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

Outpatient Parenteral Antimicrobial Therapy (OPAT) – from Cellulitis to Meningioma by Audrey Morris and Shirley Buchan

OPAT as a service has been in use in many countries for the last 30 years. It is a method of delivering intra-venous antimicrobial therapy in an outpatient setting, as an alternative to remaining an inpatient.

The advantages of providing this service for the patient means that they have a reduced hospital stay and can return home and rehabilitate in their own environment. In certain cases the patient can continue to work whilst receiving IV antimicrobial therapy therefore causing them minimal disruption to their daily life. Psychologically the patient feels happier, eats better, sleeps better and is more likely to recover quicker in their own home.

In DGRI the service started in 2012 under the “What if?” project. Its main aim at this point was treatment of non-complicated cellulitis leading to the reduction of patient admissions for short term IV antimicrobials. In the intervening years we have developed to become more involved with complicated infections requiring longer lengths of treatment i.e. up to 12 weeks of IV antimicrobials, but the patient is otherwise fit enough return home.

 
From January 2016 to the end of March 2017 we have released 1419 beds, an average of 3.2 per day. We have treated patients with Cellulitis, Osteomyelitis, Infected Joint Replacements, ESBL, UTI’s, Pseudomonas, Osteoradionecrosis, Lyme disease, Endocarditis, Discitis, Peripheral Vascular Disease, Actinomycosis, SAB, Urosepsis, E-Coli ESBL and Meningioma.

 

Why do we need OPAT?

 
In December 2015 a 30 year old man, who we will call John, was referred to us. He is a high functioning gentleman with Spina bifida who regularly competes in Shot Putt events, all over the World. He had been admitted 6 weeks previously with an infection of his hip. He was clinically improving and ready for home. His family were also keen for his discharge. On discharge John was keen to return to weekly training but due the nature of his infection this had to be put on hold. He attended the clinic daily for 12 weeks either at Dumfries or nearer his home at Castle Douglas Community Hospital, even attending on Christmas day. John had a Hickman line in-site and he decided that in order to assist us he would dress according to which lumen we were using, red top red lumen white top white lumen. He made a good recovery and was discharged from us a year ago. John still phones us now and again and had informed us he is back to full fitness, competing again and even throwing further than before. His one regret he told us, was that due to illness he was not selected for last year’s Paralympics but he is working hard to go the next event in 2020.
So why do we need OPAT? To give people like John an effective patient-focused service as good as inpatient care in an out-patient environment. Our aim is to provide patient centred care nearer to home. In some cases we train the patient or their relative/carer to administer IV antimicrobials in their own home, leading to increased independence and putting the patient at the centre of their own care.

 
Main aims of OPAT.

 
Clinical
To provide a high quality efficient clinical service using robust pathways, guidelines and protocols.
Reduce inpatient time and therefore reduce the risk of hospital acquired infections.
Develop the service to meet the changing demands on an overstretched service. With the opening of the new hospital imminent and the call for care nearer to home OPAT can help reduce demands on beds.
Patient.
Improved quality of life for patients. They eat better, sleep better and generally feel better in the own home environment.
Increase patient involvement in delivery of care, continuity of care and communication.
Provide ongoing support at home and utilise a pathway for re-admission if required.
Organisational.
Reduce the length of inpatient stays therefore utilising acute beds more efficiently.
Structured pathway from referral to discharge.
Staff development.

Patient journey from Inpatient to OPAT patient.

 
We aim to make the transition from inpatient to OPAT patient as quick and painless as possible but have to follow guidelines. Once a patient has been identified by their Consultant as a potential OPAT patient the first step is to complete an SBAR referral form (In Beacon use ‘search for document’ option). On receipt of this we visit the patient to assess them and their needs for OPAT. There are certain criteria which must be met but these are listed on our SBAR referral form and should be considered prior to referral.
The patient is then seen by our Consultant and the OPAT nurse team. If they are suitable and want to become an OPAT patient then the discharge process can begin.
So in summary OPAT provides patient centred care led by a small dedicated team. It clearly reduces the length of inpatient stays, which can be from 2 days to 12 weeks. Patients are very much involved in the method of delivery of their care, they can opt to be trained to do it themselves at home or we try to deliver care as near to their home as possible. We work around their commitments e.g. an elderly patient who has carers in the morning can get a later appointment or in the case of the patient who continues to work we can see them early in the morning to allow then to get to work. Patients feel better at home, they sleep better, eat better and psychologically feel better. They are more in control of their treatment and have continuity of care.

In the words of one of our patients we “made a bad situation better”.

Audrey Morris & Shirley Buchan are Clinical Nurse Specialists in the OPAT team.

Inspirational by Eddie Docherty

As the new Nursing, Midwifery and Allied Health Professions Executive Director I’ve now been in post since February 1st. As I write this blog almost exactly 4 months since starting, Id like to use this opportunity to introduce myself to as many staff as possible, and share some of my initial thoughts.

Prior to starting in NHS Dumfries and Galloway I’d worked in a number of health boards. Initially working in NHS Lanarkshire, in critical care and advanced practice, I moved to NHS Ayrshire and Arran in 2007, initially as nurse consultant for the acutely unwell adult, moving on to senior nurse consultant then associate nurse director. During this period I also worked in NHS Orkney as associate nurse director for 8 months, learning about the challenges and rewards of working in a remote and rural setting. For the year prior to commencing in D&G I worked as the lead nurse for East Ayrshire Integrated Joint Board and Associate Nurse Director for Primary care and Community Nursing. I’ve been incredibly lucky in my career, supported and developed by truly inspirational staff throughout the years, and have maintained roles which have allowed for direct patient contact through most of my time in nursing. Working with patients and staff has always been a key priority for me- its why I started nursing.

This link to inspirational staff continues as I’ve moved to NHS Dumfries and Galloway. At the last Twitter conversation held by the Chief Nursing Officer, Professor Fiona McQueen, one of the questions posed was: – What are you most proud of in your current role? I didn’t hesitate in my answer. I spoke of the compassion I see and hear about everyday from the staff in NHS D&G. The value of compassion is clearly embedded throughout our teams, from the Board to the staff directly delivering care to our patients. The key attitude of compassion in our delivery of care is reflected in the shared behaviours and attitudes I’ve seen in the last 4 months and is the springboard for the excellence in care we all strive for. Of course we aren’t perfect, but on the whole, compassion is being displayed. What I would ask everyone is this- are we compassionate to each other? Are you compassionate to yourself? The organisation is in a period of unprecedented change as we join an integrated world and build a new hospital. D&G couldn’t do just one major change at a time! The financial challenge is more acute than ever as we try to do the same, or even more, with less. If we are not compassionate towards ourselves and each other we may find ourselves overwhelmed and begin to lose touch with the reasons we all came into health care? Something to think about.

We often speak of our challenges, but clearly this period brings significant opportunities. I believe that each team hold the answers to most problems within their areas. The ability to adapt and innovate, to find solutions to complex problems, lie within the gift of all of our teams. If empowerment of staff is to truly have meaning then the staff have to feel empowered to enact change. The application of quality improvement methodology and an understanding of the theories of profound knowledge are the survival tools of the 21st century health care team. I have spoken to staff around our areas about the need for innovation and commonly say “The answer is in the room” It usually is. Someone within the area has the exact answer to the problem. If all staff members can see that improvement is something they do rather than have done to them, combined with the skills and understanding of the science of improvement, we can absolutely change the landscape we all work in.

Speaking to senior nursing, midwifery and AHP staff I have been incredibly impressed with the projects and ideas being developed, and in many areas there is great work being done in one key area: patient experience and satisfaction. For many years patient experience and satisfaction have been placed in the ‘nice to do’ category of work. As we move forward it is clear that the patient experiences of our systems are key to understanding how effective we are. There are many great local examples of this, from such areas as mental health, critical care, occupational therapy and medicine, but we haven’t yet shown our ability to do this at scale and share our learning across the entire organisation. I’m confident we will, following the discussions I’ve had with various teams, but it’s not something we can do without anymore. We look at, and report on, complaints as they come in and use them to look at individual areas of improvement, however, working in Scotland, we don’t spend any time looking at compliments and positive feedback. If we can capture the learning points from the good and bad episodes of the patient experience we can gain a better understanding of the impact we have in a balanced way.

I feel honoured to be Executive Director for Nursing, Midwifery and Allied Health Professions within NHS Dumfries and Galloway. Everywhere I look I see staff members that are committed to the care and well being of their patients and who place the person at the heart of everything they do. We have challenges and opportunities ahead of us and I’m absolutely convinced we can shape the future of our services together to meet the needs of our patients and improve the health of our communities.

Eddie Docherty is Director of Nursing at NHS Dumfries and Galloway

 

Sometimes you can’t see the wood for the trees… by Laura White

In September 2015 when my team and I were at the glittering Excellence in Care Awards ceremony at Easterbrook Hall after being nominated for not one, but two awards, I found myself pondering what it took for us to get from our lowest low to our highest high…

In early 2014 the Healthcare Environment Inspectorate walked into ICU unannounced and unearthed a catalogue of issues that turned our world upside down. In an instant our team went from a well-oiled machine to a rusty old tractor not knowing how to function.

The title of the blog sums up what we thought, as an organisation none of us could see what the Healthcare Inspectorate saw, we were in fact too close, too involved. For all our nursing care was never in question, we still doubted our abilities as nurses and wondered whether we were failing at the job we worked so hard at and got so much satisfaction from. The shame and embarrassment of having our place of work discussed in the newspapers and throughout the hospital, whilst trying to ‘keep it together’ still caring for critically ill patients and their families, was an overwhelmingly stressful time for all of us. The whole time we seemed to only have one question for each other…”How did this happen?” We put all our time and effort in to caring for our patients, did it matter that there wasn’t a record of the shelves being wiped down? Yes it did.

We listened to feedback, sought advice and did extensive research around the way we did things. We really dug deep and relearned our roles to include a vast new array of cleaning and infection control measures. It took months of liaising with the Infection Control Team, Domestic Services, Medics, Management, and Estates to name a few. There was clarification sought for EVERYTHING, from everyday things like bed bathing a patient to the fear of the effects of excessive Actichlor on our health.

The transition period between the inspection and the refurbishment of ICU put strain on everyone involved, however during this time it became apparent how well we pulled together, worked as a team and were committed to putting the broken pieces back together in order to be the best we could be. Staff came in to help in their own time, worked extra shifts and there was actually a lot of excitement about working in the newly refurbished unit, it was like a blank canvas. Don’t get me wrong, it wasn’t all plain sailing, the months following the inspection included periods of extremely low staff morale, increased sickness absence and an emotionally fragile workforce who at times found it difficult to talk about what happened to us. We eventually found that discussing the experience with colleagues and other professionals did help to rid us of some of the mixed emotions we were struggling with. Thankfully there did come a time when we realised we had to stop looking back and start looking forward and take the good from a bad situation.

We slowly began to regain confidence in ourselves and became very proud of our ‘new’ unit. During this time it became clear just how many of us had ‘a touch of OCD’! There were times when you could probably have eaten your dinner off the floor in ICU, and we just stopped short of putting Actichlor in our cereal! We now work relentlessly keeping our very extensive cleaning schedule up to date and everyone is involved in adhering to our philosophy of cleanliness, God help anyone who tries to put their gloves and aprons in a domestic stream waste bin! We really are acutely aware of everything now.

We knew that changing habits would be the hardest part but also that these changes had to be sustainable and over time these changes have become the new norm for us. These are the changes which are now the norm to the new staff that have joined us since the inspection and will undoubtedly evolve and develop in the future, as everything does in nursing.  The HEI inspectors have since returned to the unit and saw a drastic improvement in all aspects of cleanliness, which we knew they would.

Winning the Excellence in Care award for Infection Prevention in a way closed the chapter on the hard times we faced in 2014 and reinforced to us how we took the best from it and got to where we are today. We are dedicated, committed and knowledgeable in Infection Prevention and have regained the confidence we lost when our unit was put under the microscope.

As the saying goes “what doesn’t kill you makes you stronger”.

Laura White is the Senior Charge Nurse for ICU and Surgical HDU at DGRI

 

12 days……….and so much more by the Patient Safety Team

Sing this to the tune of ‘The 12 Days of Christmas’. Go on you know you want to!!

On the 1^st day of Christmas the safety team said to me A pledge to be harm free.

We are all working towards achieving the aims of the Scottish Patient Safety Programme and you can help us achieve this.

http://www.scottishpatientsafetyprogramme.scot.nhs.uk/about-us

On the 2^nd day of Christmas the safety team said to me 2 improvement advisors, 2 improvement trainees and a couple of Project Officers to support and guide you to make patient care even safer.

For more information on Patient Safety and Improvement team contact us on ext 34138/34154.

On the 3^rd day of Christmas the safety team said to me 3 leaders on a walk round.

There have been 37 leadership walk rounds this year across NHS Dumfries and Galloway. These provide an opportunity for frontline staff to meet with the senior management team and have a structured conversation. This helps to keep leaders in touch with issues for frontline staff that help deliver safe, effective, person centred care and to promote and share areas of good practice.

On the 4th day of Christmas the safety team said to me Get it Right For Every Child with: 4 Early Years work streams.

The early years collaborative aims to make Scotland the best place to grow up. It is the first collaborative of its kind in the world that incorporates health, education and social care. There is a huge amount of work going on across our region to improve the care given to babies, children and families.

Take inspiration from this short video showing how nursery children are becoming involved.    http://vimeo.com/102914044

On the 5^th day of Christmas the safety team said to me (lets improve handovers with…) 5 Handover questions.

November saw our 1^st handover week in NHS D and G. We are the 1^st board to focus our improvement work on handovers. We have recognised handover as a priority and for this reason handover has been added to the 9 point of care priorities for DGRI. We are also leading the way for national improvements. Interested? Them please get in touch and

Ask yourself these 5 questions next time you pass over information and see if you can improve the quality of the handover ….

On the 6^th day of Christmas the safety team said to me sock it to sepsis! Sepsis 6 saves lives; so can you!

The national sepsis awareness day was promoted in DGRI in September. Craig Stobo (from F.E.A.T) came to talk about his very personal account of sepsis. Both he and his pregnant wife contracted Sepsis, Craig survived but very sadly his wife and child did not. Craig also ‘stole shamelessly’ from NHS D and G the idea of the farthest travelled ‘sock it to sepsis’ socks. Here are some of ours. Any guesses as to where we travelled? A real conversation starter as you can imagine!

On the 7^th day of Christmas the safety team said to me 7 improvement programmes.

The patient safety and improvement team support all of these programmes

• We manage the programmes
• provide local learning events
• coach and teach people
• offer support and advice
• link with national teams
• provide monthly reports to drive improvement at ward level
• Provide reports for various management boards.

PHEW! Most importantly we want to remain visible to those providing the care and those working on improvements.

On the 8^th day of Christmas the safety team said to me 8 (hundred) ICU days between.

Well we thought we were onto a winner here with ICU having 888 days between a central line blood stream infection. However they are actually even better with 994 days today! Almost at 1000 days!!!!   What a fantastic achievement. Well done to all involved!!!!

On the 9^th day of Christmas the safety team said to me 9 point of care priorities (plus one).

Surgical site infections                                            Falls                    

Catheter Associated Urinary Tract Infections         Pressure Ulcers

Sepsis                                                                      Safer use of medicines

Heart Failure                                                             Venous thrombo embolism

Deteriorating patient                                                 Handover

Improvement teams have been set up to drive improvement in these areas. If you are interested in any of the above or have some great ideas please contact us and we will put you in contact with the clinical lead.

On the 10^th day of Christmas the safety team said to me 10 safety essentials in routine practice.

These are the areas of work that have been the focus since the start of the Scottish Patient Safety Programme in 2008. The trainee improvement advisors have been visiting all areas in DGRI to validate the data around these essentials and have been supporting teams to plan for the future.

11^th day of Christmas the safety team said to me 11 local learning events.

In 2014 we provided 11 local learning events …WOW!!!!!!  Our team works extremely hard to ensure we inspire, motivate and provide you with the tools to enable you to make improvements for the people you care for.

Feedback has included ‘fantastic event, very well organised’, ‘great to have time out of the ward to focus on improvements’, ‘great day, everyone went away with a game plan and the tools to implement it’.

On the 12^th day of Christmas the safety team said to me 12 months of data.

Measuring helps us to understand whether our changes impact on the goal we have set. As an improvement team our goal was to reduce the number of areas in DGRI not reporting data. The results are shown in the run chart below.

We have demonstrated that by increasing the visibility and accessibility of the team we were able to significantly improve. Well done to all areas. 

We would like to take this opportunity to thank everyone for your hard work and continued support.

 

 

 

Have a very merry Christmas and a happy new year.

From everyone in the Patient Safety and Improvement Team.

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

Happy birthday NHS!!!!! by @shazmcgarva & @Emmcg2

Imagine health care free from harm……

Today is most famously associated with American Independence day but it is also the 66^th birthday of the NHS (well ok, its tomorrow actually) and spookily the 66^th blog from @dghealth.   So lets reflect on the” good old days” and the stories that make the younger generation take a sharp intake of breath and say OMG/SHUT UP!!!!

1948 when it all began – a year where it was common practice to rub alcohol into healthy skin to prevent pressure ulcers (probably followed by a quick swig out of the bottle from the nurse giving this care!)

1978 –moving on to perhaps a more memorial pastime for those still awaiting their own 66^th birthday. Imagine a life pre picolax or moviprep when the alternative was two big tubes, a jug and a 3-5 litre bowel washout!

At the time this wasn’t wrong, it was just how things had always been done. But we are now in a time of innovative, evidence based practice and do not want to hear the well versed “its aye been done like that here”.

We are staff nurses currently doing a secondment as trainee improvement advisors. We have always had a passion for making things better and we are both well known for being safety geeks!

We are here to link people together, support everyone and show that quality improvement can be simple, fun and very rewarding.

 

In April we were lucky enough to attend the International Forum in Quality and Safety in Healthcare in Paris which was an amazing experience.  3000 people from over 75 countries came together to share experiences and learning in quality improvement.  We wore our Scottish flag badges with pride and were quickly given the title of ‘the tartan twins’! Meeting Don Berwick (godfather of Patient Safety) was the highlight!!

One very clear message from Paris was that Scotland are world leaders in healthcare quality improvement. We are the 1st country in the world to adopt a nationwide approach to patient safety and when are we ever 1^st at any team sport? (Andy has let us down, our footie team cannot even qualify for the World Cup finals and even @jefface3’s precious Welsh rugby team are mince.)

What made our pride blossom even further was Maureen Bisognano CEO of IHI (Institute of Healthcare Improvement in America) speaking very highly of the NHS Scotland and quoting ”I am coming to Scotland if I get ill”. 

The world is watching so lets stand tall, be proud and give them something to be in awe of.

Those of you who have had the pleasure of our company will know we are passionate about creating a happy, positive environment and want to encourage people to be proactive and not reactive.

Have you ever said?

• “I can change that?”
• “We can make this better?”
• “I have an idea”

and wondered where to start? Then in true Ghostbusters style we are the ones to call…..

So, a few things to think about to help with the quality improvements you want to make

• Don’t get lost in the jargon
• Follow you instinct
• Communicate with your team
• Take small steps

Independently we all try our best but together we can get it right for every person, every time. Deming was a quality improvement guru best known for revolutionising the Japanese car industry.   His philosophy is one of cooperation and continual improvement and his famous quote is shown here.

If we all take responsibility and the possibilities are endless. Let’s keep believing and keep fighting as Bevan, the founder of the NHS would want.

Here’s to the next 66 years.

Sharon McGarva and Emma McGauchie are Staff Nurses and Improvement Advisors with the Patient Safety Team at NHS Dumfries and Galloway. Sharron works tuesday and wednesday and Emma works wednesday and  thursday. Call us on 34138 and follow us on twitter @shazmcgarva @emmamcg2

 

 

 

 

The Value of Values by Julie Booth

Fred Lee’s book “If Disney ran your hospital 9 ½ things you would differently” argues that nobody has ‘moved the cheese’ when it comes to things that matter most to the patient or what motivates and keeps good employees. Whilst healthcare can’t be compared to Disney there is no denying that as an organisation it is amongst the top in providing excellent service to its guests

With that statement in mind let my first blog begin.

Its hard to imagine a more magical place than Walt Disney World, yet its secret is not magic pixie dust. It is its well trained, enthusiastic and motivated workforce.

 As Walt Disney himself realized

 “you can dream, create and design the most wonderful place in the world, but it takes people to make the dream a reality”.

Whilst there is no doubt that the patient is at the centre of healthcare, I had the notion that as we prepare to “create and design the most the wonderful place “ in the form the new Dumfries and Galloway Royal Infirmary, it would be an opportunity to reflect on our own values and behaviours.

Within NHS Dumfries and Galloway there is no disputing that we have an excellent workforce that, combined, have thousands of years of service. Yet time marches on (even though in my head I still think I am in my twenties) and this workforce is diminishing through retirements. So how do we ensure that the future workforce that we are recruiting continues this legacy? 

The high profile case of care failure at Mid Staffordshire Foundation Trust and the subsequent Francis Report that followed, focused on the quality of care. Within the Francis Report the importance of  values ismentioned no fewer than 49 times. Although it contained a raft of recommendations one key area commented on was that staff recruited into the NHS should have their values and behaviours tested.

Driven by the need to ensure quality care and person centred outcomes there has been a huge increase in the concept of values based recruitment. 

Values based recruitment (VBR) is defined as an approach which attracts and selects employees on the basis that their individual values and behaviours align with the values of the NHS constitution. VBR is about using a range of tools and techniques to help employee recruit staff who have the right attitudes and values for the job.

NHS VALUES

Now where does Disney fit into this? At Disney they audition prospective staff. This starts with a pre interview process which clearly outlines Disney’s expectations of its future employees (or cast members as they are known) which align with its core values. It is at this stage some prospective candidates withdraw from the face to face interview process.

So how did I get so absorbed with values and standards. Over a year ago as part of a development project which linked to various initiatives such as the 15 Steps Campaign and Leading Excellence in Care as a team we developed our ward based values and standards

The starting point was asking three simple questions:

What did the ward look like?

What did the ward feel like?

What did the ward sound like?

The responses from everyone were then framed around the Healthcare Quality Strategy for NHS Scotland  

The purpose of these values and standards is to enable us as a team to have a framework for behaviour within our ward which will empower staff to take action and challenge poor behaviours. It has been interesting whilst researching the initial project and for this blog that various NHS and healthcare organisations are moving to developing their own set of values and behaviours.

Given that 50% of complaints received in the NHS involve issues with attitude and behaviour is it time that we reflect on our own attitudes and behaviours!

I will end this blog on the following quotes

“Much of what needs to be done does not require additional financial resources, but changes in attitudes, culture, values and behaviour”. (Francis, 2013)

 

 Julie Booth is the Senior Charge Nurse on Ward 3 Dumfries and Galloway Royal Infirmary

 

 

 

 

The KIS of life by @NeilGKelly

What a great acronym!  It opens the way to multiple catch phrases some of which convey the meaning or intention better than others.  The key letter is of course the ‘I’ for it is the information that is key and the sharing that makes it function.  In a world where paranoia about personal information is rife and misdemeanours make frequent headlines, effective sharing of appropriate information about the people we care for can feel challenging.  However we all know that patients expect those who care for them to have details of their problems, tests and medication. They are often surprised to learn how poorly this information is shared and frustrated by having to answer the same set of questions time and again.

Ae fond KIS

Scotland took the bold step in 2006 and set up the universal Emergency Care Summary (ECS) which made available a small set of data about patients including details of allergies adverse drug reactions and current medication as recorded in the General Practice record.  Following wide consultation within the NHS in Scotland and with the wider public, it was agreed that permission to view this information would be ‘at the time’ the patient presented looking for help.  There was, of course, an opt out option for patients (exercised  by only 0.01% of the population) which stopped any information being sent from the GP practice to the central ECS store.  The initial program was designed to support emergency and unscheduled care. However it quickly became apparent it had application in the wider acute hospital setting and in 2012 it was permitted to access the data to support medicines reconciliation processes for any patients in hospital.  It was however the limitations of the dataset that prompted first the development and the electronic palliative care summary (ePCS) and more recently the Key Information Summary (KIS).

Beyond the KIS of Death

As we struggle with caring for ever increasing numbers of older and frailer people, many of whom have multiple medical problems, it was sometimes difficult to pause for long enough to reflect with the patient about their expectations for the future and what care and support they would really like. Even when we did find the time it was often difficult to record and share this information.  This gap was partly filled by an increasing move to ‘anticipatory care planning’ particularly with patients who were likely to have a flare up of their problem and needed to know what to do.  It is only with the advent of the KIS that we now have an effective mechanism for the sharing of this information.

 

 

It started with a KIS

Recording patient’s wishes is now very straight forward and all General Practices are able to do this as part of the day to day job in their practice computer systems.  The value of anticipatory care planning has been recognised with it being incorporated into the GP Contract and part of the deal is ensuring the KIS is completed and sent to the central store so the information can be accessed by those involved in providing care should the need arise.  At present patients are identified as being at risk of an exacerbation of their medical problem and a possible hospital admission and will be assessed and the relevant information recorded.  This will include details of carers, current clinical and caring issues, medication, facilities and equipment available in the patient’s home, care plans, place of care considerations, views on resuscitation and any arrangements in place for palliative care. This is an extensive list of possible information which can be recorded although it is not essential to record it all before some is shared.  It is also possible to review and revise the summary as time goes by and in particular add any special note which could be relevant in an out of hours situation.  The more sensitive nature of much of this information means the consent to share is sought at the point of recording before it is uploaded into the central store.  Without this consent the data cannot be shared.

KIS me quick

So what is the point of telling you all this?  Well firstly if you or your patients like the idea of having a Key Information Summary you need to ask your GP practice about how this can be set up and encourage them to do it. As time passes the numbers of patients with a KIS is growing and they will become more available.  If you are a clinician working in an area delivering unscheduled care or in any ward or clinic setting in the hospital you need to get in the habit of asking the patient if they have a KIS or checking to see if one is there.  Communication is only effective when the sent message is read.  If you are not sure how to find them you need to ensure you find out and get the appropriate access set up and passwords organised. If the KIS needs to be altered as a result of a visit to the hospital some feedback to the practice on what needs to be updated would be helpful and if there hasn’t been one set up advise the patient to ask for one.

Full on KIS

This is a project which is evolving and growing all the time but will start to bridge the information chasm between primary and secondary care.  Let’s face it, there is nothing better than a full on KIS.

 

Dr Neil Kelly is a GP in Annan and is Clinical Lead for Annandale and Eskdale LHP.

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……