Posted by: ayrshirehealth | July 16, 2014

CLAPS – that light bulb moment by @moragmcnulty

Change can be difficult!

Or you can embrace it and run with it if you can keep up.

Our journey started in March 2014 at Ayr racecourse when NHS Ayrshire and Arran held their SPSP relaunch event. SPSP eventWe went along and found Jason Leitch to be somewhat inspirational, highlighting issues about the patients’ journey and how we can all improve, simple you would think? It got me thinking about what we did in my own area (Station 14 Ayr Hospital) I was pretty sure we were ‘safe’ but was there room for improvement?

The SPSP event was quickly followed up by the national SPSP Indicator Learning Session. This event encouraged us to work with our local Boards and develop local plans and test sites for improvement as a result I was asked to join ‘the deteriorating patient group’ So now we had a focus or did we?

SPSP JourneyA lot of useful discussion took place at this event and we all left feeling pretty upbeat but unsure how to exactly take this work forward to improve the care for our patients. It really got me wondering

– I was sure I knew what was going on in my area but did everybody else?

More importantly could we do things better and safer for our patients and my staff?

The Light Bulb Moment

I was already thinking how much more work will this generate, and how will this impact on the staff who are already working under immense pressure to ensure we meet local and national guidelines. Then the light bulb moment happened – I thought why don’t we check what is being done in a formal way in the afternoon? Culture rockWe already have in place a safety brief and handover formally twice a day but after the ward round however this was usually just me checking with individuals what was required. The individual teams all knew what was happening regarding the patients in their care but now I wanted reassurances that this information was being shared amongst the wider team but how would I achieve this?

I quickly devised a checklist consisting of things I felt were important for patient safety – but what would be the best way of implementing it? After some thought I decided to call it Clinician Led Acute Patient Safety (CLAPS) and went with a brief meeting at 2pm, lasting no more than 10-15 minutes. I felt it was important to have representatives from as many of the multi disciplinary team but thought this would never happen due to everyone’s busy schedules.

PDSA cycleVerbal invitations were given to doctors, nurses ANP’s and Pharmacy and AHP staff and I waited to see what would happen. To my surprise we had an excellent turnout the middle grade medical staff where really keen to be involved in this venture. After the meeting was concluded we realized the time was wrong and so began my venture into the PDSA cycle.

That’ll never happen

ClapsI then went on annual leave fully expecting the meeting to go ahead intermittently as I realized this was a big change for us. I returned from my holiday to be bombarded with suggestions for adapting the CLAPS and did I want it carried out over the weekend as well.

In late April I attended the Improvement Science Fundamentals Course which offers an opportunity for staff to gain the skills and knowledge in relation to the Model for Improvement and learn and apply the principles and tools of improvement methodology. This gave me the insight and confidence to quickly adapt and supported by the Clinical Improvement Team’s Hazel Clark we began to make the changes required to move through our PDSA cycles. All disciplines were now fully on board and the ANP’s approached us with ideas and suggestions for improvement and for trial.

Total Curve ball

Our improvement project started late March and within three weeks we had a very workable tool which was adapted and improved by review and testing. We could feel that the ward felt safer, we now have evidence that shows tests are performed and results followed up quickly, drug prescriptions and fluid prescriptions are completed within day time hours which has not only improved the running of this area but has had a considerable impact on the workload of the ANP’s.

Spreading Good Practice

SPSP leadersThe NHS Quality strategy asks us, as practitioners, to help contribute to making the NHS in Scotland a world leader in the quality of health care services that it delivers. We believe here in Station 14 we are fulfilling that request by driving improvement initiatives such as our CLAPS project.

It is important to note however that our success has been down to the enthusiasm and determination of our nursing and medical team who have ensured the success of this work. Without their input and the additional support from the rest of the MDT we would not have progressed as far.

To date we have had numerous visitors to the area and great interest in the spread to other areas within the organisation. All feedback has been positive and we feel that we are witnessing a noticeable change in culture.

To add to our success we were recently awarded the ‘Ayrshire Achieves’ learning achievement in recognition of our success.

This week’s blog was by @moragmcnulty (Morag McNulty) Senior Charge Nurse Station 14 Ayr Hospital




  1. Fabulous example of person centred care involving the whole team. Well done Team Morag.

    • It truly makes us all think about the individual not just the ‘task’ required.

  2. Congratulations to you Morag and staff for implementing a very useful tool to improve patient safety, well done

    • Thanks, I am now wondering how it took me so long! Taken totally by surprise by the enthusiasm and commitment from all in the Team.

  3. Well done Morag and team. Excellent example of quality improvement in action. And they tell us you can’t teach an old dog new tricks ……😜

    • Thanks Laura, I agree living proof you can change!

  4. Morag, fantastic to read your journey and learn about how change- although not easy, is essential if we are to continue on our quest for excellence in care.

    I know you’ve been an inspiration to many of your colleagues- success breeds success- well done.

    • Thanks for your comments, they are really appreciated, I must state that my Team make it all so much easier with their commitment and passion!

  5. Great blog Morag, showcases determination & commitment of your team.

    • Thanks Janice, they are an inspiration and a privilege to lead.

  6. Just shows you don’t have to make a meal out of a good QI initiative. Have a good idea, get a bunch of enthusiastic people and get on with it! Well done!

    • Really proud of the Team, they are committed to delivering the best care possible, astonished how it all took off!

  7. Well done Morag. Change can be very difficult but glad to see staff embracing change and working together making a difference.

    • Simple steps Sadie, certainly the way forward!

  8. Great blog, Morag, I’m hugely impressed with what you’ve achieved.

    • Thanks Andrew been quite a journey at an incredible speed, but,loving it.

  9. Well done to you and your team demonstrates to all that change can happen will small bites as opposed to eating the whole pie at one sitting!!!

    • Exactly Liz, not forced, from the ground up, the Team ran with it, I tried to keep up!

  10. Great blogg Morag and well done on your Ayrshire Achieves award. You have given a great example of how to bring about change you involved all staff and listened to their ideas/opinions. Great leadership and it proves that your enthusiasm and belief ‘rubbed’ off on your staff…..we need more like you :))

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