Posts from the “COVID-19 blogs” Category

Virtual events: feel the fear and do it anyway – Stuart Donald

Posted on October 26, 2020

The last eight months have seen Healthcare Improvement Scotland’s wealth of events and meetings move from actual to virtual. As someone used to delivering workshops face to face – despite an early fear of speaking in front of large groups – Interim Portfolio Lead for Strategic Planning Stuart Donald offers us some food for thought.

Earlier this year, on my way to deliver a fairly typical workshop in a fairly typical conference room, I started thinking about my early experiences of speaking in front of large groups of people. As I’m sure is the case for most of us, this involved getting up in front of my high school English class and talking for five minutes about whatever generic topic our teacher could think of. Being an awkward, ridiculously self-conscious teenager, it wasn’t the most enjoyable experience I’ve ever had – particularly when it got to the point of panic attacks and vomiting.

If you’d told that kid that twenty odd years later he’d end up speaking to large groups of people for a living and that he’d actually enjoy it and be pretty good at it, he would probably have laughed in your face. Then vomited again.

Cutting a very long story short, over time and with a load of trial and error, the sheer terror of speaking to large groups of people gave way first to an ability to tolerate it, then to enjoying it and ultimately to approaching a level of competence. The nerves and self-doubt never go away, you just find ways to use them positively.

The point is that often the only way to take the fear out of something is to just get on and do it, that way you learn what works – and what doesn’t.

The days of getting a group of people into the same room to discuss, debate, share ideas, collaborate and generally put the world to rights might be a long time returning. For those of us whose work largely revolved around doing exactly that, we’ve had to figure out how we do it in an inclusive, yet physically distant way.

As Healthcare Improvement Scotland is an organisation that’s all about finding out what works well and what can be improved, a small team of us have pulled together learning from across the organisation to help us all get better at collaborating virtually. Here’s some of what we’ve learned.

Accept that it’s not the same as face to face

We’ve all experienced the joy of sitting staring at a blank flipchart while nobody answers the facilitator’s questions. Or the awkward ‘introduce yourself to the rest of the room’ and ‘share an interesting fact about yourself’ ice-breaker. Do we really need to recreate that virtually? I really, REALLY hope not.

Everyone knows the way we work now and in the future is going to change, so we need to adapt and maybe move out of our comfort zones a bit. For example, why do you need to run a virtual workshop ‘live’? Could you get the same, or better, outcomes by setting some sort of challenge to people and giving them a set time to complete it? Naturally there’s going to be risks and benefits to doing that, but that’s true of running something live too – if it’s going to achieve the outcomes you’re working towards, just do it.

Don’t be limited to one way of working. Try things out, keep doing what works, stop doing what doesn’t. By focussing on outcomes and the needs of our participants, we can design effective interventions that work for us.

How will you make sure everyone can participate?

Any time we run any kind of meeting or event we should always be thinking about accessibility. Virtual collaborations are no different. For example, you don’t need to be thinking about physical access to a venue, but you do still need to think about things like how people with sensory impairments can participate.

It’s important to remember that accessibility also means your participants having access to technology and the confidence to use it. As we get more and more used to communicating virtually, we need to make sure we’re not putting up unnecessary technological barriers for our participants as well. For example, do you know if some people might have to join your session using a smartphone rather than a PC or laptop? How does that change the experience for them? What do you need to do to make sure they can still participate?

It’s a team effort

You could certainly try and run a virtual meeting or event yourself, but I wouldn’t recommend it! What if your technology fails, the cat jumps on your keyboard and disconnects you from the session, or a child really must tell you RIGHT NOW all about the episode of Paw Patrol they’ve just watched? Take it from me, these things happen…

There are lots of eventualities and you can’t always prepare for them all, but as a minimum a good virtual session needs a delivery team. This includes someone to lead and facilitate the session, a backup facilitator, someone to monitor the chat box and respond to comments or flag them to the facilitator and someone who can support participants who need any extra help or IT troubleshooting (and potentially, someone who can provide 1-2-1 support throughout to anyone who couldn’t otherwise participate). The bigger the meeting or event, the bigger the delivery team you’ll need. In Healthcare Improvement Scotland we’re very fortunate to have so many talented and helpful colleagues to help deliver virtual meetings and events, so make the most of them.

Share your learning

As with everything we do, we should be seeking feedback and learning to help us improve for next time. Ask your participants, have a debrief amongst your delivery group, be honest with yourself about what worked well, what could have been better, and what you would do differently next time. Then share those insights with everyone else.

I’m not going to lie, I really miss presenting to a room full of people. The thought that it could be six months or more before I get to experience that buzz again is a bit sad. Delivering things virtually is definitely a different thing altogether, but it’s been great to learn about how as an organisation we’ve already started to embrace it, and to help pull what we’ve learned so far into something we can all keep building on.

Stuart Donald is Interim Portfolio Lead for Strategic Planning, within the Transformational Redesign Unit in the ihub

More information

For more information on the work of the Transformational Redesign Unit visit the ihub website.

Categories: COVID-19 blogs

Value of being clear when it comes to cancer treatment – Dr Alastair Lawrie

Posted on October 8, 2020

As we publish guidance on consent for cancer care, Consultant Haematologist Dr Alastair Lawrie tells us how important it is to ensure patients are well informed about their treatment and what it entails – and looks at where the guidance will go next, following on from the COVID-19 pandemic.

It’s May 2020, and I am phoning an elderly patient I’ve known for several years. She has chronic lymphocytic leukaemia, a common, slow-growing blood cancer. She was diagnosed incidentally after having blood samples taken for another issue and has been well until recently. Like many patients, she has been shielding at home and has not left the house since February. Her GP has contacted me highlighting concerns about weight loss and fatigue. They arranged a blood test for her at home, and this shows progression with deterioration in her blood counts. She almost certainly has reached the need for treatment that cannot wait until the COVID-19 pandemic is over.

We chat about her blood tests and condition generally. She is struggling but is clearly terrified of coming to hospital. We had discussed chemotherapy before, and she is particularly worried about the risk of regular intravenous treatments bringing her into contact with others, as well as her risk of infection generally. I explain that temporary approval has been given in Scotland during coronavirus to use a newer, oral chemotherapy treatment to treat her leukaemia. It will also increase her risk of infection, but will greatly reduce her need to leave the house or attend hospital. We have not previously discussed this medication before and she has lots of questions.

Clarity and consent are key

When it comes to cancer treatment, it’s not surprising that patients like the one in this case have a lot of questions. While Systemic Anti-Cancer Therapy (SACT) – chemotherapy – has been widely used for years, it’s still a high risk treatment with a lot of potential side effects. Yet although written consent for chemotherapy is not specifically required by law, it is widely regarded as best practice in support of a full discussion with the patient about the intended benefits and possible risks of a treatment. We know from regular audit of chemotherapy services in Scotland that current practice is good. However, it’s also been identified that there is wide variation in the approaches that individual health boards employ to seek written consent for chemotherapy.

In 2018, the Scottish Cancer Taskforce asked Healthcare Improvement Scotland to review this issue, with the aim of identifying best practice and standardising this across Scotland. A working group comprising medical, nursing and pharmacy representation from across Scotland examined and compared various approaches.

The approach endorsed by the group was to use regimen-specific consent forms. These are already widely in use in England, where a ‘library’ of over 200 custom-designed consent forms for each individual chemotherapy combination or regimen has been created. The forms have been developed by cancer clinicians at Guy’s and St Thomas’ Hospital in London and more recently, this project has been funded and supported nationally by Cancer Research UK. A key aim of this approach to improve consistency and clarity in the communication with patients. This improves shared decision-making, and makes the process of consent more patient-centred. Feedback from patients who have used the forms has been positive.

Focussing on the impact on the individual

Central to the need for clarity and consent is the need to ensure that the discussion and risks are individualised to the patient. One example given of this is the risk of nerve damage from chemotherapy, which may have different implications for a concert pianist, for example, as opposed to other people. In practice, I have found that the new forms help with this, by offering a clearer and more consistent summary of what a particular chemotherapy regimen will involve. This then helps elicit the concerns and questions of particular importance to that patient.

I’m optimistic that the CRUK regimen-specific forms will be a positive step once implemented across Scotland. The coronavirus pandemic has resulted in radical changes to many aspects of clinical work. Remote consultations and paperless working are now moving from an aspiration to the standard of care. These new forms already help with remote consultation and work is already under way to explore creation of electronic consent forms.

A successful outcome

And my patient? Well, she was receptive to discussions about her proposed treatment, both through the phone call with me and a follow-up call with a clinical nurse specialist. An information booklet on the treatment was sent to her by post, together with a consent form specific to that medication. We debated initiating the treatment remotely – a friend agreed to collect the medication – but in the end, she decided to attend clinic for in-person assessment and to receive her first prescription. She responded well, with minimal side-effects and has been treated remotely since then and continues on treatment. For her, and for me as her clinician, the opportunity to discuss the benefits and risks of her proposed treatment, particularly given her nervousness about attending hospital during this unprecedented time, cannot be overstated. To see such discussion and consent formalised for patients across Scotland will, I believe, be a benefit to all.

Dr Alastair Lawrie is a Consultant Haematologist at Aberdeen Royal Infirmary.

More information

Visit the Healthcare Improvement Scotland website to read a news article on this work and to access the latest guidance.

Categories: COVID-19 blogs

Total Recall – Gail goes from her new home back to Homeless – Gail McDonald

Posted on October 6, 2020

While the COVID pandemic has hit everyone hard, for those who are homeless the challenges have been even greater, as Senior Inspector Gail McDonald tells us.

Usually, you take up a secondment expecting you’re going to be working somewhere else for a while and you mentally prepare yourself for the changes. What you don’t expect is what happened to me. After 14 years working in Homeless Health Services, towards the end of last year I was offered a two year secondment with Healthcare Improvement Scotland as a Senior Inspector on the Adult Support and Protection (ASP) Inspection Programme. And I thought that would be it for the next two years.

But after just four months, my old colleagues were unexpectedly seeing my face again as I returned to my substantive post because of the global pandemic. It was certainly something neither me nor my colleagues could ever have predicted!

Making sure the support is there

With my old role as Team Lead for Occupational Therapy and Mental Health Teams already backfilled, there was no obvious place for me to slot into at first, but I was happy to return to the work I love, with many valued colleagues, and I was willing to pick up whatever I needed to. Ultimately, I took on a role as Occupational Therapy and Admin Team Lead and had a role in the service recovery and social distancing planning in the building.

My first days back were a bit odd, trying to deal with the sudden shift from one role to another. But in many ways we were all in the same boat: it was the early days of lockdown so the atmosphere and environment was one of uncertainty, change, but most of all of support. Staff from all teams were really pulling together to ensure the delivery of essential services for homeless people was maintained. There was a focus on mental health care and treatment, urgent General Practitioner services, wound care, needle exchange, sexual health and opiate replacement treatments. The city had already undertaken emergency action to accommodate any individuals who were rough sleeping or in night shelters where isolation and social distancing was not possible, including individuals with no recourse to public funds. This was to ensure people could keep safe and comply with isolation and ‘lockdown’ recommendations. People were primarily accommodated in city centre hotels with food parcels or meals being delivered daily.

The need to maintain contact

In the initial weeks the expectation was that those who were homeless would be disproportionately affected by COVID-19. This population have poorer health, live in more communal-type settings and are arguably less able to follow some of the restrictions of lockdown due to health and social functioning issues. The obvious conclusion, therefore, was that the death rate would be higher. Service delivery planning initially became about reducing and restricting contact for the safety of service users and staff alike, with the exception of the mental health team whose contact remained consistent due to the level of vulnerability of their service users.

However, it soon became clear that the risks of no contact with service users outweighed the risks of COVID- 19. Individuals who are homeless are dealing with a whole variety of issues beyond and arguably more severe than COVID-19. Day centres and visiting supports were closed, so social and community supports were significantly reduced. We had to set up alternatives quickly, ranging from daily visits or phone calls to weekly or a minimum of monthly face to face contact. There was a focus on assertive outreach and those service users who had no phone were issued with pay as you go mobiles. This low cost intervention proved to be hugely valuable to both service users and staff. Service users valued the means to stay in touch and have continued engagement. Health and social care interventions increased due to staff being able to contact them. Even service users who had been typically reluctant to engage with health were open and inviting increased contact – a real indication that the situation was taking its toll on how people were feeling.

Breaking down barriers

In general the situation in relation to COVID-19 strengthened the need and justification for a health service with reduced barriers and an assertive outreach approach. Much of the work was adapted or an extension to what already existed. The addiction service probably experienced the most significant learning curve as they had to work out how to continue to support those undergoing opioid replacement therapy, such as treatment with methadone. For most people, the answer was to give them longer prescriptions and more take home doses, rather than their usual daily dose at a pharmacy. But this was only undertaken after a risk assessment had been carried out. We did, of course, have a lot of service users who went through very hard times due to COVID-19. Some were not allowed back into their accommodation as they were not following lockdown rules. Drug debts increased for some, as there were far fewer opportunities for begging. Treatments for conditions like hepatitis C were suspended. Contact with children was limited and rights to have access reviewed were suspended due to courts not sitting. And, just like the rest of us, there was the sense of increased isolation from family and friends.

There was undoubtedly an increase in homeless presentations over this time, but with registered social landlords not accepting referrals and there being virtually no movement ‘out’ of homelessness into permanent accommodation, a huge block was created in the system. This will impact homeless people for months beyond this initial lockdown, and the demand on all the additional support services is continuing to grow.

A learning experience

While what I’ve seen for individuals affected by homelessness in the past few months has been some of the toughest in my career in the past few years, I’ve also learned a lot. I’ve seen first-hand how service delivery can adapt and evolve in response to a unique situation. I’ve seen a renewed commitment to challenging structured, non-flexible health care delivery. And I’ve seen the willingness and supportive nature of most staff when push comes to shove.

It’s been intense, and it’s taken me a couple of weeks to wind down from, but I’m glad to be back at Healthcare Improvement Scotland and looking forward to putting what I’ve learned to good use in the Adult Support and Protection (ASP) Inspection Programme.

More information

Visit the Healthcare Improvement Scotland website for information on our response to COVID-19.

Categories: COVID-19 blogs

Devices and data – keeping Scotland connected – Wendy McDougall

Posted on October 2, 2020

During lockdown, those people who were digitally excluded became even more isolated. Wendy McDougall, Engagement Officer in Healthcare Improvement Scotland – Community Engagement explains how her team helped keep people connected.

When the world went into lockdown, our lives moved online – even accessing health and care services was online, along with grocery shopping and only being able to see loved ones through a video call. As a result, the Scottish Government quickly implemented a £5million initiative called Connecting Scotland to get 9,000 vulnerable households online. The idea being that those who are most vulnerable across our communities will be provided with a device or training that enables them to connect with health and care services, as well as other people in their community and family that may be further afield.

There were eight teams working across the country on the Connecting Scotland initiative and our role was to find community venues that could be used for training on how to use digital equipment and distribute the devices, should they be required. We were an important part of a big jigsaw!

To do this, each engagement office across the 14 NHS board areas spent a number of weeks contacting their local third sector and community group networks. This was a great opportunity for me as a new recruit to pick up the phone and, not only introduce myself as the new Engagement Officer for Forth Valley but, more importantly, actively listen to the challenges that are sadly being faced by people living in poverty and the resulting barriers they can face on a daily basis.

Over 60 community groups were contacted in the Forth Valley area alone and we still managed to make a number of new connections ranging from the Church of Scotland to bowling clubs. The conversations had such a positive impact on me, highlighting that organisations and volunteers were willing to do anything within their power to help others. It was so insightful being in a position to witness a strong sense of community spirit and strength in practice.

Another team was responsible for identifying those who were eligible for devices and data. To be eligible households had to be digitally excluded, on low incomes and be at risk of isolation due to the coronavirus pandemic. We were able to link our community groups to these other teams to ensure they could access the resources of the Connecting Scotland initiative.

Once eligible people or organisations who worked directly with eligible people were identified, they were given an internet-enabled device and were linked with a Digital Champion who provides six months of training and support over the phone.

Connecting Scotland has made a significant difference to the lives of thousands of people who were missing out on the benefits of being online. It has enabled them to stay connected to friends and family, be informed and entertained, access health and care services and able to continue learning and working.

In the Falkirk area, a community centre was able to get iPads, Chromebooks and MiFis, – a MiFi taps into mobile phone networks and uses this to create a mini wireless broadband cloud or hotspot. Four of the community centre leaders have been trained as Digital Champions via the Connecting Scotland initiative. The centre was also able to source funding for six further laptops and a printer to start a computer companions Sunday coffee club. This allowed people to be paired up and learn from each other. They also have an IT suite through the week for people to access and get help.

One of the community centre leaders commented that, “Many of our families are living in deprivation with no access to the internet and cannot afford digital equipment. One of our aims is to help bridge the attainment gap by providing the digital equipment needed to access education to local families. Another barrier our individuals are coming up against is lack of training and isolation. They are isolated in their homes or community and unable to use the internet to stay connected. With the equipment and mentoring we aim to create ‘inclusive growth’ online through Connecting Scotland. By tackling these barriers we are encouraging education, upskilling and contributing to the community which aligns with the national framework.”

It was heartening to hear how communities have accessed Connecting Scotland, and have further developed what is on offer in their areas. I heard someone say that digital connectivity is a necessity for modern life, not a luxury. I’m glad that I could be part of a team working towards this vision.

Little did I know that this was only the first phase of the Connecting Scotland initiative.

As local lockdowns are being put in place across the country, Connecting Scotland clearly has an important role to play. An additional £15 million has recently been allocated by Scottish Government. This will help thousands more families who cannot afford to get online, making sure they are not further disadvantaged by providing the necessary hardware, data, and skills they need to get connected.

Wendy McDougall is an Engagement Officer with Healthcare Improvement Scotland – Community Engagement.

More information about the Connecting Scotland initiative.

Categories: COVID-19 blogs

Putting Evidence at the heart of everything we do – Safia Qureshi

Posted on September 10, 2020

Our Evidence Directorate are about to launch a new approach to the way they take on work. Director Safia Qureshi explains her vision for the directorate – and why evidence should lie at the heart of improvement.

Have you ever stopped to wonder how many pieces of advice or guidance, reviews, reports, statements or strategies Healthcare Improvement Scotland has published over the years? It’s the sort of question you might ask yourself if you were coming along for a job interview, which is exactly where I was around about fifteen months ago, gearing up for round one of interviews for the role of Director of Evidence.

The answer is: a lot! Search our website and there’s over 1000 items to choose from, published over the last 10 years. And that doesn’t include the work of the Scottish Antimicrobial Prescribing Group (SAPG), the Scottish Intercollegiate Guidelines Network (SIGN) or the Scottish Medicines Consortium (SMC) which sits on separate sites. Adding these publications in takes our total to well over 2600 – with around 1560 pieces of medicines advice from SMC alone – all of it robust and trusted advice.

That’s a lot of work, covering an enormous range of subjects. How did we decide what to do? How should we decide what to do? Can we make better use of our resources? How do we make best use of our resources to provide the advice and guidance that will best help to shape the decisions made by health and social care organisations as they work to resolve the issues facing the NHS in Scotland?

Building on our strengths

I didn’t get asked about publication numbers at my interview – it’s all a bit of a haze now – but we did talk about the role of Healthcare Improvement Scotland in making sure evidence is at the heart of decision making. As Angela Timoney, the Chair of SIGN, likes to remind us in these days of disparaging experts: “evidence matters – our challenge is to ensure we address the most important issues”.

This is the challenge I’ve set myself – and the teams across our Evidence Directorate: to put evidence at the heart of decision making. There’s been some great work from all the teams in the directorate- SAPG, SIGN, SMC, Scottish Health Technologies Group (SHTG), Standards & Indicators and the Data Measurement and Business Intelligence team (DMBI). Now we’re looking to build on their strengths to ensure we have something even better to offer.

A force for improvement

At present, each team has its own approach to topic selection and prioritisation of work. In practice that means each sets its own timetable for taking on new work, each has its own selection criteria and each its own selection committee. All of these individual approaches are perfectly valid – this is the Evidence Directorate after all, we think very carefully about the right way to do things. But by harnessing all these parts into a whole directorate approach that aligns stakeholders’ needs with our wide range of skills and expertise, we can think strategically about our work programme and maximise the impact of our work. This way, I think we can provide a real force for improvement, something that will make a real difference to NHSScotland.

More than the sum of our parts

With that in mind, from 17 September we will be thinking about our work programme in a completely new way. We will start our move towards a coordinated work programme that aligns more clearly with national and organisational priorities. One multidisciplinary committee will use one process and one set of criteria to agree a coordinated work programme for SIGN, SHTG and Standards & Indicators, with more explicit alignment and support from DMBI, SAPG and SMC. This will help us to use the resources of our directorate in a way that is more responsive to the questions and problems posed by stakeholders. We think it will allow us to provide a more coordinated and flexible response that can call on any or all of the skills and outputs across the directorate. At the same time we’re going to raise the profile of the Evidence Directorate in its own right, as more than a collection of the sum of its parts.

Of course, given the consideration, development and production time of our advice and guidance, it will take a while for our new approach to fully kick in. We’re still committed to delivering all of our existing programme of work, but it’s very exciting to be taking the first steps down a new road.

Safia Qureshi is Director of Evidence for Healthcare Improvement Scotland. Follow her on Twitter @qureshisafia1

More information

Find out more about the new approach

Categories: COVID-19 blogs

Tagged: Evidence

Do the Scottish public know how to use antibiotics wisely? – Jacqui Sneddon

Posted on September 8, 2020

Our Scottish Antimicrobial Prescribing Group (SAPG) have spent the last ten years raising public awareness of the threat antibiotic resistance poses. But is the message getting through? SAPG lead Dr Jacqui Sneddon decided to find out, with help from colleagues in our Community Engagement Directorate.

Since 2010, the Scottish Antimicrobial Prescribing Group (SAPG) have led annual campaigns, centred around European Antibiotic Awareness Day on 18 November. The aim is to communicate messages to healthcare staff, patients and the public about the threat of antimicrobial resistance and the need to use antibiotics wisely to protect them for future generations. Staff in health boards and our Public Partners have supported campaign activities tirelessly across hospital and community settings, including schools, youth groups and even Aberdeen Football Club. We’ve also managed to get our own Brownie badge, thanks to one enterprising SAPG committee member developing an awareness raising project for her Brownie pack. But how do we really know if these messages are reaching the public? Is what we’re doing really influencing people’s behaviour around managing common infections and seeking antibiotics from their GP?

Opportunity knocks…

After attending a Scottish Health Council (now Community Engagement) presentation on Citizens’ Panel surveys back in 2019, it struck me that there may be an opportunity to have a Citizens’ Panel survey on antibiotics.

A Citizens’ Panel is a large, demographically representative group of citizens regularly used to assess public preferences and opinions. The Our Voice Citizens’ Panel was established in 2016 to be nationally representative and currently comprises just under 1,200 members of the public from across all 31 Integration Authorities. Since the panel was established, it has gathered the public’s views on around 20 different health and social care topics and has begun to demonstrate impact on ongoing health and social care policy and practice.

Welcome result

Our survey ran earlier this year, and received a 52% response from panel members, so it’s statistically robust at a Scotland wide level. More importantly, the recently published findings make welcome reading for those of us working on safeguarding antibiotics. The majority of the panel had heard of antibiotic resistance, knew that this means bacteria fail to be killed by antibiotics and that overuse of antibiotics is the main cause of resistance. Most people also knew the difference between bacterial infections that can be serious and viral infections that usually cause coughs and colds.

When it came to seeking help when they or a family member was unwell with a suspected infection, most said they would ask a healthcare professional such as a doctor or pharmacist for advice, or consult a reputable on-line source such as NHS Inform. Over 90% of panel respondents had been prescribed an antibiotic at some time and about 40% had needed a second antibiotic, possibly because the infection was resistant. When it came to using antibiotics, most people would complete the course, would not share antibiotics with others and were not likely to try to purchase antibiotics on-line or when overseas on holiday. Respondents also knew which common infections are likely to get better without antibiotics, with the exception of earache in young children which they incorrectly thought would usually need antibiotic treatment.

Looking to the future

We also wanted to know whether the panel were aware of the campaigns run by SAPG and others on infection-related topics. About half of respondents had seen some of the campaign materials, usually in Health Centres. I was pleased to learn that over half of respondents were aware of the “Pharmacy First” service which provides treatment of common infections via pharmacies, and over one in four respondents had used the service. And as a pharmacist myself it was also good to know that the majority of people would be happy to seek and take advice from a pharmacist.

This survey has been helpful for SAPG and I’m sure it will be of interest to colleagues in other UK nations. We’re hoping the details will help us design public awareness campaigns to save our antibiotics. From the survey results, both reinforcing advice about self-care for common infections and highlighting which infections may require antibiotic treatment so that people can consult their GP or pharmacist for advice when necessary look like avenues we may explore in future. Thanks to the Citizens’ Panel, we’ll now be able to target future campaigns more effectively.

The Our Voice Citizens’ Panel Survey on awareness of antibiotic resistance, appropriate use of antibiotics and related public health campaigns report is available on the Community Engagement website.

Jacqui Sneddon is Scottish Antimicrobial Prescribing Group (SAPG) lead with Healthcare Improvement Scotland.

@jacquisneddons @HISengage @SAPGAbx

More information

Visit the SAPG website

Categories: COVID-19 blogs

Tagged: COVID-19

A helping hand to be treated at home – Shirley MacKenzie

Posted on September 2, 2020

Shirley MacKenzie’s mother, Agnes, was able to spend her final months in her own house, thanks to Hospital at Home. Here, Shirley tells us in her own words how much it meant that her mum was able to have her final wish of a peaceful death at home.

My mum Agnes was diagnosed with aggressive B cell lymphoma in June 2019 and she completed her treatment in November of that year.

Over the winter, mum kept in reasonable health, joining in with family occasions and seeing friends. Then COVID-19 changed everything and she became a shielded patient.

Fortunately she was able to maintain independent living, with her family visiting her in the garden and bringing her groceries. We were so lucky with the good weather which made the isolation easier. We were also very lucky to be able to use video technology, and she used this to keep in contact with us daily as well as with the family abroad.

In mid-June she became more unwell, developing extreme tiredness, breathlessness and back discomfort. Because she was became worse over a few days, we contacted the Beatson who directed her to her GP. Mum was reluctant to go to hospital so her GP said he would contact the Hospital at Home service operating in NHS Lanarkshire.

Same day service

A nurse from Hospital at Home came out to visit her the same day. She carried out an assessment, observations and blood tests. Later that morning, a hospital consultant came to the house, retook her history and examined her. The consultant then explained to mum that her very high calcium level, which was related to her underlying disease, was contributing to the deterioration in her symptoms. She said that she could provide some treatment that might offer some improvement to mum’s current symptoms. She then liaised with the specialists at the Beatson about what, if any, additional treatment might help mum’s underlying condition, as well as looking at community resources to provide aids that could help her maintain a safe home environment. These were delivered later that same day.

Later on in the day of her first contact with Hospital at Home, my mum was given intravenous fluids. The following day she received intravenous medicine to help lower the high calcium. At all times, the service’s staff were very professional, helpful, sympathetic and considerate of her wishes. Their communication and explanations to my mother and our family were excellent.

A final wish fulfilled

Initially, my mum picked up a bit following this treatment and a few days later the Hospital at Home service discharged her to the care of her GP and McMillan Nursing Services.

However, she deteriorated quickly in the end and died peacefully at home, being cared for by her family. Her wishes were to be cared for in her own home and to die there, if this was possible. If it had not been for The Hospital at Home services, social services, her GP, and the support of the family, I don’t think this would have been as comfortable or indeed possible to achieve.

Throughout her contact with the service, my mum was aware that the treatment offered was for symptom control and that her disease was progressing. She was comfortable and less anxious in her own familiar surroundings than she would have been in a hospital ward and said she felt more in control. It allowed her to continue to have her family around her – an important consideration for her, especially in recent times.

More information

Visit the Hospital at Home section of the ihub website.

Categories: COVID-19 blogs

Tagged: COVID-19

Rich tea and sympathy – Julie Davidson

Posted on August 18, 2020

While the pandemic has kept us apart, we’ve still found ways to be together when it matters most. As part of our Community Engagement Directorate’s virtual visiting scoping exercise to gather information about how hospital patients and their families stayed in touch when visits weren’t possible, Julie Davidson, a Community Engagement Officer in Dumfries and Galloway, reflects on how she’s learned to value technology when it comes to staying in touch.

There’s nothing better than a chat over a cup of tea and a biscuit. That bit of time between arriving at a meeting and the meeting starting, where you’re making brew and rummaging through the biscuit tin for something good to dunk in it, that’s when you find out the important stuff. It’s when you get to know what’s really going on, get to know your colleagues better and find out how things are with them. But sometimes when you have to make a 140 mile round trip just to get to the tea, the biscuits and the meeting, you do start to wonder if there’s sometimes an easier way of doing things, as much as the effort to travel all those miles is appreciated by workmates and stakeholders alike.

Face to face vs virtual meetings

Back before we had heard of COVID-19, I remember how excited/nervous/curious I was about the possibilities of using NHS Near Me, a video platform which was in many ways a forerunner to things like MS Teams. One day when I realised I wouldn’t make it back from Stranraer to a meeting in Dumfries, NHS Near Me was suggested. I had lots of thoughts about using it. Would I able to contribute as normal? Would my colleagues forget I was there? Turns out it was fantastic. I felt fully involved, and from then on used it when I couldn’t make meetings due to time and distance. It helped me stay connected and attend several meetings in one day. It saved me a day out of the office! Yet I did miss the long drives which helped me gather my thoughts. I missed catching up face to face with colleagues. Can anything beat face to face contact and the interaction it allows?

Well, almost. There’s certainly a lot things it can make easier. Using Near Me worked so well for me, I started thinking it would be great to attend GP appointments this way. Little did I know how prescient that thought was! Near Me has now been used with patients and service users throughout this pandemic, helping people attend GP and hospital appointments from the comfort of their own home. This has been particularly helpful in a rural area like ours, where people rely on public transport, as in our experience, healthcare is often provided in Glasgow or Edinburgh. Now it can be provided in your own front room.

The value of visiting virtually

I support NHS Dumfries and Galloway volunteer peer support group sessions, which have continued through MS Teams during lockdown. Recently we’ve heard emotional stories from NHS volunteers about the impact not being able to visit is having on hospital patients and their loved ones. From having a family member in hospital during this time myself, I know first-hand just how important it is to stay in touch. Technology has provided us with the means to do so. People are Zooming, Facetiming, Whatsapping, Teaming. We’re visiting virtually.

Using technology in this way has been eye opening, and the possibilities are endless. Virtual visiting means it’s now possible for someone at the other end of the country, or indeed the other side of the world, to visit a loved one in hospital without all the stress of travelling and anxiety that you won’t get there at the right time. Now that we are starting to come out the other side of lockdown, will these trends continue? For me, there’s nothing like a face to face catch up, but no one ever said you couldn’t have a cuppa and a catch up virtually. Just watch out for biscuit crumbs on your tablet!

Julie Davidson is an Engagement Officer in Dumfries and Galloway

More information

To find out more about virtual visiting and contribute to Community Engagement’s scoping exercise, go to their website:

https://www.hisengage.scot/equipping-professionals/virtual-visiting/

Categories: COVID-19 blogs

Tagged: COVID-19

The need for speed (and safety) – Rickie O’Connell

Posted on August 13, 2020

In the midst of the COVID pandemic, urgent treatment for cancer patients has continued. As part of our Off-label Cancer Medicines programme, Senior Pharmacist Rickie O’Connell tells us how a two-year test and development programme became a vital part of the response to ensuring patients received the care they needed while staying safe.

In November when I first went on secondment from my regular job as a pharmaceutical analyst with the Scottish Medicines Consortium to be a senior pharmacist for the Medical Directorate’s Off-label Cancer Medicines (OLCM) programme, I knew the work would be challenging. The programme had two years funding to develop and test an approach for improving national consistency in the use of cancer medicines in a way that is different to that described in their licence. I was looking forward to a tough but interesting couple of years. I never imagined we’d be pedal to the metal, trying to put guidance in place so people with cancer could be treated more safely in a pandemic situation.

Responding to the crisis

Patients receiving treatment for cancer were initially considered a vulnerable group for developing severe COVID-19. Not unnaturally, patients and clinical teams therefore wanted, and still want, treatment options that require fewer hospital visits, have fewer serious side effects or that can be taken orally at home rather than in hospital.

Clinical leaders within the OLCM group identified the need for a national governance group to help prevent local medicine governance systems becoming overwhelmed with requests for less familiar treatments which could meet patient’s preferences to avoid hospital visits. Such changes, if carried out at a local level, would likely result in duplication of effort at a time when the health and care system was focused on tackling COVID-19, and could result in inconsistencies in treatments available to people with cancer across Scotland.

A new project for our team

Our OLCM programme team was just four months in to our project at the time, but following this advice we were deployed to work on COVID-19 National Cancer Medicines Advisory Group (NCMAG) to help address this challenge. Like many teams in Healthcare Improvement Scotland, our team has skills in evidence review and project management, as well as links with cancer clinical teams across Scotland, so we were well placed to help.

Things moved rapidly once the group was set up. Within weeks we had all the processes and support tools in place so that clinicians could submit proposals for treatments not routinely available, we could prioritise the work and produce the guidance. We also quickly got all the key players in place, including representatives from regional cancer networks and NHSScotland National Procurement, to ensure there were sufficient supplies of the medicines the group were supporting for use, and also ways to get our advice out to those who needed it. Once issued, the advice would mean that patients could have ready access to cancer treatment options that were not previously routinely available, and with fewer hospital trips.

Going at 90 miles per hour

The benefits of this national approach were quickly acknowledged by practicing clinicians and our team received many proposals in a very short time. Fortunately, our colleagues within the wider Medicines and Pharmacy team and colleagues from Scottish Medicines Consortium kindly supported us through the heaviest workload.

From April to July, the team has been working at a pace I didn’t think was possible. The original aim of our OLCM programme was to produce up to 10 pieces of advice in two years. So far we have produced 21 pieces of advice in four months. It’s not been easy, but knowing the advice we’re producing is benefitting those who need it most makes the effort and long hours worthwhile.

Adapting to changing circumstance

Looking back, the few months have seen a lot of things change. Like most of you, I’m no longer office based, and have swapped the Glasgow commute to working from home. I even have a noisy new colleague – my daughter, Úna, turned one during lockdown and her birthday was a busy day of back to back video calls. Since then she has developed new hobbies of heckling and cyber-attacking daddy during work meetings – the broadband router now hangs high up on the wall out of the reach of her tiny fingers.

And I was right about the secondment. It has been challenging. But I’m glad our team have had the opportunity to contribute, with our individual skill sets, to the care of cancer patients during this uncertain time.

Rickie O’Connell is a Senior Clinical Pharmacist with the Off-label Cancer Medicines Programme and Area Drug and Therapeutics Committee Collaborative

More information

You can find more information about COVID-19 National Cancer Medicines Advisory Group on the Scottish Government website

Categories: COVID-19 blogs

Tagged: COVID-19

Our antimicrobial prescribing team – a big impact for a small team – Jacqui Sneddon

Posted on August 6, 2020

Although the COVID-19 pandemic is still with us, many parts of the NHS in Scotland are keeping their focus on the virus while restarting work that had to be paused. Jacqui Sneddon reflects on the work of the Scottish Antimicrobial Prescribing Group as part of the pandemic response and looks at the way forward.

The impact of the COVID-19 pandemic brought challenges and opportunities for the Scottish Antimicrobial Prescribing Group (SAPG).

Our group works with NHS boards across health and care settings in Scotland to safeguard antibiotics against the global threat of antimicrobial resistance. When both the group’s committee and project group meetings were paused, it meant that that routine work for the group was also suspended.

We’re a small and agile team of just three employees, including me, plus one day per week from our Chair, Dr Andrew Seaton from NHS Greater Glasgow and Clyde, but with a committee of national experts and clinical staff from across Scotland, as well as several project steering groups.

Initially I was seconded to support first the Medicines and Pharmacy team within Healthcare Improvement Scotland (of which SAPG is a part), and then to NHS Lothian to support the ICU pharmacy service. Marion Pirie, our team’s Project Officer, took on part-time work with NHS 24 supporting staff training by role playing real-life patient calls.

Meanwhile, Lesley Cooper, our Health Service Researcher, devoted her time to finalising evidence reviews for two of our projects – penicillin allergy de-labelling and use of antibiotics towards the end of life – which have now been submitted for publication. There was also time to write up our findings from global health partnership work we’d just recently completed with two hospitals in Ghana for future publication.

The issue of COVID-19 and antibiotics

But we couldn’t entirely take our eye off COVID-19.

The pandemic meant that we needed to be sure that use of antibiotics was still appropriate and that clinicians had the information they needed.

Literature reports of overuse of antibiotics in other countries led to SAPG producing advice to support antimicrobial teams in NHS boards to maintain stewardship of antibiotics in hospitals and care homes.

We recognised an opportunity and need to explore the impact of COVID-19 on hospital antibiotic prescribing, given emerging data form China and other parts of the UK, so SAPG led a point-prevalence survey audit examining epidemiological, clinical and prescribing data from eight boards. Data were captured from over 800 patients with suspected or proven COVID-19 across 15 acute hospitals (about one third of all hospitalised patients with COVID-19 in Scotland at the time) during the last 10 days in April. The study generated a huge amount of data that Lesley and colleagues in Public Health Scotland analysed and this provided reassurance that antibiotic use in Scotland was compliant with local guidelines, with lower use in COVID-19 patients than reported elsewhere. Thankfully there was no increased use of broad spectrum antibiotics that drive resistance although the emerging problem of secondary bacterial infections in critical care was observed. One paper has been submitted for publication focused on the epidemiology of antibiotic prescribing in COVID-19 and a second on management of suspected respiratory infections in the context of COVID-19 is underway.

Emerging from lockdown

As we gradually emerge from lockdown, SAPG work has restarted with our first virtual committee meeting recently attended by 32 members. On the agenda as well as the hospital audit data was a discussion of data on GP practice antibiotic prescribing during COVID-19, and hearing about the challenges that antimicrobial teams had faced. All of this information will allow us to continue to learn and will inform the SAPG work programme to ensure the NHS in Scotland continues to use antimicrobials optimally to preserve antibiotics for future generations.

We then turned our attention to our project groups on penicillin allergy and end-of-life antibiotics, to finalise outputs and agree plans for implementation as well as publications on our project development processes. We’re now working with our SAPG Public Partners to produce a patient version of recommendations for use of antibiotics towards the end of life to support patients and their families in shared decision making.

As I reflect on the lessons of the pandemic and the way forward for the group, it strikes me just how much COVID-19 has brought people together – we see that in society, but also within organisations like our own. Our team is contributing to cross-organisational work on older peoples’ systems and primary care where our experience of working with care homes, and with GP Practices will help to inform and support future priorities. 2020 marked 12 years since SAPG was formed and since I joined the organisation. We’ve achieved so much by working in partnership with health and care professionals across the country. Although it’s been a difficult year for everyone, we can only look forward, to continue the fight against antimicrobial resistance, and to face whatever new challenges lie ahead.

Jacqui Sneddon is Scottish Antimicrobial Prescribing Group (SAPG) lead with Healthcare Improvement Scotland.

@jacquisneddons @SAPGAbx

More information

Visit the Healthcare Improvement Scotland website for information on our response to COVID-19.

Categories: COVID-19 blogs

Tagged: COVID-19