What Matters to me? by Caroline Doidge and @shazmcgarva

If someone asked you “What matters to you?” how would you answer?

I would answer family, friends, health, to do a good job and to take early retirement!

But what about a child? We all make assumptions with children and if we answered for them our answers would probably resonate Xbox’s, phones, mine craft.

 

 

 

 

 

 

BUT you would be very surprised by what they do say when given the chance. The answers are captivating and not as you would expect.

The staff in Ward 15, our paediatric ward, have begun asking children ‘what matters to you?’ and encouraging them to display a poster near to/above their bed.

 

 

 

 

 

 

 

 

We noticed themes coming through.

• Having mummy with me
• Smiley doctors and nurses
• Games and toys
• Getting better
• Trust
• Good food
• TV and DVDs
• Playroom
• Friends and family

 

 

 

 

 

 

 

 

 

But most of all OUR FISH!!!!!

 

 

 

 

 

 

 

 

We also noticed some important and personal issues.

• ‘ECG machine is very important as it records your heart beat and is helping to fix my funny turns’
• ‘Important that I know what I am doing when injecting and having decisions explained to me. I am now a diabetic’
• ‘Miss Hawkins knows where to put my Botox!’
• ‘Nurses are very helpful when you are embarrassed’
• ‘Oxygen to help me get better’

These are not just linked to hospital stays – ‘I love to protect our planet.’ And ‘I love to play football’. This was from a girl and I am sure you were sitting thinking this was a typical boy answer!

SO how did this all begin?

Jen Rogers is the paediatric lead nurse for Yorkhill and when she was completing the fellowship for the Scottish Patient Safety Programme she started to think about asking children ‘what matters to you?. This became her improvement project.

WMTM is 3 step approach.

1. Asking what matters
2. Listening to what matters
3. Doing what matters

This is a very easy way to find out about your patient and their wider world and is particularly important in paediatrics with the focus on GIRFEC (Getting it Right For Every Child). It does not require complex grants and funding as all that is required is pens, paper and commitment.

This is not just the ‘fluffy stuff’. It is linked very well to quality, finance and patient and staff experience – a truly person centred approach.

So with this in mind please ask yourself “What do you know about your patients?” and what matters to them.

With all the competing priorities, new initiatives and increasing work load you may be sitting thinking ‘where will we get the time to do this and will it make a difference?’

Rose’s story will answer this for you. Rose needed a nurse to stay with her at all times as she was a lady with dementia. She was agitated and was at high risk of falling. She was not able to verbalise her worries and this made her care challenging and made her anxious. The ward staff asked Rose’s niece to do a ‘what matters to me?’ From this it was evident that it was her rosary beads that mattered to her, seeing them and feeling them.

 

Being the ever so neat and tidy nurses we are, with HAI inspections and housekeeping to see to, the beads were nowhere to be seen and were tidied away in Roses drawer out of her reach. The nursing staff had no idea and very quickly made sure that Rose always had her beads. The result was astounding. Rose began to settle and soon after she no longer required 1:1 care because her falls risk dramatically reduced. Why? She was not trying to get out the bed to find her rosary.

SO do you know the story behind your patients? Could the ‘fractured femur’ in bed 6 actually miss her grandchildren dearly and want to have their pictures displayed. Did the ‘man in bed 11 with a UTI fight in WW2? What matters to me lets you know more about the person you are caring for. It has no prescriptive nature and gives them the opportunity to display what matters to them in whichever way they like. We need to flip healthcare and change the question from ‘what’s the matter with you? To ‘what matters to you?’

This allows us to gain a much truer understanding of the people we look after and I challenge you all to ask the next person you care for ‘what matters to you?’.

Caroline Doidge is a Play Specialist on Ward 15 DGRI and Sharron Mcgarva is a Staff Nurse and trainee Improvement Advisor for NHS D&G

 

 

 

 

The Cancer Police by the Cancer Waiting Times Team

We are sure far too many of you have heard the dreaded phrase “We are tracking this patient who has been referred in as Urgent Suspicion of cancer”. It seems as cancer trackers we have a reputation for asking too many questions and it must sometimes feel as if we are constantly asking for outcomes and updates on patients. We ask for clinics, tests, treatments to be booked so patients can progress through from their referral, to diagnosis, to treatment as safely and as timely as possible. For each type of cancer we have developed a pathway that each patient should follow, unfortunately we only have 62 days to complete this pathway regardless of the intended treatment. This means that any delays can have a major effect on the next step in the patient’s pathway. We understand that everyone is busy and it must feel sometimes that we are jumping the queue or pushing in with patients, but we have a responsibility to ensure that all these patients are meeting this national target.

We track the cancer patients through the healthcare system from urgent suspicion of cancer referral (USOC) to first treatment and do our best to ensure we meet the Government standards of 62 days for a patient’s referral to treatment and 31 days from decision to treat to treatment. Please don’t stop reading, we understand Government standards/targets can be seen to be divisive or box ticking exercises but if it was your friend or relative that possibly had cancer wouldn’t you want them to be diagnosed and treated as quickly as possible. The Government has helpfully provided a diagram to illustrate this target

So do cancer waiting times really matter in the great scheme of things? The Government states that, “the links between specific waiting times targets and better outcomes in terms of long-term survival are generally unclear. However, there is no doubt that waiting times are closely linked with increased anxiety and concern for patients and their families”.   At the last Scottish Election waiting times for cancer treatment were shown in opinion polls to be among the top 3 concerns of the Scottish voter so they certainly matter to the public.

Unusually for a NHS standard the majority of suspected cancer patients that we start to track will not have cancer and will not be reported to the Government. It is fantastic news for all concerned when a patient is found to not have cancer but and it is a very, very small “but” this can lead to questions of why are you tracking patients that don’t have cancer? It’s tricky to explain and it reminds us of Donald Rumsfeld’s infamous quote “Reports that say that something hasn’t happened are always interesting to me, because as we know, there are known knowns; there are things we know we know. We also know there are known unknowns; that is to say we know there are some things we do not know. But there are also unknown unknowns — the ones we don’t know we don’t know”. Hopefully, we can do a better job of explaining it than Donald Rumsfeld but basically we have to track all patients referred as urgent suspicion of cancer from referral to either having the all clear after diagnostic tests or to first treatment i.e. we don’t know until test results are through if a patient has cancer but the clock for the standard has already started counting. Sorry we are beginning to sound like Mr. Rumsfeld but you get the idea, in our job it’s a mix of “known unknowns” and “unknown unknowns” which certainly keeps us on our toes. As you can see from the chart below we receive a lot of referrals that need tracking but not that many of them are cancers. Overall about 15% of the patients we track will have cancer so the key for successful cancer tracking is to identify those patients with cancer as early as possible.

As NHS employees we all want the best for our patients and we can do this by ensuring we have systems that deliver safe and timely patient appointments, results, clinic outcomes and treatments for everyone. NHS Dumfries and Galloway is a large organisation and the cancer standard is one of many standards. It can be tricky to keep abreast of the different targets and standards but we need everyone who is helping with a cancer patient’s pathway to be aware of the standard and that the Cancer Police will be continuing to track and progress patients. If we focus on delivering a quality patient focused service we will meet this standard and others as a matter of course and may be in the not too distant future there will be no need for the Cancer Police as we will always be reporting how standards and patient expectations have been surpassed.

The Cancer waiting times team are Christine McDowall, Barry Turner and Megan Thomson who all work at NHS Dumfries and Galloway.

Captains Blog Part 2 by Julie Robertson

Following on from the recent Captains Blog…Star date 26.09.14…..

“Compassion: that’s the one thing no machine ever had. Maybe it’s the one thing that keeps men ahead of them.” –DR. MCCOY, Star Trek

I’d like to tell you a little about my role as Community Link Worker.

This post was created as a direct result of the successful Community Engagement and Resilience and Health Service Development project, led by the Annandale & Eskdale Health Improvement Team.

My post gives me the opportunity to;

• Engage with people to identify what is important to them in life,
• Support them to achieve agreed outcomes and live their lives to the full.
• Link people with existing services, day centres, support groups, local activities, training or volunteering opportunities.
• Identify gaps in services and empower people to take an active role in the development and delivery of self help interventions (bringing groups of people together which was something requested in the community surveys).

Our team is part of the Safe and Healthy Action Partnership (SHAP), working with communities and other statutory and 3^rd sector organisations. This co-production has enabled us to create a calendar of activities and opportunities which we update quarterly

Activities have included

• Ipad training sessions (Silver Surfers) – supporting people to learn the basic functions of an Ipad/tablet – reducing social isolation, enabling people to access additional information
• Health Walks (Annan, Lockerbie, Langholm)
• Art Group (Annan)
• Craft Group (Annan)
• Living Life to the Full (Annan)
• Tea and Tennis (Annan)

During the short time the project has been running, we have received 158 referrals which has led to the expansion of the project and the creation of another Community Link Worker, Darren Bryan is now in post.

 

 

A significant part of our role is as part of the Forward Looking Care Team, focusing on preventative approaches to care. As well as Darren and myself

the FLC team is made up of:

Donna Wallace, Community Staff Nurse/PYF Community Staff Nurse supports people to identify and access alternatives to hospital admission and to plan their future care. 

 

 

Denise Fallon, Care Co-ordinator Social Services, Forward Looking Care Team works with people who currently have social service involvement or packages in place to ensure more joined up working avoiding duplication.

 

Dr’s Grecy Bell and Fiona O’Brien, General Practitioners support patient’s and their families to identify ways to improve their quality of life and self-management by encouraging patients to have a Forward Looking Care plan.

 

The changes that people have been supported to make have had a huge impact on those that have been involved. Some quotes from participants are shown below along with a poem written by Meg who goes to the Craft Group in Annan.

“Attending the group is one of the highlights of the week” Craft group participant

“I am able to live in my own home which means the world to me” FLC participant

“through this discussion my family are now aware of what I do and don’t want to happen to me” FLC participant

“I enjoy the company and learning new skills” Craft group participant

Do you sit all day just quiet and alone, no knock on the door, no voice on the phone?

Well we are here to talk to you; we will find you something you can do,

You can sew or knit, or sing a song,

If we know the words we’ll sing along,

Or you can just be quiet or free to have a chockie bickie and a nice cuppa tea,

Cardboard Jane she sorts us out, Gobby Meg just has to shout,

Christine is the quiet one, you hardly know she’s there,

Sandra gives us all a hug to show how much she cares,

Amanda had her hair cut it makes her face look round,

She loves to make her bracelets and sell them for a pound,

Julie and Heather are in charge, they make us tow the line, but they make a good cuppa tea so that’s all fine,

Sue is the clever one, she does sums in her head, she’ll sort out all your cash complaints especially if your dead,

Gillian too is quiet and a member of the clan, she really likes to crochet but does what she can,

Bridie’s thing is to crochet so if you don’t have a clue of how its skill is really done she’ll show you what to do,

Agnes our newest member doesn’t care for crafts, but she’ll join in all we do and join in all the laughs

By Meg Little  

As my manager Elaine ‘Captain Kirk’ Lamont says in the forward of the SHAP Annual Report – (she is) “beginning to wonder if there will ever be a time when…(sic)…we are not in a period of change”. Being involved in a ‘test of change’ our team feel that rather than shying away from the challenge of new ways of we are ready to…

“…boldly go where no ‘service’ has gone before!”

Julie Robertson is a Community Link Worker in Annandale and Eskdale Health Improvement Team

Handover by Barbara Tamburrini

How good do you think your handover technique is? 

Handover is an area of our clinical role which we all encounter regularly during our working day. We transfer patients between clinical environments and transfer clinical responsibilities at shift changes, all of which require handover actions.

As healthcare providers, we understand the importance of good handover communication and recognise the clear benefits of this for our patients and our delivery of optimal and safe clinical care. However, all too often, we are familiar with ineffective handover practice and witness the consequences of this on both the care delivered to patients and the outcomes they experience as a result.

This issue was highlighted to me quite a few years ago when inaccurate information passed on at a night time handover had a direct influence on my ability to provide an effective care response. A patient with hyperkalaemia which had yet to be fully assessed or treated, was handed over to the H@N team using an incorrect patient name. The correct patient could not be located resulting in a delay to the clinical response. During this time, an emergency call went out involving this patient and the error in handover communication became clear.

Sadly, the resuscitation attempt wasn’t successful and subsequent investigations confirmed that the incorrect handover was unlikely to have significantly contributed towards the outcome. The response time between handover and clinical assessment could certainly have been much better and this is what left its mark upon me. This delay could so easily have been avoided and could prove significant in another situation. Many years later, the impact of this episode remains vivid and this has taught me valuable lessons around the accuracy of handover communication which I use to enhance and improve handover practice wherever possible.

How do we do this though?

How do we improve something which is often taken for granted and which every health care facility nationwide finds challenging? Poor handover quality and a lack of standardisation have both been observed throughout UK healthcare facilities over recent years. In fact, it is acknowledged that this has led to medical errors, inappropriate investigations and prolonged in-patient admissions. This means we in NHS D&G are certainly not alone in needing to work on improving our handovers.

But does it make a difference that this is a national challenge? Well, the answer to that is probably No as well as Yes! It doesn’t matter whether we are isolated or whether every single facility in the world has issues with handover communication – we still need to address this and improve our practice.

Having said that, because this is a national and indeed international ‘hot potato’, there are many ideas, strategies and tools already developed and implemented in many hospitals which we can learn from and adapt for local use. So, yes, it does make a difference that this is such a widespread issue.

So the next question is – what can we do to improve our handovers?

The answer is – lots! We have many tools at our disposal which are widely available, of significant value and easily accessed but we often overlook the most basic of these…

We can, of course, use our verbal communication skills much more effectively to handover but this is much less effective when used in isolation. Research suggests only around 2.5% of patient data is retained through verbal-only handover methods. However, this increases to as much as 99% when a printed, structured and regularly updated handover containing all relevant clinical information is utilized. It’s really that simple!

The SBAR-R approach (Situation, Background, Assessment, Recommendations, Review) provides us with a platform to structure clinical communication to ensure it is concise, relevant and accurate and is delivered and received in an effective manner.

This last bit, the review, is crucial since we have all been in the situation where we have delivered what we feel is appropriate information but this may not have been correctly received for whatever reason…

Improving our clinical handovers doesn’t just involve using an SBAR-R approach correctly though. NHS D&G have formed a multidisciplinary handover group to encourage, support and improve handover practice throughout the organisation. The group have set the aim of achieving, by August 2019, 95% of patient handovers between clinical teams and shifts across NHSDG which contain all the relevant information required.

To achieve this, the group want to develop and launch an organisational handover strategy. Additionally, the group will engage with clinical teams to encourage the formulation of protocols and procedures which are standardised across the organisation whilst remaining specific to each clinical area.

The handover group are hosting a ‘Safer Handover Week’ from 24^th to 28^th November involving presentations, educational drop-ins and information sessions to raise awareness of handover practice and its improvement in clinical areas. The week will culminate in a full day event on 28^th November in Easterbrook Hall where the handover strategy will be launched and high profile national speakers will deliver presentations. The day will also involve presentations highlighting local initiatives, a storyboard competition and practical sessions to begin engagement with this improvement process.

Could you benefit from this valuable local event? I would suggest the answer is most definitely YES!

The handover group is looking for all staff, whatever your departmental area to come along to the Safer Handover Week sessions and learn more. We are also looking for multidisciplinary teams of ideally 3 people from each clinical area to attend the Handover Day. Become actively involved in improving handover practice across the organisation and crucially, you will have a direct, positive impact on improving handover practice in your own clinical area.

So, you’ve heard a very real story of the impact of poor handover communication upon our ability to practice effectively and you’ve seen ways in which we can improve this to deliver safer, higher quality care for our patients.

Therefore, my final question to you is more of a challenge. Can you really afford not to attend the Safer Handover Week?

For more information contact: Jean Robson, Director of Medical Education or Rebecca Henderson (x34257 or rebecca.henderson@nhs.net)

Barbara Tamburrini is an Advanced Nurse Practitioner for NHS Dumfries and Galloway

Communication by @kendonaldson

“My father was in hospital for 2 weeks and not once did I get to speak to a doctor”

“All it would have taken was a phone call, I kept asking day after day, but no-one bothered”

“We were watching Mum get sicker day by day and we knew she was dying but we couldn’t get anyone to talk to us about it. They kept changing drugs and trying new things but nothing was working. We knew she was going to die”

These are just a few quotes from recent complaints that I have read and demonstrate a very common theme – we are not very good at communication. There are many aspects to our failing in communication; with the patient themselves, between specialist teams or between primary and secondary care but it’s the communication with families and loved ones I wish to focus on in this blog.

To illustrate my point here is a short story. A friend of mine texted me about a year ago. I was aware that her mother had been in hospital but did not know the details. This was the text she sent me…

I decided to phone the hospital myself and managed to get through to the Consultant looking after her mother. He started to tell me the details but I stopped him and asked him to phone my friend – she was the one who needed to know. His response was “I’m in an MDT meeting and too busy. Tell her to call my secretary and I will meet up with her in a few days.” I was a tad persistent, gave him her mobile number and said “Please phone her today. 5 minutes, thats all it takes.” He was unhappy but said he would try. A little later I received the following text…

(Note my text was ‘Not Delivered’. Great communication!!)

And the next day….

So, a 5 minute conversation with the consultant completely changed that individuals ability to function at work and at home. 2 weeks of agitation, worry and poor sleep gone….in 5 minutes. So why hadn’t that conversation taken place much earlier? Why did the consultant feel the need for a ‘face to face’ meeting? I would agree these are always much more satisfactory for all concerned but they are sometimes difficult to organise and end up delaying the communication for days. All it took was a phone call.

It got me thinking about my own practice. Do I speak to relatives enough? Am I proactive in phoning families to update them on their loved ones progress? The answer to this was no, so I had to do something about it.

It may seem an overly simplistic approach but what we have done is introduce a ‘Ward Sticker’ (see below) which is effectively a checklist which we put in our patients case sheets at least once a week (sometimes less, sometimes more). Now this list covers many things of which ‘Family discussion’ is only one but it is a way of ensuring that, on a ward round, someone has asked the question “Has anyone spoken to the family?” If the answer is no then we can organise that it happens but what I often do is just pick up the phone and call them. Unless it’s really bad news I don’t see any problem with a phone chat and, often, the information I get from them is extremely useful and changes management plans.

Do I get it right all the time? Again, no. It was only a couple of weeks ago that my colleague reviewed a patient in our Medical High Dependency Unit who I had seen several times over the preceding few days. She was young and very sick and, he informed me very politely, no one had spoken to her daughter since admission. I was mortified but then we don’t use the sticker on MHDU. Am I becoming reliant upon it? Must do better!

There is no doubt our patients are getting older, more complex and are increasingly muddled, especially on admission. Making a clear and definite diagnosis takes longer and often feels less than satisfactory – ‘Probable UTI’ or ‘Probable Stroke’ – and its in these scenarios that early family input can make a massive difference. You can feel like you are working in the dark but when you pick up the phone and speak to someone who knows the patient well, and really cares for them, then it can become clearer and, I think more importantly, you can allay that loved ones fears about what you are thinking of doing in the way of tests and treatments.

So if there was one thing I could ask it would be this – think about the family and loved ones early on in admission (preferably the first day) and use your phone a little more. A quick phone call can make a big difference and will often calm their anxieties, make your life easier and, perhaps, reduce the number of complaints coming through the system.

Ken Donaldson is a Consultant Nephrologist and Associate Medical Director at NHS Dumfries and Galloway