May 292019

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

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

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

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

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