Posts from the “Uncategorized” Category

The ‘seventh dimension’ – Richard Norris

Posted on February 5, 2019

No this isn’t a blog about string theory or parallel universes. It’s about health care quality. Specifically it’s about dimensions of health care quality. How is health care quality defined? One way is to adopt what is seen as a ‘multi-dimensional approach’, i.e. using a range of health quality dimensions. This idea has been around for a number of decades, for example in 1984 the Chief Executive of the Kings Fund published a paper arguing for six quality dimensions in healthcare, summarised as Access to services, Relevance to need (for the whole community), Effectiveness (for individual patients), Equity (fairness), Social acceptability and Efficiency and economy. However, arguably the most influential framework for health quality was produced by the Institute of Medicine in 2001 in…

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Using third sector experience to positively influence change – Andrew H D Wynd

Posted on January 31, 2019

Why an involvement in the pregnancy and newborn screening (PNBS) standards was so important to SBH Scotland. For over 50 years Spina Bifida Hydrocephalus Scotland (SBH Scotland) have supported and provided information to the individuals and families in Scotland who are affected by the neural tube defect, Spina bifida. We also support those affected by hydrocephalus as an allied or sole condition. We work closely with parents from the 20 week scan when a spina bifida parent’s journey begins and no matter where their journey may lead them we are always there. SBH Scotland welcomed an invitation to be involved in offering our feedback on Healthcare Improvement Scotland’s draft pregnancy and newborn screening (PNBS) standards. The standards themselves specify a minimum level of performance…

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Reducing cardiac arrests: How we’re improving care for people at risk of deterioration – Calum McGregor

Posted on December 12, 2018

Calum The great strides that Scotland has made to reduce the number of deaths from Sepsis is now well documented – as is the impact of the Scottish Patient Safety Programme (SPSP) which is now celebrating its 10^th year of driving improvements in patient safety. Less known, but no less important, is the growing progress we’re making in reducing cardiac arrests in Scotland’s acute hospitals.

The UK resuscitation council describes a cardiac arrest as a sudden loss of blood flow resulting from the failure of the heart to effectively pump. This happens when the heart stops beating and clinical staff then attempt to restart it. These attempts involve chest compressions, delivery of high-voltage electric shocks across the chest, attempts to ventilate the lungs and an injection of drugs. In some cases a cardiac arrest happens as a result of a heart attack or another sudden health event, but in other cases the cardiac arrest comes after a period of deterioration in physical observations such as blood pressure or pulse rate.

“Since 2013, there has been a 27% drop in the cardiac arrest rate in general ward areas in 15 Scottish hospitals who have reported data to SPSP. This means that on average, there are 18 fewer people per month not suffering from this harmful and distressing experience in hospitals.”

I’m delighted to say that since 2013, there has been a 27% drop in the cardiac arrest rate in general ward areas in 15 Scottish hospitals who have reported data to SPSP. This means that on average, there are 18 fewer people per month not suffering from this harmful and distressing experience in hospitals. Key to achieving this progress has been SPSP focus on ’deteriorating patients’ since its launch in 2008. However, it is also testament to the hard work of the clinical staff in NHS boards across Scotland who have worked together to improve the recognition and response to acutely deteriorating patients.

The foundation to this reduction is early recognition of deterioration and a timely response – this is critical as it allows staff to plan and provide treatment as soon as possible to reduce the chance of cardiac arrest and death.

There are many different reasons why patients deteriorate, and we know that some patients will not benefit from certain treatment options when they do deteriorate. Therefore a range of different interventions are required in order to respond appropriately and prevent cardiac arrests. Here is a brief summary of some of the key actions that have contributed to the improvement in cardiac arrest rate:

Improve the recognition of a deteriorating patient through implementation of the National Early Warning Score (NEWS): NEWS is an evidence-based tool which helps staff to recognise deterioration early. NEWS is a critical step in improving communication in patient care which has now been implemented in 14 NHS boards and the Scottish Ambulance Service.
Improve the timely treatment for patients with Sepsis: Clinical teams have tested and implemented the Sepsis Six care bundle. Evidence tells us that reliable delivery of this care bundle can improve outcomes for people. To date, mortality rates from Sepsis have fallen by 21% and Hospital Standardised Mortality (HSMR) has fallen by 11.2% from August 2016.
Improve the response to a deteriorating patient: A structured response that includes a treatment escalation plan allows staff to provide the right treatment as soon as possible to reduce the chance of a cardiac arrest. A treatment escalation plan – that is based on an individual’s clinical condition and goals of care – supports person-centred care planning to achieve the best outcome.
Improve awareness and communication of deteriorating patients: NEWS and treatment escalation planning have become common terminology, and are a standard item on ward and hospital safety briefs – they are regularly highlighted in visual prompts, for example on ward whiteboards.
Support education. SPSP has developed educational cards and posters to support clinical staff alongside an online module to increase awareness and understanding of NEWS. SPSP have hosted networking events to share successes and challenges and support staff to learn from each other.

In short, the focus is on identifying the critical connection between NEWS, early recognition of deterioration and decision-making that uses a person-centred approach.

“The falling figures on cardiac arrests, the actions being taken in Scotland and the changing culture and understanding of staff over the last decade, are all great progress in reducing the number of cardiac arrests – in the end it all comes down to the hard work, resilience and openness of staff in the NHS in Scotland to making improvements to care.”

The falling figures on cardiac arrests, the actions being taken in Scotland and the changing culture and understanding of staff over the last decade, are all great progress in reducing the number of cardiac arrests – in the end it all comes down to the hard work, resilience and openness of staff in the NHS in Scotland to making improvements to care.

We know that there are still plenty of opportunities to reduce harm for people in health and social care. We’ll continue to collaborate and maintain our focus on prevention, recognition and response to deterioration for people in Scotland wherever they are cared for.

Dr Calum McGregor is Clinical Lead for the Acute Care portfolio of the Scottish Patient Safety Programme (SPSP)

More information

SPSP National Early Warning Score (NEWS) learning module

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The importance of listening to shape clinical guidelines in a fast-changing world – Jenny Bennison

Posted on December 7, 2018

SIGN’s stakeholder feedback report was published in August of this year and it’s my job as Chair of the Strategy subgroup of SIGN Council to ensure we listen to that feedback and act upon it. A lot has changed in NHSScotland since we published our first SIGN clinical guideline on prophylaxis of venous thromboembolism in 1996. The World Wide Web had only come into being in 1991 and busy healthcare professionals had to search for information about new therapies from scientific journals held in medical libraries, or rely on clinical update lectures, whilst trying to avoid the lures of pharmaceutical advertising and sponsorship. Today, information about the latest clinical trial is available anytime, anywhere and accessible from a smartphone – the challenge, for clinicians…

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Using SIGN to improve diabetes care in a forensic mental health service – Claire Borthwick

Posted on November 27, 2018

At The State Hospital, a high-security forensic mental health service for patients from Scotland and Northern Ireland, our team used SIGN 116 guidelines for the management of diabetes to develop our service. The following recommendation was identified as a clinical need: Children and adults with type 1 and type 2 diabetes should be offered psychological interventions (including motivational interviewing, goal setting skills and CBT) to improve glycaemic control in the short and medium term. “A range of professionals were willing to provide input during the development phase and their expertise and contributions were integral to the successful development of the programme manual.” The lead dietician approached me (a trainee health psychologist) with a request for a group psychological intervention to be developed for patients…

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Staff culture can really help unlock improvements in the care of older people – Eddie Docherty

Posted on November 19, 2018

Eddie_Docherty_2 Last year, Scotland’s population was estimated to be 5,424,800 – a record high and an increase of 6% on 2017. The largest increase was in the 75 and over age group (+31%). It is, of course, good news that we are all living longer. However that increase in older age groups is hugely significant for our health and social care system.

The likelihood of being admitted to hospital is, as expected, highly correlated with the age of the population. Around one person in three of the Scottish population aged over 75 was admitted at least once to hospital in 2016/17. By way of contrast, just under one in 11 people aged 25-44 were admitted.

“Dumfries and Galloway had some of the dynamics no doubt many boards and hospitals have: staff who were doing their utmost, in sometimes very difficult conditions, endeavouring to give the best care they possibly could.”

At the same time as we have an increasing demand in our hospitals, we have other pressures to manage which can impact on care, for example ongoing difficulties in recruiting to a range of posts, and a perennially challenging financial context.

Acute hospital care In Dumfries and Galloway had some of the dynamics no doubt many boards and hospitals have: staff who were doing their utmost, in sometimes very difficult conditions, endeavouring to give the best care they possibly could.

So when the inspections on the care of older people in two of our hospitals highlighted a number of concerns and challenges, it was a very difficult message for staff to manage – even though we knew the findings were accurate.

There is a natural emotional response that comes from staff who are working hard, doing their best and feeling like the criticism is unfair. After all, no-one was coming to work to do a bad job. I have no doubt many who have received challenging inspection reports have felt the same.

Yet, after that initial, understandable, emotional response, what has happened since those inspection reports were published has been hugely positive. That subsequent reaction has been down to the staff themselves who chose to respond to the challenges in a way that that has empowered them and benefited patients.

Culture was the key

The key to the positive response was in managers and staff using the feedback, taking stock and ‘owning’ the areas that needed improvement. There was no one silver bullet to the improvements taking place but a combination of factors which included:

An understanding that answers to improvements lay ‘in the room’
Teams delivering care were empowered to make the changes they needed to make (eg if paperwork was not helping manage care then they could change it to something that did)
We had a strong group of individuals who wanted to make the changes
The key thing to change was culture (of person-centred care) and it was staff who could shape this
Staff felt strongly connected with the patients and their families as the hospitals and their workforces were an integral part of the local community.

So, having weathered the challenge, staff developed an action plan and used improvement methodology from Healthcare Improvement Scotland’s ihub to support the improvements, look at best practice from elsewhere to understand how to make change happen.

“The key to the positive response was in managers and staff using the feedback, taking stock and ‘owning’ the areas that needed improvement. There was no one silver bullet to the improvements taking place but a combination of factors.”

It has taken at least 6-8 months for changes to feel tangible and there have also been some personnel changes which have added impetus to the cultural change. However, it is important to say that it is the teams themselves that have taken responsibility for change.

The impact

The latest inspection reports in to the two hospitals concerned are in stark contrast to the initial reports – inspectors positively commenting on team work, ethos and person-centred care. It has been a major turning point for staff. It feels like there has been a clear psychological change – and a change to a more positive perception of inspections themselves. Staff will now welcome the inspectors and the inspection process, knowing that this is an opportunity to get better. And they know that they can make the most of the improvement support that is available from Healthcare Improvement Scotland and feel they are able to embrace both aspects.

“The latest inspection reports in to the two hospitals concerned are in stark contrast to the initial reports – inspectors positively commenting on team work, ethos and person-centred care. It has been a major turning point for staff. It feels like there has been a clear psychological change – and a change to a more positive perception of inspections themselves.”

Added benefits

One of the added benefits of the changes was that, across the service in Dumfries and Galloway there has been a less fragmented feeling, and more of a feeling of a team ethos. In addition, it also feels like there has been change in the working environment to one that is a more open, learning environment.

No resting on laurels

There remains room for improvement and I’m not saying we have solved all issues. But it feel like we are more confident and in a better place to use challenges from inspections, and the improvement support available, to improve care in a way that might not have happened before. And for that, the staff in Dumfries and Galloway hospitals can take a huge amount of credit.

Eddie Docherty is Director of Nursing at NHS Dumfries and Galloway.

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Why cervical screening is important and how you can shape the standard of care – Karen Grant

Posted on November 16, 2018

Every three years, I receive a letter in the post. It’s an invitation that could change my life. Unfortunately, it is not an invitation to Bradley Cooper’s Hollywood mansion – it is, in fact, way more important than that. The invitation is for me to attend for my smear test. Every time the letter arrives, I feel my heart sink. I really don’t want to go. But, I know what it means and how important the test is in detecting early signs of cervical cancer. “Every three years, I receive a letter in the post. It’s an invitation that could change my life. Unfortunately, it is not an invitation to Bradley Cooper’s Hollywood mansion – it is, in fact, way more important than that.…

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