Posts from the “ihub” Category

How hospital inspections are aiding our national COVID-19 response – Ann Gow

Posted on February 17, 2021

As Healthcare Improvement Scotland’s programme of hospital inspections begins to focus exclusively on COVID-19, Ann Gow, our Deputy Chief Executive, outlines the role that inspections have in the pandemic response, and the role that the new focused inspections will have in helping to keep people safe.

During the pandemic, inspections by Healthcare Improvement Scotland have had an important role to play in ensuring that staff, residents in care homes and patients stay safe from harm. By providing objectivity to help hospitals and prisons, care homes and services know where to tighten up and improve key practices, we’ve been able to give assurances both publicly and to NHS boards and services that they are doing all they can to respond effectively to the virus.

During the first lockdown of March 2020, we paused our inspection programmes for hospital cleanliness, care of older people, and our inspections of independent clinics, hospitals and hospices. But as we came out of the first lockdown we resumed inspections, making sure that they were focused on ensuring that people were being kept safe from the virus. Our inspections team produced a new methodology in record time that combined the cleanliness and care of older people inspections, and our inspections of independent services focused in on ensuring that where treatments were being provided they were being done safely and following national guidance on COVID-19 to help stem the spread of the virus. As issues arose with the rate of infections in care homes, our inspectors have also joined the Care Inspectorate inspection teams to bring our expertise in the transmission of infections to bear to help keep older people and staff safe.

Being sensitive to pressures in the system

This, of course, has put our inspection teams firmly on the frontline. It has also meant that they have had to be sensitive to the ongoing vital work that care teams have been undertaking to save lives and to bring people through the worst of the virus.

Inspections are very much about conversation as well as observation. We can’t gather the necessary evidence we need without detailed discussions with healthcare professionals about how they undertake their work. Therefore, carrying out inspections during the pandemic – when services can be stretched – is an ongoing delicate balance to ensure that at a time when staff are busier than ever, we ensure that our work helps to enhance and improve the amazing work that NHS boards are doing.

Shifting our focus

In the past few weeks our inspection focus changed again, and in a highly important way. Inspections of acute NHS hospitals will now focus specifically on how hospitals are ensuring that they help prevent the spread of the virus. We’ve used the current HAI standards produced by our organisation, alongside national COVID-19 guidance, to create a focused methodology that will help staff to make improvements in key areas.

Moreover, hospital staff don’t have to wait to see the final report to know what to improve; they get feedback there and then, so that they can immediately begin to put changes in place. It gives NHS boards the assurance that they are doing the right thing, as well as giving them the information they need to make vital improvements to prevent the spread. In addition, the final reports are published so that the general public have access to this information also.

Our organisation cannot thank our inspectors and our inspection teams enough for the crucial work they are undertaking on the frontline as part of Scotland’s national response. We’re also indebted to NHS boards and services for their support and engagement which allows us to help them to improve.

Ann Gow is Deputy Chief Executive of Healthcare Improvement Scotland and Director of Nursing, Midwifery＆ Allied Health Professionals

More information

Visit the Healthcare Improvement Scotland website to read the first COVID-19 focused inspection report.

Categories: ihub

A day in the life of a Hospital At Home nurse – Richard Wells-Holland

Posted on February 10, 2021

Hospital At Home is a service gradually growing across Scotland and Healthcare Improvement Scotland is helping NHS boards establish and develop their services. But what is it like to deliver such a service? How does it work? NHS Lanarkshire Hospital At Home nurse Richard Wells-Holland explains a typical day.

Experience and research tells us that not everyone needs to go into hospital and not everyone wants to go to hospital either. Some people will be worse off as a result of their illness, either through the risk of delirium, falls or infection. In addition they will miss their family, partner or friends, as well as their own home surroundings and comfort. But, at the same time, they need the kind of interventions and care that a hospital can provide.

Hospital At Home aims to support people by providing the same level of care in the home as they would get in hospital. The service also supports A&E and ward discharges from hospital for those adults who still require acute monitoring, but are safe to be discharged home.

As a Hospital At Home nurse, I’m part of the emergency community service which is managed by Health and Social Care North Lanarkshire, based in the University Hospital Monklands. What is it like to do the job that I do? To support Healthcare Improvement Scotland’s work to develop more Hospital At Home services across Scotland, let me explain what a typical day for me is like…

8.00am: There are various shift patterns within the Hospital At Home service such as 8am to 6pm, 8.30am to 6.30pm and 10.00am to 8.00pm. Today’s shift starts for me at 8.00am, meaning that as the first nurse on duty I am responsible for organising the daily workload for my colleagues coming in later. Today we have 23 patients currently under our caseload and we have three new referrals, two from the care of the elderly wards and one from A&E. So 26 in total at the start of the day and that’s before any referrals from GPs. The team consists of Care of the Elderly consultants, nurses, allied health professionals and assistant practitioners (APRs).

9.15am: I get a call referred by a GP who is wanting an elderly lady reviewed. She lives in a residential living complex and is feeling unwell. She also has reduced consciousness and is suspected of having a urinary tract infection (UTI). Emergency patients like this are reviewed within a one-hour response time with an APR attending first to obtain emergency bloods, followed shortly afterwards by a nurse practitioner who will assess the patient and carry out a diagnosis. This will be followed up by the consultant who will review the clinical notes and plan treatment. When I arrived, the patient was fluctuating in and out of consciousness and had all the symptoms of sepsis. Sepsis can often be treated at home. However, after contacting the consultant on call, it was advised for an ambulance to be called in this instance. Paramedics arrived and she was taken to hospital for further examination. Despite us being a hospital at home service, not every patient can be managed at home, and sometimes hospital admission is required.

11.20am: Another emergency call arrived on my way back to the hospital – this was to go and see an elderly man 18 miles away. One of our APRs was already in attendance and had carried out the initial clinical observations and obtained a blood sample. The gentleman had been found wandering the streets and was becoming more and more confused. His family were all very concerned. He was very polite in his manner, but kept referring to me as his school teacher and he saying he had to get to school. Delirium and the manifestations were discussed with the family. It was explained that admission to hospital may make the delirium worse and trying to keep their dad in a familiar environment with our support would be the best option. The family agreed to keep him at home and to take it one day at a time.

12.30pm: After having some lunch in my car I headed back to the office as there were no other emergency calls. While there, I called the social work department as one of the patients under our caseload needed homecare to assist with her activities of daily living. She had recently suffered the bereavement of her husband who was her main care provider and as a result she was unable to fully look after herself at home. She had no family support and had recently developed a chest infection. I carried out the necessary assessment paperwork and sent it over. Working closely with social care departments can be a key part of what we do for our patients.

2.45pm: I took a call about a 91-year old lady who had had a fall. Prior to leaving, I accessed the patient’s medical records for any additional information. She lived alone and there was a key safe box in place and the entry code was in her medical records. I gained entry and found her in bed lying at a strange angle. She explained that she had fallen in her bathroom early in the morning and was unable to get up. She had banged her left hip off of the toilet pan which was likely a fracture, so we had to get her to X-ray as quickly as possible. Hospital At Home has access to priority X-rays, just as you would expect for an in-patient, so I knew that we would be able to get her condition confirmed as quickly as possible.

4:00pm: I was given another call to attend to an elderly man suffering from increased shortness of breath and green sputum. He was expecting me, as my APR colleague had already been and had taken venous bloods, and carried out an ECG and clinical observations. Communication both verbal and non-verbal play a fundamental role in the nurse-patient relationship and helps in gaining not only trust being built but also leads to vital patient information being obtained. The gentleman explained that he felt extremely short of breath even at times of rest. He also complained that he couldn’t stop coughing.

I explained that he would be started on a course of antibiotics and that we would arrange for him to go to the hospital in a few days’ time for a chest X-ray which he could attend before going home again afterwards.

5:00pm: I headed back to the office which was busy as everyone was trying to get their documentation done and get the results back from the laboratories for their patients’ records such as blood results etc. As an emergency service we get our blood results back the same day, avoiding any delay in treatment for the patients being kept at home.

5:45pm: After discussing my patients in full with the consultant on duty and putting plans in place for the next day, it was nearing the end of my shift. As my route home was passing my last patient, I volunteered to deliver the antibiotics that had been prescribed for him on my way home. That way he could get his first dose that night and it would also give me a chance to see how he was doing and to be reassured that he was coping.

Though no two days are ever the same, this was a pretty typical day: it’s varied, full of communication with a wide range of people and it’s satisfying to help patients stay in their familiar surroundings but get the essential treatment they need.

I’m excited about the work Healthcare Improvement Scotland is doing to increase Hospital At Home services across Scotland – it can only mean better care for patients, as well as being rewarding and satisfying for nurses like myself.

Richard Wells-Holland is a Hospital At Home nurse based within University Hospital Monklands, NHS Lanarkshire.

More information

Visit the ihub website for more information our Hospital at Home work.

Categories: ihub

The many reasons to love Hospital At Home – Dr Claire Steel

Posted on February 3, 2021

Dr Claire Steel ended up in Hospital At Home by accident. A snowboarding accident to be precise. But she quickly became a convert to the benefits it brings to patients. As our organisation’s ihub works with NHS boards across Scotland to establish more Hospital At Home services, Claire explains why every NHS board should introduce Hospital At Home as part of the service they provide to people requiring acute care.

In a way, it was becoming a patient myself that made me a convert to Hospital At Home. When I was due to take on my first consultant role, I broke my wrist snowboarding and couldn’t go onto a ward until I was healed. Instead I spent time in the community with a Hospital At Home service. Hospital At Home delivers acute care to people in their own homes through the co-ordinated efforts of a specialist team working together to keep the patient out of hospital, at the same time improving their health. I found it so inspiring that when a consultant position came up with NHS Lanarkshire, I was keen to apply as I knew they had a Hospital At Home service.

As Healthcare Improvement Scotland works with other NHS boards to help establish similar Hospital At Home services across Scotland, I’m reminded of the many reasons to love working in a Hospital At Home service and being out in the community, delivering care to patients in their homes. It might seem like a lonely business driving from one patient to another, but that’s far from being the case. It’s a day filled with discussions and conversations with other professionals, patients and family members. You still spend a lot of time on the phone discussing patients and making arrangements. Every morning we have a ward round with nursing staff before going out to undertake our visits. On home visits, usually another clinical member of staff will be there with me. The teamwork is great. It feels a lot less hierarchical – everyone is on the same level carrying out their individual duties.

In hospital, if I’m trying to get the history of a patient, it’s a matter of asking many questions and then using my imagination to try and piece together what their life at home looks like. With Hospital At Home, it’s all there. If I’m trying to get a history of a patient, Hospital At Home gives me a vivid picture before my very eyes. I get an immediate sense of what the patient’s situation is like, the care arrangements and what is required for them. Each patient’s home tells a different story and this story can be vital in helping me and the team to give the patient the care and support they need.

When is a hospital a Hospital At Home?

A typical Hospital At Home has three components: the severity of the condition that’s treated has to be similar to the type of condition they would be admitted to hospital with, the service must have access to diagnosis (for example, being able to get test results, X-rays or scans as promptly as would be the case in hospital), and care must be led by a consultant.

The Lanarkshire team works out of a space within University Hospital Monklands (one of three hubs in Lanarkshire). I work from there, but the services at Hairmyres and Wishaw have all our medications and equipment. Each member of the team acts as if each patient is right there in front of them in a hospital bed. The nurse will have phoned on ahead to see how the patient is and we discuss their condition; there may be bloods or reviews; we decide on treatment or an investigation plan. It just so happens that the patient requiring acute care is still in their home.

Our service in Lanarkshire was set up for over 65s – other parts of the world that provide Hospital At Home can provide care from mid-teens onwards. The main conditions that we treat are delirium, infections of all kinds, wounds, dehydration, kidney injuries, falls, heart failure, CPD (COPD), and palliative care.

In terms of equipment, we can provide support that a GP would not be in a position to provide. For example, we can provide drips for dehydrated patients, heart traces, intravenous antibiotics, nebulisers and oxygen. We also help provide advice to GPs, which can be helpful when a patient needs a quick diagnosis as we can get test results back more quickly.

The benefits to patients

There is, of course, still an important place for hospitals, especially in the care of older people. We admit patients when they can’t be looked after at home and when patients themselves are not comfortable being treated at home, or able to get the care and support that they need. But the real benefits to patients of care at home are many. We’ve seen during COVID-19 the loneliness of hospitals, especially for older patients, when contact with relatives was not possible.

We know that many older patients worry that if they go into hospital that they won’t come out or will end up in a care home. We know that there’s an increased risk of confusion, especially when patients are moving between different wards, and the risk of falls goes up also. Older patients can become medicalised in hospital and bedbound, where at home they’re more likely to continue their day-to-day routines, getting up and about, which can help them to stay healthy.

The benefits of Hospital At Home are being seen by more and more NHS boards across Scotland. But it’s great to see Healthcare Improvement Scotland providing support to boards so they can understand the benefits of Hospital At Home and work to establish services of their own. Some are gradually growing the service while others are scoping out how they might put it into practice. After 10 years of Hospital At Home in Lanarkshire, we know that this can only be good for patients and families alike.

Dr Claire Steel is a consultant geriatrician working in the Hospital At Home service at University Hospital Monklands in NHS Lanarkshire.

More information

Visit the ihub website for more information our Hospital at Home work.

Categories: ihub

Being aware of your unborn baby’s movements can save your baby’s life – Anna Todd

Posted on February 26, 2020

I’ve had three pregnancies and I have two children. But I see myself as having three: Rosie, Alice and my son, Scott, who was unable to survive birth.

Every year we celebrate Scott’s birthday. Five years on and it’s still emotional for us all. We take a wreath in the shape of a boat to his grave and we release balloons. We celebrate who he might have become and what he might be doing now.

But in many ways, Scott does live on and not just in our hearts. Our losing Scott helped save another life: his little sister Alice, who is now three. I like to think he’s saving other lives too as I work with various organisations to help spread the word about the importance of mums-to-be paying attention to their baby’s movements in the womb.

“The loss is indescribable. So much hope and expectancy, which grew alongside our baby growing in the womb, were all taken in the blink of an eye. The sense of profound loss was horrendous.”

My first child Rosie was born in 2011. After a textbook pregnancy I found myself whisked into theatre at Wishaw General, my baby in distress. Rosie was eventually born as healthy as can be. I however needed physio, treatment for an abscess and counselling for post-natal depression – all within a year and a half after giving birth.

By 2014, the trauma of Rosie’s birth behind me, we were ready to extend our family. Again there were no issues during the pregnancy itself, but complications arose during birth, caused by what’s known as an incompetent cervix. The condition affects 1 in 100 pregnancies and means that the body can’t hold the baby anymore. Scott was delivered stillborn.

The loss is indescribable. So much hope and expectancy, which grew alongside our baby growing in the womb, were all taken in the blink of an eye. The sense of profound loss was horrendous.

The care from staff at Wishaw General Hospital after we lost Scott was extraordinary. The bereavement care available to me and my husband Stuart allowed us both to find a way to move on. Everything in the care I received was tailored to me. I was treated like a person and nothing was too much to help us come to terms with our loss.

The counselling did its work and a year later we were both amazed that we wanted to try again. I became pregnant at the start of 2016.

After what happened to Scott, the pregnancy was naturally an anxious one. During my baby shower at 34 weeks, I was suddenly aware the baby had stopped moving. With the loss of Scott, I was acutely tuned in to how my body felt and knew something wasn’t right. Over the next 48 hours, movements were sporadic and I was in and out of hospital as the baby was monitored. It was my acute awareness of how my baby was feeling that saved her life. The hospital staff listened to me and they were receptive to my needs and concerns. After it was discovered that the baby’s blood pressure was dangerously low, an emergency Caesarean brought baby Alice into the world. At 4lb 14 ounces, Alice needed a lot of help after birth, but now she’s as healthy, amazing and troublesome as any three year old!

While the number of stillbirths has reduced in recent years, in Scotland four babies a week are stillborn. I’m delighted the Scottish Government’s Stillbirth Group have launched a new campaign to raise awareness of the three key ways expectant mums can potentially lower their risk of this happening to them. Being aware of foetal movements is one of those ways, along with sleeping on your side and stopping smoking.

“If I had one piece of advice, it would be for mothers to trust their instincts and their sense of their own body. Your baby talks to you through movement, so be prepared to listen. You could save your baby’s life.”

I’m so happy that the importance of being tuned to baby’s movements in the womb is getting the national importance that it deserves through this campaign and the work of the Scottish Patient Safety Programme’s Maternity Care Programme. Since Alice was born I’ve found myself working at times with SANDS Charity (Stillbirth and Neonatal Death Society) as a befriender to help others through the trauma of stillbirth, I’ve spoken at the Royal College of Physicians to help develop a bereavement pathway, and I’ve spoken at midwifery conferences. It all helps with the permanent sense of loss to know that others might learn and benefit, that losing Scott may be helping to save others.

If I had one piece of advice, it would be for mothers to trust their instincts and their sense of their own body. Your baby talks to you through movement, so be prepared to listen. You could save your baby’s life.

Anna Todd is a mother of three and a befriender with the SANDS Trust.

For information on work to prevent stillbirth in Scotland, visit:

SPSP Maternity Care Programme: ihub.scot

Advice on preventing stillbirth

Categories: ihub

Full ESTEEM ahead for those who experience psychosis – Jonathan O’Reilly

Posted on January 9, 2020

“I no longer see psychosis as a catastrophe…I’ve been able to accept my diagnosis and not let it define me or my trajectory.”

These words were spoken at the first meeting of our Early Intervention in Psychosis Improvement Network (EIPIN) by Michael who has personal experience of psychosis.

With vulnerability and openness, Michael – and Stephanie, who also had experience of psychosis – brought to life for those attending the meeting what the experience is like, the recovery journey, and the impact and importance of early intervention.

Michael’s words of acceptance and hope had particular resonance for those attending the network meeting, as this is the very outcome we are striving to achieve for everyone who experiences psychosis in Scotland.

What is psychosis?

“Treating psychosis in the early stages can reduce the amount of time a patient needs to spend in hospital, reduce relapses, and leads to more effective and long lasting outcomes.”

Psychosis is characterised by hallucinations, delusions and disturbed thinking. It can cause considerable distress and disability for people affected, and for their families or carers. It’s estimated that there are approximately 1,600 new cases of psychosis in Scotland each year. Psychotic disorders can be extremely debilitating and it’s vital that those experiencing psychosis are treated quickly and effectively. Treating psychosis in the early stages can reduce the amount of time a patient needs to spend in hospital, reduce relapses, and leads to more effective and long lasting outcomes. Research from previous work in Scotland has shown improved outcomes when using a specially-designed model (called ESTEEM), compared to a more generic model, as inpatient stays can be significantly reduced, sometimes by up to 55%.

How the network came about

In the summer of 2019, Scottish Government published the action plan, Our Vision to Improve Early Intervention in Psychosis in Scotland, affirming their commitment to action 26 of the Mental Health Strategy, to improve access to services for those experiencing psychosis.

The Early Intervention in Psychosis Improvement Network is part of Healthcare Improvement Scotland’s Mental Health Improvement Portfolio of work.

By establishing and launching the network with the first meeting, Scotland took its first step in achieving those actions and mobilising a network consisting of health and social care, education sector, third sector, individuals with lived experience and carers.

The first EIPIN meeting was hosted by Healthcare Improvement Scotland with over 100 people from across Scotland in attendance. The aim of the meeting was to raise awareness of the importance of Early Intervention in Psychosis, the current evidence base for treatment, and how that evidence is currently being applied in the ESTEEM service in Glasgow (a community mental health service for people between 16-35 years, who appear to be experiencing their first episode of psychosis). Most importantly, the network will look at the positive impact of early intervention services on people’s lives.

Partnership working to drive improvements in care

“This work will ensure people presenting for the first time with psychosis anywhere in Scotland get access to effective care and treatment, with a focus on early intervention and recovery.”

A crucial part of this programme of work has been to recruit NHS Forth Valley and NHS Highland and their associated Health and Social Care Partnerships (HSCPs) to better understand the current provision of EIP services, what’s required to improve services, consider how data can be best collected and optimised, and determine what a good service for people experiencing psychosis looks like for service providers and service users.

I’m delighted to be involved in this important work. The work will ensure people presenting for the first time with psychosis anywhere in Scotland get access to effective care and treatment, with a focus on early intervention and recovery.

The success of the network launch – and the enthusiasm of all those who have stepped forward to be involved – has put us all on a strong footing to deliver improvements and recommendations to change the future for so many people experiencing psychosis in our communities.

Jonathan O’Reilly is an Improvement Advisor within the Mental Health Portfolio of Healthcare Improvement Scotland

More information

To learn more about the EIPIN and how we are progressing the action plan visit ihub.scot or on Twitter @spsp_mh. Get involved in the conversation on social media by following the hashtag #EIPScot.

Categories: ihub, Mental Health

Collaboration the key to consistent hospital care for those with dementia – Matilda McCrimmon

Posted on December 17, 2019

“My Mum was admitted to the medical assessment unit. The next day she was moved to a ward…this was after I told the staff she was very distressed by being moved about. She became so distressed she pulled her cannula out…. I spoke to the nurses in ward about not moving her again, but they said it would likely happen because of policy. Luckily she was discharged suddenly and this did not happen.”

“I would like to say how kind, caring and efficient all the staff were to my Dad when he was admitted before Christmas. He has dementia and as a result really struggles to be an inpatient and get very distressed easily. My mother and siblings were able to stay overnight to keep him calm and secure, and all the staff we encountered, from medical to domestic, showed immense understanding and compassion.”

These two stories from the Care Opinion website show the different experiences people with dementia are having in our hospitals, and the clear need for a consistent approach across Scotland, to ensure both they and their carers can be confident that no matter where they are treated, their care is of good quality. The Dementia in Hospital Collaborative, led by Healthcare Improvement Scotland’s Focus on Dementia team and the Alzheimer Scotland Dementia Nurse Consultants, aims to provide that approach.

A national priority

Dementia was made a national priority by the Scottish Government in 2007. We have made huge strides in improving hospital care for people living with dementia and their carers in the past 12 years. Unfortunately, these are not universal. Excellent work has taken place in some areas to ensure patients living with dementia experience minimal moves during hospital stays and where moves are necessary they are planned and at appropriate times. Yet in other areas, patients continue to be moved or “boarded”, creating distress and potentially prolonging hospital stays. I’ve visited patients requiring one to one nursing due to distressed behaviour to find that they have a nurse who sits and observes them, only intervening to stop “unsafe” behaviour. In other areas I have witnessed this being transformed into a therapeutic experience for the patient, with the one to one being used to provide social interaction and meaningful activity.

“We have made huge strides in improving hospital care for people living with dementia and their carers in the past 12 years.”

Improving on leadership

With a focus on preventing, identifying and managing the symptoms of stress and distress, the Dementia in Hospital Collaborative will support improved care for people with dementia in hospital settings. Key to this is ensuring there is clear leadership in each board to drive and monitor improvement. This leadership and improvement role is provided by our group of 16 Alzheimer Scotland Dementia Nurse Consultants, of which I am one. Our roles are four fold: to provide professional leadership, develop expert practice, training and education and develop and support practice improvement. These roles are partially funded by Alzheimer Scotland and provide the opportunity to develop these aims in a nationally coordinated way.

“With a focus on preventing, identifying and managing the symptoms of stress and distress, the Dementia in Hospital Collaborative will support improved care for people with dementia in hospital settings.”

As individuals, not only do we come from diverse geographical locations, we also have quite diverse professional backgrounds. Some of us have worked in mental health and general nursing, some have come directly from clinical practice and others have had roles in practice development or education. Our day to day roles also vary depending on our board, with a combination of direct patient care and community care. Some have input in mental health settings and others only in acute settings. The bringing together of our varied settings, roles and experience allows us to have a view of the wider landscape but also to identify common themes and challenges. Dementia is a complex condition, often accompanied by frailty and chronic disease. We’re just at the start of our journey to improve things, but believe that by combining our expertise with that of the Focus on Dementia team, we can to make a real difference for people living with dementia and their carers when it comes to hospital care.

Matilda McCrimmon is Alzheimer Scotland Lead Nurse for Dementia at Golden Jubilee Hospital.

More information

Visit the ihub website for information on the work of the Dementia in Hospital Collaborative.

Categories: ihub

Tagged: focus on dementia