Hear nursing, midwifery and care staff talk about their experiences of identifying unwarranted variation and taking a lead in making the changes necessary to deliver improved outcomes, better experience and better use of resources.
- Leeds Respiratory Network
- The Hot Potato Project – Kendal, Cumbria
- Sandwell and West Birmingham Hospitals NHS Trust – Faecal Incontinence and Constipation Healthcare (FINCH) service
- Imperial College NHS Trust – Releasing time to care enabled by technology
- NHS RightCare Long Term Condition Scenarios: Betty’s story, wound care
From analysing data identified through the NHS Atlas of Variation it became apparent that Leeds had unwarranted variation with regards to respiratory care and outcomes, especially within primary care. To address this inequality two practice nurses established the Leeds Respiratory Network and developed a specific education approach for health care professionals.
Free educational meetings were organised, and social media accounts set up, which are used to keep professionals updated as new guidance and resources become available. The information shared helps improve the quality of care that patients receive.
The practice nurses are now working with a collaboration of 8 GP practices in Leeds to help standardise respiratory care and reduce unwarranted variation. Baseline data has been collected and an evaluation will be undertaken in a year to quantify the impact their work has had but early feedback is very positive as to improved outcomes, experience and use of resources.
In Cumbria challenges to access mental health support services had been identified and a longer wait period compared to other similar services within the country. To support members of a local youth theatre group understand more about mental health issues, a student nurse developed “The Hot Potato Project” and with support from the local Child and Adult Mental Health Service (CAHMS) created workshops where the young people could express their fears and anxieties regarding mental health and wellbeing whilst in a safe and secure peer environment.
A DVD of 40 monologues was produced, which is now being used as an educational tool amongst the schools in Cumbria, educating both the young people but also the health professionals such as school nurses who are using it. It has also been used in a university for pre-registration students when discussing holistic care.
The project focuses on developing emotional resilience within young people, therefore improving their overall mental wellbeing. The culture created by the project is one where mental wellbeing is discussed openly; promoting the young people’s health as it ensures they seek help with mental illness if needed and are able to identify signs when requiring help or intervention.
There is evidence that early intervention and prevention is particularly important in affecting outcomes for children and young people and can have a significant positive impact on a person’s prognosis. Within Kendal there has been a very positive increase in young people accessing support at an early stage when they find that they are struggling to talk about mental health.
Sandwell and West Birmingham Hospitals NHS Trust – Faecal Incontinence and Constipation Healthcare (FINCH) service
Sandwell and West Birmingham Hospitals NHS Trust have developed a nurse led Faecal Incontinence and Constipation Healthcare (FINCH) service, where an integrated care pathway has been designed to increase accessibility, streamlining of the patient pathway and provide a dedicated service for the management of faecal incontinence and constipation.
Prior to the service being developed, patients were seeing 3 or more healthcare professionals before seeing the right person, so patient and staff time was not being used as effectively as possible. The introduction of the integrated care pathway for faecal incontinence ensures that patients are seen in a timely fashion, by the correct clinician, in the right setting closer to their home address.
As a result of the service patient outcomes and experiences have significantly improved, hospital admissions have reduced and savings have been made from decreased laxative and pad usage.
The practice of documenting patient information on paper often resulted in a fragmented approach to the recording, visibility and access to information and ease of escalation of patients at risk of deterioration. Nurses and midwives provided leadership as local champions implementing bedside vital signs monitors. An electronic patient record was implemented, supported by a handover page showing a patient’s latest National Early Warning Scores (NEWS) score. Handheld devices have been used to reduce documentation time with decision support at the bedside.
This is an example of how it is possible to ‘champion the use of technology and informatics to improve practice, address unwarranted variations and enhance outcomes’ – Commitment 10. The information goes directly to the patient record reducing the incidence of transcription errors and therefore increasing the accuracy of the information. Patient safety has improved as a result of earlier and consistent referral; to critical care outreach and medical colleagues. By using bedside devices Imperial College NHS Trust have been able to release 600 hours of nursing time from routine documentation – that time can be used in direct patient care that supports patient outcomes but also supports the nurses’ wellbeing as well.
Betty’s story provides an example of what an ideal wound care pathway looks like, particularly in primary and community nursing. It demonstrates how nursing and care staff can use the Leading Change, Adding Value framework to identify and address unwarranted variation in wound care. This resource been produced in conjunction with the RightCare programme team.
Further Leading Change, Adding Value video case studies
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