University Health Board
Action Taken
The Health Board provided an action plan prior to the inquest and has updated it in response to concerns. Actions include enhanced senior clinician review of emergency medical patients, reinforced importance of nursing staff reviewing documentation, and plans to extend electronic GP record access to emergency departments. (AI summary)
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Dear your Energy
The systems in the Princess of Wales Hospital have been reviewed, in the light of this serious incident and have been enhanced to ensure all emergency medical patients admitted to the hospital are reviewed by a senior clinician or consultant within 14 hours or sooner if clinically indicated: There are two entry points through which patients who may require emergency medical admission come into the hospital: The Acute Medical Unit (AMU) and the Emergency Department (ED): The AMU accepts referrals from General Practitioners and the ED assesses patients who arrive at the hospital independently or via ambulance transportation: Every day there is a consultant physician on call and helshe will carry out two rounds in each 24 hours and be available when called to assess or provide expert opinion on patients that members of hislher junior team feel need to be clinically reviewed. At the two entrances there are two registers one in the ED department and one in the AMU department and these are now formatted the same way and require the consultant to sign the register when helshe has seen the patient (Appendix 1) This enables the nursing and medical teams to see quickly who has been reviewed and by whom and who has to be reviewed. This has replaced the tick box that previously existed; recognising that the ticks could have been entered by anyone and the system could not be reviewed and checked: The enclosed map (Appendix 2) shows the Ciinical Decision Unit (now called the Acute Medical Unit) and Emergency Department are next to each other and the medical team works in both areas throughout the 24/7 service. We will continue to monitor the system in place and the Clinical _Director will review the working practices of the Consultant Physician body in this regard. The Clinical Director has reinforced to all Consultants that it is vital that only sign the book after review has taken place and is monitoring the system. All the teams are aware of this incident and inquest and have learned from that: They continue to monitor and review and support the ongoing pilot to develop an electronic system. The Health Board is piloting a live electronic "work list" which allows medical and surgical teams to be notified of patients that are requiring reviews and decisions about their treatment: Initially the functionality will provide: A list of patients under particular consultant's care at any particular time with the ward location (and baylbed) of each patient history of previous entries saved on the work list A display to others involved in the care of the patient e.g. nurses with ability to add information (again auditable): A print out and electronic signature of the person inputting the data. All entries on the work list will be time stamped and user authenticated by the NHS National Authentication System (NADEX) Chairman/Cadeirydd: Professor Andrew Davies Chief Executivel Prif Weithredydd: Mr Paul Roberts ABM Headquarters/ Pencadiys ABM, One Talbot Gateway Seaway Parade; Baglan Energy Park; Port Talbot: SA12 7BR. Telephone: 01639 683344 Ffon 01639 683344 FAX: 01639 687675 and 01639 687676 Bwrad lechyd ABM Yw enw gweithredu Bwrdd lechyd Lleol Prifysgol Abertawe Bro Morgannwg ABM University Health Board is the operationa name of Abertawe Bro Morgannwg University Local Health Board
yet they
From September 2015 a new National Emergency Department system (called Symphony) will be implemented within the Emergency Departments and Assessment Units throughout the Health Board. Initially the system wili be introduced in Princess of Wales Hospital and Neath Port Talbot Hospitals in September 2015, the first sites in NHS Wales to go live with thesnew national system This will be followed by implementation in Morriston and Singleton Hospitals in November 2015. The Symphony ED system has the ability to request a specialist review of the patient and the time that request was made_ The system records the time when the specialist reviews the patient and enables the specialist to record clinical notes to support the review. We the facility within Symphony to set a target time from "request made" to "review actioned" and the patient will change colour if this time parameter is breached. This information will be available to all Emergency staff and on-call staff. 2 Notification that_the_review _has occurred to be indicated to Ward staff The current arrangements have been reviewed and it is clear that when patient is admitted the clinical assessment documentation is completed by the admitting doctor: copy of the document is attached (Appendix 3) and comes as a booklet rather than separate sheets. Page 8 of that document has to be completed by the senior reviewing clinician: This record is sent to the ward with the patient and so ward staff can identify whether senior review has taken place and the time that it took place quickly Nursing staff know to_seek medical review; if it has not taken place and if the patients condition required it The staff would use the National Early Warning Score (NEWS) to guide their actions when assessing patient's need for review The Chief Nurse has reinforced the importance of nursing staff reviewing the documentation that comes to the ward with the patient as the nurses admit the patient; 3_ For_Community_Health Care records_to_beelectronically availableto Emergency Medicine Departments summary of the GP record is currently available in out-of-hours GP services. This national service is currently extended for use in hospital emergency settings Pilot projects are already underway in Cardiff and the Vale and Anuerin Bevan Health Boards and our Health Board has already indicated our eagerness to provide this service locally as soon as the pilot studies have been completed: Chairman/Cadeirydd: Professor Andrew Davies Chief Executivel Prif Weithredydd: Mr Paul Roberts ABM Headquarters/ Pencadlys ABM; One Talbot Gateway, Seaway Parade, Baglan Park, Port Talbot. SA12 7BR Telephone: 01639 683344 Ffon 01639 683344 FAX: 01639 687675 and 01639 687676 BBrddlecbvd ABMYw Enw gweithredu Bwrdd lechyd Lleol Prifysgol Abertawe Bro Morgannwg ABM University Health Board is the operational name of Abertawe Bro Morgannwg University Local Health Board
have being Energy
trust that the actions takenlproposed to be taken by the Health Board addresses the matters of concern raised in the Regulation 28 Report: Please do not hesitate to contact me should you require any further information.
The systems in the Princess of Wales Hospital have been reviewed, in the light of this serious incident and have been enhanced to ensure all emergency medical patients admitted to the hospital are reviewed by a senior clinician or consultant within 14 hours or sooner if clinically indicated: There are two entry points through which patients who may require emergency medical admission come into the hospital: The Acute Medical Unit (AMU) and the Emergency Department (ED): The AMU accepts referrals from General Practitioners and the ED assesses patients who arrive at the hospital independently or via ambulance transportation: Every day there is a consultant physician on call and helshe will carry out two rounds in each 24 hours and be available when called to assess or provide expert opinion on patients that members of hislher junior team feel need to be clinically reviewed. At the two entrances there are two registers one in the ED department and one in the AMU department and these are now formatted the same way and require the consultant to sign the register when helshe has seen the patient (Appendix 1) This enables the nursing and medical teams to see quickly who has been reviewed and by whom and who has to be reviewed. This has replaced the tick box that previously existed; recognising that the ticks could have been entered by anyone and the system could not be reviewed and checked: The enclosed map (Appendix 2) shows the Ciinical Decision Unit (now called the Acute Medical Unit) and Emergency Department are next to each other and the medical team works in both areas throughout the 24/7 service. We will continue to monitor the system in place and the Clinical _Director will review the working practices of the Consultant Physician body in this regard. The Clinical Director has reinforced to all Consultants that it is vital that only sign the book after review has taken place and is monitoring the system. All the teams are aware of this incident and inquest and have learned from that: They continue to monitor and review and support the ongoing pilot to develop an electronic system. The Health Board is piloting a live electronic "work list" which allows medical and surgical teams to be notified of patients that are requiring reviews and decisions about their treatment: Initially the functionality will provide: A list of patients under particular consultant's care at any particular time with the ward location (and baylbed) of each patient history of previous entries saved on the work list A display to others involved in the care of the patient e.g. nurses with ability to add information (again auditable): A print out and electronic signature of the person inputting the data. All entries on the work list will be time stamped and user authenticated by the NHS National Authentication System (NADEX) Chairman/Cadeirydd: Professor Andrew Davies Chief Executivel Prif Weithredydd: Mr Paul Roberts ABM Headquarters/ Pencadiys ABM, One Talbot Gateway Seaway Parade; Baglan Energy Park; Port Talbot: SA12 7BR. Telephone: 01639 683344 Ffon 01639 683344 FAX: 01639 687675 and 01639 687676 Bwrad lechyd ABM Yw enw gweithredu Bwrdd lechyd Lleol Prifysgol Abertawe Bro Morgannwg ABM University Health Board is the operationa name of Abertawe Bro Morgannwg University Local Health Board
yet they
From September 2015 a new National Emergency Department system (called Symphony) will be implemented within the Emergency Departments and Assessment Units throughout the Health Board. Initially the system wili be introduced in Princess of Wales Hospital and Neath Port Talbot Hospitals in September 2015, the first sites in NHS Wales to go live with thesnew national system This will be followed by implementation in Morriston and Singleton Hospitals in November 2015. The Symphony ED system has the ability to request a specialist review of the patient and the time that request was made_ The system records the time when the specialist reviews the patient and enables the specialist to record clinical notes to support the review. We the facility within Symphony to set a target time from "request made" to "review actioned" and the patient will change colour if this time parameter is breached. This information will be available to all Emergency staff and on-call staff. 2 Notification that_the_review _has occurred to be indicated to Ward staff The current arrangements have been reviewed and it is clear that when patient is admitted the clinical assessment documentation is completed by the admitting doctor: copy of the document is attached (Appendix 3) and comes as a booklet rather than separate sheets. Page 8 of that document has to be completed by the senior reviewing clinician: This record is sent to the ward with the patient and so ward staff can identify whether senior review has taken place and the time that it took place quickly Nursing staff know to_seek medical review; if it has not taken place and if the patients condition required it The staff would use the National Early Warning Score (NEWS) to guide their actions when assessing patient's need for review The Chief Nurse has reinforced the importance of nursing staff reviewing the documentation that comes to the ward with the patient as the nurses admit the patient; 3_ For_Community_Health Care records_to_beelectronically availableto Emergency Medicine Departments summary of the GP record is currently available in out-of-hours GP services. This national service is currently extended for use in hospital emergency settings Pilot projects are already underway in Cardiff and the Vale and Anuerin Bevan Health Boards and our Health Board has already indicated our eagerness to provide this service locally as soon as the pilot studies have been completed: Chairman/Cadeirydd: Professor Andrew Davies Chief Executivel Prif Weithredydd: Mr Paul Roberts ABM Headquarters/ Pencadlys ABM; One Talbot Gateway, Seaway Parade, Baglan Park, Port Talbot. SA12 7BR Telephone: 01639 683344 Ffon 01639 683344 FAX: 01639 687675 and 01639 687676 BBrddlecbvd ABMYw Enw gweithredu Bwrdd lechyd Lleol Prifysgol Abertawe Bro Morgannwg ABM University Health Board is the operational name of Abertawe Bro Morgannwg University Local Health Board
have being Energy
trust that the actions takenlproposed to be taken by the Health Board addresses the matters of concern raised in the Regulation 28 Report: Please do not hesitate to contact me should you require any further information.