Nov 162016
 
Paul Myres, Programme Lead, Choosing Wisely Wales

Paul Myres, Programme Lead, Choosing Wisely Wales

When I was a lad, if you were ill you tried homemade remedies first – mostly pretty horrible. When I had a cold with a cough and green “snot” the doctor gave me antibiotics. I didn’t question it.

When I trained to be a doctor I was given lots of technical knowledge and excellent diagnostic skills and I learnt which treatment went with which diagnosis.

As a GP I used to ask patients what they thought the matter was. Most replied that it was up to me to tell them and then prescribe the right pill. Sometimes I told patients about side effects and sometimes they listened but were often surprised when they got them.

I used to decide what tests were needed and patients usually turned up for the test. Sometimes tests cause more uncertainties rather than produce answers.

So “doctor knows best”.  I don’t think so. And Choosing Wisely Wales doesn’t think so and nor do many others.

Choosing Wisely Wales

The clinician (not just the doctor) is an expert in diagnosis and knowing what tests and treatments may help. The patient (or individual with the health problem) is the expert about their body, their life and their community.

Both can access information about health, disease, tests and treatment from the internet, books, magazines and friends. The clinician has the expertise in assessing how good or relevant that information is and the patient is best able to apply that to their own circumstances providing they understand the words and messages.

How about if clinicians and patients had more equal conversations more often? Ones perhaps  more open and honest where the patient gets the opportunity to explain how they feel, how their problem impacts on their life, what they are worried about, what is important to them and what they expect or hope will (or will not) happen.

The clinician explains what the likely problem is and what evidence (research) suggests should be done. They also explain what improvement to expect but also what risks there may be and how easy it will be to provide the care.

The patient asks for more information. What else could we do? What harm might happen? How likely am I to get better? Will I be able to do what I need to do next week or the week after? What will happen if we do nothing? What can I do to help myself?

There won’t always be definite answers and sometimes there just won’t be enough time but this conversation will help make a shared decision more common. It means both patient and clinician are taking responsibility for the choices made both appreciating that whilst a good outcome is likely there is a risk something unintended might happen.

We know many treatments in the NHS can cause harm. That isn’t the intention but it happens. We know which treatments or tests are more likely to cause new problems than solve current ones. It makes sense to avoid those most of the time.

Choosing Wisely Wales is part of an international movement led by clinicians in partnership with patients. It aims to change or rebalance clinical conversations recognising patient and clinician as near equal partners bringing different knowledge and skills to reach an agreed plan to improve the wellbeing of one of them.

It is recommending that patients be more confident in asking four questions about suggested tests and treatment. It encourages clinicians to explain the options or choices for patients based on appropriate evidence, which is shared in the conversation.

Choosing Wisely Wales suggests several tests and treatments that should normally be avoided as of low benefit but which may occasionally be of value. It suggests alternatives to be discussed and recognises that the final choice rests with the clinician and patient together.


Dr Paul Myres is the programme lead for Choosing Wisely Wales and Chair of the Academy of Medical Royal Colleges Wales. He is also a GP in Wrexham.

Choosing Wisely Wales was launched in September and is part of an international movement. It is led in Wales through a partnership of the Academy of Medical Royal Colleges in Wales, Board of Community Health Councils and Public Health Wales and supported by Welsh Government.

For further information, visit www.choosingwisely.wales.nhs.uk or follow @ChoosingWiselyW on Twitter, or like on Facebook: Choosing Wisely Wales

Nov 162016
 
Paul Myres, Programme Lead, Choosing Wisely Wales

Paul Myres, Dewis Doeth Cymru

Pan oeddwn yn fachgen, os oeddech yn sâl roeddech yn rhoi cynnig ar feddyginiaethau cartref yn gyntaf – ac roedd y rhan fwyaf ohonynt yn erchyll. Pan gefais annwyd ynghyd â pheswch a “snot” gwyrdd, rhoddodd y meddyg wrthfiotigau i mi. Wnes i ddim cwestiynu hynny.

Pan hyfforddais i fod yn feddyg cefais lawer o wybodaeth dechnegol a meithrin sgiliau diagnostig ardderchog gan ddysgu pa driniaeth oedd yn cyd-fynd â pha ddiagnosis.

Fel meddyg teulu roeddwn yn arfer gofyn i gleifion beth oedden nhw’n credu oedd yn bod arnynt. Roedd y rhan fwyaf yn ateb gan ddweud mai fi ddylai ddweud hynny wrthyn nhw ac yna rhagnodi’r bilsen gywir. Weithiau roeddwn yn dweud wrth gleifion am sgil-effeithiau ac weithiau roedden nhw’n gwrando, ond roedden nhw’n synnu’n aml pan fyddent yn dioddef y sgil-effeithiau hynny.

Roeddwn yn arfer penderfynu pa brofion oedd eu hangen ac roedd cleifion yn cadw’r apwyntiadau hynny fel arfer. Weithiau mae profion yn creu mwy o ansicrwydd nag o atebion.

Felly “y meddyg sy’n gwybod orau”.  Dwi ddim yn credu rhywsut. Ac nid yw Dewis Doeth Cymru‘n credu hynny ychwaith na sawl un arall.

Choosing Wisely Wales

Y clinigydd (nid dim ond y meddyg) yw’r arbenigwr ar ddiagnosis a gwybod pa brofion a thriniaethau all helpu. Y claf (neu’r unigolyn gyda’r broblem iechyd) yw’r arbenigwr ar ei gorff, ei fywyd a’i gymuned.

Gall y ddau gael gafael ar wybodaeth am iechyd, clefydau, profion a thriniaeth oddi ar y rhyngrwyd, drwy lyfrau a chylchgronau a chan ffrindiau. Mae gan y clinigydd yr arbenigedd wrth asesu pa mor dda neu berthnasol yw’r wybodaeth honno a’r claf sydd yn y sefyllfa orau i allu cymhwyso hynny i’w amgylchiadau ei hun ar yr amod ei fod yn deall y geiriau a’r negeseuon.

Beth pe bai clinigwyr a chleifion yn cael sgyrsiau mwy cyfartal yn fwy aml? Sgyrsiau sydd efallai’n fwy agored a gonest lle mae’r claf yn cael y cyfle i egluro sut mae’n teimlo, sut mae ei broblem yn effeithio ar ei fywyd, am beth mae’n poeni, yr hyn sy’n bwysig iddo a beth mae’n ei ddisgwyl neu’n gobeithio y bydd (neu na fydd) yn digwydd.

Mae’r clinigydd yn esbonio beth yw’r broblem debygol a’r hyn y mae tystiolaeth (ymchwil) yn ei awgrymu y dylid ei wneud. Mae hefyd yn egluro pa welliant i’w ddisgwyl ond hefyd beth yw’r risgiau a pha mor hawdd fydd hi i ddarparu’r gofal.

Mae’r claf yn gofyn am ragor o wybodaeth. Beth arall y gallem ei wneud? Pa niwed a allai ddigwydd? Pa mor debygol ydw i o wella? A fyddaf yn gallu gwneud beth sydd angen i mi ei wneud yr wythnos nesaf neu’r wythnos ar ôl hynny? Beth fydd yn digwydd os byddwn yn gwneud dim? Beth alla i ei wneud i helpu fy hun?

Ni fydd atebion pendant bob tro ac weithiau ni fydd digon o amser ond bydd y sgwrs hon yn helpu i sicrhau bod penderfyniadau ar y cyd yn dod yn fwy cyffredin. Mae’n golygu bod y claf a’r clinigydd yn cymryd cyfrifoldeb dros y dewisiadau a wneir gan werthfawrogi, er bod canlyniad da yn debygol, bod risg y gall rhywbeth nas bwriadwyd ddigwydd.

Gwyddom y gall llawer o driniaethau yn y GIG achosi niwed. Nid dyna’r bwriad, ond mae’n digwydd. Gwyddom pa fathau o driniaethau neu brofion sy’n fwy tebygol o achosi problemau newydd yn hytrach na datrys rhai cyfredol. Mae’n gwneud synnwyr osgoi’r rheini y rhan fwyaf o’r amser.

Mae Dewis Doeth Cymru yn rhan o fudiad rhyngwladol a arweinir gan glinigwyr mewn partneriaeth â chleifion. Ei nod yw newid neu ailgydbwyso’r sgyrsiau clinigol gan gydnabod bod y claf a’r clinigydd yn bartneriaid cyfartal sy’n cyfrannu gwybodaeth a sgiliau gwahanol er mwyn gwella llesiant un ohonynt.

Mae’n argymell bod cleifion yn dod yn fwy hyderus wrth ofyn pedwar cwestiwn am brofion a thriniaeth a awgrymir. Mae’n annog clinigwyr i esbonio’r opsiynau neu’r dewisiadau ar gyfer cleifion sy’n seiliedig ar dystiolaeth briodol, a rennir yn y sgwrs.

Mae Dewis Doeth Cymru yn awgrymu nifer o brofion a thriniaethau y dylid eu hosgoi fel arfer gan mai prin yw’r budd sy’n deillio ohonynt ond a allai fod o werth o bryd i’w gilydd. Mae’n awgrymu dewisiadau eraill i’w trafod ac yn cydnabod bod y dewis terfynol yn gorffwys gyda’r clinigydd a’r claf ar y cyd.


 

Dr Paul Myres yw arweinydd y rhaglen Dewis Doeth Cymru a Chadeirydd Academi Colegau Meddygol Brenhinol Cymru. Mae hefyd yn feddyg teulu yn Wrecsam.

Lansiwyd Dewis Doeth Cymru ym mis Medi ac mae’n rhan o fudiad rhyngwladol. Caiff ei arwain yng Nghymru drwy bartneriaeth sy’n cynnwys Academi Colegau Meddygol Brenhinol Cymru, Bwrdd Cynghorau Iechyd Cymuned ac Iechyd Cyhoeddus Cymru a’i gefnogi gan Lywodraeth Cymru.

I gael rhagor o wybodaeth, ewch i  www.choosingwisely.wales.nhs.uk  neu dilynwch @ChoosingWiselyW ar Twitter, neu ei hoffi ar Facebook: ChoosingWiselyWales

Sep 132016
 

tdg-tronThe first time I ever saw or heard of Sepsis it was on a death certificate. The death certificate was my brother’s. I remember squinting across the registrar’s table at this little word next to “primary cause of death.” It meant nothing to me.

My brother was… is… Mark. He was 41 years old, married with a 3 year old daughter. He had a family and a future.

At midday on Thursday 31st May, 2012 Mark walked into A&E (London) with stomach pains. By 17.15p.m. he had suffered a cardiac arrest. By 19.00p.m. he was on a ventilator with a 50/50 chance of survival. By 01.00a.m. on Friday 1st June, his kidneys had failed, his odds had shortened and his family were on the M4 having received the phone call nobody wants. The next morning his heart was too weak for dialysis. We know now that he was in septic shock. Multiple organ failure. He fought hard on his last day as did all the ITU staff. Everyone gave everything but sepsis won. He died peacefully lunchtime on Saturday 2nd June.

We couldn’t believe how this had happened. He had a stomach bug. How could we have lost a son, a brother, a husband, and Sophie a dad? Well, what I know now which I didn’t know then is that it can happen, it does happen and it happens far too often. In fact it happens 44,000 times a year in the UK. 2,200 times in Wales. I thought we were one in a million. We were not.

Sepsis is a car crash illness. It is indiscriminate and can affect anyone. It kills nearly a third of all the people it touches. That’s more than breast, bowel and prostate cancer combined. Shocking isn’t it? You know what’s also shocking? If spotted early it’s treatable and preventable.

It’s fair to say that sepsis changed my life. It does that to lives.

Not long after Mark died I met Ron Daniels of the United Kingdom Sepsis Trust and began raising awareness in Wales. I’m now Executive Director of UK Sepsis Trust in Wales. I’ve met Ministers, cycled from West Wales to Westminster fund raising, I speak in schools, at hospitals, to the people in shops and on buses. We have engaged Welsh Government in our work, a cross-party group has been established.  People are listening.

I listen too; to survivors and how they have struggled post sepsis, to the bereaved and how they struggle too.

Awareness and education is everything. People need to know what sepsis is and what it can do. We need to get to a stage where public and health professionals alike are thinking about and recognise sepsis. They need to see it coming because it hides really well. As Mohammed Ali said, “His hands can’t hit what his eyes can’t see” Ironically he recently died from sepsis.

I’ve been helped along the way by some wonderful people both inside and outside healthcare. .  I am on the RRAILS steering group.   As such, I’ve seen first-hand the incredible hard work of dedicated NHS Wales staff committed to improve practice to improve outcomes. The programme is doing some great work striving to educate NHS Wales staff on Sepsis.  We want the same thing.

We’ve even won an award for it! It was fantastic for The Global Sepsis Alliance to recognise and reward NHS Wales for its awareness and education initiatives.

But..

We cannot afford to lose momentum. There can be no resting on laurels. We should celebrate what has been done, be proud but also continue to challenge and champion what still needs to be done. For me, there has to be a collective effort from Community to Cabinet. We need a common language for patients and practice. The patients need a pathway, an All Wales pathway. If we speak about sepsis the same, we can think about sepsis the same. It brings us together and as we say here in Wales… “together, stronger”.

Want to get involved?

@TCTRON

terence@sepsistrust.org

https://www.justgiving.com/fundraising/cycle4sepsis16

Sep 132016
 

tdg-tronY tro cyntaf i mi weld neu glywed am Sepsis oedd ar dystysgrif marwolaeth. Tystysgrif marwolaeth fy mrawd oedd hi. Dw i’n cofio craffu dros fwrdd y cofrestrydd ar y gair bach wrth ymyl “prif achos marwolaeth”. Doedd yn golygu dim i mi.

Mark oedd…yw…fy mrawd. Roedd yn 41 oed, yn briod a chando ferch 3 oed. Roedd ganddo deulu a dyfodol.

Am hanner dydd, ddydd Mawrth 31 Mai 2012, cerddodd Mark i mewn i’r Uned Damweiniau ac Achosion Brys (Llundain) gyda phoenau yn ei stumog. Erbyn 17.15pm roedd wedi cael ataliad ar y galon. Erbyn 19.00 roedd ar beiriant anadlu gyda siawns o 50% y byddai’n goroesi. Erbyn 01.00 ddydd Gwener 1 Mehefin roedd ei arennau wedi methu, roedd ei siawns o oroesi wedi lleihau ac roedd ei deulu ar yr M4 ar ôl derbyn yr alwad ffôn nad oes neb ei heisiau. Drannoeth roedd ei galon yn rhy wan i gael dialysis. Rydym yn gwybod nawr ei fod mewn sioc sepsis. Methiant nifer o organau. Brwydrodd yn galed ar ei ddiwrnod olaf fel y gwnaeth holl staff yr Uned Therapi Dwys. Rhoddodd bawb bopeth o fewn eu gallu, ond sepsis a enillodd y dydd. Bu farw’n dawel amser cinio ddydd Sadwrn 2 Mehefin.

Doedden ni ddim yn credu sut roedd hyn wedi digwydd. Byg stumog oedd ganddo. Sut gallen ni fod wedi colli mab, brawd, gŵr, a Sophie ei thad? Wel, yr hyn rwy’n ei wybod nawr nad oeddwn i’n ei wybod ar y pryd yw ei fod yn gallu digwydd, a’i fod yn digwydd yn rhy aml o lawer. Yn wir mae’n digwydd 44,000 gwaith y flwyddyn yn y DU. 2,200 gwaith yng Nghymru. Roeddwn i’n meddwl ein bod ni’n un mewn miliwn. Ond doedden ni ddim.

Mae sepsis yn salwch sy’n cael ei ddisgrifio fel damwain car. Nid yw’n gwahaniaethu a gall effeithio ar unrhyw un. Mae’n lladd traean o’r bobl y mae’n eu cyffwrdd . Mae hynny’n fwy na chanser y fron, y coluddyn a’r prostad gyda’i gilydd. Mae’n syfrdanol yn tydi? A wyddoch chi beth arall sy’n syfrdanol? Os caiff ei ganfod yn gynnar, mae modd ei drin a’i atal.

Mae’n deg dweud bod sepsis wedi newid fy mywyd. Mae’n gwneud hynny i fywydau.

Ychydig ar ôl i Mark farw mi wnes i gwrdd â Ron Daniels o Ymddiriedolaeth Sepsis y Deyrnas Unedig a dechreuais godi ymwybyddiaeth yng Nghymru. Rwyf nawr yn Gyfarwyddwr Gweithredol Ymddiriedolaeth Sepsis yng Nghymru. Rwyf wedi cwrdd â Gweinidogion, wedi seiclo o Orllewin Cymru i San Steffan i godi arian, rwy’n siarad mewn ysgolion, mewn ysbytai, gyda phobl mewn siopau ac ar fysiau. Rydym wedi cynnwys Llywodraeth Cymru yn ein gwaith, ac mae grŵp hollbleidiol wedi ei sefydlu. Mae pobl yn gwrando.

Rydw innau’n gwrando hefyd;  ar oroeswyr a sut maen nhw wedi brwydro ar ôl sepsis, ac i’r rhai sydd wedi cael profedigaeth a sut maent hwythau hefyd yn brwydro.

Ymwybyddiaeth ac addysg yw popeth. Mae angen i bobl wybod beth yw sepsis a’r hyn y mae’n gallu ei wneud. Rydym angen cyrraedd pwynt ble mae’r cyhoedd a gweithwyr iechyd proffesiynol fel ei gilydd yn meddwl am sepsis ac yn ei adnabod. Mae angen iddyn nhw ei weld yn dod  oherwydd mae’n cuddio’n dda. Fel y dywedodd Mohamed Ali, “Ni all ei ddwylo daro’r hyn na all ei lygaid ei weld”. Yn eironig iawn, bu yntau farw o sepsis yn ddiweddar.

Rwyf wedi cael cymorth ar hyd y daith gan bobl hyfryd o fewn y maes gofal iechyd a’r tu allan iddo. Rwy’n aelod o grŵp llywio RRAILS. O ganlyniad, rwyf wedi gweld drosof fi fy hun y gwaith anhygoel o galed a wneir gan staff ymroddedig GIG Cymru  sydd wedi hymrwymo i wella ymarfer er mwyn gwella canlyniadau. Mae’r rhaglen yn gwneud gwaith da o ran ymdrechu i addysgu staff GIG Cymru ar sepsis. Rydym ni oll eisiau’r un peth.

Rydym hyd yn oed wedi ennill gwobr! Roedd yn wych bod Cynghrair Sepsis y Byd wedi cydnabod a gwobrwyo GIG Cymru am ei fentrau codi ymwybyddiaeth a’i fentrau addysgol.

Ond..

Ni allwn fforddio colli momentwm. Ni allwn orffwys ar ein rhwyfau. Dylem ddathlu’r hyn sydd wedi ei wneud hyd yma, ymfalchïo yn hynny ond hefyd parhau i herio a hyrwyddo yr hyn sydd angen ei wneud . I mi, mae’n rhaid cael ymdrech ar y cyd o’r Gymuned i’r Cabinet. Mae angen iaith gyffredin arnom ar gyfer cleifion ac ymarfer. Mae angen llwybr ar gleifion, llwybr Cymru Gyfan. Os byddwn yn siarad am sepsis yn yr un ffordd, gallwn feddwl am sepsis yn yr un ffordd. Mae’n dod â ni ynghyd ac fel y dywedwn yma yng Nghymru “gorau chwarae, cyd chwarae”.

Ydych chi eisiau bod yn rhan?

@TCTRON

terence@sepsistrust.org

https://www.justgiving.com/fundraising/cycle4sepsis16

Aug 022016
 
Amanda Wilkinson, nursing student at Bangor Univeristy

Amanda Wilkinson, nursing student at Bangor Univeristy

I was so pleased to have the opportunity to attend the Patient Safety Congress. I have been keen to get involved and find out more about 1000 Lives Improvement and this was an opportunity to spend time with members of the team and learn from healthcare professionals all over the world that would be in attendance. It was great to meet fellow nursing student Bianca Jourdain from Swansea University.

From the beginning I felt empowered by Dr Suzette Woodward, director of ‘Sign up to Safety’ who valued pride for patient safety and recognised that staff should be cared for when involved in incidents. Dr Woodward spoke of compassion, trust and human conversations which link with the fundamentals of care that I am learning in my first year as an adult nursing student. The words which resonated with me the most are:

 “Learn as much as possible and never be judgemental”.

Dr Claire Gordon, Consultant in Acute Medicine at Lothian University Hospitals NHS Trust explained how planning is important in patient care with involvement from the patient and the multidisciplinary team. Clear plans should be used however small such as ‘today Mrs Jones the plan for you is to walk ten steps’. The use of planning and ‘leading indicators’ was also spoken of by Professor Maxine Power, Director of Haelo,  who also valued communication with the whole team when planning improvement. “Staff need to be aware of what they are measuring and why”. Receiving feedback means staff can see the process is worthwhile and continue to measure. Always Events® took this another step further and suggested that improvement planning should involve patients, families, carers and staff.

Technology featured prominently at the Congress. There were many companies offering electronic recording for patients’ observations with automatic escalation to the doctor and prompts, reminders and task management. Datix also attended, they showed their reporting of incidents to Bianca and I. We then achieved the second highest score on their quiz, coming second only to their own manager – another win for us both and we got to take home @thedatixbear as a reward.

Students Amanda and Bianca with the Datix bear

Students Amanda and Bianca with the Datix bear

Strong themes of trust and teamwork prevailed across the talks over the two days which was widely considered to promote openness and courage for staff to report and learn from incidents without the worry of blame. Whilst a large aspect of the Congress explored new technology for collecting and analysing data; it was evident to me that the culture within the teams was fundamental to achieving this. The need for clinical competence and judgement was highly regarded: not to over rely on checklists and numbers – sometimes a patient is ‘just not right’ and we should not be afraid to act on this.

Patient safety wasn’t the only lesson for me – I also mastered the use of chopsticks when we went to China Town for supper!

I found it sad when the Congress came to an end but was reminded by Dave Hill, Service Improvement Manager at 1000 Lives Improvement, that this is just the beginning of my journey. This experience has increased my enthusiasm and commitment to quality improvement as part of my nursing career. Thank you 1000 Lives Improvement for making it possible and for making Bianca and I feel like part of the team.

Please take a minute to look at this inspirational leadership video that was shown by Advancing Quality Alliance: https://www.ted.com/talks/drew_dudley_everyday_leadership#t-315150

Aug 022016
 
Amanda Wilkinson, nursing student at Bangor Univeristy

Amanda Wilkinson, nursing student at Bangor Univeristy

Roeddwn mor falch o gael y cyfle i fynychu’r Gynhadledd Diogelwch Cleifion. Rwyf wedi bod yn awyddus i gymryd rhan a chael gwybod mwy am 1000 o Fywydau – Gwasanaeth Gwella ac roedd hwn yn gyfle i dreulio amser gydag aelodau o’r tîm a dysgu oddi wrth weithwyr gofal iechyd proffesiynol o bob cwr o’r byd a fyddai’n bresennol yn y gynhadledd. Roedd yn wych cwrdd â chyd-fyfyriwr nyrsio Bianca Jourdain o Brifysgol Abertawe.

O’r cychwyn cefais fy ngrymuso gan Dr Suzette Woodward, cyfarwyddwr ‘Sign up to Safety‘, a oedd yn rhoi pwys ar falchder mewn diogelwch cleifion ac yn cydnabod y dylai staff gael gofal pan oeddent yn gysylltiedig â digwyddiadau. Siaradodd Dr Woodward am dosturi, ymddiriedaeth a sgyrsiau dynol sy’n cysylltu â’r hanfodion gofal rwy’n dysgu amdanynt yn ystod fy mlwyddyn gyntaf fel myfyriwr nyrsio oedolion. Y geiriau a atseiniodd gyda mi fwyaf yw:

 “Dysgwch gymaint ag y bo modd a pheidiwch byth â barnu”

Esboniodd Dr Claire Gordon, Ymgynghorydd mewn Meddygaeth Aciwt yn Ymddiriedolaeth GIG Ysbytai Prifysgol Lothian sut mae cynllunio’n bwysig o ran gofal cleifion gyda chyfraniad gan y claf a’r tîm amlddisgyblaethol. Dylid defnyddio cynlluniau clir waeth pa mor fach ydynt, fel ‘heddiw Mrs Jones y cynllun yw i chi gerdded deg cam’. Soniwyd am y defnydd o gynllunio a ‘dangosyddion arweiniol’ hefyd gan yr Athro Maxine Power, Cyfarwyddwr Haelo, a oedd hefyd yn rhoi pwysau mawr ar gyfathrebu gyda’r tîm cyfan wrth gynllunio gwelliant. “Mae angen i staff fod yn ymwybodol o’r hyn y maent yn ei fesur a pham”. Mae cael adborth yn golygu bod y staff yn gallu gweld bod y broses yn werth chweil a pharhau i fesur. Aeth Always Events® â hyn gam ymhellach ac awgrymodd y dylai’r broses o gynllunio gwelliannau gynnwys cleifion, teuluoedd, gofalwyr a staff.

Rhoddwyd sylw amlwg i dechnoleg yn y Gynhadledd. Roedd llawer o gwmnïau’n cynnig cyfleusterau cofnodi electronig ar gyfer arsylwi cleifion a oedd yn cyfeirio cleifion yn awtomatig at feddyg gan gynnig awgrymiadau, nodiadau atgoffa a chyfleuster rheoli tasgau. Roedd Datix hefyd yn bresennol, gan ddangos eu dull cofnodi digwyddiadau i Bianca a minnau. Yna cawsom y sgôr uchaf ond un ar y cwis, gan ddod yn ail i’w rheolwr – buddugoliaeth arall i ni ac aethom adref gyda @thedatixbear yn wobr.

Myfyrwyr Amanda a Bianca â’r ‘Datix Bear’

Daeth themâu cryf o ymddiriedaeth a gwaith tîm i’r amlwg yn y trafodaethau yn ystod y ddau ddiwrnod ac ystyriwyd eu bod yn hyrwyddo amgylchedd agored a dewrder i staff adrodd am ddigwyddiadau heb boeni am gael eu beio, a dysgu o’r digwyddiadau hynny. Er bod ymchwilio i dechnoleg ar gyfer casglu a dadansoddi data yn agwedd fawr ar y Gynhadledd; roedd yn amlwg i mi bod y diwylliant o fewn y timau yn hollbwysig er mwyn cyflawni hyn. Rhoddwyd pwys mawr ar yr angen am gymhwysedd a barn: peidio â gorddibynnu ar restrau gwirio a rhifau – weithiau dyw claf ‘jest ddim yn iawn’ ac ni ddylem ofni gweithredu ar hyn.

Nid diogelwch cleifion oedd yr unig wers i mi ei dysgu – llwyddais i feistroli’r defnydd o chopsticks pan aethom i China Town am swper!

Roeddwn yn drist pan ddaeth y Gynhadledd i ben ond cefais fy atgoffa gan Dave Hill, Rheolwr Gwella Gwasanaethau 1000 o Fywydau, mai dim ond dechrau fy nhaith yw hyn. Mae’r profiad hwn wedi cynyddu fy mrwdfrydedd a’m hymrwymiad i wella ansawdd fel rhan o’m gyrfa nyrsio. Diolch yn fawr 1000 o Fywydau am wneud hyn yn bosibl ac am wneud i Bianca a minnau deimlo’n rhan o’r tîm.

Treuliwch funud yn edrych ar y fideo arweinyddiaeth ysbrydoledig a ddangoswyd gan Advancing Quality Alliance:https://www.ted.com/talks/drew_dudley_everyday_leadership#t-315150

Aug 022016
 
Bianca Jourdain, nursing student at Swansea University

Bianca Jourdain, nursing student at Swansea University

When I entered the ‘A day in the life of a patient’ competition, I saw it as an opportunity to raise awareness of paediatric nursing and apply what we’re taught at university in terms of putting yourself in the shoe of your patients. However, winning it has enabled me to learn so much more than this. As a competition winner I attended the 2016 Patient Safety Congress in Manchester. With over 2,000 health professionals from clinical and non-clinical backgrounds attending, there was a vast assortment of knowledge and experience present throughout the two days.

Dr Suzette Woodward, one of the opening speakers on the first day, suggested that as health professionals, we should “learn to do the job, on the job” when discussing the education and application of patient safety. This was evident throughout the Congress as the stalls and speakers reiterated that we are trying to improve, and not replace current healthcare services and medical interventions. There were several notable themes including the use of technology to advance current practice and the need to adopt a family-centred and holistic approach, working with patients and not for them to provide the best possible care.

The interactive side of the Congress revolved around social media via Twitter allowing delegates such as myself to not only see what was happening all over the Congress, but to also get actively involved. Furthermore, the use of Sli.do, an internet based service that I had not used before, allowed direct engagement with each speaker through polls and questions.

Over the course of the two days, three sessions in particular really stood out for me: namely Cathy Sheehan, Clinical Lead for Children Protection at NHS England who gave ‘An integrated approach to safeguarding children’; Dr Daniel Cohen and Dr Stephen Webb’s ‘Investigating harmful events due to delays in diagnosis’ and the NICE Forum’s ‘The cancer drugs fund: The new arrangement’.

There were personal development opportunities at the Congress too. I asked a question in front of what felt like hundreds of people (using a microphone) and conversed with speakers after their presentations about the topics they had discussed. It was a great opportunity to meet other delegates and professionals from across the UK, learning about their fields, interests and backgrounds.

The Congress wasn’t the only positive outcome of entering the competition. I was able to explore a busy, beautiful city that I had not seen before (I would especially recommend visiting the John Rylands Library). I also met Amanda, an adult nursing student from Bangor University who shared the same enthusiasm for our chosen profession, and of course the 1000 Lives Improvement team, who had no hesitation in making us feel welcome and involved us throughout.

An additional highlight of the Congress was winning the Datix patient safety quiz with Amanda (and scoring ourselves teddy bear prizes!). I enjoyed every minute of this experience and I wouldn’t have been able to gain the exposure and knowledge of quality improvement and patient safety that I now have if it wasn’t for 1000 Lives Improvement, and for that, I am very grateful….Thank you!!

Aug 022016
 
Bianca Jourdain, nursing student at Swansea University

Bianca Jourdain, myfyrwyr nyrsio yn Prifysgol Abertawe

Pan benderfynais gystadlu yn y gystadleuaeth ‘Diwrnod ym mywyd claf’, roeddwn yn ei weld fel cyfle i godi ymwybyddiaeth o nyrsio pediatrig a rhoi’r hyn y gwnaethom ei ddysgu yn y brifysgol ar waith, sef rhoi eich hun yn esgidiau eich cleifion. Fodd bynnag, mae ennill wedi fy ngalluogi i ddysgu cymaint mwy na hyn. Fel un o enillwyr y gystadleuaeth cefais gyfle i fynd i’r Gynhadledd Diogelwch Cleifion ym Manceinion. Gyda thros 2,000 o weithwyr iechyd proffesiynol o gefndiroedd clinigol ac anghlinigol yn bresennol, roedd yno amrywiaeth eang o wybodaeth a phrofiad drwy gydol y ddau ddiwrnod.

Awgrymodd Dr Suzette Woodward, un o’r siaradwyr agoriadol ar y diwrnod cyntaf, y dylem ni fel gweithwyr iechyd proffesiynol “ddysgu sut i wneud y swydd wrth wneud y swydd” wrth drafod addysg a diogelwch cleifion. Roedd hyn yn amlwg drwy gydol y Gynhadledd ac roedd y stondinau a’r siaradwyr yn pwysleisio’r ffaith ein bod yn ceisio gwella gwasanaethau gofal iechyd ac ymyriadau meddygol presennol yn hytrach na’u disodli. Roedd nifer o themâu nodedig gan gynnwys y defnydd o dechnoleg i hyrwyddo ymarfer cyfredol a’r angen i fabwysiadu dull sy’n canolbwyntio ar y teulu a dull cyfannol, gan weithio gyda chleifion, ac nid ar eu cyfer i ddarparu’r gofal gorau posibl.

Roedd ochr ryngweithiol y Gynhadledd yn seiliedig ar y cyfryngau cymdeithasol drwy Twitter gan ganiatáu i gynadleddwyr fel fi weld beth oedd yn digwydd ar draws y Gynhadledd, ond hefyd i chwarae rhan weithredol ynddi. Ar ben hynny, roedd y defnydd o Sli.do, gwasanaeth ar y rhyngrwyd nad oeddwn wedi’i ddefnyddio o’r blaen, yn caniatáu i mi ymgysylltu’n  uniongyrchol â phob siaradwr drwy arolygon barn a chwestiynau.

Yn ystod y ddau ddiwrnod, roedd tair sesiwn benodol sy’n aros yn y cof: Cathy Sheehan, Arweinydd Clinigol ar Amddiffyn Plant yn GIG Lloegr a amlinellodd ‘Ddull integredig ar gyfer diogelu plant’; Dr Daniel Cohen a Dr Stephen Webb yn ‘Ymchwilio i ddigwyddiadau niweidiol oherwydd oedi mewn diagnosis a ‘Cronfa cyffuriau canser: Y trefniant newydd’ gan Fforwm NICE.

Roedd cyfleoedd datblygu personol yn y Gynhadledd hefyd. Gofynnais gwestiwn o flaen yr hyn a oedd yn teimlo fel cannoedd o bobl (gan ddefnyddio meicroffon) a sgwrsio â’r siaradwyr ar ôl eu cyflwyniadau am y pynciau yr oeddent wedi’u trafod. Roedd yn gyfle gwych i gwrdd â chynadleddwyr a gweithwyr proffesiynol eraill o bob cwr o’r DU, gan ddysgu am eu meysydd, eu diddordebau a’u cefndiroedd.

Nid y Gynhadledd oedd yr unig ganlyniad cadarnhaol yn sgil y gystadleuaeth. Cefais gyfle i grwydro o amgylch dinas hardd brysur nad oeddwn wedi’i gweld o’r blaen (byddwn yn argymell ymweld â’r Llyfrgell John Rylands yn arbennig). Cefais hefyd gyfle i gwrdd ag Amanda, myfyriwr nyrsio oedolion o Brifysgol Bangor a oedd yn rhannu’r un brwdfrydedd dros ein proffesiwn, ac wrth gwrs tîm 1000 o Fywydau – Gwasanaeth Gwella, a wnaeth i ni deimlo’n gartrefol ac yn rhan o bethau drwy gydol y gynhadledd.

Un o uchafbwynt ychwanegol y Gynhadledd oedd ennill y cwis diogelwch cleifion Datix gydag Amanda (a chael tedis yn wobrau!). Fe wnes i fwynhau pob munud o’r profiad hwn ac ni fyddwn wedi dod i gysylltiad â’r maes gwella ansawdd a diogelwch cleifion i’r fath raddau nac wedi gallu cael cymaint o wybodaeth amdano ag sydd gennyf yn awr heb 1000 o Fywydau, ac rwy’n ddiolchgar iawn am hynny… Diolch yn fawr!!.

 

Jul 072016
 

Dr Gethin Pugh, Consultant in Anaesthesia & Intensive Care Medicine, Welsh School of Anaesthesia

What is Quality Improvement?Welsh Anaesthesia Seminar

Quality Improvement (QI), or Improvement Science, uses a systematic approach to design and implement changes in healthcare.  Knowledge of the methodology of QI is essential when considering improvements to the modern complex healthcare environment.  QI is also included as part of many postgraduate training curricula.

In March 2016, the AoMRC published its report: Quality Improvement – training for better outcomes, which sets out recommendations for quality improvement education and training.  The report has drawn together a wide range of organizations to align efforts to implement quality improvement training as a core competence in modern clinical practice, from undergraduate curricula through specialist curricula and beyond into Consultant practice.

The report represents a starting point for future development and aims to provide a structured framework to embed improvement methodology as a core competence for all doctors.

It is recognized that significant barriers remain, with a lack of parity in access to QI training and resources across organizations and specialties.  For many senior doctors and other members of the multi-professional team, the concept of QI remains a new idea.

The rotational nature of medical training means that doctors in training, working within multi-professional teams, are well placed to share areas of good practice and support QI development.

QI Training in Anaesthesia and Intensive Care Medicine in Wales

The Welsh School of Anaesthesia working in partnership with 1000 Lives Improvement have developed a QI Training programme for both doctors in training and trainers, to provide high quality training in the principles of QI and access to QI training resources to support innovation and excellence in healthcare.

This programme aims to provide high quality QI Training through the use of interactive workshops for trainees and support the development of QI networks of both trainers and trainees across Wales.  Furthermore, it is hoped that as part of the programme, access to high quality QI projects will be enhanced and individuals will be well supported in developing their own projects.  The programme includes the courses outlined below:

Quality Improvement in Anaesthetics – a 2 Day Interactive Workshop for Specialty Trainees

The Welsh School of Anaesthesia working in partnership with 1000 Lives Improvement offers an interactive workshop for trainees in Anaesthesia & Intensive Care Medicine in Wales.

The course provides the opportunity to learn from experts in quality improvement, who have experience of successful QI projects, to advance your own knowledge and skills in this area.

Candidates have the opportunity to develop their own QI project as part of the workshop, working in small groups to gain valuable hands on practical guidance.  Attendance at both days of the workshop and submission of a successfully completed project results in the award of IQT Silver Level Accreditation.

Feedback from delegates who attended the last workshop in 2015/2016:

‘Credible faculty full of useful information’

‘Really enthused me to do QI work’

‘Great reframing and moving on from audit, good interactive style’

Bronze Level Accreditation was completed via an e-learning package prior to attending the 2-day workshop.

As part of this programme, a further QI Training Workshop for specialty trainees in anaesthesia will be held this autumn.  Dates will be confirmed shortly and will be published on the Welsh School of Anaesthesia website.

Quality Improvement in Anaesthesia:  Introduction for Trainers (1 Day Course)

This 1-day introductory course for trainers focuses on the principles of Quality Improvement.

The course provides the opportunity for trainers in Anaesthesia in Wales to build on their knowledge of QI and its role as part of training in Anaesthesia and Intensive Care Medicine.

The course enables trainers to gain an understanding of the methodology and framework that underpins QI and its role in improving healthcare.  Participants will also have access to contacts with experience in this area that will be able to provide further support for QI initiatives locally.

Future areas for development:

As part of the ongoing development of the educational programme to support QI Training in Wales, there will be a number of new opportunities for trainers and trainees this autumn:

  • Welsh School of Anaesthesia Educational Supervisors Study Day, October 2016

The workshop will provide some background of the present scope of QI Training and provide the opportunity for trainers in Wales to gain an understanding of the methodology and framework of this developing area of postgraduate training, as part of an interactive workshop.

Society of Anaesthetists of Wales, Autumn Meeting, October 2016 will also include a presentation on QI Training in Anaesthesia in Wales by a member of the QI development programme, Dr. Katy Beard.

  • Working in partnership with other Specialty Schools to support QI Training in Wales

At present, members of the programme development team are working with the All Wales School of Emergency Medicine to develop a QI Training programme for Specialty trainees in Emergency Medicine.  This includes supporting trainers to develop a QI training network as well as mapping QI training areas against the requirements of postgraduate curricula.

Jul 072016
 

Dr Gethin Pugh, Ysgol Anaestheteg Cymru

Beth yw Gwella Ansawdd?Welsh Anaesth seminar

Mae Gwella Ansawdd (GA), neu Wyddor Gwella, yn defnyddio dull systematig o gynllunio newidiadau mewn gofal iechyd a’u rhoi ar waith.  Mae gwybodaeth am y fethodoleg GA yn hanfodol wrth ystyried gwelliannau i’r amgylchedd gofal iechyd cymhleth modern.  Mae GA hefyd yn cael ei gynnwys fel rhan o nifer o gwricwla hyfforddiant ôl-raddedig.

Ym mis Mawrth 2016, cyhoeddodd AoMRC ei adroddiad: Quality Improvement – training for better outcomes, sy’n nodi argymhellion ar gyfer addysg a hyfforddiant gwella ansawdd.  Mae’r adroddiad wedi dwyn ynghyd amrywiaeth eang o sefydliadau i gysoni ymdrechion i gynnwys hyfforddiant gwella ansawdd fel cymhwysedd craidd mewn ymarfer clinigol modern, o’r cwricwla israddedig i’r cwricwla arbenigol a thu hwnt i hynny i Ymgynghorwyr.

Mae’r adroddiad yn fan cychwyn ar gyfer datblygu yn y dyfodol a’i nod yw darparu fframwaith strwythuredig i ymgorffori methodoleg gwella fel cymhwysedd craidd ar gyfer pob meddyg.

Cydnabyddir bod rhwystrau sylweddol o hyd, gyda diffyg cydraddoldeb o ran mynediad i hyfforddiant ac adnoddau GA ar draws sefydliadau ac arbenigeddau.  I lawer o uwch feddygon ac aelodau eraill o’r tîm amlbroffesiynol, mae’r cysyniad o GA yn parhau i fod yn syniad newydd.

Mae natur gylchdro hyfforddiant meddygol yn golygu bod meddygon dan hyfforddiant, sy’n gweithio mewn timau amlbroffesiynol, mewn sefyllfa dda i rannu meysydd o arfer da a chefnogi datblygiad GA.

Hyfforddiant GA mewn Anaestheteg a Meddygaeth Gofal Dwys yng Nghymru

Mae Ysgol Anaestheteg Cymru, drwy weithio mewn partneriaeth â 1000 o Fywydau – Gwasanaeth Gwella, wedi datblygu rhaglen hyfforddi GA ar gyfer meddygon dan hyfforddiant a hyfforddwyr, i ddarparu hyfforddiant o ansawdd uchel mewn egwyddorion GA a mynediad i adnoddau hyfforddi GA i gefnogi arloesedd a rhagoriaeth mewn gofal iechyd.

Nod y rhaglen hon yw darparu hyfforddiant GA o ansawdd uchel drwy ddefnyddio gweithdai rhyngweithiol ar gyfer hyfforddeion a chefnogi datblygu rhwydweithiau GA o hyfforddwyr a hyfforddeion ar draws Cymru.  Ar ben hynny, y gobaith yw, fel rhan o’r rhaglen, y bydd mynediad i brosiectau GA o ansawdd uchel yn gwella a bydd unigolion yn cael cefnogaeth dda wrth ddatblygu eu prosiectau eu hunain.  Mae’r rhaglen yn cynnwys y cyrsiau a amlinellir isod:

Gwella Ansawdd mewn Anaestheteg – Gweithdy Rhyngweithiol Deuddydd i Hyfforddeion Arbenigol

Mae Ysgol Anaestheteg Cymru, drwy weithio mewn partneriaeth â Thîm 1000 o Fywydau – Gwasanaeth Gwella, yn cynnig gweithdy rhyngweithiol ar gyfer hyfforddeion mewn Anaestheteg a Meddygaeth Gofal Dwys yng Nghymru.

Mae’r cwrs yn cynnig y cyfle i ddysgu oddi wrth arbenigwyr mewn gwella ansawdd, sydd â phrofiad o brosiectau GA llwyddiannus, i hybu eich gwybodaeth a’ch sgiliau eich hun yn y maes hwn.

Caiff ymgeiswyr gyfle i ddatblygu eu prosiect GA eu hunain fel rhan o’r gweithdy, gan weithio mewn grwpiau bach i gael arweiniad ymarferol drwy brofiad uniongyrchol.  Drwy fynychu’r ddau ddiwrnod a chyflwyno prosiect a gwblhawyd yn  llwyddiannus cewch Achrediad IQT Lefel Arian.

Adborth gan y rhai a fynychodd y gweithdy diwethaf yn 2015/2016:

‘Cyfadran gredadwy sy’n llawn gwybodaeth ddefnyddiol’

‘Mae wedi tanio fy mrwdfrydedd i wneud gwaith GA’

‘Mae’n wych ail-fframio a symud ymlaen o waith archwilio, arddull rhyngweithiol dda’

Cwblhawyd Achrediad Lefel Efydd drwy becyn e-ddysgu cyn mynychu’r gweithdy 2 ddiwrnod.

Fel rhan o’r rhaglen hon, cynhelir Gweithdy Hyfforddi GA arall ar gyfer hyfforddeion arbenigol mewn anaestheteg yr hydref hwn.  Bydd y dyddiadau’n cael eu cadarnhau cyn bo hir ac yn cael eu cyhoeddi ar wefan Ysgol Anaestheteg Cymru.

Gwella Ansawdd mewn Anaestheteg:  Cyflwyniad i Hyfforddwyr (Cwrs Undydd)

Mae’r cwrs rhagarweiniol undydd hwn ar gyfer hyfforddwyr yn canolbwyntio ar egwyddorion Gwella Ansawdd.

Mae’r cwrs yn rhoi cyfle i hyfforddwyr mewn Anaestheteg yng Nghymru adeiladu ar eu gwybodaeth o GA a’i rôl fel rhan o hyfforddiant mewn Anaestheteg a Meddygaeth Gofal Dwys.

Mae’r cwrs yn galluogi hyfforddwyr i feithrin dealltwriaeth o’r fethodoleg a’r fframwaith sy’n sail i GA a’i rôl mewn gwella gofal iechyd.  Bydd cyfranogwyr hefyd yn cael mynediad at gysylltiadau â phrofiad yn y maes hwn a fydd yn gallu rhoi cymorth pellach ar gyfer mentrau GA yn lleol.

Meysydd i’w datblygu yn y dyfodol:

Fel rhan o ddatblygiad parhaus y rhaglen addysgol i gefnogi Hyfforddiant GA yng Nghymru, bydd nifer o gyfleoedd newydd i hyfforddwyr a hyfforddeion yr hydref hwn:

  • Diwrnod Astudio i Oruchwylwry Addysg gan Ysgol Anaestheteg Cymru, Hydref 2016

Bydd y gweithdy yn darparu rhywfaint o gefndir i’r Hyfforddiant GA presennol ac yn rhoi’r cyfle i hyfforddwyr yng Nghymru feithrin dealltwriaeth o fethodoleg a fframwaith y maes hwn o hyfforddiant ôl-raddedig sy’n datblygu, fel rhan o weithdy rhyngweithiol.

Bydd Cyfarfod Hydref Cymdeithas Anesthetyddion Cymru ym mis Hydref 2016 hefyd yn cynnwys cyflwyniad ar Hyfforddiant GA mewn Anaestheteg yng Nghymru gan aelod o’r rhaglen datblygu GA, Dr. Katy Beard.

  • Gweithio mewn partneriaeth ag Ysgolion Arbenigol eraill i gefnogi Hyfforddiant GA yng Nghymru

Ar hyn o bryd, mae aelodau o’r tîm datblygu rhaglenni yn gweithio gydag Ysgol Meddygaeth Frys Cymru Gyfan i ddatblygu rhaglen hyfforddi GA ar gyfer hyfforddeion Arbenigol mewn Meddygaeth Frys.  Mae hyn yn cynnwys cefnogi hyfforddwyr i ddatblygu rhwydwaith hyfforddiant GA yn ogystal â mapio meysydd hyfforddi yn erbyn gofynion cwricwla ôlraddedig.