We catch up with Evie Lightfoot, District Nurse from Hywel Dda University Health Board on winning the RCN in Wales Nurse of the Year 2018 and the role Quality Improvement has played in her work.
Evie has developed training to help community nursing staff recognise sepsis in patients.
What does this award accolade mean to you personally and professionally?
I am so privileged to have won this award. At times I felt like giving up as it was quite a lonely journey, juggling the role of being a working single mum of 3 children with a District Nursing caseload and a research internship!
Receiving the award and recognition for my passion and dedication has made it all worthwhile and will hopefully encourage others to get involved in a project that they are passionate about.
The purpose and drive was to improve patient safety and recognition of sepsis and appropriate escalation in the community, by doing this it has enhanced the nursing teams’ knowledge, and skills, and helps to empower them to escalate appropriately.
I hope it has also raised the profile of District Nursing, improving the understanding of the important and often complex role that we have in delivering home based care, highlighting how the role of the District Nurse has evolved into a multi-faceted job caring for patients and their families with often unpredictable and complex health care needs.
On a personal note, winning the RCN in Wales Nurse of the year award 2018 and the RCN Community Nurse of the year award has been very exciting and a great honour. It has given me a platform from which to work with others to promote the role of Community Nurses in the quest to improve patient care. It has brought new opportunities and experiences which will broaden my knowledge and increase my confidence, helping to open up new possibilities for my future career. I am very privileged to have been given this opportunity.
Where did your journey begin?
My journey began almost 7 years ago when I started working as a community nurse. I had previously been employed as a junior sister in A&E and had ITU experience, so was used to assessing unwell patients using NEWS – National Early Warning Scoring System and Sepsis screening.
It was apparent to me straight away that community nurses did not have the appropriate training / education to recognise a deteriorating patient. NEWS observations were not performed in the community and staff had not had any Sepsis education training. Nor did they have the correct equipment to carry out a full set of observations.
I tried to voice my concerns which wasn’t easy, as at this time it wasn’t recognised that Sepsis was a problem in the community or that there was a need for community nurses to perform NEWS observations. This left me feeling frustrated.
I completed my SPQ District nursing degree and went on to do a research internship where my project was to establish District Nurses current knowledge of sepsis and appropriate escalation. I wrote a bespoke community sepsis education package which I delivered with the help of a colleague from the 1000 lives team. We delivered the training to over 100 nurses across Carmarthenshire, the plan was to then re questionnaire them 3 months later.
This initial project was a catalyst and it uncovered lots of issues that needed to be addressed in order to improve patient safety.
What were some of the challenges along the way and how did you overcome them?
It has been a constant challenge and still is!
There were initial concerns that if I delivered sepsis awareness education and NEWS observations to community nurses that they would suddenly escalate inappropriately and that here would be a large queue of people outside GP surgeries and A&E. It was also suggested that you didn’t need a score to know if someone was sick.
So I have had to reassure and explain that although NEWS is a valuable tool to detect deterioration and possible sepsis, it does not replace a practitioner’s clinical judgement it, is there to support and enhance it.
The NEWS system is also a common communication language used by the Welsh ambulance service and secondary care. This means that for Community and Primary care if you need to escalate a patient who is deteriorating the use of NEWS will help the process.
Even at an early stage there were practical obstacles such as finding venues to teach, to try and get staff to attend due to staffing problems and even down to the equipment and having to transport and carry a heavy TV and trolley to venues!.
I have worked closely with Chris Hancock and the 1000 lives acute deterioration team for many years involved in the National Out of Acute Hospital RRAILS group as well as Health board Out of acute hospital work.
The support that I have received from 1000 lives has been pivotal to the success of my work, they have been a fantastic team to be involved with and to help drive my initiative.
They continue to be a team that I liaise and meet with frequently to help drive forward the acute deterioration work in the community and I am excited and proud to be involved with the official launch of NEWS into Community nursing this March.
Would you recommend the Quality Improvement approach to others looking to make a change? And what do you think is key to sustaining improvement?
Yes using a QI approach allows a structured system, it prompts you to collect data and see what is working or not, and what needs to be changed. I only wish I had done this from the beginning of the project more diligently, but It’s all a learning process I guess.
I have learnt that with the best will in the world giving education and tools isn’t enough. You have to evaluate what change has taken place to inform future practice.
For it to succeed you can’t be precious, It’s imperative to share ideas and get other people on board so that the change can be embraced by others to ensure that it gains ownership and sustainability to be embedded into practice.
Do you have a plan for building on your success?
I am still collecting data, so currently success for me is measured by the feedback that I am receiving from staff and patients. The Community SBAR tool is going to be launched officially, this will then allow me to measure the outcomes of when patients care is escalated in the community. To evidence the good work that is being done by community nurses.
I am also hoping that with the launch of NEWS nationally on March 21st this will further help to embed best practice within the community nursing teams in HDUHB and nationally.
I am hoping that NEWS and the SBAR approach will be embraced into Primary Care with many interested already from care homes and GP practices.
I have recently set up a task and finish group to redesign our transfer of care document so that it contains more pertinent information that is needed, such as NEWS score, if a DNA CPR is in place etc. This will hopefully improve communication between secondary and community care. The plan is for the document could be used on transfer from hospital or from a care setting or form community, rather than just a discharge letter.
I am also very interested in doing a project in the future to look at post sepsis care and support of patients in the community.
I am currently undertaking further Quality Improvement work to establish how well the NEWS is being embraced by the community nursing teams and to be able to measure the outcomes.
What words of encouragement would you offer to others starting on an improvement journey?
I believe that it’s important to have a strong defined aim of what you are trying to achieve and why, you must keep this in mind throughout the process, to help keep your motivation up and to prevent you deviating.
If your idea to implement change is backed with integrity and a strong desire to improve patient care and the practice then you are on the right track.
Make sure your idea is evidence based and that it is something you are passionate about. You have to gain thick skin and broad shoulders, not everyone will like or agree with your ideas, it’s about developing coping strategies and enhancing communication skills to deal with it!
Learn from the hurdles and obstacles, celebrate the successes even when they small, keep knocking on doors as networking with others is the key to success.