Summer of Celebrations Part 1 by the SPSP Team

Reflections from Improvement Advisor, Paul Sammons

As an improvement advisor with no clinical background, I work closely with people who want to change things for the better, and who know their teams and roles well, but who don’t always have the skills to structure improvement work.  They may not have the capability to use the ‘model for improvement’ – a proven methodology that helps focus aims, identify change ideas and to measure what difference if any, a change actually makes.  Having completed the Scottish Improvement Leader programme (ScIL) in 2015/16 I do have that capability which, when brought together with practitioners who have a will and an urgency to change things for the better, can be very powerful.   I enjoy the privilege of working alongside, enabling, and learning from some fantastic individuals and teams who strive to improve services of their patients and service users.

Some of these moments will be with me forever – I recall working with Dr. Grecy Bell to motivate and enthuse a group of primary care staff about Medicines Reconciliation – not the most lively of topics, but Grecy created the ‘med rec fairy’ concept – a local champion in each GP practice who would carry the ‘wand’ to ensure their team saw med rec as a vital part of their work.

Another great memory for me was working alongside Dr. Mark Colwell – we teamed up to lead a local dental improvement collaborative, creating a structure around better decision making and treatment planning for patients on high risk medication.  Mark showed me how ceding power to his team enabled a flat hierarchy where all team members were able to critically observe each other’s practices, and contribute towards a more collaborative approach to patient care.   With the practices involved we improved much – starting even before patients arrived for their appointments – maximising the use of text messaging, moving through the patient’s journey. The work involved reception staff to engage with patients to obtain highest quality patient histories, and enabling dental nurses to observe and to prompt their bosses into even better patient conversations.

I have observed people in health and social care who once invigorated with a little QI magic, will stop at nothing to deliver better care, and who seem to have the energy to drive improvement forward in the most unlikely circumstances.  I spend time with Julia Hutchison in DG Smile dental practice, and I leave with a real spring in my step.  What is it about these people and all of the others that I get to support that is courageous, different and special?  I do reflect on a wee video that helps me answer that question.  You might like it too.  It is available on YouTube and can be viewed here.

I believe that attention to QI capability and capacity is key to improving services, and that we will see this develop through our local ever-expanding network of QI capable practitioners.  In the near future we will expand our practitioner level QI education and training – to ensure managers and leaders are well equipped to support, coach and supervise improvement projects.  In 2018/19 I plan to focus improvement efforts into the Women’s and Children’s teams as they settle into their new DGRI home.  I contribute to the improvement force field that is growing stronger across Dumfries and Galloway in health care and in social care.  I work as part of a small but wonderful team of hand-picked curious and quirky individuals – who quietly and tirelessly support each other, creating a synergy of support to our customers.  Perhaps you are close to that growing network of improvers – perhaps you feel the force like I do?  Well I do, and as I work with a widening spectrum of fabulous people I can honestly say that there is much joy in my work.  Long may it continue…

 

Handover by Barbara Tamburrini

How good do you think your handover technique is? 

Handover is an area of our clinical role which we all encounter regularly during our working day. We transfer patients between clinical environments and transfer clinical responsibilities at shift changes, all of which require handover actions.

As healthcare providers, we understand the importance of good handover communication and recognise the clear benefits of this for our patients and our delivery of optimal and safe clinical care. However, all too often, we are familiar with ineffective handover practice and witness the consequences of this on both the care delivered to patients and the outcomes they experience as a result.

This issue was highlighted to me quite a few years ago when inaccurate information passed on at a night time handover had a direct influence on my ability to provide an effective care response. A patient with hyperkalaemia which had yet to be fully assessed or treated, was handed over to the H@N team using an incorrect patient name. The correct patient could not be located resulting in a delay to the clinical response. During this time, an emergency call went out involving this patient and the error in handover communication became clear.

Sadly, the resuscitation attempt wasn’t successful and subsequent investigations confirmed that the incorrect handover was unlikely to have significantly contributed towards the outcome. The response time between handover and clinical assessment could certainly have been much better and this is what left its mark upon me. This delay could so easily have been avoided and could prove significant in another situation. Many years later, the impact of this episode remains vivid and this has taught me valuable lessons around the accuracy of handover communication which I use to enhance and improve handover practice wherever possible.

How do we do this though?

How do we improve something which is often taken for granted and which every health care facility nationwide finds challenging? Poor handover quality and a lack of standardisation have both been observed throughout UK healthcare facilities over recent years. In fact, it is acknowledged that this has led to medical errors, inappropriate investigations and prolonged in-patient admissions. This means we in NHS D&G are certainly not alone in needing to work on improving our handovers.

But does it make a difference that this is a national challenge? Well, the answer to that is probably No as well as Yes! It doesn’t matter whether we are isolated or whether every single facility in the world has issues with handover communication – we still need to address this and improve our practice.

Having said that, because this is a national and indeed international ‘hot potato’, there are many ideas, strategies and tools already developed and implemented in many hospitals which we can learn from and adapt for local use. So, yes, it does make a difference that this is such a widespread issue.

So the next question is – what can we do to improve our handovers?

The answer is – lots! We have many tools at our disposal which are widely available, of significant value and easily accessed but we often overlook the most basic of these…

We can, of course, use our verbal communication skills much more effectively to handover but this is much less effective when used in isolation. Research suggests only around 2.5% of patient data is retained through verbal-only handover methods. However, this increases to as much as 99% when a printed, structured and regularly updated handover containing all relevant clinical information is utilized. It’s really that simple!

The SBAR-R approach (Situation, Background, Assessment, Recommendations, Review) provides us with a platform to structure clinical communication to ensure it is concise, relevant and accurate and is delivered and received in an effective manner.

This last bit, the review, is crucial since we have all been in the situation where we have delivered what we feel is appropriate information but this may not have been correctly received for whatever reason…

Improving our clinical handovers doesn’t just involve using an SBAR-R approach correctly though. NHS D&G have formed a multidisciplinary handover group to encourage, support and improve handover practice throughout the organisation. The group have set the aim of achieving, by August 2019, 95% of patient handovers between clinical teams and shifts across NHSDG which contain all the relevant information required.

To achieve this, the group want to develop and launch an organisational handover strategy. Additionally, the group will engage with clinical teams to encourage the formulation of protocols and procedures which are standardised across the organisation whilst remaining specific to each clinical area.

The handover group are hosting a ‘Safer Handover Week’ from 24^th to 28^th November involving presentations, educational drop-ins and information sessions to raise awareness of handover practice and its improvement in clinical areas. The week will culminate in a full day event on 28^th November in Easterbrook Hall where the handover strategy will be launched and high profile national speakers will deliver presentations. The day will also involve presentations highlighting local initiatives, a storyboard competition and practical sessions to begin engagement with this improvement process.

Could you benefit from this valuable local event? I would suggest the answer is most definitely YES!

The handover group is looking for all staff, whatever your departmental area to come along to the Safer Handover Week sessions and learn more. We are also looking for multidisciplinary teams of ideally 3 people from each clinical area to attend the Handover Day. Become actively involved in improving handover practice across the organisation and crucially, you will have a direct, positive impact on improving handover practice in your own clinical area.

So, you’ve heard a very real story of the impact of poor handover communication upon our ability to practice effectively and you’ve seen ways in which we can improve this to deliver safer, higher quality care for our patients.

Therefore, my final question to you is more of a challenge. Can you really afford not to attend the Safer Handover Week?

For more information contact: Jean Robson, Director of Medical Education or Rebecca Henderson (x34257 or rebecca.henderson@nhs.net)

Barbara Tamburrini is an Advanced Nurse Practitioner for NHS Dumfries and Galloway

Medicine Safety Week – The 5 ‘Rs’

Last summer NHS Tayside ran a one week Medicine Safety Week organised by Arlene Coulson, Lead Clinical Pharmacist (@leena1208) which was a great success. The news filtered down to Dumfries and Galloway via several mediums including Twitter. It became apparent that there was an appetite to run a similar venture for the Doonhamers and so a team was assembled and planning began. At that time the last week in January seemed very far away but boy did it come round fast and here we are on the last day able to report on our success…

Day 1

 Our first lunchtime lecture was hosted by Mr Jeff Ace who introduced the week and Dr Andy Longmate, National Clinical Lead for Patient Safety, who impressed upon us the importance of medicines safety by using real life patient stories and some hard hitting data. University of the West of Scotland nursing student, Sarah Inglis, was presented with a prize for designing the Medicine Safety Week logo, which can be seen here.

Karen Hills, Karen Stitt, Emma Harper and Emma McGaughie undertook 1 minute MEDucation sessions by the canteen stand with passing nurses to identify from information word bubbles the most critical aspects of medication safety which was the logo of the week – Right medicine, Right dose, Right patient, Right route, Right time (The 5 ‘Rs’)

Laura Graham, Lydia Burnett, Daryl Pattie and Abby McFarlane spent the afternoon on the patient/carer stand in the main entrance handing our ‘Not Sure? It’s Ok to Ask’ cards. Key patient quotes – “I sometimes wonder whether they all do me any good“, “I feel my medicines are getting routine and should probably be reviewed“, “what matters to me is that they make me feel better”

Day 2

Day 2 focussed on High Risk Medicines. The lunchtime lecture was chaired by our Chief Pharmacist, Mr Mike Pratt, wearing his shower cap! There were four presentations on; safe insulin prescribing (Pam Young), anticoagulants (Artem Osipenko), vancomycin and gentamicin (Laura Graham) and antipsychotics (Wendy Ackroyd).

Once again the quartet of Karen Hills, Karen Stitt, Emma Harper and Sharron McGarver undertook 1 minute MEDucation sessions by the canteen stand with passing nurses to highlight the Learnpro training module on IV medicine administration.  An afternoon drop in session was for nursing staff on high risk medicines with practical exercises on recognising antibiotics which contain penicillin, insulin administration, warfarin chart details and good practice on IV medicine use.   Janice Cluckie & Gillian Burgess manned the patient/carer stand which highlighted that – “medicine wastage is a problem, if you stop using something then it all has to go in the bin”

Day 3

The topic on day 3 was Polypharmacy and the lunchtime lecture was a joint presentation by Dr Angus Cameron, Medical Director and Laura Graham.  Polypharmacy is a major issue particularly in an aging population with multiple co-morbidities and numerous ‘organ specific’ guidelines.

In the afternoon there was a Polypharmacy case study drop in session for nurses by prescribing support pharmacists Emily Kennedy, Gordon Loughran and Leanne Drummond in the education centre and Newton Stewart health centre. These were well attended by both primary & secondary care nurses and there were some useful discussions about cases and communication issues across the interface.  Gillian Burgess and Wendy Ackroyd attended the patient/carer stand with some comments from discussion including “How do I know if it is Ok to keep taking medicines longterm?” and “I find reviews of medicines are really useful”.

Day 4

The final ‘main topic’ of the week was Medicines Reconciliation, which has been recognised as one of the toughest patient safety issues to crack. Ken Donaldson (Chair of Safer Use of Medicines Network), Laura Graham and Janice Cluckie gave us a reminder of what Medicines Reconciliation is all about; the importance, the challenges and the way ahead. In the afternoon there was a drop in session highlighting some of the issues around med rec including examples to work through.  Margaret Marshall and Dr Charles Knoery were able to attend the patient/carer stand and hand out more of the patient advice cards ‘Not sure? It’s OK to Ask about your medicines’.

Day 5

Well that’s today so not much to say! At lunchtime we will be closing the week and presenting the Storyboard Competition winner, which I am delighted to announce, was “The introduction of an Orthopaedic Antimicrobial Ward Round” submitted by Susan Roberts on behalf of the Antimicrobial Management Team and Orthopaedic team.

All in all its been an excellent week with over 270 staff attending lectures and drop in sessions. The organising team would like to extend its heartfelt thanks to the ubiquitous Laura Graham (Clinical Pharmacist) who has gone above and beyond the call of duty by organising this week. She has worked tirelessly to ensure a good turnout at all events and, as you can see above, has presented almost every day – Thank You @lauralougraham7

So, when do we start organising the next one……