Clinical Senate Update – 8th March

Clinical Senate Cardiff and Vale 8th March

Showcasing innovation in falls prevention, neutropenic sepsis and maternal care, the first Clinical Senate of 2019 highlighted the incredible work being undertaken to further the Cardiff and Vale UHB strategy, Shaping Our Future Wellbeing.

On Friday 8th March 2019, a multi-specialism group of clinicians from across the health board came together to watch colleagues present their innovative programmes of work.   

If you missed out on the session, the quarterly gathering meets again on Friday 14th June. Clinicians from all disciplines and grades are welcome to attend; the clinical senate is an excellent opportunity to stay up to speed with work that’s happening across Cardiff and Vale.

Here’s a precis of the presentations:

Transformation: The Falls Programme

Speakers:

Oli Williams, Falls Strategy Implementation Lead, Cardiff and Vale UHB 

Sarah Simon, Physiotherapist, Cardiff Community Resource Team

Cheryl Williams, Principal Health Promotion Specialist, Cardiff and Vale Public Health Team

Helen Bonnello, Ward Sister, A4, University Hospital of Wale

Oli Williams gave an overview of the Falls Framework, a transformative programme of work that emphasises prevention and early intervention in clinical settings, the community and at home. By ‘making falls everyone’s business’, it’s hoped that major change in the causes and consequences of falls can be achieved. 

Oli also presented the Alliancing work being undertaken by the CSI team, which has just been awarded funding to drive forward the pilot scheme (read more here).  The first meeting of the Community Falls Alliance is taking place on 25th March.

He finished by showing the group a video of the Stay Steady Schools programme; a brilliant intergenerational project that sees primary school pupils invite older people from the local community to learn about areas including strength, balance, falls history and environment. 16 schools held sessions in October 2018 with 164 adults attending, supported by 20 medical and OT students with 417 children. 

Sarah Simon spoke about the Stay Steady Clinics implemented in October 2018. Open to all residents of Cardiff ages 65+, the group offers education, support and strategies to help people manage their own falls risk. It also offers a holistic assessment of factors including balance and strength, nutrition, cognition and foot health, which are all contributors that can increase the risk of falling. Meeting every Wednesday in either Llanishen or Splott, it’s hoped that the clinics will be rolled out to West Cardiff in the near future to ensure equitable access.

To find out more, call the Independent Living Services helpline on 02920 234234.

Cheryl Williams relayed the benefits of Strength and Balance groups to the senate, emphasising the importance of exercise in helping to prevent falls. There are a range of accessible classes available from dance and walking football to tai chi, which are run by trained exercise instructors. People find their way to the classes via targeted social messaging and signposting from their GP. The current retention rate for these classes is around 90%.

Helen Bonello closed the presentation by talking about falls simulation training, which provides a safe environment for the front line workforce to practice managing inpatients falls. The simulation suite, complete with 6 beds and video facilities, is available to all CAV staff.  24 nursing staff and members of the MDT have completed the training so far, instilling them with the confidence that they need to provide the best care for patients who fall. Following the success of the trial, it’s hoped that simulation training will be rolled out across more wards. 

Improving Outcomes in Neutropenic Sepsis

Speakers:

Bethan IngramSenior Nurse, Teenage Cancer Trust Unit

Siobhan SmithPharmacist, Cardiff and Vale UHB

Laura RickettsAdvanced Nurse Practicioner, B4, Cardiff and Vale UHB 

In this talk, the multi-disciplinary team discussed the implementation of the ‘Sepsis 6’, a management plan for neutropenic sepsis in teenagers and young adults. Neutropenic sepsis is a common complication of intensive treatment and accounts for 2-21% of deaths in cancer patients¹ . Teenagers and young adults (TYA) are more likely to have neutropenic septic deaths than other age group². 

On the Teenage and Young Adult Cancer Unit, nursing staff had reported delays in antibiotic delivery following sepsis recognition in neutropenic patients. An in-house audit revealed that only 27% patients received intravenous antibiotics within 60 minutes, the main reason being a delay in antibiotic prescription. The team reviewed their neutropenic sepsis pathway and implemented a Patient Group Direction (PGD) for the first line intravenous antibiotic Tazobactam/ Piperacillin 4.5g, forming part of the ‘Sepsis 6’ management plan. 

Clear guidelines and training strategies were created to support this initiative. Since the initiation of the antibiotic PGD, IV antibiotics are now administered within the hour for over 90% of patients, a significant increase. Nurses feel safe & competent delivering initial antibiotics via this method, demonstrating a robust training package. As a result of the success the team is now initiating a fluid bolus PGD to complement the whole package of care. The work had been shared with the haematology and oncology network within South Wales, as well as neighbouring medical and surgical areas so that others can benefit from the initiative. 

¹NICE (2012) Neutropenic sepsis: prevention and management of neutropenic sepsis in cancer patients

²Bate et al. (2013) Neutropenic sepsis: prevention and management of neutropenic sepsis in cancer patients (NICE Clinical Guideline CG151) Arch Dis Child Educ Pract Ed 2013; 98:73–75

BUMPES – Translating Clinical Research into Practice

Professor Julia Sanders, Professor of Clinical Nursing & Midwifery at Cardiff University and Consultant Midwife at Cardiff and Vale UHB

Kate Shinkwin, Clinical Midwife, Cardiff and Vale UHB

The acronym BUMPES stands for Birth in Upright Maternal Position, versus a lying down position, in woman with a low-dose Epidural, in the Second stage of labour.

Funded by the National Institute of Health Research (NIHR) Health Technology Assessment programme, this randomised controlled trial sought to find out whether the position adopted by nulliparous women aged 16 or older, at term with a singleton cephalic presentation and in the second stage of labour with epidural analgesia – whether upright or lying down – made a difference to their chance of having a natural spontaneous birth.

3236 women participated in total across 41 UK hospitals between October 2010 and January 2014, including 296 from the University Hospital of Wales. The results were arguably quite surprising! It was found that women in the upright group were significantly less likely to have a spontaneous vaginal birth, contrary to NICE guidelines:

  • 41.1% of the 632 women who were lying down had a spontaneous vaginal birth.
  • 35.2% of the 548 women who were upright had a spontaneous vaginal birth.

The BUMPES trial paper was published in the British Medical Journal and won the 2018 BMJ research paper of the year. Since publication, midwives and anaesthetists at the University Hospital of Wales have been working in unison to implement the trial findings.  

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