Patient Safety Group – PSG (not Paris Saint-Germain) by Emma McGauchie

Given that it is the year of the world cup we thought we would change our name to that of a football team.   For those of you (Eddie) who don’t follow football PSG stand for Paris Saint Germain and has a catchy ring to it!

Like some of these famous football players my job role as Adverse Events Co-ordinator is just as exciting!! I oversee the whole of NHS Dumfries and Galloway’s Adverse Events and risk.

I also co-ordinate the organisations Significant Adverse Event investigations and reviews and it was at one of the review meetings that I was put forward to write this blog – Cheers Ken!

I love to make the most of every opportunity therefore I thought I would use this blog to share with you some exciting changes you can expect to see over the coming year.

But firstly we would like to make a clear, public commitment to staff that our organisation supports an open and fair culture, by letting you all read a Key statement from our chair and  co-chair person, Eddie Docherty and Ken Donaldson (on behalf of Patient Safety Group (PSG))…….

“There is no doubt that over the years there has been a culture of blame in the NHS.

As chair and co-chair of the Patient Safety Group, we would like to see us move to a culture where we learn and improve from any failure.

It is our firm belief, that in a complex system like the NHS, it is often not the practitioner’s fault when things go wrong.

Staff will be treated fairly and supported to identify the failures in the system and improve service delivery.

We require ongoing honest reporting of concerns at the earliest possible stage to do what we can to ensure your working environment is safe. We would therefore ask all healthcare professionals to continue to raise all concerns in the appropriate manner predominantly by using Datix “.

 

During my first year as adverse event coordinator I found myself being asked two frequent questions, “Who are QPSLG?” and “What do they do?”

New name

Firstly the Quality and Patient Safety Leadership Group also known as QPSLG or “Quiggle Spiggle” have changed their name to Patient Safety Group (PSG for short).   We are confident this change of name will give a better understanding to everyone what we do.

 

Who are PSG?

Let me introduce you to a few of our members…..

Eddie Docherty

As Executive Director of nursing midwifery and allied health professions I chair PSG. I am passionate about pushing the organisation forward as a learning environment, with a key focus on patient and staff safety.

 

Ken Donaldson

For the past 8 years I have developed an interest in enhancing patients experience and ensuring staff experience is as good as it can be – which is difficult with current staffing issues and recruitment challenges. I believe my role in PSG is to ensure a balanced and fair approach to all serious adverse events and complaints. We need to focus on learning from error, improving systems and providing robust feedback – an area we are working on to improve. ‘To err is human…’

Andy Howat

My role as the Board’s Health & Safety Adviser involves identifying, helping manage, reduce and control exposure to workplace hazards. With the ultimate aim of reducing the number of incidents, accidents and ill health in the organisation.

I work with teams helping them assess risks, develop risk reduction strategies, instigate changes in working practice, develop and deliver coaching/training, and offer advice on all aspects of workplace safety and occupational wellbeing.

I have been part of the Patient Safety Group for about a year now and I am regularly involved in reviewing significant incidents, considering the staff, patient and organisational affect these have and trying to enable the development of practical and pragmatic ways of reducing the likelihood and consequence but, ultimately the prevention of these incidents.

Stevie Johnstone

“My name is Stevie Johnston and I provide administrative support to PSG by not only co-ordinating the meetings but by working with others throughout the organisation to gather updates on incidents and investigations.  My knowledge around adverse events and the investigation process was limited but the group has given me the confidence to ask questions from a different perspective during meetings and the review process.  I have recently undertaken Adverse Events Training and look forward to putting this into practice in order to understand why errors happen, how we can stop them from happening again and how we can share learning in order to support others within NHS Dumfries and Galloway”

Linda Mckechnie  

As Lead Nurse/Professional Manager, Community Mental Health Services, One of the most important things for me is to always look at what we can learn when things go wrong or don’t go as well as they should. This might be individual learning for staff, learning for teams or services, or learning across the organisation(s). Supporting staff when things go wrong is essential in order to encourage learning and reflection.

 

Emma Murphy

As Patient Feedback Manager, I regularly support Directorates with high level and complex complaints.  These complaints may be linked to adverse events or have other potential patient safety implications.  Sitting on the Patient Safety Group allows me to update members on relevant complaints as well as ensuring I have an overview of new and significant adverse events.   By building better links between patient safety and patient feedback, we can improve organisation learning and the patient experience.

Joan Pollard

As Associate Director of Allied Health Professions I am the professional lead for AHPs and manage the Patient Services Team and the corporate complaints team.

I am curious about processes and culture, passionate about quality and love developing people and teams.

 

Susan Roberts

I am passionate about supporting staff to learn from errors, near misses or complaints to improve care and therefore my role as professional lead on PSG is a priority for me.  It’s not always easy for us to reflect when things go wrong but this process, if supported well, not only benefits patients it helps the staff involved too.

Christiane Shrimpton

Associate Medical Director for Acute and Diagnostics, passionate about excellent patient care, keen to use any available opportunity to ensure we improve what we do and learn from situations that have gone well as well as those that have not gone so well.

 

Maureen Stevenson

As Patient Safety & Improvement Manager I am passionate about making every day an Improvement Day. I passionately believe that creating the conditions for staff and our communities to learn and share together will enable us to together find practical solutions that improve the quality, the experience and the safety of health and care.

 

Alice Wilson

Deputy Nurse Director; I am enthusiastic about what I do and motivated by seeing things improve. I really want people to be open with service users/patients and to talk with colleagues about lessons they have learned from good and bad experiences so others can reap the reward, do more of what works well and reduce the risk of repeating the same errors.

 

And me 🙂

What can you expect…….

 

Learning from Significant Adverse Events (SAEs)

We are producing Learning Summaries from all our SAEs and we plan to share these with each Directorate but we need these to be meaningful, therefore we would love to hear from you about what learning you have taken from SAEs you have been involved with and how you would uses such a summary.   Our first one is ready to distribute and should reach you all very soon so watch this space!!!

 

 

 

Patient Safety Alerts

 

We have tested a process of distributing a couple of patient safety alerts one about patients being discharged home with cannulas left in situ and one about poor communication around the location of patients with telemetry in situ.  The patient safety alerts will come from the patient safety group, are produced as a result of urgent issues arising from SAEs or themes and are designed to make you aware of a potential risk to harm. So far they have been well received; therefore we will continue to produce these. The next one is on route ………

 

 

Monthly News Letters

We plan to produce a monthly news letter on a “theme of the month“. The newsletters are informed from adverse events reported on DATIX.  Our first edition is ready to go and we have a plan for future ones therefore again watch this space……

Plan for the future

We recognise all the hard work from each directorate in relation to managing their significant adverse events therefore we have put together a timetable for each directorate to provide us with their updates to enable us to support adverse event management in a timely and effective manner.

Communication

The Patient Safety Group is contactable via

dumf-uhb.Adverse-Incidents@nhs.net 

Emma McGauchie is the Adverse Events Co-ordinator for NHS Dumfries and Galloway

‘What I am told I forget…… by the Renal Team

…what I am shown, I remember.

              …what I do, I understand.’

Confucius was credited with many words of wisdom in his 72-years.  I couldn’t vouch for the authenticity of them all – but if he did utter these words he was indeed a man before his time.

The truth behind these words was apparent to me at our recent Kidney Care Planning Education day. The Kidney Care Planning Service has undergone a bit of a re-incarnation in the last couple of years. Formerly known as the Pre-dialysis service, it is simply the care of patients with an eGFR of less than 20mls/min, as they are more likely to progress to end stage kidney failure and need to plan for such an eventuality. However, the term ‘pre-dialysis’ implies that these people are all heading towards dialysis – when in fact many will choose an alternative path. The younger fitter patients should be hoping to get a pre-emptive kidney transplant from a relative or friend, while some of our elderly, frailer patients may well not benefit from dialysis at all and will survive just as long on conservative (nondialytic) care. So when Tanya Harkness took up the mantle of lead Nurse for the pre-dialysis service, she quite rightly felt a new name was required. Many renal units use the term Low Clearance Clinics, but a straw poll of non-renal staff suggested this was more reminiscent of a rehabilitation clinic for inattentive bus drivers… So, after much discussion amongst the renal team, the more accurately named Kidney Care Planning (KCP) service was born.

The aim of the service remains unchanged and while we do take bloods and treat symptoms, easily 80% of what we do is talk. More specifically we provide as much information as we can to help every person decide which treatment option is going to suit them best. We do this with clinic visits and home visits. We provide information leaflets, website addresses and even YouTube videos – all with the aim of imparting information. Yet still we are sometimes asked a question that blindsides us – that either leaves us thinking ‘How did you not know that from all the conversations we have had?’  or ‘Crikey- that’s a good question that I have no idea how to answer!’ Because at the end of the day none of us handing out this information have ever experienced what they are going through – the actual treatments, the fear and anxiety, the dread of what their lives will become or the understandable desire to block it all out and pretend it’s not happening.

Which brings me back to Confucius! The subject of teaching is vast, with as many different approaches as there are pizza toppings. Yet 500 years BC, Confucius nailed it with this simple truth – when we actually do something, we come to understand it. So who better to teach our patients, than other patients who have been in the same boat.

We have held education days in the past, usually in a hotel function room with talks given by members of staff. Tanya was keen to resurrect the concept, but made it quite clear from the outset that there was ‘No way on God’s earth’ I think was the phrase that she was ‘EVER’ standing up in front of a room full of people to give a power point presentation. (Why not, I have no idea as I am sure she would be excellent….but there we are!)

So a new format was devised between the whole community team – a less formal approach, like an open day, where patients could turn up and wander at will from room to room – talk to the team leads, watch demonstrations, see the equipment and most importantly meet other patients.

The date was chosen to coincide with a visit from Ewen Maclean, Kidney Care UK Patient Support and Advocacy Office, Scotland. Ewen, himself a renal patient, is a mine of information about the support available to kidney patients, grants and how to apply for them and the political landscape that shapes kidney care in the UK.

We no longer had need of a hotel function suite – if there is one thing we are not short of at Mountainhall it’s space! (And the parking is pretty easy too – sorry!!) So, we sent a personal invitation to all our KCP patients, laid on refreshments and opened up the old pre-assessment unit for the day.

The Renal Community Team (Left to right): Fiona Gardiner (Renal Dietitian), Robert McLemon (Transplant) Ian Mottram (Haemodialysis – both home and in-centre), Wendy Brown (Peritoneal Dialysis) Margaret McDonald (Clinic Health Care Assistant & Phlebotomist), Linda Stiff (Vascular Access), & Tanya Harkness (Kidney care planning).

As well as written information everyone had something practical for patients who attended and the responses we had were truly illuminating. Ian had a haemodialysis machine with all the lines and bucket of dialysis fluid set up and received the comment ‘Oh, I didn’t realise it would be so small-I assumed it’d be really big.’ And why not –historically dialysis machines took up a whole room, which must be a really intimidating thought if you are going to be hooked up to one- but it has NEVER occurred to me to comment on the size of a dialysis machine in my many dialysis related conversations.

Robert had asked 3 transplant patients, with more than 50-years of experience between them to attend. I am not sure if any of them showed their scars where the transplant was placed but they had experienced all the ups and downs of transplantation and immunosuppressants so there was no glossing over the bad bits.

Linda was showing patients how to feel  their fistula and what to listen for – explaining how the noise it makes can change if a stenosis is forming – and she was able to give those with a fistula their own stethoscope to involve them in their own fistula care.

Our renal dietitian was also on hand to give practical advice on managing fluid balance, as well as providing visual aids on potassium, phosphate and salt restrictions-something that renal patients universally struggle with!

One of the biggest successes of the day came from Wendy who had persuaded one of her Peritoneal Dialysis (PD) patients & their families to come and chat so they finally actually knew what the PD catheter looked like when it was inserted and could see for themselves how an exchange worked. But more importantly they could ask someone having the treatment what it felt like, how it impacted on their lives, whether it interfered with their sleep, whether it actually helped! One of our patients who had been set on coming to the hospital for haemodialysis when his time comes, has now changed his mind. We have been sure for many reasons that he would be best suited to PD, but fear was driving his decision. One hour watching a gentleman of his own age performing an exchange and listening to his stories of how life continues almost as normal around PD, has achieved what 5-years of reassurance from us could not…

The feedback Tanya received was overwhelmingly positive, but patients are generally nice, so it is the more subtle signs that have persuaded us this is the right approach. The questions and comments patients have since made in clinic prove that they have valued and retained some of the information they learnt that day. One patient commented how reassuring it was to see dialysis patients who looked well and still lived a normal life. And I hope through this some of the fear for the future has abated.

I expect in the future we will still be blindsided by hitherto unasked questions, but it is not only the patients who are learning, as I finish with yet another Confucius quote:

‘He who knows all the answers, has not been asked all the questions!’

We would like to express our sincere gratitude for all the patients and families who came that day, especially for those who came to share their experiences with patients in the early stages of their kidney care planning journey. We are also grateful for the patients who gave their consent for us to take photographs and use them in this blog.  We hope to make “Kidney Care Planning Education day” an annual event from now on.

 

Other useful renal websites:

Patient focussed resources:

Kidney Patients UK / The National Kidney Federation, the largest kidney patient charity in the UK, run by kidney patients for kidney patients, website provides lots of useful information.

Kidney Care UK – formerly the British kidney patient association, very helpful brochures available online.

Think Kidneys – NHS England’s campaign to raise awareness of the importance of kidney disease. Lots of useful resources can be accessed with just a few clicks from this page.

Clinician focussed resources:

Renal Fellow Network – A USA based website with worldwide contributions distilling vast amounts of renal knowledge into bitesized articles, a great resource to start learning about renal medicine.

UKidney – online education on Nephrology, hypertension and kidney transplant.

#NephJC is a fortnightly Twitter-based Nephrology Journal club with visual abstracts, free access to the articles provided by major journals and regularly includes participation by the authors and other worldwide experts in the field.

 

This blog was written by Dr Alison Almond, Associate Specialist in Nephrology, with contribution from rest of the Renal Team, NHS Dumfries and Galloway.

 

Dietitians do Prevention by Laura King

Next week sees the return of Dietitians’ week and the theme this year is ‘Dietitians do Prevention’ with each day having sub-themes. Follow #DietitiansWeek on Twitter, Facebook and Instagram for some insights into our involvement in a wide and varied range of preventative activities.

Here in NHS D&G we have dietetic teams working across these areas which may come as surprise to the majority of folk working in the acute hospital who perhaps associate us mainly with artificial feeding and oral nutritional supplements for those who have scored 2 or more when nutritional screening is done on the wards.

As a small team we recognise that we have to play a role in educating and enabling patients, their families and carers to prevent over and under nutrition by supporting self-management, the dietitian can’t come shopping with you, cook your meals and help you to eat them and make the best choices, so we have to rely on using our communication skills to educate and inform patients and those close to them to help have a healthy, balanced diet that meets their needs.

We factor in ‘what matters to you’ and our assessments incorporate a huge range of factors as this poster illustrates:

Our Team works in the following areas all of which have significant roles to play in prevention:

Community Nutrition Support  (Kerry, Alexandra, Jackie, Jennifer, Lis, Dillon and Carole) – We provide practical, evidence based dietary advice, specifically tailored to each individual. Through dietary advice we aim to prevent and treat a wide range of medical conditions and empower people to make appropriate diet and lifestyle choices. Community Dietitians see patients in a variety of settings including community hospitals, nursing and residential homes, clinics and patient’s own homes. Our role identifies, prevents and manages malnutrition in the community. We liase with individuals to create realistic and achievable goals to optimise/improve their dietary intake.

Various medical conditions require an individual to be provided with their nutrition via a tube. We are responsible for managing these patients in the community, either in their own home or in a nursing home/community hospital setting.

We deliver educational talks on various topics including cardiac rehabilitation, stroke, Parkinsons disease and pulmonary rehabilitation.

Renal (Fiona) – Supporting patients with advanced kidney disease in managing complex nutritional requirements. Preventing further complications that can arise from inability to excrete electrolytes and fluid overload as well as avoiding weight and muscle loss for this group of patients who have increased requirements for protein once dialysis has commenced.

Gastro (Gemma and Sarah) – Preventing complications from poor management of coeliac disease such as the obvious GI disturbances through to the ‘hidden’ consequences such as increased risk of bowel cancer and oesteoporosis. Supporting patients living with inflammatory bowel disease to manage their symptoms and optimise their health and well being. Preventing the often crippling effects of irritable bowel syndrome by supporting patients to use the low FODMAP diet to identify trigger foods and modify their diets in a safe and sustainable way.  Preventing malnutrition in liver disease which is often masked by fluid shifts.

Paediatrics (Mhari, Anne and Tracey)  – Supporting parents & their child in managing children with complex needs, tube feeding, diabetes, gastroenterology issues, cystic fibrosis, weight management, faltering growth and allergies – preventing short and long term consequences of under nutrition.

Diabetes (Katy, Nicola, Sally, Sheena, Wendy): We are an integral part of the diabetes multi-disciplinary team providing a dynamic and evidence based service. We deliver quality assured education, and aim to support patient driven care and safe self management to those living with diabetes and their family. We also provide continuing education and support for health care professionals working with individuals with diabetes.

Weight Management (Katy, Nicola, Sally, Sheena, Wendy): We provide person centred, safe and evidence based advice to individuals with complex needs and requirements. This encompasses a variety of approaches to help aid weight loss and improve quality of life.

Mental Health and eating disorders (Sam and James) – Supporting recovery from mental health crises and from the consequences of living with disordered eating behaviours.

Catering (Debbie)- Working with Catering to achieve menus for inpatients across the region that offer a varied, balanced diet to support their recovery and prevent complications such as poor wound healing and  pressure ulcers. Also ensuring guidance for Catering teams to create therapeutic or special menus for patients’ individual dietary requirements. Training staff who make and deliver food, fluid and nutritional care to patients in hospital.

Acute (Laura, Anneka, Laura, Jennifer, Laura and Sheree) – seeing patients identified as being at risk of undernutrition to assess their individual needs and support recovery. Preventing increased length of stay, poor wound healing, pressure ulcers and other complications of malnutrition and providing advice for discharge to help patients stay well and continue their recovery once home with or without the support of the community dietitians as appropriate.

All this activity is coordinated and supported by our Head of Dietetics (Lorna).

The acute team are planning to pilot some staff education sessions on B3 and D7 to support ward staff in preventing malnutrition as well as identifying the patients who need our one-to-one support, so please get in touch with Dietetics on 01387 241568 if you would like to know more, want to arrange any training on your wards or if you have any questions about this blog post and what we do.

Meanwhile here are some pictures of the acute team (Anneka, Jennifer, Laura and Laura) ….

Laura King is Lead Acute Dietitian at Dumfries and Galloway Royal Infirmary

Let’s insist on the possible by Valerie Douglas

Many things in life are complicated, require great debate and despite huge resources are not guaranteed to be successful in practice. There are other things which are simple to understand, can easily be implemented and immediately make a difference to improve lives or in some cases save lives. You only have to think of the meaningful campaign to change the care of people with a diagnosis of dementia led by Tommy Whitelaw (Tommy Whitelaw @tommyNTour). It makes sense and it hits you in the heart. As a professional you cannot listen to Tommy talk about caring for his mum and withhold your support for this campaign. His mum is your mum.

Another example is Kate Grainger’s inspirational campaign (#hellomynameis). This focuses right in on the doctor/patient relationship. It goes further than just making us think more about face to face contact with patients who may feel vulnerable, distressed and in alien surroundings. It asks us to look at our practice on a basic level, to say our name aloud, on every contact. At one point this patient was Kate Grainger but the patient could be any one of us.

Last November an important, widely supported campaign for the mandatory teaching of Cardiopulminory Resuscitation (CPR) to schoolchildren was unsuccessful. This Emergency Bill was opposed despite irrefutable evidence that it saves lives. In Norway it has been compulsory for schoolchildren to be taught CPR since 1961 and survival rates are double what they are in the UK. As out-of-hospital cardiac arrest is the commonest life-threatening emergency in the UK so I thought this campaign was bound to be fully supported and unchallenged. You can imagine my disappointment.

I felt at a loss about what to do next, yet felt there had to be a ‘next’. To increase survival rates of cardiac arrest the immediate action of bystanders is crucial. Personally I have carried out CPR three times, twice in a hospital setting and once at a family event. A day of laughter and pleasure turned into tragedy. Event though, as a nurse, I’m aware that the outcome from CPR is variable for a myriad of reasons, I was left affected by this last experience. Then a doctor said to me, “If I had a cardiac arrest I would want someone to have a go.” I am glad I have been taught CPR and am able to ‘have a go’, otherwise the most I could have done that night would have been to phone an ambulance instead of giving a friend a chance of life.

What could I do now? I decided to put together a resolution to RCN Congress 2016 calling on governments to mandate the teaching of CPR to schoolchildren (the remit of the Emergency Bill had been wider, encompassing all kinds of First Aid). The resolution was accepted and I presented this in June this year.

There were wide ranging contributions to the debate. Personal stories were shared about children delivering CPR successfully. A delegate told us about a situation where his 27 year old teammate collapsed during a game of football. 23 players including the referee were there and nobody knew how to do CPR; this man died. He went on to describe a more recent experience when an instructor was brought in to teach CPR to the junior football team. Within 10 minutes they were doing it perfectly.
Some delegates expressed concern about the effect on children if they delivered CPR and it was unsuccessful. Others answered this by saying: remove the fear, teach them young. The evidence is there. Someone else highlighted again that encouraging CPR lessons in schools as an add option is not enough; teaching needs to be a requirement so that there is no national disparity. Kate Ashton made a very acute observation at Congress:
“If we can educate youngsters in schools about sex education and creating life then surely we can educate them about saving lives.”

Every year an estimated 60 000 out of hospital cardiac arrests occur in the UK (BMJ 2013;347:f4800) It could happen to any one of us. What can you do?
Write to your local MP and express your support for the campaign to mandate teaching of CPR.
Become a local First Responder.
Find out if your town/village has a defibrillator and where it is kept.
Ask your school if the teaching of CPR is on the curriculum.
Let’s insist on the possible.

Valerie Douglas is a Staff Nurse in Mental Health at Midpark Hospital, NHS Dumfries and Galloway

Fork Handles!!! by Helen Moores

“The single biggest problem with communication is the illusion that it has taken place” George Bernard Shaw

What is the reading age of the most popular newspaper in Scotland, The Sun?

If you were to categorise it and place it on a shelf where would you put it? 8-10 yrs? 12-14? 14-16 yrs? The answer is 8 years old.

In terms of language level, vocabulary, grammar etc. The Sun is written at the same level as a school reading book for an eight year old child. According to The Literacy Trust the average reading age in Scotland is only 9 years old. This sort of information has massive implications for the way we communicate with our patients, carers, their friends and family.  If we are producing written material or talking in a way that is too technical, medical or wordy we lose, bewilder and alienate our audience whilst thinking we have been clear. It is referred to as health literacy –  the gap between what we as professionals think we have said and what our patients have actually heard or understood or are able to access. It brings to mind the confusion in the classic Two Ronnie’s sketch where a man walks into a hardware shop and asks for Fork Handles and receives 4 candles!

October is World Health Literacy Month and the aim is to raise awareness of this gap in communication. The Health Literacy Place is a website attached to The Knowledge Network and details the Making It Easy action plan to improve Health Literacy here in Scotland. It contains some frightening statistics:

• 43% of English working age adults will struggle to understand the instructions to calculate a childhood paracetamol dose
• 26% of people in Scotland have occasional difficulties with day to day reading and numeracy
• People with lower health literacy have increased rates of emergency admissions, wait until they are sicker before visiting their GP and are less likely to engage with public health programmes eg breast screening and vaccination
• In general people remember and understand less than half of what we discuss with them

The implications for patient experience, safety and access to services are clear. This is not just a welfare or financial obligation, but a legal one. The Patient Rights (Scotland) Act 2011 states that “people should be communicated with in a way that they can understand and that healthcare staff should make sure that the patient has understood the information given.” Our skill as healthcare professionals is not only to diagnose and treat but to communicate those findings in a culturally appropriate, meaningful and memorable way.

Here in D&G it has never been more timely for us to think about these issues as we plan our own Big Move, thinking about clear signage, systems for patient appointments, e-records etc in our new home. In addition our English neighbours in Cumbria are getting to grips with the Accessible Information Standards. These legal standards were introduced into NHS England on 31^st July this year and go one step further in addressing communication needs. They stipulate that a person with a disability, impairment or sensory loss should be provided with information that they can easily read or understand with support. The Standards also state that these needs should be identified and recorded prior to a patient accessing a service.

The good news is that because of the introduction of these standards in England there are lots of resources to help us look at our practice here in Scotland. So where do we start? As a communication specialist, it’s a subject close to my heart.

If you are looking at a service audit or improvements, some handy hints include:

• to never be without a pen and paper
• to download a profession specific app or animated sequence for your phone or tablet
• sit down or be at eye level for all conversations, where possible
• order a name tag and say..”Hellomynameis…”
• attend one of the specialist workshops in the Education Centre

but also…….

“Tell me your story…”

Asking this initial interview question allows you time to tune in like a radio to the person’s wavelength. By asking this I can assess fluency, coherence, intelligibility, cognitive ability, word finding skills, language level and most importantly adjust mine accordingly .. but also assess the patient’s accuracy as a historian, their interpretation of events, what they believe the doctor said, if there’s an outstanding or unresolved issue or complaint, their mood and motivation for engaging with therapy, what is important to them, their family, goals, hobbies and start to identify any hooks that I can hang my therapy on to make it personal and meaningful and therefore increase its success. Not bad for one simple question!

 

Perform the SMOG!

The simplified measure of gobbledygook – yes it’s a real thing. Created in 1969, take any piece of written material your service routinely supplies and apply the formula to calculate a reading age. If it’s higher than 9, think again. http://prevention.sph.sc.edu/tools/SMOG.pdf

 

Access The Health Literacy Place

This NES website gives some really great tailored resources for GPs and medics, AHPs and nurses including simple techniques like Teachback, but also online courses, training and templates to re-evaluate and improve your communication personally and within your service. http://www.healthliteracyplace.org.uk/media/1360/health-literacy-month-eflyer-2.pdf

Chat to a friendly Speech & Language Therapist

But then I would say that! The Royal College has a new position paper and website to support Health Literacy or Inclusive Communication as it’s sometimes known.

And Finally……

…for a chortle and a lighter look at Health Literacy as seen from the perspective of the doctor we all love to hate, click or paste the link below…. If you can’t see it you may need to upgrade your version of Internet Explorer to 11. http://www.youtube.com/watch?v=zG2DVoRP86g

Happy Friday and happy Health Literacy Month!

#healthlitmonth

Helen Moores is a Specialist Speech and Language Therapist for Adult Service & The IDEAS Team (Interventions for Dementia, Education, Assessment & Support) at NHS D&G

Follow us @SLT_DG

Find us at NHS D&G SLT Adult

 

Health Literacy Month logo and Health Literacy Heroes illustration are reprinted with permission of Helen Osborne, founder of Health Literacy Month

“Going that extra mile” by Sharon Shaw

Patient Centred Care

Being caring and compassionate is an unique talent and sometimes sadly often gets forgotten about and falls by the wayside. We are all human beings and sometimes we all need to take a step back and grasp how valuable our lives are and that of loved ones.

I want to share my story. This is the first time I have written a blog, so please be “patient” with me.

In November 2015 I started my new job in clinical education. I was excited and yet in a way I wanted to prove to myself and others how valuable education is in this forever changing healthcare environment.

Approximately 3 weeks into my new role, the Respiratory Team contacted me concerning a patient with a complex condition. It was a 59 year old male who had severe emphysema and required an Under Water Sealed Drain (UWSD) to try and reinflate his left lung. The damage was so severe it became evident that the UWSD could not be removed or his lung would continually, spontaneously collapse.

“IT WAS HIS LIFE LINE”.

I walked into the side room in Ward 12 to introduce myself. With hos blue eyes he gazed up at me looking slightly anxious. Giving him a good firm handshake, I smiled and said

“Hello John, my name is Sharon”

I’m a great believer in “non-verbals” as it delivers communication and initially builds upon a trusting relationship. And indeed it did as from then on it had a huge impact.

As my father always said…

“Sharon a good solid handshake goes a long way”.

John was palliative. He had not long retired and to get devastating news about his diagnosis and outcome was so sad. His ultimate wish was to get back home to spend the rest of his short life left with his beloved family.

I made a point of seeing John everyday in Dumfries and Galloway Royal Infirmary. It was essential to build up that relationship. During the 2 weeks I delivered education on how to care for a patient with an UWSD. Approximately 30 nurses received education, Kirkcudbright Hospital Staff, District Nurses and Rapid Response Team. As you can imagine there was a lot of anxiety, fear and uncertainty amongst the nurses. This was actually the first patient to get discharged to Kirkcudbright Hospital with a UWSD. John was fully aware of my role and was updated.

The time had come, John was ready for discharge. Understandably so, he was very anxious. I took the decision to actually go in the back of the ambulance with him to Kirkcudbright Hospital. Holding his hand and bantering away we both arrived to our destination. We were pleasantly greeted by the nursing staff. They knew John as he was a local from the town and had received care from them in the past.

His family were so supportive especially his daughter Michelle, whom I have now made a lifelong friend.

John managed to continue life for 7 months in Kirkcudbright Hospital. Unfortunately he did not get his wish to go home but in all fairness the care he received from the hospital staff made his last few months comfortable and to have that precious time with his family. He managed to celebrate his 60^th birthday with his family. It was an emotional, uplifting day.

I guess what I’m trying to say folks….

“Going that extra mile” was so successful and beneficial. I would certainly do it all again.

Thanks for taking time to read this.

Sharon Shaw is Clinical Educator for NHS Dumfries and Galloway

 

 

 

Do you want free dental treatment? by Kim Jakobsen

#hellomynameis Kim and I am encouraging the people of Dumfries to consider self referral to a dental student at Dumfries Dental Centre for free dental treatment.

There has been a dramatic improvement in access to NHS dental care in the region over the last 6-8 years. The Dumfries Dental Centre opened January 2008 to provide an outreach / training programme for student dentists and student dental therapists, aimed at supporting the future growth of these professionals across Scotland, while continuing to provide secondary care dental services, emergency dental services and routine NHS dental services which moved from Nithbank. The plan was to provide additional access to NHS dental registration at the centre, but on opening, access to Independent Dental Contractor practices for NHS dental registration had increased. Following a review of the Health Board’s managed dental service, recognising the increased access available for patients to NHS dental registration, routine NHS dental services at Dumfries Dental Centre were withdrawn in 2015.

With the goal of improving oral health while modernising dental care, prevention has played a key role in the dental care being provided by dental professionals for some time. This means that patients who are registered and regularly seeing a dentist, dental therapist, dental hygienist or extended duty dental nurse are getting orally fit.

This combination of increased access to NHS dental registration and patients getting orally fit is great news but it does mean finding suitable patients who require routine treatment to support our dental student outreach programme is becoming more challenging each year.

Outreach programme aims

David J. Watson, Senior Clinical University Teacher at Glasgow Dental Hospital and School explains that ‘The Outreach experience is intended to enable the student who has already attained basic competence in a range of areas to grasp the concept of the provision of holistic oral health care in the primary care setting and to gain an appreciation of integrated multisectoral involvement in health care delivery. The aim of the entire experience is to aid transition from the dental school to the practice environment by replicating the primary care experience as closely as possible.’

Who makes a suitable patient?

A broad base of patients with differing needs is desirable for the Outreach programme. Patients receiving emergency dental care provision and who are unregistered with a GDP may happily return for a course of treatment. Patients who self-refer can be screened for suitability at the initial examination, as can other healthcare professional referrals.’

Please note the following;

Appointments can last 1-2 hours and sometimes a bit longer.
Patients won’t always be able to see the same dental student, as they attend Dumfries Dental Centre from Glasgow Dental Hospital and School one week at a time.
Patients should have realistic treatment expectations.
Patients who are, for example, extremely nervous of dental treatment or requiring specialist intervention should be suitably referred.
Patients with special care requirements would be assessed for their ability to cope with routine dental care.
Patients with health preclusions would not be excluded automatically unless they would impede routine treatment provision or necessitate specialist intervention.

How and where do we find patients for our students?

The answer is from You. Please spread the word about our student dental outreach programme. Come and see us for yourself if you are unsure about us and/or happy to refer people to us. The facilities at the Dumfries Dental Centre are quite something. The staff and the students are all friendly and good at what they do; believe me they get lots of praise from their patients.

Are you interested yet?  I really hope you are.

Further information and self referral application form is available at: http://www.nhsdg.scot.nhs.uk/Departments_and_Services/Dental_Services/Dental_Student

In summary;

Dumfries Dental Centre has a student dental outreach programme operating August to May.
The student dental outreach programme needs dental patients requiring routine dental treatment; this could be you, your family, a friend, your neighbour or a member of the public that you come into contact with.
Student dentists are in their final fifth year of studies.
Student dentists are supervised which includes their work being checked.
If accepted to the programme, treatment is free from a student.

Kim Jakobsen is Dental Services Manager for the Public Dental Service

Cutting the Sugar…. by Fiona Green

Over the last 2 years NHS DG have been offering a structured programme of work experience to young people in their final years at school thinking about a career in medicine. This has been very well received by the young people who attend and the success of the programme is largely down to excellent organisation and communication skills of Anne-Marie Coxon and her team in the education centre who arrange tasters in various areas of medicine including medical admissions, theatre, surgery and A&E along with some time with me in the diabetes centre

Linocut by Hugh Bryden Crichton Hall- home to the Dumfries Galloway Diabetes centre

As a clinician it has been really interesting to spend time with these young people who have yet to develop preconceived ideas about healthcare and for me to try and understand what it is that excites them about spending a lifetime in medicine and to try and remember what it was that motivated me to apply for medicine and ultimately what made me move into Diabetes and Endocrinology.

For those of you who know me you will have heard me say that it is diabetes that excites me rather than the rare and esoteric conditions that I deal with in the endocrine service but I recognise that despite my real enthusiasm and commitment to improving care in diabetes that when these young work experience students come to diabetes clinic I sometimes find myself apologising to them that I don’t have any exciting procedures to show them, or new diagnoses to make; in fact in diabetes clinic I rarely examine people and I spend my time just listening to things that seem unrelated to sugar levels and talking…..

Just Listening and Talking…

The fact that I feel the need to apologise about the nature of diabetes clinic being  “just listening and talking” has made me realise  how little value we as hospital healthcare professionals place on these core skills that we all use every day. We are required to do mandatory training in many important areas such managing the deteriorating patient, infection control, awareness and fairness to name a few- yet it is possible for a healthcare professional to go through their in working career without any update, assessment or post graduate training in the core communication skills that we use every day. This lack of post graduate training in clinical communication skills is particularly apparent in the acute hospital setting compared to our colleagues in general practice and psychiatry where advanced post graduate training in consultation skills is the norm. Despite the seemingly acute nature of a hospital environment many of us spend a large part of our working week in clinics working with people to try and improve their health and wellbeing but what are we doing to ensure that these interactions are effective and meet the patient’s agenda?  Do we find it easier and quicker to pursue our own agendas and default into education mode rather that hearing about what is really important?  Several research studies have shown that by exploring a person’s background, worries and their understanding of their condition can help to avoid unnecessary investigations or anxiety for the patient as well as reduce the strain on resources[i][ii]

The success of the late Dr Kate Granger’s “Hello my name is …” movement and the “What Matters to Me” campaign show that in acute setting healthcare teams are beginning to contemplate a change to a more patient centred rather than the traditional paternalistic, didactic approach to our interactions with patients but this change is slow and these important initiatives are only an entry level to improving our communication with the people we see in clinic and reaching a shared agenda.

Locally Jean Robson and her colleagues from psychology, human resources and other interested clinicians have recently worked hard to put together a directory of diverse courses and programmes which are delivered locally by NHS Dumfries and Galloway aimed at improving advanced communication skills including sessions on communication skills which allow individuals to film and review their performance in real life clinic setting (been there and done that -daunting but very helpful), communicating with people with existing communication difficulties, human factors training and sessions on communicating with colleagues in meetings to name a few

So, back to the title of “cutting the sugar”. The discovery of insulin almost 100 years ago is one of medicine’s most remarkable discoveries changing the outcomes for people diagnosed with type 1 immeasurably as the before and after pictures below poignantly demonstrate

December 1922

February 1923

 

 

 

 

 

 

 

 

 

“Child 3” before and 3 months after insulin treatment

There is of course a but; insulin is not a cure for type 1 diabetes just a treatment and Insulin treatment brings with it a huge burden for the person with type 1 diabetes- blood testing more than 4 times a day, injecting insulin at least 5 times a day, assessing the carbohydrate content of foods are all required to achieve the tight blood sugar targets required to maintain health and wellbeing. This all needs to be balanced against activity levels and avoidance of hypoglycaemia. People with diabetes can never have a day off.  They become experts in managing their blood sugar levels and this brings me to the “just listening and talking bit”. Listening to what’s important to people when I’m clinic seemed more time-consuming in the beginning but by encouraging this shared understanding I have come to recognise that almost universally people with type 1 diabetes want to be healthy and that they fully understand the importance of controlling blood glucose but what I also now appreciate more clearly is that there are many other things that get in the way of achieving this goal. Some of these barriers to change seem obvious e.g. fear of hypoglycaemia, fear of injections but others may take gentle probing to identify e.g. the young woman who removed her insulin pump because she had a new boyfriend who didn’t know she had diabetes, the young mum on her own putting her own health after the needs of her family. Through training, practice and reflection I have come to learn is that each person is different and whilst a particular solution may work for one person it might not work for the next and whilst the temptation is for me to offer the solutions that I think will work by practicing the skills I have learnt at various communication skills sessions I now recognise that solutions generated by the person with diabetes are far more likely to be successful that anything that I may suggest. Of course very few consultations are perfect and like every skill we use practice, reflection and additional training can help us to improve which is why I believe that consultation and communication skills shouldn’t be seen as just “the icing on the cake” but more of the “meat on the bones” of our daily work.

Dr Fiona Green is a Consultant in Diabetes and Endocrinology at NHS Dumfries and Galloway

[i] Heisler M, Bouknight RR, Hayward RA, Smith DM, Kerr EA (April 2002). “The relative importance of physician communication, participatory decision making, and patient understanding in diabetes self-management”. J Gen Intern Med. 17 (4): 243–52. doi:10.1046/j.1525-1497.2002.

[ii] eisler M, Bouknight RR, Hayward RA, Smith DM, Kerr EA (April 2002). “The relative importance of physician communication, participatory decision making, and patient understanding in diabetes self-management”. J Gen Intern Med. 17 (4): 243–52. doi:10.1046/j.1525-1497.2002.

The Dietetic Detectives by the DGRI Dietetic Team

As Dietitians’………………….. we are Detectives

The patient in front of us has a nutritional problem –they are underweight, they have lost weight and they are struggling to eat – but why? It’s a mystery! Could the mystery be they are malabsorbing due to chronic bowel inflammation, bowel obstruction, or pancreatitis? Or do they have difficulty swallowing due to stroke, neurological disorders or head and neck cancer? And the list goes on…

Cue the acute Dietitian!
To get to the bottom of this, we need to look for clues. Clues come in all forms;
anthropometry
biochemistry
presenting medical problem
current symptoms
past medical history
current medications
environment and the patient’s own beliefs
psychological factors
As Dietitians we gather this information and put it together to solve the mystery.

But then what?

We then need to work with the patient, carers and family as well as the multidisciplinary teams to translate our gathered finding (clues). We use our clues to calculate nutritional requirements, this allows us to individualise patients needs – their calorie, protein and fluid needs. We then draw from the evidence base and our own experience, incorporating the tools of our trade some of which are:
Oral nutrition – Fortified diet, nourishing drinks, snacks and oral nutritional supplements.
Enteral (tube) Feeding – Into the gastrointestinal tract
Parenteral (intravenous) Feeding – Into the blood stream via venflons or central lines

Here in Dumfries and Galloway Royal Infirmary our focus is on malnutrition.  People may think malnutrition is a thing of the past in this country, but according to a recent publication by the British Association of Parenteral and Enteral Nutrition (BAPEN) 25-34% of patients admitted to hospital in the UK are at risk of malnutrition (under nutrition).  Malnutrition is associated with less favourable outcomes such as increased length of hospital stay, impaired wound healing and reduced ability to fight infection. It is therefore important to identify and treat malnutrition as soon as possible.
Elsewhere in the other areas there are different patient groups receiving expert nutritional advice, projects being carried out and contributions to national research going on.
The evidence base regarding diet and health continues to grow; treating and preventing malnutrition in the hospital and community setting, gastroenterology, paediatrics, weight management, diabetes, renal, catering and mental health to name a few.

A few myths about dietitians:-
We never eat chocolate
We never drink alcohol
We judge you when we meet you in the local takeaway
Detox diets are good for you
Superfoods exist and are recommended
All we give is weight loss advice
Dietitians will inspect your poo (although we will ask about it)

 

So hopefully you see there is more to dietetics than the common misconceptions – that we’ll be spying on your trolley at the supermarket, and of course we never eat cake, we always have our five a day and we do in fact we always have the perfect diet!
We hope this gives you a small insight into our profession.

And so this morning we’re off to the wards again,

NG tubes, Fortisips and TPN,

We’ll calculate needs, and make sure they’re met,

We won’t stop until food charts are used, you can bet.

Ensuring good nutrition, we can’t get enough,

Though we know sometimes it’s gonna be tough,

So we’ll chat, and we’ll laugh but we’ll work till we’re blue,

So when the cake comes out remember, we’ll have some too!

This weeks blog was a joint effort by the Dietetic Team at Dumfries and Galloway Royal Infirmary

A Journey to Africa by Dave Christie (@bagheera79)

At a little half past eight in the morning on the 25th of November last year I started on the ICU ward round with the team of residents, at the Black Lion Hospital in central Addis Ababa – the capital of Ethiopia. There were sixteen patients to see, with a high proportion of trauma – especially brain injury – and severe life-threatening infections. It looked so different from the unit here in Dumfries. It had big wide windows allowing in daylight, for a start. In a UK hospital, windows at this height would be securely fixed so as to avoid the kind of unfortunate incident that makes the headlines. Here, in Addis, one of the nurses was leaning right out of the window and yelling cheerfully to a colleague in the carpark over a hundred feet below.

As I looked around I took in more differences. The beds were quite close together, with a low wall separating the heads of beds between the divided area. Instead of uniform ranks of identical equipment all bought at the same time, the pumps and ventilators were a mishmash of ancient and relatively modern kit. Huge, head height tanks of oxygen sat beside each ventilator, as there was no built in oxygen supply in the walls. Beside most beds sat a big bottle of caramel liquid – it took me a moment to work out that this was nasogastric feed. Of course! – they don’t have the pumps to delivery a trickle of feed continuously, so they have a supply for the day and administer it at intervals. Each patient’s bedsheets were different, brightly coloured, and obviously donated or brought in from home. Nobody was wearing aprons, or gloves – the bright smurf blue and purple hands of healthcare that are so ubiquitous in UK ICU were nowhere to be seen. I could imagine our own infection control team spontaneously combusting at the sight. Of course, they would likely have already lost consciousness at the sight of an entire team of doctors standing around the bedside in long-sleeved white coats – something which has been verboten in the UK for years.

But then, I looked closer and readjusted. Put into context, they were doing the same stuff we do. Airways were protected. Patients were being rolled, washed, and cleaned every day, with a change of sheets. Physiological parameters were being diligently recorded on big charts in close detail. Because pumps were usually either broken or in very short supply, sedation and analgesia were given by injection at regular intervals. They were being fed – one way or another. Patients were receiving regular chest physiotherapy to try to shift stubborn sputum and prevent pneumonias. Blood tests. The nurses still laughed and joked and teased each other. It’s the same stuff that we do, but in a much simpler, less precise way. And, a lot of the time, it worked. Which, to be brutally honest, is just as true of our own, ‘modern’ intensive care.

I turned my attention to the lady in the bed. Clearly profoundly affected by a severe head injury as a result of trauma, she also had signs of a severe chest infection. Here in the UK, it would be standard practice to send sputum samples off to the lab to identify the offending organism, certain specific blood tests might be done, and a chest x-ray would be a routine investigation in order to see the extent of the infection. I asked if they could do any of those things. Dr. Woubadel looked at me with a wry, slightly sheepish smile. “Well, we can. But we only have two antibiotics and our microbiologists have refused to analyse our sputum samples. And the lifts are out at the moment.”

Right. Wait, what? “You only have two antibiotics?”

“Yes, ceftriaxone and ceftazidime.”

If you don’t speak antibiotic, that’s a little like going to the supermarket and discovering that the only two cleaning products available are napalm and a hydrogen bomb. Given that antibiotic resistance is a real and growing threat, this is a disaster for the future.

And the lifts…. ah. The building of the Black Lion is definitely a little bit past its best, and was undergoing a phase of refurbishment. Almost all of the lifts were removed and in true, relaxed Ethiopian style, there was occasionally a warning sign. I had had a look at one of the lift shafts and it really was an open door onto a seven storey drop. Later that day, I watched a patient being taken urgently to theatre from one of the wards on the floor above the theatre complex. Four orderlies and a nurse were carrying the entire bed – with the patient lying on it – down a flight of stairs. Another nurse was carrying the drip. That morning, if they really wanted a chest x-ray, they’d have to do the same thing if the lift was out as there was no portable facility to take x-rays on the unit. And if need be, they’d have done it.

So why was I there? It’s worth pointing out that the Black Lion is a large teaching hospital in the city centre. It’s one of the lucky ones, as the facilities it has are relatively modern. They can even do cardiac bypass – provided there’s a visiting perfusionist from overseas to work the machinery. This definitely wasn’t one of the small hospitals out in the country. I was there along with Fanus Dreyer, a consultant in General Surgery here in Dumfries, to teach on a critical care course that he organises. The College of Surgeons of East, Central and Southern Africa overseas the training of surgeons in that part of the world, and the critical care course is part of the mandatory requirements of their training. It is a charity – the aim is to make the course (along with the others which deal with surgical skills, and research) self-sustaining in each of the involved countries. The idea behind all of this is to try to improve the healthcare in that part of the world, by standardising surgical training, ensuring basic competencies etc, in an area where healthcare is sporadic and frequently poor or non-existent. Peri-operative and critical care is a vital part of that – being able to competently do an emergency bowel operation is nothing if the patient dies post-operatively from a lack of care.

Being out there and teaching on the course was an extraordinary experience. Having had the chance to spend some time in the actual clinical areas, to see how they worked on a day-to-day basis, helped hugely as it helped give me direction on what the course attendants needed. The junior surgeons on the course had excellent clinical knowledge and ability – the real difference was the approach. They have the same knowledge as our junior surgeons – medicine is universal, fundamentally – but what they needed was guidance on how to organise the approach to sick patients, and how to structure their management. They were highly motivated, and very keen to learn. But as I knew, they would often be working in facilities that had next to zero resources, hundreds of miles from Addis. There’s no value in teaching about the potential uses of dialysis in critical care in that sort of scenario – but there is enormous benefit in teaching about the approach to sepsis. Being able to manage a patient with a critically endangered airway with simple techniques would be life-saving – even in the most rural surgical facilities there will be some sort of scalpel.

And over the two days of the course, in the four days that I spent there, I realised that the simplicity of approach is something that we are still striving to teach here, even with the advanced facilities available to us. Their ICU looked primitive in comparison to the UK, but it was still striving to provide the basics of critical care. I realised I was teaching the same things that I teach here – sort out the basics and communicate well. Recognise illness, recognise dying, and treat each thing in turn, with compassion. These things are universal – and we shouldn’t allow a distraction with technology to cost us our humanity.

 Dave Christie is a Consultant Anaesthetist at NHS Dumfries and Galloway