The Paediatric Care strand aims to support NHS boards to improve the quality and safety of paediatric healthcare. The key objective is to reduce avoidable harm in paediatric services by 30% by March 2019.
One of the mechanisms used to demonstrate this is the Paediatric Serious Harm Key Indicators, developed from the Cincinnati Children's Hospital model.
The areas of focus for paediatric care are:
- reduce serious safety events
- reduce medicines harm
- reduce ventilator associated pneumonia
- reduce central venous catheter bloodstream infection
- reduce unplanned admissions to intensive care
- improve child protection identification and escalation processes within acute hospitals.
To support the reduction of harm in acute care settings, there is also a focus on the identification and appropriate treatment of the deteriorating patient.
The core measures, for which MCQIC will support improvement activity across all boards, for paediatric care are detailed below. All remaining measures will be supplementary.
Rate of unplanned admissions
Central line infection rates (where applicable)
Ventilator-associated pneumonia (PICUs only)
MCQIC uses the Breakthrough Series Collaborative Model. Networking events are held every six months to encourage sharing and learning. These are interspersed with action periods, when local teams undertake small tests of change to improve care.
The Model for Improvement is used to support testing and implementing changes. Frontline staff are also supported through monthly WebEx sessions.
A key element of monitoring and guiding improvements is the use of data. All units are collecting and using local data to drive improvements.
Achievements of the paediatric care programme so far include the development of a national system-wide Paediatric Early Warning Score (PEWS) and the development of the Paediatric Sepsis Six.
A range of tools and resources for frontline staff, including the measurement plan, can be found in the SPSP Members’ Area and Tools and Resources below.
The following are recordings and PDFs of the PowerPoint presentations from the MCQIC Paediatric Care WebEx series.
21 June 2018 - Project Surgery on ‘Watchers’ and PEWS WebEx, Dr Neil Spenceley, Paediatric Clinical Lead at Healthcare Improvement Scotland.
6th March 2018, Paediatric Networking Event, Cathy Macdonald, Art of Communication Masterclass View of presentation
21 April 2017 - Increased situational awareness to reduce undetected deterioration (PDF) by Dr Pat Brady, Associate Professor of Paediatrics Division at Cincinnati Children's Hospital Medical Center.
25 May 2017 - Managing Sepsis in Paediatrics (PDF) by Dr Binita Patel, Chief of Quality of Safety in Paediatric Emergency Medicine at Texas Children's Hospital.
7 June 2017 - PEWS as a system (PDF) by Dr Damian Roland, Consultant in Paediatric Emergency Medicine at University Hospital of Leicester.
18 July 2017 - Paediatric Sepsis WebEx by Dr Neil Spenceley, Paediatric Clinical Lead at Healthcare Improvement Scotland and Drew McDonald (PDF), Senior Staff Nurse at NHS Grampian.
SPSP Paediatric Care held a Paediatric Networking Event on Wednesday 25 October 2017 in Edinburgh. The event focused on deterioration, and gave delegates an opportunity to come together as a group to network, learn from each other and plan future improvements.
To view the presentations from the event please access the links below:
- Shadows and strangers: the case of the mechanical swimmer (PDF) - Will McConn, Sport Psychologist, University of Strathclyde
- The Shell Model: inside of human factors (PDF) - Neil Clark, CEO at Integrated Human Factors Limited
- National medicines update (PDF) - David Maxwell, Improvement Advisor, Healthcare Improvement Scotland
- Theory and prediction (PDF) – Lesley Macfarlane, Associate Improvement Advisor, Healthcare Improvement Scotland
- Understanding data (PDF)– Lesley Macfarlane, Associate Improvement Advisor, Healthcare Improvement Scotland
Paediatric Early Warning Score (PEWS) Charts
PEWS charts allow the paediatric community in Scotland to put into practice a national system-wide paediatric early warning system. The charts and further information about PEWS is available here.
Paediatric measurement plan -(PDF) July 2017.
The paediatric care driver diagram (PDF) maps out the aims, outcomes and change packages for the programme.
Further tools and resources related to the paediatric care programme can be found in the Member's Area
Why is there a need for improvement in paediatric care?
Children and young people have been at the centre of policy in Scotland over recent years, with a clear recognition that the future of our nation is dependent on the health and well-being of our children.
The Local Delivery Plan (PDF) (2007) and the Emergency Care Framework for Children and Young People (PDF) (2006) have been the response to ensuring equity of access to high quality healthcare services for children in Scotland. Delivering a Healthy Future (PDF) (Scottish Government 2007) recognises the need for ongoing development of measurable improvements in the provision of healthcare, health improvement and health outcomes for children and young people.
A quality improvement programme designed specifically for paediatric care is a key step towards reducing inequalities in outcomes. Helping to deliver the content of current policy recommendations and evidence-based care will ensure safe, effective, person-centred paediatric care is delivered with a more positive experience for families.
How does this align to other national initiatives?
Other national initiatives are in progress to improve outcomes for children. We work closely with the Children and Young People Improvement Collaborative (CYPIC) and managed clinical networks to ensure consistency across Scottish paediatric units.
Who is involved?
Key partners involved in the paediatric care programme include:
- NHS territorial boards, including frontline staff in all paediatric units across Scotland
- Service user representatives
- Healthcare Improvement Scotland
- NHS Education for Scotland (NES)
- NHS Health Scotland
- NHS National Services Scotland, Information Services Division
- Professional organisations and colleges
- Scottish Government
What resources are available?
The emphasis is not on putting extra staff in place to deliver improvements but on existing staff ensuring reliability of care processes, so that every person every time receives the care they need and want. Consequently, there is also an emphasis on boards ensuring that they are building capacity and capability in quality improvement science.
NHS board staff are supported to undertake further development through the Scottish Quality and Safety Fellowship Programme, Improvement Science in Action and Scottish Improvement Leader (ScIL) courses, as well as providing links to online modules via NES and Institute for Healthcare Improvement (IHI).
More Than Minutes documented our Paediatric Networking event on 9th February 2017. Below are the images they captured on the day.