Transcript Unlocking the potential - Clinical Skills Managed Educational Network

Unlocking the potential:
how student led projects can improve service
delivery and enable workplace based education on
Human Factors
Kimberley Begg
Lorraine Armstrong
Kirsty Mcneil
Elaine Mccleary
Pam Cumming
Sarah Macpherson
Kimberley Begg
Staff Nurse NHS Forth Valley
19/03/2014 Beardmore Conference Centre
Introduction
Background
 What we did
 Daily Review Record in practice
 Did it make a difference?
 Implications for future practice
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Background

2010 - Initially created at University
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2010 - Letting people know
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2010 - PDSA cycles in ICU whilst a student
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2010+2011 - Attended SPSP conferences
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August 2012 Staff education
in ICU
Implementation
So... What is it?
Single sheet document called ‘CAUTI Daily
Review Record’
 Follows the patient’s catheter – (bundle)
 Full of prompts and tick boxes
 Works in conjunction with a label on the
drainage bag
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Why is the change needed?
Reduce incidence of CAUTI
Improved catheter maintenance/management
Inconsistency with what is accepted as sufficient
documentation
 Reduce extended hospital stays
 Financial benefits
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PROMOTES PATIENT CENTRED
CARE AND PATIENT SAFETY
What we did

Pre-implementation audit
Staff education (inc NA and StN)
Implementation of CAUTI Daily Review Record
and Labelling technique
Staff support
Feedback/PDSA cycles/improvements made that
were unique to ICU
Poster updates – staff involvement

Post-implementation staff compliance – 98%
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CAUTI Daily Review Record in
practice
Fairly well received
 Better knowledge of when catheter due
out/drainage bag changes etc
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Implications for future practice

lectures on my journey through quality
improvement project to encourage
students

Aim to spread hospital wide – education
pack, currently being trialled in theatre
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Staff will have improved awareness of
their patient’s catheter, - insertion date, removal
date, drainage bag renewal date etc.
Conclusion

Importance of quality improvement in
undergraduate curriculum

Students now have QI projects as part of
their final placements

In order to pass the course students are
expected to complete IHI modules

Promotes personal development
IMPROVING THE
IDENTIFICATION AND
DIAGNOSIS OF
DELIRIUM
Kirsty McNeil
3rd Year Medical Student
PROJECT BACKGROUND
• Delirium is under recognised in acute care
• The project was carried out in the Acute
Medical Unit of Ninewells Hospital
• We looked at the prevalence of delirium in
patients 75 and above and how many of
these had been diagnosed as having
delirium
• Only 10.5% of patients with delirium were
identified
CHANGES
• Feedback of
Background Data
• Visual Aids
• Education Sessions
for All Staff
• Implemented the
4AT tool
• Trialled a Delirium
Pathway designed
by a team within
NHS Tayside
Nurse
educations
sessions
carried out
Feedback
Sessions
carried out
Implement
ation of
delirium
pathway
STUDENTS AND
IMPROVEMENT
• The data collected by
students has prompted
a team within NHS
Tayside to continue with
the delirium work
• Getting Students
Involved: delirium
awareness week,
ongoing improvement
project
• Big Projects need time
and people
HUMAN FACTORS FOR A SAFER
SCOTLAND
Elaine McCleary and Pamela Cumming
Student Nurses
University of Dundee
IMPROVING EARLY RECOGNITION OF DELIRIUM
USING SQID (SINGLE QUESTION TO IDENTIFY DELIRIUM)
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Our aim was for 95% of multidisciplinary staff to
incorporate SQiD into daily practice in the Acute
Surgical Receiving Unit of a large teaching
hospital, by the end of an 8 week period.
During a test, this was achieved, although the
project changed direction several times.
HOW DID THE EXPERIENCE HELP US AS
HEALTH CARE PROFESSIONAL STUDENTS?

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We gained an understanding of undertaking
Quality Improvement in the 'real world' and the
continual cycle of professional and personal
development and improvement.
We also developed an understanding of human
factor science in this process, recognising how
teamwork or communication, for example,
influences the trajectory or success of a project.
WHAT DID WE LEARN ABOUT HOW STUDENTS
CAN HELP THE NHS TO IMPROVE HEALTH
CARE?

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Quality Improvement science provides the tools to
enable students to initiate, test and improve systems
and processes. Awareness of Human Factors science
is necessary to help understand the factors which
either positively or negatively affect the success of
such systems.
We understand it is everyone's business and is a way
of thinking.
QUALITY IMPROVEMENT PROJECTS CREATE
FURTHER OPPORTUNITIES….
IHI 25th International Forum, Orlando, Florida. December 2013
Improving the efficiency and
start time of trauma theatre
at the Royal Alexandra Hospital
Sarah Macpherson
5th year medical student
Project Background
• Project done as 2nd year student
• Busiest trauma theatre in Scotland
• Evening sessions proposed to deal with
workload
• Currently inefficient, many delays
• Running theatre costs £1200/hour
• Late start main problem
Example Plan Do Study Act Cycle
List to be taken to
trauma theatre by
theatre coordinator
nurse by 8am
Team decision for nurse
to take list to theatre
reception area to avoid
this problem
Theatre coordinator
nurse had inadequate
time to change into
theatre scrubs
ACT
PLAN
STUDY
DO
Not achieved
Results
• Theatre start time improved by average
30mins
• NHS saving of £600 per day
• Average 1 more operation every day
• Benefits for patients
• Scheduled staff breaks as planned
How can students help the NHS
to improve healthcare?
•
•
•
•
Fresh eyes
Useful part of project team
Less time pressure than employed staff
Can directly contribute to improved
healthcare systems and efficiency and thus
saving money
• Investment in human factors training is
valuable to promote improvement
How did the experience help me
as a medical student?
• Gained in confidence – solid grounding for
clinical years
• Better understanding of the patient
experience from patient shadowing
• 1st experience in quality improvement
• Will be better prepared to initiate changes
where required in future
RHIC and the Quality Improvement Hub
Edinburgh, 6 May 2014