Meeting Notes
Meeting:Audit Sub Group
Date:15th March 2016
Time:2 pm – 4 pm
Venue:Room 1, Wirral Hospice
Chair:Dr Alison Coackley
Y = attended; A = Apologies; X = Absent; D = Deputy; R = replaced; N/A = not applicable / 15/3/16 / 6/6/16 / 27/9/16 / 15/12/16StH&K / Janet Lawton / Macmillan Specialist Palliative Care Team Leader / Whiston / A
Liverpool / Dr Andrew Khodabukus / Palliative Medicine Consultant / Royal Liverpool / A
Dr Sarah Fradsham / Palliative Medicine Consultant / Marie Curie Hospice / A
Graham Holland / Clinical pharmacist / LHCH / A
Dr Catriona Mayland / Honorary Clinical Lecturer & Palliative Medicine Consultant / MCPCIL / X
Aintree / Dr Clare Forshaw / Palliative Medicine Consultant / Aintree / Y
WL, S & F / Dr Clare Finnegan / Palliative Medicine Consultant / WL, S&F / X
Wirral / Dr Alison Coackley (Chair) / Medical Director/Palliative Medicine Consultant / CCC / Y
Dr Catherine Hayle / Palliative Medicine Consultant / Y
Halton / Dr Averil Fountain / Palliative Medicine Consultant / Bridgewater/
Halton Haven / A
Dr Fariha Bokhari / Medical Officer / Halton Haven Hospice / X
Warr. / Dr Liz O’Brien / Palliative Medicine Consultant / WHHFT / Y
Cheshire / East / Dr Trevor Rimmer / Macmillan Consultant in Palliative Medicine / Macclesfield DGH / X
West / Jenny Smith / Palliative Medicine Consultant / Countess of Chester / Y
End of Life Pt’ship / Lynne Partington / Deputy CEO,
End of Life Partnership / End of Life Partnership / A
Dan Monnery / StR Audit Lead / Y
Kath Davies / Project Assistant / SCN / Y
Agenda Item
Welcome, Introductions and Apologies
Apologies were received fromGraham Holland, Jan Lawton, Sarah Fradsham, Averil Fountain, Lynne Partington and Andrew Khodabukus.
Notes from previous meeting
The notes from the meeting on 15th December 2015 were agreed to be an accurate record.
Matters Arising
3.1 Localised Reporting/Community Participation
Localised Reporting
Following on from previous discussions localised reports from the Hydration audit had been made available to those organisations that had submitted more than 10 results. There were 16 organisations. To make the best use of available resources a decision was taken that the report would be provided in Excel format. This would give each organisation the whole of their data to interpret themselves. However, it was suggested that perhaps the whole network data could be provided as a benchmark alongside the organisational data, which would give each organisation a comparison and would not be too onerous on available resource.
Also discussed was the ‘so what?’ question. A realistic timescale to have action plan was thought to be 12 months.
A brief questionnaire to scope units’ action plans was suggested, the design of which was put out for volunteers. Catherine Hayle volunteered to do this. The plan will be to send out by the end of June with a 2-week turnaround and receive feedback at the 14th July meeting.
Community Participation
Challenges from community teams participating in audits has been longstanding.
Barriers:
- Storage of case notes off site
- Audit of others’ practice (e.g. GP) – whose input are they auditing
- Lack of capacity / resources
- Recording of their practice unable to audit
- Own notes at HQ not comprehensive
- Less likely to input into a particular practice in the community (e.g. administer fluids) so less willing to audit
- Could progress through Primary Care Lead through the network
- Could bring to locality ICN to discuss further and highlight challenges
- Plan to produce report to show localities and teams who input into the audit process
Actions:
Add network results into localised reports - KD
Develop survey to scope action plan from localised reporting - CH
Work Programme
The draft work programme was reviewed by the group today. It was reported that this programme of work will inform what is realistic from the audit budget to deliver this work.
ASG Representation
Regarding ASG representation, it was agreed that certain stakeholders, e.g. acute oncology, could be appropriate. Regarding key people to link in with it was agreed that this should be a broad remit.
Key people:
Respiratory (who? - Sarah Sibley at Aintree and Lisa Davies, British Thoracic Society)
Dementia
Undertake survey of audit programme and guideline production amongst the wider group membership
The question was asked whether awider survey should be carried out. Some suggestions on what would we want to achieve from a wider survey:
- Does the audit programme continue?
- Should we link in with Manchester?
- Should use national guidance only?
- Should do more or less?
- How to make guidelines available?
- Should venue rotate?
Dissemination and Engagement
It was considered whether a dissemination plan would need to be advised from any survey. However, the group felt the need to be mindful whether there would be capacity to make any changes if offered. This could be discussed further at the July meeting.
The possibility of developing an App has been discussed previously it was reported that Ami would be keen to get involved in App development and that Apps are in use in the North West Region. It was agreed that some groundwork could be carried out to see what is possible, which Ami could be involved in.
Beyond March 2017
The main concern would be the website resources. On asking whether the web content could it be hosted by another organisation suggestions were:
- MCPCIL
- EoLP
- Deanery
The work programme was ratified by the ASG today.
Terms Of Reference
The Terms of Reference were reviewed by the group today.
Although the group agreed membership is appropriate there were some gaps identified in locality representation, as well as poor attendance at meetings. The group discussed how to promote attendance. The rotation of venue and day of the week is already in use as a way of promoting attendance. The group agreed that a named deputy as stated in the TOR should be encouraged as well as to recommend at least 60% attendance.
Programme for Guideline Review
6.1 Review Progress
The ASG reviewed the current 48 sets of guidelines today to agree consensus on whether they should remain as network guidance, become static or be removed.
Name of Guideline / Comments / Consensus Agreement
Agitation / Under review 2016/17 / Remain as separate guideline on current list
Antibiotics / Reviewed 2012 / Trust guidance followed;
Remove from guideline list
Anticoagulation / Remain on current list
Anticonvulsants / Reviewed 2012 / Remain on current list; change title to ‘Management of Seizures in PC’
Ascites / Remain on current list
Bereavement / Reviewed recently / Remain on current list to be audited locally
Bisphosphonates / ?Merge with pathological fractures / Remain as separate guideline on current list
Blood Transfusion / Under review 2016/17 / Remain on current list
Bowel Obstruction / Remain on current list
Breakthrough Pain / Remain on current list
Breathlessness / Remain on current list
Constipation / Review overdue / Remain on current list
Corticosteroids / Remain on current list
CPR / Under review 2016/17 / As there is national guidance could become a static guideline
Delirium / Under review 2016 / Remain on current list
Depression / Remain on current list
Diabetes / Under review 2016/17 / Remain on current list
EoL Drugs / NICE guidance but not user friendly / Remain on current list
Fatigue / Remain on current list
Genograms / Review then become static
Hydration / Reviewed recently / Remain on current list; review if significant change in evidence base
Hypercalcaemia / Under review 2016 / Remain on current list
Insomnia / Remain on current list
Interventional pain / Specialist Topic; last audit 2008 / Remain on current list
Itch / Last review 2003 / Review then become static
Ketamine / Remain on current list
Major Haemorrhage / Become static
Methadone / Remain on current list
N&V / Remain on current list
Neuropathic Pain / Reviewed 2014; awaiting final S&G – action below / Remain on current list
Nutrition / Remain on current list
NSAID / Remain on current list
Opioid substitution / Remain on current list
Opioids in drug abuse / Remain on current list
Oral Care / Remain on current list
Oxygen / Recently reviewed; national guidance available / Remain on current list as recently reviewed; for future adhere to national guidance
Pleural Effusion / BTS National Guidance / Remove from list
Pathological Fracture prevention / Remain on current list
Psychostimulants / Audit 2001 / Review in line with latest PCF the static at “date reviewed” with advise to ensure referral to latest PCF
Psychological Support Services / Audit service or restrict to clinical audit. Need to make global decision about services / Static; audit locally
Rehabilitation in Lung Cancer / Rename rehabilitation and re-audit service. Other types of rehab – may need to be as part of other guidance when relevant to that guidance. / Remain on current list
Renal Failure / need to rename to be more specific
Sexual Health / ?rename sexuality / Remain on current list
Spiritual Care / Remain on current list
Spinal cord compression / Regional and NICE guidelines / Remove from list; signpost to national guidance
Syringe Driver / Review and become static
Transdermal opioids / Remain on current list
Urinary Incontinence / Remove from list
Actions:
- Antibiotics –Note in Pink Book “please refer to local guidance” - KD
- Neuropathic pain – presented May 2014; external review done; met with GDG in October, still not available – liaise with GDG to finalise - Clare Forshaw
- Spinal cord compression - Pink Book need to signpost to national guidance - KD
Actions:See above
Feedback from Trainee Rep
Dan reported that he had put the questions to Trainees about reducing the 4 month gap between presentations to 2 months. The general view was that this would be unrealistic to amend the guidance but if this was only to update the PowerPoint presentation slides this could be achieved. However, it was not understood how this would reduce the time taken to update the guideline. Alison pointed out that this should help to shave some time off production of the guidance. Otherwise there were no other updates.
Actions:
Budget for Network Work Programme
The audit budget should be informed by the ratified work programme to agree what is realistic to deliver the agreed work. As it is difficult to quantify the amount of time spent in hours from an admin point of view and the Consultant Lead input it was agreed to do a basic time and motion log of hours.
Actions:
Review audit budget and ratify – AC/KD
Time and motion log – AC/KD
Education and Training Plans for 2016
The education and training programme is now available to register on the website:
via the events calendar at
or via the education and training page
The group was encouraged to promote the sessions within their localities.
Research
No new developments to report currently.
Patient and Carer Involvement Plans for 2016
The next patient focus day is planned for 24th May 2016 at Wirral Hospice.
Once attendance from each group confirmed an invite will be sent to PPI reps, ideally by first week in April to ensure good attendance.
- Confirmed attendance:
Anthony Thompson – CPR
Clare Forshaw/Esraa Sulaivany – Blood transfusion
- Unable to attend:
Grace Ting – Blood Transfusion (unable to attend due to staffing issues)
Dan Monnery – Diabetes (on leave)
- Awaiting Confirmation:
Penny Shepherd – Agitation (possible could attend if others cannot – will check)
- No response yet:
Joanna Roberts and Rachel McDonald – CPR
Teen Cartwright-Terry – Diabetes
It was suggested that a formal Lead rotation could ensure that all 26 senior medics participate on rota basis, which would mean the potential to lead on audit would only occur once every 5 years. For those localities with fewer Consultants a buddy system or proportional workload could be in place. Catherine agreed to look at developing a process for further discussion at the July meeting.
Actions:
List of Consultants/localities to CH – KD
Develop rota process; further discussion July meeting - CH
Audit Programme
12.1 Review Matrix 2016/2017
Title of Draft Standards and Guidelines / Date of Audit Presentation / Date expected for Subgroup Review / Reviewer
Subgroup member 1 / Reviewer
Subgroup Member 2 / Reviewer
Subgroup member 3 / Reviewer
Subgroup member 4
Nausea and Vomiting / January 2015 / February 2016 / Trevor Rimmer / Jenny Smith / Cath Hayle
Bisphosphonates / May 2015 / To be clarified / Andrew Khodabukus tbc
Clinically Assisted Hydration in the Dying patient / November 2015 / End March 2016 / Clare Forshaw / Catriona Mayland
Bereavement Services / January 2016 / June/ July 2016 / Lynne Partington
Delirium / May 2016 / November 2016
Hypercalcaemia / September 2016 / February 2017 / Dan Monnery tbc
As there were gaps in the reviewer matrix for each group the ASG agreed to try and populate this further.
Dissemination
In order to disseminate information wider it has been suggested that business cards and posters could be produced.
A sample card was discussed today and this will be circulated electronically for further feedback. In particular suggestions were requested for formatting and content.
Actions: Circulate sample card for feedback – KD/All
Submission for NICE Accreditation
The first guidelines will be submitted for NICE Accreditation at the end of April.
Actions: Submit to NICE - AC
Next Meeting:
6th June 2016; 2 pm – 4 pm
Mercer Suite, Linda McCartney Centre, Royal Liverpool Hospital
C&MSCN Audit Sub Group1
High quality care for all, now and for future generations
Meeting Notes
Meeting:Audit Sub Group
Date: 15thMarch 2016
Time:2 pm – 4 pm
Venue: Wirral Hospice
Chair:Dr Alison Coackley
Agenda Item / Action Agreed / Lead / Date3.1 /
- Develop survey to scope action plan from localised reporting
- Send out end June with 2 week deadline for further discussion at July meeting
3.1 /
- Add network results into localised reports
6 /
- Antibiotics –Note in Pink Book “please refer to local guidance”
- Neuropathic pain – presented May 2014; external review done; met with GDG in October, still not available – liaise with GDG to finalise
- Spinal cord compression - Pink Book need to signpost to national guidance
CF
KD
8 /
- Review audit budget and ratify
- Time and motion log of hours
11 /
- Finalise Patient Focus Dayand send invites
- List of Consultants/localities to CH
- Develop Consultant Lead rota for audit cycle
CH / 4.4.16
14.7.16
13 / Dissemination plan:
- circulate sample business card/poster
- Provide feedback
All / 16.3.16
14.7.16
C&MSCN Audit Sub Group1
High quality care for all, now and for future generations