The great strides that Scotland has made to reduce the number of deaths from Sepsis is now well documented – as is the impact of the Scottish Patient Safety Programme (SPSP) which is now celebrating its 10th year of driving improvements in patient safety. Less known, but no less important, is the growing progress we’re making in reducing cardiac arrests in Scotland’s acute hospitals.
The UK resuscitation council describes a cardiac arrest as a sudden loss of blood flow resulting from the failure of the heart to effectively pump. This happens when the heart stops beating and clinical staff then attempt to restart it. These attempts involve chest compressions, delivery of high-voltage electric shocks across the chest, attempts to ventilate the lungs and an injection of drugs. In some cases a cardiac arrest happens as a result of a heart attack or another sudden health event, but in other cases the cardiac arrest comes after a period of deterioration in physical observations such as blood pressure or pulse rate.
“Since 2013, there has been a 27% drop in the cardiac arrest rate in general ward areas in 15 Scottish hospitals who have reported data to SPSP. This means that on average, there are 18 fewer people per month not suffering from this harmful and distressing experience in hospitals.”
I’m delighted to say that since 2013, there has been a 27% drop in the cardiac arrest rate in general ward areas in 15 Scottish hospitals who have reported data to SPSP. This means that on average, there are 18 fewer people per month not suffering from this harmful and distressing experience in hospitals. Key to achieving this progress has been SPSP focus on ’deteriorating patients’ since its launch in 2008. However, it is also testament to the hard work of the clinical staff in NHS boards across Scotland who have worked together to improve the recognition and response to acutely deteriorating patients.
The foundation to this reduction is early recognition of deterioration and a timely response – this is critical as it allows staff to plan and provide treatment as soon as possible to reduce the chance of cardiac arrest and death.
There are many different reasons why patients deteriorate, and we know that some patients will not benefit from certain treatment options when they do deteriorate. Therefore a range of different interventions are required in order to respond appropriately and prevent cardiac arrests. Here is a brief summary of some of the key actions that have contributed to the improvement in cardiac arrest rate:
- Improve the recognition of a deteriorating patient through implementation of the National Early Warning Score (NEWS): NEWS is an evidence-based tool which helps staff to recognise deterioration early. NEWS is a critical step in improving communication in patient care which has now been implemented in 14 NHS boards and the Scottish Ambulance Service.
- Improve the timely treatment for patients with Sepsis: Clinical teams have tested and implemented the Sepsis Six care bundle. Evidence tells us that reliable delivery of this care bundle can improve outcomes for people. To date, mortality rates from Sepsis have fallen by 21% and Hospital Standardised Mortality (HSMR) has fallen by 11.2% from August 2016.
- Improve the response to a deteriorating patient: A structured response that includes a treatment escalation plan allows staff to provide the right treatment as soon as possible to reduce the chance of a cardiac arrest. A treatment escalation plan – that is based on an individual’s clinical condition and goals of care – supports person-centred care planning to achieve the best outcome.
- Improve awareness and communication of deteriorating patients: NEWS and treatment escalation planning have become common terminology, and are a standard item on ward and hospital safety briefs – they are regularly highlighted in visual prompts, for example on ward whiteboards.
- Support education. SPSP has developed educational cards and posters to support clinical staff alongside an online module to increase awareness and understanding of NEWS. SPSP have hosted networking events to share successes and challenges and support staff to learn from each other.
In short, the focus is on identifying the critical connection between NEWS, early recognition of deterioration and decision-making that uses a person-centred approach.
“The falling figures on cardiac arrests, the actions being taken in Scotland and the changing culture and understanding of staff over the last decade, are all great progress in reducing the number of cardiac arrests – in the end it all comes down to the hard work, resilience and openness of staff in the NHS in Scotland to making improvements to care.”
The falling figures on cardiac arrests, the actions being taken in Scotland and the changing culture and understanding of staff over the last decade, are all great progress in reducing the number of cardiac arrests – in the end it all comes down to the hard work, resilience and openness of staff in the NHS in Scotland to making improvements to care.
We know that there are still plenty of opportunities to reduce harm for people in health and social care. We’ll continue to collaborate and maintain our focus on prevention, recognition and response to deterioration for people in Scotland wherever they are cared for.
Dr Calum McGregor is Clinical Lead for the Acute Care portfolio of the Scottish Patient Safety Programme (SPSP)
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