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Bite Size 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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