SPARC.ICM Meeting Summary

SPARC.ICM Meeting Summary
Meeting 1: April 22nd 2014. Queen Alexandra Hospital, Portsmouth
Thanks to everyone who came along, presented and participated in the discussions
Project Idea: PRoVENT (Dr Honor Hinxman for Dr Nigel Chee)
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Summary of the PRoVENT study that is being conducted in June. It is an international multicentred observational study looking at current practice in ventilation settings in patients in ICU.
o Primary Outcome: Tidal volumes in ventilated patients with varying degrees of ARDS
and those without ARDS.
o Multiple secondary outcome measures
Discussion around the role of the SPARC-ICM group in established national projects as other
groups have done (e.g. SWARM and SPARC). Sometimes the timing of the trial is in conflict
with the dates of other studies being conducted in a department. In order for this to work, we
need to work with the local research teams.
Discussion about SPARC-ICM group or individuals getting involved in this particular study
that is being performed in some hospitals around the region.
o Requirement for GCP training
Also a discussion around the idea of starting a project in the region looking at our practice –
highlighted that such a project would need to either audit ARDS patients against current
guidelines or be research on those other patients (i.e. no guidelines exist for the ventilation
strategy that we should use in those patients without a lung injury).
o A new project would have to focus on one element of ventilation
o It would have to consider the volume of data and the timing at which this data is
collected, e.g. how often and at what time of day would you record a patient’s tidal
volumes?
o If the project is not an audit, then it would have to go through the research departments
for approval.
Please contact Nigel Chee via [email protected] for more information about getting
involved in a project or contact your local research department to identify the PI to get involved
with the PRoVENT trial.
Project 1 Update & Results (Dr Adrian Wong)
The results of project one were presented to the group: A prospective CVC Insertion Audit
o Excellent involvement of every ICU in the region.
o 181 CVC lines were inserted during the week studied
o General poor documentation, especially of sterility
o Focus of the discussion was on the importance of sterility (USA has penalties now) and the
documentation of the use of hats AND gloves AND a mask. New guidelines are supportive of
the use of these 3 things during line insertion.
o The importance of this was also discussed – the next project should involve looking at
spreading good practice and or compliance with recommended CVC line care bundles.
An abstract has been submitted to the autumn ESICM conference
Thank to all of the trainees involved in making the project happen:
Basingstoke: Alex Smythe
Southampton:
QAH: Adrian Wong & Huw Wilkins
GICU: Clare Morden
Chichester: Laura Pocock
NITA: Sumair Hassan
Winchester: Emma Norman
CICU: Nigel Chee
Salisbury: Davina Watson
PICU: Emma Fitzgerald, Claire Germain & Sarah Wright
Poole & Bournemouth: Laura Wood & Alex Belcher
Dorset: Fiona Linton & Erica Jolly
Consenting for Clinical Trials (Dr David Pogson)
The Presentation is available to download (WICS & SPARC websites)
A clear and concise summary of the process of consenting patients for clinical trials was presented.
o The process of Good Clinical Practice Training
o The importance of being prepared – the person consenting needs to be able to have a full
discussion with the patient about the trial for which they require consent
o Communication strategies
o Tips and common traps
o Review of capacity and previous expressed beliefs and the importance of identifying the
appropriate person to consent on the patient’s behalf
o Therapeutic misconceptions
o A list of questions is a useful way of ensuring that they understood the information.
SPARC & Research Networks (Dr Ben Harris)
A presentation about the development and successes of trainee-led research groups
o Other regional groups have been in place for a number of years. There has recently been
development of a National group: RAFT (Research and Audit Federation of Trainees)
o An overview of SPARC and its recent project and involvement in SNAP-1.
o How SPARC-ICM will work with SPARC in order to maximise the projects that we conduct
ICU Think Tank (Dr Nigel Beauchamp)
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A proposal was put forward for the development of online communication of new ideas that can
link people with similar interests in order that they can create a proposal for a project that we can
discuss at SPARC-ICM meeting.
A discussion followed that involved consideration of the format that this could take.
An online forum was suggested
Project Idea: Communication (Dr Adrian Wong)
Proposal: Communication & Feedback on the ICU
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Why do this project?
o Communication issues is cited as the main cause of medical complaints and patient dissatisfaction
o Feedback now forms an integral part of CQC and appraisal
o ICM as a specialty should stop hiding behind the fact that our patients are sedated – we should collect feedback
What is best practice currently and how is this defined?
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No established guidelines as to what is best practice except for the fact that we should obtain feedback
Several versions of feedback form already available
Baseline measure of quality of communication: simple questionnaire, standardised patient (& relative) feedback form
Publication of results –it needs to be fed back to patients and relatives
An idea for a baseline measure of quality was proposed and discussed
o Discussions about methodology and generally how this is possible
o Problems with identification of a representative sample
o Suggestion of involving outreach to identify patients in the first 24 hours post-discharge
o Likely that a pilot in one hospital will allow development of a questionnaire that could
later be used in multiple hospitals.
Please Contact Adrian Wong via [email protected] if you are interested in getting involved.
Project Idea: NCEPOD Sepsis (Dr Honor Hinxman)
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It was highlighted that a national audit is going to be conducted and that people can get involved
with this by contacting the local PI
www.ncepod.org.uk/sepsis
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Discussion about running a concurrent audit to establish how well we are applying the Sepsis-6,
although the general consensus for a concurrent project was not enthusiastic especially given the
short time window.
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That said the sepsis 6 is a NICE guideline so should be being audited and should be done well.
Might make a nice regional project at a later date
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Discussion about the problems previously faced with the timing of diagnosis and the
identification of such patients – methodology would need to be clear. Probably easier if done
PROSPECTIVELY, rather than retrospectively.
o Please Contact Honor Hinxman via [email protected] if you are interested in getting
involved.
Contact Details
Please contact us if you would like to know more about these projects or have a project that you are
doing in one hospital that could be undertaken around the region.
We are keen to help you role out your ICU projects around the region, rather than just in one unit.
We will be at the WICS Summer Meeting on 6th June
NEXT SPARC-ICM Meeting: Late June 2014
Email us: [email protected]
Follow us at @SPARC_ICM
Visit us:
www.wessexics.com/Training/SPARC-ICM
www.wessex-sparc.com/sparc-icm
Many Thanks,
The SPARC-ICM Team
Dr Emma Fitzgerald, Dr Honor Hinxman, Dr Phil Mcglone, Dr Nigel Beauchamp, Dr Fiona Linton.
ICM consultant lead: Dr Kayode Adeniji

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