May 292019
 

My name is Christine Welburn, I am the thromboprophylaxis clinical nurse specialist (CNS) at Ysbyty Glan Clwyd (YGC). When I started my job in August 2017 along with my clinical lead Mr Hanna, I identified the issue of poor compliance in completing the thromboprophylaxis risk assessment. The initial audit showed that we was only 34% compliant, I discussed this with the Quality Improvement manager Mel Baker who encouraged me to complete the Silver IQT training which would equipped me with the knowledge and skills of using different methods in order to get engagement and change practice.

I enrolled on the Silver IQT training and decided to do my project on increasing compliance in completing the thromboprophylaxis risk assessment. I decided to get engagement from front line staff and drive the improvement by completing weekly thromboprophylaxis walk around.  The walk around team consists of myself (CNS), Mr Hanna (Clinical Lead) and Haimon (Lead pharmacist), this team has a lead from each discipline we wanted to be engaged in changing practice. Every week we walk around the wards (initially targeting the acute admission wards and now including in-patient wards) and randomly select 5 – 10 case notes on each ward to audit and review.  We assess if the thromboprophylaxis risk assessment has been completed (and if it is correct), if the VTE box on the drug card is completed and if the prescription is correct. We also assess if mechanical and chemical thromboprophylaxis is prescribed, given, contraindicated and any missed doses.  This gives us the opportunity to give on the spot feedback and education to all the clinical staff involved, correct any prescription errors that we find and give lessons learnt and advice in the clinical area.

After ten months of the walk around intervention our compliance had increased to 84% and after eighteen months of the intervention the acute admission wards achieved 100%.  This project was spread across site with Ysbyty Wrexham Maelor achieving the same results within six months of adopting YGC finial walk around procedure.  We adapted the walk around audit technique after several PDSA cycles until we was happy we was capturing the relevant information and feedback technique.  This quality improvement project has led Ysbyty Glan Clwyd becoming an exemplar site for VTE prevention, winning the first place award for harm free care in the BCU quality improvement and research conference and a becoming a finalist in the upcoming HSJ national award for acute service redesign award.

Prior to learning about quality improvement, I recognised what needed to change in practice but not necessarily the best way to implement the change.  After completing the Silver IQT training at YGC, it equipped me with the knowledge and skills on how to assess and implement change using different methods in order to get the desired outcome. I would advise anyone who is looking to do a quality improvement project to complete the IQT training and complete a project on their idea, as often a small change in practice can have a big impact on our patients safety.

May 292019
 

Fy enw i yw Christine Welburn ac rydw i’n nyrs glinigol arbenigol thromboproffylacsis yn Ysbyty Glan Clwyd. Pan ddechreuais y swydd ym mis Awst 2017, ar y cyd â Mr Hanna, yr arweinydd clinigol, nodais fod cydymffurfiaeth wael o ran cwblhau’r asesiad risg thromboproffylacsis. Dangosodd yr archwiliad cychwynnol mai 34% yn unig o asesiadau risg oedd yn cael eu cwblhau. Trafodais y sefyllfa gyda Mel Barker, y Rheolwr Gwella Ansawdd, a anogodd fi i fynychu hyfforddiant Gwella Ansawdd Gyda’n Gilydd (Arian), a fyddai’n fy arfogi gyda’r wybodaeth a’r sgiliau angenrheidiol i ddefnyddio dulliau gwahanol er mwyn sicrhau ymgysyllted ac i newid arferion.

Cofrestrais ar gyfer yr hyfforddiant Gwella Ansawdd Gyda’n Gilydd (Arian), a phenderfynais wneud prosiect ar wella cydymffurfiaeth o ran cwblhau asesiadau risg thromboproffylacsis. Penderfynais ymgysylltu ag aelodau staff rheng flaen a gyrru’r gwelliant trwy gwblhau taith gerdded thromboproffylacsis wythnosol o amgylch yr ysbyty. Mae tîm y daith gerdded yn cynnwys fi (Nyrs Glinigol Arbenigol), Mr Hanna (Arweinydd Clinigol) a Mr Haimon (Fferyllydd Arweiniol), sef arweinydd o bob maes sydd angen ymgysylltu â hwy er mwyn newid arferion. Bob wythnos, rydym yn cerdded o amgylch y wardiau (gan dargedu’r wardiau derbyn aciwt i gychwyn, ond bellach yn cynnwys wardiau cleifion mewnol) ac yn dewis 5-10 o nodiadau achos ar hap ar bob ward er mwyn eu harchwilio a’u hadolygu. Rydym yn asesu a yw’r asesiad risg thromboproffylacsis wedi cael ei lenwi (ac a yw’n gywir), a yw’r blwch thromboemboledd gwythiennol ar y cerdyn cyffuriau wedi’i lenwi ac a yw’r presgripsiwn yn gywir. Yn ogystal, rydym yn asesu a yw thromboproffylacsis mecanyddol a chemegol wedi cael ei ragnodi, ei weinyddu, ei wrthgymeradwyo ac a yw’r claf wedi methu unrhyw ddosau. Mae hynny’n rhoi cyfle i ni ddarparu adborth uniongyrchol i bob aelod staff clinigol perthnasol, cywiro unrhyw gamgymeriadau rhagnodi a rhannu gwersi a chyngor yn yr ardal glinigol.

Ar ôl deg mis o gynnal taith gerdded wythnosol, cynyddodd ein cydymffurfiaeth i 84% ac, ar ôl deunaw mis o ymyrraeth, cydymffurfiodd y wardiau derbyn aciwt 100%. Lledaenwyd y prosiect ledled y safle a chyflawnodd Ysbyty Maelor Wrecsam yr un canlyniad o fewn chwe mis o fabwysiadu gweithdrefn Ysbyty Glan Clwyd. Addaswyd ein techneg archwilio ar ôl nifer o gylchdroeon PDSA tan ein bod yn hapus gyda’r dechneg adborth ac ein bod yn casglu gwybodaeth berthnasol. Mae’r prosiect gwella ansawdd hwn wedi sicrhau bod Ysbyty Glan Clwyd yn safle blaenllaw o ran atal thromboemboledd gwythiennol, gan ennill y brif wobr ym maes gofal heb niwed yng Nghynhadledd Ymchwil a Gwella Ansawdd Bwrdd Iechyd Prifysgol Betsi Cadwaladr a chyrraedd rownd derfynol Gwobr Genedlaethol HSJ (Ail-ddylunio Gwasanaeth Aciwt).

Cyn dysgu am wella ansawdd, roeddwn yn gallu adnabod beth oedd angen newid o ran arferion, ond ddim o reidrwydd y ffordd orau o weithredu’r newid. Ar ôl cwblhau hyfforddiant Gwella Ansawdd Gyda’n Gilydd (Arian) yn Ysbyty Glan Clwyd, cefais fy arfogi gan y wybodaeth a’r sgiliau i asesu a gweithredu newid, gan ddefnyddio dulliau gwahanol er mwyn cyflawni’r deilliant delfrydol.  Byddem yn cynghori unrhyw un sy’n chwilio am brosiect gwella ansawdd i gwblhau hyfforddiant Gwella Ansawdd Gyda’n Gilydd ac i gwblhau prosiect ar ei syniad, oherwydd, yn aml, gall newid bach ymarferol gael effaith pellgyrhaeddol ar ddiogelwch cleifion.

May 142019
 

We catch up with Paul Gimson, Medicine Safety Programme Lead, 1000 Lives Improvement to talk about the plans for the Medicine Safety programme.

1.What is your background in medicine safety?

I’m a pharmacist by background so medicines safety is in my blood! I’ve worked in community pharmacy and as a prescribing advisor in local health boards. I’ve was the lead for Medicines Safety at the Royal Pharmaceutical Society.

  1. What are the plans for the Medicine Safety Programme?

The programme is being established in response to both the World Health Organisations Global Safety Challenge ‘Medication without Harm’ and the Welsh Governments Long Term plan for Health and Social Care: A Healthier Wales. We aspire to make Wales the safest place in the World to take medicines.

Our programme will be focussed on addressing four key challenges;

  • Systems – how can we improve the systems and processes that underpin prescribing, safety and medicines management? We will focus on prescribing practices, interfaces of care and applying the evidence base that exists around systems thinking and safety.
  • Harm – how can we tackle specific areas of harm that we know contribute significantly to avoidable admissions to hospital? Areas of concern include admissions due to falls, bleeds and acute kidney injury.
  • Prudent Prescribing – how can we apply the principles of prudent healthcare to prescribing? How can we improve areas such as polypharmacy, medication review and antimicrobial resistance? Can we make better use of the multidisciplinary team?
  • Person Centred-Care – how can we support a more person-centred approach to medicines safety in Wales? How can we best apply the principles of co-production and behavioural change psychology to medicines use?
  1. How do you plan to achieve the key outcomes of the programme?

As the title suggests it will be a challenge, and it won’t happen overnight. I have found myself wondering –what are the elements of a high performing medicines safety system. Is it better use of data? Is it better learning from error? Is it improved multidisciplinary working? What does any of his look like in an improved system?

In order to find out we plan to bring together the improvement expertise of 1000Lives with the knowledge and experience of those in NHS who have an interest in medicines safety, as well as the public, to co-produce a series of high impact interventions that have the potential to transform medicines safety in Wales. We will then test those interventions with a view to spreading them nationally via a national Medicines Safety Collaborative.

  1. Why are you excited to be working on it?

I have been involved in medicines safety all of my career. For me personally it is an opportunity to apply all I have learnt about improvement to a topic that I am passionate about. By bringing together pharmaceutical and improvement expertise we can make a real difference to peoples’ lives through safer and more effective use of medicines.

Paul wants to hear from you – what ideas do you have to improve medicines safety? What projects are you involved in that you want to share? If you want to get involved then please contact him at paul.gimson@wales.nhs.uk

May 142019
 

Cawsom sgwrs gyda Paul Gimson, Arweinydd Rhaglen Diogelwch Meddyginiaethau, 1000 o Fywydau – Gwasanaeth Gwella, i drafod y cynlluniau ar gyfer y Rhaglen Diogelwch Meddyginiaethau.

1.Beth yw’ch cefndir ym maes diogelwch meddyginiaethau?

Rwyf wedi bod yn fferyllydd, felly mae diogelwch meddyginiaethau yn fy ngwaed! Rwyf wedi gweithio ym maes fferylliaeth gymunedol ac fel cynghorydd rhagnodi mewn byrddau iechyd lleol. Roeddwn i’n arweinydd ar gyfer diogelwch meddyginiaethau yn y Gymdeithas Fferyllol Frenhinol.

  1. Beth yw’r cynlluniau ar gyfer y Rhaglen Diogelwch Meddyginiaethau?

Caiff y rhaglen ei sefydlu mewn ymateb i Her Diogelwch Byd-eang Sefydliad Iechyd y Byd, ‘Meddyginiaeth heb Niwed’, a chynllun tymor hir Llywodraeth Cymru ar gyfer iechyd a gofal cymdeithasol, Cymru Iachach. Rydym ni’n ceisio gwneud Cymru’r lle mwyaf diogel yn y byd i gymryd meddyginiaethau.

Bydd ein rhaglen yn canolbwyntio ar fynd i’r afael â phedair her allweddol;

  • Systemau – sut gallwn ni wella’r systemau a’r prosesau sy’n tanategu rhagnodi, diogelwch a rheoli meddyginiaethau? Byddwn ni’n canolbwyntio ar arferion rhagnodi, rhyngwynebau gofal, a chymhwyso’r gronfa dystiolaeth sy’n bodoli ynghylch meddwl a diogelwch systemau.
  • Niwed – sut gallwn ni fynd i’r afael â meysydd penodol o niwed rydym ni’n gwybod sy’n cyfrannu’n sylweddol at dderbyniadau osgoadwy i’r ysbyty? Mae’r meysydd o bryder yn cynnwys derbyniadau i ysbyty yn sgil cwympiadau, gwaedu, ac anaf acíwt i’r arennau.
  • Rhagnodi darbodus – sut gallwn ni gymhwyso egwyddorion gofal iechyd darbodus i ragnodi? Sut gallwn ni wella meysydd fel polyfferylliaeth, adolygu meddyginiaethau, ac ymwrthedd i gyffuriau? Allwn ni wneud defnydd gwell o’r tîm amlddisgyblaeth?
  • Gofal sy’n canolbwyntio ar yr unigolyn – sut gallem ni gefnogi ymagwedd sy’n canolbwyntio fwy ar yr unigolyn at ddiogelwch meddyginiaethau yng Nghymru? Beth yw’r ffordd orau i gymhwyso egwyddorion cynhyrchu ar y cyd a seicoleg newid ymddygiadau at y defnydd o feddyginiaethau?
  1. Sut ydych chi’n bwriadu cyflawni canlyniadau allweddol y rhaglen?

Fel y mae’r teitl yn ei awgrymu, bydd yn her ac ni fydd yn digwydd dros nos. Rwyf wedi bod yn tybio -beth yw elfennau system diogelwch meddyginiaethau o’r radd flaenaf. A yw’n ddefnydd gwell o ddata? A yw’n well dysgu o wall? A yw’n gweithio amlddisgyblaeth well? Sut beth fydd hyn mewn system well?

Er mwyn darganfod mwy, rydym ni’n bwriadu dod ag arbenigedd gwella 1000 o Fywydau, a gwybodaeth a phrofiad y rheiny yn y GIG sydd â diddordeb mewn diogelwch meddyginiaethau, yn ogystal â’r cyhoedd, at ei gilydd, i gynhyrchu ar y cyd cyfres o ymyriadau effaith uchel sydd â’r potensial i drawsnewid diogelwch meddyginiaethau yng Nghymru. Wedyn, byddwn ni’n profi’r ymyriadau hynny gyda’r bwriad o’u lledaenu nhw’n genedlaethol, trwy Gydweithrediaeth Diogelwch Meddyginiaethau genedlaethol.

  1. Pam ydych chi’n gyffrous cael gweithio ar hyn?

Rwyf wedi bod yn gysylltiedig â diogelwch meddyginiaethau ar hyd fy ngyrfa. I mi yn bersonol, mae’n gyfle i gymhwyso popeth rydw i wedi’i ddysgu am wella i bwnc rwy’n frwdfrydig yn ei gylch. Trwy ddod ag arbenigedd fferyllol a gwella at ei gilydd, gallwn wneud gwahaniaeth gwirioneddol i fywydau pobl trwy ddefnydd mwy diogel a mwy effeithiol o feddyginiaethau.

Hoffai Paul glywed oddi wrthych chi – pa syniadau sydd gennych chi i wella diogelwch meddyginiaethau? Pa brosiectau ydych chi’n gysylltiedig â nhw yr hoffech eu rhannu? Os hoffech gymryd rhan, cysylltwch ag ef ar paul.gimson@wales.nhs.uk

 

Apr 092019
 

In March over 3350 attendees from 70 different countries got together at the International Quality Forum 2019 in Glasgow to learn and share knowledge on improving the quality and safety of care for patients across the world. We catch up with Dr John Boulton, Interim Director of NHS Quality Improvement and Patient Safety, 1000 Lives Improvement to find out what his key reflections were from the event.

What were the team doing at the event this year? 

The Quality Forum is an important event for us as it provides an opportunity for us to interact with a large number of improvement experts from all over the world under the one roof. As a team we’ve attended for a number of years and always take away really valuable learning that we can bring back to Wales.

This year the 1000 Lives team had a good presence at the event. We jointly hosted a pre-day session with colleagues from Scotland, Brazil, Australia, England on designing and managing large scale collaborative quality based improvement projects, where the Welsh OBS Cymru team spoke about their experience of measurement for improvement.

Joanna Doyle, All Wales Nurse Staffing Programme Manager delivered a poster presentation on the Nurse Staffing Levels (Wales) Act and we also made some great connections on our stand where we were introducing delegates to the concept of using Lego® Serious Play® to create models of leadership.

Personally, I was delighted to host two extremely full sessions discussing leadership for improvement (utilising Lego) with Dr Sara Long, Clinical Fellow, Aneurin Bevan Continuous Improvement. In addition I co-led a plenary session on learning from failure with Dr Barbara Grey, Director of Quality Improvement and SLaM Partners, South London and Maudsley NHS Foundation Trust. We addressed identifying failure early on, what to do next, working creatively with the messiness of change and also explored the psychology of failure in QI.

It was a privilege to be there with colleagues from PHW and HEIW as part of the wider NHS Wales team.

What were your main reflections from the event? There was a vast amount of great work that was showcased at the forum that we could usefully learn from in Wales. However, we should also be increasingly taking the opportunity to learn from programmes that are less successful. At the conference Wales was well represented and I think we should be proud of the excellent work that is taking place within the country

And what will you take away from the Forum?

That improvement science in healthcare is perhaps more important than ever. This has spurred us on even more to finalise and share our framework for improvement and our plan for how we are going to work with health and social care to support them to deliver improvements for Wales. It’s going to be a significant year for improvement in Wales and we look forward to working with our many partners together on this.

 

Apr 092019
 

Ym mis Mawrth, daeth 3350 o fynycheion o 70 o wledydd gwahanol at ei gilydd yn Fforwm Ansawdd Rhyngwladol 2019 yng Nglasgow, i ddysgu a rhannu gwybodaeth am wella ansawdd a diogelwch gofal ar gyfer cleifion ledled y byd. Rydym ni wedi bod yn siarad â Dr John Boulton, Cyfarwyddwr Dros Dro Gwella Ansawdd a Diogelwch Cleifion y GIG, 1000 o Fywydau – Gwasanaeth Gwella, i ddarganfod beth oedd ei fyfyrdodau allweddol am y  digwyddiad.

Beth oedd y tîm yn ei wneud yn y digwyddiad eleni?

Mae’r Fforwm Ansawdd yn ddigwyddiad pwysig i ni gan ei fod yn rhoi cyfle i ni ryngweithio â nifer fawr o arbenigwyr gwella o bob cwr o’r byd, o dan un to. Fel tîm, rydym ni wedi mynychu’r digwyddiad ers nifer o flynyddoedd, a bob amser yn dysgu pethau gwerthfawr iawn y gallwn ni ddod nôl gyda ni i Gymru.

Eleni, roedd gan dîm 1000 o Fywydau bresenoldeb da yn y digwyddiad. Cynhaliom sesiwn ymlaen llaw ar y cyd â chydweithwyr o’r Alban, Brasil, Awstralia, a Lloegr, ar ddylunio a rheoli prosiectau gwella cydweithredol, ar sail ansawdd, ar raddfa fawr, lle siaradodd tîm OBS Cymru am eu profiad o fesur er gwella.

Cyflwynodd Joanna Doyle, Rheolwr Rhaglen Staff Nyrsio Cymru Gyfan, gyflwyniad poster ar Ddeddf Lefelau Staff Nyrsio (Cymru), a llwyddom i wneud cysylltiadau gwych ar ein stondin, lle buom yn cyflwyno cynrychiolwyr i’r cysyniad o ddefnyddio Lego® Serious Play® i greu modelau arweinyddiaeth.

Yn bersonol, roeddwn wrth fy modd yn cael cynnal dwy sesiwn lawn iawn, yn trafod arweinyddiaeth er gwella (gan ddefnyddio Lego) gyda Dr Sara Long, Cymrawd Clinigol, Gwelliant Parhaus Aneurin Bevan. Hefyd, arweiniais sesiwn lawn ar y cyd, ar ddysgu yn sgil methu, gyda Dr Barbara Grey, Cyfarwyddwr Gwella Ansawdd, a SLaM Partners, South London and Maudsley NHS Foundation Trust. Fe aethom i’r afael ag amlygu methiant yn gynnar, beth i’w wneud nesaf, gweithio’n greadigol ag aflerwch newid, ac archwilio seicoleg methiant wrth wella ansawdd.

Roedd yn fraint cael bod yno gyda chydweithwyr o Iechyd Cyhoeddus Cymru ac Addysg a wella Iechyd Cymru, fel rhan o dîm ehangach GIG Cymru.

Beth oedd eich prif fyfyrdodau am y digwyddiad?

Roedd llawer iawn o waith gwych yn cael ei arddangos yn y fforwm, y gallem ni ddysgu oddi wrtho yng Nghymru. Fodd bynnag, dylem ni hefyd fod yn achub ar y cyfle yn gynyddol i ddysgu o raglenni sy’n llai llwyddiannus. Yn y gynhadledd, roedd cynrychiolaeth dda o Gymru, a chredaf y dylem ni fod yn falch iawn o’r gwaith gwych a gyflawnir yn y wlad.

Beth ddysgoch chi o’r Fforwm?

Efallai bod gwyddor gwella ym maes gofal iechyd yn bwysicach nag erioed. Mae hyn wedi ein hysgogi ni hyd yn oed yn fwy i orffen a rhannu ein fframwaith gwella, a’n cynllun ar gyfer sut i weithio gydag iechyd a gofal cymdeithasol i’w cefnogi nhw i gyflwyno gwelliannau yng Nghymru. Bydd yn flwyddyn arwyddocaol ar gyfer gwella yng Nghymru, ac rydym ni’n edrych ymlaen at gydweithio â’n partneriaid niferus ar hyn.

 

 

Apr 052019
 

Midwifery is renowned for being one of the most rewarding professions there is; however as so many midwives will testify it is also at times one of the most challenging. It is however incredibly rare to be given the opportunity to take part in quality improvement projects which not only see almost immediate benefits to the women we care for; but which also shape the profession and wider clinical practice. OBS Cymru – the Obstetric Bleeding Strategy for Wales- has been one such project. OBS Cymru is the result of research which began in Cardiff over 10 years ago, and developed over time into an evidence based, highly effective strategy for managing Postpartum Haemorrhage. This approach has now been rolled out to every health board in Wales and has significantly changed practice, seemingly overnight (no mean feat as I’m sure you’ll agree).

Each Consultant Led Unit’s (CLU) OBS Cymru Champion Team have overseen the implementation of the project. I have had the honour of being one of the Champion Midwives in Ysbyty Glan Clwyd in North Wales and I can honestly say it has been more rewarding and equally more influential to my practice than anything I’ve been a part of previously. Simple evidence based interventions with an emphasis on early recognition of PPH through Risk Assessment and measuring blood loss rather than estimating it. This was a major change in practice but one which was adopted by all staff and with remarkable results. Change is inevitable in Maternity care but it is not always so easily achieved!

As Champion Midwives we have encouraged truly multidisciplinary team working and training, generating remarkable and undeniable results for women in our care. The success for OBS Cymru in our unit has been largely due to the engagement of the support workers and midwives. They led the change to measuring blood loss and instigating early recognition and management of PPH.

OBS Cymru as a QI project has now drawn to a close. However, I don’t see this as signifying the end of the OBS Cymru work. Rather, primarily it is an opportunity to reflect on just how far we have come as a nation that is leading the way in effective management of PPH. But in addition it is an opportunity to look to the future and plan our own strategies for ensuring this invaluable work continues and embeds even further into everyday practice.

I feel fortunate to have worked with such an enthusiastic, motivated and knowledgeable team who will help this work continue and who will drive forward change to achieve the best for the women in our care. For us OBS Cymru is here to stay!

Apr 052019
 

Caiff bydwreigiaeth ei gydnabod fel un o’r meysydd proffesiynol mwyaf gwobrwyol sy’n bodoli. Fodd bynnag, fel mae cymaint o fydwragedd yn tystio, mae’n faes hynod heriol hefyd. Prin yw’r cyfleoedd i gyfrannu at brosiectau gwella ansawdd sydd o fudd uniongyrchol i’r menywod yn ein gofal ac sydd hefyd yn siapio’r maes proffesiynol ac arferion clinigol ehangach. Mae Strategaeth Gwaedu Obstetreg i Gymru (OBS Cymru) yn brosiect o’r fath. Eginodd OBS Cymru o ganlyniad i waith ymchwil a ddechreuodd yng Nghaerdydd dros ddeg mlynedd yn ôl, gan ddatblygu dros amser yn strategaeth seiliedig ar dystiolaeth hynod effeithiol ar gyfer rheoli gwaedu ôl-enedigol. Bellach, mae’r dull wedi cael ei gyflwyno ym mhob bwrdd iechyd yng Nghymru, gan newid arferion yn sylweddol, a hynny dros nos i bob golwg.

Mae pob Tîm Hyrwyddo OBS Cymru sy’n rhan o Uned o dan Arweiniad Ymgynghorydd wedi goruchwylio cyflwyniad y prosiect. Rydw i wedi cael y fraint o fod yn Hyrwyddwr Bydwragedd yn Ysbyty Glan Clwyd yng ngogledd Cymru, a gallaf ddatgan yn gwbl ddiffuant bod y profiad wedi bod yn hynod wobrwyol a’i fod wedi cael mwy o ddylanwad ar fy arferion nag unrhyw beth rydw i wedi bod yn rhan ohono yn y gorffennol. Ymyriadau syml, seiliedig ar dystiolaeth, gyda phwyslais ar adnabod gwaedu ôl-enedigol yn gynnar trwy asesiadau risg a mesur colledion gwaed, yn hytrach nag amcangyfrifo. Mabwysiadwyd y newid arfer mawr hwn gan bob aelod staff gan arwain at ganlyniadau nodedig. Mae newidiadau yn anochel ym maes bydwreigiaeth, er nad yw’n cael ei gyflawni mor hawdd fel arfer!

Fel Hyrwyddwyr Bydwragedd, rydym ni wedi annog gwaith tîm a hyfforddiant amlddisgyblaethol go iawn, sydd wedi arwain at ganlyniadau nodedig ac anwadadwy i’r menywod yn ein gofal. Mae llwyddiant OBS Cymru yn ein huned yn seiliedig ar ymgysylltu â’r gweithwyr cynorthwyol a’r bydwragedd. Nhw arweiniodd y newid i fesur colledion gwaed a chydnabod a rheoli gwaedu ôl-enedigol yn gynnar.

Fel prosiect QI, mae OBS Cymru wedi dod i ben. Fodd bynnag, nid dyma ddiwedd gwaith OBS Cymru. Yn hytrach, dyma gyfle i fyfyrio ar ba mor bell rydym wedi dod fel cenedl sy’n arwain y ffordd o ran rheoli gwaedu ôl-enedigol yn effeithiol. Yn ogystal, dyma gyfle i ni edrych tua’r dyfodol a chynllunio strategaethau er mwyn sicrhau bod y gwaith amhrisiadwy hwn yn parhau ac yn dod yn rhan annatod o arferion bob dydd.

Teimlaf yn ffodus o fod wedi cael cyfle i weithio gyda thîm mor frwdfrydig, gwybodus a llawn cymhelliant, a fydd yn sicrhau bod y gwaith yn parhau ac yn gyrru newidiadau er lles y menywod yn ein gofal. I ni, mae OBS Cymru yma i aros!

Apr 032019
 

We catch up with Evie Lightfoot, District Nurse from Hywel Dda University Health Board on winning the RCN in Wales Nurse of the Year 2018 and the role Quality Improvement has played in her work.

Evie has developed training to help community nursing staff recognise sepsis in patients.

What does this award accolade mean to you personally and professionally?

I am so privileged to have won this award. At times I felt like giving up as it was quite a lonely journey, juggling the role of being a working single mum of 3 children with a District Nursing caseload and a research internship!

Receiving the award and recognition for my passion and dedication has made it all worthwhile and will hopefully encourage others to get involved in a project that they are passionate about.

The purpose and drive was to improve patient safety and recognition of sepsis and appropriate escalation in the community, by doing this it has enhanced the nursing teams’ knowledge, and skills, and helps to empower them to escalate appropriately.

I hope it has also raised the profile of District Nursing, improving the understanding of the important and often complex role that we have in delivering home based care, highlighting how the role of the District Nurse has evolved into a multi-faceted job caring for patients and their families with often unpredictable and complex health care needs.

On a personal note, winning the RCN in Wales Nurse of the year award 2018 and the RCN Community Nurse of the year award has been very exciting and a great honour. It has given me a platform from which to work with others to promote the role of Community Nurses in the quest to improve patient care. It has brought new opportunities and experiences which will broaden my knowledge and increase my confidence, helping to open up new possibilities for my future career. I am very privileged to have been given this opportunity.

Where did your journey begin?

My journey began almost 7 years ago when I started working as a community nurse. I had previously been employed as a junior sister in A&E and had ITU experience, so was used to assessing unwell patients using NEWS – National Early Warning Scoring System and Sepsis screening.

It was apparent to me straight away that community nurses did not have the appropriate training / education to recognise a deteriorating patient.  NEWS observations were not performed in the community and staff had not had any Sepsis education training. Nor did they have the correct equipment to carry out a full set of observations.

I tried to voice my concerns which wasn’t easy, as at this time it wasn’t recognised that Sepsis was a problem in the community or that there was a need for community nurses to perform NEWS observations. This left me feeling frustrated.

I completed my SPQ District nursing degree and went on to do a research internship where my project was to establish District Nurses current knowledge of sepsis and appropriate escalation. I wrote a bespoke community sepsis education package which I delivered with the help of a colleague from the 1000 lives team. We delivered the training to over 100 nurses across Carmarthenshire, the plan was to then re questionnaire them 3 months later.

This initial project was a catalyst and it uncovered lots of issues that needed to be addressed in order to improve patient safety.

What were some of the challenges along the way and how did you overcome them?

It has been a constant challenge and still is!

There were initial concerns that if I delivered sepsis awareness education and NEWS observations to community nurses that they would suddenly escalate inappropriately and that here would be a large queue of people outside GP surgeries and A&E.  It was also suggested that you didn’t need a score to know if someone was sick.

So I have had to reassure and explain that although NEWS is a valuable tool to detect deterioration and possible sepsis, it does not replace a practitioner’s clinical judgement it, is there to support and enhance it.

The NEWS system is also a common communication language used by the Welsh ambulance service and secondary care. This means that for Community and Primary care if you need to escalate a patient who is deteriorating the use of NEWS will help the process.

Even at an early stage there were practical obstacles such as finding venues to teach, to try and get staff to attend due to staffing problems and even down to the equipment and having to transport and carry a heavy TV and trolley to venues!.

I have worked closely with Chris Hancock and the 1000 lives acute deterioration team for many years involved in the National Out of Acute Hospital RRAILS group as well as Health board Out of acute hospital work.

The support that I have received from 1000 lives has been pivotal to the success of my work, they have been a fantastic team to be involved with and to help drive my initiative.

They continue to be a team that I liaise and meet with frequently to help drive forward the acute deterioration work in the community and I am excited and proud to be involved with the official launch of NEWS into Community nursing this March.

Would you recommend the Quality Improvement approach to others looking to make a change? And what do you think is key to sustaining improvement?

Yes using a QI approach allows a structured system, it prompts you to collect data and see what is working or not, and what needs to be changed. I only wish I had done this from the beginning of the project more diligently, but It’s all a learning process I guess.

I have learnt that with the best will in the world giving education and tools isn’t enough. You have to evaluate what change has taken place to inform future practice.

For it to succeed you can’t be precious, It’s imperative to share ideas and get other people on board so that the change can be embraced by others to ensure that it gains ownership and sustainability to be embedded into practice.

Do you have a plan for building on your success?

I am still collecting data, so currently success for me is measured by the feedback that I am receiving from staff and patients. The Community SBAR tool is going to be launched officially, this will then allow me to measure the outcomes of when patients care is escalated in the community. To evidence the good work that is being done by community nurses.

I am also hoping that with the launch of NEWS nationally on March 21st this will further help to embed best practice within the community nursing teams in HDUHB and nationally.

I am hoping that NEWS and the SBAR approach will be embraced into Primary Care with many interested already from care homes and GP practices.

I have recently set up a task and finish group to redesign our transfer of care document so that it contains more pertinent information that is needed, such as NEWS score, if a DNA CPR is in place etc. This will hopefully improve communication between secondary and community care. The plan is for the document could be used on transfer from hospital or from a care setting or form community, rather than just a discharge letter.

I am also very interested in doing a project in the future to look at post sepsis care and support of patients in the community.

I am currently undertaking further Quality Improvement work to establish how well the NEWS is being embraced by the community nursing teams and to be able to measure the outcomes.

What words of encouragement would you offer to others starting on an improvement journey?

I believe that it’s important to have a strong defined aim of what you are trying to achieve and why, you must keep this in mind throughout the process, to help keep your motivation up and to prevent you deviating.

If your idea to implement change is backed with integrity and a strong desire to improve patient care and the practice then you are on the right track.

Make sure your idea is evidence based and that it is something you are passionate about. You have to gain thick skin and broad shoulders, not everyone will like or agree with your ideas, it’s about developing coping strategies and enhancing communication skills to deal with it!

Learn from the hurdles and obstacles, celebrate the successes even when they small, keep knocking on doors as networking with others is the key to success.

 

Apr 032019
 

Rydym ni’n dal i fyny gydag Evie Lightfoot, Prif Nyrs Iau Tîm Ymateb Acíwt (ART) yn Sir Gâr, Bwrdd Iechyd Prifysgol Hywel Dda, ar ôl ennill Nyrs y Flwyddyn RCN yng Nghymru 2018, a’r rôl y mae Gwella Ansawdd wedi’i chwarae yn ei gwaith.

Mae Evie wedi datblygu hyfforddiant i helpu staff nyrsio cymunedol i adnabod sepsis mewn cleifion.

Beth mae’r wobr yn hon yn ei olygu i chi yn bersonol ac yn broffesiynol?  

Mae’n fraint fawr ennill y wobr hon. Ar adegau, roeddwn i’n teimlo fel rhoi’r gorau iddi, oherwydd yr oedd hi’n daith eithaf unig, yn jyglo’r rôl o fod yn fam sengl i dri o blant sy’n gweithio, gyda baich achosion Nyrsio Ardal ac interniaeth ymchwil!

Roedd derbyn y wobr a’r gydnabyddiaeth am fy mrwdfrydedd a’m hymroddiad wedi gwneud y cyfan yn werth chweil, a gobeithio bydd hyn yn annog pobl eraill i gymryd rhan mewn prosiect y maent yn frwdfrydig amdano.

Y diben a’r nod oedd gwella diogelwch cleifion ac adnabod sepsis, a chynnydd priodol yn y gymuned, trwy wneud hyn, mae wedi gwella gwybodaeth a sgiliau timau nyrsio, ac mae’n helpu i’w grymuso nhw i ddatblygu’n briodol.

Rwyf hefyd yn gobeithio ei fod wedi codi proffil Nyrsio Ardal, gan wella dealltwriaeth o’r rôl bwysig, a chymhleth yn aml, sydd gennym o ran cyflwyno gofal yn y cartref, ac amlygu sut mae rôl y Nyrs Ardal wedi datblygu i fod yn swydd aml-ffasedog yn gofalu am gleifion a’u teuluoedd, gydag anghenion gofal iechyd cymhleth ac anrhagweladwy yn aml.

Yn bersonol, mae ennill Gwobr Nyrs y Flwyddyn RCN yng Nghymru 2018, a Nyrs Gymunedol y Flwyddyn RCN, wedi bod yn gyffrous iawn, ac yn anrhydedd mawr. Mae wedi rhoi llwyfan i mi weithio gyda phobl eraill i hyrwyddo rôl Nyrsys Cymunedol yn y cwest i wella gofal cleifion. Mae wedi arwain at gyfleoedd a phrofiadau newydd, a fydd yn ehangu fy ngwybodaeth a chynyddu fy hyder, a helpu i gyflwyno posibiliadau newydd ar gyfer fy ngyrfa yn y dyfodol. Mae wedi bod yn fraint fawr cael y cyfle hwn.

Ble ddechreuodd eich taith?

Dechreuodd fy nhaith bron i 7 mlynedd yn ôl, pan ddechreuais weithio fel nyrs gymunedol. Roeddwn i wedi cael fy nghyflogi’n flaenorol fel prif nyrs iau yn yr adran damweiniau ac achosion brys, ac roedd gen i brofiad yn yr uned triniaeth ddwys, felly roeddwn i’n gyfarwydd ag asesu cleifion anhwylus gan ddefnyddio NEWS – System Sgôr Rhybudd Cynnar Cenedlaethol, a sgrinio Sepsis.

Roedd yn amlwg i mi ar unwaith nad oedd gan nyrsys cymunedol yr hyfforddiant / addysg briodol i adnabod claf sy’n dirywio. Ni chafodd arsylwadau NEWS eu cyflawniad yn y gymuned, ac nid oedd staff wedi cael unrhyw hyfforddiant addysg sepsis. Ac nid oedd ganddynt yr offer cywir i gyflawni set lawn o arsylwadau chwaith.

Ceisiais leisio fy mhryderon, nad oedd yn hawdd iawn oherwydd, ar y pryd, nid oedd sepsis yn cael ei gydnabod fel problem yn y gymuned, a bod angen i nyrsys cymunedol gyflawni arsylwadau NEWS. Roedd hyn yn gwneud i mi deimlo’n rhwystredig iawn.

Fe wnes i gwblhau fy Ngradd Nyrsio Ardal SPQ, a mynd ymlaen i wneud interniaeth ymchwil, lle sefydlwyd fy mhrosiect i sefydlu gwybodaeth Nyrsys Ardal presennol am a chynnydd priodol. Ysgrifennais becyn addysg sepsis cymunedol pwrpasol, a chyflwynais hwn gyda help cydweithiwr o dîm 1000 o Fywydau. Fe gyflwynom yr hyfforddiant i dros 100 o nyrsys ledled Sir Gâr, a’r cynllun wedyn oedd eu holi nhw eto 3 mis yn ddiweddarach.

Roedd y prosiect cychwynnol hwn yn gatalydd, ac fe wnaeth ddadorchuddio llawer o broblemau yr oedd angen mynd i’r afael â nhw er mwyn gwella diogelwch cleifion.

Beth oedd rhai o’r heriau ar hyd y ffordd, a sut gwnaethoch chi eu goresgyn?

Mae wedi bod yn her gyson, ac mae’n parhau i fod!

Roedd pryderon i ddechrau, petawn i’n cyflwyno addysg ymwybyddiaeth o sepsis ac arsylwadau NEWS i nyrsys cymunedol, y byddent yn cynyddu’n amhriodol yn sydyn, ac y byddai ciw mawr o bobl y tu allan i feddygfeydd ac adrannau damweiniau ac achosion brys. Awgrymwyd hefyd nad oedd angen sgôr i wybod a oedd rhywun yn sâl.

Felly, rydw i wedi gorfod tawelu meddwl ac esbonio, er bod NEWS yn offeryn gwerthfawr i ganfod dirywiad a sepsis posibl, nid yw’n amnewid dyfarniad clinigol ymarferydd, mae yno i’w ategu a’i wella.

Mae NEWS hefyd yn iaith gyfathrebu gyffredin a ddefnyddir gan Wasanaethau Ambiwlans Cymru a gofal eilaidd. Mae hyn yn golygu, ar gyfer gofal cymunedol a sylfaenol, os oes angen i chi uwchgyfeirio claf sy’n dirywio, a bydd defnyddio NEWS yn helpu’r broses.

Yn gynnar, hyd yn oed, roedd rhwystrau ymarferol, fel dod o hyd i leoliadau i addysgu, i geisio cael staff i fynychu oherwydd problemau staffio, a hyd yn oed yr offer a gorfod cludo a chario teledu trwm a throli i leoliadau!

Rwyf wedi gweithio’n agos â Chris Hancock a thîm dirywio acíwt 1000 o Fywydau ers nifer o flynyddoedd, bod yn gysylltiedig â grŵp RRAILS Allan o Ysbyty Acíwt Cenedlaethol, yn ogystal â gwaith Allan o Ysbyty Acíwt Byrddau Iechyd.

Mae’r gefnogaeth rydw i wedi’i derbyn gan 1000 o Fywydau wedi bod yn ganolog i lwyddiant fy ngwaith, maen nhw wedi bod yn dîm gwych i fod yn gysylltiedig â nhw, ac i helpu hybu fy menter.

Maen nhw’n parhau i fod yn dîm rydw i’n cysylltu â nhw ac yn cyfarfod â nhw’n aml i helpu hybu’r gwaith dirywio acíwt yn y gymuned, ac rwy’n gyffrous ac yn falch o fod yn gysylltiedig â lansiad swyddogol NEWS mewn nyrsio cymunedol ym mis Mawrth.

A fyddech chi’n argymell yr ymagwedd Gwella Ansawdd i bobl eraill sydd eisiau gwneud newid? A beth ydych chi’n meddwl sy’n allweddol i gynnal gwelliannau?

Mae defnyddio ymagwedd gwella ansawdd yn caniatáu system strwythuredig, mae’n eich hybu chi i gasglu data a gweld beth sy’n gweithio ai peidio, a beth sydd angen ei newid. Pe bawn i ond wedi gwneud hyn o ddechrau’r prosiect yn fwy dyfal, ond mae’r cyfan yn broses ddysgu, am wn i.

Rydw i wedi dysgu, hyd yn oed â’r ewyllys gorau yn y byd, nad yw rhoi addysg ac offer yn ddigon. Rhaid i chi werthuso’r newid sydd wedi digwydd i lywio ymarfer yn y dyfodol.

Er mwyn sicrhau ei fod yn llwyddo, ni allwch fod yn fursennaidd. Rhaid rhannu syniadau a chael pobl eraill yn gysylltiedig er mwyn i bobl eraill allu derbyn y newid i sicrhau ei fod yn cael ei ddefnyddio a’i fod yn gynalidawy, er mwyn ei ymgorffori mewn ymarfer.

A oes gennych chi gynllun i adeiladu ar eich llwyddiant?

Rwy’n dal i gasglu data, felly ar hyn o bryd, caiff y llwyddiant ei fesur yn ôl yr adborth rwy’n ei dderbyn gan staff a chleifion. Bydd yr offeryn SBAR cymunedol yn cael ei lansio’n swyddogol, a bydd hyn wedyn yn caniatáu i mi fesur y canlyniadau pan fydd gofal cleifion yn cael ei uwchgyfeirio yn y gymuned, i dystio’r gwaith da sy’n cael ei wneud gan nyrsys cymunedol.

Rwyf hefyd yn gobeithio, ar ôl lansio NEWS yn genedlaethol ar 21 Mawrth, bydd hyn yn helpu ymhellach i ymgorffori ymarfer gorau mewn timau nyrsio cymunedol ym Mwrdd Iechyd Prifysgol Hywel Dda, ac yn genedlaethol.

Rwy’n gobeithio y bydd NEWS ac ymagwedd SBAR yn cael eu defnyddio mewn gofal sylfaenol, gyda nifer o gartrefi gofal a meddygfeydd eisoes â diddordeb.

Yn ddiweddar, sefydlais grŵp gorchwyl a gorffen i ail-ddylunio ein dogfen trosglwyddo gofal, er mwyn iddi gynnwys gwybodaeth fwy perthnasol sydd ei hangen, fel sgôr NEWS, a oes gorchymyn DNA CPR ar waith, ac ati. Gobeithio y bydd hyn yn gwella cyfathrebu rhwng gofal eilaidd a chymunedol. Y bwriad yw i’r ddogfen gael ei defnyddio wrth drosglwyddo o ysbyty neu o leoliad gofal, neu o’r gymuned, yn hytrach na llythyr rhyddhau’n unig.

Mae gen i ddiddordeb hefyd mewn gwneud prosiect yn y dyfodol a fydd yn edrych ar ofal ar ôl sepsis, a chefnogi cleifion yn y gymuned.

Rydw i ar hyn o bryd yn cyflawni gwaith Gwella Ansawdd i sefydlu pa mor dda y mae timau nyrsio cymunedol yn defnyddio NEWS, a gallu mesur y canlyniadau.

Pa eiriau o anogaeth fyddech chi’n eu cynnig i bobl eraill sy’n dechrau ar daith wella?

Rwy’n credu ei bod hi’n bwysig cael nod diffiniedig cryf o beth rydych chi’n ceisio ei gyflawni a pham. Rhaid i chi gadw hyn mewn golwg trwy gydol y broses i helpu i sicrhau eich bod chi’n parhau’n frwdfrydig a’ch atal rhag gwyro.

Os yw’ch syniad i weithredu newid yn cael ei ategu gan onestrwydd a dyhead cryf i wella gofal cleifion a’r ymarfer, yna rydych chi ar y trywydd cywir.

Gwnewch yn siŵr bod eich syniad ar sail tystiolaeth a’i fod yn rhywbeth rydych chi’n frwdfrydig amdano. Rhaid i chi fod yn groendew a bod gennych chi ysgwyddau llydan. Ni fydd pawb yn hoffi nac yn cytuno â’ch syniadau. Mae’n ymwneud â datblygu strategaethau ymdopi a gwella sgiliau cyfathrebu i fynd i’r afael â hyn!

Dysgwch o’r rhwystrau, dathlwch y llwyddiannau, hyd yn oed pan eu bod nhw’n fach, parhewch i gnocio ar ddrysau gan fod rhwydweithio ag eraill yn allweddol i lwyddiant.