collaboration Archives - Page 2 of 4 - Health Innovation West of England

QI in pharmacy? It’s a brave new world.

Posted on November 23, 2021January 5, 2022 by Vanesther Hamer

In this joint blog from Senior Project Manager, Chris Learoyd and Ola Howell, Clinical Pharmacy Lead at the West of England AHSN, we explore the value of Quality Improvement (QI) for pharmacy teams, why it hasn’t really been embedded so far and how pharmacy can get involved, including at our first-ever Pharmacy Showcase on 12 January.

First we hear from Chris…

As the Senior Project Manager for the Medicines Optimisation team at the West of England AHSN, but a former Physiotherapist, I won’t say it was always easy, but I have finally got my head around the wider challenges and issues with safe prescribing of medications.

The numbers are eye watering – circa 237 million medication errors occurring at some point in the medication cycle per year in the NHS in England and 66 million of these considered potentially clinically significant errors. Reducing medication errors can clearly have a significant and immediate effect on patient safety.

We know that as experts in medication management and optimisation, pharmacists and pharmacy technicians are ideally positioned in the healthcare system to improve current processes and reduce avoidable medication-related harm – and that QI approaches are vital to creating lasting change.

As every pharmacy team will know they are being positioned more centrally within healthcare services and have more clinical autonomy. Services such as the Discharge Medicines Service and Community Pharmacy Consultation Service provide a step change to embed pharmacy professionals as an important first point of call for healthcare information rather than traditional settings such as General Practice / Emergency Departments.

Introducing QI

Despite all this, pharmacists often lack the basic tools required to lead on or participate in QI initiatives as they’ve historically not been trained or required to perform QI projects. This is slowly changing, and here at the AHSN we’re working to drive adoption of QI approaches across pharmacy.

Here we’re handing over to Ola who gives details of the reasons for this, the impact and our new offer for pharmacy colleagues….

I’m a clinical pharmacist and over the last 12 years I’ve worked in a community pharmacy (very many of them), a General Practice (very briefly) and a hospital (or three, to be precise). Over those years I have met hundreds of pharmacy technicians and pharmacists determined to ensure their patients got the best (aka safest) care they could.

But I’ve never worked on QI before – what is it?

We are diligent, we are keen, and we are truly brilliant! No need to argue that. The thing that we are not good at is quality improvement. It is not that we don’t do it well, we simply don’t do it enough… And why would we? If you are anything like me and your registration number starts with 20*****, you would, most likely, had never been taught what QI is and how to do it well.

It wasn’t until the last couple of years that I started hearing about the QIPs, the PDSAs and the “driver diagrams”. Maybe I was not expected to know then, but I am now. (And there are masses of free resources on the West of England Academy website to help anyone embarking on QI work – but join our Pharmacy Showcase on 12 January to hear more about free, interactive and tailored support for your team).

Embracing QI to support our profession and wellbeing

Like never before, we are forced to do more and faster with less resources and time. We need to learn how to improve what we do in order to survive. And we need to do it now. The numbers are scary, with every fourth pharmacist reporting feeling ‘very stressed’ at work, mainly due to the increased demand for services and the lack of funding. That is 37% of community teams (up from 17% last year), 20% of hospital pharmacists (up from 10% in 2020) and 14% of GP and PCN pharmacists (up from 5% in 2020)[1]. I anticipate that the figures among pharmacy technicians follow a similar trend. Grim. Burnout alarm bells ringing all over the place.

When I asked around, I wasn’t surprised by the number of suggested solutions to various work problems we come across every day.

Not-a-surprise No. 1: We often know what goes wrong.

Not-a-surprise No. 2: We also often know a solution (or improvement) to the status quo. We sometimes even make that improvement ourselves!

For some reason, however, we rarely document the before and after and so are unable to prove our intervention has worked. “I am not wasting time on the data collection when I have so much to do”, I heard recently from a fellow pharmacist. “But your idea is brilliant! And it saves time, so if other people knew about this, the impact could be huge”, I reply. “Nah, too much effort”, I hear back. I bet this sounds familiar…

Don’t we all roll our eyes when an audit arrives and we need to fill out a spreadsheet, often without pausing for a moment to question what it’s for, and how the results will affect us in the future. Here in lies the answer – capturing our learning and experiences through QI.

Get involved

So come and meet us on the 12 January at our Pharmacy Showcase to hear about the projects our AHSN is involved in, meet the team, network with other pharmacy colleagues and learn more about a free, tailored Pharmacy for QI course coming in spring 2022.

[1] The Pharmaceutical Journal, PJ, November 2021, Vol 307, No 7955;307(7955)::DOI:10.1211/PJ.2021.1.114907

Working with the learning disability community to produce our new annual health check videos

Posted on November 22, 2021November 22, 2021 by Vanesther Hamer

The West of England Learning Disabilities Collaborative puts people with a learning disability at the centre of everything we do.

The Misfits Theatre Company, based in Bristol, have previously worked with the AHSN to create videos on topics such as the flu vaccine. In our latest video series, commissioned by NHS South West, we have worked with the Misfits to produce a range of videos that encourage greater uptake of annual health checks for those with a learning disability. The videos cover a range of audiences including health professionals working in primary care, with a second playlist focusing on people with a learning disability and those that care for them.

In this joint blog from members of the Misfits Theatre Company and Rosy Copping, Project Support Officer for the West of England Learning Disabilities Collaborative, we talk about how the video project came to fruition and what it was like to get involved in the filming.

The AHSN perspective from Rosy

Co-creation is the most important factor in our work at the West of England Learning Disabilities Collaborative. It is essential that we gain an insight into the lives of people with a learning disability and their carers, so that we can ensure the needs, concerns and views of the community is reflected through our work.

The video series was created to educate health professionals, carers and people living with learning disabilities on the importance of annual health checks. Annual health checks are so important for people living with learning disabilities as it can help alert them, their carers and their doctors to any underlying medical conditions, and to help manage any current medical conditions that the individual may also be living with, such as epilepsy or diabetes.

We have worked with many experts by experience to produce these videos, namely, the Misfits Theatre Company, Andrew Bright, Head of Development at Thera Trust and Ian Harper, Service Quality Director at Aspire Living. Without their help, the videos may not have spoken to people with learning disabilities in the same way and we might not have been communicating effectively how important it is to get an annual health check. We think it’s vital that when we produce resources, we ensure people from the community who will be using them, get to shape their creation and be directly involved.

We worked with Ian and Andrew on the development of the scripts, and they helped us to ensure that the wording was appropriate for people with learning disabilities to understand, and that the style and tone was friendly and informative. For example, Ian suggested that we change the phrasing of epilepsy to read “seizures”. We then worked with Misfits Theatre Company to film the videos. The Misfits added their own flair to the videos, and we hope they will inspire many others living with learning disabilities to get their annual health checks.

We very much enjoyed working with the Misfits, Andrew and Ian for this piece of work, and we hope that their depictions of why annual health checks are so important, resonate with viewers as much as they did with us. We certainly could not have achieved this work without their help, so we’d like to say a big thank you!

The Misfits Theatre Company Perspective from Sara Melton

It was fantastic to be part of this very important project. It is so vital that people with learning disabilities are aware of the importance of having their annual health check and what’s involved in the process.

We asked the actors working on the project to tell us what it meant to them. Here’s what they said:

Rob “I always enjoy helping create different accessible information about the importance of health care. The fact that the people are willing to get the information out there is wonderful. I felt the filming went smoothly. I always have fun doing filming”.

Beth “It was nice to be involved in the project and feel like I can make a difference by getting the important messages across. The day was exciting. I loved using my skills and abilities to educate and inform others”.

Bill “It was brilliant to be involved and I loved being on location filming. It is so important for people like me to get an annual health check. The filming went smoothly, and I really enjoyed myself. The people we worked with were really friendly, which always helps”.

Penny “The annual health check film went really well. It helps people with learning disabilities to get their health check. I really enjoyed being involved in the project. The film is informative for people like me. It is rewarding to know I have made a difference for other people with learning disabilities. I always have fun being involved in films!”

As you can tell from our actors’ comments they really enjoyed being involved in the project. It is of utmost importance for them to be able to educate others who also have learning disabilities, as well as health care professionals. Their first-hand experience really enables them to connect and relate with their audience. The filming also gives them a platform to educate professionals who will be working with people with learning disabilities like them.

We look forward to the next film project!

To find out more about the West of England Learning Disabilities Collaborative, including signing-up to receive newsletters, please visit the collaborative’s webpage.

AHSN Network’s COVID Oximetry @home programme wins at the HSJ Awards 2021

England’s 15 AHSNs and the AHSN Network celebrated a win at the prestigious HSJ Awards ceremony in London on 18 November.

The team were successful in the patient safety category for the significant support Patient Safety Collaboratives and AHSNs provided to implement COVID Oximetry @home and virtual wards. The programme was delivered in partnership with NHS England and NHS Improvement, NHS Digital and NHSX, and helped thousands of people most at risk from COVID-19 to be safely supported at home, through remote self-monitoring of their oxygen saturation levels.

By May 2021 over 2000 patients in the West of England had been enrolled on either COVID Oximetry @home or COVID virtual wards. Read about our rapid and collaborative implementation of pulse oximetry services across the region, as well as our local case study.

The judges said:

“The judges felt that this was an outstanding example of a true system wide collaboration. This project not only touched the UK but positively impacted people’s lives across the world. The outcomes were positively overwhelming in relation to lives saved, bed day reduction and early admissions which improved mortality and morbidity rates. It was clear that this approach contributed heavily to the prevention of the NHS becoming overwhelmed during the pandemic. The patient testimonial demonstrated the real impact to individuals and added value to the presentation coupled with the passion and authenticity of the presenters.”

Natasha Swinscoe, Chief Executive Officer at West of England AHSN and national patient safety lead for the AHSN Network said:

“We are delighted to receive this award on behalf of all our partners, frontline staff and patients.

The AHSN Network was proud to lead the rapid implementation of the COVID Oximetry @home and COVID virtual ward programmes during the coronavirus pandemic. Success would not have been possible without our partners NHSX, NHS Digital and sponsors NHS England and NHS Improvement, who fully supported this innovative and novel pathway of care.

This award recognises collaborative working across health and care systems and we share this with NHS England and NHS Improvement, particularly the NHS@home team, regional and local CCG teams, NHSX, NHS Digital, our Patient Safety Collaboratives and clinical leads.

Learning from this innovative pathway has led to the development of other pathways such as a blood pressure at home initiative, part of our cardiovascular disease management portfolio of programmes in the AHSN Network.”

Cheryl Crocker, AHSN Network Patient Safety Director, said:

“We entered this award to showcase the extraordinary achievement of multiple partners, supported by regional Patient Safety Collaboratives, who came together to respond to the pandemic and keep patients safe. This national programme is estimated to have benefitted in excess of 40,000 people.”

The West of England and South West AHSNs were also shortlisted for Provider Collaboration of the Year award for PERIPrem (Perinatal Excellence to Reduce Injury in Premature Birth).

PERIPrem is a perinatal care bundle to improve the outcomes for premature babies across the West and South West regions. The bundle consists of a number of interventions that will demonstrate a significant impact on brain injury and mortality rates amongst babies born prematurely.

Welcoming Chief Executive Officers appointed to lead our new Integrated Care Boards

NHS England and NHS Improvement are recruiting new Chief Executive Officer (CEO) designates for all 42 Integrated Care Boards (ICBs) around the country. The three ICBs in the West of England region have recently made these appointments, and the West of England AHSN are delighted to continue working with our local systems, their boards and the new designate CEOs.

Shane Devlin has been announced as the Chief Executive designate of the new ICB for Bristol, North Somerset and South Gloucestershire (BNSSG).

Sue Harriman, CEO of Solent NHS Community and Mental Health Trust in Hampshire, has been appointed designate Chief Executive of the NHS Bath and Northeast Somerset, Swindon and Wiltshire (BSW) ICB.

Mary Hutton, currently One Gloucestershire Integrated Care System (ICS) lead, has been appointed as CEO designate of the new Gloucestershire ICB.

Tasha Swinscoe, Chief Executive Officer for the West of England AHSN said:

“I would like to congratulate the three designate CEOs on their appointments. Here at the AHSN we’re looking forward to working with Shane, Sue and Mary and their teams to continue to support ICS priorities and the transition to the new ways of working with ICBs.

The AHSNs priorities are closely aligned to our member and system priorities – by working together we’ll continue to support ongoing system transformation and adoption of proven innovations around tackling health inequity, providing more integrated, patient-centred care and the Sustainable NHS agenda”.

What is an Integrated Care Board (ICB)?

At the end of March 2022, the functions of all Clinical Commissioning Groups (CCGs) will transition to ICBs. This is part of the Health and Care Bill, currently going through Parliament, which sets out plans to put Integrated Care Systems (ICSs) on a statutory footing, empowering them to better join up health and care services, improve population health and reduce health inequalities.

Each ICS will be led by both an ICB (the organisation with responsibility for NHS functions and budgets, formerly the CCG), and an Integrated Care Partnership (ICP), a statutory committee bringing together all system partners, including local authorities, to produce a health and care strategy. Find out more on the NHS website.

The ICB will work collaboratively with partner organisations including the AHSN, VCSE sector and people and communities in each Integrated Care System (ICS).

Marking COPD Awareness Month – improving patient safety

During COPD Awareness Month, the acute hospitals in the West of England have been celebrating their work to improve patient safety as part of the NHS England and Improvement Adoption and Spread Safety Improvement Programme. This has included a 34% increase (to June 2021) in the number of patients receiving all elements (for which they are eligible) of the COPD Discharge Bundle.

The British Lung Foundation describes COPD as a group of lung conditions that make it difficult to empty air out of the lungs because the airways have become narrowed. This causes breathlessness. Worsening of breathlessness (often as a result of infection) is called an exacerbation. Exacerbations of COPD are one of the leading causes of hospital admission, and readmission following exacerbation also occurs frequently. All admissions to hospital have a negative impact on patients both physically and psychologically. Reducing the impact of admissions for lung disease is one of the key ambitions of the NHS Long Term Plan.

Adoption and spread of the COPD Discharge Bundle

Providing COPD patients with a number of simple interventions while they are in hospital, can reduce the chance of readmission. These interventions (listed below) form the COPD Discharge Bundle:

Inhaler technique assessed and corrected
Patient or carer has written information & understands their self-management plan
Provision of rescue medication packs
Smokers referred for smoking cessation
Assessment for enrolment in pulmonary rehabilitation
Appropriate follow-up arranged within 72 hours

The National Patient Safety Improvement Programme project – which started in November 2019 – has focussed on increasing the use of all appropriate elements of the bundle. This work has been coordinated across the region by the West of England AHSN alongside each of our acute hospital trusts:

Gloucestershire Hospitals NHS Foundation Trust (GHT)
Great Western Hospitals NHS Foundation Trust (GWH)
North Bristol Trust (NBT)
Royal United Hospital Bath NHS Foundation Trust (RUH)
University Hospitals Bristol and Weston Foundation Trust (UHBW)

Improving patient safety

Since commencing the project, we have seen some significant regional and local improvements in delivery of the bundle:

34% of patients in the West of England region received every element of the bundle (for which they are eligible) in June 2021, up from 0% in November 2019.
From April to June 2021, between 66-71% of COPD patients across the West of England were provided with a self-management plan.
In June and July 2021, 100% of GHT COPD patients had their inhaler technique checked.
In June 2021, 91% of GWH COPD patients who smoke were offered smoking cessation support.
In July 2021, 95% of RUH COPD patients were assessed for their suitability for pulmonary rehabilitation.
In RUH and GWH over 90% of COPD patients had a follow-up appointment arranged.

Working collaboratively to drive improvement

Through a West of England network, the respiratory teams have worked collaboratively to collectively share ideas and overcome barriers to optimise the use of the bundle.

Alongside improvements made to the delivery of the bundle, each team has also completed their own local quality improvement (QI) project to improve aspects of patient care. These projects are related to the bundle elements, including upskilling staff on Brief Intervention Training for smoking cessation, reviewing self-management plans and delivering training to improve front door diagnosis. The outcomes of these projects will be shared and celebrated through the month of November.

Mark Juniper, Respiratory Consultant and Clinical Lead at the West of England AHSN said:

It has been great to work with the teams from different hospitals on this project for the last two years. Despite the pressure on respiratory services during the pandemic, they have managed to improve the care of patients with COPD. This work has provided an ideal focus for improvement and bringing the teams together to share ideas and what they have learned has been really exciting.

What’s next

On 9 November, we are running a joint event with the South West and Wessex AHSNs on the wider aspects of COPD and asthma care. This event is now fully booked however recordings of a number of the sessions will be available afterwards, so please join our waiting list.

The West of England AHSN are also celebrating COPD Awareness Month – and World COPD Day on 17 November – throughout November on Twitter. This will include showcasing the QI projects undertaken by each respiratory team.

Updated 26 November – COPD Quality Improvement reports:

The COPD Discharge Bundle is one element of the national Adoption and Spread Patient Safety Improvement Programme. Find out more about our work on the programme here.

Celebrating SHarED: a positive impact on patients and ED staff

As the Supporting High impAct useRs in Emergency Departments (SHarED) project comes to a close the collaborative are celebrating the interim results for patients and staff. The project aimed to pilot a High Impact User (HIU) service in each Emergency Department (ED) in the West of England in order to better manage and support a cohort of patients that frequently attend EDs. Before being chosen for regional adoption and spread as one of two successful 2019 Evidence in to Practice applications, a HIU model was developed at University Hospitals Bristol and Weston (UHBW), where it has been running for five years.

Why is supporting HIUs so important?

HIU of EDs suffer some of the most severe health inequalities in the UK. HIU and ‘super-users’ are defined as those who attend the ED more than five and 20 times respectively each year. As a patient group, HIUs experience exceptionally high rates of mental health challenges; learning disability; homelessness; substance misuse; domestic abuse and safeguarding concerns. HIUs often attend the ED as they have nowhere else to go.

As well as the negative outcomes for HIUs attending ED when that service may be unsuitable for their needs, and the resulting strain on ED staff to manage high levels of repeat attendances, there is also a significant financial impact on the NHS. Some ‘super-users’ cost £30,000 per year in ED attendance and hospital admission.

The impact on patients

Whilst working on a new project during the COVID-19 pandemic offered a series of challenges, collectively the five ED teams across the West of England have supported over 140 patients.

Interim data demonstrates:

a 44% reduction in the number of attendances following the first month of engagement for 89% of the patients engaged.
The remaining 11% of the patients saw a significant escalation in their behaviour, however it is broadly acknowledged that the highly complex nature of these individuals often means that where attendances cannot be reduced, the teams are there to provide appropriate support and improve the experience of the patients and staff members alike.
Additional data collected by a number of trusts demonstrates that where attendance had increased, the impact and cost of each attendance had reduced.

Dr Rebecca Thorpe, the Clinical Lead for SHarED said:

The SHarED project has propelled our work to support some of the most vulnerable, marginalised patient groups in society, who access Emergency Departments frequently, for a variety of reasons. Working with teams from Emergency Departments all over the West of England, we’ve educated staff and supported patients to work towards safer patient care and an improved experience for patients and staff. It’s a fantastic example of cultural change across the whole patch.

Clare Evans, the Programme Manager for SHarED said:

The West of England AHSN are proud to have supported the adoption and spread of the HIU model across our region. The project has flourished despite the challenges presented by the pandemic and that is a testament to the dedication and hard work of everybody involved – especially the staff in ED teams. The commitment to appropriately supporting this most vulnerable of patient groups has been exemplary.

The impact on ED staff

Throughout the funded period of the project, the ED teams have delivered training to over 360 members of staff to raise awareness of the service and best practice guidance on how to manage HIUs, ultimately seeking to improve the culture in the department.

Feedback from a recent staff experience survey included:

“Dedicated HIU teams are making a real difference to the appropriate management of these patients.”
“Great to have agreed (HIU) plans that are regularly reviewed with opportunity for patient input.”
“Our HIU team are brilliant and have made a huge impact on not only the number of attendances but patient outcome and reduction in violence and aggression cases”
“The (HIU) support plans in place currently are really helpful. Keep it up!”

Dr Sarah Harper, Pain Consultant and HIU Team Lead, Gloucestershire Hospitals NHS Foundation Trust said:

Taking part in SHarED allowed our HIU Team the time, support and resource to really address the underlying issues which can drive patient requirement for large amounts of unscheduled care. By developing Personal Support Plans, in collaboration with patients and other professionals, we managed to reduce attendance rates, reduce admission rates to hospital and smooth the path of patients when they did attend the Department, thereby supporting our staff in dealing with these patients who often have complex health needs. Feedback from our ED staff was extremely positive. Looking to the future, with thanks to SHarED, we’re continuing to develop our HIU service.

What’s next?

While the West of England AHSN funding has now ceased, the ED teams are working with their trusts to secure on going support. Each team are passionate about continuing the important work that has been started in the SHarED project.

We are now looking forward to the seeing the full project evaluation, which will seek to fully understand the effectiveness of the SHarED model. We expect to receive the completed evaluation in Autumn 2022.

Read more about the SHarED project. Our free resources include an implementation guide to support trusts and systems outside the West of England to review, adopt and spread the model.

PreciSSIon awarded Quality Improvement Team of the Year

We are delighted to announce that PreciSSIon – a regional collaborative to reduce surgical site infection after elective colorectal surgery – has scooped an award in the Quality Improvement category at The BMJ Awards 2021.

The project – in partnership with Royal United Hospitals Bath NHS Foundation Trust; Gloucestershire Hospitals NHS Foundation Trust; North Bristol NHS Trust; University Hospitals Bristol and Weston NHS Foundation Trust; and Great Western Hospitals NHS Foundation Trust – was awarded the accolade for using original ideas in quality improvement to better outcomes for patients.

Anne Pullyblank, Medical Director, West of England AHSN said:

“This has been a fantastic project to be a part of, and the figures we have been able to achieve at such a challenging time for many in hospitals are absolutely incredible. Combined regional average baseline figures showed surgical site infection (SSI) was 18% pre-November 2019. Implementation of the PreciSSIon bundle elements in all trusts between November 2019 and June 2021 resulted in an amazing almost 50% improvement in SSI rate, leading to a regional average of just 9.5%; a significant improvement in patient experience.

The collaborative element enabled staff and trusts to support each other during the difficulties of the COVID-19 pandemic and engagement was high, with theatre teams in particular being empowered to make a difference. It’s amazing for the hard work of everyone involved to be recognised at the BMJ Awards in the Quality Improvement category.”

Read our Celebrating PreciSSIon article: Reducing SSI rates by 50% with estimated savings of over £500k.

The BMJ Awards ceremony took place on the evening of Wednesday 29 September.

This follows PreciSSIon winning the Perioperative and Surgical Care Initiative of the Year at September’s HSJ Patient Safety Awards. The collaborative project was also shortlisted for the Infection Prevention and Control Award.

Find out more about PreciSSIon.

Marking World Mental Health Day – reflecting on our mental health training for care home managers

Posted on September 28, 2021September 29, 2021 by Vanesther Hamer

In this new blog to mark World Mental Health Day, our Programme Assistant, Millie O’Keeffe talks through the journey she and Bristol Mind took as they worked together to build a free mental health focused training package for care home managers across the West of England. Millie picks out some of the feedback the training (which ran in cohorts from January to June 2021) received and why working on this project was so important to her, our care homes programme and the care home managers who attended.

From a seed

The journey started when some of our key stakeholders in local systems told us about the significant challenges staff in care homes were facing around high COVID rates, deaths of residents, PPE and staff shortages, and isolation – we’d heard about these challenges in the news too – and the effect this was having on care staffs’ wellbeing and mental health. We knew our colleagues in social care were struggling and so wanted to support them somehow. Line managers at the West of England AHSN had recently been trained by Bristol Mind in mental health awareness, and we had heard good feedback from those sessions, so we reached out to Bristol Mind who were happy to work with us to tailor the line manager session for a care home manager audience.

Pulling the jigsaw together

The content of the free training focused on supporting the wellbeing of managers so they were able to better support their staff. There was a lot of ground we could have covered but the fantastic team at Bristol Mind focused on the stress curve, tools like STOPP, how to have a sensitive conversation, and advice on supporting staff who are grieving or anxious about COVID. We also shared lots of resources, including a workbook, and signposted to local support organisations after the training.

Suzanne Pearson, a mental health trainer and consultant and BABCP Accredited Cognitive Behavioural Therapist, worked with us to adapt the content and deliver the training.

How did it go?

I am really proud to say we received incredibly positive feedback from the managers about Suzanne and 97% of attendees said they would recommend the training to a colleague.

“I found it calming, almost therapeutic, I know that may sound odd but just listening to others’ experiences made me feel connected.”

Thanks to the efforts of our contacts in regional systems, provider organisations, primary care, councils (and more) in promoting the training to their local care homes, over two busy cohorts we trained 159 care home managers from across the West of England region.

What did the data look like – how did the training make a difference?

I’m always keen to dig into the data and understand what changed because of the training we provided. Prior to the training, managers cited they were most concerned about their staff’s own mental health and wellbeing, with fear of spreading COVID to residents coming in second. When asked how concerned they were about their staff’s wellbeing, zero responders chose ‘I am not concerned at all’ – that showed me just how much stress each and every care home was dealing with. However, most (59%) managers believed themselves to be fairly confident in supporting their staff, and following the training, their confidence improved even further. A follow up survey showed a third of responders use the tools and tips from the training regularly (a few times a week), and that the training has changed how they support their own (76%) and their staff’s (94%) wellbeing for the better.

It was great to see such positive data from the surveys, but what really hit home to me and the rest of the care homes team were the comments from managers:

“I was really interested in the approach of asking the care home managers how they were feeling and giving them a voice. This was a powerful and quite shocking start. The look on 25 participants faces at the thought of focusing on themselves instead of on their staff. The shock came from the understanding that with COVID we have all just kept going and going, the instruction ‘right, now stop, what about you’ was bizarre.”

Making connections

A positive by-product of the training was that a large number of attendees mentioned they felt the session provided valuable time and space to connect with other managers who have experienced similar pressures over the past year, especially managers from different organisations, and specifically managers in social care.

Suzanne also offered some valuable insight from discussions in the sessions, including a fear that the sector could not influence decision makers and was at risk of being forgotten about. Many managers described burn out, exhaustion, and weariness, and shared concerns around staff recruitment.

These key messages and the evaluations have been shared with our regional stakeholders and internally with colleagues across the Care Homes Programme, so we hope that the training has not only supported managers and staff in care homes but will also go towards illuminating the wellbeing needs of the sector going forwards.

Talk ‘ain’t’ cheap

As I reflected on the training programme and World Mental Health Day, I considered that making time and listening and learning from all our colleagues across the whole health and social care spiderweb is vital – talking is so important and sometimes we forgot to do it. Mental health has always been something I’ve felt should be spoken about more honestly and openly, so as I bid farewell to the AHSN in the weeks to come I remain proud to have coordinated this positive training programme.

Tracheostomy community of practice supports improvements in patient safety

A national Patient Safety Collaborative programme, led by NHS England and delivered by the AHSN Network, commenced in 2020 to improve the care of patients with tracheostomies within acute hospitals. The programme focussed on ensuring that all patients had three elements:

a bedhead sign and emergency algorithm,
emergency equipment and
a daily care bundle.

A short-term Community of Practice (CoP) with the tracheostomy teams from across Bristol, North Somerset, South Gloucestershire; Gloucestershire and Bath, North East Somerset, Swindon and Wiltshire was set up by the West of England AHSN to facilitate shared learning across the teams to improve the care of tracheostomy patients.

What did the Tracheostomy CoP hope to achieve?

Following an audit to understand how the elements were used in the region’s hospitals, it was established that while most trusts did have the elements in place there was room for improvement in their consistency. The teams therefore set out to improve the consistency and efficiency of their internal systems and to align to the national guidelines for tracheostomy care.

What were the outcomes of the Tracheostomy CoP?

Positive multi-disciplinary collaboration for improvement projects
Alignment of paperwork to national guidance and inclusion of Response Team number
Making emergency equipment boxes the same colour throughout the trust
Sealing the emergency equipment boxes to ensure equipment is not removed and reduce the need for regular full checks
Training resources developed and delivered to targeted areas e.g. to oncology and ICU,
Improved processes for Datix
Updated policies
Development of a tracheostomy team with the Acute Care Response Team
Minimising variation between teams

In University Hospitals Bristol and Weston (UHBW), the tracheostomy programme spearheaded a larger Quality Improvement project involving a group of multidisciplinary enthusiasts. The project aims to reduce the number of preventable tracheostomy related incidents to zero by December 2022 through the change ideas shown in the driver diagram below:

Isabel Barfield, Patient Safety Improvement Nurse, at UHBW said:

“In UHBW it has been great to get the multidisciplinary team across the newly merged trust working together on such an important project. Tracheostomy care has needed streamlining for a while now, so far we’ve written new care plans, discharge documentation, incorporated the NTSP videos into our training, and identified emergency boxes and bedside trolleys to facilitate the best care.”

Mark Juniper, Respiratory Consultant and Clinical Lead at the West of England AHSN said:

“It’s always a privilege to bring acute teams together to enable sharing of learning and ultimately improve patient safety – COVID provided an additional challenge but I am proud of the work we’ve completed as a collaborative. The Tracheostomy Community of Practice has gone from strength to strength and the great work we’ve started will now continue – I am particularly looking forward to hearing more about the progress made in UHBW (as part of their on-going tracheostomy quality improvement work).

I know that any improvements or new ways of working will now be shared with acute trusts across the region, so all tracheostomy patients can benefit”.

What’s next?

The tracheostomy programme has now closed, however teams are continuing on their improvement journeys to enhance tracheostomy care safety with their own local projects.

The tracheostomy community of practice is one element of the national Adoption and Spread Patient Safety Improvement Programme. Find out more about our work on the programme here.

New e-learning module to support detection of early deterioration of patients with COVID-19

The West of England Academic Health Science Network has worked in partnership with other NHS organisations, Health Education England e-Learning for Healthcare (HEE e-LfH), the Wessex Local Medical Committee and the TEL programme simulation and immersive technology team, to develop two free e-learning resources to support detection of early deterioration of patients with COVID-19.

The new COVID Oximetry @home and COVID Virtual Wards e-learning modules – launched in May 2021 – aim to support the detection of early deterioration of patients with COVID-19 in primary and community care settings.

The e-learning provides an overview of pulse oximetry for patients and carers and explains how to monitor oxygen levels at home or in a care home setting.

People at high risk of becoming seriously unwell from COVID-19 are being provided with a pulse oximeter to monitor the oxygen levels in their blood at home for up to 14 days. This includes people who are clinically extremely vulnerable to COVID-19 and people living in care homes.

A pulse oximeter is a small medical device that is put on the tip of the finger. By regularly monitoring oxygen levels it can be easier to spot if COVID-19 symptoms are getting worse and whether people need treatment or support. People with COVID-19 may become very unwell if their oxygen levels fall too far.

The West of England AHSN is supporting the continued roll-out of ‘COVID Oximetry @home’ and ‘COVID virtual wards’ in our region. Our local support offer makes use of our existing expertise, infrastructure and resources.

Click here to find more information about COVID Oximetry @home and COVID virtual wards, including links to relevant resources and webinars.

Dr Alison Tavaré. Clinical Lead NHS@Home South West and West of England AHSN Primary Care Clinical Lead said:

“Many people with COVID-19 were living in residential homes and we realised that carers were being asked to monitor patients with little opportunity to have had any training; therefore this e-learning was co-developed by carers and clinicians. The aim is to provide a quick overview of COVID-19, how to use a pulse oximeter and most importantly give clear information on what to look out for and who to call if a carer is worried”.

This e-learning provides an overview of pulse oximetry for carers, including how to take the measurements and how to tell others if they are worried. It is designed to be used alongside the NHS pulse oximetry guidance.

More information, including access details, is available on the programme page.

By mid-May 2021, over 2000 patients had been supported through COVID Oximetry @ home and virtual ward models in the West of England. Read more about this collaborative programme, including the patient’s journey, here.