1000 Lives Improvement

1000 Lives Improvement is the national improvement programme, supporting organisations and individuals, to deliver the highest quality and safest healthcare for the people of Wales.

Mar 162017
 

The 2017 #HelloMyNameIs student competition asked healthcare students to submit a 500-word reflective piece on where they’ve used the phrase “Hello! My name is…” and how it’s helped their development as a healthcare professional. Our second winner, Sera Llywelyn Davies of Bangor University won on the strength of this submission:


Sera Llywelyn Davies, Bangor University

Hello my name is Sera and I am a third year nursing student at Bangor. A simple statement makes a big difference to patient experiences within the health service. In terms of experience, introducing yourself and generally chatting and communicating with patients is crucially important. You establish an interaction and build a relationship with the patient whilst improving the quality of care. You naturally get to know the patient, which helps with care planning, collaboration and implementing their care. By introducing yourself to patients and their families they feel valued, and uplifted as they feel safe. Being cared for through the medium of Welsh is crucial and the passion to provide a bilingual service for patients is important.  It is important that patients are able to express themselves in their mother tongue.

I reflect on my experience when I was on a clinical placement on a surgical ward. I was charged with caring for a group of patients, where patients receive pre- and post-operative care. At the beginning of duty, I would go around the patients greeting them with a smile … “Good morning, ‘Hello my name is Sera, I’m a nursing student, how are you feeling this morning?”. I felt the warmth between myself and the patient when they talked about their health, life and in general conversation about everyday life. I will focus on a day when a patient came to the bay from recovery after being treated a few hours earlier. The patient’s pain was being managed and he felt uncomfortable following surgery. I introduced myself by saying ‘Hello my name is Sera’ and welcomed the patient to the ward. The patient told me how grateful he was for being able to have a conversation in Welsh. As a nurse it’s important to respect the values and beliefs of patients through dignified care at all times. I explained what was going to happen within the first few hours, for example that a number of observations would be completed such as blood pressure, pulse, temperature, respiratory pulse etc. Secondly, I explained to the patient that he could call me if he needed anything. After ensuring that the patient was settled and content, I went to see to the other patients. As I left the bay, the patient called me to ask for pain relief medication. This demonstrated how important and effective it is to start a conversation with the simple phrase ‘Hello my name is’. It shows that small things make a big difference in relation to the care that patients receive.

The campaign must contine to encourage others to start every conversation with ‘Hello my name is’. Inspired by my experience, this will stay with me throughout my career as a nurse. I would like to see this development being rolled out and used across the health service.

Remember, always introduce yourself and wear your #Helo my name is… ID badge.

Mar 162017
 

Sera Llywelyn Davies, Prifysgol Bangor

Helo fy enw i ydy Sera, rwy’n fyfyrwraig nyrsio trydedd flwyddyn ym Mangor. Mae datganiad syml yn gwneud gwahaniaeth mawr i brofiadau cleifion o fewn gwasanaeth iechyd. O ran profiad, mae cyflwyno eich hun ac yn gyffredinol sgwrsio a chyfathrebu effeithiol gyda cleifion yn holl bwysig. Rydych yn magu rhyngweithio ac adeiladu perthynas rhwng y chi a’r claf gan sicrhau gwella ansawdd. Yn naturiol rydych yn dod i adnabod y claf,ble bydd hyn yn helpu i gynllunio gofal,annog i gyd weithio a gweithredu eu gofal.Wrth gyflwyno eich hunan i’r cleifion a’u teuluoedd maent yn teimlo’n werthfawr,ac yn galonogol drwy deimlo’n ddiogel.Credir fod cael eu gofalu drwy gyfrwng y Gymraeg yn holl bwysig, mae’r angerdd i rhoi gwasaneth dwy ieithog i gleifion yn bwysig.  Mae’n bwysig bod cleifion yn gallu mynegi eu hunain yn eu mamiaith.

Wrth adfyfyrio ar brofiad a ddigwyddodd imi, roeddwn ar leoliad clinigol ar ward llawfeddygol. Cefais ofalu am grŵp o gleifion, ble roedd cleifion yn derbyn gofal tuag at gofal cyn llawdriniaeth, ac ar ôl llawdriniaeth. Ar ddechrau dyletswydd,byddwn yn  mynd o gwmpas y cleifion gan eu cyfarch gyda gwen … “Bore da, ‘Helo fy enw i ydy Sera, rwy’n fyfyrwraig nyrsio, sut ‘ydych yn teimlo bore yma?”. Teimlais y cynhesrwydd rhwng y claf a mi pan roeddent yn siarad am eu hiechyd, eu bywyd ac yn sgwrsio yn gyffredinol am bywyd bob dydd.Canolbwyntiaf ar y diwrnod yma, yn y bae cefais glaf yn dod o adran adferiad ar ôl derbyn triniaeth ychydig oriau ynghynt. Mi roedd y claf dal o dan reolaeth at boen a teimlo’n anesmwyth o’r llawdriniaeth. Cyflwynais fy hunan ‘Helo fy enw i ydy Sera’ a croesawu’r claf i’r ward. Dywedodd y claf wrthai faint o ddiolchgar oeddo am gael sgwrs yn y Gymraeg. Fel rôl nyrs mae’n bwysig sicrhau gwerthoedd a credoau cleifion drwy gofal urddasol bob amser. Eglurais beth oedd yn mynd i ddigwydd o fewn yr oriau cyntaf er enghraifft angen cyflawni nifer o arsylwadau megis pwysau gwaed, pỳls, tymheredd, curiad resbiradol ac ati. Yn ail, eglurais wrth y claf iddo alw arnai os bydd ef angen rhywbeth. Ar ôl sicrhau bod y claf yn gartrefol ac yn fodlon, roeddwn wedi mynd at gweddill o’r cleifion. Wrth fynd allan o’r bae, roedd y claf wedi galw arnaf angen i gael meddyginiaeth tuag at boen. O’r sefyllfa yma,dangoswyd pa mor bwysig ac effeithiol yw dechrau sgwrs gyda’r frawddeg syml ‘Helo fy enw i ydy’. Dangosir fod pethau bychain yn gwneud gwahaniaeth mawr o fewn gofal mae’r cleifion yn eu derbyn.

Rhaid parhau i ymgyrchu ac annog eraill i ddechrau bob sgwrs gyda Helo fy enw i ydy. Yn ysbrydoledig a drwy brofiad, mi fydd hyn yn parhau imi drwy gydol fy ngyrfa fel Nyrs. Hoffwn i weld y datblygiad yma yn ehangu ac yn cael ei ddefnyddio ar draws y gwasanaeth iechyd.

Cofiwch,gyflwyno eich hunain bob amser a gwisgwch eich bathodyn adnabod #Helo fy enw i ydy…

Mar 162017
 

The 2017 #HelloMyNameIs student competition asked healthcare students to submit a 500-word reflective piece on where they’ve used the phrase “Hello! My name is…” and how it’s helped their development as a healthcare professional. Our first winner, Emma Morgan-Williams of Swansea University won on the strength of this submission:


Emma Morgan-Williams, Swansea University

I first became aware of Dr Kate Granger’s ‘Hello my name is’ campaign during the initial lectures I attended at Swansea University. I knew that at some point during my forthcoming placements I would use the phrase, however, I was not expecting it to become one of the very first things I would say.

On the very first day, of my very first ward placement within a local hospital I had the opportunity to use and slightly adapt the phrase ‘Hello my name is’, personally feeling more comfortable with ‘Hiya, I’m Emma’.

My mentor gave me the opportunity to assist in the personal care of a patient who was on end of life pathway. As we entered the patients room my mentor spoke to the family. Before even thinking, the words ‘Hiya I’m Emma, I’m a student nurse. Would you mind if I helped my mentor?’ came out of my mouth.  The family gave permission for me to help, as due to the medication that the patient was having he was not in a position to do so. Even though they had granted me permission, I gave them a further opportunity to change their mind; I did not want them to feel obligated in allowing me to assist. Understanding this was a difficult time for them, I would not have been offended if they had wanted a more experienced pair of hands to care for their Dad at this time.

The simple use of ‘Hiya, I’m Emma’ gave me an instant opening for a conversation with the family. Had I not introduced myself properly I might never have been told how my patient had spent many years working within a hospital setting. I would never have known of his fondness for students. Nor would I have learnt how his daughter thought that it was very fitting that a student was there helping him in his last days. ‘Hiya I’m Emma’ helped me to feel more confident in caring for my patient. ‘Hiya I’m Emma’ meant enabled me to learn more about my patient, due to conversations I subsequently had with the patient’s family. I learnt that he had a nickname that he liked to be called, whereas he hated the name printed on his chart. I found that this aided me when attending to personal care to address the patient with a familiar name. This is something I might never have known if I had not taken the time to introduce myself properly.

This My variation of Dr Kate Granger’s ‘Hello my name is’, ‘Hiya, I’m Emma’ enabled the patient’s family to feel that they could speak to me, that I was approachable and open. This simple introduction made me feel more confident approaching the patient’s family and assisting in the care of the patient. I have used ‘Hiya, I’m Emma’ daily since; I am sure that it will follow me through each and every placement and through the rest of my career.

Mar 162017
 

Emma Morgan-Williams, Prifysgol Abertawe

Y tro cyntaf i mi glywed am ymgyrch ‘Helo fy enw i ydy’ Dr Kate Granger oedd yn fy narlithoedd cyntaf ym Mhrifysgol Abertawe.  Roeddwn yn gwybod y byddwn yn defnyddio’r ymadrodd rhywbryd yn ystod fy lleoliadau, ond nid oeddwn wedi meddwl mai dyma fyddai un o’r pethau cyntaf y byddwn yn ei ddweud.

Ar fy niwrnod cyntaf un, ar fy lleoliad cyntaf ar ward mewn ysbyty lleol, cefais y cyfle i ddefnyddio ac addasu ychydig ar yr ymadrodd ‘Helo fy enw i ydy’; yn bersonol, roeddwn yn teimlo’n fwy cyfforddus yn dweud ‘Haia, Emma ydw i’.

Cefais gyfle gan fy mentor i gynorthwyo gyda gofal personol claf a oedd ar y llwybr diwedd oes.  Wrth fynd i mewn i ystafell y claf fe siaradodd fy mentor gyda’r teulu.  Cyn i mi gael cyfle i feddwl, dywedais y geiriau ‘Haia, Emma ydw i, dwi’n fyfyrwraig nyrsio.  A fyddai’n iawn i mi helpu fy mentor?’.  Cefais ganiatâd y teulu i helpu,  oherwydd ni allai’r claf roi caniatâd o ganlyniad i’r feddyginiaeth yr oedd yn ei derbyn.  Er eu bod wedi rhoi caniatâd i mi, rhoddais gyfle pellach iddynt newid eu meddwl; nid oeddwn eisiau gwneud iddynt deimlo rheidrwydd i mi gael cynorthwyo.  Oherwydd ei fod yn gyfnod anodd iddynt, byddwn wedi deall yn iawn pe byddai’n well ganddynt gael dwylo mwy profiadol i ofalu am eu Tad yn y cyfnod hwn.

Roedd defnyddio ‘Haia, Enw ydw i’, yn ffordd naturiol o ddechrau sgwrs gyda’r teulu.  Pe na fyddwn wedi cyflwyno fy hun yn iawn efallai na fyddwn wedi canfod bod fy nghlaf wedi treulio blynyddoedd lawer yn gweithio mewn ysbyty.  Ni fyddwn wedi clywed am ei hoffter o fyfyrwyr.  Ni fyddwn ychwaith wedi dysgu gan ei ferch y byddai wedi credu ei bod yn briodol i fyfyriwr ei gynorthwyo yn ystod ei ddyddiau olaf.  Roedd dweud ‘Haia, Emma ydw i’ wedi gwneud i mi deimlo’n fwy hyderus yn gofalu am fy nghlaf.  Roedd ‘Haia, Emma ydw i’ yn fy ngalluogi i ddysgu mwy am fy nghlaf, drwy’r sgyrsiau dilynol a gefais gyda theulu’r claf.  Dysgais beth oedd y llysenw yr hoffai i bobl ei alw, a’i fod yn casáu’r enw a oedd ar ei siart.  Roedd hyn yn fy helpu i gyfeirio at y claf gydag enw cyfarwydd wrth roi gofal personol iddo.  Mae’n bosibl na fyddwn wedi cael gwybod hyn oni bai fy mod wedi cyflwyno fy hun yn iawn.

Roedd fy amrywiaeth i ar ymadrodd ‘Helo fy enw i ydy’ Dr Kate Granger, ‘Haia, Emma ydw i’ yn galluogi’r teulu i deimlo y gallant siarad gyda mi, fy mod yn gyfeillgar ac yn agored.  Rhoddodd y cyflwyniad syml hwn fwy o hyder i mi siarad gyda theulu’r claf a chynorthwyo gyda gofal y claf.  Rwyf wedi defnyddio ‘Haia, Emma ydw i’ bob dydd ers hynny; rwy’n siŵr y bydd yn fy nilyn ymhob lleoliad ac am weddill fy ngyrfa.

Feb 032017
 

Kathryn Greaves, National Project lead for the Safer Pregnancy Campaign

I will always remember the midwife who diligently guided me through my pregnancy, mindful of the pitfalls and tribulations I would encounter on my way.  When I developed pre eclampsia in the later stages of pregnancy and my husband (a serving soldier at the time) was away filling the gaps created by the ambulance strike in 1990, I will always remember the care and consideration of my doctors in taking good care of me in his absence.  When she arrived safely in the August I don’t think I appreciated how lucky I was to hold my healthy baby girl.

A beautiful bouncing baby is what we all expect these days when we become pregnant.   We live in a world where people assume all will be ok. Of course happy healthy mothers and babies is why we specialise in professions such as Midwifery and Obstetrics.  We know the pitfalls, we know the associated problems with pregnancy and childbirth, and we all know it’s only normal after the event.

Pregnancy and childbirth are everyday physiological events, but in today’s world where not all of us are in the peak of physical health and wellbeing, not everyone is ready for the trials of pregnancy.

Helping women and the wider community understand the need for pre-conceptual preparations for pregnancy is something we are all striving to create but worried we will never quite achieve.  The reality is that women arrive pregnant with a number of health and social issues that we need to support and manage together in pregnancy.

Not all pregnancies make it to full term.  Understanding and, more importantly, supporting women to understand some of the factors that could ensure a healthy safer pregnancy are key in addressing awareness of known risk factors to fetal loss.

There have been number of publications from the Welsh Government such as the Welsh Government Maternity Strategy Report from the Quality and Safety Sub-Group June 2013 and A Maternity Network for Wales July 2013, raising the importance for Wales in addressing the crushing effects of losing a baby.  The Maternity Network Wales have been driving a collective response to addressing these issues to ensure a collective shared responsibility between health professionals, the women and their families.

We need to work with women and the wider community to raise awareness about the loss of a baby and why some of the choices we make as women may affect the outcome of a pregnancy. Raising awareness and having difficult conversations with women is the only way that we can affect and hope to reduce the number of babies lost every year.  We are all using the GAP/GROW package to monitor the growth of babies. We must be honest with women about their personal health factors and supporting them gently to understand their own personal risks.

So how are we going to do this?

The Maternity Network, in collaboration with 1000 Lives Improvement are launching a “National Safer Pregnancy” campaign on the 28 March 2017 to introduce a bundle of care including resources for women and health professionals that will do what it says on the tin “raise awareness” and bring to the public arena health choices and factors influencing safer pregnancy.

We have a collective responsibility in ensuring that women and professionals have the right platform to address issues that affect healthy pregnancies. As National Project lead for the Safer Pregnancy campaign, I feel a great sense of pride in the work and input by the Health Boards and supporting partners in creating a bundle of care to share with the wider community. And after two years of collaborative work we are ready to share and work with our families as equal partners in taking responsibility for the protection of our babies.


The Safer Pregnancy Campaign page launches 28 March. Contact Kathryn at Kathryn.Greaves2@wales.nhs.uk

If you have any concerns during your pregnancy speak to your midwife immediately. For more information on what you can do during pregnancy read the “Your pregnancy and baby guide”

Useful links:

Feb 032017
 

Kathryn Greaves, Arweinydd Prosiect Cenedlaethol yr Ymgyrch dros Feichiogrwydd Mwy Diogel

Byddaf wastad yn cofio’r fydwraig a’m tywysodd yn ofalus drwy fy meichiogrwydd, gan roi sylw i’r peryglon a’r anawsterau y byddwn yn eu hwynebu ar y daith.  Pan ddatblygais gyneclampsia yn ystod camau diweddarach fy meichiogrwydd tra roedd fy ngŵr (milwr ar y pryd) oddi cartref yn llenwi’r bylchau a grëwyd gan y streic ambiwlans yn 1990, byddaf wastad yn cofio’r gofal da a’r sylw a gefais gan fy noctoriaid ac yntau’n absennol.  Pan anwyd fy merch yn ddiogel ym mis Awst nid wyf yn credu fy mod wedi gwerthfawrogi pa mor lwcus oeddwn i o fod yn cydio yn fy merch fach iach.

Y dyddiau hyn rydym i gyd yn disgwyl rhoi genedigaeth i glamp o fabi mawr braf pan fyddwn yn feichiog.   Rydym yn byw mewn byd lle mae pobl yn cymryd yn ganiataol y bydd popeth yn iawn. Wrth gwrs, mamau a babanod iach a hapus yw’r rheswm pam rydym yn arbenigo mewn proffesiynau megis Bydwreigiaeth ac Obstetreg.  Rydym yn ymwybodol o’r peryglon, rydym yn ymwybodol o’r problemau sy’n gysylltiedig â beichiogrwydd a geni plentyn, ac rydym i gyd yn gwybod mai ar ôl y digwyddiad yn unig y gellir dweud ei fod yn normal.

Mae beichiogrwydd a genedigaeth plentyn yn ddigwyddiadau ffisiolegol beunyddiol, ond y dyddiau hyn, pan nad yw pob un ohonom ar ein gorau o ran ein hiechyd corfforol a lles, nid pawb yn barod am dreialon beichiogrwydd.

Rydym i gyd yn ymdrechu i helpu menywod a’r gymuned ehangach i ddeall yr angen i baratoi ar gyfer beichiogrwydd cyn cenhedlu, ond yn poeni na fyddwn yn cyflawni hynny’n llwyr.  Y realiti yw bod menywod yn beichiogi gyda nifer o faterion iechyd a chymdeithasol y mae angen i ni eu cefnogi a’u rheoli gyda’n gilydd yn ystod beichiogrwydd.

Nid pob beichiogrwydd sy’n cyrraedd y cyfnod llawn.  Mae deall ac, yn bwysicach, cefnogi menywod i ddeall rhai o’r ffactorau a allai sicrhau beichiogrwydd iachach a mwy diogel yn allweddol wrth fynd i’r afael ag ymwybyddiaeth o ffactorau risg hysbys mewn perthynas â cholli ffetws.

Cyhoeddwyd nifer o ddogfennau gan Lywodraeth Cymru megis  Adroddiad Strategaeth Famolaeth Llywodraeth Cymru gan yr Is-grŵp Ansawdd a Diogelwch Mehefin 2013 a Rhwydwaith Mamolaeth i Gymru Gorffennaf 2013 yn nodi pwysigrwydd mynd i’r afael ag effeithiau lloriol colli babi.  Mae Rhwydwaith Mamolaeth Cymru wedi bod yn arwain ymateb ar y cyd i fynd i’r afael â’r materion hyn i sicrhau bod gweithwyr iechyd proffesiynol, y menywod a’u teuluoedd yn rhannu’r cyfrifoldeb.

Mae angen i ni weithio gyda menywod a’r gymuned ehangach i godi ymwybyddiaeth ynglŷn â cholli babi a pham y gallai rhai o’r dewisiadau a wnawn fel menywod effeithio ar ganlyniad beichiogrwydd. Codi ymwybyddiaeth a chael sgyrsiau anodd â menywod yw’r unig ffordd y gallwn effeithio ar hyn a gobeithio y gallwn leihau nifer y babanod sy’n marw bob blwyddyn.  Rydym i gyd yn defnyddio’r pecyn GAP/GROW i fonitro twf babanod. Mae’n rhaid i ni fod yn onest â menywod ynglŷn â’u ffactorau iechyd personol a’u cefnogi i ddeall eu risgiau personol eu hunain.

Felly sut mae cyflawni hyn?

Mae’r Rhwydwaith Mamolaeth, mewn cydweithrediad â 1000 o Fywydau – Gwasanaeth Gwella yn lansio ymgyrch genedlaethol “Beichiogrwydd Mwy Diogel” ar 28 Mawrth 2017 i gyflwyno bwndel gofal, sy’n cynnwys adnoddau i fenywod a gweithwyr iechyd proffesiynol a fydd yn cyflawni’r hyn a ddywedir ary label, sef “codi ymwybyddiaeth” a sicrhau bod y dewisiadau a’r ffactorau iechyd sy’n dylanwadu ar feichiogrwydd mwy diogel yn hysbys i’r cyhoedd.

Mae gennym gyfrifoldeb ar y cyd i sicrhau bod menywod a gweithwyr proffesiynol yn cael y llwyfan cywir i fynd i’r afael â materion sy’n effeithio ar feichiogrwydd iach. Fel Arweinydd Prosiect Cenedlaethol yr ymgyrch dros Feichiogrwydd Mwy Diogel, mae gwaith a mewnbwn y Byrddau Iechyd a phartneriaid cefnogi wrth greu bwndel o ofal i’w rannu â’r gymuned ehangach yn destun balchder sylweddol i mi. Ac ar ôl dwy flynedd o waith ar y cyd rydym yn barod i rannu a chydweithio â’n teuluoedd fel partneriaid cyfartal wrth gymryd cyfrifoldeb am ddiogelu ein babanod.


Mae tudalen ymgyrch Beichiogrwydd Mwy Diogel yn cael ei lansio ar 28 Mawrth. Cysylltwch â Kathryn ar Kathryn.Greaves2@wales.nhs.uk

Os oes gennych unrhyw bryderon yn ystod eich beichiogrwydd siaradwch â’ch bydwraig ar unwaith. Am ragor o wybodaeth ynglŷn â’r hyn y gallwch ei wneud yn ystod beichiogrwydd, darllenwch “Eich canllaw i feichiogrwydd a’ch baban”

Dolenni defnyddiol:

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