Improving outcomes for cardiovascular disease Georgina Murphy-Jones, Clinical Education Tutor Joanna Shaw, Clinical Audit Manager Rachael Fothergill, Head of Clinical Audit & Research Introduction Cardiovascular disease (CVD) is the most common cause of death in the UK, with patients often presenting to ambulance services with a heart attack. Early treatment can prevent death and influence the patient’s future health. The London Ambulance Service NHS Trust (LAS) has over 3,500 pre-hospital clinicians who attend over 3,000 heart attack patients every year. Aims This project focussed on improving clinical practice for heart attack patients. Method One hundred and fifty one heart attack patient clinical records from May 2009 were reviewed, and pain scoring and analgesia were identified as areas for improvement. Process mapping and root cause analysis were used to develop improvement initiatives and clinical practice was systematically evaluated weekly whilst initiatives were designed and tested using Plan Do Study Act cycles. Implementation of change: Using data from the review and findings from the process mapping and root cause analysis, a pain scoring and management tool and training session was designed for use at every ambulance station and the LAS training school (supported by a poster and a heart attack audio podcast for the intranet). Clinicians also developed a heart attack flowchart, highlighting the importance of pre-hospital pain management. Re-audit: Following introduction of the improvement initiatives, end of project findings from September 2014 demonstrated great improvement in clinical practice: two pain scores were recorded for 91% of patients, and 76% of eligible patients received analgesia, representing improvements of 7% and 27% respectively. Results Initial audit: In May 2009, two pain scores were appropriately recorded for 84% of patients, and 49% of eligible patients received analgesia. Clinicians perceived barriers to effective pain management to include: clinician belief regarding patients’ pain; language barriers, and confusion regarding analgesia administration. Conclusion These initiatives collectively resulted in improvements in both pain scoring and analgesia administration, therefore improving care for heart attack patients. Contact Information www.londonambulance.nhs.uk Clinical Audit & Research Unit, London Ambulance Service NHS Trust Email: [email protected]