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.

Aug 082018
 

Dawn Parry, Paediatric Project Lead

As I walked to a meeting in the Children’s Hospital for Wales recently, I found myself reflecting on how much has happened since I came into post in January, when prior to my current role, I was based at that very hospital.

My nursing career commenced  in 1984 when I started my RGN training in Bangor, North Wales, close to my home town on Anglesey. Upon qualifying, I started as a Staff Nurse on the paediatric unit before obtaining my RSCN in Great Ormond Street in 1989. I then moved to Cardiff where my career has progressed to the present day. I feel I have been fortunate to have insight into paediatric nursing in both rural and urban settings, in tertiary and district general hospitals. This insight has proved invaluable to me in connecting with new colleagues from hospitals across Wales and to understand some of the pressures they experience and the challenges they seek to overcome.

Not all the changes I have seen during my career have been positive, but the introduction of the Nurse Staffing Levels (Wales) Act, 2016 I believe will be one of the most important changes I have witnessed. I consider it to be a positive step for health boards, nursing staff and most importantly, for our children, young people and their families.

The  All Wales Nurse Staffing Programme supports NHS Wales in meeting the requirements of the Nurse Staffing Levels (Wales) Act, which places a legal duty upon health boards and trusts to ensure that they are providing sufficient nurses to allow nurses time to care for patients sensitively.

The role of the paediatric work stream is to devise an evidence based approach to determine appropriate staffing levels within identified paediatric inpatient wards. The approach must be evidenced in the Welsh context and follow a common model of triangulation, which centres on three critical sources of knowledge: patient acuity, quality indicators and professional judgement. To date, 18 inpatient paediatric wards over the five health boards have been involved in capturing the acuity data for the audits on a twice daily basis.

In June this year, we hosted a successful paediatric event where paediatric nurses came together from across Wales to share their knowledge and expertise in reviewing and revising the new draft paediatric Welsh levels of care in preparation for testing on the wards.

My enthusiasm for this project has intensified during this time, due to fantastic reception I have received from colleagues across the whole of Wales and the sense that something very significant can be achieved through collaborative working, forming partnerships and support systems that could potentially transcend the aims of the current project.

Aug 082018
 

Dawn Parry

Wrth i fi gerdded i gyfarfod yn Ysbyty Plant Cymru yn ddiweddar, dechreuais fyfyrio ar faint sydd wedi digwydd ers i fi ddechrau yn y swydd ym mis Ionawr, oherwydd cyn fy swydd bresennol roeddwn yn gweithio yn yr union ysbyty hwnnw.

Dechreuodd fy ngyrfa nyrsio ym 1984, pan ddechreuais fy hyfforddiant RGN ym Mangor, Gogledd Cymru, ger fy nhref enedigol ar Ynys Môn. Ar ôl cymhwyso, dechreuais fel Nyrs Staff ar yr uned bediatrig cyn ennill fy RSCN yn Great Ormond Street ym 1989. Yna, symudais i Gaerdydd lle mae fy ngyrfa wedi mynd o nerth i nerth hyd heddiw. Rwyf wedi bod yn lwcus i gael mewnwelediad i faes nyrsio pediatrig mewn lleoliadau gwledig a threfol, mewn gofal trydyddol ac ysbytai cyffredinol rhanbarthol. Mae’r mewnwelediad hwn wedi bod yn amhrisiadwy i fi wrth gysylltu â chydweithwyr newydd mewn ysbytai ledled Cymru ac i ddeall rhywfaint o’r pwysau sydd arnynt, a’r heriau maen nhw’n ceisio eu goresgyn.

Nid yw’r holl newidiadau yr wyf wedi’u gweld yn ystod fy ngyrfa wedi bod yn rhai cadarnhaol, ond yn fy marn i, bydd cyflwyno Deddf Lefelau Staff Nyrsio (Cymru) 2016 yn un o’r newidiadau pwysicaf yr wyf wedi’u gweld. Rwy’n ystyried hwn yn gam cadarnhaol i fyrddau iechyd, staff nyrsio ac, yn bwysicaf oll, i’n plant, pobl ifanc a’u teuluoedd.

Mae Rhaglen Staff Nyrsio Cymru Gyfan yn cynorthwyo GIG Cymru i fodloni gofynion Deddf Lefelau Staff Nyrsio (Cymru), sy’n gosod dyletswydd gyfreithiol ar fyrddau iechyd ac ymddiriedolaethau i sicrhau eu bod yn darparu digon o nyrsys i roi amser i nyrsys ofalu am gleifion mewn ffordd sensitif.

Rôl y llif gwaith pediatrig yw dyfeisio dull ar sail tystiolaeth er mwyn pennu lefelau staff priodol o fewn wardiau cleifion mewnol pediatrig a amlygwyd. Rhaid rhoi tystiolaeth mewn cyd-destun Cymreig i’r dull, a dylai ddilyn model cyffredin o driongli, sy’n canolbwyntio ar dair ffynhonnell hanfodol o wybodaeth: aciwtedd cleifion, dangosyddion ansawdd, a barn broffesiynol. Hyd yma, mae 18 o wardiau pediatrig cleifion mewnol dros y pum bwrdd iechyd wedi cymryd rhan mewn cofnodi data am aciwtedd ar gyfer yr archwiliadau ddwy waith y dydd.

Ym mis Mehefin eleni, cynhaliom ddigwyddiad pediatrig llwyddiannus lle daeth nyrsys pediatrig ynghyd o bob cwr o Gymru i rannu eu gwybodaeth a’u harbenigedd am adolygu a diwygio fersiwn ddrafft lefelau gofal pediatrig newydd Cymru i baratoi ar gyfer profi ar y wardiau.

Mae fy mrwdfrydedd am y prosiect hwn wedi tyfu yn ystod y cyfnod hwn, yn sgil adborth gwych yr wyf wedi’i dderbyn gan gydweithwyr ledled Cymru, a’r teimlad y gellir cyflawni pethau arwyddocaol trwy weithio gyda’n gilydd, creu partneriaethau a systemau cymorth a all fynd y tu hwnt i nodau’r prosiect presennol.

Jul 312018
 

Amy Howells

During my work placement with the 1000 Lives Improvement team, I have enjoyed a variety of sessions in different areas in the department and have learned about the ways that the team improve outcomes for NHS Wales service users.

My learning around IQT…

A particular highlight for me was discussing IQT training with Keely McCarthy (Improvement Manager) and being able to complete the Bronze level IQT later on that day. I learned about the different levels of IQT training that can be carried out by NHS staff. I felt that the way the levels are taught by enhancing lateral thinking, would greatly improve confidence and teamwork. Using evidence-based practice by collecting data before, during and after small changes were made to departments, helps massively with implementing a change on a larger scale, if successful, and making adjustments if necessary. The most important thing I learned was that any member of NHS staff could take part and implement changes to make improvements to patients and staff-wellbeing. It is great that all staff members can be involved in improving quality, rather than this solely happening at a senior level.

The All Wales Nurse Staffing Programme…

I thoroughly enjoyed my time at the Prince of Wales hospital, where I was able to watch Dawn Parry (Paediatric Project Lead of the All Wales Nurse Staffing Programme) talk to paediatric nurses, doctors and healthcare assistants about patient acuity and the All Wales Nurse Staffing Programme. I was unaware of patient acuity levels (grading patients 1 to 5 based on the level of care needed and the time it takes to provide this care) before spending the morning with Dawn. The importance of correctly grading patients to ensure safe levels of Nursing staff on wards was emphasised in the presentation, and I found the interactive nature of these sessions really interesting and informative. I also spent the day at Singleton Hospital watching Joanna Doyle (All Wales Nurse Staffing Programme Manager) run a Nurse Staffing information day. Different bands of healthcare professionals and other areas of the health board attended this staffing day, and it was extremely interesting to listen to how the All Wales Nurse Staffing Act currently runs in adult acute medical and surgical inpatient divisions.

During the week, I also had some insight into different programmes relating to antimicrobial resistance and healthcare associated infections, which I found very interesting. In meetings with Helen Ronchetti (HCAI Programme Manager) and Paul Gimson (National Primary Care Programme Manager) I learned about the initiatives in community care and within hospitals that aim to reduce the number of healthcare associated infections, and subsequently antimicrobial resistance. Actions including limiting the time that invasive devices such as catheters and cannulas are used for, reducing the over-prescription of medications, including antibiotics, and increasing hydration in the elderly to reduce UTI instances all aim to reduce infections within healthcare. It was interesting to see how these small changes could have a huge impact on healthcare associated infections and antimicrobial resistance.

Jul 312018
 

Amy Howells

Yn ystod fy lleoliad gwaith gyda’r tîm Gwella 1000 o Fywydau, dw i wedi mwynhau amrywiaeth o sesiynau mewn gwahanol feysydd yn yr adrannau ac wedi dysgu am y ffyrdd y mae’r tîm yn gwella canlyniadau ar gyfer defnyddwyr gwasanaeth y GIG yng Nghymru.

Fy nysgu o gwmpas Gwella Ansawdd Gyda’n Gilydd (IQT) …

Uchafbwynt penodol i fi oedd trafod Hyfforddiant IQT gyda Keely McCarthy (Rheolwr Gwelliant) a gallu cwblhau’r IQT lefel Efydd yn ddiweddarach ar y diwrnod hwnnw. Dysgais am y gwahanol lefelau o hyfforddiant IQT y gellir eu gwneud gan staff GIG. Teimlais y byddai’r ffordd y mae’r lefelau’n cael eu dysgu drwy ehangu meddwl ochrol yn gwella hyder a gwaith tîm.  Mae defnyddio arfer ar sail tystiolaeth drwy gasglu data cyn, yn ystod ac ar ôl gwneud newidiadau bach i adrannau, yn help mawr gyda gweithredu newid ar raddfa fwy, os yn llwyddiannus, a gwneud addasiadau os oes angen. Y peth pwysicaf a ddysgais oedd y gallai unrhyw aelod o staff y GIG gymryd rhan a gweithredu newidiadau i wneud gwelliannau i les cleifion a staff. Mae’n grêt bod yr holl aelodau o staff yn gallu bod yn rhan o wella ansawdd, yn hytrach na bod hyn yn digwydd ar lefel uwch yn unig.

Rhaglen Staffio Nyrsys Cymru Gyfan…

Fe wnes i lwyr fwynhau fy amser yn Ysbyty Tywysog Cymru, lle roeddwn yn gallu gwylio Dawn Parry (Arweinydd Prosiect Pediatrig Rhaglen Staffio Nyrsys Cymru Gyfan) yn siarad â nyrsys pediatrig, meddygon a chynorthwywyr gofal iechyd ynglŷn â chraffter a Rhaglen Staffio Nyrsys Cymru Gyfan. Nid oeddwn yn ymwybodol o lefelau craffter cleifion (graddio cleifion o 1 I 5 ar sail lefel y gofal sydd ei angen a’r amser y mae’n ei gymryd i ddarparu’r gofal hwn) cyn treulio’r bore gyda Dawn. Cafodd pwysigrwydd graddio cleifion yn gywir er mwyn sicrhau lefelau diogel o staff nyrsio ar wardiau ei bwysleisio yn y cyflwyniad, a theimlais fod natur ryngweithiol y sesiynau hyn yn ddiddorol a gwybodus iawn. Treuliais y diwrnod hefyd yn Ysbyty Singleton yn gwylio Joanna Doyle (Rheolwr Rhaglen Staffio Nyrsys Cymru Gyfan) yn cynnal diwrnod gwybodaeth Staffio Nyrsys. Mynychodd gwahanol fandiau o weithwyr iechyd proffesiynol a meysydd eraill o’r bwrdd iechyd y diwrnod staffio hwn, ac roedd yn hynod ddiddorol gwrando ar sut mae’r Ddeddf Staffio Nyrsys Cymru Gyfan yn gweithredu mewn adrannau cleifion mewnol meddygol a llawfeddygol dwys i oedolion.

Yn ystod yr wythnos, cefais hefyd fewnwelediad i wahanol raglenni yn ymwneud â gwrthsefyll gwrthficrobaidd a heintiau yn gysylltiedig â gofal iechyd, a oedd yn ddiddorol iawn yn fy marn i. Mewn cyfarfodydd gyda Helen Ronchetti (Rheolwr Rhaglen HCAI ) a Paul Gimson (Rheolwr Rhaglen Gofal Sylfaenol Cenedlaethol) dysgais am y mentrau mewn gofal cymunedol ac o fewn ysbytai sy’n anelu at leihau nifer yr heintiau sy’n gysylltiedig â gofal iechyd ac, yn sgil hynny, gwrthsefyll gwrthficrobaidd. Mae gweithredu sy’n cynnwys cyfyngu ar yr amser y defnyddir dyfeisiadau ymwthiol fel cathetr a chaniwla, lleihau gor-rhagnodi meddyginiaethau, gan gynnwys gwrthfiotigau a chynyddu hydradaeth mewn hen bobl er mwyn lleihau enghreifftiau o Heintiau’r Llwybr Wrinol i gyd yn anelu at leihau heintiau o fewn gofal iechyd. Roedd hi’n ddiddorol gweld sut gallai’r newidiadau bach hyn gael effaith anferth ar heintiau sy’n gysylltiedig â gofal iechyd a gwrthsefyll gwrthficrobaidd.

Jul 182018
 

Owen Hughes Consultant Counselling Psychologist and Head of Pain and Fatigue Management Service, Powys Teaching Health Board

The Q community has opened its doors to new members again and you may be wondering how this community is dissimilar to the other improvement organisations that are available in health. For me, the Q community IS different. It brings together a unique group of people and has led to learning and opportunities that I just haven’t found elsewhere.

In days gone by one could be forgiven for thinking that improvement or organisational development was the sole job of people who were brought in to fix problems. Now, however, it is very much part of the day job for us all. As a clinician and service lead, I am constantly looking for resources and networks to help me come up with ways of meeting the needs of our population, without having to spend more money, and for me the Q community has been a fantastic opportunity to meet some great people and hear some truly inspirational ideas.

The Q community is run by the Health Foundation. It is a network of people who are interested in improving the health and wellbeing in all its facets. Whilst there are many members who work in the field of continuous improvement or organisational development there are also plenty of professionals from health, care and housing and third sector organisations as well as the people using services themselves.

I joined approximately two years ago and almost immediately got involved in the first of the “Q Labs” which was focused on developing peer support. I have always been a fan of people working with their peers to overcome their challenges. People who are willing to share their lived experience can be so powerful but too often peer support schemes have ended prematurely. The Q Lab enabled me to network with a diverse range of people with a huge amount of combined experience and allowed me to learn some better ways forward. To this end we are now working with Digital Communities Wales to help service users become more confident and proficient at using online resources to support their self management.

I have been impressed by the time and thought that has been put into the design of the Q labs. The materials used in the workshop and the way the process has been put together has been so provoking that I have never left an event with anything other than a head full of ideas and contacts. It has really given me pause for thought with regard to the materials I use in workshops and meetings with service users and colleagues and has shown me what an important part that design plays in improvement. They say good design releases dopamine in the brain and it goes some way to explaining why the process feels so worthwhile.

Recently, I have been participating in the Q Exchange process. At the end of the process is the possibility of receiving up to £30,000 to support a project but equally valuable has been the process of putting together the bid with the support and challenge of other members of the Q community. The input of the community has meant that the project has developed from an initial idea to a much more robust concept that may be worthy of funding. The projects that will be funded will be chosen by the community in September after another round of development. If we are lucky enough to be selected I know that there will be further support to maximise its chance of success.

If you are interested in developing your skills in improving services, want to be exposed to new ideas and challenges, and want to be a part of a kind and supportive community then I highly recommend the Q community to you.

Apply today https://q.health.org.uk/join-q/

Jul 182018
 

Owen Hughes Seicolegydd Cwnsela Ymgynghorol a
Phennaeth y Gwasanaeth Rheoli Poen a Blinder, Bwrdd Iechyd Addysgu Powys

Mae cymuned Q wedi agor ei drysau i aelodau newydd unwaith eto, ac efallai eich bod yn meddwl tybed sut mae’r gymuned hon yn wahanol i’r sefydliadau gwella eraill sydd ar gael ym maes iechyd. I fi, mae cymuned Q YN wahanol. Mae’n dod â grŵp unigryw o bobl at ei gilydd ac mae wedi arwain at ddysgu a chyfleoedd nad ydw i wedi dod o hyd iddyn nhw yn unman arall.

Yn y gorffennol, byddai’n ddigon teg meddwl bod gwelliant neu ddatblygu sefydliadol yn gyfrifoldeb i’r bobl sy’n dod i ddatrys problemau yn unig. Fodd bynnag, erbyn heddiw, mae’n rhan o waith beunyddiol pawb. Fel clinigydd ac arweinydd gwasanaeth, rwy’n chwilio am adnoddau a rhwydweithiau o hyd i fy helpu i feddwl am ffyrdd o fodloni anghenion ein poblogaeth heb orfod gwario mwy o arian, ac i fi, mae cymuned Q wedi bod yn gyfle gwych i gwrdd â phobl wych ac i glywed syniadau gwirioneddol ysbrydoledig.

Y Sefydliad Iechyd sydd y tu ôl i gymuned Q. Mae’n rhwydwaith o bobl sydd â diddordeb mewn gwella pob elfen o iechyd a lles. Er bod nifer o aelodau yn gweithio ym maes gwella parhaus neu ddatblygu sefydliadol, mae digonedd o weithwyr proffesiynol o sefydliadau iechyd, gofal, tai a’r trydydd sector yn aelodau, yn ogystal â’r bobl sy’n defnyddio’r gwasanaethau eu hunain.

Ymunais tua dwy flynedd yn ôl, a chymerais ran fwy neu lai yn syth yn y “Q Lab” cyntaf, oedd yn canolbwyntio ar ddatblygu cymorth cymheiriaid. Rwyf wastad wedi hoffi gweld pobl yn gweithio gyda’u cymheiriaid i oresgyn eu heriau. Mae pobl sy’n fodlon rhannu eu profiad bywyd yn gallu bod yn hynod bwerus, ond yn aml iawn, mae’r cynlluniau cymorth i gymheiriaid yn dod i ben yn rhy fuan. Mae’r Q Lab wedi fy ngalluogi i rwydweithio ag ystod amrywiol o bobl sydd â phrofiad helaeth gyda’i gilydd, ac mae wedi fy ngalluogi i ddysgu ffyrdd gwell o symud ymlaen. Felly, rydym bellach yn gweithio gyda Chymunedau Digidol Cymru i helpu defnyddwyr gwasanaethau i fod yn fwy hyderus a medrus wrth ddefnyddio adnoddau ar-lein i’w helpu i hunan-reoli.

Rwyf wedi cael fy mhlesio gan yr amser a’r ystyriaeth a roddwyd i ddylunio’r Q Labs. Mae’r deunyddiau a ddefnyddir yn y gweithdy a’r ffordd y mae’r broses wedi cael ei rhoi at ei gilydd wedi bod mor ysgogol, ac rwyf wedi gadael pob digwyddiad gyda thoreth o syniadau a chysylltiadau. Mae wedi gwneud i fi feddwl am y deunyddiau rwyf’n eu defnyddio mewn gweithdai a chyfarfodydd gyda defnyddwyr gwasanaethau a chydweithwyr, ac mae wedi dangos i fi pa mor bwysig yw dylunio wrth wella gwasanaethau. Maen nhw’n dweud bod dyluniad da yn rhyddhau dopamin yn yr ymennydd, ac mae hynny’n esbonio pam mae’r broses yn teimlo mor fuddiol.

Yn ddiweddar, rwyf wedi bod yn cymryd rhan yn y broses Q Exchange. Ar ddiwedd y broses, ceir posibilrwydd o dderbyn hyd at £30,000 i gefnogi prosiect, ond mae’r broses o roi’r cynnig at ei gilydd gyda chymorth a heriau aelodau eraill cymuned Q wedi bod yr un mor werthfawr. Mae mewnbwn y gymuned yn golygu bod y prosiect wedi datblygu o syniad dechreuol i gysyniad llawer mwy cadarn a allai fod yn deilwng o gyllid. Y gymuned fydd yn dewis y prosiectau a ariennir ym mis Medi, ar ôl rownd arall o ddatblygu. Os byddwn yn ddigon lwcus i gael ein dewis, rwy’n gwybod y bydd rhagor o gymorth ar gael i sicrhau ei fod mor llwyddiannus â phosibl.

Os oes gennych chi ddiddordeb mewn datblygu eich sgiliau gwella gwasanaethau, eisiau syniadau newydd a chael eich herio, ac eisiau bod yn rhan o gymuned garedig a chefnogol, rwyf yn argymell cymuned Q yn fawr.

Jul 112018
 

Kate Mackenzie leading a team trust exercise!

We all know someone who always seems to have boundless energy, a drive that puts Audi to shame. Someone who seems to stuff more into a week than most can in a month – you know the type…the ones with a massively busy job, hectic family with at least 2 dogs and a rescue cat, a baking habit and a highly successful allotment (or amateur dramatics club).

Simply put they are a tour de force (that’s force not France…I won’t stray into cycling analogies). It is precisely these Tours de Force that generally won’t stand for max effort for substandard outcomes and embark upon “sorting things out” or what we like to call “improvement projects”. These are the magicians that yank their metaphorical boots up, declare very loudly that it’s time to change and generally cajole their peers, teams, colleagues to follow suit.

And if that doesn’t work they beg and plead with detractors or pull some supernanny tricks to get them to fall in line (naughty step anyone?). It can be quite a thing to witness.

Problem is that it can quickly become their pet project, their thing, their baby to drive – it is quickly evident in language used “I have to go to a meeting for Chris’ thing” or I need to record some info in Avril’s tool”.

And so for all their success, the Tour de Force worries that it hinges on them being there.

All. The. Time.

And it can. But it needn’t.

Good communication in the early days to make others believe (arghh…the data girl is banging on AGAIN about talking) or identifying another TdF in the midst is a great way of doing a double flanking manoeuvre on the less enthusiastic. It certainly shares the load.

I think great leadership for improvement is about never wavering from your core message, never swaying away from the non-negotiables. Key to the last bit is actually knowing what these are, so that the other stuff, well – let others achieve those in whichever way they choose. Your colleagues are free thinking adults, treat them as such and remember just because you have the drive doesn’t mean you have all the good ideas.

Most importantly drip feed….drip…drip…drip. Same language. Same concepts. If it’s good, it will stick – with or without your presence.

We in 1000 Lives Improvement are always on our own improvement journey, we want to make sure we are using our skills and talents to their best. We had a substantial reboot, 3 years ago heralded by the arrival of an uncompromising English man, very tall, quietly spoken and rather stubborn. He was absolutely insistent about aligning with IHI’s model for improvement and frankly OTT about measurement.

His homeland has come calling and he has answered, leaving our fair and sunny shores. I can’t tell you how many people have asked what will become of 1000 lives improvement without Aidan. Truth is, we know which bits are ingrained in us, which bits still need working on and, of course, there maybe a thing or two that we might revise/quietly let slip.

 

 

 

 

 

It’s an entirely backhanded compliment (but meant in the best possible way) to say “Boss, it’s okay, we don’t need your presence to carry on the great work you started, we got this”

That’s leadership.

Jul 112018
 

Mae pob un ohonom yn adnabod rhywun sydd ag egni diddiwedd, a digon o fynd ynddo i godi cywilydd ar Audi. Rhywun sydd i’w weld yn cyflawni mwy mewn wythnos nag y mae’r rhan fwyaf o bobl yn llwyddo i’w wneud mewn mis – wyddoch chi… y rhai sydd â swydd sy’n gofyn llawer, teulu prysur gydag o leiaf 2 o gŵn a chath achub, yn pobi cacennau’n rheolaidd ac yn cynnal rhandir llewyrchus dros ben (neu glwb drama amatur).

Yn syml, maen nhw’n ‘tours de force’ (‘Force’ nid ‘France’, hynny yw… wna i ddim meiddio dechrau ar y cyffelybiaethau seiclo). Ni fydd y Tours de Force hyn yn derbyn ymdrechu’n galed er mwyn cael canlyniadau o ansawdd is, ac maen nhw’n mynd ati i ddatrys pethau, neu’r hyn yr ydyn ni’n hoff o’i alw’n “brosiectau gwella”. Dyma’r consurwyr sy’n torchi llewys ac yn datgan ar goedd ei bod hi’n hen bryd am newid, ac sy’n annog eu cymheiriaid, eu timau a’u cydweithwyr i wneud yr un fath.

Ac os na fydd hynny’n gweithio, byddan nhw’n ymbil ac yn pledio ar y rhai sy’n eu bychanu, neu’n rhoi cynnig ar hen driciau gwarchodwyr plant i’w hysgogi i’w dilyn (y stepen ddrwg, unrhyw un?). Mae’n gallu bod yn dipyn o sioe.

Y broblem yw y gall droi’n gyflym yn brosiect unigol iddyn nhw, eu ffefryn nhw, eu baban – ac mae hyn yn amlwg yn yr iaith a ddefnyddir – “Mae angen i fi fynd i gyfarfod sy’n trafod peth Chris” neu “Mae angen i fi gofnodi gwybodaeth yn offeryn Avril”.

Felly, ni waeth pa mor llwyddiannus yw’r prosiect, mae’r Tour de Force yn poeni bod angen iddo fod yno i sicrhau ei fod yn parhau.

Drwy’r amser.

Ac efallai bod hynny’n wir weithiau. Ond does dim rhaid iddo fod.

Mae cyfathrebu’n llwyddiannus yn y dyddiau cynnar i wneud i bobl eraill gredu (dyma ni… mae’r ferch data yn mwydro ETO am siarad) neu amlygu Tour de Force arall yn ein plith yn ffordd wych o newid meddwl y rhai sy’n llai brwdfrydig. Yn sicr, mae’n rhannu’r baich.

I fi, y peth pwysig ar gyfer arwain yn dda er mwyn gwella yw cadw at eich neges graidd, a pheidio â gwyro oddi wrth yr hyn nad oes modd cyfaddawdu arno. Yr hyn sy’n allweddol yn y rhan olaf yw gwybod yn union beth yw hynny, fel bod modd i bobl eraill gyflawni’r pethau eraill ym mha ffordd bynnag a ddewisant. Mae eich cydweithwyr yn oedolion sy’n gallu meddwl drostyn nhw eu hunain, felly dylech eu trin yn yr un ffordd, a chofiwch fod gan bobl eraill syniadau da, er mai chi, efallai, sydd â’r holl ysgogiad.

Yn bwysicaf oll, bwydwch nhw fesul dipyn… drip…drip…drip. Yr un iaith. Yr un syniadau. Os ydyn nhw’n dda, byddan nhw’n parhau – p’un a ydych chi’n bresennol ai peidio.

Rydyn ni yng Ngwasanaeth Gwella 1000 o Fywydau ar daith barhaol i wella, ac rydyn ni eisiau sicrhau ein bod yn manteisio’n llawn ar ein sgiliau a’n doniau. Cawsom ein hailwampio’n sylweddol dair blynedd yn ôl dan arweiniad Sais digyfaddawd tal iawn, a oedd yn siarad yn dawel ac yn ystyfnig fel mul. Roedd yn gwbl benderfynol ynghylch unioni â model gwella IHI, ac roedd braidd yn or-frwdfrydig am fesur.

 

 

 

 

 

Yn awr, mae ei famwlad wedi ei alw yn ôl, ac mae’n gadael Hen Wlad ein Tadau. Alla’ i ddim cyfrif faint o bobl sydd wedi gofyn beth fydd hanes gwasanaeth Gwella 1000 o Fywydau heb Aidan. Y gwir amdani yw, rydyn ni’n gwybod pa rannau sydd wedi’u hymgorffori ynom ni, a pha rannau y mae angen rhywfaint o waith arnynt. Wrth gwrs, efallai byddwn yn addasu rhai pethau, neu’n gadael iddyn nhw fynd yn dawel bach.

Er nad yw hyn yn ymddangos fel canmoliaeth, rydym yn ei olygu yn y ffordd orau bosibl: “Bos, mae’n iawn, does dim angen i ti fod yn bresennol i barhau â’r gwaith gwych rwyt ti wedi’i ddechrau, mi fyddwn ni’n iawn”.

Dyna beth yw arwain.

Jul 092018
 

OBS Cymru, the all-Wales collaborative quality improvement project aiming to reduce harm from postpartum haemorrhage, has been shortlisted for two awards this year at the Patient Safety Awards and NHS Wales Awards.

We’ve been getting an update on the project from its two national lead midwives, Elinore Macgillivray and Kathryn Greaves.

 

For anyone who hasn’t heard of OBS Cymru, can you start by giving an overview?

Elinore: Postpartum haemorrhage (excessive bleeding after childbirth) is the second leading cause of direct maternal death in the UK, and accounts for 80% of maternal morbidity.1 in 20 women will experience a postnatal blood loss 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 (PPH) will result in a baby that goes home without its mother. This being so, there was a clear need for quality improvement in the management of PPH, with all the Health Boards in Wales agreeing to take part in the project.

Kathy: PPH is in the top five quality and safety risks identified for every maternity unit in Wales. OBS Cymru – the Obstetric Bleeding Strategy for Wales is a three year national quality improvement project, now in its second year, aiming to reduce harm from PPH. The primary aim of the project is to reduce the number of women suffering a massive obstetric haemorrhage.

How is the project meeting its aims?

Elinore:  Since the project was first launched in November 2016 a number of interventions have been put in place across all Obstetric led labour wards in Wales, and having positive results:

  • Risk Assessment for PPH is now becoming a routine part of the admission process in obstetric led birth settings, leading to increased awareness of and early planning for PPH detection, prevention and management.
  • Early identification by means of Measuring Blood Loss is quickly becoming embedded in practice, with over 90% of women having their postnatal blood loss measured.
  • Multidisciplinary Team Working is improving as a result of the training provided by OBS Cymru teams. Clinicians including Midwives, HCAs, anaesthetists, obstetricians, ODPs, and students working in maternity settings have received OBS Cymru training, and have embraced the 4 stage approach to PPH management.
  • 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. Early data suggests this is leading to a decrease in the administration of blood products for the reason of PPH.

Kathy:   These interventions are supported by a robust system of data collection by local OBS Cymru champion teams, we have a dedicated team in every obstetric led labour ward in Wales.  Local teams utilise this data collection to analysis and establish areas for improvement within their own health boards.  The Champion teams attend national meetings in which clinical examples presented show how the OBS Cymru principles supported resolution and improved outcomes for women.  In addition the Midwives from each of the health boards meet annually to review and share learning and take this back to their health boards to disseminate good practice.

Are you seeing any changes since the project was first launch in May 2016?

Elinore – Early data is showing that now over 90% of women are having their blood loss measured, which empowers clinicians to provide the right treatment to the right women at the right time. Blood product usage due to PPH is also beginning to decrease.

Kathy: OBS Cymru is a live quality improvement project and there are daily conversations about good practice happening in the health boards and about it’s impact on practice.  One health board has incorporated the risk assessment as part of their multidisciplinary handover when reviewing the women in labour so that as a team they know and are aware of any potential risks and make appropriate preparations as a team prior to delivery.  Others have noted a potential risk when using drapes during delivery and the hidden blood loss which is collected.  A simple solution of using the suction tubing during a procedure placed in the drape has fixed this potential to miss the slow steady bleed which goes unrecognised.  These gems of learning are being shared across Wales so that others can benefit from practice examples and our Champion teams are integral to the dissemination of this.  We are absolutely thrilled that the project has been recognised in the Patient Safety and NHS Wales Awards.  We are privileged to have been shortlisted and recognise that we are fortunate to be representing all of Wales maternity services and that this award is for them and their hard work and commitment to the project.

What makes you both so passionate about this project?

Kathy:  It’s always humbling to see the growth in confidence of myself as a practitioner and my midwifery colleagues as a profession and their integral role in managing PPH.  The 4 stage paper work has given midwives an indicative tool that is diagnostic of PPH and that it has formalised defined trigger points for action that supports the team’s situational awareness when managing obstetric bleeding. Everyday midwifery teams go to work intent on doing a good job, this is one tool in their armoury to achieve this day in day out, from Bangor in the North to Carmarthen in the West and Cardiff in the South, once for Wales.

Elinore: It’s a privilege to be involved in a project that is not only improving outcomes for women, but also empowering teams to use the skills they have acquired to have the confidence to provide the right treatment to the right women at the right time. Measured blood loss is becoming a powerful tool for communication during postpartum haemorrhage, improving team working.  An important part of the project is the women’s experience. Our patient survey shows that although PPH can be a frightening experience, women and their birth partners feel confident that they are receiving a high standard of care, which is very pleasing.

Two years into a three year project, what does the future hold for OBS Cymru?

Elinore:  Although we have made great inroads towards improving care during a PPH, we will continue to work on sustaining these changes beyond the lifespan of the project. The OBS Cymru approach to PPH management has now been incorporated into All Wales PROMPT as an integral part of sustaining the principles of risk assessment, measuring blood loss, early MDT involvement, and ROTEM POCT testing. We are also keen to see how the data reflects these changes.

Find out more about OBS Cymru here and follow the conversation on Twitter #OBSCymru

Jul 092018
 

Mae OBS Cymru, prosiect gwella ansawdd cydweithredol Cymru gyfan sydd â’r nod o leihau niwed yn sgil gwaedlif ôl-enedigol, wedi cyrraedd y rhestr fer ar gyfer dwy wobr eleni yn y Gwobrau Diogelwch Cleifion a Gwobrau GIG Cymru.

Rydym ni wedi bod yn cael diweddariad ar y prosiect gan ei ddwy fydwraig arweiniol genedlaethol, Elinore Macgillivray a Kathryn Greaves.

 

Ar gyfer unrhyw un sydd heb glywed am OBS Cymru, allwch chi ddechrau trwy roi trosolwg?

Elinore: Gwaedlif ôl-enedigol (gwaedlif gormodol ar ôl geni plentyn) yw’r ail achos mwyaf o farwolaethau mamol uniongyrchol yn y DU, ac mae’n cyfrif am  80% o farwolaethau mamol. Bydd 1 o bob 20 menyw yn colli dros 1 litr o waed ôl-enedigol, ac ar gyfer 1 o bob 200, bydd gwaedu sy’n bygwth bywyd yn digwydd, sy’n arwain at nifer o ganlyniadau corfforol ac emosiynol niweidiol. Mewn achosion prin (oddeutu unwaith bob 3 blynedd yng Nghymru), bydd gwaedlif ôl-enedigol (PPH) yn arwain at faban yn mynd adref heb ei fam. Gan ystyried hyn, roedd angen amlwg i wella ansawdd rheoli gwaedlif ôl-enedigol, a chytunodd yr holl Fyrddau Iechyd yng Nghymru i gymryd rhan yn y prosiect.

Kathy: Mae gwaedlif ôl-enedigol yn un o’r pum prif risg ansawdd a diogelwch a amlygwyd ar gyfer pob uned famolaeth yng Nghymru. Mae OBS Cymru – Strategaeth Gwaedu Obstetrig i Gymru yn brosiect gwella ansawdd tair blynedd cenedlaethol, bellach yn ei ail flwyddyn, sy’n ceisio lleihau niwed yn sgil gwaedlif ôl-enedigol. Prif nod y prosiect yw lleihau nifer y menywod sy’n dioddef gwaedlif obstetrig enfawr.

Sut mae’r prosiect yn cyflawni ei nodau?

Elinore:  Ers lansio’r prosiect ym mis Tachwedd 2016, mae nifer o ymyriadau wedi cael eu rhoi ar waith ar draws wardiau geni dan arweiniad obstetrig yng Nghymru, gan arwain at ganlyniadau cadarnhaol:

  • Mae asesu risg ar gyfer gwaedlif ôl-enedigol nawr yn dod yn rhan arferol o’r broses dderbyn mewn lleoliadau geni dan arweiniad obstetrig, sydd wedi arwain at ymwybyddiaeth gynyddol o ganfod, atal a rheoli gwaedlif ôl-enedigol a chynllunio’n gynnar ar gyfer hynny.
  • Mae amlygu cynnar trwy fesur colli gwaed yn cael ei ymsefydlu mewn ymarfer, a chaiff faint o waed ôl-enedigol a gollir gan dros 90% o fenywod ei fesur.
  • Mae gwaith tîm amlddisgyblaethol yn gwella o ganlyniad i’r hyfforddiant a ddarparwyd gan dimau OBS Cymru. Mae clinigwyr, gan gynnwys bydwragedd, cynorthwywyr gofal iechyd, anesthetyddion, obstetryddion, ymarferwyr yr adran lawdriniaethau, a myfyrwyr sy’n gweithio mewn lleoliadau mamolaeth, wedi derbyn hyfforddiant OBS Cymru, ac maent wedi defnyddio’r ymagwedd 4 cam i reoli gwaedlif ôl-enedigol.
  • Mae peiriannau profi pwynt gofal ROTEM wedi cael eu gosod ym mhob ward geni yng Nghymru i ganiatáu mynediad at ganlyniadau tolchi cyflym ac arwain rheoli cynhyrchion gwaed. Mae data cynnar yn awgrymu bod hyn yn arwain at ostyngiad mewn rhoi cynhyrchion gwaed yn sgil gwaedlif ôl-enedigol.

Kathy:   Caiff yr ymyriadau hyn eu cefnogi gan system gadarn o gasglu data gan dimau hyrwyddo OBS Cymru lleol, ac mae gennym ni dîm pwrpasol ym mhob ward geni dan arweiniad obstetrig yng Nghymru. Mae timau lleol yn defnyddio’r data a gesglir i ddadansoddi a sefydlu meysydd i’w gwella o fewn eu byrddau iechyd eu hunain. Mae’r timau hyrwyddo yn mynychu cyfarfodydd cenedlaethol lle mae enghreifftiau clinigol a gyflwynir yn dangos sut mae egwyddorion OBS Cymru wedi cefnogi penderfyniadau a chanlyniadau gwell i fenywod.  Yn ogystal â hyn, mae bydwragedd o bob bwrdd iechyd yn cyfarfod yn flynyddol i adolygu a rhannu dysgu, a chyflwyno hyn i’w byrddau iechyd i ledaenu arfer da.

Ydych chi wedi gweld unrhyw newidiadau ers lansio’r prosiect ym mis Mai 2016?

Elinore – Mae data cynnar yn dangos bod faint o waed a gollir gan dros 90% o fenywod yn cael ei fesur, sy’n grymuso clinigwyr i roi’r driniaeth gywir i’r menywod cywir, ar yr adeg gywir. Mae’r defnydd o gynhyrchion gwaed yn sgil gwaedlif ôl-enedigol hefyd yn dechrau gostwng.

Kathy: Mae OBS Cymru yn brosiect gwella ansawdd byw a chynhelir sgyrsiau dyddiol yn y byrddau iechyd am arfer da a’i effaith ar arferion. Mae un bwrdd iechyd wedi ymgorffori asesu risg yn rhan o drosglwyddo amlddisgyblaethol wrth adolygu’r menywod sy’n esgor, fel bod y tîm yn ymwybodol o unrhyw risgiau posibl ac yn gwneud paratoadau priodol fel tîm, cyn i’r menywod roi genedigaeth. Mae eraill wedi nodi risg bosibl wrth ddefnyddio gorchuddion yn ystod  esgor, a’r gwaed cudd a gollwyd sy’n cael ei gasglu. Mae ateb syml, sef gosod y tiwb sugno a ddefnyddir yn ystod gweithdrefn yn y gorchudd, wedi datrys y posibilrwydd o fethu gwaedu araf, cyson, na sylwir arno. Mae’r perlau dysgu hyn yn cael eu rhannu ledled Cymru, er mwyn i eraill allu elwa ar enghreifftiau o ymarfer, ac mae ein timau hyrwyddo yn rhan annatod o ledaenu hyn. Rydym ni wrth ein bodd bod y prosiect wedi cael ei gydnabod yn y Gwobrau Diogelwch Cleifion a Gwobrau GIG Cymru. Mae’n fraint cyrraedd y rhestr fer ac rydym ni’n cydnabod ein bod ni’n ffodus i gael cynrychioli holl wasanaethau mamolaeth Cymru, a bod y wobr hon ar eu cyfer nhw, a’u gwaith caled a’u hymrwymiad i’r prosiect.

Beth sy’n eich gwneud chi’ch dwy mor frwdfrydig am y prosiect hwn?

Kathy:  Mae bob amser yn galonogol gweld twf yn fy hyder i fel ymarferwr, a fy nghydweithwyr bydwreigiaeth fel proffesiwn, a’u rôl annatod o ran rheoli gwaedlif ôl-enedigol. Mae’r gwaith papur 4 cam wedi rhoi offeryn dangosol i fydwragedd sy’n mesur gwaedlif ôl-enedigol yn ddiagnostig, ac mae wedi ffurfioli pwyntiau sbardun penodol ar gyfer gweithredu, sy’n ategu ymwybyddiaeth sefyllfaol y tîm wrth reoli gwaedu obstetrig. Bob dydd, mae timau bydwreigiaeth yn mynd i’r gwaith gyda’r bwriad o wneud gwaith da, a dyma un o’r dulliau sydd ganddyn nhw i allu cyflawni hyn bob dydd, o Fangor yn y gogledd, i Gaerfyrddin yn y gorllewin, a Chaerdydd yn y de, unwaith i Gymru.

Elinore: Mae’n fraint bod yn gysylltiedig â phrosiect sydd nid yn unig yn gwella canlyniadau i fenywod, ond hefyd yn grymuso timau i ddefnyddio’r sgiliau y maen nhw wedi’u caffael i gael yr hyder i ddarparu’r driniaeth gywir, i’r menywod cywir, ar yr amser cywir. Mae mesur colli gwaed yn dod yn offeryn pwerus i gyfathrebu yn ystod gwaedlif ôl-enedigol, sy’n gwella gwaith tîm. Rhan bwysig o’r prosiect yw profiad y menywod. Mae ein harolwg cleifion yn dangos, er y gall gwaedlif ôl-enedigol fod yn brofiad brawychus, mae menywod a’u partneriaid geni yn teimlo’n hyderus eu bod nhw’n derbyn gofal o safon uchel, sy’n rhoi boddhad mawr.

Ar ôl dwy flynedd o brosiect tair blynedd, beth yw dyfodol OBS Cymru?

Elinore:  Er ein bod ni wedi cymryd camau breision tuag at wella gofal yn ystod  gwaedlif ôl-enedigol, byddwn ni’n parhau i weithio ar gynnal y newidiadau hyn y tu hwnt i oes y prosiect. Mae ymagwedd OBS Cymru at reoli gwaedlif ôl-enedigol wedi cael ei hymgorffori yn PROMPT Cymru Gyfan, fel rhan annatod o gynnal egwyddorion asesu risg, mesur colli gwaed, ymwneud cynnar gan dîm amlddisgyblaethol, a phrofi pwynt gofal ROTEM. Rydym ni hefyd yn awyddus i weld sut mae’r data’n adlewyrchu’r newidiadau hyn.

Darganfyddwch fwy am OBS Cymru yma a dilynwch y sgwrs ar Twitter #OBSCymru