to improve
patient care. However, to ensure the maintenance of this standard a mandatory field
“consulted with...” in ED electronic patient notes system is planned.
• To improve documentation of key elements of patient care/observations it is planned to
amend the proforma in use in the Emergency Department to provide a prompt to staff
• Appointment of an Epilepsy Specialist Nurse is planned.
• To improve response times after patients call for help a direct link from the Cardiac Care
Unit and the ambulance has been established. It is also planned to increase the use of
the air ambulance where possible.
Actions planned to improve stroke care include:
• Creation of a new Standard Operating Procedure to ensure that stroke patients have a
maximum 3 hour wait in ED before transfer to the acute stroke unit
• Introduction of screening for carotid stenosis out of hours from Spring 2013
• Training for stroke nurse practitioners on dysphasia assessment and management
• Future provision for early supported discharge scheme in negotiation with the
commissioners
• Seeking patient user representatives to participate in stroke team governance meetings.
Actions planned as a result of the recommendations form this audit include:
• Mortality & Morbidity (M&M) meetings to be held more frequently and in more depth
• National Emergency Laparotomy clinical guidelines are being introduced and followed.
• To improve reporting and monitoring of cardiac arrest incidents, change in practice to
report all cardiac arrests through Trust electronic incident reporting system (DATIX)
• To improve the appropriate escalation of treatment, focused work on improving the use
of ‘Treatment Escalation Plan (TEP) and resuscitation Forms’.