In 2021 there were 1,330 drug deaths in Scotland, this was a decrease of 1% (9 deaths) compared with 2020. It is the second highest drug deaths figure on record. Deaths have increased substantially over the past few decades – there were more than five times as many deaths in 2021 compared with 1996. (National Records of Scotland)
Recent figures show that sadly 35 people in Dumfries and Galloway died from a drug death in 2021. Each death impacts on families, friends and communities across the region. And even when we hear the statistics, we don’t want to think about the fact that there are real people behind those numbers – real lives lost and real people grieving.
Throughout this month I have had interesting conversations with members of the public regarding addiction and drug related deaths. One person told me “we don’t have drug deaths around here”, she proceeded to be surprised when informed that there had been drug deaths in that area, and replied with “but no one talks about it”. Another person told me “see those lot outside the chemist, on who knows what. I’d give them nothing”.
As more and more people are touched by addiction, more and more families and communities are left with the grief of a drug related death. Yet the unique experience of addiction and grieving a drug related death is still pushed under the rug. It hides out in the shadows. It is veiled in guilt and shame and stigma and discomfort. Though we know addiction touches hundreds of thousands of families each year, the individuals, family and friends experiencing addiction often suffer in silence. When someone dies from overdose this isolation often continues.
That is why, together, we need to do something about it.
People mistakenly believe that drug related deaths ‘only happen to other people’ (or to ‘other families’) — until it suddenly happens at home. Or suddenly happens to a neighbour, parent, grandparent, or workplace colleague. A drug related death could happen to almost anyone. Drug related deaths are preventable deaths, and it is important that we work together and openly talk about drug use to help reduce stigma. Stop alienating our communities. Stop discouraging people to seek help.
On the 31st of August it is International Overdose Awareness Day (IOAD). For those who are not familiar with this day, the campaign raises awareness of overdose, which is one of the world’s worst public health crises, and stimulates action and discussion about evidence-based overdose prevention and drug policy. The campaign acknowledges the profound grief felt by families and friends whose loved ones have died or suffered permanent injury from a drug overdose. IOAD spreads the message about the tragedy of drug related death and that it is preventable.
This year for throughout August the Alcohol and Drug Partnership and We Are With You had arranged local pop up awareness stalls around Dumfries and Galloway, along with other key partners such as Dumfries and Galloway Recovery Together and Alcohol and Drug South West Scotland’s Being There team. These pop ups have taken place in Stranraer, Newton Stewart, Castle Douglas, Dalbeattie, Sanquhar, Thornhill, Langholm and Annan. These pop ups have been used to spread awareness for the upcoming IOAD, spread harm reduction advice, be on hand to train those how to use naloxone and to signpost people to services in Dumfries and Galloway.
On the 31st of August there will be three remembrance events at We Are With You in Stranraer, We Are With You in Dumfries and the Specialist Drug and Alcohol Service Lochside Clinic in Dumfries. Information packs on overdose awareness, harm reduction and contact details for local support services will be available at these locations. Friends, families and members of the community are being invited to tie a purple ribbon at these locations to remember those who have lost their lives to drug related death. Ribbons will be available at each location.
As Dumfries and Galloway is a large rural area, we recognise that many people may not be able to attend these events in Dumfries or Stranraer. Therefore we have created an online tribute wall to allow those who have lost a loved one, whether they are a friend, family member or professional who worked with them, to write their memory or tribute online. The link to this tribute wall is: www.memorialboard.wixsite.com/overdoseawareness
On the night of the 31st of August, the council offices on English Street in Dumfries, the Crichton Church in Dumfries and the Castle of St John’s in Stranraer will be lit up purple (the colour of IOAD); in remembrance of those we have lost to a drug related death. Literally shining a light on those who have died and acknowledge the grief of the families and friends left behind.
IOAD is an essential and impactful day, and it is extremely important that we use it to remember those we have lost, openly talk about addiction and try to reduce the stigma attached to addiction and drug related death. However, this is something we should be doing all year round.
We have lost too many people to a drug related death, and too many families are suffering in silence.
Coming out of the back of Covid -19 resourcing continues to be a challenge; however alongside our business as usual, we will show that our staff have a healthy appetite to deliver improvements to our services.
We (the Patient Safety and Improvement team) want to share with you some recent improvement initiatives – specifically those brought to the fore via a recent poster competition. We will also use this opportunity to talk about other improvement work specifically relating to falls prevention which is one of our recurring challenges.
The Poster competition Monday 20th June, 2022
Each year the Medical Education Team help spread learning by running a poster competition to bring together some of this great work. In recent years they have teamed up with the Patient Safety and Improvement team to include work done using Quality Improvement approaches.
A total of 36 posters were submitted into this year’s competition. The design style was for virtual viewing so every poster should be readable on screen. No posters were printed. This is in itself an improvement, because it means that all posters can be viewed online using this link. Posters will remain accessible in this way and we would encourage you to spend some time and take a good look at the great work that our people are doing.
A panel of judges chose the lucky winners, and the top 6 were asked to present on the day. Judgment is never easy as every single poster was of a really good standard. In addition, an electronic survey was used to give people the opportunity to vote for their favourite poster – this attracted 194 voters.
There were 16 people on the virtual call, joining the people present in the DGRI (Dumfries and Galloway Royal Infirmary) lecture theatre.
Let’s take a walk through those winning posters, and conclude with an inspirational story about falls prevention…
Medication
The ScotGEM students played their part in providing us with some improvement examples. They have as part of their studies, the time and capacity to undertake a Quality Improvement project- so it is no surprise that we receive high quality entries from them.
Kieran Hoban, a third-year ScotGEM student presented a project centred on ensuring monitoring for Edoxaban in general practice was in place to improve patient safety. Warfarin is a well-known, safe and effective anticoagulant; however, it has a narrow therapeutic range, and thus requires frequent monitoring. To improve safety and alleviate pressure on the NHS many patients were switched from Warfarin to Edoxaban. This medication requires significant less monitoring and is as effective as Warfarin. Kieran’s presentation style was exceptional, and he won the ‘best presentation’ prize.
The chart shows the progress of the project over time, and as the green line is going upwards, this shows improvement.
Kieran suggests that staff of any role or seniority can be involved in improvement projects, which have a positive impact on both the organisation and the patients we care for.
Waste management – recycling
Another winning example of the ScotGEM work was present by Shona Gallagher, Andrew Blain and Millie O’Gorman, illustrating that not all improvement work has a clinical focus. The work relates to improving waste management in one of our GP practices. The poster can be seen here.
Waiting times
We are all aware of pressures around waiting times for a wide range of services. Sometimes this can be due to needing to access a specific clinical specialist, some of whom are in short supply. There is much work effort going into redesigning flows to minimise such bottlenecks, and to reduce waits.
Anne Wilkinson, an Advanced Nurse Practitioner in Orthopaedics has been working on this in her area. Patients in the orthopaedic outpatient unit were at times experiencing long waits to be seen by the registrar who was often tied up in theatre. Anne tested the idea of seeing the patient herself, undertaking tasks including examinations, taking bloods and x-rays for diagnosis and treatment. This test of change resulted in reduced waits, faster turnaround and faster discharge from the department, and improved patient experience, borne out by positive feedback.
Patients attending and waiting times recorded are displayed in the chart. It shows that this test of change proved successful and has now been imbedded in practice.
The idea has been spread to include taking referrals and inquiries from areas including General Practice, Emergency Department, Physiotherapy and Podiatry. Anne has given us another winning poster. Full details can be seen here.
Young people’s Participation in Mental Health services
Participation is “working together to improve the experiences and outcomes of our services.” Participation involves bringing together young people, carers, families, staff and our wider communities as equal partners working to shape and deliver mental health services for the benefit of everyone. We know that when care and services are designed and delivered in collaboration with people who use them, there will be better outcomes for all.
Involving young people and families brings new energy and ideas to projects and services. Arnstein’s Participation Ladder 1969, whereby power moves hands from professionals to people. At the top of this ladder is; shared decision making and co-production. This level enables both sides to equally influence outcomes with their expertise, decisions are safe, person centred, ‘Doing With’ rather than ‘Doing to’. This is the direction CAMHS is moving in. Alison Telfer, a CAMHS Participation Lead has produced a fantastic poster to show off this piece of work. Alison’s poster was awarded joint 1st place for the best QI Poster category.
The CAMHS Youth Forum is a small group of young people who are currently accessing services or have in the past. After gaining external funding from the See Me Anti-Stigma Art Fund they worked with a local artist Hope London and CAMHS Participation Lead to produce their own ‘Be Kind’, mental health animation and educational booklet. Full details can be read within the poster.
Alison has shared with us an impact statement that she received from a parent;
“We will be forever grateful that our daughter had this opportunity. During lockdown she suffered badly with anxiety and had started self harming again. The CAMHS ‘Be Kind’ project gave her focus and allowed her to put her experiences forward to help others.…The CAMHS Youth Forum has given her the confidence, the experience, various techniques and the feeling that she can make a difference in everyday life. This has ultimately made her life one of purpose at a time when she had given up hope, and it has allowed our family to move forward happily.
Self management for COPD
Ailsa Peel is one of the Specialist Physiotherapists who recently had the opportunity to do a secondment post for 9 months working with the respiratory team in DGRI. This post was as a project practitioner working directly with the Scottish Government to pilot an online self-management tool for COPD (Chronic Obstructive Pulmonary Disease) in Dumfries &Galloway.
This project focuses on one of the key actions identified in the recent Respiratory Care Action Plan and has the potential to change how patients manage their long-term condition, improving their health literacy and ability to cope with the day-to-day challenges. This self-management programme has been designed by healthcare professionals and gives patients relevant advice on how to deal with exacerbations. As a rural region time spent travelling to routine appointments can be significant therefore an online tool such as this one gives patients the confidence that they can manage. Following on from the production from the poster the project will continue.
Ailsa Peel was another winner in the QI poster competition, be sure to visit the poster here and read all about the good work.
Excellent learning for our Allied Health Professionals
It can be challenging at times to ensure students receive the best on-job experience. Fast pace working, high pressure and demanding work flows can challenge the quality of learning. There is coverage in the media on the shortage of placements for Allied Health Professionals (AHP’s) in Scotland. We challenge the traditional 1:1 placement model, and are working to prevent problems including recruitment and retention that may arise.
We are fortunate in Dumfries and Galloway that our AHP student coordinators do consider diverse placement models as part of growing capacity for student practice based learning (PrBL).
This ensures their students receive the highest quality learning opportunities, across the widest spectrum of working scenarios.
Laura Lennox, AHP Practice Education Lead has presented her poster here which was awarded joint 1st place as the best QI poster. It describes the improvement journey, illustrating how the learning is embedded into new ways of delivering student PrBL.
If you would like to find out more about how to become a Practice Educator and/or different models and modes of hosting Student PrBL for AHP students, then please click the link below: https://sway.office.com/X8zC6MC7Fyfct8vZ?ref=Link
From the poster, the picture shows a great example of a Quality Improvement tool that the AHP’s use for effective meetings. It illustrates how feedback is used to continually improve. The approach enables people to say what went well (WWW) and how it might be even better if (EBI):
Aside from the poster competition there is improvement work taking place across a range of services. Let’s look at a very interesting initiative, relating to managing the ever-present falls risk…
Falls prevention – an appetite for risk?
Amy Conley Consultant Physician tells us that falls are a common cause of harm for hospital inpatients. Lots of factors contribute to falls, particularly for frail older patients –for example, acute illness, mobility problems, cognitive problems, sensory impairments, medication effects and incontinence.
Within DGRI, all patients are in single rooms. This means that patients are less visible to staff, and patients and visitors and can find it more difficult to obtain assistance.
We often talk about minimising the “risk” of falls for our patients. We assess risk, and may provide things to reduce risk such as mobility aids, bed rails and falls monitors. Sometimes we supervise patients very closely, even using a 1:1 basis (impractical and resource-heavy) for those deemed at “risk”.
Hold on a minute – we also recognise that harm may be caused by reduced mobility in hospital. We have just told you that we find ourselves preventing patients from getting up and mobilising and leaving their rooms to walk on the ward. Perhaps different approaches are required according to the patients situation we call this person centred care.
“End PJ Paralysis” is a well-known campaign both here and across the UK.
Clearly, there is a fine balance between keeping patients from falling, and keeping patients active. Amy asks how much of our decision making in trying to prevent falls is based on what is best for each individual patient, and how much is based on our unwillingness to accept “risk”, and our anxiety and fear of being blamed when a patient in our care suffers a fall.
Think about “risk enablement”. How do we best benefit the psychological and physical well-being of our patients? Might we involve patients and relatives in deciding what is safe, how to mitigate “risk”, and how much “risk” is reasonable for each person.
Would patients and relatives prefer reduced risk of a fall, perhaps by restricting the patient to a bed or chair in their room, with intrusive alarms and constant supervision and the resulting frustration and agitation? Or should we in our conversations with patients and relatives encourage people to accept some risk, and encourage freedom of movement and the associated benefits of maintaining their activity levels? Let’s look at a patient story…
Embracing the risk for the benefit of patients – a patients story
In DGRI ward C4 we are working to understand and accept the risk of falls, and to make patients and their relative’s central to decision-making. We recently discharged a patient whose story reflects a success in this approach and a positive outcome to accepting risk…
Mary, aged 87, is a patient with vascular dementia. After a fall at home in February she was admitted to hospital. Fortunately she sustained no significant injury, but required an admission for rehabilitation – admission was to a very busy acute ward. Mary regained her ability to move around (mobilise) on her own. However, given her frailty and cognitive problems, it was decided that she should move to residential care rather than return home.
Due to her impaired cognition, frailty and poor mobility Mary was considered to be at high risk of falls while in hospital. So for many weeks, Mary had constant 1:1 supervision from nursing staff – she could not mobilise freely on the ward and was often prevented from mobilising outwith her room due falls risk.
Mary was assessed by several care homes, but none could offer her a home due to the perceived level of supervision and intervention that she required. It was difficult to see how we could find Mary a suitable place to live.
So we moved Mary to ward C4 (where Amy has much influence) where we have a cohort of patients who are “medically fit for discharge”. Mary told us that she wanted to walk about and to go home. We spoke to Mary’s daughter, explaining that it would be impossible to eliminate the risk of Mary falling, but we could assess and reduce the risk as far as possible. We discussed the benefits to allowing Mary to mobilise independently on the ward – improving muscle strength and exercise tolerance, and improving Mary’s mental health.
So, with a little bit of trepidation, we removed the 1:1 supervision and the falls monitor and let Mary walk…
Mary had no falls on ward C4. She was mainly very calm, interactive with life on the ward and episodes of frustration or agitation were minimised. She was often found sitting on a chair halfway down the ward chatting to passers-by, or simply taking a walk down the corridor…
And four weeks after moving to ward C4, despite the initial concern that it was challenging to discharge Mary from hospital due to her falls risk – Mary was successfully discharged to a local care home chosen by Mary and her daughter…
So perhaps some appetite for risk is not such a bad thing after all.
Compiled by Anita Hall, Project Officer, with support from Paul Sammons, Improvement Advisor.
As today is the funeral of Ian Hancock we have decided to replace the original blog with some pictures and ask everyone to remember him in their own way.
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