Posted by: ayrshirehealth | December 30, 2016

Can You See the Forest? by @fionacmcqueen

‘My family will always be grateful…’

These are the first words I saw when looking at Patient Opinion and reflecting on how people are experiencing our services.  Patient OpinionThey are words that are often reflected in how people think of the care they receive from nurses and midwives across the country, and as we move forwards into a new year, words that should ring in our ears and encourage us to be even better than we are just now.Caring hands

Every nurse and midwife wants to do the very best for their patients and the people they serve; at times it feels as though practitioners can’t do that for a variety of reasons.  Too busy, too many patients, not the right clinical skills or services available…

So how then can we lift our heads and make sure excellent care is delivered to the people of Scotland reliably, and every time?  forestAnd how then can we support practitioners to contribute to improving health – either with individuals or communities.  How can we create the conditions for nurses and midwives to flourish and for them to believe that they can at all times do the very best for their patients and their loved ones.

At times we can be so busy in the here and now, it can seem impossible to take time to plan a new future, but if we are to continue to service the people of Scotland, we do need to be able to lift our heads and think through how to respond and prepare for the future.

2016

Putting the surprises (at least for some of us and certainly the pundits) of Brexit and the American presidential campaign and election to one side, much has gone on in 2016 for our professions.hscp-integration

The creation of Health & Social Care Partnerships, whilst maybe formalising what was already happening for some, saw one of the biggest changes to the delivery and decision making system within health for generations.

NMCOur regulator, the NMC, is reviewing the education standards for nurses (almost ready to come out for consultation), for midwives (just about to start) and supervision of midwives will be removed from statute

Wider UK/English health policy on immigration, as well as the creation of the Nursing Associate in England may well have implications as to how nurses and midwives work within Scotland.

Clinical Strategy for ScotlandCloser to home, this year saw the publication of the National Clinical Strategy and just last week the health and social care delivery plan was published. Each of these outlining the transformation that is needed to respond to the needs of the population and to support care to be delivered closer to home. 2030-nursing-vision

I was also delighted to launch the consultation of the creation of a nursing vision which would take the profession into the future and support nurses to be prepared to deliver care within partnerships and also from our hospitals where services that require more specialisation will be developed.

So what will next year bring?

Building on the actions that we’ve taken I am keen to see further work on Excellence in going forwards,  which is a care assurance system the Cabinet Secretary asked to be developed in response to the Vale of Leven Inquiry, as well as the first steps to support the government’s intention to introduce safe staffing into legislation.

leap-of-faithI’m looking forwards to the launch of the Mental Health Strategy as well as the Maternity and Neonatal Strategy and am confident that nurses and midwives will play a central role in the transformation of all of our services and continue to play our part in improving the nation’s health.

Our national health service is rightly, a national treasure, we have a real role in helping develop and deliver services that create a sustainable future. For that to happen we may have to let go some of what is familiar and comforting to us.  Much of that will be striving to deliver excellence in care; some of it will be working to create a new future.

I’m confident the profession will be part of the new paradigm that is being created, and look forwards to stepping into our future.

This week’s blog was by @fionacmcqueen (Professor Fiona McQueen), Chief Nursing Officer for Scotland, Scottish Government.

 

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Posted by: ayrshirehealth | December 22, 2016

10 Things I learnt in 2016 by @jasonleitch

It’s harder than I thought

jason-bike1. Cycling is better than running, however, turns out the kit can be ridiculously expensive (but it’s worth it for the reversible green and black cycling jacket and the fancy reflective tabs on my cycling trousers….)

2. It’s harder than I thought to keep up the momentum for continuous improvement. This is one of the problems that troubles me most.

Within the safety programme, expanding to new areas such as dentistry and community pharmacy is great for creating new momentum. But keeping the energy around the existing programmes is more difficult.

ihi-breakthrough-model3. We have outgrown the Breakthrough Collaborative method for our more mature improvement work, so we have had to think differently:sepsis-cake

… more regional work; more campaign style changes, and more celebration.

We need not to forget to celebrate
apple4. The iPhone 7+ is way  better than the 6+ because I can now take it swimming and the phone would survive (unlike the blackberry….long story)

5. There is absolutely no substitute for understanding a system from everyone’s perspective, before you can start to improve it. Particularly service users.

nhsNHS Scotland logo6. How about this for a statistic? 73% of the UK population defines the NHS as the quintessential feature that made them proud to be British

– higher than the monarchy, higher than Dr Who, higher than the Beatles, the Armed Forces and Football Association1.

Reduce re-offending

7. I learnt that you can reduce the chances of a prisoner re-offending by six times with parenting classes in prisons. 16,500 children in Scotland live with a parent in prison every year – that is more children each year than divorce2.   hmp-shotts

And it turns out that by supporting dads to keep in touch with their kids and teaching them how best to “parent from afar” helps them to feel closer to their families and when they return home from prison, they are less likely to reoffend.

Shotts prison is doing some great improvement work as part of the Children and Young People’s Improvement Collaborative,  supporting dads to develop their parenting skills. They are making a fantastic difference.

8. Voting polls are basically rubbish. #justsaying

jason-tedx9. An acting coach is not as bad as she sounds – she taught me to get better at storytelling for “What Matters to Me: a new vital sign” for TEDx Glasgow in June. http://www.tedxglasgow.com/talks/

wmtm-badgesAnd talking of What Matters To Me, I learnt that “What Matters To You Day” on June 6th 2016 attracted 500 health systems and 11 countries to take part – a fantastic achievement for everyone involved.

Have a look at the website, there are some amazing stories:    http://www.whatmatterstoyou.scot/

We fought hate with the only thing we had – Love !

10. And finally, I learnt how the only way to fight hate is love. On June 12 2016 The Orlando Regional Medical Center received 36 critically ill gunshot victims from the largest mass shooting in US history at the Pulse Nightclub. 36 survived.ihi-world-forum

At the IHI World Forum last week, I had the privilege to hear six of the team describe their roles and the role of hundreds of others. From an ED nurse to the CEO their compassion and technical ability were palpable.

The nurse finished her story by saying “we fought hate with the only thing we had, love“.

A very merry Christmas and Happy New Year to you all.

This blog was written by @jasonleitch, National Clinical Director @scotgovhealth : Senior Fellow at The IHI : Health Foundation/IHI Fellow

  1. Mark Britnell, In Search of the Perfect Health System 2015
  2. Families Outside 2009, extrapolated from Scottish Prison Service 2002
Posted by: ayrshirehealth | May 25, 2016

So long, farewell, auf wiedersehen, goodbye by @dtbarron

And now the end is near

AyrshirehealthAfter four years of posting a blog every week come rain, shine and holidays, leading to 215 blog posts, Ayrshirehealth blog is coming to an end – it is a situation of mixed emotions and necessitates some important thank yous.

Two main groups of people need to be thanked.

We have read blogs from over 50 bloggers throughout the four years, some are multiple bloggers and some are one-off bloggers.  I’d like to say a massive thank you to each and every single of one them – they’ve taken the time to write the blogs and to share their thoughts, ideas, expertise and experience.

Blog readersThe second group of people to thank are you, the reader (especially those that follow the blog and get a weekly email directly into their inbox) – without you joining us in the journey of sharing and co-learning the value of the blog would have been greatly diminished – you are the essential life blood of any blog.

Throughout the years many of you have posted comments on various blogs; thank you for doing so, our bloggers appreciate you taking the time to do so, it’s a useful avenue to explore thoughts, feelings and actions.

Individually I was always encouraged on the road around digital engagement by Fiona McQueen (@fionacmcqueen) and via the support of May Smith (Comms)(@mayjs_93) – both of whom have now left Ayrshire.  The ongoing support from the Comms team in A&A has been much appreciated.

DGHealth

DGHealthAlthough Ayrshirehealth is now ‘resting’ there is another blog which models itself on the Ayrshirehealth approach, which I’d encourage you to sign up to follow.

Ken Donaldson (@kendonaldson), NHS Dumfries and Galloway started dghealth.wordpress.com a short time after Ayrshirehealth. We have collaborated and shared our blogging journey, I’d highly recommend it to you, it follows the same format of having different bloggers each week – some clinical, some not, but always interesting and engaging.

Why the end?

And so to why Ayrshirehealth is coming to an end?

ErskineAfter 32 years in the NHS I am leaving to take on a new opportunity (@dtbarron) – this time, just like the NHS, with another much loved organisation – Erskine, the veterans charity, where I’ll be privileged to take up the post as Director of Care.

Begin with the end on mind

It would be a fair to reflect on if the blog has achieved what it set out to do.

In June 2012 the ‘target’ was to have the blogs viewed 3000 times by December (six months) – extrapolating that to the eight half years the blog has been running would mean 36,000 views of the blog over the four years – so having had 113,800 views the blog has exceeded my expectation, especially as that equates to 48,384 visitors.  As can be seen in the link above, instead of 3000 reads of the blog in the first six months we achieved 6000 reads.

Driver DiagramAdditionally I underestimated the reach of the blog, seeing readership in over 120 countries was beyond anything I had imagined, even if year one stats made interesting reading.

Lessons for us all

The lesson for us all when considering how to engage is to look at social media, and blogging specifically, as an additional route to reach audiences that might not be reached via traditional methods.

It can, where required, open up global networks of professionals, service users and carers allowing the sharing of knowledge and information.

Douglas Adams RulesBut – if there is one thing I’ve learnt it’s that blogging and/or social media isn’t for everyone – neither is email, or telephones!!

Any road will get you thereIf you are thinking of starting your own blog – consider adopting Stephen Covey’s second habit “Begin with the end in mind” remembering, if you don’t know where you want to go, then any road will take you there:

Hopefully you’ll agree the Ayrshirehealth blog had a purpose, which it achieved in sharing knowledge and experience related to health and care across Ayrshire and beyond, as laid out in the Driver Diagram.

It simply remains for me to say thanks to each of you for reading this – I wish you all the very best for the future.

This week’s blog was written by @dtbarron (Derek T Barron), Lead Nurse, North Ayrshirehealt & Social Care Partnership | Associate Nurse Director, NHS Ayrshire & Arran.

Posted by: ayrshirehealth | May 18, 2016

In the house of tomorrow by @fionacmcqueen

Posted by: ayrshirehealth | May 11, 2016

Nursing in Partnership by @dtbarron

What can be achieved together 

NAHSCP LogoOn Friday of last week (6th May) nurses in North Ayrshire Health & Social Care Partnership (NAHSCP)  held a ‘Nursing in Partnership’ event.

Over 80 of our nurses came together to share knowledge, skills and expertise.

Nursing in Partnership delegatesThey also came together to share an understanding of the diverse scope of practice across NAHSCP, where we have over 800 nurses working in the Partnership, and to explore how we, as a profession, continue to contribute to the Partnership’s vision and objectives.

A significant feature of the whole day was the buzz from beginning to end, the unmistakable enthusiasm from the nurses there – to their individual roles, but also to the partnership – this wasn’t about nurses being self isolating, this was about embracing what we can achieve together.

The vision

Starting off the day, Iona Colvin (@iona_colvin) shared her vision for NAHSCP – the presentation was titled “Seven steps to change the world”. The vision was unmistakably inclusive, each one of us was left in no doubt that our contribution was valued and valuable. 7 steps to change the world

Key messages included the need to have a plan and that we all need to understand it. As leaders there is no point in charging ahead only to find out that no-one is with us.

The importance of both authentic and distributed leadership was emphasised in encouraging us that we can ‘change the world’ but we need to be on that journey together.

It was clear from Iona that this wasn’t about being ‘generalists’, there wasn’t an agenda of developing some form of generic workers, this was about the added value each profession brings to the partnership from their core skill set; it was however about considering what we need to do differently.

A key point, welcomed by all the delegates was the need to “stop assessing each other’s assessments” – whether that is a nurse reassessing a social workers assessment or vice versus, we need to share knowledge and trust each other in assessing needs.

The context

We then heard from the Chief Nursing Officer for Scotland, Professor Fiona McQueen (@fionacmcqueen) on developing her vision for Scotland.  The policy context was evident in her third slide, but so to was the challenge around how we own the policy context locally, and in the future shape our own policies. Policy context

As a profession we were challenged to considered our place in integrated teams, to think differently both in terms of new roles, but also traditional boundaries – extended, enhanced, specialist and advanced practice. What part do each of these have in our ‘future’ profession?

The professional context was explored by Fiona in relation to revalidation, the NMC educational standards review and the inevitability of many in the room working longer – this means we need to consider now what the future may look like in order that we can shape it, rather than being shaped by it.

TwitterIn addition to other events that have been held, or will be held, for those on Twitter Fiona will be holding a ‘Tweetchat’ around developing the vision of nursing in Scotland – it will be held on 24th May from 19:00-20:00hrs, using #CNOScot as the hashtag. Please feel free to join in.

The unknown unknowns

Of course it would be remiss not to mention the ice breaker word search where one team scored 152 words from their grid – but where one team ended up with three ‘J’s in their word grid there was always going to be wide variations in possibilities.

The nursing roleHaving heard from our keynote speakers, stimulated their grey matter with the word search the nurses then spent time considering and sharing ‘what are the key components of your role?’ and ‘what do you think colleagues don’t know about your role?’  The final question from the morning session was ‘how do you contribute to the profession?’

In the morning feedback it was clear that nurses are people people – person centred care was central in the feedback from each group. Being with people (and families) was an unmistakable theme.  ‘What matters to you’ and ‘making a difference’ were messages from each of the tables.

The privileged position that nurses hold in society, within communities, with families and with individuals was recognised and highly prized by the delegates. There was also overwhelming acknowledgement that with that privileged position came great responsibility.

Strategic contributions

In the afternoon the delegates spent time looking at ‘the plan’ – the NAHSCP Strategic Plan – a plan that had been developed with input from the people of North Ayrshire.

Each of the tables (10) took one of the five strategic priorities and explored how they, as nurses can support the delivery of the plan.

Strategic Plan*Priority 1 – Tackling Inequalities

*Priority 2 – Engaging Communities

*Priority 3 – Bringing Services Together

*Priority 4 – Prevention and Early Intervention

*Priority 5 – Improving Mental Health and Wellbeing

The afternoon feedback session focused on the above topics was to the Chief Executives of North Ayrshire Council and NHS Ayrshire & Arran, to NAHSCP’s three Heads of Service and to the Senior Management Team.

Feedback

Again we saw key themes coming from delegates around the role of the nurse in accessing families at times of need, that nursing is one of the few roles that are with people throughout their lifespan – this brings a unique opportunity to influence health literacy, healthy choices, access to service and to address inequalities.

Nursing InformaticsInformation and health was recognised as an important enabler, both in terms of sharing information across and within teams, but also in reducing administrative aspects of the nurses role.  There was a clear enthusiasm evident from those present.

In closing the event we heard from Elma Murray (@NAC_CEO), Chief Executive, North Ayrshire Council who recapped on the commitment she had heard during feedback, before re-emphasising the power of us all working together – not just within the Partnership itself, but also with colleagues from across the Council services.  This theme of us being stronger together was continued in the feedback from John Burns, Chief Executive, NHS Ayrshire & Arran.

Farewell

It was then left to one of our newest Ayrshire nurses, Hazel Borland (@hazelNMAHPdir), Executive Nurse Director to recognise the significant contribution of one of our longest serving nurses, Jeanette Henderson who retires this week, 52 years after she first began her career here in NHS Ayrshire & Arran.  Jeanette Henderson

Inspirational, caring, compassionate, role model are just a few words used to describe Jeanette – a nurse who hasn’t lost an ounce of her drive and enthusiasm for delivering person centred care from the beginning to the end of her career.  We all wish Jeanette well in her retirement – and as one of our ‘bank nurses’, in the years ahead – yes, she has signed up to come back.

A fuller, more detailed collation of outputs will be drawn together over the coming weeks – there was so many powerful messages of what nurses can do that a blog cannot do the day justice.  Watch this space  there is more to come.

This week’s blog was by @dtbarron (Derek T Barron), Lead Nurse, North Ayrshire Health & Social Care Partnership; Associate Nurse Director, NHS Ayrshire & Arran.

The pictures below are the posters which the nursing teams wrote to describe their role – they were designed by Eleanor McCallum (ellie_mccallum) and printed by Steve Palmer (@stevemedphot): thanks to them both for their invaluable assistance.

Posters 1Posters 2Posters 5Posters 3Posters 4Posters 6

 

Posted by: ayrshirehealth | May 4, 2016

I’ve been hack’ed by @maidenturret

Healthcare hackathon

I’ve had 24hrs to reflect on my experience of the first healthcare ‘hackathon’ to take place in Scotland. Care Hackathon

So was it another tick in the box of the latest workshop methodology or was it a meaningful, purposeful exercise to explore the complex issue of unscheduled care, shape ideas and build commitment for change?

Building the conditions for creativity

The hackathon was held in the Mclellan Art Galleries (Glasgow), which is currently being used as studio space for the Glasgow School of Art. McLellan GalleryI was originally concerned about participants having to travel from Ayrshire, but this was an inspired choice.

The location created a real sense of a working space for the creative expression against a backdrop of the grand (Even the toilets added to the sensory experience – flashback to my school days!). Participants commented on a real sense of getting away from the daily pressures and the casual dress code added to the feel of something different! McLellan Day 1

There was a real buzz in the room as the 150 participants (public sector, third sector, patients, private sector, art & design students) took their seats to hear the introduction from Dr Hans Hartung (project lead for hack).

Hans emphasised the importance of carving out even a small amount of time to ‘day-dream’ and think about the future state and he reminded us that all great inventors achieved through failure – testing their ideas through prototyping.

Trust the Process

As a new experience it was clear that the hackathon methodology was taking many in the room out of their usual ‘comfort zone’. Steps in processWorking in the public sector we tend to stick to linear, structured planning processes and a hackathon is more iterative, with a focus on discovery of ideas to refine through prototyping. So we were told to trust the process (the approach is rooted in the double diamond design model developed by the Design Council).

The first phase on day 1 involved the process of discovery. Snook had undertaken a considerable amount of pre-hack research, talking to a wide rnge of people about their experiences of unscheduled care.

Stepped processA number of case studies of an individual’s lived experience of various elements of unscheduled care were mapped out on story boards round the room. Participants were asked to consider the case studies and uncover challenges relating to unscheduled care.

Listening and talking to participants, I was blown away by the insightfulness and powerful reflections on considering each case study.

There was a real cacophony of debate, with many participants commenting positively about the opportunity to reflect on people’s end to end journey and not just thinking about their bit of the process. The feedback powerfully relayed the challenges of committed staff working with broken systems and processes.

‘Why do we do it this way? – it looks and feels like a production line’

‘Why was the patient not asked what they wanted at the beginning of their journey?’

‘Can we not shape our services round our citizens?’

‘Do we have to see a doctor? Do you have to come into hospital?’

‘There should be more ‘love’ in our systems and processes’

‘We make simple things complex and complex things simple’

‘Carers and families could be much better supported’

Defining Challenges and forming Teams

The passion for a more person centred approach was palpable in the room and it was humbling to hear feedback from participants that was rooted in a desire for collective change. TeamsThe next phase of the ‘hack’ involved participants defining challenges that could be addressed and then forming teams around a mutual area of interest.

This was a fluid process that allowed people to self select and changes teams as they wished.

The last activity of the day involved the generation of ideas (as many and as ‘whacky’ as they liked), ‘chewing the fat’ over solutions to the unscheduled care challenge.

I have been to very few events on a Friday where almost all participants stayed to 5pm on a Friday!

Prototyping, Testing and Defining Ideas

It was great to see more than one hundred and twenty people return on the Saturday for day two of the ‘hack’. Day 2 readinessDay two focused on refining their ideas and prototyping how the ideas would work in practice. Day 2 working

Teams greatly benefited from the art & design students facilitation (they are used to testing the ‘how’) and the support of expert mentors in the room (including product design, data management and quality improvement). This made me reflect on our historical practice in the NHS, where we plan in infinite detail to get it right first time, rather than prototype using an iterative process.

We were furnished with loads of props and ‘arty’ materials to support us in our testing.

Show and Not Tell

Design aidsThe final stage in the process was for teams to present their proposals from the perspective of what it would feel like to experience their idea (in 4 minutes or less). So no death by powerpoint!

The teams rose to the challenge – we had drama, role play, audience participation, 3d models amongst the approaches used to get their ‘idea’ across.

I never realised Ayrshire had so many talented actors! The change ideas for unscheduled care were big and small including:

  • Self-referral for psychological distress
  • Volunteers to support end of life care
  • Development of community hubs and integrated health and social care teams to deliver the right care in the right place
  • Using existing technology to support the sharing of anticipatory care plans
  • Enhancing homecare to prevent hospital admission

Next steps and date for the diary

As well as the enthusiasm, passion and commitment generated by participants (I wish I could bottle this for use!), copious amounts of valuable data, change ideas and projects were generated during the two day process. It is important that the synthesis and outputs from the event link with other conversations and change plans that are already in train (lots of good work already happening in partnership between the Health and Social Care Partnerships, Acute Services and other service providers).Co-created

This was reinforced by Mr John Burns our Chief Executive in his closing remarks. The focus must now be on delivery, using the outputs from the hackathon to deliver the required change to sustainable person centred models of care. The outputs from the hackathon will be shared widely with stakeholders and there will be a follow up event on Friday 3rd of June at University Ayr and University Crosshouse Hospitals.

So back to my original question – was the Hackathon a tick in the box or a meaningful exercise?  I think it was really worthwhile for a number of reasons, but the ‘proof of the pudding’ will be in the delivery of change.

This week’s blog was by @maidenturret (Andrew Moore), Lead Nurse, South Ayrshire Health & Social Care Partnership; Assistant Nurse Director, Quality Improvement and Governance, NHS Ayrshire & Arran

Posted by: ayrshirehealth | April 27, 2016

Are you sure you can revalidate? by @markfleming1

Posted by: ayrshirehealth | April 20, 2016

Sssh! by Julie Wands

The library can save you time so you can save lives.

What does a health librarian do? Librarian

I’m always amused by the comments I get when I’m asked what I do for a living. It has included “Do you go round the wards with a trolley?” and “It must be nice to be able to read all the books”.

As for the latter comment, even if I had the time, the finer details of pathophysiology would not be my idea of a page-turner!

So, I thought I’d try to remove the mystique of what goes on behind that library desk over the course of a typical week. In doing so, I hope that you may be able to see ways in which the library service can help you in your own role.

Monday – Supporting Students

Monday morning and a new intake of medical students have arrived at Ayr Hospital. MedstudentdemoIn a memory test worthy of “The Generation Game”, I give them an induction in what they need to know about the library; access, door code, open access wifi, using memory sticks, library catalogue, self-issue machine etc.

Libray TwitterThen it’s time to check our Twitter account (@NHSAAALibrary) for notifications and any useful tweets to pass on.

Literature searching for evidence-based information takes over the rest of the day and into Tuesday.

Tuesday – Finding Evidence to Support Patient Care

Literature searches for the latest evidence and providing summary digests are a main part of our role within the healthcare community, and also the most rewarding. KnowledgeNetworkToday, one search is on service improvement, the other on the latest evidence for treating a patient with multiple conditions.

Later, I have a teleconference with other NHS librarians (aka “knowledge brokers”) on developments with national projects, such as The Knowledge Network – NHS Scotland’s information portal.

Being part of a wider network is so important when there’s only a few of us in any one Board. It gives us the ability to collaborate on larger projects.

Wednesday – Information Skills Training

I meet up with my colleague, Susan, on Wednesday to deliver information skills training to a group of social care staff from the new Health & Social Care Partnerships. NAC Libraries Twitter

It is held at Greenwood Resource Centre, Irvine, thanks to collaboration with North Ayrshire Council Library Service.

We are also joined by Rob Westwood from NES who talks about the Social Services Knowledge Scotland (SSKS) website. Our role is expanding to include Health and Social Care Partnerships – a new challenge for us.

Thursday – Promoting the Library Service

Today I’m presenting at two audit meetings – Anaesthetics and Ophthalmology. LibrarybannerThe main message is that Library Services saves clinicians time and provides them with up-to-date information to inform their practice. Promotion of the service and the resources available to staff and students is a constant part of my role.

Even though staff may have been with the organisation for years, they are still surprised at the range of ways in which we can help them. If you have used our services in the past and found them useful, please pass this on to your olleagues.

I also provide free pens, which always goes down well.

Friday – New Books, New Library, New Horizons

I have time to do some new book selection and ordering on Friday before going to Woodland View for an update on the move to our new library there. WoodlandViewIt’s great to have the library in the centre of the new facility for easy access by staff and students and it’s close to the coffee shop too.  I can’t wait to see it open.

So that’s my week in a nutshell. I hope it inspires you to come in or drop me a line if you are looking for the latest information to inform your practice.

This week’s blog was written by Julie Wands, Library Manager (South), NHS Ayrshire & Arran

 

Posted by: ayrshirehealth | April 13, 2016

Breathing space by Kate Hollins

 

Kilner Jars

When I was a student nurse back in the 1980s, caring for patients with malignant pleural effusion traditionally involved a lengthy hospital stay.  Chest drainI was quite frightened of chest drains, which were clumsy and cumbersome, with apparatus consisting of lengthy rubber tubing, and underwater drainage systems using heavy glass cylinders, like over-sized Kilner jars.

Rope-like sutures and large amounts of pink, sticky, sleek tape adhered to the patient’s chest wall, held the daunting structure in place.  The risk of displacement of the drain apparatus required it to be kept upright and not pulled or tugged.

This left the patient dependent on others for assistance with mobility and the activities of daily living.  I approached these patients with much anxiety, terrified that I would disturb their respiratory plumbing; goodness knows how they felt!

More breathing space

Three years ago, when I first encountered Dr. Guhan, chest physician, I had to challenge my thinking.  Breathing SpaceHe demonstrated that indwelling catheters are now neat, light-weight, soft silicone devices: a delicate tube is initially neatly sutured in place and protected by a showerproof dressing.

“Removing the fluid provides more breathing space”,

he said.

“The procedure is done using ultrasound and under local anaesthetic and the patient can be home by tea-time.” 

Algorithm

In addition to the manufacturer’s product guidance, Dr. Guhan has produced a flowchart algorithm which provides district nursing staff with the autonomy to manage chest drains themselves, and a troubleshooting guide that indicates when to contact him for guidance.  District NursesThe flowchart indicates frequency of aspiration as determined by patient symptoms and pleural volume.

When required, disposable plastic bottles are attached to the catheter to allow pleural drainage.  Anchoring sutures are removed seven days post-insertion.  Thereafter, a polyester cuff forms a seal under the skin surface to hold the catheter in place.

Sounds simple?

Yes, it is.  However, in order to enhance my own understanding and share this new knowledge with others, I was required to research a little more.

Back in control

In developing the workforce’s knowledge, one of my colleagues demonstrates the procedure in a YouTube video: Dr. Guhan has also provided educational sessions for district nurses, GPs and hospital personnel, with participation from patients who, despite the limited prognosis of malignant disease, have shared stories of the positive impact of being looked after within their community.

This patient-centred approach puts the individual back in control of their situation, allowing them to be cared for at home with minimal hospital attendance, usually on an out-patient basis.

This enables the patient to choose how to spend valuable time when feeling less fatigued: whether with family or friends, pottering about in the garage, at the flower show, or on the golf course.  For those less able, breathlessness can be eased by draining their pleural catheter in the comfort of their own bed.

Getting married

I am currently caring for a young lady with breast cancer, who developed a malignant pleural effusion 18 months ago.  Just marriedAn indwelling pleural catheter really has provided her with breathing space: she is no longer breathless and can get on with life, getting married last autumn and now planning a family holiday to America.

Last week, I received an email from Dr. Guhan inviting me to a meeting to discuss the care of patients with heart failure who have chronic pleural effusions.   He wants me to consider whether they can be managed at home with indwelling pleural catheters so they can have more breathing space too.

My learning continues…

This week’s blog was by Kate Hollins, Clinical Team Leader (District Nursing), South Ayrshire Health & Social Care Partnership, NHS Ayrshire & Arran

Posted by: ayrshirehealth | April 6, 2016

Hack a what …! by @maidenturret

Health Hackathon

The first time I heard the word ‘Hackathon’ I have to admit that I rolled my eyes at the thought of yet another proposal for hard pressed frontline staff to be obliged to engage with.  Haka

I also had a vision of healthcare workers venting their ‘initiative fatigue’ using the traditional warrior dance to intimidate those who had the bright idea of a specific event to explore ideas to address the ‘wicked’ problem of unscheduled care.

However, I have been intrigued by the opportunity offered by this novel approach.

So what is a ‘hackathon’?

With its roots in computer programming, a hackathon provides an opportunity for people to come together to form teams around a problem or idea, and collaboratively create a unique solution from scratch. Hackathon

A famous example of an output from a hackathon includes the Facebook ‘Like’ button! (If you have seen the film ‘The Social Network’, you will have witnessed a small hackathon in action).

In recent times, Healthcare organisations in the USA have used this methodology to find creative solutions to wicked problems.

 The NHS Ayrshire and Arran Event

ScottishGovtNHSaaaSponsored by the Scottish Government, NHS Ayrshire & Arran are hosting a Healthcare Hackathon with a focus on the complex challenge of developing innovative solutions to the wicked problem of Unscheduled Care.

The ‘hackathon’ is taking place on the 29th and 30th April 2016 in the McLellan Galleries, Renfrew Street, Glasgow.

We know that that all unscheduled care services are creaking from the increasing rise in demand and the relentless pressures faced by health and social care staff.  Wicked problemThis can make it increasingly difficult for health and social care staff to carve out time to lift their heads; to reflect and explore sustainable solutions to the wicked problem of working with broken systems and processes.

This approach carves out time for stakeholders to pause, reflect and use their lived experiences to generate ideas and solutions.

The event will take a creative, fun and person centred approach – focusing on real peoples stories of seeking, receiving and delivering unplanned care and developing ideas for new approaches to improve people’s experience and outcomes. The event will be facilitated by Snook – an award winning service design agency who have considerable experience in running hackathons and supported by Glasgow School of Art.

Care Hackathon

Attendees are being sought from staff working in acute care, health and social care partnerships, partner organisations, patients and other services/industries where flow and quality are key to success. We have had more than a hundred expressions of interest to date. We are particularly interested to have more representation from patients, carers, acute nursing, community nursing and GP’s.

How can I get Involved?

If you are interested in being involved, please register your interest with Snook via their website carehackathon.com .

Even if you can’t make the 29th and 30th April, we would encourage you to get involved.

We want to hear your experiences, reflections, ideas.

You can get in touch in a number of ways (Snook would be delighted to have a conversation with you), including:

What will happen after the hackathon?

The ideas will be developed with the teams into design briefs that will be presented at a post-hackathon event at the beginning of June. We hope that innovative ideas that do not involve technical development will be prototyped quickly and integrated into existing unscheduled care change programmes to contribute towards new models of care. Those requiring further technical development may be openly shared as design briefs for technical development.Carehackathon 2

We look forward to hearing from you and a big thanks to all who have shared their experience or expressed an interest to date.

‘Change will not come if we wait for some other person or some other time. We are the ones we’ve been waiting for. We are the change that we seek’

Barack Obama

This week’s blog was by @maidenturret (Andrew Moore), Interim Lead Nurse, South Ayrshire Health and Social Care Partnership; Assistant Nurse Director, Quality Improvement and Governance, NHS Ayrshire & Arran

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