What Matters to You? by Alice Wilson (& many others!)

“What matters to you?” day is on 6^th June and you may have seen information about it around the place. We are encouraged to think about what matters to us and to have conversations with individual service users, their families and our colleagues about what matters to them, so we can use that information to improve the care and support we give to individuals and their families and promote a healthy working environment.

I thought it would be an idea to focus this blog on people who work in our health and care system and asked them to share what matters to them in and out of work and to share a few photos if they wish. I am grateful to those people who have shared what matters to them. Thank you, this blog is yours:

 

Emma Jackson is a physiotherapist at Newton Stewart Hospital:

In work

Up to date handovers and good communication between staff

Being able to build trusting relationships with patients by using appreciative inquiry, and having the time to get to know them as a person

Out of work

Being able to spend quality time with my family, friends and pets

Having personal goals to work towards

– Being able to get outside as often as possible – walking in long grass with my dogs is my fix

 

Morag McMinn, support services assistant, Gerry McDermott, support services manager, Kay Shepherd, support services supervisor

Liz Jardine, support services assistant, Linsey Wharram, support services assistant, Helen McCaig, support services assistant

 

Morag McMinn:

In work

To come into work and not get hassle.

That staff get things right, especially the care and the care of people with dementia

Out of work

My two granddaughters

 

Gerry McDermott:

In work

My staff feel respected and part of the whole network of the NHS

Out of work

My kids and the football (Celtic FC)

The kids are growing up fast and I want them to fulfil their dreams

CFC has fulfilled its dreams this year!

Kay Shepherd:

In work

Staff are happy and get on well, there is mutual respect

Staff trust me to come and speak to me

 

Out of work

My four kids – my weans

Liz Jardine:

In work

It’s all about the patients; I enjoy talking to them and being part of the team

Being able to go to the supervisors and talk to them

Being happy in work

 

Out of work

My two sons and spending time with my husband as well as my wider family.

Supporting our sons to achieve in life

Lynsey Wharram:

In work

Being involved with the patients, additional responsibility is a privilege, such as taking people on their last journey to the mortuary

Being part of the team, uniform colours don’t matter

Out of work

My wee brother (Murrey) and people now recognising disability more

Proper training for people about disability and dementia

 

Helen McCaig:

In work

To come to work and being happy working

Being part of making patients feel their privacy is respected

Out of work

My husband and son – we are really proud of our son who is now doing his Masters at

Cambridge University

My cat, Salem

Helping my father who has dementia

 

Pictured: Jeanie Gallacher and Stephanie Phillips, Primary Care Mental Health Liaison, Stewartry. Norma Cunningham, Community Mental Health Team Support Worker, Stewartry.

 

Jeannie Gallacher & Stephanie Phillips

In work

As staff working within a new project in Primary Care Mental Health Liaison, it matters to us that patients feel they can have quick access to appropriate mental health treatment.  It matters to us that we forge good working relationships with our colleagues and that the service we provide is supportive and effective.

Out of work

Jeanie –   I feel it is important to have lots of quality time with my family and it matters to me that we try to get away for family days out and holidays!

Stephanie – It’s important to me in my home life that my family are healthy.  I enjoy walking my dog every day and this matters to me.

 

Norma Cunningham: 

In work

Firstly what matters to me is that I provide a good service to our patients.

It also matters to me that staff feel valued and encouraged to reflect and develop, and that staff receive positive feedback when there have good outcomes for patients.

Out of work

I have learned that it is not what you have in life but who you have in your life. My life is richer for having a family to love, grand children to cherish, friends you can rely on and pampered pets.

 

Grecy Bell is a GP and Deputy Medical Director in Primary Care

 

In work

Team work, having a shared understanding of each other’s role and common goals

Out of work

Having time to enjoy shared memories with family and friends

 

 

Linda Williamson is a General Manager in Women Children & Sexual Health

Linda has a pictorial creation, representing her in work and out of work “what matters to me”

 

Then there’s me:

Alice Wilson, Deputy Nurse Director

In work

Being able to see the impact of my work on individuals and teams

Knowing that what I do makes a positive difference to the people we care for and their families

Being proud of my profession

Out of work

Spending time with my family and friends and living in a lovely place which feels a million miles away from the hustle and bustle of work. I’m part of a big family and a small community – ideal

Knowing (through whatever means necessary!) that someone will make sure I have nice shoes even when I am no longer able to walk in them!

Pictured: the view I see every day from the front of my house…it is amazing even at the close of the day – the bike is just there to fool you into thinking that’s the only mode of transport I use!

On 6^th June and every other day, take a minute to think about what matters to you and ask yourself if you know what matters to your colleagues and those people you care for and support; if not, why not ask them?

Alice Wilson is Deputy Nurse Director at NHS Dumfries and Galloway

What a waste! by Dot Kirkpatrick

It cannot have escaped your attention that the media has been writing about food waste. The Guardian recently reported the latest figures, showing that UK households are throwing away £13bn of food each year. This equates to 7.3m tones of household food waste. Of this, 4.4m tones were deemed to be avoidable. This set me thinking about my own food waste. I can honestly state that apart from the occasional out of date yogurts caused “buy” 2 packs for £3 scenario, I either cook and freeze or make the ingredients into soup! I am not precious about sell by dates unless associated with a dairy product, fish or chicken, apart from when I am having people for dinner! I can’t be poisoning the guests? A plaque in my kitchen states… “Many people have eaten here and lived!”

This brings me around to the purpose of this blog. Medicines waste. I feel a bit of a turncoat as I have given many a presentation clearly stating that you cannot compare the difference between Kellogg’s cornflakes and a supermarket cheaper own brand with branded drugs and their generic equivalent. However in this instance there is an analogy.

A report by the Department of Health estimates that unused medicines cost the NHS around £ 300 million every year, with an estimated £ 110 million worth of medicines returned to pharmacies, £90 million worth of unused prescriptions being stored in homes and £50 million worth of medicines disposed by Care Homes.

These figures don’t even take into account the cost to patient’s health and well being if medications are not being correctly taken. If medicines are left unused, this could lead to worsening symptoms and extra treatments that could have been avoided.

Due to the complexity of the causes of medicines wastage, a multifaceted and long-term approach across all healthcare sectors is required including partnership working with third sector organisations, public health, voluntary groups and local councils.  Coming to a surgery, pharmacy, library, council office near you soon, will be posters(designed and printed by our local council)  letting you know that each year in Dumfries & Galloway, we waste £3m worth of medicines of which over half is avoidable.  Look out also, for twitter feeds, Facebook postings and press releases. The posters and social media messages will attempt to engage with the public on how we can work together to reduce medicines waste. Simple tips such as “Only order what you need”; “Check before ordering”; “Don’t stockpile medicines” will feature in our waste campaign. With £3m required to be saved from our drugs budget this year, we cannot afford to ignore the unnecessary cost of waste.

Waste campaigns have been featuring on the Prescribing Support Team’s remit for many years. There was Derek the Digger whose sole purpose in life was to pick up medicines waste by the ton. Then there was our Big Red Bus Campaign. We had a range of items with catchy slogans e.g. erasers stating “Wipe out Medicines Waste”. Last but not least was our ferret, carrying a bag of drugs out of which coins were leaking and going down a drain This time our Waste Campaign will be ongoing. The posters will change, the messages will vary but our mission will stay the same. Medicines cost money and we do not have an endless supply of resources. We need to use our allocated funding for medications where it will benefit patients by improving health outcomes.

And back to the analogy. I must admit that my husband randomly buys jars of chutney despite having adequate supplies in the cupboard. There are far worse faults and I can live with that.  I however know what is in my fridge/cupboards/freezer and so I don’t stockpile resulting in wasting food supplies. I think what I need, I buy what is necessary and I don’t buy items that I don’t want. Simple no waste!

It is everyone’s responsibility to promote the messages around using medicines responsibly and I hope we can rely on your support by promoting our campaign.

Dot Kirkpatrick is a Prescribing Support Pharmacist at NHS Dumfries and Galloway

I walk and cycle to work because I’m lazy by Rhian Davies

It’s true, I’m lazy. If I didn’t travel on foot or by bike to work, the shops, the pub, I’d need to find the time, inclination and means to exercise. So I walk and cycle because it:

• Gets me there

Walking is the oldest form of transport. In fact we’ve evolved to do it – having been walking around for about 1.9million years. Cycling has been a means of getting from A to B for nearly 200 years.

• Gets me there quickly

No searching for car keys, waiting in traffic and finding parking spaces. A journey by bike in Dumfries takes about the same time as a journey by car. Walking or cycling on traffic free and quiet routes means I don’t get held up by queues and stay clear of road works.

• Saves time

No need to find time to get to the gym or go for a run as travel is my exercise. Most people say they would exercise more if they had the time. As I’m travelling anyway, that time is put to use as exercise time too.

• Is enjoyable

The main thing for me is the fresh air, being outside and enjoying the wildflowers and wildlife that I see and hear, especially at this time of year. Winter has an upside too – no need to get up early to see a beautiful sunrise and the moonrises can be pretty spectacular too. I’ve also seen shooting stars on my way home from work. And despite what it feels like, it doesn’t rain that much! In fact, there’s a 95% chance of NOT getting rained on, on your way to work.

• Is sociable

I often see people I know on the way and enjoy having a chat with them. Waving to the lollipop lady on the way to work or chatting with the nice man who walks his spaniel adds a little happiness to my day.

• Is safe

The most recent figures from the Department of Transport show the fatality rate for pedestrians and cyclists is the same, with one death per 29 million miles walked or cycled. Looking at how many people were killed or seriously injured, it works out at one person for every 1 million miles cycled and one person for every 2 million miles walked.

• Keeps me fit

The main difference compared to driving is that whenever you walk or cycle your health benefits, whereas remaining seated in a car does nothing to improve it. Typically I cycle to work, a 20 minute journey each way, which easily meets the guidelines for 150 minutes of moderate exercise a week.

• Benefits people and planet

You only have to look at the news and you’ll see an almost daily report on worsening air pollution and the effect this is having on people and the environment. Walking and cycling isn’t the only way to tackle this problem but it is a difference we can make every day to the people and place we live.

• Is easy to get parked

In my role as Active Travel Officer, I’m here to help anyone who is thinking of travelling by foot or by bike. I’m working with staff at DGRI, the new hospital, Crichton Hall and The Willows.

Over summer I’m running events including basic bike maintenance workshops, Essential Cycling Skills, information stalls on route finding and guidance on buying a tax free bike through Cyclescheme. Upcoming events are posted online and advertised in the core briefing and posters around DGRI, Crichton Hall and The Willows.

So if you’re feeling inspired come along to:

Bike Maintenance for beginners

Drop in session – not sure how to change an inner tube? Need to know how to check your bike is safe to ride? Find out how and have a go.
Monday 22 May and Friday 26 May: 12noon – 2pm and 4pm – 6pm

Venue: Garage 26, the hospital residences

Cyclescheme information stall

Come along to find information on applying for a tax free bike

Crichton Hall Canteen on Tuesday 23 May: 12 – 2pm

Essential Cycling Skills (Beginner)

Can’t remember the last time you’ve ridden, or feeling wobbly when you ride? This is the course for you. Please book here.
Part 1 Wednesday 24 May: 11.30am – 1pm, Part 2 Thursday 25 May: 11.30am – 1pm

Part 1 Monday 5 June: 5pm – 6:30 pm, Part 2 Tuesday 6 June: 5pm – 6:30pm

Meeting point: Garage 26, the hospital residences 

Essential Cycling Skills (Intermediate)

Are you happy cycling on quiet roads but not sure how to navigate roundabouts or junctions confidently? Then this is the course for you. Please book here.
Part 1 Wednesday 24 May: 5:30pm –7pm, Part 2 Thursday 25 May: 5:30pm –7pm

Part 1 Wednesday 7 June: 11am – 12:30pm, Part 2 Thursday 8 June: 11am – 12:30pm

Meeting point: Garage 26, the hospital residences 

Bike Security Marking

Thursday 1 June: 12 – 2pm and 4pm – 6pm

Meeting point: Garage 26, the hospital residences 

I also want to hear from you about what would help you get out and about on two feet or two wheels. Are there facilities or infrastructure improvements that would allow you to walk and cycle? Have you heard about electric bikes but never had a go on one? Just let me know!

Contact me on:

rhian.davies@sustrans.org.uk

Mob: 07788336211

Tel:  01387 246246 EXT: 36821

 

Rhian Davies is an Active Travel Officer for NHS D&G

Lochar North

Crichton Hall

Bankend Road

Dumfries

DG1 4TG

 

 

 

 

 

Outpatient Parenteral Antimicrobial Therapy (OPAT) – from Cellulitis to Meningioma by Audrey Morris and Shirley Buchan

OPAT as a service has been in use in many countries for the last 30 years. It is a method of delivering intra-venous antimicrobial therapy in an outpatient setting, as an alternative to remaining an inpatient.

The advantages of providing this service for the patient means that they have a reduced hospital stay and can return home and rehabilitate in their own environment. In certain cases the patient can continue to work whilst receiving IV antimicrobial therapy therefore causing them minimal disruption to their daily life. Psychologically the patient feels happier, eats better, sleeps better and is more likely to recover quicker in their own home.

In DGRI the service started in 2012 under the “What if?” project. Its main aim at this point was treatment of non-complicated cellulitis leading to the reduction of patient admissions for short term IV antimicrobials. In the intervening years we have developed to become more involved with complicated infections requiring longer lengths of treatment i.e. up to 12 weeks of IV antimicrobials, but the patient is otherwise fit enough return home.

 
From January 2016 to the end of March 2017 we have released 1419 beds, an average of 3.2 per day. We have treated patients with Cellulitis, Osteomyelitis, Infected Joint Replacements, ESBL, UTI’s, Pseudomonas, Osteoradionecrosis, Lyme disease, Endocarditis, Discitis, Peripheral Vascular Disease, Actinomycosis, SAB, Urosepsis, E-Coli ESBL and Meningioma.

 

Why do we need OPAT?

 
In December 2015 a 30 year old man, who we will call John, was referred to us. He is a high functioning gentleman with Spina bifida who regularly competes in Shot Putt events, all over the World. He had been admitted 6 weeks previously with an infection of his hip. He was clinically improving and ready for home. His family were also keen for his discharge. On discharge John was keen to return to weekly training but due the nature of his infection this had to be put on hold. He attended the clinic daily for 12 weeks either at Dumfries or nearer his home at Castle Douglas Community Hospital, even attending on Christmas day. John had a Hickman line in-site and he decided that in order to assist us he would dress according to which lumen we were using, red top red lumen white top white lumen. He made a good recovery and was discharged from us a year ago. John still phones us now and again and had informed us he is back to full fitness, competing again and even throwing further than before. His one regret he told us, was that due to illness he was not selected for last year’s Paralympics but he is working hard to go the next event in 2020.
So why do we need OPAT? To give people like John an effective patient-focused service as good as inpatient care in an out-patient environment. Our aim is to provide patient centred care nearer to home. In some cases we train the patient or their relative/carer to administer IV antimicrobials in their own home, leading to increased independence and putting the patient at the centre of their own care.

 
Main aims of OPAT.

 
Clinical
To provide a high quality efficient clinical service using robust pathways, guidelines and protocols.
Reduce inpatient time and therefore reduce the risk of hospital acquired infections.
Develop the service to meet the changing demands on an overstretched service. With the opening of the new hospital imminent and the call for care nearer to home OPAT can help reduce demands on beds.
Patient.
Improved quality of life for patients. They eat better, sleep better and generally feel better in the own home environment.
Increase patient involvement in delivery of care, continuity of care and communication.
Provide ongoing support at home and utilise a pathway for re-admission if required.
Organisational.
Reduce the length of inpatient stays therefore utilising acute beds more efficiently.
Structured pathway from referral to discharge.
Staff development.

Patient journey from Inpatient to OPAT patient.

 
We aim to make the transition from inpatient to OPAT patient as quick and painless as possible but have to follow guidelines. Once a patient has been identified by their Consultant as a potential OPAT patient the first step is to complete an SBAR referral form (In Beacon use ‘search for document’ option). On receipt of this we visit the patient to assess them and their needs for OPAT. There are certain criteria which must be met but these are listed on our SBAR referral form and should be considered prior to referral.
The patient is then seen by our Consultant and the OPAT nurse team. If they are suitable and want to become an OPAT patient then the discharge process can begin.
So in summary OPAT provides patient centred care led by a small dedicated team. It clearly reduces the length of inpatient stays, which can be from 2 days to 12 weeks. Patients are very much involved in the method of delivery of their care, they can opt to be trained to do it themselves at home or we try to deliver care as near to their home as possible. We work around their commitments e.g. an elderly patient who has carers in the morning can get a later appointment or in the case of the patient who continues to work we can see them early in the morning to allow then to get to work. Patients feel better at home, they sleep better, eat better and psychologically feel better. They are more in control of their treatment and have continuity of care.

In the words of one of our patients we “made a bad situation better”.

Audrey Morris & Shirley Buchan are Clinical Nurse Specialists in the OPAT team.

Be Prepared ….Have the Power by Graham Abrines

I think all of us would agree that making informed decisions for ourselves or others is one of the most responsible and indeed worthwhile things we do on a regular basis. It’s something we largely take for granted.

It’s only when matters begin to stray from the norm that we question our or others ability to make informed decisions. How many of us have parents, aunt’s uncle’s, partners even whose steady decline is becoming increasingly evident? Bring that same question into the professional arena; it will be more relevant for some than others, watching patients who you may have known for some time or perhaps only just met who are just struggling to make informed decisions.

Having conversations with people, whatever the context, about their wishes around how they want to be supported when they are not in a position to make informed decisions is important. It’s important for a whole raft of reason. The primary one for me; knowing how that person wants to be treated, cared for and supported  when they are unable to make informed decisions for themselves!

That’s why we all need to be better prepared

The message is quite simple if you have family members, patients or even yourself, who haven’t yet thought about how they would like to be supported if they lose the ability to make informed decisions for themselves then now is a good time to consider doing something about it.

Power of Attorney (POA) allows people, whilst they still have full decision making capacity, to state how they want to be treated and who and it can be more than one person, should be making decisions on their behalf when they are no longer able to do so. Quite simply it takes away many of the dilemmas that families and on occasion clinicians find themselves in when deciding what or what not to do in supporting the person.

There are some patients across our hospital settings, who with no POA  in place, require  an application by a family member or the local authority  for a Guardianship Order which is required to be heard in the Sheriff Court  to establish who should be making those informed decisions on their behalf. Take a moment; if that was you, or somebody you knew how does that make you feel? Particularly if you know there was an easier alternative where the person’s wishes were fully known?

POA is a legal process and the POA documents need to be very clear and detail the powers the adult proposes to grant to the prospective attorney/s.  As it’s a legal process involving a solicitor at an early point may be useful and most local solicitors should be able to assist in the drafting of a POA and can provide legal advice on this matter. A solicitor will charge a fee for this service.

Over the next number of weeks the Health & Social Care Partnership, via work within the Delayed Discharge Partnership, Local Authority Communications Unit & Local Authority legal services will be running a media campaign on local radio & TV supported via other methods, buses, bus shelters, flyers & local newspapers to encourage people to think about Power of Attorney.

Many of the local solicitors across our whole region, who are fully supportive of this approach will give a 10% discount to anyone wanting to progress with a POA until the end of June.

If you require further information, please contact Phyllis Wright, Regional  Statutory Mental Health Team Manager  on 03033333001 or Phyllis.wright@dumggal.gov.uk .  The Office of the Public Guardian in Scotland registers continuing and/or welfare powers of attorney under the terms of the Adults with Incapacity (Scotland) Act 2000, and their website offers full information on the POA process. www.publicguardian-scotland.gov.uk/power-of-attorney/power-of-attorney/the-power

So please, for everyone’s benefit   …. Be prepared and Have the Power of Attorney in place.

Graham Abrines is Interim General Manager Community Health and Social Care