Performance (month 1, April 2014)
• ED Performance against the 4 hour standard in April was 96.8%.
• All three Referral To Treatment standards were achieved at aggregate Trust level with non-compliance for the admitted standard in T&O.
• Cancer access: All Cancer standards were achieved in April.
• Patient safety indicators continued to show expected levels of performance.
• The latest HSMR data and SHMI data both show overall trust mortality is lower than expected for all our patient groups.
• The Trust had no MRSA bloodstream infection however there were 3 episodes of C-Diff in April.
• Maternity indicators continue to show positive performance.
Diagnostic Imaging Update
GP/Outpatient X-ray services are available across all sites within the trust (East Surrey, Crawley, Caterham Dene & Horsham) strictly between the hours of 0900 and 1700 Monday to Friday.
Patients arriving outside these times will be asked to return during these hours.
Caterham Dene currently offers a GP list between 1200 – 1900 on Saturdays and Sundays BY APPOINTMENT ONLY. Patients must contact the radiography department at Caterham to make an appointment.
We are exploring the idea of direct GP access for CT referrals if this is something you feel would be of benefit to your service & patients. Please email your responses, to allow us to gauge demand.
Drugs and Therapeutics Committee
The D&TC is the Trust’s internal formulary committee meets every two months and works in close collaboration with the Prescribing Clinical Network. The multidisciplinary committee also includes Trust Consultants and Pharmacy staff, a patient representative and reps from the CCGs. Decisions taken at the last meeting in April include:
Octasa brand of mesalazine for Ulcerative Colitis
Fesoteridine to bring us into line with the local Overactive Bladder pathway agreed by CCGs
Dymista (azelastine and fluticasone) nose spray – following black status at PCN
Revlar Ellipta – concern over the safety of this product, especially the potential for confusion over the name and colour
Electronic Prescribing and Medicines Administration
The Trust is working on a project to have our first ward live in November 2014. We’ll be using Cerner for this project and we expect the systems to integrate into a new discharge letter. Roll out will be slow as we pilot new processes so you will more often see the current discharge letters for the time being.
The Trust is keen to hear feedback on the quality of medicines information on discharge letters. Please contact David Heller, Chief Pharmacist via email firstname.lastname@example.org with general feedback.
Lead Pharmacist for Surgery: Mead Ali email@example.com
Lead Pharmacist for Women and Child Health: Agnieszka Cedro-Sogliani Agnieszka.Cedro-Sogliani@sash.nhs.uk
Lead Pharmacist for Antimicrobials: Amy Lee firstname.lastname@example.org
Formulary Development Pharmacist: Omar Ali email@example.com
Lead Pharmacist for Cancer Services: Wasifa Webb firstname.lastname@example.org
We’ve had a few queries about this product which is no longer made. The best alternative is Nystaform cream, a combination of nystatin and chlorhexidine.
Acute Kidney Injury: Predict, Avoid and Early recognition.
Acute kidney injury (AKI) is seen in 13–18% of all people admitted to hospital. With this high numbers of patients, it is important for all health professionals to be aware of the new definition of AKI, when to predict AKI, how to prevent it and how to manage it.
To predict AKI, we should measure serum creatinine and compare with baseline in every adult presenting with acute illness if any of the following are likely or present:
– Chronic kidney disease (CKD), heart failure, liver disease, diabetes.
– Neurological or cognitive impairment or disability (limited access to fluids)
– Oliguria (urine output less than 0.5 ml/kg/hour)
– Use of drugs with nephrotoxic potential ( NSAIDs, ACE, ARBs, diuretics, etc) within the past week, especially if hypovolaemic.
– Use of iodinated contrast agents within the past week
– Symptoms or history of urological obstruction.
– Age 65 years or over.
-People admitted to hospital that are at risk of developing AKI (as above) should have ongoing assessment to recognise and respond to oliguria and change in creatinine level.
– Offer intravenous volume expansion to adults having iodinated contrast agents if they are at high risk of developing acute kidney injury.
– Consider temporarily stopping ACE inhibitors and ARBs in adults having
Iodinated contrast agents if they have CKD with an eGFR
Less than 40 ml/min/1.73 m2.
Detect AKI as by AkIN/ KDIGO staging for AKI:
Stages Stage Serum creatinine Urine output
1 rise > 26 μmol/L within 48hrs
or rise >1.5- to 1.9 X baseline SCr 6 consecutive hrs
2 rise > 2 to 2.9 X baseline SCr 12 hrs
3 rise >3 X baseline SCr or rise 354 μmol/L or commenced on renal replacement therapy (RRT) 24 hrs
or anuria for 12 hrs
If a patient in primary care is found to have AKI:
1- For stage 1 AKI: we need to treat the acute illness, adjust medication, keep the patient well hydrated and repeat serum creatinine in 48H.
2- For stage 2 or 3: the patient needs to be referred to hospital for assessment and management.
For further information contact Dr Hanadi Asalieh at Hanadi.Asalieh@sash.nhs.uk
Therapy Team in ED
An occupational therapist and physiotherapist are providing a 7 day a week service in the Emergency Department. The team’s aim is to provide patient centred assessment and treatment, facilitating and co-ordinating safe discharges and working as part of a multi-professional and multi-agency team.
The average response rate for the team has been audited and is 5 minutes for patients in majors and minors and 8 minutes for patients in the clinical decision unit. From October 2013 to January 2014 they have seen 1346 referrals and avoided 373 admissions to the main hospital.
The therapists carry out an initial joint assessment and then contact the relevant community or social care teams if the patient needs further on-going support in the community. Future plans include extending the hours the team is available, focusing on re-attendance rates and rolling the service out to the Acute Medical Unit.
For further information contact Head of Therapies Sally Dando at email@example.com
Carers Week Event
Our Macmillan Breast Care Clinical Nurses Specialists are organising a Carers Week Event on Tuesday June 10 from 10.30am to 2.30pm in the Atrium of the Post Graduate Education Centre at East Surrey Hospital.
A number of organisations including Macmillan, Cancervive, The Olive Tree and Jigsaw will be there offering support and information to anyone who is a carer. For more information contact: