Sep 172019


Phil Routledge was, until his recent retirement earlier this year, Founding Clinical Director of the All Wales Therapeutics and Toxicology Centre (AWTTC) at University Hospital Llandough. AWTTC provides professional support to AWMSG in their aim to help to obtain the best possible outcomes from medicines for the people of Wales. He is now a member of the Medicines Safety Programme Management Board.

In June 2017, Sir Liam Donaldson, the World Health Organization (WHO) Director-General’s envoy on patient safety came to Wales to deliver the fourth Felicity Newton-Savage Memorial lecture* entitled “Medication and its Use; a Priority for Patient Safety” at the 15th Anniversary Conference of the All Wales Medicines Strategy Group (AWMSG). He recounted that just three months previously in Bonn, WHO had launched its third global patient safety challenge Medication Without Harm. The two preceding challenges had been Clean Care is Safer Care in 2005 and Safe Surgery Saves Lives in 2008. The vital importance of all such aspects of patient safety is now to be recognized internationally in the decision earlier this year by the 72nd World Health Assembly, WHO’s governing forum to designate September 17th each year as World Patient Safety Day (1). The theme for the day is “Patient Safety: a global health priority” and the associated slogan is “Speak up for patient safety.”

Medication Safety is a hugely important aspect of patient safety and WHO has agreed that the aim of Medication Without Harm will be to reduce severe, avoidable harm related to medications by 50% over 5 years, globally. They have identified four key domains involved in the challengePatients and the public, Medicines, Health care professionals, and Systems/ practices of medication. Within these domains they have chosen to focus on three key action areas, – Polypharmacy, High risk situations, and Transitions of care. Three WHO technical reports concerning these action areas have recently been published (2).

Polypharmacy is the concurrent use of multiple (i.e. more than one) medications. Although there is no standard definition, polypharmacy is often described as the routine use of five or more medications, although this includes over-the-counter (OTC), prescription and/or traditional & complementary medicines (3).  Polypharmacy may be appropriate in some cases but may also be inappropriate if one or more medicines are prescribed that are not, or no longer needed. The AWMSG Polypharmacy Guidance has produced a suite of policies to support polypharmacy management, including deprescribing (stopping medicines) when clinically appropriate (4).

Transitions of care (2) are “the various points where a patient moves to, or returns from a particular physical location or makes contact with a health care professional for the purposes of receiving health care. This includes transitions between home, hospital, residential care settings and consultations with different health care providers in out-patient facilities” (5). Although they may result in circumstances in which medication error can occur especially if communication is inadequate, they also provide opportunities for using resources such as the AWMSG Multidisciplinary Medicines Reconciliation Policy (6) and person-centred medication review.

High Risk Situations (2) are, those circumstances which are associated with a significant risk of medication- related harm, either due to medication factors, provider and patient factors or systems factors (e.g. the work environment) or a combination of these working together. The All-Wales polypharmacy guidance (4) focuses on the at-risk, the frail older person and on some of the high-risk (high alert) medications identified in the WHO technical report. Separate resources on particular high-risk (high-alert) medicines such as anticoagulants and opioids (including tramadol) are also available on the AWMSG Website.

Earlier this year Andrew Evans, our Chief Pharmaceutical Officer for Wales, commissioned 1000 Lives to develop a national Medicines Safety Programme for Wales in response to ‘A Healthier Wales’ and ‘Medication without Harm’. Paul Gimson, Programme Lead for Primary Care and Medicines Safety at 1000 Lives Improvement/Improvement Cymru is leading the development of a new Medicines Safety Cymru programme.

On this first World Patient Safety Day, Paul is asking healthcare professionals in Wales to highlight initiatives planned or already underway in medicines safety across Wales. Some of these areas (e.g. deprescribing in GP Practice and reducing anticholinergic medicines burden (7)) have already been presented to a wider audience at previous AWTTC annual best-practice days organised by AWTTC’s Welsh Analytical Prescribing Support Unit (WAPSU) but I’m aware that there are many more examples of best practice in medication safety across Wales from which we can all learn.  A range of the projects received will then be discussed at a special Medicines Safety Cymru masterclass on 26 November 2019. Please send in your project details to by 18 October 2019.

*The late Felicity Newton Savage was the first Director of the Welsh Medicines Resource Centre (WeMeReC), now part of AWTTC. She was instrumental in developing products unique to WeMeReC that are highly regarded and valued by healthcare professionals within and outside of Wales.

References/ Links

  1. World Health Organization: World Patient Safety Day .(accessed 29/08/2019)
  2. World Health Organization. Medication safety in key action areas, World Health Organization 2019. (accessed 29/08 2019)
  3. Masnoon N et al. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017; 17: 230 (accessed 02/09/2019)
  4. All Wales Medicines Strategy Group. Polypharmacy guidance (accessed 29/08/2019)
  5. Transitions of Care: Technical Series on Safer Primary Care. Geneva: World Health Organization; 2016. (accessed 29/08/2019)
  6. All Wales Medicines Strategy Group. All Wales Multidisciplinary Medicines Reconciliation Policy (accessed 02/09/2019)
  7. All Wales Therapeutics and Toxicology Centre: Best Practice Day 2018. (accessed 02/09/2019)
Sep 172019

Roedd Phil Routledge, hyd nes ei ymddeoliad diweddar yn gynharach eleni, yn Gyfarwyddwr Clinigol Sefydlu Canolfan Therapiwteg a Thocsicoleg Cymru Gyfan (AWTTC) yn Ysbyty Athrofaol Llandochau. Mae AWTTC yn darparu cefnogaeth broffesiynol i AWMSG yn eu nod i helpu cael y canlyniadau gorau posibl o feddyginiaethau ar gyfer pobl Cymru. Mae bellach yn aelod o’r Bwrdd Rheoli Rhaglen Diogelwch Meddyginiaethau.

Ym mis Mehefin 2017, daeth Syr Liam Donaldson, cennad Cyfarwyddwr Cyffredinol Sefydliad Iechyd y Byd (WHO) ar ddiogelwch cleifion, i Gymru i gyflwyno pedwaredd Ddarlith Goffa Felicity Newton-Savage*, o’r enw “Medication and its Use; a Priority for Patient Safety”, yng nghynhadledd pen-blwydd Grŵp Strategaeth Meddyginiaethau Cymru Gyfan (AWMSG) yn 15 oed. Soniodd fod WHO, ond tri mis yn flaenorol, wedi lansio ei drydedd her diogelwch cleifion byd-eang, Medication Without Harm, yn Bonn. Y ddwy her flaenorol oedd Clean Care is Safer Care yn 2005 a Safe Surgery Saves Lives yn 2008. Mae pwysigrwydd hanfodol yr holl agweddau hyn ar ddiogelwch cleifion bellach yn mynd i gael ei gydnabod yn rhyngwladol yn y penderfyniad yn gynharach eleni gan 72ain Cynulliad Iechyd y Byd, sef fforwm llywodraethu  WHO, i bennu 17 Medi bob blwyddyn yn Ddiwrnod Diogelwch Cleifion y Byd (1). Thema’r diwrnod yw “Diogelwch cleifion: blaenoriaeth iechyd fyd-eang”, a’r slogan cysylltiedig yw “Siarad dros ddiogelwch cleifion.”

Mae diogelwch meddyginiaethau’n agwedd hynod bwysig o ddiogelwch cleifion ac mae WHO wedi cytuno mai nod Medication Without Harm fydd lleihau niwed difrifol, osgoadwy sy’n gysylltiedig â meddyginiaethau o 50% dros 5 mlynedd, yn fyd-eang. Maen nhw wedi amlygu pedwar parth allweddol sy’n gysylltiedig â’r her – cleifion a’r cyhoedd, meddyginiaethau, gweithwyr gofal iechyd proffesiynol a systemau/arferion meddyginiaethau. O fewn y parthau hyn, maen nhw wedi dewis canolbwyntio ar dri maes gweithredu allweddol – polyfferylliaeth, sefyllfaoedd risg uchel a phontio gofal. Mae WHO wedi cyhoeddi tri adroddiad technegol yn ddiweddar sy’n ymwneud â’r meysydd gweithredu hyn (2).

Polyfferylliaeth yw’r defnydd cydamserol o feddyginiaethau lluosog (h.y. mwy nag un). Er nad oes unrhyw ddiffiniad safonol, caiff polyfferylliaeth ei ddisgrifio’n aml fel y drefn o ddefnyddio pump neu fwy o feddyginiaethau, er bod hyn yn cynnwys meddyginiaethau dros y cownter, presgripsiwn a/neu feddyginiaethau traddodiadol a chyflenwol (3).  Gall polyfferylliaeth fod yn briodol mewn rhai achosion, ond gall hefyd fod yn amhriodol os caiff un neu fwy o feddyginiaethau eu rhagnodi, nad oes eu hangen mwyach. Mae Canllaw Polyfferylliaeth AWMSG wedi cynhyrchu cyfres o bolisïau i gefnogi rheoli polyfferylliaeth, gan gynnwys dadragnodi (stopio meddyginiaethau) pan ei fod yn briodol yn glinigol (4).

Pontio gofal (2) yw’r “pwyntiau amrywiol lle mae claf yn symud i, neu’n dychwelyd o, leoliad ffisegol penodol neu’n gwneud cysylltiad â gweithiwr iechyd proffesiynol at ddibenion derbyn gofal iechyd. Mae hyn yn cynnwys pontio rhwng y cartref, ysbytai, lleoliadau gofal preswyl ac ymgynghoriadau â darparwyr gofal iechyd gwahanol mewn cyfleusterau cleifion allanol” (5). Er efallai y byddant yn arwain at amgylchiadau lle gall gwallau ddigwydd o ran meddyginiaethau, yn enwedig os nad yw’r cyfathrebu’n ddigonol, maen nhw hefyd yn darparu cyfleoedd i ddefnyddio adnoddau fel Polisi Cysoni Meddyginiaethau Amlddisgyblaethol AWMSG (6) ac adolygiad o feddyginiaethau sy’n canolbwyntio ar yr unigolyn.

Sefyllfaoedd Risg Uchel (2) yw’r amgylchiadau hynny sy’n gysylltiedig â risg sylweddol o niwed sy’n gysylltiedig â meddyginiaethau, naill ai yn sgil ffactorau meddyginiaethau, ffactorau darparwyr a chleifion, neu ffactorau systemau (e.e. yr amgylchedd gwaith) neu gyfuniad o’r rhain yn gweithio gyda’i gilydd. Mae canllaw polyfferylliaeth Cymru gyfan (4) yn canolbwyntio ar yr unigolyn hŷn, bregus, mewn perygl, ac ar rai o’r meddyginiaethau risg uchel (rhybudd uchel) a amlygir yn adroddiad technegol WHO. Mae adnoddau ar wahân ar feddyginiaethau risg uchel (rhybudd uchel) penodol, fel gwrthgeulyddion a opioidiau (gan gynnwys tramadol) ar gael ar wefan AWMSG hefyd.

Yn gynharach eleni,  comisiynodd Andrew Evans, Prif Swyddog Fferyllol Cymru, 1000 o Fywydau i ddatblygu Rhaglen Diogelwch Meddyginiaethau Cymru genedlaethol mewn ymateb i ‘Cymru Iachach’ a ‘Meddyginiaeth Heb Niwed’. Mae Paul Gimson, Arweinydd Rhaglen Gofal Sylfaenol a Diogelwch Meddyginiaethau yn 1000 o Fywydau – Gwasanaeth Gwella/ Gwelliant Cymru, yn arwain datblygu rhaglen newydd, Diogelwch Meddyginiaethau Cymru.

Ar y Diwrnod Diogelwch Cleifion y Byd cyntaf, mae Paul yn gofyn i weithwyr gofal iechyd proffesiynol yng Nghymru amlygu mentrau sydd wedi cael eu cynllunio, neu sydd eisoes ar waith, ym maes diogelwch meddyginiaethau ledled Cymru. Mae rhai o’r meysydd hyn (e.e. dadragnodi mewn meddygfeydd a lleihau meddyginiaethau gwrthgolinerig (7)) eisoes wedi cael eu cyflwyno i gynulleidfa ehangach mewn diwrnodau arfer gorau blynyddol  blaenorol AWTTC a drefnwyd gan Uned Cymorth Rhagnodi Dadansoddol Cymru (WAPSU) AWTTC, ond rwy’n ymwybodol bod nifer mwy o enghreifftiau o arfer gorau ym maes diogelwch meddyginiaethau ledled Cymru, y gallwn ni gyd ddysgu ohonynt.  Bydd amrywiaeth o’r prosiectau a dderbyniwyd yna’n cael eu trafod mewn dosbarth meistr Diogelwch Meddyginiaethau arbennig ar 26 Tachwedd 2019. Anfonwch fanylion eich prosiect at erbyn 18 Hydref 2019.

*Y diweddar Felicity Newton Savage oedd Cyfarwyddwr cyntaf Canolfan Adnoddau Meddyginiaethau Cymru (WeMeReC), sydd bellach yn rhan o AWTTC. Roedd yn gyfryngol o ran datblygu cynhyrchion a oedd yn unigryw i WeMeReC, sy’n cael eu parchu a’u gwerthfawrogi’n fawr gan weithwyr gofal iechyd proffesiynol yng Nghymru a thu hwnt.

Geirda/ Dolenni

  1. World Health Organization: World Patient Safety Day .(accessed 29/08/2019)
  2. World Health Organization. Medication safety in key action areas, World Health Organization 2019. (accessed 29/08 2019)
  3. Masnoon N et al. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017; 17: 230 (accessed 02/09/2019)
  4. All Wales Medicines Strategy Group. Polypharmacy guidance (accessed 29/08/2019)
  5. Transitions of Care: Technical Series on Safer Primary Care. Geneva: World Health Organization; 2016. (accessed 29/08/2019)
  6. All Wales Medicines Strategy Group. All Wales Multidisciplinary Medicines Reconciliation Policy (accessed 02/09/2019)
  7. All Wales Therapeutics and Toxicology Centre: Best Practice Day 2018. (accessed 02/09/2019)
Sep 172019

Mike Fealey, Head of Patient Safety at 1000 Lives Improvement, shares his thoughts on the use of the words “Patient Safety”

The use of the term “patient” has often been queried in some areas of healthcare. In maternity they have expectant mothers – not patients; some areas of mental health and learning disability use service user – not patients. But soon, 1000 Lives Improvement service will be transitioning into Improvement Cymru, and our remit will expand to include social care where the term ‘patient safety’ has even less or no meaning. So, a bold question coming from  Head of Patient Safety but there is an argument that it is time to change the focus from ‘patient safety’ to just ‘safety’ or ‘safety culture’.

I’m in good company because Liam Donaldson, writing in the foreword of IHI Patient Safety Officer’s Guide (2009) stated “Patient safety should not ultimately be a field in itself but be deeply ingrained throughout the field of (health) care industry” 1

There has been an increased focus on Patient Safety in the UK since the launch of the National Patient Safety Agency (NPSA) in 2001. At that time it was estimated that 840,000 incidents and errors occurred in the NHS every year.

The idea behind the NPSA was to create a learning system that used tools, developed in other safety critical industries i.e. aviation, nuclear, rail, etc., to improve organisational safety and reduce avoidable harm. These tools had been proved successful in creating and sustaining a ‘safety’ culture in the industries in which they were used and have had some success across the NHS since 2001.

Wales further promoted the patient safety agenda with the launch of the 1000 Lives campaign in 2008. This was based on the ‘Saving 100,000 Lives’ campaign in the USA that promoted the use and monitoring of evidence based ‘bundles of care’ to reduce avoidable harm in a number of specific areas, generally in hospital. These included Ventilator Associated Pneumonia, Hospital Acquired Thrombosis, Lower Segment Caesarean Sections, and others.

The first time the term ‘Safety Culture’ was used was following the International Atomic Energy Agency’s initial report into the Chernobyl disaster (IAEA, 1986).  Although there has been many studies, publications, articles and reports relating to safety culture, there is still no agreed definition. Some definitions include2:

  • ‘The way we do things around here’ (Confederation of British Industry (CBI) 1990);
  • ‘A set of attitudes, beliefs or norms’ (Turner, 1989);
  • ‘A constructed system of meaning (or shared understanding) through which the hazards of the world are understood’ (Pidgeon, 1998);
  • ‘A safety ethic’ (Wert, 1986).

There is another reason why I think we should start to focus more on ‘safety culture’. We must deliberately include the staff who work in those areas and the relatives and contractors who can also interact with the system: Harm figures in healthcare do not usually include the workforce! As well as the potential physical injuries that the workforce can suffer, they are often negatively impacted by being involved in the harm of a “patient”. This psychological harm can lead to isolation, depression, self-harm and in extreme circumstances, even suicide.

Zero harm to “patients” and the workforce is only possible with both a robust culture of safety and an embedded organisational learning system.

So, as part of Improvement Cymru’s new way of working, we will return to an emphasis on the six ‘Domains of Healthcare Quality’ as described by the Institute of Medicine in 19993. They state that any quality system or improvement must be Safe, Timely, Effective, Efficient, Equitable and Person-Centred with ‘Safety’ always shown as Principle number 1!

There is no doubt that creating a safety culture starts at the top. The Board and Senior team have the responsibility for setting the vision and the direction of their organisation and this is another area we look forward to supporting in collaboration with our stakeholders. It’s an exciting time for 1000 Lives / Improvement Cymru, and we recognise that we must adapt our approach to make us relevant to all we work with.

So ditch the words ‘patient safety’? I think I’m becoming ever more in favour.

What do you think?

1 – Institute of Healthcare Improvement: The Essential Guide for Patient Safety Officers: Leonard M, Frankel A, Federico F, Frush K, Haraden C (editors). Chicago: Joint Commission Resources with the Institute for Healthcare Improvement; 2009)

2 – accessed August 2019

3 – Institute of Medicine (IOM). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C: National Academy Press; 2001

Find out more about the 1000 Lives’ transition to Improvement Cymru here

Sep 172019

Yma, mae Mike Fealey, Pennaeth Diogelwch Cleifion 1,000 o Fywydau, yn rhannu ei safbwyntiau ar ddefnydd y geiriau “Diogelwch Cleifion”.

Yn aml, caiff defnydd y term “claf” ei gwestiynu gan rai o feysydd gofal iechyd. Ym maes mamolaeth, cyfeirir at ‘famau beichiog’ yn hytrach na chleifion; tra bod rhai meysydd iechyd meddwl ac anableddau dysgu’n cyfeirio at ‘ddefnyddwyr gwasanaeth’. Cyn bo hir, bydd gwasanaeth 1,000 o Fywydau yn trawsnewid i Gwelliant Cymru, a bydd ein cylch gorchwyl yn ehangu i gynnwys gofal cymdeithasol lle nad oes gan ‘ddiogelwch cleifion’ lawer, os unrhyw, ystyr o gwbl. Dyma gwestiwn eofn i Bennaeth Diogelwch Cleifion ei ofyn, ond a yw’n bosibl dadlau bod yr amser wedi dod i newid y ffocws o ‘ddiogelwch cleifion’ i ‘ddiogelwch’ neu ‘ddiwylliant diogelwch’?

Ysgrifennodd Liam Donaldson yn rhagair Canllaw Swyddogion Diogelwch Cleifion IHI (2009) “na ddylai diogelwch cleifion fod yn faes ar wahân, yn hytrach dylai fod yn rhan annatod o faes a diwydiant gofal iechyd”1.

Mae mwy o ffocws wedi bod ar Ddiogelwch Cleifion yn y DU ers lansiad yr Asiantaeth Diogelwch Cleifion Cenedlaethol (NPSA) yn 2001. Ar y pryd, amcangyfrifwyd bod 840,000 o ddigwyddiadau a chamgymeriadau yn digwydd yn y GIG bob blwyddyn.

Y syniad tu ôl i NPSA oedd creu system ddysgu sy’n defnyddio offer a ddatblygwyd mewn diwydiannau eraill lle mae diogelwch yn hollbwysig, e.e. y diwydiant awyrennau, niwclear, rheilffyrdd ac ati, er mwyn gwella diogelwch sefydliadol a lleihau niwed osgoadwy. Mae’r offer hyn wedi bod yn llwyddiannus o ran creu a chynnal diwydiant ‘diogelwch’ yn y diwydiannau lle cânt eu defnyddio, ac maen nhw wedi cael cryn lwyddiant ar draws y GIG ers 2001.

Hyrwyddwyd yr agenda diogelwch cleifion ymhellach yng Nghymru gyda lansiad ymgyrch 1,000 o Fywydau yn 2008. Roedd yr ymgyrch yn seiliedig ar ymgyrch ‘Saving 100,000 Lives’ yn America, a hyrwyddodd defnydd a monitro ‘sypiau gofal’ seiliedig ar dystiolaeth er mwyn lleihau niwed osgoadwy mewn nifer o feysydd penodol, ac mewn ysbytai yn gyffredinol. Roedd y rhain yn cynnwys Niwmonia Cysylltiedig ag Awyrydd, Thrombosis a Ddaliwyd mewn Ysbytai, Toriadau Cesaraidd Is ac eraill.

Defnyddiwyd y term ‘diwylliant diogelwch’ am y tro cyntaf yn dilyn adroddiad cychwynnol yr Asiantaeth Ynni Atomig ar drychineb Chernobyl (IAEA, 1986). Er y bu llawer o astudiaethau, cyhoeddiadau, erthyglau ac adroddiadau yn ymwneud â diwylliant diogelwch dros y blynyddoedd, nid oes diffiniad cytûn yn bodoli hyd heddiw. Mae rhai o’r diffiniadau yn cynnwys2:

  • ‘Y ffordd y caiff pethau eu gwneud yn y fan hyn’ (Cydffederasiwn Diwydiant Prydain (CBI) 1990);
  • ‘Set o agweddau, credoau neu arferion’ (Turner, 1989);
  • ‘System adeiledig o ystyr (neu gyd-ddealltwriaeth) ar gyfer deall peryglon y byd’ (Pidgeon, 1998);
  • ‘Egwyddor diogelwch’ (Wert, 1986).

Yn fy marn i, mae rheswm arall pam y dylwn ni ddechrau canolbwyntio mwy ar ‘ddiwylliant diogelwch’. Yn bwrpasol, rhaid i ni gynnwys y staff sy’n gweithio yn y meysydd hynny, yn ogystal â’r perthnasau a’r contractwyr sydd hefyd yn gallu rhyngweithio â’r system: Fel arfer, nid yw ffigyrau niwed gofal iechyd yn cynnwys y gweithlu! Yn ogystal â’r anafiadau corfforol posibl y gall y gweithlu eu dioddef, yn aml caiff unigolion eu heffeithio’n negyddol o fod yn rhan o ‘niwed’ y claf. Gall y niwed seicolegol hwn arwain at arwahanu, iselder, hunan-niweidio a hyd yn oed hunanladdiad mewn achosion eithafol.

Yr unig ffordd o sicrhau nad yw “cleifion” a’r gweithlu’n cael eu niweidio yw trwy ddiwylliant diogelwch cadarn a system ddysgu sefydliadol wedi’i hymgorffori’n llawn.

Felly, fel rhan o feddylfryd newydd Gwelliant Cymru, byddwn yn dychwelyd at bwysleisio’r chwe Pharth Ansawdd Gofal Iechyd, yn unol â disgrifiadau’r Sefydliad Meddygaeth ym 19993. Maent yn datgan bod rhaid i unrhyw system ansawdd neu welliant fod yn Ddiogel, Amserol, Effeithiol, Effeithlon, Cyfiawn ac yn Canolbwyntio ar Unigolion, gyda ‘Diogelwch’ bob amser yn cael ei ddangos fel Egwyddor rhif 1!

Does dim amheuaeth bod creu diwylliant diogelwch yn dechrau ar y brig. Rhaid i’r Bwrdd a’r Uwch Dîm fod yn gyfrifol am osod y weledigaeth a’r cyfeiriad ar gyfer y sefydliad, a dyma faes arall y byddwn yn ei gefnogi, mewn cydweithrediad â’n rhanddeiliaid. Mae’n amser cyffrous i 1,000 o Fywydau / Gwelliant Cymru, ac rydym yn cydnabod bod rhaid i ni addasu ein dulliau er mwyn sicrhau ein bod yn berthnasol i bawb rydym yn gweithio â nhw.

Felly, a ddylwn waredu’r geiriau ‘diogelwch cleifion’? Rwy’n dechrau credu mai dyna’r peth cywir i’w wneud.

Beth amdanoch chi?

1Institute of Healthcare Improvement: The Essential Guide for Patient Safety Officers: Leonard M, Frankel A, Federico F, Frush K, Haraden C (editors). Chicago: Joint Commission Resources with the Institute for Healthcare Improvement; 2009)

2 accessed August 2019

3Institute of Medicine (IOM). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C: National Academy Press; 2001

Mae mwy o wybodaeth am drawsnewidiad 1,000 o Fywydau i Gwelliant Cymru ar gael fan hyn.

Sep 122019

David Wastell is a Registered Nurse and Service Improvement Manager within the Acute Deterioration team in 1000 Lives Improvement.

We spoke to him about the ongoing roll out of Community NEWS in Wales –  a key part of the  *1000 Lives Improvement response to the challenge included in the ‘A Healthier Wales’ plan to improve management of acute illness across the whole system pathway.

Tell us a bit about your background

I qualified in Sydney Australia 21 years ago. My background has predominately been working in Intensive Care Units, I was fortunate to be involved in the ‘Between the Flags’ Programme in New South Wales and the implementation of colour coded charts in the health board in Northern Sydney. This was my first exposure to a chart that aided staff at the front line in identifying Acute Deterioration (AD).

How are charts being used in Wales?

I returned to Wales in 2014 and was amazed to find that colour coded, scoring observation charts were being widely used in the acute care sector and were a key element in identifying patients with Sepsis.   NHS Wales has since been internationally recognised through the ‘Global Alliance Award’ (2016) for embedding a standardised approach to identifying Sepsis in acute settings through NEWS.

Until 2017, the primary focus for the Acute Deterioration team was working within acute settings. However, the emphasis has recently shifted in line with the ‘Healthier Wales’ agenda, and we are now focussed on working with staff in community settings to embed NEWS in practice. This is with the aim of making NEWS the single language for identifying patients at risk of acute deterioration across all parts of the health and social care system together.  Through the implementation of NEWS and the early warning scoring system for Acute Deterioration, discussions around ceiling of treatment, escalation of care and Advanced Care Planning can be at the forefront of the individuals needs thus potentially providing care closer to home.

What’s the scale of this work in the community?

It’s huge – there are over 170 teams across Wales and together that totals over 1500 district nurses alone.  We are also working with GPs, and Acute Response Teams across every health board as well as First Responders (Welsh Ambulance Services Ambulance and St John’s Wales). My role is to assist individuals and teams to look at their systems and processes in relation to acute deterioration and implement standardised improvement measures and tools across their teams to improve the identification of patients at risk of acute deterioration (including Sepsis).

What improvement measures and tools do you mean? 

Working within the new Improvement framework we have supported community teams with the Model for Improvement, stakeholder engagement and forcefield analysis and using data collection and analysis tools. Utilising interactive maps of Wales we are able to plot the progress of the teams with a traffic light system. As the various teams have become NEWS Ready (Amber) to NEWS Active (Green), it is a visual representation of the improvements teams and health are making. Vitally important has been the monthly Programme Leads days, it has provided the opportunity for shared learning, in a supportive and non-judgemental environment. We have also developed  tools such as NEWS charts, sepsis screening tools and Acute Kidney Injury bundles.  You can download these from the 1000 Lives Improvement website or request copies from any members of our national team.

Why did the focus shift to community settings?

The success of NEWS in acute settings shows that it provided the basis for a unified and systematic approach to the first assessment and triage of acutely ill patients. It is a simple track-and-trigger system for monitoring clinical progress for all patients – reflected by its use today in 60 hospitals in Wales, as well as by the Welsh Ambulance Service (WAST).

However, there appeared to be a gap between what was happening in the Acute Care Sector and that of the Community. I had the opportunity in 2017 to undertake some work with Eve Lightfoot (RCN Nurse of the year 2018), to get involved with District Nurse training around Sepsis awareness and acute deterioration. I quickly realised that teams had obvious enthusiasm and desire to utilise NEWS but appropriate education around AD and Sepsis recognition was missing. At the same time, teams had limited resources yet their workload and complexity of patients’ needs was increasing dramatically.

I spent a lot of initial time shadowing District Nursing Leads and teams across Wales where I observed varied cases; from daily visits to check blood ketones and catheter flushes, to complex leg dressings and abdominal wound packing.

The focus was to observe the number of patients having a full set of observations and from that having a baseline NEWS score.  This was not happening regularly.

The need to provide care closer to home for the people of Wales was fully supported by the Welsh Government and in particular the “Healthier Wales” strategy document made it a priority. In March 2019 the Chief Nursing Officer (CNO) mandated that NEWS should be rolled out and be implemented by all district nursing teams across Wales.

 What difference would NEWS have made to changing outcomes in the cases observed?

If NEWS had been available in many of the cases that I observed, it would have provided a subjective measure of any deterioration and perhaps trigger the question around possible Sepsis.  It also became very evident that staff did not have all the necessary equipment to provide a NEWS assessment. Training was needed to be provided around the recognition and response to Acute Deterioration in the community, and at an-all-Wales level.   That became our programme focus.

How do you think improvement knowledge and training will make a difference to staff and patients?

Personally, I have seen in two continents the impact of embedding a systematic approach in identifying an unwell patient, underpinned by an improvement mind- set and desire to change. NEWS in the Community Sector in Wales will have a massive impact on how we communicate to patients and families. I believe NEWS will greatly improve the care we give, putting the person at the centre of everything we do.

For professionals, in particular more junior staff members, it will offer them the skills, tools and training resources they need to make changes that give them a greater sense of personal and team achievement.  On that level, NEWS is an empowering tool.

For the first time we now have a common sickness language that connects all parts of the health and social care system together in Wales. Through NEWS, everyone is speaking the same language for identifying Acute Deterioration and sepsis, and at the earliest point in time which we know makes a huge difference. This is exciting for everyone, most of all our patients!

*1000 Lives Improvement is re-launching as Improvement Cymru – the new all-Wales improvement service for health and social care.  Join us at the launch In November. Read about it and sign up here

Sep 122019

Mae David Wastell yn Nyrs Gofrestredig a Rheolwr Gwelliant Gwasanaeth gyda thîm Dirywiad Acíwt 1,000 o Fywydau.

Siaradom ni ag ef am gyflwyno’r Sgôr Rhybudd Cynnar Cenedlaethol (#NEWS) mewn cymunedau ledled Cymru – sef rhan allweddol o ymateb 1,000 o Fywydau i’r her oedd yn rhan o gynllun Cymru Iachach i wella rheoli salwch acíwt ar draws y llwybr system cyfan.

Dywedwch ychydig wrthym am eich cefndir?

Cymhwysais yn Sydney, Awstralia, un mlynedd ar hugain yn ôl. Mae fy nghefndir yn bennaf wedi bod yn gweithio mewn Unedau Gofal Dwys, ac roeddwn yn ffodus i fod yn rhan o’r Rhaglen ‘Rhwng y Baneri‘ yn New South Wales, a chyflwyno siartiau â chodau lliw ym mwrdd iechyd Gogledd Sydney. Hwn oedd fy mhrofiad cyntaf o siart a gynorthwyodd staff rheng flaen i adnabod Dirywiad Acíwt (DA).

Sut mae’r siartiau yn cael eu defnyddio yng Nghymru?

Dychwelais i Gymru yn 2014 a chefais sioc i ddarganfod bod siartiau arsylwi a sgorio lliw â chod yn cael eu defnyddio’n eang yn y sector gofal acíwt a’u bod yn elfen allweddol wrth adnabod cleifion â sepsis. Ers hynny, mae GIG Cymru wedi cael ei gydnabod yn rhyngwladol trwy’r ‘Wobr Cynghrair Byd-eang’ (2016) am ymgorffori dull safonol o adnabod sepsis mewn lleoliadau acíwt trwy’r Sgôr Rhybudd Cynnar Cenedlaethol (NEWS).

Tan 2017, prif ffocws y tîm Dirywiad Acíwt oedd gweithio mewn lleoliadau acíwt. Fodd bynnag, mae’r pwyslais wedi symud yn ddiweddar, yn unol ag agenda Cymru Iachach, ac rydym ni bellach yn canolbwyntio ar weithio gyda staff mewn lleoliadau cymunedol er mwyn gwreiddio NEWS yn ymarferol. Y nod yw sicrhau mai NEWS yw’r iaith sengl ar gyfer adnabod cleifion sydd mewn perygl o ddirywiad acíwt ar draws pob rhan o’r system iechyd a gofal cymdeithasol. Trwy gyflwyno NEWS a’r system sgorio rhybudd cynnar ar gyfer dirywiad acíwt, bydd modd sicrhau bod triniaeth, gofal a chynllunio gofal uwch yn cael lle blaenllaw mewn anghenion unigolion, gan arwain at ddarparu gofal yn agosach at adref.

Beth yw graddfa’r gwaith hwn yn y gymuned?

Mae’n anferth – bellach, mae dros 170 o dimau yn weithredol ledled Cymru, sydd gyfwerth â dros 1,500 o nyrsys ardal. Yn ogystal, rydym yn gweithio â meddygon teulu a thimau ymateb acíwt  ar draws pob bwrdd iechyd, yn ogystal ag ymatebwyr cyntaf (Gwasanaeth Ambiwlans Cymru ac Ambiwlans Sant Ioan). Fy rôl i yw cynorthwyo unigolion a thimau i graffu ar y systemau a’r prosesau mewn perthynas â dirywiad acíwt a chyflwyno mesurau ac offer gwelliant safonol ar draws eu timau er mwyn gwella’r broses o adnabod cleifion sydd mewn perygl o ddirywiad acíwt (gan gynnwys sepsis).

Pa fesurau ac offer gwelliant ydych chi’n eu golygu? 

Gan weithio o fewn y fframwaith gwelliant newydd, rydym wedi cefnogi timau cymunedol gyda’r Model Gwelliant, ymgysylltu â rhanddeiliaid a dadansoddi maes grym a defnyddio offer casglu a dadansoddi data. Gan ddefnyddio mapiau rhyngweithiol o Gymru, gallwn blotio cynnydd y timau gyda system goleuadau traffig. Wrth i’r gwahanol dimau ddod yn NEWS Barod (melyn) neu’n NEWS Weithredol (Gwyrdd), mae’n gynrychiolaeth weledol o’r gwelliannau y mae’r timau ac iechyd yn eu gwneud. Bu’r diwrnodau Arweinwyr Rhaglenni misol yn hanfodol bwysig, ac maent wedi darparu cyfleoedd i ddysgu ar y cyd, mewn amgylchedd cefnogol ac anfeirniadol. Yn ogystal, rydym wedi datblygu offer yn cynnwys siartiau NEWS, cyfarpar sgrinio sepsis a phecynnau anafiadau arennau acíwt. Gallwch lawrlwytho’r rhain o wefan 1,000 o Fywydau neu ofyn am gopïau gan unrhyw aelod o’r tîm cenedlaethol.

Pam gwnaeth y ffocws symud i leoliadau cymunedol?

Mae llwyddiant NEWS mewn lleoliadau acíwt yn dangos ei fod wedi darparu’r sail ar gyfer dull unedig a systematig o asesu a blaenoriaethu cleifion sy’n ddifrifol wael. Mae’n system tracio a sbarduno syml ar gyfer monitro cynnydd clinigol pob claf, a chaiff hynny ei adlewyrchu gan y ffaith ei fod yn cael ei ddefnyddio mewn 60 o ysbytai yng Nghymru heddiw, yn ogystal â Gwasanaeth Ambiwlans Cymru.

Fodd bynnag, roedd bwlch amlwg rhwng yr hyn a oedd yn digwydd yn y Sector Gofal Acíwt ac yn y gymuned. Yn 2017, cefais gyfle i weithio gydag Eve Lightfoot (Nyrs y Flwyddyn Coleg Nyrsio Brenhinol 2018) a chyfrannu at faes hyfforddiant nyrsys ardal mewn perthynas ag ymwybyddiaeth sepsis a dirywiad acíwt. Sylweddolais yn gyflym fod gan dimau frwdfrydedd ac awydd amlwg i weithredu NEWS, ond roedd addysg briodol ynghylch cydnabyddiaeth dirywiad acíwt a sepsis yn brin. Ar yr un pryd, roedd gan y timau adnoddau cyfyngedig, er gwaethaf y ffaith bod eu llwythi gwaith a chymhlethdod anghenion eu cleifion yn cynyddu’n aruthrol.

Treuliais lawer o amser yn cysgodi Arweinwyr Nyrsio Ardal a thimau ledled Cymru, lle cefais y cyfle i arsylwi achosion amrywiol; o ymweliadau dyddiol er mwyn gwneud gwiriadau cetonau gwaed a charthu cathetrau i rwymo coesau cymhleth a phacio anafiadau abdomenol.

Y nod oedd arsylwi sawl claf a oedd yn cael set lawn o arsylwadau ac, o hynny, pennu gwaelodlin NEWS. Nid oedd hynny’n digwydd yn rheolaidd.

Cefnogwyd yr angen i ddarparu gofal yn agosach at adref i bobl Cymru yn llawn gan Lywodraeth Cymru ac, yn benodol, roedd y ddogfen strategaeth “Cymru Iachach” yn ei gwneud yn flaenoriaeth. Ym mis Mawrth 2019, gorchmynnodd y Prif Swyddog Nyrsio y dylid cyflwyno NEWS a’i weithredu gan bob tîm nyrsio ardal ledled Cymru.

Pa wahaniaeth fyddai NEWS wedi’i wneud o ran newid deilliannau yn yr achosion a arsylwyd?

Petai NEWS wedi bod ar gael yn nifer yr achosion a arsylwais, byddai wedi darparu mesur goddrychol o unrhyw ddirywiad ac, o bosibl, wedi codi cwestiynau am sepsis. Yn ogystal, daeth yn amlwg iawn nad oedd gan staff yr holl offer angenrheidiol i ddarparu asesiadau NEWS. Roedd angen darparu hyfforddiant o ran cydnabod ac ymateb i ddirywiad acíwt yn y gymuned ac ar lefel Cymru gyfan. Daeth hynny’n ganolbwynt i’r rhaglen.

Sut ydych chi’n meddwl y bydd gwybodaeth a hyfforddiant gwelliant yn gwneud gwahaniaeth i staff a chleifion?

Yn bersonol, rydw i wedi gweld effaith gwreiddio dull systematig o adnabod claf afiach ar ddau gyfandir, yn seiliedig ar feddylfryd gwelliant a’r awydd i newid. Bydd NEWS yn y sector cymunedol yng Nghymru’n cael effaith sylweddol ar y ffordd rydym yn cyfathrebu â chleifion a theuluoedd. Yn fy marn i, bydd NEWS yn gwella’r gofal rydym yn ei ddarparu, gan roi’r unigolyn yng nghanol popeth rydym ni’n ei wneud.

I weithwyr proffesiynol, yn enwedig aelodau staff amhrofiadol, bydd NEWS yn darparu’r sgiliau, offer ac adnoddau hyfforddi angenrheidiol iddynt i wneud newidiadau a fydd yn rhoi mwy o ymdeimlad o gyflawniad personol a thîm iddynt.

Am y tro cyntaf erioed, mae gennym iaith salwch cyffredin sy’n cysylltu pob rhan o’r system iechyd a gofal cymdeithasol gyda’i gilydd yng Nghymru. Trwy NEWS, mae pawb yn siarad yr un iaith ar gyfer adnabod dirywiad acíwt a sepsis, a hynny ar yr adeg gynharaf, sy’n gwneud gwahaniaeth enfawr. Mae hyn yn gyffrous i bawb, yn bennaf oll ein cleifion!

* Mae 1,000 o Fywydau yn cael ei ail-lansio fel Gwelliant Cymru – gwasanaeth gwelliant Cymru gyfan ar gyfer iechyd a gofal cymdeithasol. Ymunwch â ni yn y lansiad ym mis Tachwedd. Darllenwch amdano a chofrestrwch fan hyn:

Sep 102019

After our big news last week that 1000 Lives Improvement will become Improvement Cymru on 25 November 2019 – we catch up with Dr John Boulton, now the permanent Director of 1000 Lives Improvement/Improvement Cymru to find out more.

Why rebrand 1000 Lives Improvement to Improvement Cymru?

I first became aware of 1000 Lives Improvement when I was working as a physician in Sheffield over a decade ago. It’s a well-respected and established brand. Since the 1000 Lives patient safety campaign 11 years ago it has been synonymous with improving patient safety across Wales. But that’s exactly why we need to change and evolve our brand. The Parliamentary Review and A Healthier Wales both suggested that we needed to consider how we support improvement within health care as well as begin to work with social care organisations. So, although patient safety will remain very important to improvement work in Wales, we must now offer an improvement service to support the wide range of challenges facing both health and social care. We need a brand to reflect this and Improvement Cymru fits the bill – it’s short, simple and self-explanatory.

What is different about Improvement Cymru?

As Improvement Cymru we will be even more focussed on  working collaboratively with our partners in Wales and beyond. For us it’s not about Improvement Cymru, it’s about Improvement – promoting and enabling improvement as a vehicle for transformation to achieve great care for the people of Wales. We are already working to support organisations to embed a culture of improvement and we want to elevate this further, and unite everyone to develop a new shared ‘Vision for Improvement’ for health and social care in Wales that we can all work together to achieve.

What does the change to Improvement Cymru mean for improvement in Wales?

If all health and social care organisations across Wales are working together to achieve the same ‘Vision for Improvement’, this will mean more and more people across Wales will experience and receive consistently great care. Our staff in health and social care are so important and valued and we want to support them by offering them improvement training and coaching – that’s why we are establishing the Improvement Cymru Academy. So when they see something that could be made better for the people they are caring for, they have the skills and confidence to improve it. We hope that this will give them an even bigger sense of achievement, to be able to sit on their sofa at the end of a busy day knowing that they and made something better and delivered great care. This is what we want for our staff and the people of Wales.

How will the 1000 Lives Improvement Programmes change?

You won’t notice any immediate changes to our programmes as we rebrand to Improvement Cymru. Over time, however, we will be reviewing all of our programmes of work, ensuring that they reflect the new approach.

What’s next for Improvement Cymru?

Over the next few months the  team will be engaging with people across health and social care, working with our colleagues and partners to develop a new shared ‘Vision for Improvement’ for health and social care in Wales. We’ll be exhibiting at a range of partner events to do this, starting at the Social Care Wales conference this week. If you don’t catch us at an event you’ll be able to engage with us online.

The next big milestone for us will be our conference on 25 and 26 November. This is when we’ll relaunch as Improvement Cymru and share the new ‘Vision for Improvement’ for health and social care in Wales. If you are interested in being part of improvement in Wales I really encourage you to register, places are filling up fast – we’ve had 150 registrations in just 3 days! We are keen for this to be a platform to showcase the amazing improvement work already going on across Wales and beyond – if you have been involved in great improvement work that you want to share, please submit your abstracts here.

This is a really exciting time for improvement in Wales and I hope even more people will join this journey with us and be a part of the future of improvement.

Sep 102019

Ar ôl ein newyddion mawr yr wythnos ddiwethaf y bydd 1000 o Fywydau – Gwasanaeth Gwella yn newid i fod yn Gwelliant Cymru ar 25 Tachwedd 2019 – rydyn ni’n sgwrsio gyda Dr John Boulton, Cyfarwyddwr parhaol 1000 o Fywydau – Gwasanaeth Gwella/Gwelliant Cymru i ddarganfod mwy.

Pam ail-frandio 1000 o Fywydau – Gwasaaneth Gwella i fod yn Gwelliant Cymru?

Cefais fy ngwneud yn ymwybodol o 1000 o Fywydau – Gwasaaneth Gwella am y tro cyntaf pan roeddwn i’n gweithio fel meddyg yn Sheffield dros ddegawd yn ôl. Mae’n frand sefydledig, uchel ei barch. Ers ymgyrch diogelwch cleifion 1000 o Fywydau 11 mlynedd yn ôl, mae wedi bod yn gyfystyr â gwella diogelwch cleifion ledled Cymru. Ond dyna pam mae angen i ni newid a datblygu ein brand. Fe wnaeth yr Adolygiad Seneddol, a Chymru Iachach awgrymu bod angen i ni ystyried sut rydyn ni’n cefnogi gwelliant ym maes gofal iechyd, yn ogystal â dechrau gweithio gyda sefydliadau gofal cymdeithasol. Er y bydd diogelwch cleifion yn parhau’n bwysig iawn i waith gwella yng Nghymru, rhaid i ni nawr gynnig gwasanaeth gwella i ategu’r ystod eang o heriau sy’n wynebu iechyd a gofal cymdeithasol.  Mae angen brand arnom sy’n adlewyrchu hyn ac mae Gwelliant Cymru yn ateb i ddiben – mae’n gryno, yn syml ac yn hunanesboniadol.

Beth sy’n wahanol am Gwelliant Cymru?

Bydd Gwelliant Cymru yn canolbwyntio hyd yn oed yn fwy ar gydweithio gyda’r partneriaid yng Nghymru a thu hwnt. I ni, nid yw’n ymwneud â Gwelliant Cymru, mae’n ymwneud â gwelliant – mae hyrwyddo a galluogi gwelliant yn gerbyd i drawsnewid i gyflawni gofal gwych i bobl Cymru. Rydyn ni eisoes yn gweithio i gefnogi sefydliadau i fewnosod diwylliant o wella, ac rydyn ni eisiau cynyddu hyn ymhellach, ac uno pawb i ddatblygu ‘Gweledigaeth ar gyfer Gwelliant’ ar y cyd newydd, ar gyfer iechyd a gofal cymdeithasol yng Nghymru, y gallwn weithio gyda’n gilydd i’w chyflawni.

Beth mae’r newid i Gwelliant Cymru yn ei olygu ar gyfer gwelliant yng Nghymru?

Os bydd yr holl sefydliadau iechyd a gofal cymdeithasol ledled Cymru yn gweithio gyda’i gilydd i gyflawni’r un ‘Gweledigaeth ar gyfer Gwelliant’, bydd hyn yn golygu y bydd mwy o bobl ledled Cymru yn cael profiad o ofal gwych, cyson ac yn ei dderbyn. Mae ein staff ym maes iechyd a gofal cymdeithasol mor bwysig ac yn cael eu gwerthfawrogi, ac rydyn ni eisiau eu cefnogi nhw drwy gynnig hyfforddiant gwella – dyna pam rydyn ni’n sefydlu Academi Gwelliant Cymru. Felly, pan fyddan nhw’n gweld rhywbeth y gellir ei wella ar gyfer y bobl y maen nhw’n gofalu amdanynt, bydd ganddynt y sgiliau a’r hyder i’w wella. Rydyn ni’n gobeithio y bydd hyn yn rhoi ymdeimlad hyd yn oed yn fwy o gyflawni iddyn nhw; byddan nhw’n gallu eistedd i lawr ar ddiwedd diwrnod prysur, gan wybod eu bod nhw wedi gwneud rhywbeth yn well, a’u bod nhw wedi cyflwyno gofal gwych. Dyma beth rydyn ni ei eisiau ar gyfer ein staff a phobl Cymru.

Sut bydd Rhaglenni 1000 o Fywydau – Gwasaaneth Gwella yn newid?

Ni fyddwch chi’n sylwi ar unrhyw newidiadau ar unwaith i’n rhaglenni wrth i ni ailfrandio i Gwelliant Cymru. Fodd bynnag, dros amser, byddwn ni’n adolygi ein rhaglenni gwaith, gan sicrhau eu bod nhw’n adlewyrchu’r ymagwedd newydd.

Beth nesaf ar gyfer Gwelliant Cymru?

Dros y misoedd nesaf, bydd y tîm yn ymgysylltu â phobl ledled iechyd a gofal cymdeithasol, gan weithio gyda’r cydweithwyr a’n partneriaid i ddatblygu ‘Gweledigaeth ar gyfer Gwelliant’ ar y cyd newydd ar gyfer iechyd a gofal cymdeithasol yng Nghymru. Byddwn ni’n arddangos mewn amrywiaeth o ddigwyddiadau partneriaid i wneud hyn, gan ddechrau yng nghynhadledd Gofal Cymdeithasol Cymru yr wythnos hon. Os na fyddwch chi’n cael gafael arnom mewn digwyddiad, gallwch ymgysylltu â ni ar-lein.

Y garreg filltir fawr nesaf i ni fydd ein cynhadledd ar 25 a 26 Tachwedd. Dyma pryd fyddwn ni’n ail-lansio fel Gwelliant Cymru ac yn rhannu’r ‘Gweledigaeth ar gyfer Gwelliant’ ar y cyd newydd, ar gyfer iechyd a gofal cymdeithasol yng Nghymru. Os oes gennych ddiddordeb mewn bod yn rhan o welliant yng Nghymru, byddwn yn eich annog i gofrestru (gosod dolen), gan fod lleoedd yn cael eu llenwi’n gyflym – mae 150 o bobl wedi cofrestru mewn tridiau’n unig! Rydyn ni’n awyddus iddo fod yn llwyfan i arddangos y gwaith gwella ardderchog sydd eisoes yn digwydd ledled Cymru a thu hwnt – os ydych chi wedi bod yn gysylltiedig â gwaith gwella yr hoffech ei rannu, cyflwynwch grynodebau yma.

Mae hwn yn gyfnod cyffrous iawn i Gymru, a gobeithiaf y bydd hyd yn oed mwy o bobl yn ymuno â’r daith hon gyda ni a bod yn rhan o ddyfodol gwelliant.


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.