QI culture

• Dr Sunil Dasan, Consultant, Emergency Medicine
• Liz Clark, Clinical Nurse Specialist, Domestic Abuse and Female Genital Mutilation
• Karen Lewis, Specialist Midwife, Women and Children, Domestic Violence and Substance Misuse
• Sally Bartolo, Team Leader, Redthread Youth Violence Intervention Service
• St George’s University Hospitals NHS Foundation Trust

Background

We know that Domestic Abuse increased through the Covid-19 pandemic. We also knew locally that our data and processes were poor. With the setting up of a new electronic referral in August 2021 we saw modest improvements in referrals however to further improve this, we set up a Domestic Abuse Steering Group as a forum through which improvements could be planned and implemented. The Group included a wide range of stakeholders and we used the numbers of electronic referrals as a proxy measure of the impact of our interventions.

Reena Barai, Community Pharmacist, S G Barai Pharmacy

Background

Valproate is a treatment for epilepsy and bipolar disorder. Children born to women who take valproate during pregnancy are at significant risk of birth defects and persistent developmental disorders. Therefore, MHRA set guidance in 2018 that valproate medicines must not be used in women or girls of childbearing potential unless a Pregnancy Prevention Programme (PPP) is in place. Despite awareness of this issue, according to a safety report issued in 2020, three babies per month are still being born after exposure to valproate. The devastating issue of sodium valproate has been described by Henrietta Hughes, the patient safety commissioner, as “a far bigger scandal than thalidomide.”

Olivia Frimpong, Jonathan Grellier, Kath Thacker, Eleanor Roland, Sarah
Morrison, Paul Riddle, Sally Coulthard, Lara Maddison, Jen Bunn, Alwen Pritchward – Kingston Hospital NHS Foundation Trust

Background

An improvement system was introduced to Outpatient Physiotherapy in January 2022. Like many elective services the Outpatient Physiotherapy Team were faced with a number of challenges during 2020/21 as the hospital began to return to ‘business as usual’ following the national response to Covid. This included managing the disruption to patients in their elective recovery, responding to an increasing waiting list, whilst also addressing the wellbeing of staff who had worked tirelessly throughout the height of the pandemic. It felt like the opportune time to try something new, to address the frustrations of staff, support the service to incorporate problem solving into the day-to-day, and to ensure that the team could move forwards with what really mattered to them and their patients Following engagement sessions with leaders and staff, daily improvement huddles were
commenced to incorporate and promote improvement thinking into the everyday and gave staff the opportunity and space to apply QI principles and techniques for problem solving. This was complimented by monthly performance dashboard meetings and ‘Wildly Important Goal’(WIG) meetings. Through the senior leaders engagement sessions a mission and vision was developed that aligned with the WIG and department KPIs and trust patient first strategy. By March 2023, the Outpatient Physiotherapy Team were performing at a Maturity Level 4 (out of 5) for their deployment of an Improvement System, indicating that it is ‘embedded’. Other teams in the trust now visit the improvement system meetings and huddles to learn how it has been embedded.

Susan Kitaka – Epsom and St Helier University Hospitals NHS Trust

Background

Venous thromboembolism (VTE) is a leading cause of potentially preventable harm. Randomized controlled trials have demonstrated that VTE prophylaxis, when administered completely, significantly reduces the risk for deep vein thrombosis, pulmonary embolism (PE), and fatal PE (Streiff and Lau, 2012). Non-administration of VTE prophylaxis medication is a pervasive problem in both academic and community hospitals, where 10–15% of doses are not administered. Nearly half of hospitalized patients missed ≥1 dose (Lau et al., 2018).

Florence Ilegbusi, Lead Nurse for Continence Service, Clinical Nurse Specialist – Epsom and St Helier University Hospitals NHS Trust

Background

The process on Frank Deas Ward is that any patient admitted with urinary catheter or requiring a urinary catheter inserted in hospital should have their catheter checked using the parameters in the catheter care bundle to ensure good quality catheter care for the patient. In the course of continence round it was discovered on Frank Deas Ward that catheter bundle was not being followed.

Learning Disability Health Facilitation Team, Sutton Health and Care and Sutton Primary Care Networks

Background

People with a learning disability will die around 24 years younger than the general population 49% of deaths were rated as “avoidable” compared to 22% for the general population (LeDeR report, 2021). NHS England fund GPs to complete an annual health check to anyone on their Learning Disability (LD) register aged 14 and over. The national target is 75% (reduced temporarily to 67% during 2020/21).
Sutton as an area completed health checks for 56% of their LD register (2019/20) but during the Pandemic (2020/21) uptake was only around 20% in Q3. SWL funded a LD health facilitation team for Sutton to increase uptake and make sure as many people in this very vulnerable group were seen.

Project team

• Hina Rahimi, Assistant Head of Transformation, NHS South West London
• Dr Debbie Stinson, Clinical Lead for Adult Mental Health, NHS South West London
• Dr Vidhya Thiagamoorthy GP and Primary Care Lead, NHS South West London
• Sian Hopkinson, Deputy Director of Primary Care, NHS South West London
• Diki Fundu, Senior Primary Care Transformation Manager, NHS South West London
• Komal Bhura, Serious Mental Illness Lead, NHS South West London
• Lee Lewis, Data Lead, NHS South West London
• Lizanne Baldwin, Administration and Data Lead, NHS South West London
• Lisa Lancefield, Chief Executive, Sutton Mental Health Foundation
• Carole Jacques, Peer Support Manager, Sutton Mental Health Foundation
• Sam Wilkie, Peer Support Worker, Sutton Mental Health Foundation
• Kiran Toora, Clinical Manager, South West London and St George’s NHS Mental Health Trust

Background

Within Sutton borough of the 23 GP practices only 32% of patients in the community on the SMI register were compliant with their SMI annual physical health checks, thereby demonstrating health inequalities and health impacts in a hard to engage patient cohort. The life expectancy for people with SMI is 15-20 years lower than the general population.

Background

Evidence Based and Task Oriented practice have led to decreased client centred practice. The project commenced with the notion of creating a more suitable environment for patients on the ward to lead to positive interactions with the MDT, ultimately leading to a quicker yet safer discharge, as environment is a subtle yet vital influence on impeding or enhancing success in the therapy process (MacAllister, Zimring, and Ryherd, 2016). People in rehabilitation units remain inactive and isolated, which contributes to occupational deprivation (Singer, 2018). Occupational deprivation leads to lack of meaning and affects rehabilitation potential and overall quality of life (Whiteford, 2000).

Lou Naidu, Caroline Pollington, Mary Hopper, Dr Simon Elliott and Emma Stapleton – South West London Integrated Care System

Background

The availability of QI skills in Sutton general practice was unknown. The increased national focus on QI was a driver and primary care can contribute to improving patient outcomes using QI methodology. All 23 practices were invited to take part and the programme was delivered on-line to facilitate attendance and minimize costs.

Deborah Gouveia, Senior Project Manager and Programme Lead; Frank Deas, Frailty MDT and Richard Bright Nursing Team – Epsom and St Helier University Hospitals NHS Trust

Background

During the initial wave of Covid, to reduce the footfall of staff congregating in the site team office to provide in-person, verbal, multiple daily updates regarding ward bed status and patient care plans, the trust’s Patient Tracking System (PTS) was reintroduced by Senior Service Improvement Manager, Deborah Gouveia. This significantly improved timely, live, electronic updates entered by the MDT whereby improving communication centrally via the trusts Patient Tracking System.

Project by Ana Weithers, Sepsis Clinical Specialist Nurse – Epsom and St Helier University Hospitals NHS Trust

Background

Sepsis remains the hidden killer in the NHS until now; 52,000 lives are lost to sepsis every year in the UK. Early identification and treatment are the key elements of improving outcome in sepsis. Under the NHS Long Term Plan all hospitals are required to deliver the best possible practices for identifying and treating sepsis.
The sepsis screening tool provides healthcare professionals with a method of supporting the decision-making process to identify sepsis and those patients likely to require escalation and urgent treatment in both primary and secondary care settings (Edwards et al, 2019). Unwarranted variation was identified as a result of ongoing Sepsis quality standard audit (NICE – QS 161), identifying the opportunity for improvement in the compliance and use of sepsis screening throughout the Trust.