Download - Kimberley Begg Lorraine Armstrong Kirsty Mcneil Elaine Mccleary Pam Cumming Sarah Macpherson
Unlocking the potential:
how student led projects can improve service delivery and enable workplace based education on Human Factors Kimberley Begg
Lorraine ArmstrongKirsty Mcneil
Elaine McclearyPam Cumming
Sarah Macpherson
Kimberley BeggKimberley BeggStaff Nurse NHS Forth ValleyStaff Nurse NHS Forth Valley
19/03/2014 Beardmore Conference Centre19/03/2014 Beardmore Conference Centre
Introduction
Background What we did Daily Review Record in practice Did it make a difference? Implications for future practice
Background 2010 - Initially created at University
2010 - Letting people know
2010 - PDSA cycles in ICU whilst a student
2010+2011 - Attended SPSP conferences
August 2012 Staff education Implementation in ICU
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
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
PROMOTES PATIENT CENTRED PROMOTES PATIENT CENTRED CARE AND PATIENT SAFETYCARE 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%
CAUTI Daily Review Record in practice
Fairly well received Better knowledge of when catheter due
out/drainage bag changes etc
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
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
Feedback Sessions carried out
Nurse educations sessions carried out
Implementation 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)
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?
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?
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 Macpherson5th 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
ACT PLAN
STUDY DOTheatre coordinator nurse had inadequate time to change into theatre scrubs
Team decision for nurse to take list to theatre reception area to avoid this problem
Not achieved
List to be taken to trauma theatre by
theatre coordinator nurse by 8am
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 NHSto 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 HubEdinburgh, 6 May 2014