Sample: National Early Warning Score and associated Education Programme Project Plan Version Modifications 0.1 Draft Initial Draft 0.2 Draft Modifications to initial draft Adapted with kind permission of Beaumont Hospital Updated 23rd May 2012 Author Date Objectives √ • Agreement in principle to the Project Initiation Document (PID) √ • Direction & guidance on some key decisions relating to project scope • Medical leadership to be identified √ • Highlight significant service implications associated with NEWS project rollout √ • Identification of pilot wards/units/departments Table of Contents 1. Introduction Purpose of the document Project Context 2. National NEWS Framework NEWS Framework Objectives Key Components of NEWS Project NEWS project scope Project Phasing 3. Project Management NEWS project structure Project roles & responsibilities Project Assumptions 4. Project Workstreams Work streams overview NEWS policy & Observation chart Emergency Response System /MET Team Development & Escalation protocol Education -COMPASS, ViEWS and ISBAR Communication tool Evaluation & Audit 5. Project Plan Project Implementation Plan 6. Project Assumptions 7. Clinical Risk Assessment and KPI’s Purpose of the document • The purpose of this document is to set out the terms of reference for a project to deliver the Implementation of NEWS Project in ………………………Hospital through a Project Initiation Document (PID) • The document will also outline how the NEWS Project will be managed. The project organisation are also detailed in this document. • The PID addresses the following fundamental aspects of the project: – What the project is aiming to achieve – Why it is important to meet the stated aims – To provide a clear and unambiguous view of how the project will be managed and controlled – Who will be involved in managing & delivering the project; their roles and responsibilities – How and when the arrangements covered in this document will be put into place. • This document will be agreed and approved by the NEWS Steering Group as part of the project initiation stage • The Project Manager (………………….) will be responsible for it’s maintenance throughout the project life Project Context The National Early Warning Score initiative is a work stream of the Acute Medicine Programme in association with other Clinical Programmes, Quality & Patient Safety, Office of the Nursing and Midwifery Services Director, Clinical Indemnity Scheme, the Assistant National Director, Acute Hospital Services, Integrated Service Directorate, Irish Association of Directors of Nursing and Midwifery (IADNAM) and the Therapy Professionals Committee. •International literature identifies that 11% of hospital deaths can be attributed to patient deterioration not recognized or acted upon. •National Patient Safety Agency (2007) Patient deterioration not recognized in hospitalized patients. •International literature identifies that 11% of hospital deaths can be attributed to patient deterioration not recognized or acted upon. •A large proportion of patients who suffer cardiac arrest in hospital have recognisable changes in routine observations during the preceding 24hrs including changes in vital signs, level of consciousness and oxygenation. One study showed that 60% of primary events investigated (deaths, cardiac arrests and unplanned ICU admissions) were preceded by abnormal physiology. (Hillman K.M. et al. “Antecedents to Hospital Deaths”. Intern Med J 2001; 31(6); 343-8) •Early recognition of clinical deterioration, followed by prompt and effective action, can minimise the occurrence of adverse events such as cardiac arrest, and may mean that a lower level of intervention is required to stabilise a patient. (Smith GB et al, Resuscitation 2006; 71: 19-28) Project Context • Early warning scores have been developed to facilitate early detection of deterioration by categorising a patient’s severity of illness and prompting nursing, and other healthcare professionals, to request a medical review at specific trigger points, utilising structured communication tools whilst following a definitive escalation the occurrence of adverse events such as cardiac arrest, and may mean that a lower level of intervention is required to stabilise a patient. plan. • Phase 1 of the National Early Warning Score initiative applies to Adult patients in Acute Hospital Services. • In April of 2011 HIQA recommended that the HSE should, as a priority, agree and implement a national early warning score to ensure that there is a system of care in place for the prompt identification and management of clinically deteriorating patients. • In July, 2011 the National Early Warning Score Governance Group launched the guiding framework and policy for the national Early Warning Score System to recognise and respond to clinical deterioration. This document was updated in January 2011, following a review of the programme, to take account of more recent international research. The Australian Compass Programme (2010) has been selected as the national tool for education on the deteriorating patient which now incorporates the VitalPACTM (ViEWS) scoring parameters (Dec 2011). On March 27th 2012 the National Clinical Programmes formally launched the National Early Warning Score and associated COMPASS Education Programme. HIQA Report 2012 The National Early Warning Score (NEWS) should be implemented in all clinical areas providing inpatient care. An emergency department specific system of physiological monitoring and triggered responses comparable to the NEWS should be implemented. HIQA Report 2012 ‘It is not acceptable that an EWS was not in place given that the Authority had previously recommended in the Report of the investigation into the quality and safety of services and supporting arrangements provided by the Health Services Executive at Mallow General Hospital (2010) that an EWS be implemented in all hospitals in Ireland and that the HSE should ensure a system-wide application and dissemination of this. National Early Warning Score Framework Objectives To improve patient safety and outcomes by : • Supporting the implementation of the national standard for recognising and responding to clinical deterioration -the ViEWS system and the associated multidisciplinary educational programme – COMPASS in acute healthcare settings • Promoting more effective inter-professional communication and teamwork by recommending the implementation of the structured communication tool “ISBAR” (Identification; Situation; Background; Assessment; Recommendation) • Supporting the development and implementation of appropriate organisational support systems for the early detection and escalation of care of at risk patients • Enabling audit of outcomes and performance comparison between different healthcare facilities Project Implementation Principles • All clinical staff must comply with the national guiding framework and related policies, clinical guidelines, procedures and protocols. Each employee must adhere to their professional scope of practice guidelines and maintain competency, in recognising and responding to patients with clinical deterioration, including the use of the National Early Warning Score System (ViEWS). • All staff will be comprehensively trained and supported during the NEWS implementation • The operation of the NEWS will require MDT co-operation • While aspects of the NEWS may be customised for use in ……………………. Hospital the ViEWS parameters and core objectives of the National Programme will be maintained • All policies, protocols, documents, forms etc, will be initially developed in draft form, extensively consulted and formally approved by the appropriate body before implementation In Scope\Out of Scope Patients (in scope) • All adult in-patients & out patients requiring interventional procedures and sedation • All patients attending AMU/AMAU/MAU • ED presentations identified as requiring NEWS at triage & all patients identified for admission • Any patient where professional judgement of staff identifies a need to carry out an EWS because of concern re their condition • Patients in a critical care environment (ITU, Recovery Room, CCU) EWS at transfer to ward Patients (out of scope) • Palliative care (active end of life care) & routine OPD • Not For Resus (NFR) Patients (documented in Patients Chart) • Paediatrics, CNU • Obstetric Patients In Scope\Out of Scope (cont.) Key tasks (in scope) • Develop a Hospital wide NEWS Policy • Develop and implement an Escalation plan & Emergency Response System / Medical Emergency Team (MET) integrating with existing arrangements • Review and design an observation chart incorporating (NEWS) for use in …………………(name of service) • Provision of education and training of all clinical staff measuring/interpreting Vital Signs • Implementation of the standard communication tool (ISBAR) • Implementation of an Evaluation and Audit process • Delivery of a comprehensive cross hospital communications plan • Key tasks (out of scope) • Education for undergraduate Nursing students year 1-3 and Medical students Project Management Structure •The Project Management Structure will comprise the following components: – Oversight (“Steering Group”) – Management & Execution - Project Manager and Work stream Leads to work on the Individual work streams – The Work stream leads will establish their own work stream groups as required – Each work stream will have a Working Group to support it in its work. The composition of the Working Group will be agreed by the Work stream Lead in conjunction with the Project Manager. It is possible that some Working Groups may provide support to more than one work stream or that individuals may be on more than one Working Group •The structure and the Roles and Responsibilities are outlined in the following slide •The Steering Group will meet every 6-8 weeks during phase 1 of the project: – On the first occasion to approve the Project Initiation Document (including objectives, timelines, etc) – On subsequent occasions to get a project progress reports & authorise key stages/ decisions of the project •The Project Team will meet on a fortnightly basis •Work stream and Working Group meetings will occur as required by the Work stream lead Project Roles & Responsibilities Steering Group • • • • • • • • • Ensure the project is established and appropriately managed Provide overall direction and leadership for the delivery and implementation of the project Ensure that the project is aligned with Hospital & HSE Strategic objectives Ensure that the project Manager and Work stream Leads have the staff and other resources to deliver the project Resolve any issues that are escalated from the project Manager and Work stream Leads Ensure that the project in on target and meets its approved objectives Sign off on key project milestones / deliverables Monitor for changes in the external environment that may impact on the project Play an advocate role across the Hospital for the project Project manager • • • • • • • • • • • Leads the project on a day-today basis Ensures that the overall project is appropriately structured into work streams Drives overall project plan & project direction Monitors the progress of all work streams Ensures project meetings with Work stream Leads takes place on a weekly basis Develops Steering Group Update / Report Ensures an appropriate stakeholder and cross hospital engagement plan is established and is implemented Manages overall project risks and issues Reports to project sponsor on a weekly basis Escalates to Steering Group risk and issues where appropriate Play an advocate role across the Hospital for the project Project Team • • • • • • Responsible for planning of the project Provides the relevant leadership & expertise from specialist areas Represents the interests of stakeholders in Clinical areas Identifies opportunities in EWS project & takes the lead in implementing these Directly works on a work stream tasks on a day to day basis Reports on a weekly basis to the project team & communicates all relevant information clearly to the project team Workstream Leads • • • • • • Leads the work stream on a day-to-day basis involving team members as appropriate Monitors the progress of all activities within the work stream plan in conjunction with the project manager Develops & submits to the project manager a weekly status report on progress during the week Ensures an appropriate stakeholder and engagement plan is established and is implemented with respect to the work stream Liaises with other key stakeholders as required who impact on the project Interacts with and involve the project team in the activities of the work stream 13 NEWS Project Structure HSE NEWS National Steering Comm NEWS Project Steering Group (see next slide for suggested membership) Hospital Clinical/ Senior Exec Leadership Team Hospital PMO AMP Steering Comm Project Manager …………………….. NEWS Project Team Project Support Quality Assurance Administrative Support Workstream Groups EWS Project Steering Group as appropriate to hospital (Suggested Membership) • • • • • • • • • • • • • • • • • ………………….Project Sponsor …………………Clinical Director Medicine …………………Anaesthetist …………………ED Consultant …………………Resuscitation Officer ……………….. Consultant (Surgical) ………………….Clinical Governance Manager (IQS) ………………….ICT Director ………………… Financial Controller ………………… Practice Development Co-ordinator …………………..Medicine Directorate Nurse Manager ………………….Surgical Directorate Nurse Manager ………………….Specialist areas Directorate Nurse managers ………………….Critical Care Directorate Nurse Manager …………………..Physiotherapy Manager ………….........Out of Hrs Nursing Representative ………………….Associated Third Level Lecturer (Nursing and/or Medical) NEWS Project Phasing : The EWS project will be rolled out in …………………………… on a phased basis Phase 1 of the project (Timeframe) will deliver: -Review & design of an appropriate observation chart incorporating ViEWS parameters for use in …………………………… -Development of Emergency Response System e.g. MET team integrating with existing arrangements -Development of an NEWS policy incorporating escalation protocol and communication tool (ISBAR) -Train the trainer Programme for identified Medical & Nursing EWS programme trainers -Rollout of COMPASS education programme to clinical staff on selected pilot site(s) - Development of audit tool -Pilot ………………………………..(timeframe) -Evaluation of outcome of pilot Phase 2 Hospital rollout to begin ……………………………(tmeframe) Phase 3 Implementation of later phases Project Workstreams Project Manager……………………………. NEWS Policy & Obs chart Emergency Response System Lead: ……….. Lead: ……………. Work stream lead supported by Practice dev, Clinical governance, Medical leadership Objective: To support the development & implementation of NEWS and related systems into clinical practice in ………………. Hospital. -NEWS policy development -Obs chart /fNEWS sign off Work stream lead supported by Medical & Nursing Mgmt Objective: To design composition of ERS / MET and develop supporting escalation protocol incorporating EWS trigger and communication tool -Escalation protocol agreement -Emergency Response System - Communication tool sign Nursing: All inpatient areas Dir reps ED ITU Out of hours Clinical Governance Medical: Physicians /Surgeons, Critical Care Medicine : as appropriate to hospital Respiratory, Cardiology , other Anaesthetics, Surgeons Critical Care Nursing Out of Hours Nursing ICT Education Lead: Medical /Nursing Work stream lead supported by Nurse Education, Practice Development & Medical Tutors Objective: To provide clinical staff with an understanding of the underlying physiology of acutely unwell patients, clear guidelines on the measurement of vital signs & the documentation &, escalation /communication of triggered NEWS to appropriate medical personnel - Train the trainer - Rollout of COMPASS programme incorporating ISBAR communication tool - -Documentation process NCHD Trainers Nurse Education/ Practice Development ACLS instructors Identified Cnm’s/SN’s AHP’s Evaluation & Audit Lead: Work stream lead supported by Clinical Governance & Practice Development Objective: To develop and implement appropriate evaluation & clinical audit systems to support the continuous quality improvement process in relation to implementation of the NEWS system. Nursing: Practice dev, Senior Medical support Ward Managers ITU, Audit nurse RTO input ICT Project Plan - suggest Gannt Chart • Use the Implementation Plan provided on the NEWS website below as a guide for the development of a phased roll out of the NEWS in the Hospital. • Identifying key milestones, timelines, planning targets – tasks completed, planned etc • Task requiring urgent action etc • www.hse.ie/go/nationalearlywarningscore/ Key Assumptions • Senior Medical & Clinical Managers will support the EWS project implementation • Medical and clinical staff will support the practice changes required by the project • Budgetary and other resources including Human resources will be made available to the project and will not impact on timelines • Staff will be released to attend training • Trainers/Instructors will be released to provide training • There will be no delays in getting training for additional ‘Train the Trainer’ staff • The AMP project will support the NEWS project as required. Clinical Risk Assessment and KPI’s • Clinical Risk assessment will be key to prioritising areas for immediate implementation of the NEWS • Identification of Key Performance Indicators (KPI’s) to assess performance patient safety and quality of care is recommended.