Oct 112017
 

HeatherJane Coombs – SANDS

In 2004, I thought after your 12 week scan you were home and dry in your pregnancy and you just waited for the little of bundle of joy to join you. How naïve was I! I had heard of stillbirth and babies dying but only from soap operas, it didn’t happen in real life to normal people… Did it?

On the 1 September 2004 I realised that yes stillbirth DOES happen to normal people like myself when I was told at 10.31pm that my son Xander had died inside of me due to a placenta abruption. I wasn’t sure how I expected him to come out, but to then realise I was going to have to give birth to a baby that would never cry broke me in two.

I was in labour for the next 2 days and finally gave birth at 2.43pm to a gorgeous (yes I’m biased, but he was) 5lb 5.5oz baby boy who we named Xander Dangerfield Coombs. I can tell you every single detail of the time spent in that room waiting to give birth, even how uncomfortable the bed was and the posters of babies on the wall. That first night I heard 7 babies being born and knowing my baby would never cry like their babies was torture.

When I was told my baby had no heart beat and then the news that he had died, it was a student midwife who held my hand and cried with me. Her compassion stays with me.  My midwife Cath who was there for the days of my labour and helped me through some tough hours is on a pedestal and will always remain Queen of Midwives to me, she was amazing.  I also know that her shift finished at 2pm on that Wednesday, but she was still there looking after her “poppet” as she referred to Xander and me until gone 9pm when I left.  She dressed him, talked to him and gave us the time to be with him, whilst still being there when we needed something, she was amazing.  I am in awe of a midwife who can deal so lovingly and perfectly with a family in heartbreak and then go next door to a family whose lives have changed in another way differently to ours.

Through my work with Sands (Stillbirth and neonatal death charity), first as a volunteer and then as an employee I have heard so many stories and met so many health professionals, some good and some not so good.  When I was asked to join the National Stillbirth Working Group I was both elated and scared!  My work back ground was a team leader in a call centre and my first few meetings I felt like I was a rabbit caught in the head lights, I was just waiting for someone to tell me I was an imposter and ask me what I was doing there.  The medical talk went right over my head, and often I went home with lots of notes so that I could google what words meant so I could understand what the conversation was about. I would like to think that over time though I have started contributing as the voice of the parents and made a small difference within the group.

Being part of the launch of the Safer Pregnancy Wales Campaign and fortunate enough to be able to share Xander with everyone was amazing and the partnership between Sands and the Maternity Network/1000 Lives Improvement seems to have gone from strength to strength, the upcoming launch of the Pathway being even more exciting.  When we start seeing the stillbirth rates reduce as they did in Scotland then that will really be amazing. His feet may have been small, but Xander’s foot print gets deeper with time.

We will be joining in raising awareness during baby loss awareness week. For more details of events please go to http://www.babyloss-awareness.org

Oct 112017
 

HeatherJane Coombs – SANDS

Yn 2004, roeddwn yn meddwl eich bod yn ddiogel ar ôl eich sgan 12 wythnos yn ystod eich beichiogrwydd, ac mai aros i’ch babi gyrraedd oedd y cam nesaf. Dyna naïf roeddwn i! Roeddwn wedi clywed am fabis marw-anedig ac am fabis yn marw ar ôl cael eu geni ond dim ond mewn operâu sebon. Doedd hyn ddim yn digwydd mewn bywyd go iawn ac i bobl arferol….Nag oedd?

Ar 1 Medi 2004, sylweddolais fod pobl arferol fel fi yn cael babis marw-anedig pan ddywedwyd wrthyf am 10.31pm fod fy mab Xander wedi marw y tu mewn i mi oherwydd toriad yn y brych. Doeddwn ddim yn gwybod sut roeddwn yn disgwyl iddo ddod allan, ond fe wnaeth y sylweddoliad fy mod yn mynd i roi genedigaeth i fabi na fyddai byth yn crio dorri fy nghalon yn ddwy.

Parhaodd yr enedigaeth am y 2 ddiwrnod nesaf ac, yn y diwedd, am 2.43pm ganwyd bachgen bach 5lb 5.5oz hynod hardd (ydw, dw i’n unochrog, ond mae’n wir) a enwyd gennym yn Xander Dangerfield Coombs.  Gallen i ddweud pob manylyn wrthoch chi am yr amser y treuliais yn yr ystafell honno yn aros i roi genedigaeth, hyd yn oed pa mor anghyffyrddus oedd y gwely a’r posteri o fabis ar y waliau. Y noson gyntaf honno, fe glywais 7 babi yn cael eu geni ac roedd gwybod na fyddai fy mabi i byth yn crio yn artaith.

Pan ddywedwyd wrthyf nad oedd gan fy mabi guriad calon ac yna’r newyddion ei fod wedi marw, myfyrwraig o fydwraig ddaliodd fy llaw a chrio gyda mi. Mae ei thosturi hi wedi aros gyda mi. Dwi wedi rhoi fy mydwraig, Cath, oedd yna am ddyddiau’r enedigaeth ac a’m helpodd i drwy oriau anodd iawn, ar bedestal a hi fydd brenhines y bydwragedd am byth yn fy marn i. Roedd hi’n anhygoel. Dw i hefyd yn gwybod bod ei shifft gwaith hi wedi dod i ben am 2pm ar y dydd Mercher hwnnw, ond roedd hi’n dal yna yn gofalu am ei “poppet”, sef yr enw roddodd hi ar Xander, a mi tan wedi 9pm pan adewais i. Fe’i gwisgodd, siaradodd ag e a rhoi amser i ni gael bod gydag e, ac roedd hi yno pan oedd angen unrhywbeth arnon ni. Roedd hi’n anhygoel… Dw i’n rhyfeddu at fydwraig sy’n gallu ymdrin mor gariadus a pherffaith â theulu yn ystod torcalon ac yna’n mynd drws nesaf at deulu y mae eu bywydau wedi newid mewn ffordd arall, yn wahanol i’n bywyd ni.

Trwy fy ngwaith gyda  Sands (elusen ar gyfer babis marw-anedig a marwolaeth ar ôl genedigaeth), yn gyntaf fel gwirfoddolwr ac yna fel gweithiwr, dw i wedi clywed gymaint o straeon ac wedi cwrdd â chymaint o weithwyr iechyd proffesiynol, rhai’n dda a rhai nad ydynt cystal. Pan ofynnwyd i mi ymuno â’r Gweithgor Marw-anedig Cenedlaethol, roeddwn wrth fy modd ac yn ofnus! O ran fy ngwaith, roeddwn yn arweinydd tîm mewn canolfan alwadau, ac yn ystod fy nghyfarfodydd cyntaf roeddwn yn teimlo allan o fy nyfnder, yn aros i rywun ddweud wrthyf fy mod yn twyllo a gofyn i mi beth oeddwn i’n ei wneud yno. Doeddwn i ddim yn deall y siarad meddygol, a byddwn yn aml yn mynd adref â llawer o nodiadau fel y gallwn chwilio ystyr geiriau ar y we, er mwyn deall am beth oedd y sgwrs. Serch hynny, hoffwn feddwl fy mod wedi dechrau cyfrannu dros amser, fel llais y rhieni, ac wedi gwneud rhywfaint o wahaniaeth o fewn y gweithgor.

Roedd bod yn rhan o lansio’r Ymgyrch Beichiogrwydd Mwy Diogel Cymru a bod yn ddigon ffodus i allu rhannu Xander gyda phawb yn anhygoel, ac mae’r bartneriaeth rhwng Sands a’r Rhwydwaith Mamolaeth/Gwella 1000 o Fywydau i’w weld wedi mynd o nerth i nerth, gyda lansio’r Llwybr hyd yn oed yn fwy cyffrous. Pan fyddwn yn dechrau gweld niferoedd y marw-anedig yn gostwng fel y gwnaethon nhw yn yr Alban, bydd hynny wir yn ardderchog. Efallai bod ei draed yn fach, ond mae Xander yn sicr yn gadael ei ôl.

Byddwn yn ymuno i godi ymwybyddiaeth yn ystod wythnos ymwybyddiaeth o golli babis. Am ragor o fanylion am ddigwyddiadau, ewch i www.babyloss-awareness.org

Aug 292017
 

Can you remember when you visited the theatre? What was memorable and enjoyable? Are you looking forward to visiting again?

If it was an operating theatre, would you feel differently? Imagine if:

  • You couldn’t understand what was happening, or why;
  • You were made to wear someone else’s clothes (a hospital gown);
  • On your way to the theatre the people stared/ looked away;
  • The theatre smelled and the lights were very bright;
  • In the theatre noisy machines had flashing lights;
  • You didn’t know any of the people who all wore the same clothes;
  • You kept saying you were confused and scared, but no one noticed;
  • You wanted to leave, but they stopped you. The people appeared to be annoyed?

It would be memorable, but would you want to visit again?

Can we comprehend how a person with a learning disability experiences a hospital? Do we understand how previous experiences influence future behaviour? It may be a typical day for healthcare workers but a very different day for hospital users. It is essential we demonstrate empathy, compassion and understand how the environment and processes within a hospital may be very difficult for others. Whether, we are aware through the learning disability hospital passport, our knowledge or because we have listened to the person and their carers, it is essential we meet those essential reasonable adjustments for treatment.

Our team developed the Soothing Patients Anxiety “SPA” Experience to deliver a less distressing day and a positive experience within the theatre in a hospital. We achieved this by using iterative Plan Do Study Act cycles and other techniques taught by the Silver IQT course to ensure constant refinement of our processes. Patients and/or their carers are equal partners in planning their care. Reflection on every interaction and constant feedback provide new learning for continuous service improvement. An enjoyable memorable day is achieved through patient choice distraction techniques during induction of the general anaesthetic that we call “stealth or themed anaesthesia” which minimises/avoids sedation/and or positive behavioural management (restraint). All techniques are practiced within the theatre with the patient and carers prior to the day of operation, “a dress rehearsal”.

  • Stealth anaesthesia – covert administration of the anaesthetic whilst the individual involved in their favourite activity and chosen distraction technique.
  • Themed anaesthesia- the journey is built around a favourite thing. A gentleman with a learning disability during our dedicated pre anaesthetic assessment clinic remarked that the anaesthetic facemask reminded him of what fighter pilots used in his favourite film Top Gun. The morning of the operation he watched the movie. Walking to theatre he listened to the theme music. In theatre he was involved in a pre flight/anaesthetic checklist. He drifted off to sleep holding his facemask he watched an aerial flight scene via an i-pod in front of his eyes. On waking he received a Top Gun flight certificate.

Awards embody the opportunity to share learning and influence care external to your organisation. Last year the team won the NHS Wales Citizens at the Centre of Service Redesign Award and this year BMJ Anaesthesia Team of the Year. We are honoured to work with people with learning disabilities and the intrinsic opportunity to challenge the norms of healthcare. Our diverse and unique service users ensures constant learning and quality improvement as they each inspire new possibilities/options for future users.

Question: What would you need for a memorable and enjoyable visit to theatre?

For more information email: Paul.Harris@wales.nhs.uk

YouTube: NHS Wales Awards The Spa experience

Aug 292017
 

Allwch chi gofio pryd aethoch chi i’r theatr? Beth oedd yn gofiadwy ac yn bleserus?
Ydych chi’n edrych ymlaen at ymweld â’r theatr eto?

Petai’n theatr llawdriniaethau, a fyddech chi’n teimlo’n wahanol? Dychmygwch:

  • Pe na fyddech yn deall pam neu beth oedd yn digwydd.
  • Petai’n rhaid i chi wisgo dillad rhywun arall (gŵn ysbyty).
  • Ar eich ffordd i’r theatr, roedd pobl yn syllu/ edrych i ffwrdd.
  • Bod y theatr yn arogleuo a bod y goleuadau’n llachar iawn.
  • Yn y theatr, bod golau’n fflachio ar y peiriannau swnllyd.
  • Nad oeddech chi’n adnabod dim un o’r bobl, a oedd yn gwisgo’r un dillad.
  • Eich bod chi’n parhau i ddweud eich bod chi wedi drysu ac yn ofnus, ond bod neb yn cymryd unrhyw sylw. Eich bod chi eisiau gadael, ond eu bod nhw wedi eich atal chi. Bod y bobl yn ymddangos yn flin?

Byddai’n gofiadwy, ond a fyddech chi eisiau ymweld eto?

Allwn ni amgyffred beth yw profiad unigolyn ag anabledd dysgu o ysbyty? A ydym ni’n deall sut mae profiadau blaenorol yn dylanwadu ar ymddygiad yn y dyfodol? Efallai ei fod yn ddiwrnod nodweddiadol ar gyfer gweithwyr gofal iechyd, ond yn ddiwrnod gwahanol iawn i ddefnyddwyr ysbyty. Mae’n hanfodol ein bod ni’n dangos empathi, tosturi, a deall sut gall yr amgylchedd a’r prosesau mewn ysbyty fod yn anodd iawn i bobl eraill. P’un ai a ydym ni’n ymwybodol yn sgil y pasbort ysbyty anabledd dysgu, ein gwybodaeth, neu oherwydd ein bod ni wedi gwrando ar yr unigolyn a’i ofalwyr, mae’n hanfodol ein bod ni’n bodloni’r addasiadau hanfodol, rhesymol hynny ar gyfer triniaeth.

Datblygodd ein tîm Profiad Lleddfu Pryder Cleifion (Soothing Patients Anxiety) “SPA”, i gyflwyno diwrnod llai gofidus a phrofiad cadarnhaol yn y theatr mewn ysbyty. Cyflawnom hyn trwy ddefnyddio cylchau ailadroddol Cynllunio, Gwneud, Astudio, Gweithredu, a thechnegau eraill a addysgwyd gan y cwrs IQT Arian i sicrhau y caiff ein prosesau eu mireinio’n barhaus. Mae cleifion a/neu eu gofalwyr yn bartneriaid cyfartal wrth gynllunio eu gofal. Mae myfyrio ar bob rhyngweithiad ac adborth cyson yn cynnig dysgu newydd i wella’r gwasanaeth yn barhaus. Cyflawnir diwrnod cofiadwy a phleserus trwy dechnegau tynnu sylw y mae’r claf yn eu dewis, wrth roi’r anesthetig cyffredinol, yr ydym yn ei alw’n “anaesthesia diarwybod neu anaesthesia â thema”, sy’n lleihau/osgoi tawelyddiad a/neu reoli ymddygiad yn gadarnhaol (ataliaeth). Caiff yr holl dechnegau eu hymarfer yn y theatr gyda’r claf a’i ofalwyr cyn diwrnod y llawdriniaeth, sesiwn “ymarfer”.

  • Anaesthesia diarwybod – rhoi’r anaesthetig tra bod yr unigolyn dan sylw yn cymryd rhan yn ei hoff weithgarwch a’r dechneg tynnu sylw dewisol.
  • Anaesthesia â thema – caiff y daith ei hadeiladu o gwmpas hoff beth. Fe wnaeth dyn ag anabledd dysgu wneud sylw yn ystod ein clinig asesu cyn anaesthetig pwrpasol, bod y mwgwd wyneb anaesthetig yn ei atgoffa o beth yr oedd peilotiaid awyrennau ymladd yn eu defnyddio yn ei hoff ffilm, Top Gun. Fore’r llawdriniaeth, gwyliodd ef y ffilm. Wrth gerdded i’r theatr, gwrandawodd ar gerddoriaeth thema’r ffilm. Yn y theatr, cymerodd ran mewn rhestr wirio cyn hedfan/anaesthetig. Aeth i gysgu yn dal ei fwgwd wyneb wrth wylio golygfa hediad awyrol trwy i-pod o’i flaen. Ar ôl deffro, derbyniodd dystysgrif hedfan Top Gun.

Mae’r Gwobrau’n ymgorffori’r cyfle i rannu dysgu a dylanwadu ar ofal y tu allan i’ch sefydliad. Y llynedd, enillodd y tîm Wobr Dinasyddion wrth Wraidd Ail-ddylunio Gwasanaeth GIG Cymru, ac eleni, Tîm Anaesthesia  y Flwyddyn BMJ. Mae’n anrhydedd cael gweithio gyda phobl ag anableddau dysgu a’r cyfle cynhenid i herio normau gofal iechyd. Mae ein defnyddwyr gwasanaeth amrywiol ac unigryw yn sicrhau dysgu parhaus a gwella ansawdd, gan fod pob un ohonynt yn ysbrydoli posibiliadau/dewisiadau newydd ar gyfer defnyddwyr yn y dyfodol.

Cwestiwn:

Beth fyddech chi ei angen ar gyfer ymweliad cofiadwy a phleserus â’r theatr?

I gael mwy o wybodaeth:

E-bost: Paul.Harris@wales.nhs.uk

Aug 212017
 

Elinore Macgillivray, National Lead Midwife OBS Cymru

It’s an exciting time in any family’s life when a new baby is expected. With all the assurances of modern healthcare, the expectation is for a pregnancy to end with a healthy mum and baby. Still, for 1 in 20 women obstetric blood loss will be in excess of 1 litre, and for 1 in 200 life threatening bleeding will occur, leading to a number of adverse physical and emotional consequences. Rarely (around once every 3 years in Wales) postpartum haemorrhage (excessive bleeding after childbirth) will result in a baby that goes home without its mother.

Postpartum haemorrhage (PPH) continues to be one of the leading causes that adversely affects maternal well-being (morbidity) in Wales and is in the top 5 quality issues for every maternity unit. OBS Cymru – the Obstetric Bleeding Strategy for Wales is a 3 year national quality improvement project aiming to reduce harm from postpartum haemorrhage. The primary aim of the project is to reduce the number of women suffering a massive obstetric haemorrhage. It also aims to reduce the amount of blood products given, critical care admissions and hysterectomies performed due to PPH.

Over the last 10 years Cardiff and Vale University Health Board has been leading research into understanding the role of blood clotting in PPH. During the sequential research projects undertaken, a reduction in PPH associated morbidity was observed; felt to be not only linked to the impact of the research projects, but to multiple changes in practice.  Following discussion between delivery units across Wales, the themes listed below were identified as crucial to improving mother’s outcomes, and informed the OBS Cymru approach.

How are we going to achieve our aim of reducing harm from PPH?

Wales is in a privileged position of having a dedicated Maternity Network that engages stakeholders from all over country, and provides a forum for sharing ideas, and supporting quality improvement and standardisation nationally. A number of interventions have already been put in place across all Obstetric led labour wards in Wales:

  • Risk Assessment – each woman admitted to an obstetric lead labour ward in Wales will have a standard PPH risk assessment completed, in order to identify those at increased risk.
  • Early identification by means of Measuring Blood Loss – traditionally, we have estimated blood loss following birth, a practice that we are woefully poor at. We are now moving rapidly towards measuring all blood loss following all births, with training supported by the project team.
  • Multidisciplinary Team Working – we have developed a 4 stage PPH management tool which supports a unified approach to multidisciplinary team working. OBS Cymru funds champion teams in each of Wales’ 7 Health Boards consisting of a midwife, anaesthetist, obstetrician and haematologist. These teams have been vital in delivering quality improvement messages.
  • ROTEM point of care testing – machines have been installed in every labour ward in Wales to allow access to rapid coagulation results and guide blood product management.

Of course, in order to demonstrate the positive changes we are expecting, we have a robust system of data collection supported by local OBS Cymru champion teams. This is already beginning to show some positive changes in practice.

Events such as this year’s UK Patient Safety Congress also provide invaluable network opportunities with health professionals all across the UK, and further afield, who share a common interest and commitment to quality improvement in maternity care. These collaborations will allow us to spread improvements across not just Wales, but the rest of the world.

As one of the national midwife leads for OBS Cymru, I passionately believe that this project will have a significant positive impact on reducing harm from postpartum haemorrhage.  After all, no matter what part we play, a healthy mother and baby is what we all strive for.

For more information on OBS CYMRU visit our page

Aug 212017
 

Elinore Macgillivray, Bydwraig Arweiniol Genedlaethol OBS Cymru

Mae’n gyfnod cyffrous ym mywyd unrhyw deulu pan ddisgwylir babi newydd. Gyda’r holl sicrwydd a ddaw yn sgil gofal iechyd modern, y disgwyliad yw y bydd y fam a’r babi’n iach ar ddiwedd y beichiogrwydd. Ond bydd 1 o bob 20 o fenywod yn colli dros 1 litr o waed obstetrig, a bydd 1 o bob 200 o fenywod yn colli cymaint o waed nes rhoi eu bywyd yn y fantol, gan arwain at nifer o ganlyniadau corfforol ac emosiynol andwyol. Mewn achosion prin (tuag unwaith bob 3 blynedd yng Nghymru) bydd gwaedlif ôl-enedigol (gwaedu gormodol ar ôl genedigaeth) yn golygu y bydd y babi’n mynd adref heb ei fam.

Mae gwaedlif ôl-enedigol (PPH) yn parhau i fod yn un o’r prif achosion sy’n cael effaith andwyol ar les (afiachedd) y fam yng Nghymru ac mae’n un o’r 5 prif broblem ansawdd ar gyfer pob uned famolaeth. Mae OBS Cymru – Strategaeth Gwaedu Obstetrig ar gyfer Cymru yn brosiect gwella ansawdd cenedlaethol 3 blynedd sy’n anelu at leihau niwed yn sgil gwaedlif ôl-enedigol. Prif nod y prosiect yw lleihau nifer y menywod sy’n dioddef gwaedlif obstetreg difrifol. Mae hefyd yn anelu at leihau faint o gynhyrchion gwaed a roddir, nifer y derbyniadau gofal critigol a nifer yr hysterectomïau a gaiff eu cynnal oherwydd gwaedlif ôl-enedigol.

Dros y 10 mlynedd diwethaf mae Bwrdd Iechyd Prifysgol Caerdydd a’r Fro wedi bod yn arwain ymchwil i ddeall swyddogaeth ceulo gwaed mewn gwaedlif ôl-enedigol. Yn ystod y prosiectau ymchwil dilyniannol a gynhaliwyd, gwelwyd gostyngiad mewn afiachedd sy’n gysylltiedig â gwaedlif ôl-enedigol; teimlwyd bod hyn yn gysylltiedig â nifer o newidiadau mewn ymarfer yn ogystal ag effaith y prosiectau ymchwil.  Yn dilyn trafodaeth rhwng unedau cyflenwi ar draws Cymru, nodwyd y themâu a restrir isod fel rhai sy’n hanfodol i wella canlyniadau i’r fam, gan lywio dull gweithredu OBS Cymru.

Sut yr ydym yn bwriadu cyrraedd ein nod o leihau niwed yn sgil gwaedlif ôl-enedigol?

Mae Cymru mewn sefyllfa freintiedig gan fod ganddi Rwydwaith Mamolaeth pwrpasol sy’n cynnwys rhanddeiliaid o bob cwr o’r wlad, ac mae’n darparu fforwm i rannu syniadau, a chefnogi gwella ansawdd a safoni yn genedlaethol. Mae nifer o ymyriadau sydd eisoes wedi cael eu rhoi ar waith ar draws yr holl wardiau esgor sy’n cael eu harwain gan Obstetreg yng Nghymru:

  • Asesiad Risg – bydd pob menyw sy’n cael ei derbyn i ward a arweinir gan obstetreg yng Nghymru yn cael asesiad risg safonol ar gyfer gwaedlif ôl-enedigol, er mwyn gallu adnabod y rhai sy’n wynebu’r mwyaf o berygl.
  • Adnabod achosion yn gynnar drwy Fesur y Gwaed a Gollir – yn draddodiadol, rydym wedi amcangyfrif y gwaed a gollir yn dilyn genedigaeth, a hynny’n druenus o wael. Rydym bellach yn symud yn gyflym tuag at fesur yr holl waed a gollir yn dilyn pob genedigaeth, gyda hyfforddiant a gefnogir gan dîm y prosiect.
  • Gwaith Amlddisgyblaethol– rydym wedi datblygu offeryn 4 cam i reoli gwaedlif ôl-enedigol sy’n cefnogi dull unedig o weithio mewn tîm amlddisgyblaethol. Mae OBS Cymru yn ariannu timau hyrwyddwr ym mhob un o 7 Bwrdd Iechyd Cymru sy’n cynnwys bydwraig, anesthetydd, obstetrydd a haematolegydd. Mae’r timau hyn wedi bod yn hanfodol o ran cyflwyno negeseuon gwella ansawdd.
  • Cynnal profion ar y pwynt gofal drwy ddefnyddio ROTEM – mae peiriannau wedi cael eu gosod ym mhob ward esgor yng Nghymru er mwyn caniatáu mynediad i ganlyniadau ceulo cyflym a thywys y broses o reoli cynhyrchion gwaed.

Wrth gwrs, er mwyn dangos y newidiadau cadarnhaol rydym yn eu disgwyl, mae gennym system gadarn ar gyfer casglu data a gefnogir gan dimau hyrwyddwr lleol OBS Cymru. Mae hyn eisoes yn dechrau dangos rhai newidiadau cadarnhaol mewn ymarfer.

Mae digwyddiadau fel Cyngres Diogelwch Cleifion y DU eleni hefyd yn darparu cyfleoedd amhrisiadwy i rwydweithio gyda gweithwyr iechyd proffesiynol ar draws y DU, a thu hwnt, sy’n rhannu diddordeb ac ymrwymiad cyffredin i wella ansawdd mewn gofal mamolaeth. Bydd y cydweithio hwn yn ein galluogi i ledaenu gwelliannau ar draws Cymru yn ogystal â gweddill y byd.

Fel un o’r bydwragedd arweiniol cenedlaethol ar gyfer OBS Cymru, rwy’n credu’n gryf y bydd y prosiect hwn yn cael effaith gadarnhaol sylweddol ar leihau niwed yn sgil gwaedlif ôl-enedigol.  Wedi’r cyfan, waeth pa ran y byddwn yn ei chwarae, rydym oll yn anelu at sicrhau bod y fam a’r babi’n iach.

I gael mwy o wybodaeth am ymweliad OBS CYMRU ewch i’n tudalen we

Jul 262017
 

Kate Mackenzie (back), Senior Measurement Improvement Manager

So I went running on the weekend (“So what?!”).

I took part in a running event (“Oh you’re are one of those types!”).

I ran 104 miles.

Now I have your attention. I ran 28 miles on day 1, 39 miles on day 2 and 37 miles on the final day.

I should add for the millennials amongst you, that’s 167 km. Or Milford Haven to Cardigan for visualisers and geographers. Some of you are likely wondering why on earth I would do such a thing. You may even be thinking – I’d love to try something like this. And the compassionate ones might be concerned for the state of my feet (a bit weary, puffy ankles and medically taped up. My ice bath is calling!).

It is the same with improvement projects.

Rarely can you capture interest or support merely by saying “I am doing some improvement”. The only people whose heads will turn are other improvers. “I am doing an improvement project” might capture a few more as it sounds like something out of the ordinary. The third gets everyone’s attention. It’s the data.

Done right, the data is your common language. It immediately gives a frame of reference for your journey. And it explains the magnitude of your achievement. It provokes a response. It shouldn’t be complicated or onerous to collect or explain.

The words “data” or “measures” often raises groans of not being mathematically minded or it’s all too hard. It can feel that it is something extra to do on top of all the lovely improving that you are doing.

Measuring your improvement is inextricably linked to the change you are making. Your data is sitting all around you. You just need to look around with your project aim clearly in mind and think how do I check whether this has improved?

If you don’t know your numbers at the start (your baseline), how can you truly know that you are putting your effort into the right thing?

By monitoring your progress (regular measurement), you are aware of positive results which can be a massive morale boost to keep going. Or you know that blips are just blips or if there is something more determinedly awry.

And then when it comes broadcasting your success to your colleagues, your peers, your directorate manager or the finance director. You want them to recognise and celebrate your achievements but you need to tell them in a way that is meaningful to them as well as you.

You could think about another example – many people undertake a personal improvement project at some stage of their lives,  to lose some weight. In this instance, decisions are taken about what time of day to weigh, how often or whether to enlist the support of a local club. The key point is that no-one starts without knowing their weight to begin with and without recording their regular weigh-ins. Measurement is how you keep yourself on track, how you keep pushing forward with your project.

In short, DATA IS YOUR FRIEND.

It is how you prove to the detractors that your efforts are making a tangible difference. It will be how you convince your upper echelons to give you the support and investment.  And when you look back, it will be the thing that crystallises your success.

Happy measuring!

Jul 262017
 

Kate Mackenzie

Es i i redeg ar y penwythnos (“Beth am hynny?!”).

Cymerais ran mewn digwyddiad rhedeg (“O un o’r rhieni wyt ti!”).

Rhedais 104 o filltiroedd.

Nawr rwyf wedi llwyddo i ddal eich sylw. Rhedais 28 milltir ar ddiwrnod 1, 39 milltir ar ddiwrnod 2 a 37 milltir ar y diwrnod olaf.

Dylwn ychwanegu ar gyfer y mileniaid yn eich plith mai 167 km yw hynny. Neu o Aberdaugleddau i Aberteifi i ddelweddwyr a daearyddwyr.

Bydd rhai ohonoch siŵr o fod yn meddwl pam ar y ddaear y byddwn yn gwneud y fath beth. Efallai y byddwch hyd yn oed yn meddwl – Byddwn wrth fy modd yn rhoi cynnig ar rywbeth fel hyn. Ac efallai y bydd y rhai trugarog yn eich plith yn pryderu am gyflwr fy nhraed (braidd yn flinedig, wedi’u lapio mewn tâp meddygol gyda fferau chwyddedig. Mae’r bath iâ yn galw!) Mae’r un peth yn wir am brosiectau gwella.

Anaml y gallwch ddal diddordeb neu ennyn cefnogaeth rywun drwy ddweud “rwy’n gwneud ychydig o waith gwella”. Yr unig bobl y bydd eu pennau’n troi yw pobl eraill sy’n gwneud gwaith gwella. Efallai y bydd “Rwy’n gwneud prosiect gwella” yn ennyn diddordeb ychydig mwy o bobl gan ei fod yn swnio’n rhywbeth allan o’r cyffredin. Mae’r trydydd yn denu sylw pawb. Y data.

O’i wneud yn iawn, y data yw eich iaith gyffredin. Maent yn rhoi fframwaith cyfeirio ar gyfer eich taith ar unwaith. Ac maent yn esbonio maint eich cyflawniad. Maent yn ennyn ymateb.

Ac ni ddylent fod yn gymhleth neu’n feichus i’w casglu na’u hesbonio.

Mae’r geiriau “data” neu “mesurau” yn aml yn ysgogi cwynion nad oes gan rywun feddwl mathemategol neu bod y cyfan yn rhy anodd. Gall deimlo ei fod yn rhywbeth ychwanegol i’w wneud ar ben yr holl waith gwella hyfryd rydych chi’n ei wneud.

Mae cysylltiad annatod rhwng eich gwaith gwella a’r newid rydych chi’n ei wneud. Mae eich data o’ch amgylch chi. Y cyfan sydd angen i chi ei wneud yw edrych o amgylch gyda’ch prosiect mewn golwg a meddwl sut y gallwch wirio a yw hyn wedi gwella?

Os nad ydych yn gwybod y rhifau ar y dechrau (eich llinell sylfaen), sut y gallwch wybod i sicrwydd eich bod yn canolbwyntio eich ymdrechion ar y peth cywir?

Drwy fonitro eich cynnydd (mesur rheolaidd), rydych yn ymwybodol o ganlyniadau cadarnhaol a all fod yn hwb enfawr i forâl a’ch helpu i ddal ati. Neu sut mae gwybod mai gwyriadau yw gwyriadau ynteu a oes rhywbeth mwy difrifol yn bod.

Ac yna pan ddaw’n amser i roi gwybod i’ch cydweithwyr, eich cyfoedion, eich rheolwr cyfarwyddiaeth neu’r cyfarwyddwr cyllid am eich llwyddiant. Rydych am iddynt gydnabod a dathlu eich cyflawniadau ond rhaid i chi ddweud wrthynt mewn ffordd sy’n ystyrlon iddyn nhw yn ogystal â chi.

Gallech feddwl am enghraifft arall – mae llawer o bobl yn ymgymryd â phrosiect gwella personol ar ryw adeg yn ystod eu bywydau, er mwyn colli ychydig o bwysau. Yn yr achos hwn, gwneir penderfyniadau ynghylch pa amser o’r dydd i bwyso, pa mor aml, neu a ddylid troi at glwb lleol am gymorth. Y pwynt allweddol yw nad oes neb yn dechrau heb wybod eu pwysau cychwynnol a heb gofnodi eu cynnydd bob tro y byddan nhw’n pwyso eu hunain. Mesur yw sut rydych yn cadw eich hun ar y trywydd iawn, sut rydych yn parhau i wthio ymlaen gyda’ch prosiect.

Yn gryno, DATA YW EICH FFRIND.

Dyma sut rydych yn profi i’r difriwyr bod eich ymdrechion yn gwneud gwahaniaeth gwirioneddol.

Dyma sut y byddwch yn argyhoeddi’r rhai ar y lefelau uwch i’ch cefnogi ac i fuddsoddi.

A phan fyddwch yn edrych yn ôl, dyma fydd yn crisialu eich llwyddiant.

Mwynhewch y mesur!

Jun 072017
 

Sera Llewelyn Davies

I recently had the privilege of attending the International Forum on Quality and Safety in Healthcare in London. I was allowed to choose a total of nine sessions that were held over two days. I was very interested in all the sessions, so it was difficult to choose as there were many interesting events taking place.

After travelling from North Wales to London, I was looking forward to attending the forum on Thursday morning. The venue was full of individuals from across the world and I was extremely lucky to be there to learn and share ideas.

The day began with a word of welcome and announcements, which then led on to the first session, entitled ‘International Quality and Safety: where are we now and where are we going to?’ lead by Donald Berwick and Lord Darzi. The session included a discussion on what needs to be changed and how this will happen in years to come.

After attending a variety of sessions over the two days, one that stood out was the second session on the Thursday, ‘How leaders navigate the way’. The main lesson that I learnt from this session was ‘I’ve got the gift’, which is a culture within leadership to improve quality. That gift is passed on down the line to the next person. It is important to remember that it is a path and not a map, which means that it takes time to travel down that path to implement actions. There is a great deal of pressure in the health and care sector. I learnt that, in order to improve quality, this is the gift, with empowerment, engagement and culture being an important part of how we would lead within a placement. I will certainly take that message back and put it into practice on the ward in future, in order to make changes and emphasise the importance of everyone working together and being involved in any action that is taken. Questions must be asked about how to assess, improve safety and improve the service and, as a result, improve experiences. In order to make a difference, I have some ideas for helping new staff on the ward by producing an information booklet and placing an educational notice board on the ward. I learnt a lesson to take back to my workplace, namely that changing and improving quality is a process similar to cooking, and what makes it tasty is collaboration to make something work successfully.

At the end of the two days, I had learnt a great deal. My mind is full of ideas, and I will take them back to my workplace where I work as a New Registered Nurse.

I am very pleased that I entered the #Hellomynameis competition, and will continue with the work of campaigning on the ward. If you are a student nurse or a medical student, you can enter and you could be lucky enough to attend a forum such as this in the future. I am looking forward to attending another forum in the future as part of my work as a nurse. The work of improving the quality of care for patients needs to continue to ensure they have the best care possible. The forum and working with the 1000 Lives staff was extremely inspirational.

Emma Morgan-Williams

Wow! I feel so privileged, honoured and humbled to think that my entry to the “Hello my name is” competition, led to me being given the opportunity to attend this year’s International Forum on Quality and Safety in Healthcare at the Excel London. The speakers were world class and I have to confess to being a little star struck; I had to pinch myself. As a first year nursing student to be able to attend the sessions at such a renowned conference was an honour.

The opening keynote was delivered by Dr Donald Berwick, and Professor Lord Ara Darzi which then was followed by a panel that also included Margaret Murphy, External Lead Advisor for WHO Patients for Patient Safety Programme and Anya De Longh, Self management coach and patient. The panel agreed that greater patient involvement is the way forward.

Another keynote session focussed on ‘Patient Innovators’ and how the impact of technology is creating innovations from patients who proudly shout #WeAreNotWaiting for the mass market to find solutions for their conditions.

Instead these patients are researching, and developing positive solutions through self management to improve their lives and those of others with similar health conditions. I have recently been on an outpatient placement at a diabetic clinic, and I couldn’t wait to share the innovation of Tim Omer, Diabetes Advocate who developed a ‘Tic tac’ glucometer and Artificial Pancreas System. I have shared with colleagues on my placement the innovative work of Sara Riggare, a PhD student at Karolinska Instituet in Sweden and self care expert, who has developed a digital self care mapping tool for the management of her own Parkinson’s disease.

The Friday morning key note was by Jason Leitch, National Clinical Director at The Scottish Government and Derek Feely, President and CEO of IHI, who encouraged us to ask our patients ‘What matters to you?’ This simple concept really inspired me so much that I have since suggested that our Swansea University Student Chapter gets involved in a “What matters to you day 2017”. This simple, yet effective question can help us to provide more holistic and person centred care. As the mother of a child who is deaf I could easily relate; I know if I asked my son “What matters to you?” it wouldn’t be hospital appointments, or hearing aids, it would be football and swimming, demonstrating beautifully that patients are more than just their condition.

One of the real highlights for me was listening to Ingrid Brindle patient of Haughton Thornley Medical Centres and the Chair of Haughton Thornley Patient Participation Group, along with Dr Amir Hannan, GP at Haughton Thornley Medical Centres and Chair of World Health Innovation Summit, who both spoke about the patient #empowerlution – an empowerment revolution. Advocating for full disclosure and individual access to medical records, which they believe will ultimately lead to better patient care.

I also had the opportunity to speak to many people about a variety of issues. These included the 1000 Lives Improvement programmes on Safe staffing levels, sepsis and safer pregnancy campaign to name a few. This opportunity would not have presented itself had I not attended the conference. As a student I made full use of the reading materials which I know I will use in order to build my knowledge and as reference materials for my written assignments.

Listening to Colonel Chris Hadfield, former military test-pilot and astronaut, also gained me a few credibility points with my children, and taught me that the sky really is the limit when delivering quality patient centred care.

Thank you 1000 Lives Improvement for such an amazing experience! I am sure the impact of this conference will carry on throughout the rest of my professional career. I hope that you run a similar competition next year, in order to give another student like myself a learning opportunity that is incomparable to any learning opportunity I have experienced as a student.

Jun 072017
 

Sera Llewelyn Davies

Yn ddiweddar cefais y fraint o fynychu Fforwm Rhyngwladol ar Ansawdd a Diogelwch mewn Gofal Iechyd yn Llundain. Cefais ddewis naw sesiwn i gyd â oedd ymlaen ystod y ddau ddiwrnod. Roeddwn gyda  llawer o ddiddordeb ym mhob un ohonynt, ac felly yn anodd dewis rhai gan fod yna llawer o bethau diddorol ymlaen.

Ar ôl trafeilio o Ogledd Cymru i Lundain ar brynhawn Mercher, mi roeddwn yn edrych ymlaen at fynychu’r fforwm bore Iau. Mi roedd yr adeilad yn llawn o unigolion o bob man o’r byd ac roeddwn yn hynod lwcus i gael dysgu, rhannu syniadau.

Dechreuodd y diwrnod gydag Agoriad o groesawu a chyhoeddiadau gan ddilyn ymlaen i’r sesiwn cyntaf sef ‘International Quality and Safety where are we now and where we going to?’ o dan ofal Donald Berwick ac Lord Darzi. Roedd y sesiwn yn cynnwys beth fydd angen a sut i newid hyn ymhen blynyddoedd.

Wrth fynd i amrywiaeth o sesiynau dros y ddau ddiwrnod, sesiwn â wnaeth sefyll allan oedd yr ail sesiwn ar y dydd Iau, ‘How leaders navigate the way’. Prif beth dysgais o’r sesiwn yma oedd ‘ I’ve got the gift’ sef diwylliant o fewn arweinyddiaeth er mwyn gwella ansawdd ei fod yn anrheg. Mae’r anrheg hynny yn cael ei basio ymlaen lawr llwybr i’r person nesaf. Rhaid cofio mae llwybr ydyw ac nid map, sy’n golygu ei bod yn cymryd amser i fynd lawr y llwybr hynny i roi pethau ar waith. Mae yna bwysau mawr o fewn y maes iechyd a gofal. Dysgais er mwyn gwella ansawdd hyn yw’r anrheg, gyda ‘empoweremnet, engagment + culture’ yn rhan fawr o sut byddem yn arweinio o fewn lleoliad. Byddaf yn sicr mynd ar neges hyn yn ôl drwy ei weithredu ar y ward yn y dyfodol, er mwyn newid rhywbeth a’r pwysigrwydd fod pawb yn gyd weithio ac yn cynnwys pawb yn y weithred. Rhaid cwestiynu ar gyfer sut i asesu, gwella diogelwch, gwella’r gwasanaeth a drwy hynny angen profiadau. Er mwyn gwneud gwahaniaeth syniadau bach ar gyfer helpu staff newydd ar y ward drwy wneud llyfryn gwybodaeth a bwrdd hysbysfwrdd addysgol ar y ward. Dysgais gan gofio mynd ar ddyfyniad hyn yn ôl i le rwy’n gweithio bod newid a gwella ansawdd yn broses fel coginio ar hyn sydd yn rhoi blas yw’r cyd weithio i wneud rhywbeth weithio yn llwyddiannus.

Ar ddiwedd y ddau ddiwrnod, roeddwn wedi dysgu llawer o bethau. Gyda syniadau yn dod yn fyw yn fy meddwl, er mwyn mynd a nhw nôl i’r lleoliad lle rwy’n gweithio fel Nyrs Newydd Gofrestredig.

Rwy’n hynod o falch fy mod wedi ymgeisio am y gystadleuaeth #Helofyenwiydy, gan barhau gyda’r gwaith o ymgyrchu yn y ward. Os ydych yn fyfyriwr nyrsio neu myfyriwr meddygaeth ymgeisiwch ac mi fyddwch yn hynod ffodus o gael fynychu fforwm fel hyn yn y dyfodol. Mewn amser rwy’n edrych ymlaen eto i fynychu yn rhan o’r gwaith fel nyrs. Mae angen parhau gyda gwella ansawdd cleifion er mwyn iddyn nhw gael bob gofal gorau posib. Roedd y fforwm a chyd weithio gyda gweithwyr 1000 o fywydau yn hynod o ysbrydoledig.

Emma Morgan-Williams

Waw! Mae’n fraint ac anrhydedd meddwl bod fy nghais i’r gystadleuaeth “Helo fy enw i ydy…” wedi arwain at y cyfle i fynd i Fforwm Rhyngwladol ar Ansawdd a Diogelwch mewn Gofal Iechyd yn Excel Llundain eleni. Roedd y siaradwyr o’r radd flaenaf ac roeddwn i wedi gwirioni arnynt; roedd yn rhaid imi binsio fy hun. Fel myfyrwraig nyrsio blwyddyn gyntaf roedd yn anrhydedd cael mynd i’r sesiynau mewn cynhadledd mor enwog.

Rhoddwyd y brif araith agoriadol gan Dr Donald Berwick, a’r Athro yr Arglwydd Ara Darzi a ddilynwyd gan banel a oedd hefyd yn cynnwys Margaret Murphy, Cynghorydd Arweiniol Allanol Rhaglen Diogelwch Cleifion ar gyfer Cleifion Sefydliad Iechyd y Byd ac Anya De Longh, hyfforddwr hunanreoli a chlaf. Cytunodd y panel mai sicrhau mwy o gyfranogiad gan gleifion yw’r ffordd ymlaen.

Canolbwyntiodd prif sesiwn arall ar ‘Gleifion sy’n Arloesi’ a sut mae effaith technoleg yn galluogi cleifion i arloesi a gweiddi’n falch #NidYdymYnAros i’r farchnad fawr ddod o hyd i atebion ar gyfer eu cyflyrau.

Yn lle hynny mae’r cleifion hyn yn ymchwilio i atebion cadarnhaol drwy hunanreoli er mwyn gwella eu bywydau a bywydau eraill â chyflyrau iechyd tebyg a datblygu’r atebion hyn. Rwyf wedi bod ar leoliad cleifion allanol mewn clinig diabetig yn ddiweddar, ac nid oeddwn yn gallu aros i rannu arloesedd Tim Omer, Eiriolwr Diabetes a ddatblygodd fesurydd glwcos ‘Tic tac’ a System Pancreas Artiffisial. Rwyf wedi rhannu â chydweithwyr ar fy lleoliad waith arloesol Sara Riggare, myfyrwraig PhD yn Karolinska Instituet yn Sweden ac arbenigwraig hunanofal, sydd wedi datblygu offeryn mapio hunanofal i reoli ei chlefyd Parkinson ei hun.

Roedd y brif araith ar fore dydd Gwener gan Jason Leitch, Cyfarwyddwr Clinigol Cenedlaethol yn Llywodraeth yr Alban a Derek Feely, Llywydd a Phrif Swyddog Gweithredol IHI, a anogodd ni i ofyn i’n cleifion ‘Beth sy’n bwysig i chi?’ Roedd y cysyniad syml hwn wedi fy ysbrydoli cymaint ac ers hynny rwyf wedi awgrymu bod ein Cymdeithas Myfyrwyr Prifysgol Abertawe yn cymryd rhan mewn “Diwrnod beth sy’n bwysig i chi 2017”. Gall y cwestiwn syml, ond effeithiol hwn ein helpu i ddarparu gofal mwy cyfannol sy’n canolbwyntio ar y person. Fel mam plentyn sy’n fyddar gallwn uniaethu â hyn yn hawdd; rwy’n gwybod pe bawn yn gofyn i fy mab “Beth sy’n bwysig i ti?” nid apwyntiadau ysbyty na chymhorthion clyw fyddai’r ateb. Yr ateb fyddai pêl-droed a nofio, gan ddangos yn hyfryd bod cleifion yn fwy na dim ond eu cyflyrau.

Un o’r uchafbwyntiau i mi oedd gwrando ar Ingrid Brindle, claf Canolfannau Meddygol Haughton Thornley a Chadeirydd Grŵp Cyfranogi Cleifion Haughton Thornley, ynghyd â Dr Amir Hannan, meddyg teulu yng Nghanolfannau Meddygol Haughton Thornley a Chadeirydd Uwchgynhadledd Arloesi Iechyd y Byd, a siaradodd y ddau am y claf #empowerlution – chwyldro o ran grymuso. Gwnaethant eirioli ar gyfer datgelu llawn a mynediad unigol i gofnodion meddygol, a fydd, yn eu barn hwy, yn arwain at well gofal cleifion yn y pen draw.

Cefais y cyfle hefyd i siarad â llawer o bobl am amrywiaeth o faterion. Roedd y rhain yn cynnwys y rhaglenni 1000 o Fywydau a Mwy – Gwasanaeth Gwella ar lefelau staffio diogel, sepsis a’r ymgyrch beichiogrwydd mwy diogel i enwi ond ychydig. Ni fyddai’r cyfle hwn wedi codi pe na bawn wedi mynd i’r gynhadledd. Fel myfyrwraig gwnes ddefnydd llawn o’r deunyddiau darllen ac rwy’n gwybod y byddaf yn eu defnyddio er mwyn adeiladu fy ngwybodaeth ac fel deunyddiau cyfeirio ar gyfer fy aseiniadau ysgrifenedig.

Yn ogystal, drwy wrando ar y Cyrnol Chris Hadfield, cyn-beilot prawf milwrol a gofodwr, llwyddais i greu argraff ar fy mhlant, a dysgais nad oes terfyn wrth gyflwyno gofal o ansawdd sy’n canolbwyntio ar y claf.

Diolch 1000 o Fywydau a Mwy – Gwasanaeth Gwella am brofiad mor wych! Rwy’n siŵr y bydd effaith y gynhadledd hon yn parhau drwy gydol gweddill fy ngyrfa broffesiynol. Gobeithio y byddwch yn cynnal cystadleuaeth debyg y flwyddyn nesaf, er mwyn rhoi cyfle dysgu i fyfyriwr arall, cyfle na ellir ei gymharu ag unrhyw beth yn fy mhrofiad i fel myfyrwraig.