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