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NHS Tayside Aims and Programme Goals Mortality: 15% reduction Adverse Events: 30% reduction Ventilator Associated Pneumonia: 0 or 300 days between Central Line Bloodstream Infection: 0 or 300 days between Blood Sugars w/in Range (ITU/HDU): 80% or > w/in range Staph Aureus Bacteraemias: 30% reduction Crash Calls: 30% reduction Harm from Anti-coagulation: Reduction in INRs > 6 Surgical Site Infections: 50% reduction in population of choice All process measures will be > 95% reliable LIST OF KEY CHANGES 1 ALISON LIST OF KEY CHANGES 2 ALISON Scottish Patient Safety Programme Critical Care Driver Diagram Outcomes Primary Drivers Secondary Drivers Processes, Rules of Components, Activities Conduct, Structure Reliable Process of Care: • Prevent ventilator complications Provide reliable, • Prevent CL complications timely, care using • Prevent Inf. & cross contamination evidence-based • Proper Sepsis Rec. and Rx therapies • PVC Bundle Integrate patient Communications Team & Family Improved and family into Clarify care wishes and EOL planning Patient care Appropriate Infrastructure to Provide Outcomes Reliable, Evidence Based Care (Reduced Mortality, Develop Infections, & Other infrastructure that Improve ICU throughput Adverse Events) promotes quality care Competent staff with knowledge in QI Work Create a Reliable planning, communication collaborative team and collaboration of a multi and safety culture disciplinary team Repeated Use of the PDSA Cycle Reduction in Central venous catheter infections 30% reduction in SAB infections by January 20011 Introduction of a tested and compliant CVC maintenance bundle within the Medical HDU in Ninewells. Test 4 – new individuals successfully assessing compliance to ensure a variety of compliance perspectives Test 3 – individual elements of the bundle tested successfully over subsequent months showing continued compliance. Test2 – Following methodology rapid spread throughout unit of maintenance bundle. Test 1 - Central venous Catheter maintenance bundle introduced to Medical HDU Ninewells with one nurse and one patient. No clinical trolley available so staff using patient bed table. Trolley purchased and re tested. Repeated Use of the PDSA Cycle To implement the Peripheral vascular cannula (PVC) Bundle within Intensive care Unit in Ninewells Hospital 95% compliance with PVC bundle and SPSP 30% reduction in related Staphylococcus Aureus bacteraemia Change current practice to improve the compliance with the PVC Bundle Test idea and spread PVC bundle in ICU Ninewells Test 3 – As well as monthly random audits with compliance, senior nurse now reviews all bundle documentation nightly, which has shown further significant compliance. Test 2 – Compliance improving but introduction of daily spot checks of bundle by 2 members of staff initiated to raise profile. Test 1 – Bundle tested on patient with one nurse but documentation unclear. Issues raised and changes made. Discussions initiated empowering staff to remove cannula. Repeated Use of the PDSA Cycle Implement changes to our Ventilator Acquired Pneumonia (VAP) Bundle Achieve 95% compliance with VAP Bundle Achieve SPSP goal of zero incidences in 300 days. Change current practice to include the use of Chlorhexidine gel prior to intervention with ventilated patients. Test 3 – change in practice shows larger decrease in reduction of VAP within ICU at Ninewells. Element now added to the existing IHI Ventilation bundle. Test 2 - Introduction of chlorhexidine gel prior to intervention with ventilated patients. Finalised protocol tested on 2nd patient then protocol shared at Multi professional awareness sessions. Test 1 - Full compliance with VAP bundle but little reduction noted in VAP. Gel was tested on one patient. Agreement then reached as to definition of what constitutes a ventilated patient prior to testing. CRITICAL CARE KEYS TO SUCCESS Introducing Changes to the VAP Bundle within ICU Ninewells Following using IHI improvement methodology the full VAP bundle was successfully implemented within ICU at the Ninewells site. Improvement is recorded over a significant period of time but with a slowly decreasing trend. The wider team agree to test adding Chlorhexidine Gel to increase the reduction of VAP. Having tested this on one patient with one nurse, there is then Staff discussion and consensus around the definition of what constitutes a ventilated patient for the purpose of the test, and this is written into the unit protocol. The new protocol is tested on a second patient successfully, and is therefore spread throughout the unit quickly using improvement methodology. The protocol is introduced to the wider Multi professional team through staff awareness sessions. Following the introduction of the new VAP protocol and Bundle there is a marked sustained reduction in VAP in ICU Ninewells. CRITICAL CARE KEYS TO SUCCESS Implementation of the CVC maintenance bundle within medical HDU Ninewells In an effort to reduce central line infections within the Medical HDU the CVC maintenance bundle was introduced testing with one nurse and one patient. Although technique was compliant with the bundle, a vital piece of equipment (a clinical trolley) required to be purchased to ensure that there was the maintenance of a sterile field. From this further testing of the bundle, following staff awareness sessions, allowed a quick spread of the methodology and 95% compliance. To ensure full compliance with the bundle on a monthly basis, the senior nurses within the HDU observed different elements. This has given staff a clear focus in maintaining the high standards already set. Presently this was initially a person dependant system but now all members of staff are being supported to observe practice to give an objective balanced peer perspective to the monitoring and compliance with this bundle. CRITICAL CARE KEYS TO SUCCESS Implementation of the PVC bundle within ICU Ninewells The PVC Bundle was tested on one patient with one nurse using PDSA. Following feedback, discussions were initiated around the quality of the nursing documentation (to which changes were made) and encouraging empowerment nursing staff to remove the cannula. Following this discussion compliance improved. This was also then supported with the introduction of daily spot checks of the bundle by 2 members of staff initially to raise its profile within the unit. The introduction of this practice has ensured maintenance of the established levels of compliance within the department and effectively contributed to the reduction of PVC related SAB. CRITICAL CARE PROCESS MEASURES Oral hygiene element of VAP Implementation bundle implemented of daily goals CRITICAL CARE OUTCOME MEASURES ALISON INSERT HERE 304 days since last infection Implementation of daily goals Oral hygiene element of VAP bundle implemented TREND SHIFT Scottish Patient Safety Programme General Ward Driver Diagram Outcomes Primary Drivers Secondary Drivers *Early warning system (EWS) to identify Provide reliable, patient deterioration *Early response system (Outreach or timely, care using Rapid Response Team (RRT)) to evidence-based respond to deterioration therapies *Prevent healthcare associated infections, pressure ulcers Improved general Create a PVC bundle ward outcomes collaborative team Hand Hygiene practices (Reduced and safety culture *Reliable planning, communication and infections, collaboration of multi disciplinary team crash calls, Involve Pt./family into goal setting pressure Ensure patient and Open communication team & Family ulcers, AE in CHF family centered Clarify care wishes and EOL planning and AMI patients) Ensure patients physical comfort care Develop infrastructure that Optimise transitions to home or other facility (CHF,MI) promotes Optimise flow & efficiency in admission quality care process, handoffs, discharge process, care for high volume conditions (CHF,MI) PVC Bundle, Orthopedic Ward - PDSA Cycle Implement PVC Bundle all Wd 16 patients Ninewells Hospital 95% compliance with PVC Bundle Process Adapt and test existing PVC Bundle process from SPSP to suit within ward 16 Test collection of date and audit regarding compliance Continue to test with all patients and involving all staff Adapt bundle and test with 3-5 patients and 3 nurses Test suitability of PVC Bundle to be used within orthopedic clinical setting with one patient and one nurse SEWS, Angus Community Hospital - PDSA Cycle Implement SEWS Chart Brechin GP Ward 95% compliance with SEWS and early identification of patient deterioration Adapt and test existing SEWS process from other areas to suit within Community Hospital e.g. local algorithm Tested SEWS chart on staff redeployed from local ward that provide cover Tested Algorithm with one call to Out of Hours service Revised Algorithm then further testing with 3 then 5 patients and revised protocol with staff to ensure chart fit for purpose Test suitability of SEWS Chart within Community Hospital with one patient by one nurse Safety Briefings, Perth Community Hospital - PDSA Cycle Implement daily Safety Briefings within St Margaret's Community Hospital 95% compliance with Safety Briefings including Multi Disciplinary Team (MDT) Adapt and test existing Safety Briefing process from other areas to suit within Community Hospital Test that members of the MDT are aware of White Board and importance information displayed Test that staff on each shift check and initial White Board ensuring compliance Test that new safety issues are appropriately added to White Board Test staff awareness of new system (White Board) of where to locate and read safety notices Hand Hygiene, Medicine for the Elderly - PDSA Cycle Hand Hygiene reliable in Wd 5 RVH with 30% reduction in SABs 95% compliance with Hand Hygiene compliance within the ward and reduction in SABs Adapt and test existing Hand Hygiene audit tool from other areas to suit within the ward Re-test staff compliance for Hand Hygiene using best practice when washing hands Test staff that their Hand Hygiene method and practice used meets current best practice guidelines Test staff in correct use of audit tool for measuring Hand Hygiene compliance Test staff knowledge of reason for Hand Hygiene in relation to SABs and HAIs GENERAL WARD KEYS TO SUCCESS IMPLEMENTING A PVC BUNDLE IN WARD 16 NW Replacing the existing documentation currently in use within ward 16 regarding PVC post insertion care with the SPSP PVC Bundle would allow for a uniform NHST wide format. The documentation previously in use on the ward had been developed due to high risks of HAIs and their impact because of the type of surgery delivered within ward 16. Initial testing looked at the suitability of the new bundle for use within the ward and in particular the Integrated Care Pathway (ICP) currently utilised within the ward. This was initially done with one patient and one nurse before being tried with 5 patients and 3 nurses. Testing was done to ensure all staff were aware of the planned change of documentation within the ICP before implementing across the entire ward. Compliance and how data was gathered was then tested to ensure reliability of the information being gathered and that compliance rates were being met. GENERAL WARD KEYS TO SUCCESS IMPLEMENTING DAILY SAFETY BREIFINGS WITHIN St MARGARETS COMMUNITY HOSPITAL Daily electronic handovers were already part of the nursing culture, however to increase the reliability and increase dissemination of the information the Senior Charge Nurse wanted to introduce a system that would involve all of the Multi Disciplinary Team, support staff and GPs. A white board was placed within the nursing office with relevant, concise and precise details written upon it. Awareness systems were conducted to ensure with all staff as to how the system would be implemented and maintained. The first test involved ensuring that all the appropriate safety issues were visible. Subsequently testing was carried out around the updating of information on the board. Relevance etc. Compliance was tested next by asking all staff on a shift by shift basis to initial that they had read and understood the information on the board. This was further supported by identifying two champions who further tested that information continued to be updated and that all staff were initialling that they had read the board. The next test involved rolling out the process to all the support staff and members of the MDT. To ensure that the safety issues were relevant spot audits were carried out by the designated champions GENERAL WARD KEYS TO SUCCESS IMPLEMENTING SEWS CHART IN GP WARD BRECHIN SEWS charts are now an integral component of how care is delivered within the Acute setting, its integration within the community hospital setting is seen as the next logical step. Education for the staff around use of and background to the development and use of SEWS was the first part of process. After testing with one patient and one nurse it was noted that the algorithm used within the acute setting did not suit the environment and conditions found within the community hospital setting. The algorithm was reviewed and revised by staff and then further testing was undertaken with the new format with 3 patients and 3 nurses. Further discussion with staff around implementing SEWS chart throughout the ward highlighted pockets of limited knowledge and lack of confidence with using SEWS across the ward. Further targeted training and education addressed this issue and SEWS were implemented across the ward. With HCA‟s an integral part of care provision delivery within the ward, they were trained in a similar fashion to the qualified staff in the use of SEWS charts including determining criteria as to how and when to notify qualified staff of any changes in a patients SEWS score. Staff from local wards often assist on the GP ward and using lessons learned from the process of introducing SEWS training of likely relief is presently being undertaken. GENERAL WARD KEYS TO SUCCESS HAND HYGIENE: Wd 5 RVH Good hand hygiene was recognised as being a vital component in preventing the contracting and spreading of SABs and HAIs within any clinical setting. The first step undertaken within the ward was testing the staff‟s existing knowledge around infection control and hand hygiene in particular. This involved the Infection Control team who also delivered education for all of the ward staff around this area. Testing of the observation tool used in auditing of Hand Hygiene opportunities highlighted that there was not a uniform understanding of what represented and „opportunity‟. Further education and clarification on the tool itself eliminated this as an issue. Further testing of the audit tool threw up discrepancies in hand washing techniques used by staff underlining that current best practice was not being used 100% of the time which could affect both effectiveness and in measuring compliance. Again education was undertaken around current best practice and estates where asked to replace any taps at the sinks that required staff to touch with just washed hands. Run charts demonstrate that compliance is meeting the minimum standard within the ward and that C-diff rates have been positively affected. GENERAL WARD PROCESS MEASURES ALISON Testing of algorithm of acute services Staff unfamiliar with use of SEWS GENERAL WARD PROCESS MEASURES Audit tool tested Staff education in hygiene provided by Infection Control Staff issues resulted in deployment of relief staff unfamiliar with surrounding Dressing not Dressing not intact intact Dressing not intact GENERAL WARD OUTCOME MEASURES ALISON GENERAL WARD OUTCOME MEASURES Scottish Patient Safety Programme Peri-operative Management Driver Diagram Outcomes Primary Drivers Secondary Drivers Processes, Rules of Components, Activities Conduct, Structure Prevent Surgical Site Infections Provide appropriate, Ensure proper prescribing and reliable and timely care administration of prophylactic antibiotics Ensure, if hair removal was required, Improved peri to patients using operation site is clipped, not shaved evidenced-based operative therapies to prevent Maintain normal blood glucose level (for/ surgical site infections known diabetic patients) outcomes Ensure normal body temperature (excludes (Reduce peri- cardiac patients) operative adverse Create a team culture Use briefings events: infections, attuned to detecting and Use standard intra-operative procedures to cardiovascular prevent AEs rectifying intra operative events) errors Undergo team training Maintain team focus during surgery Provide appropriate, Have responses to intra-operative adverse reliable and timely care events ready to patients using evidenced-based Identify patients at risk therapies to prevent DVT prophylaxis peri-operative Continuation of beta blockers cardiovascular events Repeated Use of the PDSA Cycle Implement World Health Organisation (WHO) Checklist in one theatre for one month. 95% compliance noted with use of checklist in one theatre. Adapt and test WHO checklist to Changes That Result in Improvement suit theatres within NHS Tayside Test 3 – Challenges remain in relation to compliance with use of the checklist. Issues emerged when trying to use this checklist to eliminate all other checklists in wards and theatres. Testing continues. Test 2 – Issues with checklist following the process of patient from ward to theatre. Some parts of the ward checklist not completed. Suggested changes made to checklist. Test 1 – Checklist tested on one ward, one patient and one theatre in Ninewells. This test showed that the checklist does not follow the patients’ journey and the form was then segmented into ward and theatre journey for suitability. Repeated Use of the PDSA Cycle Implement peri operative safety briefings within ADTC at Stracathro hospital There is 95% compliance noted with safety briefings. Change current practice to improve the exchange of important patient safety information Test 5 – plan to spread testing of Safety Briefings with all staff present in anaesthetic room to 4 consultant surgeons and 4 consultant anaesthetists (3 specialties) with patients being sent for, checked in, and held in reception prior to the Safety Briefing staring therefore preventing any delay to list start times Test 4 – re-testing of Safety Briefing with all staff present in anaesthetic room with 2 consultant surgeons and 2 consultant anaesthetists (2 specialties) – currently being led by nursing staff – this is still likely to present a delay to list start times Test 3 - SCN and 2 Senior Theatre nurses or designated deputy (1 Scrub/1 Anaesthetics/Recovery) meet for daily meeting to discuss staffing, staff allocations, patient cancellations, list order changes, equipment issues, other work commitments etc – information disseminated to individual theatres, and incorporated into Safety Briefing. Test 2 – testing of a modified Safety Briefing following discussions with senior theatre management staff – tested and implemented a revised and agreed to Safety Briefing with staff available, then disseminated to key personnel within the relevant theatre team – no delays to lists starting. Test 1 – testing of Safety Briefing with all team present – unsuccessful as unable to get all team together – waiting for all staff to attend, inclusive of medical staff, resulted in significant delays to the start of the list. PERI OP KEYS TO SUCCESS Implementation of WHO surgical checklist within Main theatre suite at Ninewells With the introduction of the World health organisation peri operative checklist, it was tested for its suitability within one theatre, one ward with one patient and one nurse. Multi professional feedback was welcomed and changes to the checklist were initiated for retesting. Further feedback at second retest identified more changes were required to the checklist due to inconsistencies in the quality of the documentation on completion. The value of Multi professional feedback is key to the success of implementing this checklist within the main theatres as testing currently continues. PERI OP KEYS TO SUCCESS Peri operative Safety briefings in Stracathro Hospital In an effort to improve theatre planning, theatre efficiency, peri operative communications and team cohesiveness, the Daily Meeting was introduced to give an overview for the day. Team Leader Meetings and Staff Team Meetings fortnightly have also been introduced to allow for more effective theatre planning, improve communications and disseminate information. A 3-point Safety Briefing was successfully tested and implemented, with agreement from theatre management. This involved the Anaesthetist and Anaesthetic Nurse meeting, the Surgeon and Scrub Practitioner meeting, then the 2 teams disseminating the information to each other - this resulted in no delays to the lists starting. With more understanding of and involvement in SPSP, nursing staff are leading testing of the Safety Briefing with all staff present in the anaesthetic room - this is currently being tested with 2 consultants and 2 anaesthetists. To prevent any delays to the start of the list, theatre nursing staff redesigned and redecorated the theatre reception area, and each theatre anaesthetic nurse will send for the patient, check them in and then hold them in the reception area while they attend the Safety Briefing. The application of IHI improvement methodology has allowed the team to customise current documentation being used on sister sites for their own use. PERIOPERATIVE PROCESS MEASURES Safety briefings Safety briefings performed, however, ALISON INSERT performed, however, not supported with not supported with completed completed documentation documentation Documentation not Documentation not completed completed PERIOPERATIVE PROCESS MEASURES Documentation not completed Documentation not ALISON completed Documentation not completed Documentation not completed Documentation not completed Documentation not completed Scottish Patient Safety Programme Leadership Driver Diagram Outcomes Primary Drivers Secondary Drivers Processes, Rules of Components, Activities Conduct, Structure Establish an SPSP Implementation Committee Ensure a feedback mechanism for issues raised in Walk-rounds Develop the Ensure the development of a measurement Provide the infrastructure to system used to understand and drive patient Leadership support quality and care quality and safety indicators safety Assign a senior leader to each work streams System to improvement Support the Meet with the Programme Manager remove Improvement barriers Meet regularly with the SPSP Implementation of Safety and Provide oversight Committee to track progress and remove to programme barriers Quality Display the Gantt chart that depicts progress towards SPSP goals Outcomes in Promote the your Board position of safety Ensure that the senior team participants in walk-rounds and quality in the Place safety and quality issues at the top of organisation senior leader meetings agendas Add SPSP progress and outcomes to the Board agenda Patient Safety leadership Walkrounds - PDSA Cycle Spread of Patient safety Leadership walkrounds within NHS Tayside across all services by Dec 2009 Achieve 100% completion of action identified within specified time scale Adapt and test existing walkround process, including tracker of actions and involvement of Non Executive members Pre walkround briefing included explanation of non- executive role within the process and how and why actions are tracked (not all staff aware this is an SPSP outcome measure) Increase in actions completed as a result of previous test, however more realistic time scales are required on certain actions i.e. estates issues Testing of tracker process which involves contacting the ward at given time periods via email to gather updates on action progress, executives are copied into these emails along with given timescales. Test the involvement of one non executive Board member one walkround. Successful, Board member to feedback process to other Board members and future dates circulated to all non-executive members LEADERSHIP KEYS TO SUCCESS PATIENT SAFETY LEADERSHIP WALKROUNDS NHS Tayside senior leaders have embraced patient safety as a strategic priority. This is demonstrated in a number of ways; commitment from both executive and non-executive Board members in the safety leadership walkround process. Prior to each walkround a briefing takes place with the executive team members and the representative from Safety Governance and Risk. This gives the opportunity to discuss previous visit reports and patient safety data collected as part of the SPSP. Walkrounds are now attended by non-executive members of the Board. Feedback has been extremely positive and is discussed at the NHS Tayside Board meetings. Improvements have been made to the tracker system for actions identified on the walkrounds and as a result we are showing an increase in number of completed actions per month. This data is shared at the monthly patient safety update with the Executive Management Team. WORKSTREAM EXECUTIVE SPONSORS The sponsors play a key role in ensuring patient safety is seen as a strategic priority and have been active in ensuring patient safety is integrated into the new organisational structure. The Patient Safety Development Manager meets with the sponsors on a monthly basis prior to the Executive Management Team Meetings to discuss successes and challenges within each workstream. LEADERSHIP KEYS TO SUCCESS ROBUST REPORTING MECHANISM A robust system from ward to board has enabled the organisation to link process and outcome patient safety measures i.e. run charts at the frontline, use of driver diagrams for monthly executive safety updates, use of SPSP assessment scale to open all patient safety reports JOINT CLINICAL BOARD LEADERSHIP BREAKFAST SESSIONS To support the integration of patient safety and improvement methodology sessions have been delivered to new managers and senior leaders within the organisation, sessions include: reliability, harm verses error, driver diagrams, using data for improvement CLINICAL PATIENT SAFETY LEADS 5 Clinical Leads for Patient Safety have recently been appointed by the Chief Operating Officer as part of the new organisational structure LEADERSHIP DATA ALISON LEADERSHIP DATA ALISON Improvement to tracker system made including e-mail reminders and realistic timescales for completion of actions Scottish Patient Safety Programme Medicines Management Driver Diagram Outcomes Primary Drivers Secondary Drivers Processes, Rules of Components, Activities Conduct, Structure Use standardised protocols and algorithms for high risk meds Provide reliable Routine and reliable patient and laboratory Safe & medicines monitoring Identify high risk areas using FMEA effective management Pharmacy consultation service processes Identify patients at risk with high-alert medicines medications management Standardise recovery protocols (e.g. (Reduce adverse opiate over-sedation) drug events: r/t high risk processes Accuracy of medicines at the interface & medicines e.g. Coordination of “One stop” delivery system care Reliable in-hospital handoffs medicines at the Communication with primary care interface and High risk medicines management services anticoagulation) Patient and family Patient and family education involvement Self management protocols Medicines Reconciliation Perth Royal Infirmary - PDSA Cycle Implementation of medicines reconciliation on all patients admitted to Perth Royal Infirmary within 6 months Achieve 95% compliance with medicine reconciliation process on all patients Adapt and test existing medicines reconciliation form used at Ninewells hospital Med rec form now in all admission packs and testing of data collection continues. Data successfully collected as part of ward round. Data gathered as testing continues to include all patients, and to support this process one consultant tested the inclusion of med rec as element of his ward round. Testing continued no changes to form required however educational issues identified and plans for educational sessions planned and delivered by pharmacist to the medical staff Test the medicine reconciliation from implemented on the Ninewells site on one patient by one doctor supported by one pharmacist. Medicines Reconciliation Mental Health Services - PDSA Cycle Implement Med Rec in Mental Health 95% compliance with Med Rec Process Implementation of Adapt and test existing Med Rec process from other areas, for use Med Rec Process, within Mental Health Wards monthly monitoring of compliance Test 4: Further Testing of Med Rec Process Test 3: Testing of Med Rec Process Test 2: Further testing across variety Adapt Med Rec of conditions to ensure form fit for Form for use purpose. Format agreed for use. within Mental Health Test 1: Test suitability of Med Rec Form MEDICINES MANAGEMENT KEYS TO SUCCESS MEDICINES RECONCILIATION ON ADMISSION, PERTH ROYAL INFIRMARY During early testing and implementation a medical champion was identified. This Consultant supported the implementation by focusing on medicine reconciliation completion on every patient during his daily ward round. Junior doctors are challenged if the form is not completed. Changes were supported by a comprehensive education programme delivered by the ward pharmacist. This was directed at medical staff and included the teaching of FY1 doctors on induction highlighting the errors as a result of inaccurate reconciliation. The pharmacist and medical staff have access to the Emergency Care Summary providing an additional source of patient‟s medication history. Measurement of medicine reconciliation compliance has been extended to include accuracy and this information is reported every three months at the clinical effectiveness meetings MEDICINES MANAGEMENT KEYS TO SUCCESS MEDICINES RECONCILIATION, MENTAL HEALTH SERVICES, MURRAY ROYAL HOSPITAL The patient safety framework across Tayside facilitates sharing of progress and challenges across workstreams. The Pharmacist within the Acute Mental Health Ward at Murray Royal Hospital recognised potential of testing the medicines reconciliation form already implemented in Perth Royal Infirmary. Pharmacy resource within this service is limited and therefore it was vital that medical staff support this change. General Adult Mental Health Consultants agreed to review and check the medicines reconciliation forms at the ward round following admission. They also requested that the run chart illustrating the data be displayed within the ward areas to facilitate improvement in compliance. They also proposed that two junior doctors be selected for registration with the ECS. Induction and teaching sessions have been delivered to new junior doctors. These sessions have been delivered by Specialist Pharmacist and Consultant Psychiatrist MEDICINES MANAGEMENT PROCESS MEASURES No data due to No data due to staffing resource ALISON staffing resource MEDICINES MANAGEMENT OUTCOME MEASURES DIANE TREND MAJOR CHALLENGES AND BARRIERS CLINICIAN ENGAGEMENT Their involvement is vital for spread, sustainability and aligning objectives to existing national targets. SPSP changes are still seen as another initiative, therefore change is required to be integrated into everyday practice and so becomes part of “the way we do things around here” MULTIDISCIPLINARY ENGAGEMENT TO DRIVE IMPROVEMENTS IN MEDICINES MANAGEMENT We have medicine management and everyone is responsible; it remains a challenge to ensure we do not create a pharmacist dependant process. DATA MANAGEMENT Supporting frontline staff and managers to relate process and outcomes measures in their improvement work. OUT OF HOURS Developing robust and comprehensive communication links enabling continuity of care 24/7 throughout the patients journey whilst improving patient safety. Help Needed Please! Involving patients more in each workstream Involving patients in walkrounds SPSP tool kit of resources Engaging GP and Out of Hours Implementing WHO checklist
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