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                                                                                                                     NHS
            Best Practice                                                                            NHS Trust

ISSUE NO. 2    FEBRUARY 2004




Good Communication makes Good Practice
Penelope A L Gordon
Consultant Radiologist



T
       he essence of good medicine lies in good                Two consultant radiologists meet on the intensive care unit
       communication, not only with our patients,              once a week and the radiology of all the in-patients is
       but also with other members of the                      reviewed with available members of the critical care team.
professional team. This was recognised in the                  Images are reviewed on the Picture Archiving and
Calman Hine report on cancer services in 1995, when            Communication System (PACS) workstation and the
a recommendation was made for multidisciplinary                educational benefits are enormous on all sides. The
team meetings to discuss patients with cancer.                 patients especially benefit by having their challenging
However, this idea was not new. For generations                conditions discussed by experts in an open forum so that
doctors have been discussing difficult and                     the correct investigations can be instigated and performed
interesting clinical cases formally in grand rounds            in a timely fashion with the appropriate priority given.
and clinico-pathological-radiological meetings, and
informally in corridors, car parks and over lunch.             Recently there was a problem with booking a biopsy in
                                                               Computed Tomography (CT) and the radiologists were
Sadly, modern life, with its constant pressures, has           asked to advise. A quick assessment of the patient revealed
made a lunch break an uncertain and irregular luxury           that the biopsy could be done at the bedside with
and the opportunity for informal discussion is reduced.        ultrasound, so one of the radiologists took the meeting
In an effort to compensate for this, a new initiative          while the other did the biopsy. Within the hour the
between the Department of Radiology and Department             specimen was in the laboratory, the juniors had undergone
of Critical Care has tried to bridge the gap between           teaching, and all the patients on the ward had been
formality, with all its attendant paperwork, and               discussed amongst the appropriate medical experts, with
informality, relying on the oral tradition which is part of    no additional paperwork to hinder the process. The
standard medical practice. In short, we have set up            consultants’ learning experience from this must also not
another meeting.                                               be underestimated!


                                                              THINKPOINT…
  inside this issue                                           “Working in a large organisation such as PHT, it is inevitable there
                                                              will be many challenges. Clinical Governance is just one of these.
▲ Good Communication makes Good                               It is concerned with learning and reflecting on our personal and
  Practice                                                    professional responsibility in light of new information. It is not
                                                              about blame, it is about being responsible enough to be honest
                                                              and open, and being willing to learn, and willing to change in order
▲ Endocrine Nurse Specialist improves                         to improve the services and the safety of the services we offer.
  patient care
                                                              The article on resuscitation on page 4 highlights this perfectly.
                                                              Good clinical governance means reading the article, thinking
▲ Fitness for Fertility                                       about the questions it raises, and then, actually doing something
                                                              about it. Have a go… It will make you feel really good. Tell us about
▲ Flexible Working                                            what you did, or what you changed, and we will include it in a
                                                              future issue!”

▲ Resuscitation - is your ward prepared?                      Helen Jones
                                                              Clinical Governance Manager
      Bite Size Best Practice
                                                                                                                                                                                                                                                                      NHS
                                                                                                                                                                                                                                                          NHS Trust




Endocrine Nurse Specialist                                                                                                                          Fitness for Fertility                                                    Karen Ralph
                                                                                                                                                                                                                             Fertility Nurse Specialist

improves patient care                                                                                                                               20% of women with sub-fertility have polycystic
                                                                                                                                                    ovaries. One feature of this syndrome is obesity,
                                                                                                                                                                                                                     diet programme from the dietician, now Rebecca Page
                                                                                                                                                                                                                     or Anna Brian, and a daily exercise plan from Ann.
Jean Munday                                                                                                                                         which can be a particular problem for women seeking
                                                                                                                                                    fertility treatment. Obesity reduces the effectiveness           Client evaluations have all been good. Women gain
Endocrine Nurse Specialist, Department of Diabetes & Endocrinology                                                                                                                                                   understanding of how their condition is exacerbated
                                                                                                                                                    of fertility medicines, and also makes becoming
                                                                                                                                                    pregnant less safe for both mother and baby. For this            by obesity and learn how to make permanent
Background                                                                         their, often rare, conditions with a nurse who can provide       reason, fertility specialists often recommend body               alterations to their lifestyles, rather than continue with
Dynamic function tests are required to diagnose a                                  written information and counselling when required.               weight is reduced to improve natural or treatment                faddy dieting. A major benefit of the group is the
range of endocrine disorders. In the past these were                                                                                                related fertility.                                               support that the women get from each other.
performed as in-patient investigations by junior doctors                           Conclusion
                                                                                                                                                    In the Fertility Clinic at SMH, we would sometimes               Approximately 70% of women who have been
on general medical wards. Delays in diagnosis and                                  In the first 7 months of the post the cost of 82 acute
                                                                                                                                                    see women every six months but have to withhold                  successful in losing 10% of their body weight have so
treatment were occurring and an audit revealed                                     medical bed days was saved, including 27 overnight stays                                                                          far achieved a pregnancy. In some instances this is
                                                                                                                                                    more active fertility treatment as their weight had
frequent delays to planned in-patient investigations and                           plus considerable savings in junior doctors hours. With          increased rather than reduced.                                   through weight loss alone, in other cases this is in
cancellation of planned appointments. It was felt that                             enhanced hours the ENS would be able to expand and                                                                                conjunction with other fertility treatments. Sadly not
an Endocrine Nurse Specialist (ENS) could be trained                               develop the post further, for example, setting up nurse led      I started the Fitness for Fertility group whilst studying        all women have succeeded in losing weight.
to perform all the necessary tests in a controlled out-                            clinics for additional groups of patients with the potential     Polycystic Ovary Syndrome for a Diploma in Fertility
patient setting. Funding from           pharmaceutical                             to relieve pressure on medical clinics.                          Nursing. Physiotherapist for women’s health, Ann                 Despite the success of the group, it remains difficult to
companies enabled the establishment of a post for two                                                                                               Vestigaarde, and dietician Sarah Brown contributed               ensure regular attendance and gain commitment to
days per week. Following the establishment of the role                             Further pharmaceutical funding is unlikely to be available       their experience and enthusiasm and were crucial in              lifestyle change. Reducing the length of the course and
a re-audit of the service demonstrated considerable                                in the future. The immediate challenge therefore, is to          making the group a reality.                                      providing stricter targets have helped, but only been
improvement.                                                                       obtain permanent funding from the Trust for this post                                                                             partially successful. Lack of self-esteem and
                                                                                                                                                    At each session a short talk is given by each of the             depression could be contributory factors, and we
                                                                                   which has clearly demonstrated an improvement in
                                                                                                                                                    professionals, followed by half an hour of circuit               believe that psychotherapist input to the group would
Results                                                                            patient care alongside a cost saving.
                                                                                                                                                    training led by Ann. Each woman has a personalised               be a huge advantage.
Both pre and post ENS appointment audits collected
data on timing of tests, cancellations, and informing
patients and GP’s of the results (Figure 1). This clearly
demonstrates improved patient access to endocrine                                   Flexible Working                                 THE ANSWER TO EFFECTIVE RECRUITMENT AND RETENTION OF STAFF
investigation.
                                                                                   Janice Cloud
 Figure 1: Audit Results                                                           Modern Matron, Head & Neck & Ophthalmology Services             24-hour period is broken down into a number of shift               patient department and improved the nurses’ knowledge
                                                                                                                                                   options including: early, late, twilight, nights, school hours,    and skills. It has also increased the efficiency and
100
                                                                                   Flexible working was introduced on the Head & Neck Unit         term-time, weekend shifts, double shifts and fixed                 flexibility of the team.
80                                                                                 (HNU) at the end of 1999 in response to a high level of         days/nights. Contracts are variable and range from 8 hours
                                                                                   vacancies and difficulties recruiting and retaining nursing     per week to full time and include the option of annualised         There is evidence to support the hypothesis that flexible
60
                                                                                   staff. Flexible working is a strategy that can be used to       hours. The duty rosters are worked out well in advance and         working benefits the employee, the organisation and the
40                                                                                 increase the efficiency of staffing as well as improving the    are almost at the self-rostering stage.                            patient. Sickness absence levels on HNU are 2.8%, - well
                                                                                   lives of the employees, and therefore will benefit both the                                                                        below the national and Trust average. The use of agency
20
                                                                                   organisation and the workforce. This has the knock on           Since 2001 there has been no specialist nurse training             staff is minimal, recruitment and retention is stable,
 0                                                                                 effect of improving patient care as well. The HNU cares for     available within our local university and there is a dearth        patient audits are favourable and the staff survey results
       Test performed    Cancellations        Results to patient   Results to GP
          <1 month                                                                 patients with otolaryngological, maxillo-facial and             across the country. Flexible working has been utilised again       report high levels of staff satisfaction. The HNU is
          Prior to ENS     After ENS appointment
                                                                                   ophthalmic conditions as well as patients with head and         to respond to this. There have been joint contracts set up         predicted to end the financial year within budget.
                                                                                   neck cancer. The speciality requires a stable and skilled       between the Ear, Nose and Throat Out Patients
                                                                                   workforce.                                                      Department (ENT OpD) and the HNU, and one full time                The evidence is there and, if HNU can do this, it is an
The appointment of an ENS within the department has                                                                                                post in the ENT OpD is permanently staffed by the HNU.             option that can be taken on elsewhere. The Trust has a
meant that patients can be commenced on specialist                                 The interpretation of flexible working used by the HNU is       Staff from the ward rotate through this post and gain              policy to support flexible working, and the government,
drugs and treatment monitored in nurse led clinics.                                that it should be a negotiated process where it fits both the   knowledge of anatomy and physiology and the use of                 under improving working lives and equal opportunities,
Patients have found it beneficial to be able to discuss                            requirements of the individual employee and the ward. The       equipment. This has benefited recruitment in the out-              expects it.
    Bite Size Best Practice



Resuscitation -                                                     contributions sought
is your ward prepared?                                  ● Has your team introduced a new practice that has
Sheena King                                               impacted on clinical outcomes or patient satisfaction?
Head of Risk Management Complaints & Legal              ● Have you been involved in innovation that has
Services                                                  reduced adverse incidents?
                                                        ● Could others learn from what you have done?
The Risk Management Department has recently
received an adverse incident form concerning the
                                                        We are looking for short articles (a maximum of 300 words)
preparedness of the ward resuscitation (resus)
                                                        about practices that demonstrate improved patient care.
trolley following a cardiac arrest call. This is not
the first incident form of this nature.
                                                        You may structure your article as you wish, but typically your
Although the patient involved in this incident died,    article might describe the following:
that, fortunately, was not as a result of the lack of
preparedness. However, it could all have been so        ▲ What was the problem?
very different. Even so, the situation must also        ▲ How did you research what to do?
have been very distressing for the staff involved       ▲ How did you change practice?
and you do not want to find yourself in this            ▲ What were the results?
position. Indeed, this was an incident that should      ▲ What is the evidence for improvement?
never have occurred. It all revolved around the fact    ▲ What can other staff or wards or departments learn
that the contents of the resus trolley had not been       from this?
checked properly and when staff came to use the
trolley, vital equipment was either missing or
                                                        Contributions should include your name, job title and
inappropriate.
                                                        contact details, and be sent to Fran Lamusse in the Library
● There were no Electro Cardio Graph (ECG)
                                                        at QAH (internal e-mail or extension 6042).
   dots/pads
● The defibrillator pads had round connectors
                                                        If you would like an informal discussion about a possible
   and the defibrillator machine had rectangular
                                                        contribution, please contact Fran or a member of the
   connectors
                                                        editorial team.
As always, the Risk Management Department is
not singling out this ward for criticism or blame of     Editorial Team - Bite Size Best Practice
any kind. We are just trying to raise awareness
across the Trust of incidents that could be easily       Sarah Balchin
prevented if only simple procedures were followed        Senior Nurse Clinical Governance Directorate           ext 2397/2398
appropriately and regularly.                             Helen Bingham
                                                         Library Services Manager                               ext 6042
Please think                                             Dr Penelope Gordon
● What procedures are in place for checking the          Consultant Radiologist Clinical Director Radiology     ext 5498/5302
   resus trolley in your area?                           Christine Hayward
● Who is responsible for checking your resus             Physiotherapy Professional Advisor                     023 92866811
   trolley?                                              Barbara Hamilton
● How often are the contents of your resus               Deputy Director Nursing                                ext 2398
   trolley checked?                                      Helen M Jones
● Does anyone sign to say who checked the                Clinical Governance Manager                            ext 2400
   trolley and when it was last checked?                 Sheena King
                                                         Head of Risk Management, Complaints & Legal Services   ext 2424
This is not rocket science - these are simple            Fran Lamusse
procedures which could save a life and prevent a         Clinical Support Librarian                             ext 6042
distressing incident for all concerned.

								
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