Meeting Name: Audit Sub Group

Date and time / Monday, 6th June 2016 at 2 – 4 pm
Venue / Mercer Suite, Linda McCartney Building, Royal Liverpool University Hospital
Present
Name / Title/role
Andrew Khodabukus / Consultant in Palliative Medicine
Liz O’Brien / Consultant in Palliative Medicine
Jenny Smith / Consultant in Palliative Medicine
Dan Monnery / SpR
Kath Davies / Project Assistant
Apologies
Sarah Fradsham / Consultant in Palliative Medicine
Catherine Hayle / Consultant in Palliative Medicine
Alison Coackley / Consultant in Palliative Medicine
Graham Leng / Consultant in Palliative Medicine
  1. Welcome, introduction and apologies

Andrew welcomed the group and individual introductions were made. Apologies noted above.

  1. Agree accuracy of last notes 15th March 2016

The notes were agreed as an accurate record.

  1. Matters arising

3.1 Update on scoping report of unit engagement with localised reporting

Catherine Hayle has developed a short survey to scope any quality improvements made following the localised reporting from the hydration audit. The group asked for this to be circulated for feedback by the end of June, at which point it will be decided what format this survey takes, likely to be a survey monkey.

Regarding the question of a ‘small fee’ further clarification is required. It was felt that this should take into account not just localised reporting but to include being able to participate in the whole audit process.

Action:

  • Circulate questionnaire for comments by end of June 2016

  1. 2016 and beyond; the future of the audit and guideline development work

Points for consideration

  • update on network plans
  • resources/budget
  • name
  • support
  • website
  • work programme
  • Terms of reference and membership
  • impact on NICE

As the Audit Sub Group (ASG) has been informed that there is no longer resource from the Network to provide support from the end of July 2016 the group was asked to consider how the audit group should plan to continue going forward. As well as administrative support to the ASG in terms of meeting organisation there is also the background work of maintenance of the website and database to meet NICE criteria, which is a significant amount of work.

There has previously been discussion about the website being hosted by another organisation and suggestions have been Mersey Deanery, MCPCIL and CCC. Another suggestion was the EoLP; however, they link with East Cheshire who are now back under the Greater Manchester SCN. There is no one obvious solution but consideration should be given to these.

Although the audit group has been in existence since 1995 prior to receiving support from the Network it is acknowledged that Network support has provided more structure and the framework developed would be difficult to maintain without robust admin support. The ASG formally thanked the Network team for their support.

The ASG strongly support continuing the audit cycle and noted the participation of the rest of the North West Coast regions (Blackpool, Lancaster and South Cumbria) in the past in supraregional audits.

In order to sustain the current programme the group agreed the need to consider what changes, if any, are feasible and how the programme can be taken forward with these changes without detriment to the process. There is much value in a formal and robust audit programme to provide quality assurance and consistency across the region.

Regarding the Network’s recent question about the possibility of adopting Northern symptom control guidelines for generalists the group’s thoughts were:

Audit Sub Group Future and Cheshire and Merseyside Standards and Guidelines

  • Strong feeling that audit group should absolutely continue.
  • Acknowledged that getting the revised process right has had impact on timelines this is now becoming easier and in addition NICE accreditation ensures C&M guidance is robust.
  • Ethos has always been having guideline can be used across settings the same as patients transfer between settings – keep standards the same in each care setting.
  • Not originally designed only to be for specialists – however, some topics are specialist and needed for specialists.
  • The ‘SPC community’ is strong in C&M and advice is well thought of.

Generalist Palliative Care Guidelines

  • There is a duty of care to support community practice.
  • When considering generalist guidelines, need to consider whether guidelines aimed at “Generalists”, c.f. GPs would be appropriate for e.g. DN, Care Home Nurses, Hospital Nurses.
  • C&M guidelines have now start with a summary – could make sure that these summary recommendations are reformatted so suitable for generalist use – best of both ensure strong, robust with evidence base into a format that GPs can use in practice to ensure quality assurance.
  • Happy to have wider professional input into guideline presentation Difficult in the past to get generalist involved in the process.
  • If want to meet their needs they need to have greater involvement.
  • Is criticism needs to be easier to use justified? Simple guidelines versus complex nature of healthcare; could mean oversimplifying.

Guideline Review Process

  • Consider where NICE guidelines for Care of the Dying Adultwould fit.

North East Guidelines

  • Why go further afield geographically than next door to our region. Why NE? Why not Manchester and have a third set of guidelines?
  • Misunderstandings could happen with multiple guidelines– is this defendable?
  • Whose responsibility is it going to be to produce and maintain the proposed guidance? Ensure adequate capacity and resource.
  • NE guideline shown to a GP colleague whose comment was that it’s too big.
  • How will these fit in with the regional audit programme given the uncertainty with reduced support at this moment in time
  • Strongly feel should use the resource that has already been established in C&M – feel this additional guidance could undermine that audit process.
  • Implementation aspect – if different guidelines to those that may be NICE accredited.
  • Guidelines should not just be for generalists but as specialists need to ensure consistency across patch. If the NE set are not endorsed by the audit group cannot expect generalists to follow different guidance to what the specialists would follow – “do as I do not as I say”.
  • Some of the guidance contradicts the audit findings of C&M – would be giving different advice; one example was the delirium pathway – find these could be giving dangerous advice.

Quality Improvement

  • As long as the guidance is consistent and robust does it matter where guidelines originate?
  • Competency of staff following guidance needs to be appropriate and supported in implementation
  • What is the point of guidelines if they are not used for quality assurance?
  • SPC support education of generalists – there to help support teaching and improving practice.
  • What is adopted directly affects what the audit group does.
  • Ensure defendable from a legal view point - C&M have a peer reviewed robust process.

Key phrase: consistent approach with back up of evidence base for individualised care. It was agreed the Andrew would formally respond to the Network on behalf of the ASG with agreement from the group on the wording.

In order to plan further it was agreed that an away half-day would be required.

NICE accreditation is currently on hold pending agreement on future support as that is necessary to provide the required to maintain the database/website.

Action:

  • Summarise response for ASG for group to agree – AK
  • Once agreed provide feedback to the Network

  1. Feedback from Trainee Rep

Dan reported that no new issues had been raised from the trainees meeting last Friday. Although, people are finding it a challenge to run more than one GDG due to the overlap of finalising one and starting another, in general progress is good and people are happy to continue to work on audit topics.

  1. Education and training plans for 2016/Feedback

Essential Skills in improving palliative care programme was developed to address the identified the training needs in searching literature to support clinical audit.

Three sessions were delivered in May and October 2015 and January 2016. Positive feedback has further developed the programme, which is now planned to continue as a rolling programme. The continued support of the host sites, along with time to deliver dedicated from those professionals involved in the training sessions, has meant these sessions have been delivered for a minimal cost. Thanks must be extended to MCPCIL, MCHL and Wirral Hospice for hosting sessions.

As far as the question is it sustainable as free programme, it has been thus far and it is possible that once this reaches a point that a group of people are sufficiently trained it could become more of TtT type course. Being able to offer free places means multi-professional access is good, as medical staff are allowed a study leave allowance that other HCP may not have. The group agreed that although the places are free this does not mean there is no value and discussed the possibility of having a nominal fee to ensure continued good attendance. Another consideration is that admin support for the current cycle will continue but in for future programmes this will need to be addressed.

Thirteen are currently registered on the next session to be held on 14th July 2016, while the 21st September session has ten registered. A reminder to sign up to these sessions will be sent periodically to promote registration.

Action:

  • Circulate reminder to promote sign up - KD
  • Consider admin support for future programmes - All

  1. Links with research workstream

The link between the audit programme and research is important to continue as searches carried out in the audit process flags up any gaps in research and it is important to emphasise this to raise awareness.

Catriona Mayland and Clare Forshaw use the results information to support research within settings within the area and close integration with clinical settings is a funding plus point. Liaison with the education and training programme to support research awareness and part of that skill set should be considered to ensure smart working.

Action:

  • Continue to link audit to research workstream

  1. Patient and carer involvement – feedback from May event

The second successful patient focus group was held on 24th May 2016 at Wirral Hospice where the guideline development group leads/reps presented on CPR, Blood Transfusion, Agitation and Diabetes to seven patient/public representatives. Although the numbers completing evaluation forms were poor, those that were received evaluated well. Following the event there has been PPI sign up to each of the guideline development groups with commitment to attend meetings where possible and/or provide input and review documentation via email. The GDG leads have been put in touch with those PPI reps who committed to a topic group. It is important to note that the feedback from the PPI reps is that they have felt their opinion was listened to and valued.

The ASG asked whether future access could be given to the Network’s database of People’s Voice for any work that requires patient/public involvement and how to continue to be able to use this resource.

Post meeting note: on discussion with the Network it has been agreed the Cancer team would be available to act as a conduit for the ASG to provide a link to the People’s Voice database.

  1. Audit Programme – July 2016

For the July audit session the presentation of two case studies is confirmed and Ami will present a proposed App version of the audit manual. The second Essential Skills education session will follow immediately afterwards.

Next Meeting:

27th September 2016; 2 – 4 pm

HR Room 1&2

Clatterbridge Cancer Centre

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