ACTION PERIOD CALL - NOTES

SCALING UP SHARED Haemodialysis CARE

Date: Thursday 9th February 2017

Location: Teleconference

Time: 14:30PM – 16:00PM

1  Introductions & Welcome

Teams Present:

·  Stevenage (Paul Warwicker(Partial))

·  Nottingham (Alison Kitchin, Kat Ka….

·  Stoke (Helen Barlow, Mark Lambie (partial))

·  Wolverhampton (Stacey Robinson, Helen Spooner)

·  Sheffield (Mandy Plant)

Teams Absent: Sunderland

Core Team: Tania Barnes, Sonia Lee, Martin Wilkie, Steven Ariss, Steve Harrison (STH QI), Andy Henwood, Jo Blackburn

Item / Comment
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Updates

·  Learning event 1 reflective feedback has been received from 3/6 sites. If possible please could the reflective feedback be sent back to Sonia to inform the forthcoming events.
·  Heads-up on learning Event 2 content was provided. The invites which include Agenda have now been sent to all participants. Key feedback has been that the QI session was intense, it should be noted that this was peculiar to the first event to give context and future events will be more targeted.
·  Approx. 584 patients have been recruited to the study – Baseline and first data-point questionnaires are being returned to Sheffield for data input. There are gaps in the data with some questionnaires missing for some patients. The specifics per site will be advised to the PI /Research lead requesting that if at all possible the gaps be filled to maximise the validity of the research activity.
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Discussion point 1 – Expectations of the collaborative

Andy Henwood initially explained the core teams expectations in terms of the current activities already planned within the programme, Face to face learning events, Teleconference Action Period calls, Website details, Newsletter, Twitter, facebook (nurses), watsapp (patients).
Wider conversations suggested the following :
‒  PW (Stevenage) – some people might prefer email, as can read and respond in their own time rather than having to look for other social media.
‒  Paul (Stevenage) – Learning event was a long day and time away from base meant catch up was required. For future events looking to rotate people attending with others executing improvement work at base.
‒  Mandy (Sheffield): conference calls might be too long; probably would be best for a ‘surgery’ type call for help with specific issues
‒  Steve H: (prompted by request for the Stevenage questionnaire) mentioned the Frail safe project website which was used to share leaflets, questionnaires etc. There is potential to use the website for this.
‒  Alison from Nottingham said that the event made us work as a team and they had enjoyed the event. She thought that the frequency was good as it would keep them energised.
‒  Stoke The team were enthused and found it beneficial, but little time to deliver or cascade learning when they got back to work.
Patient involvement:
‒  All seemed to think that patients were appropriately involved.
‒  Andy offered help with support, mentorship & guidance as they were probably not as used to collaborative working as members of staff were.
‒  Patient from Wolverhampton has been transplanted, and whilst it would be fine for him to continue, it might take some time for him to be well enough, so probably best looking for someone else.
‒  Stoke team said that their patient gave good feedback and really felt part of the team. They thought the social media side was good for the collaborative.
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PDSA Show and Tell

a)  Nottingham

‒  PDSA objective: increase number of patients taking own obs in waiting room.
‒  Progress: station set up in waiting room with paper, pens and different sized BP cuffs (learned that his was necessary). Just weight and BP at present; thermometer for temperature later.
‒  Nurses have been allocated initially to the waiting are to teach and ensure that obs are being taken correctly (e.g. BP cuffs applied correctly etc). Question was raised “Will the patients continue if the nurse is not there?”
‒  Audit: out of 47 patients, only 7 were doing BP.
‒  Next steps: Checking/audit again in a couple of weeks (it was suggested not to wait that long).
‒  Steve H: possibility for data for a run chart to plot progress as collection of tickets and putting that data into a chart on a very regular basis is readimade monitoring.
‒  Steve H: Might be useful to identify people who have and haven’t taken obs, and ask them why they have and haven’t; is it motivation or ability?
‒  Nottingham hope is that all patients will do their observations as a matter of course when they enter the waiting room. Once this is stable then undertaking obs during dialysis and after treatment could be progressed as follow on cycles.

b)  Stoke

‒  PDSA objective: patients recording weight and BP in waiting area
‒  Progress: Not taken much action: waiting for new IT system Fresenius card system (although not the full system). This will mean that obs will automatically be recorded and entered onto the machine, so that the machine will not need manual programming.
‒  Steve H: Shouldn’t wait for the IT system, this can take a long time and can miss opportunities to improve in the meantime.
‒  Mark: have already waited a long time so should be imminent.
‒  Steve thought that when it was in place that having a new piece of technology would be a good opportunity and catalyst to implement change as people may be more responsive if it has to happen.

c)  Stevenage

‒  PDSA objective slightly changed now planning to trial moving the shared care space around the unit to see if they can influence uptake from other patients and staff to train. (ACTION – SL to forward original to PW/SD for update so that revised test is clear)
‒  Currently only certain nurses do training and there has been a high staff turnover rate
‒  To enable measurement a questionnaire has been designed to assess how patients feel about this (ACTION – PW to forward this to SL for information)

d)  Sheffield

‒  PDSA objective; measuring number of patients washing hands
‒  3 units: Peter Moorhead (PMH), & 2 satellites (1 NHS [Heeley] and 1 privately run [Rotherham-Diaverum]).
‒  Has been difficult to get time together as a team across the 3 units. Suggested that all 3 units might consider making and implementing their own plans.
‒  Progress: Audit undertaken and only 20% of patients are washing hands which has proven that ‘we will need to change this’
‒  Next step is to educate patients and staff. However, there are not currently very good facilities at all locations. E.G at PMH there is only one sink at the end of the bay [observation at unit: Patients seem to all come in at once, this could cause a bottleneck].
‒  Steve H: Need to make it as easy for people as possible & produce visual reminders. Needs to be easy and no bad experiences, so that it becomes ‘habit’.
‒  Steve H: Discussion of the need for understanding behaviour change techniques. He suggested a good speaker for learning event that we could use to help with this. Tania suggested use of patient photographs washing hands.
During discussion of PDSAs, Nottingham noted that they also need to address hand washing and this would be an area that they would like to look at soon. Wolverhampton had mandatory hand washing with a member of staff that did not let people on to the ward unless hands were washed. Stoke encouraged fistula site washing and had an audit every 2-3 months. Andy thought it was okay to mandate certain tasks when the safety of others was at risk, but not for instance priming machines. This discussion in itself prompted a lot of interest.

e)  Wolverhampton

‒  PDSA objective to replace post-it notes for recording obs with a wipe-clean tag/fob.
‒  Baseline measurement : 2/5 patients lose the post-its currently
‒  Worth considering that there may be something else in the patient flow that is causing this?
‒  It was noted that the request to change from post-it to fob should not impact patients as they are already (apparently) taking the obs it is just getting mislaid.
‒  Steve H: could perhaps look to get even more baseline data to demonstrate how reliability might be improved
‒  Card has been designed: rolling out next week to a couple of patients on each shift
‒  ACTION – Stacey to send photo of the fob to SL
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Any Other Business / Points Raised :

‒  Unintended consequences/balancing measures: Tania suggested that there is there a risk of introducing too much too soon, which might unintentionally ‘turn patients off’. This could be further explored in later learning events.
‒  Behaviour change: is very important and should be covered in future events (perhaps Martin Wildeman (cystic fibrosis behaviour change) for learning event #3). This was reiterated by Nottingham (Alison)
‒  Other learning needs of teams: There are some online QI courses that have been identified (some free and some at a cost), e.g. 6 week University of Bath.
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Thank you and Close

Thanks to all for attending the call. We will ask for reflective feedback to tailor these calls during the next learning event but please feel free to pass your comments direct to Sonia

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