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AAA 2016 networking day final presentations
- 2. Part of Public Health England Abdominal Aortic Aneurysm NHSAAAScreening Programme Network meeting June 2016 Jonothan JEarnshaw Clinical Lead
- 3. Results • 1.3 million men invited • 1,019,480 men screened (uptake 79.5%) • Almost 13,000 AAA (>3cm) detected • Prevalence 1.3% •Almost 12,000 men in surveillance • Some 1923 men referred for surgery results available https://www.gov.uk/topic/population- screening-programmes/abdominal-aortic-aneurysm
- 4. LargeAAA(>5.4cm) detected 1025 65-year-old men first scan 898 men from surveillance 49% EVAR 51% Open repair (OR) (3:1 EVAR:OR rate in UK overall) Intervention rate around 91% Mortality rate 0.9%
- 5. Update on Programme optimisation: Health ImprovementAnalyticalTeam, Department of Health • Reducing surveillance • Reinviting men with subaneurysmal aorta • Inviting women
- 6. Surveillance intervals Option A 2year, 3month Option B 1year, 6month Option C 2year, 6month Option D 3year, 3month Cost Savings per man invited (£) 2.57 1.51 3.45 3.78 QALY Gain per man invited (£)⁺ -1.25 -1.41 -2.46 -3.28 Net Benefit per man invited (£) 1.33 0.10 0.99 0.50 Total Cost Saving from fewer Screens per invited cohort (£)⁰ 680,000 480,000 1,110,000 960,000 Fewer Scans per invited cohort 12,000 8,750 20,000 17,000 ⁰ Total savings associated to invited cohort of 300,000, discounted at 3.5% per annum ⁺QALYs monetised at £20,000
- 7. Increasing detection ofAAA Subaneurysmal aorta – 25 year data from Gloucestershire 0 .2.4.6 0 5 10 15 20 25 Time (years) Initial Diameter: 2.6-2.9cm Initial Diameter: 3.0-5.4cm with mortality as a competing outcome Cumulative Incidence Function for Progression to 5.5cm 0 .2.4.6 CumulativeIncidence 0 5 10 15 20 25 Time (years) <3cm+ 5 years after first scan 3cm+ 5 years after first scan with mortality as a competing interest Cumulative Incidence Function for Reaching 5.5cm+
- 8. Subaneurysmal aorta >2.9cm % 0f 1156 >5.4cm % 0f 1156 Within 5 years 541 47% 7 0.6% Within 10 years 659 57% 71 6% Within 15 years 674 58% 138 12% Within 20 years 674 58% 151 13% Latest results from the Gloucestershire and Swindon AAA Screening Programme (unpublished)
- 10. Health ImprovementAnalytical Team Recommendations: Surveillance intervals for men with small AAAs should be extended so that scans are performed biennially, as opposed to annually. This will lead to a more cost-effective programme and 12,000 fewer rescans per invited cohort. The NSC is asked to give careful consideration to the existing published evidence relating to sub-aneurysmal aortic dilation. A rescan at 5 years would require an additional 6,500 scans per invited cohort. There is not currently enough evidence to justify the introduction of AAA screening for women though this issue should be revisited in future years.
- 11. Optimising AAA screening • Evidence review • NAAASP Strategic and Research Groups • NAAASP Directors, and other interested parties • NAAASP Advisory Board • Costing options DH Health Improvement Analytical Team • 4 Nations Group (June 2015) • Advice to obtain more independent evidence • National Screening Committee (Oct 2016) • Department of Health and Public Health England • Implementation (2018/19)
- 13. Other programme matters Equality and diversity policies 4 nations results
- 15. Uptake of screening and aneurysms detected by decile of deprivation
- 16. Equality and diversity report Jo Jacomelli Conclusions: • Uptake affected by social deprivation • AAA prevalence affected by social deprivation • Uptake affected by ethnicity – need to improve recording • AAA prevalence may be affected by ethnicity (confounder is relationship between ethnicity and deprivation)
- 17. Improving uptake • Inequalities research • Local solutions • NAAASP toolkit (4 nations approval)
- 19. NAAASP National Networking and Information Day Lisa Summers NHSAAAScreening Programme Manager June 2016 Public Health England leads the NHS Screening Programmes
- 20. 2016-17 Objectives Review optimisation of AAA Screening Programme Specify and re-procure national IT screening system to support existing programme Improve the dissemination of data to support local screening programmes, commissioners and QA linking in programme specific operating model for QA and inequalities reports for local programmes and commissioners 20 ISF UPDATE
- 21. Headline data 2015-2016 (provisional) 21 ISF UPDATE
- 22. Reports • Pathway standards • Quarterly/annual standards reports • Quarterly waiting times • KPIs • Death proformas 22 ISF UPDATE
- 23. IT • SMaRT:- • Training for Co-ordinators/Admin • Training for SQAS staff • Version 9.4 • User Group • Northgate Helpdesk 23 ISF UPDATE
- 24. New Qualification • Structure • Assessment • Awarding organisations and centres • Costs • Re-accreditation 24 ISF UPDATE
- 25. Nurse Practitioner Group • Develop, implement and monitor best practice guidelines • Best practice guidelines to support AAA Nurse Specialist • Develop and introduce nursing Standard Operating Procedures 25 ISF UPDATE
- 26. Screening Quality Assurance Service • Visit schedule • PSOM • PCAs and PCA training 26 ISF UPDATE
- 27. Screening in Prisons • PHE/NHSE/NOMs • Interim Solution • Pathways • AAA SOPs - Annexe
- 28. Communications GOV.UK: User Survey – professional-facing screening content Shared Leaning Policy: https://www.gov.uk/government/publications/nhs-population-screening- submitting-a-case-for-shared-learning Accessible information standard: Implementation - 31 July 2016 Information resources expert group 28 ISF UPDATE
- 29. Sign up to our Blogs!
- 30. Coming up…. • Four Nations • PHE Annual Conference • Programme optimisation • Programme Directors meeting – November 2016 • National Research Meeting – Spring 2017 30 ISF UPDATE
- 32. NAAASP research • External to the Programme (Research Lead: Tim Lees) • Programme research/evaluation - Self referred men - Prevalence monitoring - Safety in surveillance - National mortality rates
- 33. Approvals Prehabilitation Diet & AAA Understanding non-attendance Cardiovascular risk reduction – feasability study Drug study – reducing growth Aardvark Pre-operative exercise Data to inform treatment risk algorithm UKAGS Metabonomic analysis serum & urine Multimodal assessment of AAA pathogenesis Programme evaluation – growth rates & surveillance data
- 34. Self referral
- 35. Reducing prevalence Screening year Tested Aneurysm % aneurysm 2009/10 17,133 249 1.45 2010/11 30,549 490 1.60 2011/12 98,529 1,378 1.40 2012/13 183,034 2,463 1.35 2013/14 235,409 2,941 1.25 2014/15 224,517 2,674 1.19
- 36. Reducing prevalence ofAAA BJS, 2015 AAA screening of 65 year old men remains cost effective to a prevalence of 0.35%
- 37. Safety in surveillance Total 12,804 men in surveillance Follow-up 24,127 person years Risk of rupture: 3-4.4cm (7 ruptures) – 0.03 (c.i. 0.02-0.07) per 100 person years 4.5-5.4cm (8 ruptures) – 0.42 (c.i. 0.21-0.85) per 100 person years
- 38. NAAASP Research day January/February 2017
- 39. ReducingAAA-related mortality Anjum et al. BJS 2012
- 40. Deaths with mention ofAAAin men and women in England from ONS statistics
- 41. Deaths from rupturedAAAin men and women per 100,000 population from ONS data
- 42. Deaths from rupturedAAAin men in England from ONS statistics according to age
- 43. Hospital admission with code for rupturedAAAin men and women in England according to age
- 44. Conclusion NHS AAA Screening Programme is feasible and cost effective. Referral threshold safe Still room for optimisation On target to reduce deaths by up to 50%
- 46. Data and Reporting AAAnetworking day, 28 June 2016
- 47. Programme specific operating model 47 Data and reporting Aim – To describe the activities of the Screening Quality Assurance Service Data chapter • Outlines the indicators used by SQAS for visits and ongoing activities • Cover key points in the screening pathway • Information on sources, data sharing, reporting and data requests https://www.tumblr.com/search/cute%20possums
- 48. PSOM indicators National / retired standards • Ineligible men • Incorrect contact details • Eligible men excluded • Men with an aorta ≥ 3.0cm on initial screen • Referrals deemed fit for intervention at first assessment post referral • Operative procedures on AAA <5.5cm at last ultrasound • 30 day mortality following elective surgery • One year any cause mortality following elective surgery • One year AAA cause mortality following elective surgery 48 Data and reporting
- 49. PSOM indicators Invitation and attendance standards • Men declining screening • Men who DNA their first appointment • Men who attend after not attending first appointment • Men with an aorta 3.0 – 4.4cm on initial screen • Men with an aorta 4.5 – 5.4cm on initial screen • Men with an aorta ≥5.5cm on initial screen Internal QA • Percentage of scans sent for IQR • Percentage of men recalled following internal QA • Delay between scan and QA review Surveillance men • Percentage of men lost from surveillance by reason 49 Data and reporting
- 50. Process for PSOM data • Collected from routine SMaRT data • Produced quarterly on a programme level • Draft report will be signed off by QA steering group • Will be piloted with the SQAS (regions) to ensure it is fit for purpose and obtain a baseline • No thresholds initially • Will be made available to programmes through SMaRT 50 Data and reporting
- 51. Inequalities report • Available through SMaRT quarterly • Tables of • Eligible, offered, screened and declined by • GP • LSOA • LA • Ethnicity of men tested by • Programme • LA • Ethnicity of men with aorta ≥3.0cm • Line list of men referred for surgery by LSOA and ethnicity 51 Data and reporting
- 52. Report table examples 52 Data and reporting
- 53. How can this information be used? How do I know if I have a particular ethnic group not attending screening? Sources of ethnicity data • Office for national statistics • NOMIS : https://www.nomisweb.co.uk/query/construct/summary.asp?mode=constru ct&version=0&dataset=651 • NOMIS uses 2011 census data – most up to date You can create a table and chart comparing the breakdown of men you have tested by ethnicity and the percentage of men in that ethnic group in the population 53 Data and reporting
- 54. Table 54 Data and reporting Area tested perc tested testedtot population pop total perc_pop 1 0 0.00 608 6 5821 0.10 2 0 0.00 1087 3 9094 0.03 3 0 0.00 1470 5 10323 0.05 4 0 0.00 1768 14 17150 0.08 5 0 0.00 1147 8 9148 0.09 6 0 0.00 1186 13 8906 0.15 7 4 0.25 1611 87 11681 0.74 8 0 0.00 1057 3 8588 0.03 9 15 1.54 973 160 8454 1.89 10 3 0.12 2426 224 20420 1.10 11 0 0.00 2303 17 17811 0.10 12 0 0.00 1231 57 12036 0.47 13 1 0.07 1521 43 11027 0.39 14 1 0.08 1303 16 9547 0.17 15 3 0.18 1711 73 14051 0.52 16 4 0.29 1401 220 11135 1.98 17 9 0.50 1814 91 16213 0.56 18 121 1.85 6540 3398 60611 5.61 19 1 0.10 978 30 7633 0.39 20 1 0.10 1052 8 8533 0.09
- 55. Scatter chart – national black or black British: Caribbean 55 Data and reporting
- 56. Scatter chart – national black or black British: Caribbean 56 Data and reporting
- 57. Deprivation How do I know if men in particular areas aren’t attending? Sources of information: Office for national statistics: http://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/ populationestimates/datalist Link to IMD2015 by LSOA https://www.gov.uk/government/statistics/english-indices-of-deprivation-2015 Look at areas of low uptake and see if they are in areas of deprivation 57 Data and reporting
- 58. Can anyone help me with this? Yes! We will produce a template to help with the ethnicity comparison and deprivation Your commissioners can help with interpretation Look at issues in your area in order to decide which interventions are the most suitable 58 Data and reporting
- 59. 8 week waiting time – 2014/15 Breakdown of men referred to and not declining surgery by outcome for the 8 week to treatment standard, by programme 59 Data and reporting
- 60. 8 week waiting time – Q1 to Q3 2015/16 Breakdown of men referred to and not declining surgery by outcome for the 8 week to treatment standard, by programme 60 Data and reporting
- 61. Improvements 2014/15 Q1-Q3 2015/16 England % men operated on in 8 weeks 56.9% 75.5% England % breach - patient comorbidity 24.8% 12.8% England % breach - hospital factors 18.3% 11.7% Number of programmes reaching acceptable 16 14 Number of programmes reaching achievable 5 19 61 Data and reporting
- 63. Managing and learning from incidents in the AAA screening programme JaneWoodland: Regional HeadofQualityAssurance,MidlandsandEast 28June2016 Public Health England leads the NHS Screening Programmes
- 64. • Why this is important • What we like you to know and do • Examples for discussion
- 65. Why this is important • Ethical duty • Statutory requirement Mid Staffs Duty of candour • Improve quality and safety of screening programmes – locally and nationally 65 Managing Safety Incidents in NHS Screening Programmes
- 66. Learning from incidents 66 Managing Safety Incidents in NHS Screening Programmes National learning • The 2015-16 national service spec was updated to reflect programme responsibility to track referrals • All screen positive AAA referrals are tracked using the SMaRT referral tracking application which was installed as part of release 9 software upgrade in July 2015 • The national programme checks AAA death proformas and ensures that a copy is sent to QA if not already done so • National “blogs” and previous newsletter articles, and enquiries made to programmes via QA teams • Refining the process for dealing with queries/incidents involving the national software ……huge learning and a safer service for patients
- 67. What we’d like you to know The policy framework
- 68. The Policy framework Managing Safety Incidents in NHS Screening Programmes (MSI in NSP) https://www.gov.uk/government/publications/managing-safety-incidents-in- nhs-screening-programmes (October 2015) NHS England Serious Incident Framework (SIF) https://www.england.nhs.uk/patientsafety/serious-incident (March 2015) 68 Managing Safety Incidents in NHS Screening Programmes
- 69. Screening safety incident Screening safety incidents include: • any unintended or unexpected incident(s), acts of commission or acts of omission that occur in the delivery of an NHS screening programme that could have or did lead to harm to one or more persons participating in the screening programme, or to staff working in the screening programme • harm or a risk of harm because one or more persons eligible for screening are not offered screening. Refer to: Section 1.5 ‘Definition of a screening safety incident’ Managing Safety Incidents in NHS Screening Programmes 69 Managing Safety Incidents in NHS Screening Programmes
- 70. 70 Managing Safety Incidents in NHS Screening Programmes • Serious incidents in screening programmes have consequences that are so significant that they require a heightened response • Avoidable severe harm or death if situation continues • Case by case judgement and expert advice needed Serious incidents in NHS screening programmes
- 71. Serious incidents in screening programmes Organisation unable to deliver acceptable quality of healthcare services Examples include Serious data loss/information governance related incident Where the potential for harm may extend to a large population Systematic failure to provide an acceptable standard of safe care Major loss of confidence in the service including prolonged adverse media coverage or public concern about the quality of healthcare or the organisation 0eRefer to: Section 1.6 ‘Definition of a serious incident ’ Managing Safety Incidents in NHS Screening Programmes 71 Managing Safety Incidents in NHS Screening Programmes
- 72. 72 Managing Safety Incidents in NHS Screening Programmes Providers SIT / responsible commissioner PHE QA Accountability, roles & responsibilities
- 73. What we’d like you to do Reporting, management and investigation
- 74. Screening incident assessment form The screening incident assessment form (SIAF) is to be used for suspected safety incidents and serious incidents in NHS screening programmes. The form should be accessed from the DH.gov.uk website at https://www.gov.uk/government/publications/managing-safety-incidents-in-nhs- screening-programmes 74 Managing Safety Incidents in NHS Screening Programmes
- 75. 75 Managing Safety Incidents in NHS Screening Programmes Safety incident suspected Provider informs QA & SIT Fact Finding Classification and handling plan in 5 working days Serious incident declared Reported on STEIS within 48hours Serious incident team Serious Incident team reports level of investigation within 72 hrs SI Report including incident chronology and RCA & recommendations QA disseminates lessons identified Screening incidents –Actions
- 76. Incident team Immediate actions – patient focus Produce / implement Action plan RCA – depth varies Oversee implement actions Identify and share lessons learnt Agree timescales for closure 76 Managing Safety Incidents in NHS Screening Programmes Managing incidents
- 77. 77 Managing Safety Incidents in NHS Screening Programmes Data Gathering Analysis Solution What’s happened? Investigation Why did it happen? Determine root cause What should we do to prevent it happening again? Implement corrective actions Adapted from CPA Standard H6.2
- 78. Safety Incident reports by SIAF classification Safety incidents for internal investigation – no further QA action – • Provider decides format in line with its governance process • Screening and immunisation team may want to review • Recorded on SQAS and SIT monitoring systems Safety incidents internal investigation and RCA • QA advise that a one page report is produced – suggested template available • SIAF included as an appendix Safety incident (multi-organisation/disciplinary, investigation panel and RCA • QA advise that NPSA concise report with SIAF included as an appendix 78 Managing Safety Incidents in NHS Screening Programmes
- 79. Escalation 79 Managing Safety Incidents in NHS Screening Programmes
- 80. Scenarios for discussion Is this a - • safety incident • a serious incident • not an incident What immediate actions would you take? 80 Managing Safety Incidents in NHS screening Programmes Activity
- 81. Categories 81 Managing Safety Incidents in NHS Screening Programmes Not an incident Screening safety incident Serious incident
- 82. Questions – Slide 1 (10minstodiscuss) 82 Managing Safety Incidents in NHS Screening Programmes Scenarios around 8 week breaches 1 Patient cancelled surgery date which was offered within 8 weeks (due to his daughters wedding), and then AAA ruptured before next offered surgery date. 2 Stent was not available within 12 weeks and patient’s AAA ruptured 3 Surgery cancelled due to ITU bed availability. Surgery re-scheduled for after 12 weeks. Patient AAA ruptured in the interim but patient recovered well from emergency surgery. 4 Surgery scheduled outside of 12 weeks due to shortage in interventional radiologists. Patient died of a AAA rupture before surgery date. 5 AAA repair conducted successfully. Patient died post operative within 30 days.
- 83. Questions – Slide 2 (10minstodiscuss) 83 Managing Safety Incidents in NHS Screening Programmes Scenarios within the screening pathway 1 Images saved to incorrect patient file 2 Images lost during upload to SMaRT 3 Patient appointments cancelled due to staff sickness on day of clinic 4 Scanner stolen from technician’s front seat of car after a busy clinic day 5 Last weeks 2nd DNA letters to GP did not generate and SMaRT shows an error 6 A number of surveillance patients were not being routinely called to 3 monthly surveillance appointments over an annual period.
- 84. Any Questions?
- 86. Self referral to the NHS Abdominal Aortic Aneurysm Screening Programme Lewis Meecham, Jo Jacomelli, Arun D. Pherwani, Jonothan Earnshaw
- 87. Introduction & Aims • NHS abdominal aortic aneurysm screening programme introduced in England 2009 • Fully operational since 2013 • All men are invited for screening in 65th year • Men aged more than 65 years are allowed to self –refer for screening • Currently screening approximately 300, 000 men per annum • The aim was to provide a descriptive analysis of men who self refer to the NAAASP from 2009 toAugust 2014
- 88. Demographics • 2009 to Aug 2014 • 58,999 self referrals (700,816 invited in same time period) • Mean age 73 years (range 47-100). • 82% with smoking history • Incidence of AAA was 4.13% (n = 2,438), in contrast to 1.4% in the invited cohort (age 65) • Of these 7.6% (n=186) were 5.5cm or greater. Small AAA (3- 4.5cm) Large AAA (5.5cm and greater) PValue Aspirin 41.7% 43.0% 0.416 Statin 64.9% 61.3% 0.681
- 89. Results Self referrals have increased year on year Monthly increase in self referrals with noticeable spikes
- 90. Results Type of surgery N Percentage Open 39 38.8% EVAR 84 55.3% Outcome Percentage Surgery 81.7% (n=152) Declined 5.4% (n= 10) Unfit 4.8% (n = 9) Died in referral pathway 1% (n=2) 30 day operative mortality – 0% 8Week referral to surgery target –(n = 88) (57.9%) Mean time from referral to surgery was 69 days (2 – 361 days)
- 91. Discussion • NAAASP 65 currently 1.4% 1 • MASS trial incidence 4% (screen age 65-74)2 • US veterans affairs incidence 7% (mean age 72)3 • We found in self referrals an incidence of 4.13% likely due to (age (73 years), smoking (82%), ethnicity (96% white), low compliance with BMT) • Self referral element is cost effective • Role of future publicity from local / natinal programme 1. http://aaa.screening.nhs.uk/news.php?monthye=0713 2. Thompson SG, et al. Screening men for abdominal aortic aneurysm: 10 year mortality and cost effectiveness results from the randomised Multicentre Aneurysm Screening Study. BMJ 2009;38:2307 3. Chun KC, et al. Risk factors associated with the diagnosis of abdominal aortic aneurysm in patients screened at a regional Veterans Affairs health care system. Ann Vasc Surg. 2014 Jan;28(1):87-92.
- 92. Conclusion • Self-referral has yielded higher detection rates than the invited cohort, more than justifying its cost. • Now that NAAASP is fully operational it is important to continue media campaigns and publicity to target the high risk men over 65 who would otherwise miss the benefits of AAA screening. • Self referrals increased with increased publicity – could this be channeled to target more at risk individuals • Publicity should be targetted to high risk individuals
- 93. UKAGS and Research on Screening Women Matt Bown University of Leicester www.le.ac.uk
- 94. UK Aneurysm Growth Study
- 95. Background • Prospective cohort study of men screened for AAA • Circulation Foundation/British Heart Foundation funded • Sample size: 10,000 controls, 5000 AAA • Postal consent • Various invitation methods – Invitation card at screening/surveillance clinic – Mailshot – Direct contact (media) – Non-NAAASP surveillance clinics
- 99. Projects 1. Screening Women for abdominal aortic ANeurysm (SWAN) 2. Female Aneurysm screening STudy (FAST)
- 100. SWAN • NIHR HTA commissioned project • Project team – Simon Thompson (PI) – Mike Sweeting – Janet Powell – Edmund Jones – Pinar Ulug – Matt Glover – Jonothan Michaels – David Sidloff
- 101. SWAN: Rationale
- 102. SWAN: Methods • New programmable statistical/economic model • Wide range of parameters required • Data sources – Literature – Databases (NVR, HES-ONS, Vascunet) – Male (screening) data
- 103. SWAN: Outputs • New model • Estimate of clinical effectiveness • Economic analysis • Value of information
- 104. FAST • NIHR RfPB (researcher led) • Pilot of AAA screening for women • Leicestershire, Rutland and Northamptonshire
- 105. FAST: Methods • GP read codes used to identify cohorts at GP practices – Smoking (current or ex) – History of coronary heart disease (MI, PCI, CABG) – Ethnicity – Healthy (non-smokers and no CHD) – First-degree relatives of patients with AAA • 65 to 74 year-old women
- 106. FAST: Methods • GP read codes used to identify cohorts at GP practices – Smoking (current or ex) – History of coronary heart disease (MI, PCI, CABG) – Ethnicity – Healthy (non-smokers and no CHD) – First-degree relatives of patients with AAA • 65 to 74 year-old women
- 107. FAST: Methods • NAAASP type invitation • Consent at clinic for screening • Consent for research at the same time as screening • Data collection – Screening outcomes – Basic demographics/biometry – QoL – Linkage (GP, hospital, HES-ONS)
- 109. FAST: Sample size n • Smoking: Current smokers 2626 Ex-smokers 2626 • History of coronary heart disease 1700 • Ethnicity 1000 • Healthy (non-smokers and no CHD) 1000 • First-degree relatives of patients with AAA 1003
- 110. FAST: Outcome measures • Primary – Attendance – Prevalence of AAA • Secondary – Accuracy of primary care read codes for AAA risk – Long-term outcomes
- 111. FAST: Timeline • Project start: 1st Aug 2016 • Screening start: 1st Nov 2016 • Project end: 31st Dec 2017
- 112. FAST: Timeline • Project start: 1st Aug 2016 • Screening start: 1st Nov 2016 • Project end: 31st Dec 2017
- 113. FAST: Timeline (not so FAST) • Original application: 16th Sept 2014 • Rejection: 23rd March 2015 • Revised application: 18th May 2015 • Acceptance: 26th Nov 2015 • Pre-project bureaucracy: 7 months! • Project start: 1st Aug 2016 • Screening start: 1st Nov 2016 • Project end: 31st Dec 2017
- 115. NAAASP National Networking and Information Day Patrick Rankin National education and training manager Public Health England leads the NHS Screening Programmes
- 116. New qualification • level 3 award on the regulated qualification framework (RQF) • Level 3 is academic level not AfC • Diploma for Health Screeners (DES/AAA/NBHS) • provides clinical screening staff with a nationally recognised qualification • ensures clinical staff have the knowledge, skills and understanding to work in a healthcare environment • provides screening staff with a framework to develop knowledge and clinical skills required for their specific screening programme • opens up numerous career development opportunities for staff within screening programmes • can add additional screening programmes if required Reaccrediation Update June 2016
- 117. Who needs to take the qualification….? • from 1st April this is the required qualification for clinical staff in DES, AAA and NBHS(2017) • includes new all non-professionally regulated new clinical staff • screening technicians in NAAASP • previous qualification will remain valid and existing staff do not have to undertake the diploma for health screeners • can apply for recognition of prior learning Reaccrediation Update June 2016
- 118. Structure of the qualification • similar structure to NVQs • work based qualification • based on a number of units and evidencing work based competency to an assessor • assessors will need to have a qualification in assessing • learners provide evidence of competency via local assessments • different method of delivery from current course Reaccrediation Update June 2016
- 119. Mandatory units (13) • provides screening programme staff with the basic understanding and core knowledge and skills of working in a healthcare setting • formalisation of learning that should already undertaken in screening programmes • should be covered in employee induction • based on significantly on the care certificate • provides confidence that all staff have the same induction - learning the same skills, principles, knowledge and behaviours to provide compassionate, safe and high quality health care • resources available online that cover the majority of the learning outcomes required for the mandatory units • skills for care and skills for health websites have lots for resources…….. Reaccrediation Update June 2016
- 120. Mandatory units • Engage in personal development in health, social care or children’s and young people’s settings • Promote communication in health, social care or children’s and young people’s settings • Promote equality and inclusion in health, social care or children’s and young people’s settings • Promote and implement health and safety in health and social care • Principles of safeguarding and protection in health and social care • Promote person centred approaches in health and social care • The role of the health and social care worker • Promote good practice in handling information in health and social care settings • The principles of Infection Prevention and Control • Causes and Spread of Infection • Cleaning, Decontamination and Waste Management • Principles for implementing duty of care in health, social care or children’s and young people’s settings • Health Screening Principles Reaccrediation Update June 2016
- 121. Reaccrediation Update June 2016
- 122. Core units • 3 core units for AAA • similar content and level to the previous qualification • updated and combined • based on feedback and survey from learners who have undertaken the previous qualification • allows local programmes to tailor the learning and assessment for each individual learner • Undertake role specific units……….. Reaccrediation Update June 2016
- 123. Core unitsAAA • Principles of AAA screening and treatment • Principles of ultrasound for AAA screening • Undertake AAA screening • All staff that undertake screening within NAAASP need to undertake the qualification Reaccrediation Update June 2016
- 124. Unit structure • each unit has a number of learning outcomes • these are statements that describe the essential learning that learners need to be able to clearly demonstrate at the end of the unit • Syllabus • the learning outcomes can then be broken down into assessment criteria • these list in further detail the content that the learner must be able to demonstrate during assessment of the unit • should be used to guide the learners in their study and as to what needs to be covered • the assessors will then also receive the indicative content • this details what the learner must cover in their assessment of the unit • learners must not see the indicative content learning outcomes assessment criteria indicative content Reaccrediation Update June 2016
- 125. Unit structure Reaccrediation Update June 2016
- 126. Principles ofAAAScreening and Treatment 1. Understand the circulatory system 2. Understand the medical terms relevant to Abdominal Aortic Aneurysm Screening 3. Understand the pathophysiology and formation of arterial disease 4. Understand the treatment options for Abdominal Aortic Aneurysms • 30 hours minimum • An elearning package exists for this unit • Significant supplemental learning will be required • Use internal resources and supplement learning • CST/assessor should have oversight of this Reaccrediation Update June 2016
- 127. Principles of ultrasound forAbdominal AorticAneurysm Screening 1. Understand the theory of diagnostic B-mode ultrasound 2. Understand the main functions of ultrasound equipment controls 3. Understand ultrasound safety and the potential biological effects • Minimum 40 hours total learning hours • Elearning package to compliment • Significant supplemental learning required • Oversight from CST/assessor Reaccrediation Update June 2016
- 128. UndertakeAAAScreening 1. Be able to minimise risk of injury within the health screening setting 2. Be able to assess the environment and equipment for an Abdominal Aortic Aneurysm screening episode 3. Be able to prepare the individual for an Abdominal Aortic Aneurysm screening episode 4. Be able to use an ultrasound transducer to acquire diagnostic images of the abdominal aorta 5. Be able to manipulate the ultrasound equipment controls to optimise images 6. Be able to accurately save, record and store results of the screening event 7. Be able to follow agreed protocols following the screening event to determine the appropriate course of action Reaccrediation Update June 2016
- 129. • Practical unit • Portfolio of experience on the CDP screening website • Similar to previous portfolio • Same competency levels • Gateway one and two replaced with stage one and stage two • Internal clinical assessments for each stage by CST • External clinical assessment replaces the OSCE at Salford • Internal and external CST complete the assessment • 4 individuals (2 minimum to be aneurysmal) • 300 hours of work based learning Reaccrediation Update June 2016
- 130. Reaccrediation Update June 2016
- 131. Assessors • OFQUAL and Skills for Health requirement that there must be suitable trained workplace assessors for this qualification • level 3 Certificate in assessing vocation achievement (CAVA) • City and Guilds assessors without the CAVA qualification or equivalent will need to undertake it • PHE Screening and NOCN have developed a streamlined process at a significantly reduced price • work based distance learning/3 months to undertake • recognition for prior learning and assessing • completion of log book outlining previous experience • final professional discussion with an external assessor • Will provide assessors with nationally recognised assessor qualification, role enhancement and CPD • 1-3 per local programme Reaccrediation Update June 2016
- 132. Assessment methods • feedback from programmes and learners was the assessment requirements were too rigid • now local programmes can tailor the assessments they use to the individual learners • will be quality assured by the awarding centre to ensure appropriateness of assessments • can use existing resources and assessments Assessment methods portfolio of evidence logbooks on-line tests clinical assessments elearning assignments case studies reflective practice short notes course attendance one:one discussions recorded discussions existing in-house resources Reaccrediation Update June 2016
- 133. Technicians as assessors • Existing screening technicians can train to become assessors within their departments • Undertake the CAVA qualification locally • Can assess parts of the qualification • Must be occupationally competent in the learning outcome • Funded by local screening programme • Will need to be putting a new technician through the qualification whilst undertaking the CAVA • CAVA must be sourced and undertaken locally • Liaise with Trust’s Learning and Development departments regarding the CAVA initially Reaccrediation Update June 2016
- 134. Funding • Health Education England are funding the qualification for 2016/17 • PHE Screening are administering it centrally • only for new clinical staff within local programmes • cost varies between awarding centres • £800-1000/learner Reaccrediation Update June 2016
- 135. How to register a new learner…… Reaccrediation Update June 2016
- 136. Further information Reaccrediation Update June 2016
- 137. Nurse Specialist Best Practice Guidance Background • Role of the nurse has been varied across the country since inception • The nurse specialist is an important role in the NHS abdominal aortic aneurysm screening programme • The role of the nurse practitioner/vascular nurse is to assess men and give them appropriate advice on lifestyle changes • They can also refer men on to other specialists and services, such as smoking cessation. • Links with other departments within the Trust to support these men • All men found to have a small (3.0-4.4cm) or medium (4.5-5.4cm) aneurysm are offered an appointment with their local programme’s nurse specialist • Requirement for appointment within 12 months/3 months • Phone appointments!!! Reaccrediation Update June 2016
- 138. New guidance • Developed following consultation with nurse specialists, programme co- ordinators, directors • Programmes had been asking for further guidance and support • 18 months to develop • a document that encompasses the best practice guidelines for those nurses undertaking the role of nurse specialist within a local provider of NAAASP • Endorsed by Society For Vascular Nurses as best practice • SQAS to use to benchmark Nurse Specialist service within local programmes • Not mandated via programme standards or service specification Reaccrediation Update June 2016
- 139. Contents • Background and training of nurse specialists • Staffing requirements • Roles and responsibilities within the programme • Clinic locations • Timeliness of the nurse assessment • What the nurse assessment should include • Importance of face to face assessments • Role of Screening technicians in nurse assessment Reaccrediation Update June 2016
- 140. Background and Training • Registered general nurse • 3 years post registration experience • Appropriate knowledge of the management of vascular disease (AAA) • Job description for their role including clinical accountability • Links with other key clinicians within the programme • Knowledge of the screening programme • NAAASP don’t provide specific training • Working towards the SVN ‘Advanced Nurse Competency’s’ Reaccrediation Update June 2016
- 141. Staffing requirements • 0.1 WTE as a minimum • Highly recommend this time is ring-fenced • Attend appropriate meetings of the screening programme and MDTs • Provide training and support to screening technicians where appropriate • Regular contact with the programme co-ordinator and director Reaccrediation Update June 2016
- 142. Roles and responsibilities • Ensure all men have opportunity to attend face to face • Provide support, advice, secondary prevention and referrals if appropriate to screen positive men • Use SMaRT system to record patient contact • Attend training where appropriate • Cannot screen unless they have completed the required training • Cannot sign of screening technicians as competent or perform IQA of scans unless they possess a post graduate degree in medical ultrasound Reaccrediation Update June 2016
- 143. Operational requirements • Face to face appointment within 12 weeks • Telephone consultation with those that can’t or won’t • Reason for decline to be added to patient record • Once they reach 4.5cm additional appointment to be offered • Administrator should be utilised to book and contact patients • Additional appointments can be given if requested • 30 minute time slot for each appointment Reaccrediation Update June 2016
- 144. Assessment • Measure and record weight and height • BMI • Smoking status • Resting BP • Review current medication • Diet, exercise and alcohol consumption if appropriate Reaccrediation Update June 2016
- 145. Assessment advice • Explanation of condition and brief overview of possible treatment options • Surveillance programme and clinical preference • Optimisation of BP • Smoking cessation advice • Determine and discuss any potential interventions required by GP • Appropriate lifestyle advise in line with NICE guidelines • Addressing emotional issues • Discuss contact with DVLA • Discuss familial risks with AAA • SMaRT letter to GP and patient Reaccrediation Update June 2016
- 146. • Following detection of an aneurysm technicians should actively encourage men to attend • Technicians should not be undertaking physiological measurements under the auspices of working as a screening technician within NAAASP • Not included in their scope of practice • Appropriate training, QA, competencies would be requires if NAAASP was to introduce this role enhancement • Not recommended from NAAASP Reaccrediation Update June 2016
- 147. More details • PHE Screening CPD website http://cpd.screening.nhs.uk/cms.php?folder=5165 • PHE Screening blog https://phescreening.blog.gov.uk/ • PHE Screening helpdesk PHE.screeninghelpdesk@nhs.net Reaccrediation Update June 2016
- 148. CST training • role of CST is integral to NAAASP • improving the integration over the last 2 year into the programme • updated the training of CST’s from May 2016 following discussions with vascular scientists, CST’s and screening technicians • training can now all be undertaken locally • 7 elearning units • 0.5 days shadowing an existing CST in clinic • SMaRT/data session with co-ordinator • assessor qualification (if appropriate) • sign off from programme director • must maintain their appropriate registration/accreditation with appropriate bodies • Do not have to attend for reaccreditation Reaccrediation Update June 2016
- 149. Screening technician reaccreditation • Reaccreditation process updated April 2016 • More robust framework to help strengthen technician understanding of the core principles of their roles • Now consists of two sections • Knowledge assessment • Scanning assessment • Knowledge assessment • Two elearning modules • Must be completed before they can register for scanning assessment • Pass mark of 90% • Scanning assessment • Two scans to NAAASP requirements • Recovery portfolio if unsuccessful • Reaccreditation every two years Reaccrediation Update June 2016
- 150. Feedback from external QAvisits MarkGannon,VascularConsultant,AAAScreening,HeartofEnglandNHSFoundation Trust KimKavanagh,AAAScreeningCoordinator,HeartofEnglandNHSFoundationTrust PhilippaCastell,SeniorQAAdvisor,PublicHealthEngland
- 151. AAA QA Visits Process tips and outcomes Public Health England leads the NHS Screening Programmes
- 152. Visit in a nutshell 6 months - date agreed - documentation sent for completion (contacts list, room booking requirements and pre-visit questionnaire) 2 ½ months - return completed questionnaire to QA team Day of visit - relax! 4-6 weeks post visit - factual accuracy comments required 8 weeks post visit – final report issued –start action plan 12 weeks post report published – exec summary published Every quarter – progress against action plan required 12 months post visit – completed action plan requested 153 AAA QA visits tips and outcomes
- 153. Process tips • Use your QA advisors – they are there to help and support you • Don’t be afraid to ask questions or ask for clarification • Let your QA advisor know if there is something you are anxious about or feel should be included as part of your visit • Answer the questions in the pre-visit questionnaire as fully as possible and wherever possible provide evidence (or state evidence can be provided if required) • Label and reference your evidence logically • Don’t be worried about recommendations– we aren’t going to ask you to do something for the sake of doing it • Use the process to foster engagement with your wider team and to highlight the good work you are doing or where you need support with you executive level team and commissioning team 154 AAA QA visits tips and outcomes
- 154. Process tips 6 months – date agreed and documentation sent to you so ideal time to think about……. Who is going to be the lead for the visit (usually falls to programme co- ordinator) Letting everyone know about the visit date – make sure those required for interview will be available How you will complete the pre-visit questionnaire – who will do what sections, who will co-ordinate? What venue will you use for the day, how many rooms can you book in advance, can you provide lunch? Post visit – establish task and finish group for producing action plan 155 AAA QA visits tips and outcomes
- 155. Recommendation themes Staffing – organisational diagrams, job descriptions and wte, regular systematic feedback on screener performance and quality of images, training, attendance at team meetings SOPs – document key work areas and appropriate formatting (version control, review dates and sign off) Risks – risks on programme register, clear governance and escalation processes Incidents – policy in line with national incident guidance, reporting of incidents Treatment timelines - review of processes, monitoring, tracking and breach reporting, actions identified and implemented Non-visualisation – monitoring equipment and staffing against rates, timelines, tracking and access of appointments Audits – undertake DNA audits, audit NVR completion, share results and actions from audits at boards 156 AAA QA visits tips and outcomes
- 156. Recommendation themes 157 AAA QA visits tips and outcomes Programme board – quoracy, membership, participation, standard agenda items, action logs, inclusion of compliments/complaints, user representation, Equipment - checks performed in line with NAAASP recommendations, processes documented in a SOP, replacement plans, maintaining competency on models, storage Cohort information - review including information requests on transgender males to females / translation / disability / mobility needs/additional support when asking GPs for relevant information on their eligible cohort prior to invitation, processes within prisons, home visits, risk assessments, user surveys, requirement for early/late/weekend clinics
- 157. Shared learning themes Technicians – involved in audits, increased understanding of functionalities with ultrasound machines, attending theatre to observe EVAR procedures and vascular clinics, training in British Sign Language, dementia training, opportunity to observe and scan aneurysms being imaged in the main vascular laboratory to ensure regular exposure, physiotherapy support, left and right handed scanning techniques, protocol for return to work after absence, CSTs running educational and interesting case reviews Service improvement - improving access for men with learning disabilities, detailed analysis of uptake rates/dna rates and targeted initiatives with lower uptake GPs, engagement with homeless shelters, summary language sheet to identify requirement for information in another language, project with traveller community to promote GP registration, GPs review cohort lists, electronic warning alert added to hospital Trust systems for all men detected with an AAA , card provided to surveillance men to carry which states they have a AAA, men routinely opted in to a smoking cessation service 158 AAA QA visits tips and outcomes
- 158. Shared learning themes Health Promotion - ongoing encouragement strategy and promotion/screening at various venues – golf clubs, bowling clubs, football/rugby/cricket clubs, rotary clubs, round table events, DIY stores (on discount days for 50+), betting shops, supermarkets, libraries, keep fit classes Policies/Processes - Detailed overarching operational policy for the entire screening programme, referencing all policies, procedures and governance arrangements in one document, trackers developed for ensuring robust failsafe of patients through referral, surveillance, non-visualisation and incidental findings and production of waiting times, streamlined same day assessment clinic for pre-operative investigations, decline forms for opting out of surveillance and non-visualisation appointments Programme Board - effective working relationships between providers and commissioners, service user attending and contributing to the programme board 159 AAA QA visits tips and outcomes
- 159. Feedback Feedback through our questionnaire link is currently limited – please complete the link provided to you after a visit so that we can evaluate and review the process. Overall, has been noted as a positive experience, better than expected and that good support is provided. To note: review of pre-visit questionnaire is taking place review of screener technician input into process is taking place 160 AAA QA visits tips and outcomes
- 160. Professional ClinicalAdvisor plea! Being a PCA is really interesting, you learn a lot, is a great opportunity to network and make friends, along with visiting a different part of the country Opportunity for CPD – undertake national training Plea for CSTs/QA Leads to become reviewers, please contact your QA advisor if interested in becoming a PCA 161 AAA QA visits tips and outcomes