Take Two Bottles Into The Shower? Not me, I’m a Clinical Health Psychologist by Ross Warwick

image1Because you’re worth it

Bang! And the dirt is gone!

Eat fresh

I’ve been thinking a lot about advertising these past few weeks as September is a significant time for my team in Clinical Health Psychology. This month we will be making a concerted effort to promote our service, raise our profile and increase our contact with the people we aim to help.

As part of this, Ken has kindly allowed us to take over the blog for a few weeks. I’m kicking things off with an account of what the service does and I thought I would take inspiration from psychological tricks used in the world of advertising to help draw you in and get the message out there.

image2I’ll start, then, with a summary of the service that follows the advice of a Professor of Experimental Consumer Psychology at the University of Wales, Jane Raymond. Prof Raymond advises that rather than bombard the audience with information I should break it into chunks to allow the brain time to process each component:

  • Chunk 1: The Clinical Health Psychology service helps people who have a psychological problem that is caused and maintained by a physical illness.
  • Chunk 2: These problems usually involve unpleasant feelings and unhelpful thoughts about the illness that keep someone from doing things that matter to them.
  • Chunk 3: This can cause distress, affecting overall well-being, medical treatment, self-management and health outcomes

An article in a social psychology journal showed that a wide range of people respond well and are persuaded by stories (Thompson and Haddock, 2012). So to illustrate chunks 1-3 here’s a fictionalised case based on real events:

Jane is a young teacher who has type 1 diabetes. Her condition and the things she must do to keep on top of it are often accompanied by feelings of shame, anger and loneliness. She has frequent thoughts that her condition means she is abnormal and that it must be hidden from others. Because of these unhelpful thoughts and feelings she avoids testing her blood, guesses her insulin levels, is inconsistent with her diet and keeps problems to herself.

She has been absent from work and in and out of the DGRI several times within the past twelve months. Because of this she believes friends, family and colleagues are annoyed with her for not taking proper care of herself and landing them with more responsibility. As a result, she avoids seeing people and has become more and more isolated.”

The next steps for Jane are chunked below:

  • Chunk 4: In therapy we would work with Jane to live well with her condition by addressing her unhelpful thoughts, feelings and avoidant behaviour
  • Chunk 5: As therapy is all about collaboration, Jane’s most likely to have a good outcome if she’s motivated to participate and make changes to her life
  • Chunk 6: Jane can be referred to Clinical Health Psychology by anyone who is involved in her care, be it her GP, Practice Nurse, Dietician, Diabetes Specialist Nurse or Consultant.

In Jane’s story, she’s in and out of DGRI because thoughts and feelings stop her from acting in a way that would help keep her well. So psychological therapy would add value by reducing her distress and unplanned contact with services (and by highlighting that sentence your attention has been focused on a key message about how psychology makes a difference to both the person and the hospital; Pieters and Wedel, 2004).

But would you believe that individual therapy expertly delivered by members of our experienced, compassionate, and, yes, attractive, team is but one feature of our service? In Clinical Health Psychology we also provide training, teaching, supervision and consultation because you don’t need to be a psychologist to provide psychological care (worth mentioning because (a) it’s completely true and (b) according to Goodman and Irmak, 2013, audiences are likely to prefer multi-featured products).

Already the Diabetes and Cardiac Teams are benefitting from increasing their psychological knowledge and skill through participating in Emotion Matters training, and a group of local GPs have recently completed training to introduce CBT techniques into their routine consultations. Recruitment of a second cohort will be underway soon.

Time for pictures of the product:

headshotsBy now thanks to my evidence-based and scientifically informed techniques of persuasion, you will no doubt want to know how you can benefit from working with our wonderful service.

You can contact us by email or by calling us at the psychology department to talk about matters psychological, be it complex cases, potential referrals, or training your department. Find out more about making referrals by consulting our service leaflets which are available absolutely FREE through Beacon by searching for ‘Clinical Psychology’ or looking under ‘Documents’ after following the link below. And as the Patient Information Leaflet can also be found there, you enjoy a 2 for 1 bonus!

http://hippo.citrix.dghealth.scot.nhs.uk/sorce/beacon/?pageid=Sitesearch&searchCriteria=clinical%20health%20psychology

Keep your eyes open for opportunities to attend training events we’re delivering this month and enjoy the blog posts written by the Clinical Health Psychology team over the next few weeks. Finally, to eke this advertising ruse out just a little further, comment below to be part of a Clinical Health Psychology virtual focus group.

Just do it.

Ross Warwick is a Consultant Clinical Health Psychologist and Lead for Clinical Health Psychology at NHS Dumfries and Galloway

Endings…………and new beginnings by Ken Donaldson & Julie White

By Ken Donaldson

For anyone working for NHS D&G it is unlikely that you have failed to recognise that at the end of the year some of us will be moving in to a new hospital. I am aware this will not directly effect those of you who work in the community or services that are not moving across to the new site but it is likely to have some impact. This is an exciting time; the building itself will be quite spectacular and it offers lots of opportunities for change.

3367921_a75008e7That change is coming is apparent. In December we will move to the new site and whilst I am quietly terrified at the prospect of this move it is not what this blog is about. Nor do I want to talk about change but its accompanying partner, transition. So what is the difference? Well change is situational, the physical move, how we will get all the equipment, beds and kit across to the shiny new building. Its how we move the patients and ourselves and, then, start to work in the new environment. This may sound like a transition but its not the same thing. Transition is psychological, how we actually deal with this momentous move.

Transition

unknownWe have all been through transition before; starting a new job, moving house, taking a newborn baby home for the first time. And although you may not realise it you have gone through a process during that transition. There are three broad stages to transition. First we ‘let go’ of the old ways then we enter a ‘neutral zone’, where we are neither doing the old or the new, and finally we have a ‘new beginning’. If we take the newborn baby example then we can see that whilst there are so many wonderful aspects of bringing your first baby home there are also many things that we have to let go; a good nights sleep, a significant amount of money and the freedom to just go away for the weekend to name a few. Most people just get on with it and accept the losses but others can struggle. The neutral zone may be brief but still exists, often at 2am! As the dust settles and visitors stop coming so often and reality sinks in. This is it now, no going back. After that the new beginning as we settle in and accept the new way of life. The transition process is different for all of us and for some may happen very quickly, over days. However for others it may take a lot longer. Sometimes just knowing that this is a process can help.

Letting go

This stage can feel akin to bereavement. The emotions we go through are similar and the ‘Transition curve’ is to all intents and purposes identical to the ‘Grieving curve’ or stages of bereavement. When we know change is coming (as we do right now) then we can enter a state of denial which is entirely normal and hopefully doesn’t last too long. This is followed by anger, bargaining, anxiety, depression before being followed by understanding, acceptance and moving on. Not everyone experiences these emotions and some are fleeting but the reality is that they will all be manifest in our teams to varying degrees as the move to the new hospital approaches and ultimately happens. There is not a vast amount that can be done to deal with this process other than recognise it and support each other through it but small gestures can help; we want to remember the ‘old’ hospital so what can we take other than memories? Perhaps you can make up a photograph album for your area or ensure that some memorable artefacts (posters, pictures, the Ward Gonk) are not forgotten and adorn the new environment.

The neutral zone

bridges-3-phases-of-transitionSo this unusually named area, like something out of Superman (okay, that was the Phantom Zone and was in Supergirl; the neutral zone was, apparently, in Star Trek, but I’m no Trekkie) is a bit of a psychological no-mans land. It is the time when the old way has gone but the new way does not feel comfortable yet. It is important to recognise this zone and not try to rush through it prematurely. Its also important not to be frightened of it and try to escape i.e. get a new job. People do this frequently and it is rarely the right thing for them or the organisation. Finally, recognising this area and staying with it is important because it is often the time of real innovation and a chance to revitalise our services. The neutral zone is an area of opportunity, a chance to replace old habits with new ones more suited to the new environment.

A new beginning

July Photo SiteNew beginnings are much more than starts. We will ‘start’ in the new hospital the Monday after the migration when the majority of staff and all patients have moved. And we will get on with it, of that I have no doubt. It is going to be a real challenge coping with the move then a few weeks later the Christmas/New Year double whammy and THEN January! But I suspect the majority of us will still be in a neutral zone just coming to terms with the new environment and will not yet have made the new beginning. Starts involve new situations, beginnings involve new understandings, new values, new attitudes and new identities. This can take time and may take longer as we will be extremely busy just keeping the new hospital functioning but, again, its important we recognise that it has to happen. If we don’t move to the new beginning then we can hold our team back, sound like a stuck record “It wouldn’t have happened like this in the old hospital” etc.

ginThere is no doubt the next 6 months will be hard. There will be increasing visits to the new DGRI and next month the structure will be complete and we will have ‘the keys’. I suspect December will loom ever larger on the horizon as the migration and all that entails becomes a reality. As I said above I am positive that we will just get on with it and things will work out fine, albeit there are bound to be some bumps along the way. But I think it is important that we recognise the psychological impact on all of us involved in the move. It will have a massive impact on our lives and if we understand just a little of why we are feeling the way we most certainly will feel then that may help us all get through it. That and looking out for each other, remembering to be kind and a smidgen of gin.

 

By Julie White

We are now only weeks away from our staff and patients being able to experience the benefits of a modern, state of the art hospital which will enable us to continue to provide the highest possible standards of care to our patients in the 21st Century. However this change means a significant transition for many of us. Transition has been defined as any event, or non-event, that results in changed relationships, routines or roles. (Schlossberg, N 1995) The move to the new hospital will mean changes to routines, working relationships and roles for a large group of our staff. However, we all go through transitions, big and small, as part of our everyday lives. How we deal with these transitions is important……
Right now, for me and my family, we are going through a transition which will be familiar to many. My 11 year old son, Adam, is just about to undergo the transition from primary to secondary school. Whilst the school have worked hard to prepare him for this move, Adam is having to ‘let go’ of the comfort blanket of primary school, being one of the ‘big boys’ and having the security of a well-known routine and the familiar faces of teachers and pupils. I am also having to ‘let go’ and accept that Adam is becoming more independent (even allowing him to walk to the end of the road to catch the bus to Lockerbie!). This transition is huge for both of us, for different reasons.
I recognise, however, that we are entering a new phase and there is no going back now. I have to admit, however, I am far more nervous about the future than Adam is – he has the fantastic ability to see this as an adventure, an opportunity to learn new things and make new friends. He also particularly liked the lunches at the Academy when he visited which is always good news for an 11 year old boy!!!. I am anxious about the move to a much larger school, worried that he will need to make new friends (whom I won’t initially know) and that our very close relationship may change as he nears the teenage years!!. I know, however, that I will do everything I can to make this transition a success as I will do with another major transition in my life – the move to the new hospital.
July Photo SiteIt is less than 4 weeks until we ‘get the keys’ to the new hospital and we can begin our commissioning and migration process. Feedback from staff who have had the opportunity to visit has been overwhelmingly positive. All staff will have the opportunity to visit for orientation sessions between September and the end of November (if you haven’t booked a slot yet please do so!).
Whilst the move to a brand new state of the art hospital will be an exciting prospect for many, it is important to recognise that for some staff, the move will evoke emotions such as fear, loss, anxiety and sadness. We have lots of staff who have spent most of their working lives in DGRI (some of whom have worked in the same ward or clinical area for 20 years or more) and we cannot underestimate the scale of the transition for lots of us. Some staff will also have memories of being a patient (or having friends and family members cared for in the existing hospital) and we have a general attachment to the past, to our history here and to our memories of the good times. I would encourage staff to think of ways of ensuring that you and your teams don’t forget the good times and take photos and memorable artefacts with you. The new build team will also be ensuring that some of the treasured artwork from our existing hospital is incorporated in the new DGRI eg the tree of life. I am sure we will all create new memories and have good times in the new hospital but it’s important not to forget the past.
In order to help with the transition process, we are planning a couple of events to celebrate our new beginning and to recognise the varied emotions that people will experience.. We will hold our annual Winter Service at Crichton Church with a theme of “ new beginnings”. I also hope to hold an event in the Atrium of the new hospital soon after the move to acknowledge the huge amount of work undertaken by staff, celebrate the fact that we have had a safe, successful and smooth move (which I am confident we will achieve by pulling together) and to focus on our future in our new surroundings. If anyone has any ideas about how else we could mark our transition, please get in touch.
I would also like to acknowledge that not everyone in the current hospital will move to the new facility. Some staff will choose to retire or leave but other teams will be moving to Mountainhall Treatment Centre (Cresswell to us all just now!) and I fully appreciate that these teams will experience different emotions when the move to the new DGRI takes place. We will work hard to ensure that we support all staff during this transition and it would be great to hear people’s thoughts about how they can best be supported during this time.

 

Julie White is Chief Operating Officer and Ken Donaldson is Deputy Medical Director Acute Services at NHS Dumfries and Galloway.

References

Bridges, William. Managing Transitions. 3rd ed. Nicholas Brealey Publishing, 2009.

Kubler-Ross, Elizabeth. On Death & Dying. Scribner, 2014.

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!”

Dot 2This 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.

Dot 1Waste 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.

Rhian 1

  • 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

Rhian 2The 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

Rhian 3In 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

 

 

 

 

 

The QI Hub by Wendy Chambers

 

 Wendy C 1

 

Wednesday 19th of April – Marks the official launch of The Quality Improvement Hub for Dumfries and Galloway

Our vision: To support health and social care staff to design and deliver services that better meet the changing needs and aspirations of people, families and communities that access care.

The purpose: Quality is everyone’s responsibility. We aim to build a culture where continuous improvement is the norm and develop a network to share resources, learn and work together, to make it easier to do the right thing at the right time, every time.

Wendy C 2The QI Hub is a creative space where you can connect with others throughout health & social care, people with a passion to make a difference. Thinking space, away from the hustle & bustle that is daily life!! Come and find a supportive network of colleagues, share experiences and learning. Choose from a library of resources and practical tools to help structure your improvement projects and explore development and coaching opportunities.

Wendy C 3Building capability and capacity to lead improvement is vital, it empowers people and teams to own change; one resource available is a locally delivered Scottish Improvement Skills Programme. To illustrate how this is already having impact Wendy Chambers, who has recently graduated from Cohort 1, shares her reflections.

3 lessons from Scottish Improvement Skills (SIS) in D&G

Having recently completed cohort 1 of the SIS course in Dumfries, with a project that hasn’t gone quite according to plan, I thought I’d share 3 things I’ve learned along the way.

Lesson 1 – I’m not alone

I’ve always been comfortable questioning my own clinical practice; to be honest I ask “why” and “how” about most things in life; it drives my other half, and now as a parent I can appreciate must have driven my parents, mad! For me though questioning things is a reason why I get out of bed in the morning and keeps my job interesting and challenging. But in my 20 plus years of clinical practice, in many different settings, I’m acutely aware that not everyone thinks as I do…. then came SIS.

I walked into a room, filled with 30 other people, on the first day of the course and I felt like I had arrived, I’d come home! These were my people, this was my tribe – we spoke the same language, had the same fire in our bellies and were comfortable with the “what if …” questions!

Wendy C 4Being surrounded by similar and like minded people; learning from each other, sharing ideas, both the things that go well and the things that fail – I’ve come to appreciate that this support is essential to the process of implementing and testing change ideas. Because when I go back out into the real world, with all its pressures and realities, the natives won’t necessarily be as welcoming or receptive to my “bright ideas” and things won’t feel as cosy.  So now I won’t be alone, I’ve found my tribe, I’ve found support.

Lesson 2 – “Whose project is it anyway?”

The SIS course has given me an opportunity to consider and reflect on the process of implementing a change idea from conception through, in theory, to completion. And one of the fundamental pieces of learning for me has been – it’s all about the relationships; the people who I need to work with and who need to work together cohesively, in order to try things out.

None of us like, or take kindly, to being told what to do, regardless of how much positive evidence there may be that it’s the right thing to do. We all like to feel and be in control of our own destiny and decisions, try things out and discover for ourselves – and I’m no different from anyone else, in fact I’m possibly worse!

A change project idea that one person has come up with is exactly that – it’s their idea, their project.  It doesn’t, at that point, belong to the team for whom it is intended will be the “willing” guinea pigs to trial and develop the ideas. At that point it is “my project, not yours” and “your project, not mine”.

Wendy C 5
I’ve had the opportunity to reflect on my current and also previous projects, consider and question when I’ve done this well and a team has taken on board an idea and really owned it and made it their own and when it has most definitely remained my idea and no one else has bought in.
And my reflections go back to the relationships and the time that I have spent in this part of the process as a whole. And I realise that the time spent in the planning, alongside and with the others who will be involved and affected by the change idea is essential to the process, not the icing on the cake.

This isn’t new, or rocket science, any leadership book or workshop will include this – but we rarely have the luxury of “thinking space” to reflect on our learning.  And having a space, such as the SIS course, where failure is seen as valuable a part of learning as success has been enlightening, reassuring – it feels like home.

Lesson 3 – Skills

Apart from the thinking and reflection space the SIS course has also given me an opportunity to learn some real, practical skills and to relearn some old ones. I feel as if I now have a working toolbox of things which I can use and try out next time around, and every time around, when my next bright idea pops up.  I also have access to a whole tribe of people who can help me when I get stuck – which I will.

Wendy C 6

Old dogs, New tricks, nothing new under the sun.

But in the current health and social care climate things have never felt so uncertain, it’s all about change and innovation. We are all being expected to get comfortable in a world which is full of discomfort and will be constantly shifting. In this world my learning and reflection would be – get skilled, take time building relationships, find your tribe!

 Wendy C 7

Wendy Chambers is  a Mental Health Occupational Therapist and AHP Practice Education Lead at NHS Dumfries and Galloway

The QI Hub is for you and your team and you’re invited to actively contribute. Your ideas, knowledge and experiences are crucial to ensure the hub provides what you want!

Join us on Wednesday 19th April 2017, Conference Room, Crichton Hall. Programme and registration available by contacting Stevie.johnstone@nhs.net

QI Hub Development Team

Can I make a difference? by Paul Gray

It’s a big question – can I make a difference?  How does it feel to ask yourself that?  For some of us, the answer will be different on different days.  My experience suggests that your answer depends much less on what you do, than it does on how you feel.  In this blog, I’d like to offer some thoughts on making a difference.

However, some context first.  I fully recognise the challenges we face.  Health budgets are going up – but pressures on recruitment, and the demands of an aging population, are also very real.  There is also still much to do in tackling inequalities, and improving the health of the population, which NHS Scotland can’t do on its own.  And we do know that people have the best outcomes when they are treated and cared for at home, or in a homely setting.  So our current models of care are transforming to meet these demands, and to provide the most appropriate care and treatment for people, when they need it, and change brings its own challenges.

So my first suggestion is to turn the question, “Can I make a difference?” into a statement – I can make a difference.  If you start from that standpoint, you’re much more likely to succeed.  It’s easy to become pre-occupied with the things we can’t change, and the barriers and problems – I know that I fall into that trap from time to time.  But wherever I go, I see people throughout the NHS, and in our partner organisations, making a difference every day.  So ask yourself, what is the one thing I can do today that would make a difference?  And then do it!

paul-1Now, give yourself some credit – think of an example where you did something that was appreciated.  Write it down and remember it.  If you’re having a team meeting, take time to share examples of things that the team did, that were appreciated by others.  Sharing these examples will give you a bank of ideas about simple things that matter to other people.  And it also gives you something to fall back on, if times are tough.

Next – think of an example when someone did something for you, which you appreciated.  Find a way to share these examples too – if it worked for you, it might work for someone else as well.  Ask yourself when you last thanked someone for something they did well, or something you appreciated.  It’s easier to go on making a difference if others notice what you’re doing!

If you’re leading or managing a team, ask yourself how much time the team spends discussing what went well.  It’s essential to be open and transparent about problems and adverse events, but if that’s the whole focus of team discussions, we overlook a huge pool of learning, resources and ideas from all the positive actions and outcomes.  And we risk an atmosphere where making a difference is only about fixing problems, rather than about improvement.  So, as yourself and your team, what proportion of time should be spent on what went well?

Remember to ask “What Matters to You?”.  I know that the focus of this question is on patients, and that’s right because they are our priority, but it’s a good question to ask our colleagues and our teams as well.  Just asking the question makes a difference – it gives you access to someone else’s thoughts and perspectives, and is likely to lead to better outcomes.

paul-2Will any of this change the world?  Not on its own, of course.  But you could change one person’s world, by a simple act of kindness, or listening, or a word of thanks.  You can make difference!

Paul Gray is the Chief Executive Officer for NHS Scotland and the Director General for Health and Social Care at the Scottish Government

Is My Prescription Ready Yet? by Laura Graham

Have you ever pondered why this question is asked so frequently? The lifecycle of a hospital discharge prescription is rather complex, hopefully I am going to highlight the current process, and why it matters for everyone to be mindful of it in order to help improve it.
• Patient identified as being suitable for discharge within 48 hours, via a daily dynamic discharge meeting or ward huddle (planned) or during a ward round (often unplanned)
laura-g-1 Doctor finalises typing the prescription which also includes a summary letter of the admission using the inpatient notes, electronic prescribing system (HEPMA) and any other relevant info e.g. lab findings/scan results/social work info/referrals for follow clinics etc. Most prescriptions are started prior to discharge, but only submitted to the pharmacy team once finalised (doctors have the option not to submit to the pharmacy team where possible, for example a nurse could dispense simple prelabelled medicines from the ward). Average time 20 minutes

laura-g-2Clinical pharmacist performs an initial prescription check–
which means that they are happy that the prescription is accurate, cost-effective and safe for that patient. On surgical, medical and care of the elderly wards this happens at ward level using the initial medicine reconciliation (list of medicines that a patient was actually on admission), inpatient notes, any relevant investigations, and by speaking to the patient which helps detect any discrepancies or further issues. The medicines are sorted into either ward stock, pharmacy stock, medicines to be labelled on discharge or the patient’s own medicines to be returned (note we try to only supply any new or changed medicines to improve efficiency & reduce confusion for the patient) Average time 30 minutes

• Amendments are required in 75% of DGRI prescriptions by the prescriber for various reasons e.g. Wrong inhaler device selected, interacting medicine, out of stock medicine prescribed, incorrect legal requirements documented, non-formulary medicine started with no documented rationale, patient requests an alternative medicine, medicine missing from the discharge prescription that the patient was previously on. This percentage just highlights the complexity of the process and does not reflect lazy doctors. Average time 15 minutes.
• Prescription and medicines are taken to the pharmacy department on the lower ground floor by a porter or auxiliary nurse (no designated service). Average time 10 minutes
laura-g-3Prescription is dispenesed then accuracy checked, relevant medicines are supplied, labelled and any pharmacy stock returned by a pharmacy technician. It is then accuracy checked by a different staff member, usually a checking pharmacy technician, before the patient copies of the discharge prescription are printed and an electronic copy is emailed to their GP. Note the dispensary also produces prescriptions for other areas such as out patient clinics, peripheral hospitals, prelabelled ward medicine packs, controlled drug orders, therefore there is often an invisible workload already there. Average time 60 minutes.
• Prescription identified as ready & collected from pharmacy by a nurse checking the ward Cortix board for the live status of when a prescription is ready (green pill icon) or pharmacy will call the ward if it requested urgently. The prescription must then be collected from pharmacy by a porter or nurse. Average time 10 minutes
• Registered nurse goes through the prescription with the patient on the ward. Average time 10 minutes
Are you still awake? Me neither! So on an average day it takes around 2-3 hours from when a patient has been told that they are going to home, to their prescription being ready, and that is only if we get each of the 8 steps correct. In practice, there is usually a delay in one or more of the steps which can be very frustrating for the whole team and the patient. The exact point of the delay varies each time due to external factors such as staffing levels, the POD system not working, no designated prescription porter service, a high number of patients admitted, complex polypharmacy, high risk medicines, poor documentation or planning. We do have quicker variations of the above cycle,but only for patients deemed to be at a lower risk of medication errors, such as arranged admissions where prelabelled medicine packs are available for nurses to dispense straight from the ward for simple medicine regimes, such as painkillers.
The most crucial part of the whole process, I would argue, is talking to the patient. It is well documented that 50% of patients do not take their medicines as prescribed, for various reasons, perhaps lack of understanding, their regime is too complex or they get unbearable side effects. Up to 10% of hospital admissions are due to medicines, again perhaps due to side effects or treatment failure by not taking the correct regime. The most common medical intervention in hospital is to prescribe or alter a medicine. We also know that 25% of medicine reconciliation lists are incorrect on admission and 75% of discharge prescriptions require amendments. Our current I.T systems are very useful in isolation, but information often must be copied from one system to another making mistakes easy and slowing us down significantly. Here in lies the problem; the communication of what a patient was taking when they came into hospital, verses any changes made during their hospital stay is not always fully documented, especially for patients already on several medicines (polypharmacy). Medicines are poisons when not used correctly or with extreme care. Why does it matter if we get a few medicines wrong or miss off their bisoprolol 2.5mg daily, who cares?
I want my prescription now and I want to get home!
Currently the pharmacy team are spending too much resource focusing on rectifying problems at the point of discharge, resulting in avoidable delays. We have completely revamped the way we work by:
• Becoming paperless for our pharmacy team communication (via notes on HEPMA) and documenting any relevant information within the inpatient notes
• Constantly developing a semi electronic discharge prescription & workflow system (eIDD & eIDL)
• Developing a triaging process for emergency admissions; so that only relevant patients are followed up during their inpatient stay, as we need to focus on where we have the most impact which is admission & discharge
• From this week, investment has enabled the triaging service for emergency admissions to be extended to 7 days a week, this will improve the number of patients seen on admission by the pharmacy team (currently only 10% with a weekday service) to allow any medicine related issues to be identified earlier.
• This investment also includes a hospital pharmacist now working with primary care to follow up any complex issues or referrals from the hospital team on discharge
Discharge times matter to us all. So what can you do the improve this?
• Follow the national medicine reconciliation process when clerking in, if you do not carefully check what medicines a patient is actually taking on admission, this will cause delays in their discharge when the junior doctor is trying compare the admission and discharge medicine list for any changes.
• If you are reviewing a patient, look at the medicine reconciliation list, if there is not a clear plan documented for each medicine, challenge it and ensure someone reviews it. It will soon become common practice not to ignore any lists which do not include a dose or a plan.
• If you prescribe a medicine, document an indication, plan and review date. Never assume that it is obvious, telepathy is not a skill! Everyone has different knowledge.
• Also think about ‘realistic medicine’, could you manage to take the regime that you have just prescribed?
• Listen to patients during a medicine administration round, if they think something is wrong, please check as we are all human and errors happen.
• Encourage patients to bring their medicines into hospital, it reduces missed doses, unnecessary ordering of medicines and highlights any compliance issues (our pharmacy technicians check them against the HEPMA system)
• If you are a patient, please ask at every opportunity, what medicines you are being given and why. It matters to all of us that there is a clear rationale and plan for everything.
• If you want to check if a prescription is ready, view the colour of the pill symbol on your ward’s cortix board before calling the pharmacy team, as this delays us
I apologise that the blog today was not an easy read, but if you have any further ideas for improvement then please contact us at dg.pharmacydept@nhs.net.

Laura Graham is a Clinical Pharmacist at NHS Dumfries and Galloway