Medicine Safety Week – The 5 ‘Rs’

Last summer NHS Tayside ran a one week Medicine Safety Week organised by Arlene Coulson, Lead Clinical Pharmacist (@leena1208) which was a great success. The news filtered down to Dumfries and Galloway via several mediums including Twitter. It became apparent that there was an appetite to run a similar venture for the Doonhamers and so a team was assembled and planning began. At that time the last week in January seemed very far away but boy did it come round fast and here we are on the last day able to report on our success…

Day 1

 Our first lunchtime lecture was hosted by Mr Jeff Ace who introduced the week and Dr Andy Longmate, National Clinical Lead for Patient Safety, who impressed upon us the importance of medicines safety by using real life patient stories and some hard hitting data. University of the West of Scotland nursing student, Sarah Inglis, was presented with a prize for designing the Medicine Safety Week logo, which can be seen here.

Karen Hills, Karen Stitt, Emma Harper and Emma McGaughie undertook 1 minute MEDucation sessions by the canteen stand with passing nurses to identify from information word bubbles the most critical aspects of medication safety which was the logo of the week – Right medicine, Right dose, Right patient, Right route, Right time (The 5 ‘Rs’)

Laura Graham, Lydia Burnett, Daryl Pattie and Abby McFarlane spent the afternoon on the patient/carer stand in the main entrance handing our ‘Not Sure? It’s Ok to Ask’ cards. Key patient quotes – “I sometimes wonder whether they all do me any good“, “I feel my medicines are getting routine and should probably be reviewed“, “what matters to me is that they make me feel better”

Day 2

Day 2 focussed on High Risk Medicines. The lunchtime lecture was chaired by our Chief Pharmacist, Mr Mike Pratt, wearing his shower cap! There were four presentations on; safe insulin prescribing (Pam Young), anticoagulants (Artem Osipenko), vancomycin and gentamicin (Laura Graham) and antipsychotics (Wendy Ackroyd).

Once again the quartet of Karen Hills, Karen Stitt, Emma Harper and Sharron McGarver undertook 1 minute MEDucation sessions by the canteen stand with passing nurses to highlight the Learnpro training module on IV medicine administration.  An afternoon drop in session was for nursing staff on high risk medicines with practical exercises on recognising antibiotics which contain penicillin, insulin administration, warfarin chart details and good practice on IV medicine use.   Janice Cluckie & Gillian Burgess manned the patient/carer stand which highlighted that – “medicine wastage is a problem, if you stop using something then it all has to go in the bin”

Day 3

The topic on day 3 was Polypharmacy and the lunchtime lecture was a joint presentation by Dr Angus Cameron, Medical Director and Laura Graham.  Polypharmacy is a major issue particularly in an aging population with multiple co-morbidities and numerous ‘organ specific’ guidelines.

In the afternoon there was a Polypharmacy case study drop in session for nurses by prescribing support pharmacists Emily Kennedy, Gordon Loughran and Leanne Drummond in the education centre and Newton Stewart health centre. These were well attended by both primary & secondary care nurses and there were some useful discussions about cases and communication issues across the interface.  Gillian Burgess and Wendy Ackroyd attended the patient/carer stand with some comments from discussion including “How do I know if it is Ok to keep taking medicines longterm?” and “I find reviews of medicines are really useful”.

Day 4

The final ‘main topic’ of the week was Medicines Reconciliation, which has been recognised as one of the toughest patient safety issues to crack. Ken Donaldson (Chair of Safer Use of Medicines Network), Laura Graham and Janice Cluckie gave us a reminder of what Medicines Reconciliation is all about; the importance, the challenges and the way ahead. In the afternoon there was a drop in session highlighting some of the issues around med rec including examples to work through.  Margaret Marshall and Dr Charles Knoery were able to attend the patient/carer stand and hand out more of the patient advice cards ‘Not sure? It’s OK to Ask about your medicines’.

Day 5

Well that’s today so not much to say! At lunchtime we will be closing the week and presenting the Storyboard Competition winner, which I am delighted to announce, was “The introduction of an Orthopaedic Antimicrobial Ward Round” submitted by Susan Roberts on behalf of the Antimicrobial Management Team and Orthopaedic team.

All in all its been an excellent week with over 270 staff attending lectures and drop in sessions. The organising team would like to extend its heartfelt thanks to the ubiquitous Laura Graham (Clinical Pharmacist) who has gone above and beyond the call of duty by organising this week. She has worked tirelessly to ensure a good turnout at all events and, as you can see above, has presented almost every day – Thank You @lauralougraham7

So, when do we start organising the next one……

 

 

 

A parent in the Healthcare system (and proof I did not steal the DaVinci) by @peterbryden1

I was fairly young at 23 expecting the birth of our first child.  It had been a warm summer and my wife had struggled with the heat during our first pregnancy and I was a naive young guy who knew everything was going to be fine!

 That day, I was stressed, wanting to get our new kitchen that I was fitting finished. Our 1 year old Labrador had also found a wasps nest and her swollen face confirmed the wasps had not been happy about this. I was busying myself with the kitchen when my wife Sarah said her wrists were sorer today.  I noted that she looked…. well …. “bigger” and “puffed up”.  As a man, it is impossible to think how to phrase this to your wife even if she is pregnant and indeed dangerous to do so to a pregnant wife on a hot day.  I advised that she seemed a wee bit puffy and should go and see the doctor.

By midday after seeing the GP we were in Cresswell watching a monitor which showed that Sarah’s blood pressure was sky high.  By 1pm a Registrar advised that an ambulance was coming to take Sarah up to the Queen Mother’s hospital in Glasgow, she was concerned that Sarah may have pre-eclampsia.  I wasn’t able to go in the Ambulance and arranged to rendezvous in Edinburgh Road and follow them after I had been home to pack a bag.  For the few minutes I waited, I sat in the car wondering what pre-eclampsia was and panicking, why had I not paid more attention at the pre-natal classes?

 The Queen Mother’s was an old hospital, a big grey concrete post world war 2 cold looking building and nothing like the warm modern new Cresswell back home.  We were placed in a room on the third floor and we were left by the friendly midwife who had travelled with Sarah from Cresswell.  I noticed straight away that the Queen Mother’s staff spoke around us, not to us, and after all the rush to get to Glasgow we sat for an hour or so before anyone came back to see us.  It’s hard to explain why however we both felt instinctively that we could not ask questions, the staff demeanour seemed to convey “I’m too busy to speak”.

 Over the next few hours I watched as Sarah’s blood pressure continually rose, occasionally staff came (and even more occasionally) said a word or two to Sarah, ignored me, recorded observations and went away again.  No one was telling us what was happening and we didn’t want to bother them, so it was best to be quiet.   In the evening one of the nurses said “you look more oedemic and puffed up” and said we were being moved to another room because “it was nearer to theatre”.

 At 10pm, I was getting pretty upset, the whole day had been a shock, someone had mentioned pre-eclampsia before we had came up the road, and now Sarah had something called oedema?  To top things off, I was now told I could not stay in the room after 10pm.  I was advised by the grumpy nurse, who wasn’t looking forward to the rest of her nightshift, that I could sleep on the chairs in the main waiting area on the ground floor.  My wife was very unwell, we didn’t know how this was affecting the baby, I was going to have to leave Sarah and our unborn baby overnight in this state, the staff were aloof and dismissive, we didn’t want to bother them with questions and I now felt more alone than any other point in my life. 

 As I was about to leave, and putting on a brave face whilst choking back an overwhelming need to cry, another nurse came through to do observations. This nurse asked where I was going and once I explained, she shouted the nurse who told me to leave and asked her to bring in a “zed” bed so that I could stay.   Grudgingly and clearly embarrassed Staff Nurse “I hate nightshift” brought this and bedding into the room, making the excuse “I forgot we had these”.  The night passed with a routine of the blood pressure alarm sounding, staff coming through to check but telling us nothing and my wife becoming increasingly unwell.  Still no answers, still no knowledge, still not able to ask.

 In the morning about 7am things changed.  A middle grade doctor came to see us, she asked our names and if it was okay to call us by our first names, she acknowledged we were a long way from home and it must be really stressful for us.  She could not believe we had no idea what was happening and said the doctors who had seen us on lateshift and nightshift should have explained this all.  I said that we had not seen a doctor on the nightshift?  It turned out that one of the “nurses” who appeared a couple of times on nightshift was a doctor, the problem was we could not tell as everyone was wearing scrubs.  

 The middle grade explained that what my wife was experiencing was pre-eclampsia which was the reason she had “puffed up” due to the build up of oedema (fluid) in her body.  She explained that there was no known cause of pre-eclampsia but it was thought to be something to do with the placenta, we would need to wait until she had spoken with the Consultant but the baby may need to come early. 

 The middle grade returned after an hour or so with the Consultant who advised that things were not going to get better, the baby would have to come today by C section.

 Around 11am we were being taken to theatre just as our parents arrived, I had been strong up to this point but seeing my parents obviously worried set me off and I realised at that point how worried I actually was. 

 Theatre was chaos, chaos to me for only one reason, I didn’t know what was going on and there seemed to be a cast of thousands on the other side of the green sheet that had been put up as a curtain.  I was scared, Sarah was now incoherent and despite all the people around I was now really on my own, the Anaesthetist appeared not to be aware of my existence despite sitting beside me. 

 At 11:21, on 27 August 2003, (around the exact time that the Madonna with the Yarnwinder was being stolen in the robbery at Drumlanrig Castle) Abbie was delivered, all 2lb 13oz of her, she was tiny.  We saw her for a few seconds and she was taken away to an incubator in the Special Care Baby Unit (SCBU) and we were taken back to the room where Sarah fell into a well earned deep morphine assisted sleep.  I was then told I could go down and see Abbie.

The SCBU felt like a different planet in comparison, the midwives were excellent, talkative and re-assuring.  They spoke to me constantly and told me everything they were doing, what the tiny cannula’s were for and the tiny nasogastric tube for feeding Abbie.  Abbie was in an incubator and I could not cuddle her, all I could do was put a well disinfected hand inside and cup her head and rub the back of her tiny neck.  The tiny skinny baby, slightly bigger than my hand was the most beautiful thing I have ever seen

It was a day and a half before my wife could go down to SCBU on a wheelchair, pushed by me, to see Abbie properly.  After a week of the Queen Mother’s and its other issues we were transferred back to Cresswell where care and communication were excellent, the staff were amazing and over the next few weeks, until Abbie was considered a “full term baby” and allowed to go home, we were looked after extremely well. 

 The point of this blog is not just to moan, I am actually trying to reflect on why this happened and why it was such a negative experience.  I had to be signed off work after a few weeks of Abbie being back at Cresswell as the stress of the 26^th and 27^th had caught up with me.

 In reflection, I think the problem was that the Queen Mother’s was a big extremely busy maternity hospital and we were just the next couple on the never-ending conveyor belt.  Apart from the SCBU, the majority of staff we came into contact with had became transactional and lost the link with each individual’s personal patient experience we were the next package to be sorted out and sent on its way.  I think there was also an assumption that we knew what was happening.  In honesty, I was expecting someone to come in and tell us what was going on and kept expecting this to happen shortly.   I will never now know what the root cause of all of this was.

 I have to ask the obvious question, “why the hell did I not do more to ask questions?”  Now that I have been with the NHS for over 5 years I realise that doctors, nurses, midwives and all other staff are in the main very approachable.  My problem at that time was that I had an old fashioned view that these were extremely busy people who had enough to do without me annoying them by asking questions, which I was worried I should have known the answer to.  I didn’t want to compromise our care by doing this.  I now realise and strongly believe that I should never have been in a position where questions regarding such a huge life-changing event were necessary?

 Values based reflective practice (VBRP) is centred around sharing stories and using VBRP methodology to help individuals share their experience and to allow teams to learn.  I wish I had known of this back then.

Peter Bryden is Patient Experience and Safety Facilitator at NHS Dumfries and Galloway

Crabbit Old Woman by @gbhaining

This poem was written by Phyllis Mabel McCormack 30/06/1913–10/01/1994. Originally entitled “Look Closer” she wrote it in the early 1960s for publication in the Sunnyside Chronicle, which was a magazine produced by the staff of Sunnyside Royal Hospital for circulation within the hospital. She submitted it anonymously as she felt it was critical of some of her colleagues. A copy of the magazine was loaned to a patient in a nearby hospital, Ashludie near Dundee. Before returning the magazine, the old lady copied the poem out in her own handwriting and kept this copy in her bedside cabinet. When she died and the staff cleared her belongings, it was found and, as it was in her handwriting, it was assumed that she was the author.

POEM  Please take a little time to read this, also the nurses response!

I first learned of this poem whilst undertaking my mental health nurse training in the late 1980s.

This poem resonated with me, and, has stuck with me throughout my career. This led me towards “care of the elderly mentally ill nursing” as it was then called, and, ultimately to strive for the delivery of the best possible care for people with dementia, their families and carers.

Why Dementia?

Traditionally dementia has been the “business” of mental health services but if we consider the statement below, this confirms that wherever we work, whoever we are, at some point we are going to come in contact with a person who has dementia.

“Dementia is one of the foremost public health challenges worldwide. As a consequence of improved healthcare and better standards of living more people are living for longer. This means in Scotland that the number of people with dementia is expected to double between 2011 and 2031. This presents a number of challenges, most directly for the people who develop dementia and their families and carers, but also for the statutory and voluntary sector services that provide care and support. Over time we expect that a greater proportion of health and social care expenditure will focus on dementia, and there is evidence of that change already. There are no easy solutions and transformation will take time. This document sets out what we will do in the next three years.”  Scotland’s National Dementia Strategy 2013 – 2016

What was it like away back then?

 Crichton Hospital (William Burns 1834)

Well…. whilst I was training in the 1980s I had various placements with the Crichton Royal Hospital that had wards for people with dementia.

These were large institutional wards with nooks and crannies all over the place, they had nightingale dormitories and from an observational point of view were a challenge.

The wards included acute assessment and long stay and it was dependent on the stage of your illness where you were placed. There was little evidence (in my opinion) at this time of person centred care. People were well cared for but personal choices were limited.

We had charts for bathing, toileting, weighing, to name but a few.

We dished out meals of limited choice and drinks based on what we knew, however, I mostly prefer to drink coffee BUT do like to be given the option of having a cup of tea!

We had large sitting rooms where everyone was expected to congregate between getting up, mealtimes, toileting times, bath times and going to bed. The telly or some Scottish music was generally going on in the background.  

I want to stress that we didn’t think we delivering poor care, we weren’t. We were delivering the care that met the physical needs of people with dementia and had to do this because of the numbers of people we were caring for. 

So have things changed?

YES!

We no longer have large institutional wards for people with dementia. People with dementia are cared for within their local community. 

We have memory clinics where people are assessed and diagnosed early. People with dementia are supported to take control of their care and treatment including planning for their future and determining their wishes.

We have commitment from the Scottish Government to ensure that all people including people with dementia receive excellent person centred health and social care.

We have national programmes to support this including:-

• Scotland’s National Dementia Strategy            
• Older People in Acute Hospitals
• Dementia Standards
• Promoting Excellence
• People at the Centre of Health and Care

So……………….back to my point about dementia touching each and every-one of us.

Yes it will:  be it personally or professionally, be it in the work place or at home. We will all have to be prepared to care for people with dementia as our aging population grows and we all live longer.

My current role as Alzheimer Scotland Dementia Nurse Consultant is as a result of the commitment from Alzheimer Scotland, the Scottish Government and a fundraising appeal by Kay the Dowager Duchess of Hamilton.

 I am a small cog in a big wheel but I am working with my colleagues across the region and striving to make sure “we get it right for every person every time” and particularly if that person has dementia.

Gladys Haining is an Alzheimer Scotland Nurse Consultant working at the Mental Health, Learning Disability and Psychology Directorate of NHS Dumfries and Galloway.

Telephone 01387 244007 (internal: 36606)

email: ghaining@nhs.net

Dementia helpline: 0808 808 300    www.alzscot.org

Have a nice day! by @carolinesharpe50

(or…..My New Year’s resolution to support better staff experiences in 2014)

Its a New Year, and a chance to reflect on what could make 2014 a better year than the one that has just gone. That’s not to say that 2013 was a bad year per se, but ever the optimist, I believe in looking forward (with the odd backward glance to make sure I remember where I have just come from), dreaming about how things could be different and better, and then working out what I need to do differently to make it happen.

 Two recent events have helped me to think about my 2014 resolution for better staff experiences for us all here in NHS Dumfries and Galloway. The first was that I had the chance in December to celebrate a significant birthday (very personal, so please don’t ask for the details) with a trip to New York. It was in all aspects perfect – snow, blue sky and sunshine, Christmas decorations everywhere, and above all, a community of New Yorkers with a common goal and a strong culture who obviously pull together to make a city that is welcoming, vibrant, safe and exciting – and a place to be proud of.

 The second was a hugely successful joint Area Partnership Forum and Area Clinical Forum conference in the Autumn when we worked together to consider the Francis report, and the issues arising from it relating to culture, values and behaviours of staff within the NHS. The conference was, in places, powerfully personal, and many staff members shared experiences, good and bad, that demonstrated the intrinsic link between staff experience and the experience of our patients when in our care. This was further reinforced at the most recent Scottish Person Centred Care Learning set which was the subject of a blog in December, and really got me thinking (again) and excited (all over again) about, staff experience, and what makes the difference between a great day and one best left behind at the end of the shift.

 Both of these experiences have in their background and context some difficult stuff; New York will never forget the date 9-11, and NHS England (and probably Scotland too) will take years to recover fully the confidence of patients following the tragic events reported in the Francis report into Mid Staffordshire Foundation Trust. But both of these situations also show how communities can grow and be stronger as a result, by having both the skill and the will to learn from what has happened, and getting to the heart of the values, beliefs and behaviours that will ensure it is different for the future.

 And so to my New Years resolution; as they say in New York, I want staff to ‘Have a nice day!’ and I’m going to get really focused on how best I can help to make that happen over the next 12 months. In the wake of Francis, 2014 is definitely the year for improving staff experience alongside patient experience – let’s not settle for one only when, with a little imagination and care we can achieve both, and in so doing enhance the health and wellbeing of ourselves (staff) as well as our patients and clients, and build a more resilient and stronger working community that is ready to take on the challenges of 2014 and beyond.

 And my starting point in looking forward? A little reflection of course! In 2007, the APF and ACF worked collaboratively for perhaps the first time to produce RESPECT – Our Code of Positive Behaviour. Its simple. It just asks each of us, every day in every interaction to;

 *Recognise our Responsibilities – in our role and to each other; and acknowledge that each of us contribute to shaping the culture, values and behaviours (good or poor) we all experience every day, and pass on to our patients and clients in each interaction with them

 *Value Equality and diversity – we are all different and we all have something valuable to contribute

 *Be Supportive and understanding – using our talents to support and develop others and our challenges and mistakes to learn and improve ourselves

 *Give, and receive Positive feedback – valuing those around us in a positive and dignified way, and making sure they know we value them

 *Develop and work in Effective teams – always striving to improve trust, relationships and performance for the benefit of those we care for

 *Strengthen our Communication – open, honest, clear and timely, with listening as a key skill to learn and practice every day

 *And finally, build a culture of zero Tolerance – none of us should tolerate poor or inappropriate behaviour and we should all feel confident to challenge it and support colleagues and the organisation to improve whenever and wherever we come across it.

 And when you add it all up?

 ‘Have a nice day’ = RESPECT – a code of positive behaviour

 Its simple – I agree. However, this code still feels as relevant to me in 2014 as it did when it was first developed in 2007. And the ambition and focus for improvement in staff experience feels much more real, and more connected to our ambitions around patient experience now than it has ever felt before, and so I am feeling optimistic that 2014 will be a good year for us in our NHS staff community to really pull together, to make experiences for patients and staff that that are welcoming, safe and person centred – an experience that we will be proud of.

 Best wishes for 2014, good luck with your own New Year’s resolution and I look forward to working with all of you to help me ‘Have a nice day’!

 Caroline Sharp is the Workforce Director at NHS Dumfries and Galloway

 carolinesharp@nhs.net