4 million Opportunities by Gordon Loughran

Almost 4 million medicines are prescribed every year in Dumfries & Galloway’s GP practices. To save you doing the Maths around that, this is just short of 11,000 medicines prescribed every single day, making it the most common intervention taking place in the health and social care system. It is the most common intrusion that the people we come in to work each day to serve and care for, allow us to make into their lives. It represents 11,000 opportunities to make a difference to someone’s life. 11,000 chances to help them live happier, healthier and longer lives! This is a huge thing. 

Medicines improve the quality of life of the people living here in D&G. They give people more time to spend with their family and loved ones and doing the things that they enjoy, whether that be running, walking, swimming, cycling, shopping or engaging in their communities to help their neighbours and friends. This is amazing. Medicines have changed the way human beings live their lives. They have changed what is and isn’t possible for us over the last 100 years.

Having said all of that, medicines can also have a negative impact with side-effects and interactions needing to be managed. The hopes, fears and expectations of the people we are caring for also need to be managed. A busy health and social care system makes it challenging to keep on top of this and make sure that the people we care for are experiencing healthier, happier, longer lives without the down sides that the medicines they are taking can bring. The published evidence provides a range of estimates in terms of how many hospital admissions are the result of something going wrong with someone’s medicines and it is somewhere between 6% and 14%. Around half of these admissions are thought to be preventable. In Dumfries & Galloway that means there are anything up around 1,200 preventable admissions to our hospitals each year.

The people on the front line of managing all of this are our pharmacy professionals. We now have pharmacy teams in every GP practice in Dumfries & Galloway either physically working alongside the Practice staff or working with them remotely. Every day, our pharmacists, pharmacy technicians and pharmacy support workers are reviewing medication, supporting people following a hospital admission and providing advice on how to use medicines effectively to manage long term conditions. More and more of our pharmacists are now prescribing medication themselves and taking full ownership of managing aspects of care that previously would have sat with the person’s GP.

The impact that pharmacy teams have in practices and the leadership they provide within the health and social care system in terms of maximising those 4million opportunities that occur every year was recognised in 2018 when the Scottish Government committed to ensuring that every practice in the country would benefit from our skills, expertise and leadership. We were already having a positive impact on the lives of people that live in D&G but the investment that came with the Scottish Government commitment has allowed us to expand our reach. Our service remains in its infancy, which is so exciting because it means as we evolve and develop the service over the coming years we are going to have a bigger and bigger impact on the health and happiness of people living in D&G. As our team develops we will reach more and more people and use more and more of those 4million opportunities to positively impact on someone’s life and that of their family. We will reduce the risk of harm that needs to be acknowledged whenever something is prescribed and as a result, prevent some of those 1,200 hospital admissions. We are already doing this and have a team here in D&G that has won national awards and continues to be nominated for them (I see you Amy Robinson, Leanne Drummond and the rest of the Wigtownshire team…. I see you Emily Kennedy – good luck in the upcoming Chemist & Druggist Awards!). We have a team that is asked to speak at national conferences and to be part of national professional groups which isn’t always something that happens for people working in smaller Boards. This is recognition of what we are doing here in D&G. It’s recognition of our appetite for innovation and moving the profession forward and improving people’s lives.

Everyone in our team comes in to work each day to take advantage of some of the 11,000 opportunities to positively impact someone’s life through the medicines they take. It may be taken for granted and it may not always be noticed, but that is what our pharmacy team does. That is how I look at each day as a pharmacist…. there will be 11,000 chances to make a positive intervention in life of someone living here in D&G today by helping them use their medicines effectively…. if I can take just one of them and put a smile on their face, or on the face of someone they know, then that is a brilliant thing and that is job done. Little by little, the increasing influence of our pharmacy team in GP practices is helping to make Dumfries and Galloway that healthy and happy place for people to live that all of us are striving to make it.

Gordon Loughran is Lead Pharmacist for Community Health & Social Care at NHS Dumfries and Galloway

“Fancy meeting you here!” by Jacqueline Wilson

All of us, within the NHS, come to work each day and meet a large, diverse range of people. Which depending on our roles and place of work could be; Patients, their family members, other NHS employees, workmen (or should that be work people to be politically correct?) who are contracted in to do the jobs we don’t know a thing about! It could be new members of staff who arrive anxious, but keen to start their new role, but may be too nervous to ask the questions that we all take for granted now that we are no longer the newest member of our teams. It could just be the person’s voice you recognise from the IT Helpdesk that we feel we talk to more regularly than is normal.

But if we are honest, some people we meet at work are easier to be around than others……. There are no guarantees we will all get along, but we stay professional regardless – it wouldn’t do if we were all the same, life would be boring….

Then there are the people we meet within our working lives who come to mean so much more to us, they are no longer just a colleague. People we meet and just click with, the ones we love to spend time with, to laugh and make plans with, to dissect our weekends with. The ones that come in and share concerns and worries over the lunchtime chat, ones who know when we are not at our best and take time to show us they care, ones that become loved and cherished. The ones who leave a huge hole in our life when they are no longer with us.

One such colleague but more importantly friend was Anneka Johnstone (nee Maxwell) HCPC Registered Senior Dietitian. Wife; mother to her beautiful baby girl, friend, confidant, and all out kind, funny, bubbly, happy, lovely person.

For those that didn’t know Anneka, she was one of those people who was always in a good mood. Always smiling, with her beautiful long blonde hair; her crowning glory (as long as it wasn’t humid or she likened herself to Monica from Friends)

Which would normally be piled up on her head, just waiting for Christmas week so she could wrap a bit of tinsel in it, to go with her Christmas earrings ( Anneka prided herself that she always ensured she had a different pair for the 5 working days before Christmas).

She was the one who decided our department needed to have a weekly Monday “Bake Off” challenge, to help make Mondays more bearable (who says Dietitians don’t eat cake!) The one who would eat too much fresh pineapple at lunchtime and then complain her lips felt fuzzy!! The one who never left the office without checking that she didn’t have any remnants of her lunch in her teeth!

Anneka was the one who in her own time, wrote in the now published “Critical Care Handbook for Global Surgery” https://albacccd.files.wordpress.com/2015/05/digital-edition-cchfgs-final.pdf after Mr Dreyer asked for her support. It kept her up at night worrying, but she was always humble, always generous with her time and always keen to help others.

Anneka was the Critical Care Dietitian who made the transfer to the new DGRI without any fuss or confusion; she was instrumental in managing her precious patient transition to the new CCU. Patients were always at the forefront of her daily work plan, she would always go the extra mile to ensure that not only her patients, but also their concerned loved ones, were considered and involved.

Anneka also had a secondment within the Community Nutrition Support Team. Successfully rising to the challenges of what community working brings, and realising it was just as busy as the wards but a different kind of busy. Hearing of her exploits of trying to find patient houses in the middle of nowhere. In the rain, no toilets for miles and still determined to get to the next appointment on time (so many stories that made us laugh). However, she never failed to remain professional, compassionate and caring (even if she was rather stressed).

We could go on for so long, talking about who and what Anneka was, but that is not the main point of our blog. What we wanted was for everyone to have a small insight into who our beautiful friend and colleague was, and to share with you all how much we will always love and miss her❤️. We wanted to give you the time it takes to read our blog, to consider those around you in your work and home life, in the hope that you take time to tell them how you feel about them. Life is precious and short and we never really appreciate how cruel it can be until a loved one is taken too soon. At each birthday Anneka would tell us “every year is a blessing” – oh how true that is.

Anneka passed away peacefully on 18th November 2019, aged 33, in the care of the wonderful staff we have in our Palliative Care Unit – after a short but intense fight. She was surrounded by her husband Alan, family and close friends.

This blog had been postponed due to Lockdown in March, and was to co-inside with our Cake and Candy Sale in support of Alan’s charity walk for the Brain Tumour Charity https://www.justgiving.com/fundraising/southernuplandwayinmemoryofanneka (postponed until April 2021) but as the first anniversary of Anneka’s passing is upon us, and with everything else that is going on in the world, the dietetic team feel even more so, how important it is to tell those we love and appreciate, how much they mean to us. Especially at a time when we are unable to be close to each other.

Stay safe ❤️❤️❤️❤️❤️❤️

Jacqueline Wilson is a Dietetic Assistant Practitioner for the Community Nutrition Support Team at NHS D&G

It nice, to be nice… to ourselves! by Sarah Geidesz

Today is World Kindness Day and as a final year Occupational Therapy student on a placement with the Organisational Development and Learning (ODL) team I felt like it was the perfect time to reflect on how kindness can contribute to our own wellbeing. My role within ODL is to help facilitate the winter wellbeing campaign that aims to support health and social care staff wellbeing across Dumfries and Galloway. Being here has given me an opportunity to really think about ways to promote wellbeing but more notably consider how I manage my own wellbeing needs.

I am not sure about everyone else but personally, I feel like everything just now is in a constant state of flux. I feel like I am governed by new, changing, and unfamiliar rules that require me to constantly adjust to new ways of being and doing. These changes are not just in my personal world but my working world too.

As health and social care staff we are currently working within a rapidly changing work environment. These environments can often feel intense and overwhelming, only accentuated by ongoing periods of uncertainty. For me there is no doubt that when up against varying forms of challenge, like we are now we lose sight of ourselves and what keeps us well. But it also makes me wonder if we do not take the time to care for ourselves then how can we truly care for others?

Being kind to ourselves isn’t easy

For me, kindness is an innate attribute for most of us working across health and social care. It is the fuel that helps us care for vulnerable people, evidenced to have a significant impact on positive health related outcomes (Barsade and O’Neill, 2014). That is what we strive to achieve, we want people to feel as though they have been looked after, that we have made a positive difference. Kindness seeps through everything we do. We find it easy to care for and comfort those who rely on the services we work for, those who need help, those in distress. Yet, I feel what is not so easy is to show that same kindness to ourselves.

I will openly admit, I am not kind to myself. I put myself under immense amounts of pressure to please others at a consequence to my own wellbeing. I will let myself run on empty for far longer than I should and then wonder why I am in a bathroom stall weeping at a video of a piglet wearing a cowboy hat.

Yet, if I have learnt anything during this placement it is that I need to change this pattern of behaviour. I need to show myself kindness in the same way I would show kindness to those I serve through my role in health and social care.  I do not think it is an unfamiliar concept, particularly in our roles, to give to others both physically and emotionally but to neglect ourselves. But this cannot be maintained, we need to be kind to ourselves.

There are endless ways we can show ourselves kindness. It might be that we incorporate exercise into our day or read a book in a quiet spot or even set time aside to make our favourite meal. Yet, one way that stands out to me is proactively engaging in random acts of kindness.

What can we do

A random act of kindness is an action designed to offer kindness to another. Engaging in random acts of kindness it is not only beneficial to those who receive the act but also to us as the actor (Mental Health Foundation, 2019). Research suggests that being proactive in such acts can positively impact our happiness, improve our mood, and increase life-satisfaction (Curry, et al., 2018).

It is about being genuine in your actions, about seeing that someone is not quite themselves and offering them a listening ear. Hold that door open for a parent with a pushchair, drop your friend some shopping at their door, send a colleague a kind message or a thanks for their efforts. By doing this, by really paying attention to those around me, I feel as though I get the best of both worlds. I can be kind to others and in turn show myself some kindness.

As part of my work here at ODL over the coming months we will be highlighting resources and services that can support us in caring for our own wellbeing as well as sharing kindness among colleagues. This information will be distributed virtually on social media platforms and intranet systems across the Dumfries and Galloway Health and Social Care Partnership, so do keep an eye out!

Final thoughts…

I am learning that I need to use kindness to support my own wellbeing, to direct it internally, to weave it throughout my personal routines and make it a consistent part of my daily life.

By showing kindness to family members, friends, colleagues and even strangers this is one way I can start to make this happen. It is a small step in the right direction. Still, it is not the only step I need to take.  

So, lets starts a conversation… what do you do to be kind to yourself and others?  

Sarah Geidesz is a Student Occupational Therapist at Napier University Edinburgh 

References

Barsade, S. G., & O’Neill, O. A. (2014). What’s Love Got to Do With It? A Longitudinal Study of the Culture of Companionate Love and Employee and Client Outcomes in a Long-Term Care Setting. Administrative Science Quarterly. 1-48. http://dx.doi.org/10.1177/0001839214538636

Curry, O., S. Rowland, L., A., Van Lissa, C., J., Zlotowitz, S., McAlaney, J., and Whitehouse, H. (2018). Happy to help? A Systematic review and meta-analysis of the effects of performing acts of kindness on the wellbeing of the actor. Journal of Experimental Social Psychology. 76. 320 – 329

Mental Health Foundation. (2019). Random acts of kindness. Retrieved from: https://www.mentalhealth.org.uk/blog/random-acts-kindness

Random Acts of Kindness Foundation. (2020). World Kindness Day Image. Retrieved from: https://www.randomactsofkindness.org/world-kindness-day

Random Acts of Kindness Foundation. (2020). 7 ways to start making kindness the norm in your daily life image. Retrieved from: https://www.randomactsofkindness.org/world-kindness-day

Getting the Balance Right- The Impact of Social Isolation by Jennifer Hutcheson

Mr Dee is 84 years old. He lives alone and up until now he has functioned very independently with no physical health concerns and remains independently mobile with no aids.

Mr Dee’s daily routine normally consists of him getting up, washed and dressed. He walks to Tesco with his rucksack and picks up food for his breakfast. He comes home, prepares and eats it, then repeats his journey to and from Tesco twice more during the day for his lunch and his tea. He also regularly visits his local pub to socialise. Mr Dee’s daughter confirmed that he likes to take the bus to other towns nearby for the day, and there has never been any issue with him being unsafe or getting lost.

However, his family have noticed recently that his memory has declined and he received a diagnosis of Alzheimers’ dementia. His family, along with the community mental health team have helped to organise his home with the addition of ‘dementia friendly’ items but he still struggles to use the phone, despite trying the adapted type. For this reason his daughter now visits on a Wednesday afternoon consistently.

What happened to him?

Due to restrictions that were brought into place for COVID-19, Mr Dee was no longer able to go to the shops three times a day. In line with the rules, he should only go to the supermarket once a week. On the visits he did make to the shop, he struggled with the long queues at the doors and was unable to make sense of the one-way systems or the social distancing advice. This lead to confrontation from staff and members of the public making him very stressed and frustrated. Mr Dee tried to overcome this by buying more food, however he was unable to unpack this correctly at home. He was also not accustomed to managing his food or monitoring ‘use by’ dates, as he usually shopped for only his immediate needs, with a little and (very) often approach.

When Mr Dee recovered from his stressful shopping trip, he was unable to understand why his daughter hadn’t visited as she usually does. He attempted to phone her but found this very frustrating. He would walk to her house and knock on the door but she was unable to let him in due to her own health concerns and risk of COVID-19. She tried her best to explain the reasons but he became quite upset and confused when walking home.

This situation for Mr Dee continued for the first three weeks of lockdown. His daughter realised that his visits to her window were becoming more frequent and Mr Dee more distressed. She decided to ‘break the rules’ and take him home, where she found the house unkempt, out of date food in the kitchen and burned pans on the cooker.

He was admitted to hospital due to ‘acute confusion’ one month into COVID-19 lockdown and moved to the care of the elderly ward. Many tests later, including a negative COVID-19 swab, it was decided that there was no medical reason for an acute deterioration in his cognition.

Doctors deemed him medically fit for discharge and physiotherapy discharged him as independently mobile. He was then referred to Occupational Therapy.

Occupational Therapy Perspective

Occupational therapists (OTs) work in a wide and diverse range of areas across health and social care. It was in the care of the elderly ward in Dumfries and Galloway Royal Infirmary where Mr Dee met the OT.

OT focuses treatment on a patient’s remaining abilities, and how to capitalise on those to make the individual as independent as possible. Common goals include restoration, maintenance of abilities/routines, and adaptation and grading of activities (RehabVisions, 2015). OTs offer a unique perspective in the multi-disciplinary team by considering a person’s health holistically, focussing on physical health, alongside mental, social, cognitive and environmental factors.

When assessing Mr Dee it became apparent to the OT that his ‘acute confusion’ had not been caused by a physical health concern, but a social and environmental change. Mr Dee’s routine had been completely altered beyond recognition, leaving him feeling lost, frustrated and confused. For someone like Mr Dee, with a diagnosis of dementia, routine is of particular importance as routine is known to maintain functional abilities, independence, and to reduce anxiety (NICE, 2015).

OTs often refer to the concept of occupational balance. This concept arises through acknowledging that a person’s occupations can be split into three main categories; self care, productivity and leisure. For people to maintain their mental health they need to complete a balance of all these tasks daily. Prior to COVID-19 lockdown, Mr Dee’s daily tasks could be split fairly evenly into;

Self Care – getting washed and dressed, and receiving regular visits from his daughter

Productivity – need to walk to shops and prepare meals

Leisure – getting the bus to nearby towns and visiting the pub

With the commencement of the lockdown and the drastic change in Mr Dee’s daily routine, his daily activities could no longer be evenly distributed between the three areas of occupational balance. The underlined occupations above were no longer available to Mr Dee, leaving him in a state of occupational deprivation. In 2019, Abson described occupational deprivation as;

“prolonged restriction from participation in necessary or meaningful activities due to circumstances outside the individual’s control.”

The OT was able to advocate for Mr Dee, supporting discharge home while he still appeared to be confused. This risk was clinically reasoned, and taken considering the social and environmental reasons for his hospital admission. The OT was able to organise for a reablement service to visit daily to provide Mr Dee with support to identify, construct, rehearse and carry out new daily routines, with the aim to reinstate occupational balance and promote his return to independence within his home environment (NICE, 2020). For Mr Dee, the involvement of OT in his treatment planning was crucial in his safe and timely discharge home. The OT was able to approach his treatment holistically, with his feelings and abilities central to treatment planning, but also considering their impact on his function, while he is in his surrounding environment. This OT model of practice is depicted below by the Canadian Model of Occupational Performance and Engagement (CMOP-E).

So to conclude…

Mr Dee exemplifies the impact the COVID-19 lockdown has had. His situation demonstrates the importance of daily engagement in meaningful occupations and routine. His circumstances were exaggerated due to circumstances that are specific to him, however the impacts of occupational deprivation have been (and will continue to be) experienced by many people. Trying to maintain occupational balance when schools have been closed, outdoor activities are limited, socialising with friends and family is not permitted and shopping experiences can be terribly stressful, has been incredibly difficult for us all.

As health and social care professionals we have a responsibility to provide care to many people every day.  We need to ensure that we are also providing the same level of care to ourselves. Remembering that we all require to live life with occupational balance, allowing ourselves time to not only focus on productivity and work during this difficult time, but allow time for ourselves, our families and the things that make us happy.

COVID-19 has had an impact on all of our lives in many ways, and it’s important to acknowledge that despite a negative swab result, Mr Dee was also a victim of COVID-19.

Jennifer Hutcheson is an Occupational Therapist for NHS Dumfries and Galloway

References:

Deborah Abson (2019) Occupational Deprivation. Available at:  https://www.theothub.com/post/occupational-deprivation (Accessed 27/10/20)

NICE (2015)  Older people: independence and mental wellbeing. Available at: https://www.nice.org.uk/guidance/ng32/resources/older-people-independence-and-mental-wellbeing-pdf-1837389003973 (Accessed 27/10/20)

NICE (2020) Occupational therapy and the promotion of mental wellbeing.. Available at: https://www.nice.org.uk/sharedlearning/occupational-therapy-and-the-promotion-of-mental-wellbeing (Accesssed 27/10/20)

RehabVisions (2015) Dementia & Occupational Therapy . Available at: https://rehabvisions.com/dementia-occupational-therapy/ (Accessed 27/10/20)

RCOT (2020) Staying well when social distancing. Available https://www.rcot.co.uk/staying-well-when-social-distancing (Accessed 27/10/20)