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.

Oct 282019
 

Gofal Clefyd Niwronau Motor De Cymru / South Wales Motor Neurone Disease Care NetworkLast month, Swansea Bay University Health Board UHB, Cardiff and Vale UHB, Aneurin Bevan (UHB), Cwm Taf Morgannwg UHB and Hywel Dda UHB were one of the nine winners of the NHS Wales Awards 2019 for ‘providing services in partnership across NHS Wales.’

We speak to Dr Idris Baker, Consultant in Palliative Medicine and co-director of the award-winning South Wales Motor Neurone Disease Care Network.

What is your experience with improvement?

We got started with improvement because we were all aware of problems that needing fixing, of something that needed improving. Although we got involved at different stages, each of us could see that care for people with Motor Neurone Disease (pwMND) was great in places but lacking in other places. It was patchy and inequitable. For pwMND in South Wales, as in many parts of the UK, there were wide variations in access to well-coordinated care.

How did you get started?

We started by understanding where we were and the strengths of that starting point. We had patients and families wanting to work with us to improve things. The right expertise to provide good care was in place, there was interest in spreading it more equitably across the region, and there were willing partners in the statutory and – crucially – voluntary sectors.

Voluntary sector support brought initial investment, peer learning from other regions and political capital. User involvement helped to make sure we were focusing on what was needed, not just on what seemed obvious to us.

We built coalitions of interest across South Wales.  For instance, we harnessed the voluntary sector’s support by showing commitment to improve and to help deliver some of their aims.  We got the interest of acute hospitals by showing that well-coordinated care reduces unnecessary admissions and interventions.  With each potential partner we were able to identify their interest in MND and show how the improvements we aimed at could address that interest.  We were able to find substantial areas where the different parties interests were sufficiently closely aligned that they could work together to achieve the same improvements.

How are you using improvement today?

Today we continue to seek improvement.  We know that although there is much less inequity than when we started, there is still some.  People in some parts of the region are still more easily able to access some interventions.  And while provision is more equitable, that does not mean it is good enough.  We are using available measurements – measures of outcomes and experience and standard national audit tools – to identify where things can be improved further and to demonstrate that improvement when we have been able to act.  The user involvement element of that is important, and although we get lots of spontaneous positive feedback we actively seek out comments about what we could do better or what we need to change next.

Some barriers are harder to overcome, but we have learnt that we don’t need to win every time.  Each success, each improvement, has followed a few failed attempts so we have learnt to see those failures as merely a deferral of success.

Gofal Clefyd Niwronau Motor De Cymru / South Wales Motor Neurone Disease Care NetworkWhat value has improvement brought to your team?

Each of us has taken huge satisfaction from being involved in this.  We have learnt, and have found ways to apply that learning to other aspects of our work; we have enjoyed seeing the benefits our patients experience, even when they don’t know how things were before; and we have enjoyed being able to share that learning with others in the region and across the country.  Simply being involved in people’s care is deeply satisfying, but we have found that improving the care they get multiplies and deepens the satisfaction we get from our work.

What we experience working together is a scaling up of the individual satisfaction that comes from seeing things improve.  We’re able to celebrate each other’s success.

What would you say to anyone else getting started with improvement?

Ask yourselves some key questions. We knew where we were starting from but it took us a while to work out how to broaden the interest in improving it:

  • What is it that needs to improve?
  • What allies can you find and why are they interested?
  • What gaps are there in your own knowledge of the field or of improvement?
  • Who can you enlist to plug these gaps?
  • How can you harness their interest, how can you help them see that your improvements will help them and how can they support you?

Involve users early on. Work out what needs to change and – just as importantly – what things you should keep the same. Test ideas for change and test the implementation of the changes you make.  And whatever changes you consider, remember that some groups of people find it harder to access health care.  So ask yourself whether your ideas will tend to help with that, to narrow the gaps in access, or whether the changes would make it easier for people like us, people who already have the easiest access to services.  Your user involvement will help with that.  Our focus has been on people with a rapidly worsening disability who are losing their voice and living with a condition no one seems to know about, all things that tend to make access to care harder, and we’ve consulted users on whether our changes make it easier for them.

Build alliances everywhere you can.  Think laterally about which parts of your organisation might be interested in your approach, which other organisations, or which charities or social care organisations or businesses or anyone at all.  We have a small core team, just a handful of colleagues, but we’ve been able to build a network of hundreds of people and scores of statutory and voluntary organisations because we spotted that they all have an interest in getting this care right.

Don’t be too ambitious to start with. It’s fine to have huge ambitions but you want to understand what small steps you might be able to take, what small improvements might come early on, and you want to get used to not succeeding first time every time.

Reflect on where you went wrong, and if you can see a better approach, change to that.  We’ve got plenty of things wrong. We’ve had to learn to regroup and change tack and we’ve found we sometimes succeed the next time.  Either way you can learn from your failures. Give yourself and your team permission to fail.  Failing is much better than not trying.

Use data. Find the data that shows what needs to improve and work out how you will demonstrate the improvement you make.  If you don’t know how to find and use the data you need, find people who know and can help you.  Ask the improvement teams in your organisation. Don’t be daunted by what you don’t know or can’t do; using data is not always as complicated as it first seems. We’ve needed to find experts in outcome measures, in psychological measures, we’ve needed to get involved in national audits to harness their measurement power even though parts of them are a bit tedious, and we’ve started working with people running national databases so that we can compare populations.

And finally, remember that there is always something to do next.  Look for the next thing.  You will achieve improvement, but you will never finish. Celebrate, but don’t stop.


Read about the Award entry here

Oct 282019
 

Gofal Clefyd Niwronau Motor De Cymru / South Wales Motor Neurone Disease Care Network Fis diwethaf, enillodd Bwrdd Iechyd Prifysgol Bae Abertawe, Bwrdd Iechyd Prifysgol Caerdydd a’r Fro, Bwrdd Iechyd Prifysgol Aneurin Bevan, Bwrdd Iechyd Prifysgol Cwm Taf Morgannwg, a Bwrdd Iechyd Prifysgol Hywel Dda un o’r naw o wobrau yng Ngwobrau GIG Cymru 2019 am ‘ddarparu gwasanaethau mewn partneriaeth ar draws GIG Cymru.’

Siaradwn â Dr Idris Baker, Ymgynghorydd Meddygaeth Liniarol a chyd-gyfarwyddwr Rhwydwaith arobryn Gofal Clefyd Niwronau Motor De Cymru.

Beth yw’ch profiad chi o waith gwella?

Dechreuom gymryd rhan mewn gwaith gwella oherwydd yr oeddem ni i gyd yn ymwybodol o’r problemau yr oedd angen eu datrys, o rywbeth yr oedd angen ei wella. Er y dechreuom gymryd rhan ar adegau gwahanol, roedd pob un ohonom yn gallu gweld bod gofal ar gyfer pobl â Chlefyd Niwronau Motor (pwMND) yn wych mewn rhai mannau, ond yn ddiffygiol mewn mannau eraill. Roedd yn anghyson ac anghyflawn. Ar gyfer pobl â Chlefyd Niwronau Motor yn ne Cymru, fel nifer o ardaloedd y DU, roedd amrywiadau eang o ran mynediad at ofal wedi’i gydlynu’n dda.

Sut dechreuoch chi arni?

Dechreuom drwy ddeall ble’r oeddem ni a chryfderau’r man cychwyn hwnnw. Roedd gennym ni gleifion a theuluoedd a oedd eisiau gweithio gyda ni i wella pethau. Roedd gennym ni’r arbenigedd iawn i ddarparu gofal da, roedd diddordeb mewn ei ledaenu’n decach ar draws y rhanbarth, ac roedd partneriaid parod yn y sector statudol ac, yn hollbwysig, yn y sector gwirfoddol.

Arweiniodd cefnogaeth y sector gwirfoddol at fuddsoddiad cychwynnol, dysgu gan gymheiriaid o ranbarthau eraill, a chyfalaf gwleidyddol. Fe wnaeth cynnwys defnyddwyr helpu i sicrhau ein bod ni’n canolbwyntio ar beth oedd ei angen, nid beth oedd yn ymddangos yn amlwg i ni yn unig.

Fe wnaethom ni ffurfio cynghreiriau o ddiddordeb ledled de Cymru. Er enghraifft, defnyddiom gefnogaeth y sector gwirfoddol trwy ddangos ymroddiad i wella a helpu i gyflawni rhai o’u nodau. Fe wnaethom ennyn diddordeb ysbytai acíwt trwy ddangos bod gofal a gydlynir yn dda yn lleihau derbyniadau ac ymyriadau diangen. Gyda phob partner posibl, roeddem ni’n gallu amlygu eu diddordeb mewn Clefyd Niwronau Motor a dangos sut y gallai’r gwelliannau yr oeddem ni’n anelu atynt fynd i’r afael â’r diddordeb hwnnw. Bu modd i ni ddod o hyd i feysydd sylweddol lle’r oedd diddordebau’r gwahanol bartïon yn ddigon cyffredin i allu gweithio gyda’i gilydd i gyflawni’r un gwelliannau.

Gofal Clefyd Niwronau Motor De Cymru / South Wales Motor Neurone Disease Care NetworkSut ydych chi’n defnyddio gwaith gwella heddiw?

Heddiw, rydym ni’n parhau i geisio gwelliannau. Er bod llawer llai o anghyfiawnder na phan ddechreuom ni, rydym ni’n gwybod bod ychydig yn bodoli o hyd. Mae pobl mewn rhai rhannau o’r rhanbarth yn gallu cael mynediad at rai ymyriadau’n haws o hyd. Ac er bod y ddarpariaeth yn decach, nid yw hynny’n golygu ei bod hi’n ddigon da. Rydym ni’n defnyddio’r mesuriadau sydd ar gael – mesurau canlyniadau a phrofiad, ac offer archwilio cenedlaethol safonol – i amlygu ble gellir gwella pethau ymhellach ac arddangos y gwelliant hwnnw pan rydym ni wedi gallu gweithredu. Mae’r elfen cynnwys defnyddwyr yn bwysig, ac er ein bod ni’n cael llawer o adborth cadarnhaol digymell, rydym ni’n cymryd camau pendant i geisio sylwadau am beth y gallem ni fod yn ei wneud yn well, neu beth y mae angen i ni ei newid nesaf.

Mae rhai rhwystrau’n anoddach i’w goresgyn, ond rydym ni wedi dysgu nad oes angen i ni ennill bob tro. Mae pob llwyddiant, pob gwelliant, wedi dilyn rhai cynigion sydd wedi methu, felly rydym ni wedi dysgu ystyried y methiannau hynny fel gohirio llwyddiant.

Sut mae gwaith gwella wedi bod o fudd i’ch tîm?

Mae pob un ohonom wedi cael boddhad mawr o gymryd rhan yn hyn. Rydym ni wedi dysgu, ac wedi dod o hyd i ffyrdd o gymhwyso’r hyn a ddysgwyd i agweddau eraill o’n gwaith; rydym ni wedi mwynhau gweld y buddion i’n cleifion, hyd yn oed pan nad ydynt yn gwybod sut oedd pethau o’r blaen; ac rydym ni wedi mwynhau gallu rhannu’r hyn a ddysgwyd â phobl eraill yn y rhanbarth a ledled y wlad. Mae bod yn rhan o ofal pobl yn hynod foddhaol, ond rydym ni wedi canfod bod gwella’r gofal y maen nhw’n ei dderbyn yn cynyddu a dwysáu’r boddhad rydym ni’n ei gael o’n gwaith.

Mae’r boddhad rydym ni’n ei gael o weithio gyda’n gilydd yn fwy na’r boddhad unigol a ddaw o weld pethau’n gwella. Rydym ni’n gallu dathlu ein llwyddiannau ein gilydd.

Beth fyddech chi’n ei ddweud wrth unrhyw un arall sy’n dechrau ar waith gwella?

Gofynnwch rai cwestiynau allweddol i’ch hun. Roeddem ni’n gwybod o ble i ddechrau, ond cymerodd dipyn o amser i ni benderfynu sut i ehangu’r diddordeb yn ei wella:

  • Beth y mae angen ei wella?
  • Pa gefnogwyr allwch chi ddod o hyd iddyn nhw a pham mae ganddynt ddiddordeb?
  • Pa fylchau sydd yn eich gwybodaeth eich hun am y maes neu am waith gwella?
  • Pwy allwch chi alw arnynt i lenwi’r bylchau hyn?
  • Sut gallwch chi ddefnyddio eu diddordeb, sut gallwch chi eu helpu i weld y bydd eich gwelliannau yn eu helpu nhw, a sut gallan nhw eich cefnogi chi?

Dylech gynnwys defnyddwyr yn gynnar. Penderfynwch beth y mae angen ei newid – ac yr un mor bwysig – pa bethau y dylech eu cadw’r un fath. Profwch syniadau ar gyfer newid, a phrofwch weithredu’r newidiadau rydych chi’n eu gwneud. Pa newidiadau bynnag rydych chi’n eu hystyried, cofiwch ei bod hi’n anoddach i rai grwpiau o bobl gael mynediad at ofal iechyd. Gofynnwch i chi’ch hun a fydd eich syniadau’n helpu gyda hynny, i leihau’r bylchau o ran mynediad, neu a fyddai’r newidiadau’n ei gwneud hi’n haws i bobl fel ni, pobl sydd eisoes â’r mynediad hawsaf at wasanaethau. Bydd cynnwys defnyddwyr yn helpu gyda hynny. Rydym ni wedi bod yn canolbwyntio ar bobl ag anabledd sy’n gwaethygu’n gyflym, sy’n colli eu llais ac sy’n byw â chyflwr nad yw’n ymddangos bod neb arall yn gwybod amdano, popeth sy’n dueddol o wneud mynediad at ofal yn anoddach, ac rydym ni wedi ymgynghori â defnyddwyr ynghylch a fydd ein newidiadau yn ei gwneud hi’n haws iddyn nhw.

Adeiladwch gynghreiriau ym mhob man posibl.  Meddyliwch yn anuniongyrchol am ba rannau o’ch sefydliad a allai fod â diddordeb yn eich ymagwedd, pa sefydliadau eraill, neu ba elusennau neu sefydliadau gofal cymdeithasol, neu fusnesau, neu unrhyw un o gwbl. Mae gennym ni dîm craidd bach, llond llaw o gydweithwyr, ond rydym ni wedi gallu adeiladu rhwydwaith o gannoedd o bobl, a llu o sefydliadau statudol a gwirfoddol, oherwydd i ni sylwi bod ganddyn nhw i gyd ddiddordeb mewn sicrhau bod y gofal hwn yn iawn.

Peidiwch â bod yn rhy uchelgeisiol i ddechrau. Mae’n iawn cael uchelgeisiau mawr, ond mae angen i chi ddeall pa gamau bach y gallwch chi eu cymryd, pa welliannau bach a allai ddigwydd yn gynnar, ac mae angen i chi ddod yn gyfarwydd â pheidio â llwyddo’r tro cyntaf bob tro.

Myfyriwch ar ble aeth pethau o chwith, ac os gallwch weld ymagwedd well, newidiwch i honno. Rydym ni wedi gwneud llawer o bethau’n anghywir. Rydym ni wedi gorfod dysgu ailgynnull a newid trywydd, ac rydym ni wedi canfod ein bod ni weithiau’n llwyddo y tro nesaf.  Y naill ffordd neu’r llall, gallwch ddysgu o’ch methiannau. Rhowch ganiatâd i chi a’ch tîm fethu. Mae methu llawer yn well na pheidio â rhoi cynnig arni.

Defnyddiwch ddata. Dewch o hyd i’r data sy’n dangos beth y mae angen ei wella a phenderfynwch sut byddwch chi’n dangos y gwelliant y byddwch chi’n ei wneud. Os nad ydych chi’n siŵr sut i ddod o hyd i’r data y mae ei angen arnoch, na sut i’w ddefnyddio, dewch o hyd i bobl sy’n gwybod ac a all eich helpu. Gofynnwch i’r timau gwella yn eich sefydliad. Peidiwch â chael eich digalonni gan beth nad ydych chi’n ei wybod neu na allwch chi ei wneud; nid yw defnyddio data mor gymhleth ag y mae’n ymddangos bob amser. Bu angen i ni ddod o hyd i arbenigwyr ar fesurau canlyniadau a mesurau seicolegol, bu angen i ni ymwneud ag archwiliadau cenedlaethol i ddefnyddio eu grym mesur, er bod rhannau ohonynt ychydig yn ddiflas, ac rydym ni wedi dechrau gweithio gyda phobl sy’n cynnal cronfeydd data cenedlaethol er mwyn i ni allu cymharu poblogaethau.

Ac yn olaf, cofiwch fod rhywbeth arall i’w wneud bob amser. Chwiliwch am y peth nesaf. Byddwch yn cyflawni gwelliannau, ond ni fyddwch byth yn gorffen. Dathlwch, ond peidiwch â stopio.

Darllenwch fwy am y cais a enillodd y Wobr yma

 

Oct 072019
 

Dominique Bird, Head of Capacity and Capability, tells us about plans for the new Academy and how growing your own veg really is a science!

I’m pleased to share with you that my efforts at home growing vegetables seem to have finally paid off! Although I’d put lots of time and effort into my previous attempts there wasn’t much worth serving up at dinner time. After much perseverance and learning from my well-intentioned mishaps, the results have stepped up a notch and my boys have been enjoying eating the bumper crop we’ve produced over the summer.

This has got me thinking of how we use improvement science to learn about a system. The past couple of years for my veggie patch (my system in this scenario) has focused on learning what works, in what situations with what conditions and with what growing partners – carrots and tomatoes!

Reflecting on what we have achieved in NHS Wales through the Improving Quality Together programme, has resulted in similar conclusions.  IQT was incredibly successful in establishing a common language for improvement across NHS Wales. The Model for Improvement has offered a simple framework for those embarking on their first improvement work/project, and raised awareness of this approach to over half the workforce.  However, when we look at the ‘so what’ element, there are lessons to learn.

Just like my tomatoes and carrots in various patches of my garden, some of the training has resulted in crops of improvement projects, combining to make significant impacts on the safety, effectiveness, person-centred approach, timeliness, efficiency and equity of our services.  However, just as many have faltered – for a number of different reasons.

Over the last 18 months we have been working with improvement teams within all organisations, to see what makes a successful improvement project and what are the common barriers. We’ve been looking at what is needed in terms of wider capability in the system; we have also been working with network experts to look at how these elements are best connected in Wales; and international mature improvement systems to look at learning on cultural system wide change.

As part of the relaunch of 1000 Lives Improvement as Improvement Cymru, we are bringing this learning together under the umbrella of the Improvement Cymru Academy.  To embed an ethos of improvement across the system, the Academy will provide support on the three following areas:

  • Conditions – organisational support to enable a system of improvement
  • Connections – networking improvement leaders, locally, across the country and beyond
  • Capability – improvement development for individuals, teams, coaches and leaders

The Academy will work closely with experts in all areas of the domains of quality, broadening the spectrum of improvement approaches to meet the maturing needs of the system.

When nurturing improvement within our system, we need to focus on all the aspects at once – but where to start? This is the most common question I am asked – you can’t grow a forest immediately, but paying attention to the conditions of the soil, how the plants and trees will connect together, and nurturing small steps in the most fertile ground, will give you a boost.

We’ll  be sharing more with you over the coming weeks of what we hope to achieve with our Academy and we hope you can join us at the launch of Improvement Cymru on the 25 November where you will find out more. Read further about Improvement Cymru Academy here, and get in touch if you’d like to be involved.

Oct 072019
 

Mae Dominique Bird, Pennaeth Capasiti a Gallu, yn sôn wrthym am y cynlluniau ar gyfer yr Academi newydd a sut mae tyfu eich llysiau eich hun wir yn wyddor!

Rwy’n falch cael rhannu gyda chi bod fy ymdrechion i dyfu llysiau adref wedi bod yn llwyddiannus o’r diwedd! Er fy mod i wedi buddsoddi llawer o amser ac ymdrech yn fy ngheisiadau blaenorol, nid oedd llawer oedd yn werth ei weini amser swper. Ar ôl llawer o ddyfalbarhad a dysgu o’m  hanffodion â bwriad da, mae’r canlyniadau wedi gwella ychydig, ac mae fy mechgyn wedi bod yn mwyhau’r cnwd mawr a gynhyrchwyd dros yr haf.

Mae hyn wedi gwneud i mi feddwl sut rydym ni’n defnyddio gwyddor gwella i ddysgu am system. Dros y blynyddoedd diwethaf, mae fy llecyn llysiau (fy system yn y senario hwn) wedi canolbwyntio ar beth sy’n gweithio, ym mha sefyllfaoedd ym mha amodau, a gyda pha bartneriaid tyfu – moron a thomatos!

Mae myfyrio ar beth rydym ni wedi’i gyflawni yn GIG Cymru trwy’r rhaglen Gwella Ansawdd Gyda’n Gilydd wedi arwain at gasgliadau tebyg.  Roedd Gwella Ansawdd Gyda’n Gilydd yn hynod o lwyddiannus mewn sefydlu iaith gyffredin ar draws GIG Cymru. Mae’r Model Gwelliant wedi cynnig fframwaith syml ar gyfer y rheiny sy’n dechrau ar eu gwaith/prosiect gwelliant cyntaf, a chodi ymwybyddiaeth o’r ymagwedd hon i dros hanner y gweithlu. Fodd bynnag, wrth edrych ar yr elfen ‘felly beth’, mae gwersi i’w dysgu.

Fel fy nhomatos a’m moron mewn mannau amrywiol yn fy ngardd, mae ychydig o’r hyfforddiant wedi arwain at gnydau o brosiectau gwelliant yn cyfuno i gael effaith sylweddol ar ddiogelwch, effeithiolrwydd, ymagwedd sy’n canolbwyntio ar yr unigolyn, amseroldeb, effeithlonrwydd ac ecwiti ein gwasanaethau. Fodd bynnag, mae’r un faint wedi methu – am nifer o resymau gwahanol.

Dros yr 18 mis diwethaf, rydym ni wedi bod yn gweithio gyda thimau gwelliant ym mhob sefydliad i weld beth sy’n gwneud prosiect gwelliant llwyddiannus a beth yw’r rhwystrau cyffredin. Rydym ni wedi bod yn edrych ar beth sydd ei angen o ran gallu ehangach yn y system; rydym ni hefyd wedi bod yn gweithio gydag arbenigwyr y rhwydwaith i edrych ar sut i gysylltu’r elfennau hyn yn y ffordd orau yng Nghymru; a systemau gwelliant aeddfed rhyngwladol i edrych ar ddysgu ar newid ar draws system ddiwylliannol.

Yn rhan o ail-lansio 1000 o Fywydau – Gwasanaeth Gwella fel Gwelliant Cymru, rydym ni’n dod â’r dysgu hyn at ei gilydd o dan ymbarél Academi Gwelliant Cymru.  I fewnosod ethos gwelliant ar draws y system, bydd yr Academi yn darparu cymorth ar y tri maes canlynol:

  • Amodau – cymorth sefydliadol i alluogi system gwelliant
  • Cysylltiadau – rhwydweithio arweinwyr gwelliant, yn lleol, ar draws y wlad, a thu hwnt
  • Gallu – datblygu gwelliant i unigolion, timau, hyfforddwyr ac arweinwyr

Bydd yr Academi’n gweithio’n agos ag arbenigwyr ym mhob maes o’r parthau ansawdd, ehangu’r sbectrwm o ymagweddau gwelliant i fodloni anghenion sy’n aeddfedu’r system.

Wrth faethu gwelliant yn  ein system, mae angen i ni ganolbwyntio ar yr holl agweddau ar unwaith – ond ble mae dechrau? Dyma’r cwestiwn mwyaf cyffredin a ofynnir i mi – ni allwch dyfu coedwig ar unwaith, ond bydd talu sylw at gyflwr y pridd, sut bydd planhigion a choed yn cysylltu â’i gilydd a maethu camau bach yn y tir mwyaf ffrwythlon yn rhoi hwb i chi.

Byddwn ni’n rhannu mwy gyda chi dros yr wythnosau nesaf ynghylch beth rydym ni’n gobeithio ei gyflawni gyda’n Hacademi a gobeithiwn y gallwch ymuno â ni i lansio Gwelliant Cymru ar 25 Tachwedd, lle cewch wybod mwy. Darllenwch fwy am Academi Gwelliant Cymru yma, a chysylltwch os hoffech gymryd rhan.

Sep 172019
 

 

Phil Routledge was, until his recent retirement earlier this year, Founding Clinical Director of the All Wales Therapeutics and Toxicology Centre (AWTTC) at University Hospital Llandough. AWTTC provides professional support to AWMSG in their aim to help to obtain the best possible outcomes from medicines for the people of Wales. He is now a member of the Medicines Safety Programme Management Board.

In June 2017, Sir Liam Donaldson, the World Health Organization (WHO) Director-General’s envoy on patient safety came to Wales to deliver the fourth Felicity Newton-Savage Memorial lecture* entitled “Medication and its Use; a Priority for Patient Safety” at the 15th Anniversary Conference of the All Wales Medicines Strategy Group (AWMSG). He recounted that just three months previously in Bonn, WHO had launched its third global patient safety challenge Medication Without Harm. The two preceding challenges had been Clean Care is Safer Care in 2005 and Safe Surgery Saves Lives in 2008. The vital importance of all such aspects of patient safety is now to be recognized internationally in the decision earlier this year by the 72nd World Health Assembly, WHO’s governing forum to designate September 17th each year as World Patient Safety Day (1). The theme for the day is “Patient Safety: a global health priority” and the associated slogan is “Speak up for patient safety.”

Medication Safety is a hugely important aspect of patient safety and WHO has agreed that the aim of Medication Without Harm will be to reduce severe, avoidable harm related to medications by 50% over 5 years, globally. They have identified four key domains involved in the challengePatients and the public, Medicines, Health care professionals, and Systems/ practices of medication. Within these domains they have chosen to focus on three key action areas, – Polypharmacy, High risk situations, and Transitions of care. Three WHO technical reports concerning these action areas have recently been published (2).

Polypharmacy is the concurrent use of multiple (i.e. more than one) medications. Although there is no standard definition, polypharmacy is often described as the routine use of five or more medications, although this includes over-the-counter (OTC), prescription and/or traditional & complementary medicines (3).  Polypharmacy may be appropriate in some cases but may also be inappropriate if one or more medicines are prescribed that are not, or no longer needed. The AWMSG Polypharmacy Guidance has produced a suite of policies to support polypharmacy management, including deprescribing (stopping medicines) when clinically appropriate (4).

Transitions of care (2) are “the various points where a patient moves to, or returns from a particular physical location or makes contact with a health care professional for the purposes of receiving health care. This includes transitions between home, hospital, residential care settings and consultations with different health care providers in out-patient facilities” (5). Although they may result in circumstances in which medication error can occur especially if communication is inadequate, they also provide opportunities for using resources such as the AWMSG Multidisciplinary Medicines Reconciliation Policy (6) and person-centred medication review.

High Risk Situations (2) are, those circumstances which are associated with a significant risk of medication- related harm, either due to medication factors, provider and patient factors or systems factors (e.g. the work environment) or a combination of these working together. The All-Wales polypharmacy guidance (4) focuses on the at-risk, the frail older person and on some of the high-risk (high alert) medications identified in the WHO technical report. Separate resources on particular high-risk (high-alert) medicines such as anticoagulants and opioids (including tramadol) are also available on the AWMSG Website.

Earlier this year Andrew Evans, our Chief Pharmaceutical Officer for Wales, commissioned 1000 Lives to develop a national Medicines Safety Programme for Wales in response to ‘A Healthier Wales’ and ‘Medication without Harm’. Paul Gimson, Programme Lead for Primary Care and Medicines Safety at 1000 Lives Improvement/Improvement Cymru is leading the development of a new Medicines Safety Cymru programme.

On this first World Patient Safety Day, Paul is asking healthcare professionals in Wales to highlight initiatives planned or already underway in medicines safety across Wales. Some of these areas (e.g. deprescribing in GP Practice and reducing anticholinergic medicines burden (7)) have already been presented to a wider audience at previous AWTTC annual best-practice days organised by AWTTC’s Welsh Analytical Prescribing Support Unit (WAPSU) but I’m aware that there are many more examples of best practice in medication safety across Wales from which we can all learn.  A range of the projects received will then be discussed at a special Medicines Safety Cymru masterclass on 26 November 2019. Please send in your project details to Paul.Gimson@wales.nhs.uk by 18 October 2019.

*The late Felicity Newton Savage was the first Director of the Welsh Medicines Resource Centre (WeMeReC), now part of AWTTC. She was instrumental in developing products unique to WeMeReC that are highly regarded and valued by healthcare professionals within and outside of Wales.

References/ Links

  1. World Health Organization: World Patient Safety Day https://www.who.int/campaigns/world-patient-safety-day/2019 .(accessed 29/08/2019)
  2. World Health Organization. Medication safety in key action areas, World Health Organization 2019. https://www.who.int/patientsafety/medication-safety/technical-reports/en/ (accessed 29/08 2019)
  3. Masnoon N et al. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017; 17: 230 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5635569/ (accessed 02/09/2019)
  4. All Wales Medicines Strategy Group. Polypharmacy guidance http://www.awmsg.org/awmsgonline/app/sitesearch?execution=e2s1 (accessed 29/08/2019)
  5. Transitions of Care: Technical Series on Safer Primary Care. Geneva: World Health Organization; 2016. http://apps.who.int/iris/bitstream/handle/10665/252272/9789241511599-eng.pdf?sequence (accessed 29/08/2019)
  6. All Wales Medicines Strategy Group. All Wales Multidisciplinary Medicines Reconciliation Policy http://www.awmsg.org/docs/awmsg/medman/All%20Wales%20Multidisciplinary%20Medicines%20Reconciliation%20Policy.pdf (accessed 02/09/2019)
  7. All Wales Therapeutics and Toxicology Centre: Best Practice Day 2018.https://www.awttc.org/news/best-practice-day-2018 (accessed 02/09/2019)
Sep 172019
 

Roedd Phil Routledge, hyd nes ei ymddeoliad diweddar yn gynharach eleni, yn Gyfarwyddwr Clinigol Sefydlu Canolfan Therapiwteg a Thocsicoleg Cymru Gyfan (AWTTC) yn Ysbyty Athrofaol Llandochau. Mae AWTTC yn darparu cefnogaeth broffesiynol i AWMSG yn eu nod i helpu cael y canlyniadau gorau posibl o feddyginiaethau ar gyfer pobl Cymru. Mae bellach yn aelod o’r Bwrdd Rheoli Rhaglen Diogelwch Meddyginiaethau.

Ym mis Mehefin 2017, daeth Syr Liam Donaldson, cennad Cyfarwyddwr Cyffredinol Sefydliad Iechyd y Byd (WHO) ar ddiogelwch cleifion, i Gymru i gyflwyno pedwaredd Ddarlith Goffa Felicity Newton-Savage*, o’r enw “Medication and its Use; a Priority for Patient Safety”, yng nghynhadledd pen-blwydd Grŵp Strategaeth Meddyginiaethau Cymru Gyfan (AWMSG) yn 15 oed. Soniodd fod WHO, ond tri mis yn flaenorol, wedi lansio ei drydedd her diogelwch cleifion byd-eang, Medication Without Harm, yn Bonn. Y ddwy her flaenorol oedd Clean Care is Safer Care yn 2005 a Safe Surgery Saves Lives yn 2008. Mae pwysigrwydd hanfodol yr holl agweddau hyn ar ddiogelwch cleifion bellach yn mynd i gael ei gydnabod yn rhyngwladol yn y penderfyniad yn gynharach eleni gan 72ain Cynulliad Iechyd y Byd, sef fforwm llywodraethu  WHO, i bennu 17 Medi bob blwyddyn yn Ddiwrnod Diogelwch Cleifion y Byd (1). Thema’r diwrnod yw “Diogelwch cleifion: blaenoriaeth iechyd fyd-eang”, a’r slogan cysylltiedig yw “Siarad dros ddiogelwch cleifion.”

Mae diogelwch meddyginiaethau’n agwedd hynod bwysig o ddiogelwch cleifion ac mae WHO wedi cytuno mai nod Medication Without Harm fydd lleihau niwed difrifol, osgoadwy sy’n gysylltiedig â meddyginiaethau o 50% dros 5 mlynedd, yn fyd-eang. Maen nhw wedi amlygu pedwar parth allweddol sy’n gysylltiedig â’r her – cleifion a’r cyhoedd, meddyginiaethau, gweithwyr gofal iechyd proffesiynol a systemau/arferion meddyginiaethau. O fewn y parthau hyn, maen nhw wedi dewis canolbwyntio ar dri maes gweithredu allweddol – polyfferylliaeth, sefyllfaoedd risg uchel a phontio gofal. Mae WHO wedi cyhoeddi tri adroddiad technegol yn ddiweddar sy’n ymwneud â’r meysydd gweithredu hyn (2).

Polyfferylliaeth yw’r defnydd cydamserol o feddyginiaethau lluosog (h.y. mwy nag un). Er nad oes unrhyw ddiffiniad safonol, caiff polyfferylliaeth ei ddisgrifio’n aml fel y drefn o ddefnyddio pump neu fwy o feddyginiaethau, er bod hyn yn cynnwys meddyginiaethau dros y cownter, presgripsiwn a/neu feddyginiaethau traddodiadol a chyflenwol (3).  Gall polyfferylliaeth fod yn briodol mewn rhai achosion, ond gall hefyd fod yn amhriodol os caiff un neu fwy o feddyginiaethau eu rhagnodi, nad oes eu hangen mwyach. Mae Canllaw Polyfferylliaeth AWMSG wedi cynhyrchu cyfres o bolisïau i gefnogi rheoli polyfferylliaeth, gan gynnwys dadragnodi (stopio meddyginiaethau) pan ei fod yn briodol yn glinigol (4).

Pontio gofal (2) yw’r “pwyntiau amrywiol lle mae claf yn symud i, neu’n dychwelyd o, leoliad ffisegol penodol neu’n gwneud cysylltiad â gweithiwr iechyd proffesiynol at ddibenion derbyn gofal iechyd. Mae hyn yn cynnwys pontio rhwng y cartref, ysbytai, lleoliadau gofal preswyl ac ymgynghoriadau â darparwyr gofal iechyd gwahanol mewn cyfleusterau cleifion allanol” (5). Er efallai y byddant yn arwain at amgylchiadau lle gall gwallau ddigwydd o ran meddyginiaethau, yn enwedig os nad yw’r cyfathrebu’n ddigonol, maen nhw hefyd yn darparu cyfleoedd i ddefnyddio adnoddau fel Polisi Cysoni Meddyginiaethau Amlddisgyblaethol AWMSG (6) ac adolygiad o feddyginiaethau sy’n canolbwyntio ar yr unigolyn.

Sefyllfaoedd Risg Uchel (2) yw’r amgylchiadau hynny sy’n gysylltiedig â risg sylweddol o niwed sy’n gysylltiedig â meddyginiaethau, naill ai yn sgil ffactorau meddyginiaethau, ffactorau darparwyr a chleifion, neu ffactorau systemau (e.e. yr amgylchedd gwaith) neu gyfuniad o’r rhain yn gweithio gyda’i gilydd. Mae canllaw polyfferylliaeth Cymru gyfan (4) yn canolbwyntio ar yr unigolyn hŷn, bregus, mewn perygl, ac ar rai o’r meddyginiaethau risg uchel (rhybudd uchel) a amlygir yn adroddiad technegol WHO. Mae adnoddau ar wahân ar feddyginiaethau risg uchel (rhybudd uchel) penodol, fel gwrthgeulyddion a opioidiau (gan gynnwys tramadol) ar gael ar wefan AWMSG hefyd.

Yn gynharach eleni,  comisiynodd Andrew Evans, Prif Swyddog Fferyllol Cymru, 1000 o Fywydau i ddatblygu Rhaglen Diogelwch Meddyginiaethau Cymru genedlaethol mewn ymateb i ‘Cymru Iachach’ a ‘Meddyginiaeth Heb Niwed’. Mae Paul Gimson, Arweinydd Rhaglen Gofal Sylfaenol a Diogelwch Meddyginiaethau yn 1000 o Fywydau – Gwasanaeth Gwella/ Gwelliant Cymru, yn arwain datblygu rhaglen newydd, Diogelwch Meddyginiaethau Cymru.

Ar y Diwrnod Diogelwch Cleifion y Byd cyntaf, mae Paul yn gofyn i weithwyr gofal iechyd proffesiynol yng Nghymru amlygu mentrau sydd wedi cael eu cynllunio, neu sydd eisoes ar waith, ym maes diogelwch meddyginiaethau ledled Cymru. Mae rhai o’r meysydd hyn (e.e. dadragnodi mewn meddygfeydd a lleihau meddyginiaethau gwrthgolinerig (7)) eisoes wedi cael eu cyflwyno i gynulleidfa ehangach mewn diwrnodau arfer gorau blynyddol  blaenorol AWTTC a drefnwyd gan Uned Cymorth Rhagnodi Dadansoddol Cymru (WAPSU) AWTTC, ond rwy’n ymwybodol bod nifer mwy o enghreifftiau o arfer gorau ym maes diogelwch meddyginiaethau ledled Cymru, y gallwn ni gyd ddysgu ohonynt.  Bydd amrywiaeth o’r prosiectau a dderbyniwyd yna’n cael eu trafod mewn dosbarth meistr Diogelwch Meddyginiaethau arbennig ar 26 Tachwedd 2019. Anfonwch fanylion eich prosiect at Paul.Gimson@wales.nhs.uk erbyn 18 Hydref 2019.

*Y diweddar Felicity Newton Savage oedd Cyfarwyddwr cyntaf Canolfan Adnoddau Meddyginiaethau Cymru (WeMeReC), sydd bellach yn rhan o AWTTC. Roedd yn gyfryngol o ran datblygu cynhyrchion a oedd yn unigryw i WeMeReC, sy’n cael eu parchu a’u gwerthfawrogi’n fawr gan weithwyr gofal iechyd proffesiynol yng Nghymru a thu hwnt.

Geirda/ Dolenni

  1. World Health Organization: World Patient Safety Day https://www.who.int/campaigns/world-patient-safety-day/2019 .(accessed 29/08/2019)
  2. World Health Organization. Medication safety in key action areas, World Health Organization 2019. https://www.who.int/patientsafety/medication-safety/technical-reports/en/ (accessed 29/08 2019)
  3. Masnoon N et al. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017; 17: 230 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5635569/ (accessed 02/09/2019)
  4. All Wales Medicines Strategy Group. Polypharmacy guidance http://www.awmsg.org/awmsgonline/app/sitesearch?execution=e2s1 (accessed 29/08/2019)
  5. Transitions of Care: Technical Series on Safer Primary Care. Geneva: World Health Organization; 2016. http://apps.who.int/iris/bitstream/handle/10665/252272/9789241511599-eng.pdf?sequence (accessed 29/08/2019)
  6. All Wales Medicines Strategy Group. All Wales Multidisciplinary Medicines Reconciliation Policy http://www.awmsg.org/docs/awmsg/medman/All%20Wales%20Multidisciplinary%20Medicines%20Reconciliation%20Policy.pdf (accessed 02/09/2019)
  7. All Wales Therapeutics and Toxicology Centre: Best Practice Day 2018.https://www.awttc.org/news/best-practice-day-2018 (accessed 02/09/2019)
Sep 172019
 

Mike Fealey, Head of Patient Safety at 1000 Lives Improvement, shares his thoughts on the use of the words “Patient Safety”

The use of the term “patient” has often been queried in some areas of healthcare. In maternity they have expectant mothers – not patients; some areas of mental health and learning disability use service user – not patients. But soon, 1000 Lives Improvement service will be transitioning into Improvement Cymru, and our remit will expand to include social care where the term ‘patient safety’ has even less or no meaning. So, a bold question coming from  Head of Patient Safety but there is an argument that it is time to change the focus from ‘patient safety’ to just ‘safety’ or ‘safety culture’.

I’m in good company because Liam Donaldson, writing in the foreword of IHI Patient Safety Officer’s Guide (2009) stated “Patient safety should not ultimately be a field in itself but be deeply ingrained throughout the field of (health) care industry” 1

There has been an increased focus on Patient Safety in the UK since the launch of the National Patient Safety Agency (NPSA) in 2001. At that time it was estimated that 840,000 incidents and errors occurred in the NHS every year.

The idea behind the NPSA was to create a learning system that used tools, developed in other safety critical industries i.e. aviation, nuclear, rail, etc., to improve organisational safety and reduce avoidable harm. These tools had been proved successful in creating and sustaining a ‘safety’ culture in the industries in which they were used and have had some success across the NHS since 2001.

Wales further promoted the patient safety agenda with the launch of the 1000 Lives campaign in 2008. This was based on the ‘Saving 100,000 Lives’ campaign in the USA that promoted the use and monitoring of evidence based ‘bundles of care’ to reduce avoidable harm in a number of specific areas, generally in hospital. These included Ventilator Associated Pneumonia, Hospital Acquired Thrombosis, Lower Segment Caesarean Sections, and others.

The first time the term ‘Safety Culture’ was used was following the International Atomic Energy Agency’s initial report into the Chernobyl disaster (IAEA, 1986).  Although there has been many studies, publications, articles and reports relating to safety culture, there is still no agreed definition. Some definitions include2:

  • ‘The way we do things around here’ (Confederation of British Industry (CBI) 1990);
  • ‘A set of attitudes, beliefs or norms’ (Turner, 1989);
  • ‘A constructed system of meaning (or shared understanding) through which the hazards of the world are understood’ (Pidgeon, 1998);
  • ‘A safety ethic’ (Wert, 1986).

There is another reason why I think we should start to focus more on ‘safety culture’. We must deliberately include the staff who work in those areas and the relatives and contractors who can also interact with the system: Harm figures in healthcare do not usually include the workforce! As well as the potential physical injuries that the workforce can suffer, they are often negatively impacted by being involved in the harm of a “patient”. This psychological harm can lead to isolation, depression, self-harm and in extreme circumstances, even suicide.

Zero harm to “patients” and the workforce is only possible with both a robust culture of safety and an embedded organisational learning system.

So, as part of Improvement Cymru’s new way of working, we will return to an emphasis on the six ‘Domains of Healthcare Quality’ as described by the Institute of Medicine in 19993. They state that any quality system or improvement must be Safe, Timely, Effective, Efficient, Equitable and Person-Centred with ‘Safety’ always shown as Principle number 1!

There is no doubt that creating a safety culture starts at the top. The Board and Senior team have the responsibility for setting the vision and the direction of their organisation and this is another area we look forward to supporting in collaboration with our stakeholders. It’s an exciting time for 1000 Lives / Improvement Cymru, and we recognise that we must adapt our approach to make us relevant to all we work with.

So ditch the words ‘patient safety’? I think I’m becoming ever more in favour.

What do you think?

1 – Institute of Healthcare Improvement: The Essential Guide for Patient Safety Officers: Leonard M, Frankel A, Federico F, Frush K, Haraden C (editors). Chicago: Joint Commission Resources with the Institute for Healthcare Improvement; 2009)

2 – http://safetyculturetoolkit.rssb.co.uk/safety-culture-information/what-is-safety-culture.aspx accessed August 2019

3 – Institute of Medicine (IOM). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C: National Academy Press; 2001

Find out more about the 1000 Lives’ transition to Improvement Cymru here

Sep 172019
 

Yma, mae Mike Fealey, Pennaeth Diogelwch Cleifion 1,000 o Fywydau, yn rhannu ei safbwyntiau ar ddefnydd y geiriau “Diogelwch Cleifion”.

Yn aml, caiff defnydd y term “claf” ei gwestiynu gan rai o feysydd gofal iechyd. Ym maes mamolaeth, cyfeirir at ‘famau beichiog’ yn hytrach na chleifion; tra bod rhai meysydd iechyd meddwl ac anableddau dysgu’n cyfeirio at ‘ddefnyddwyr gwasanaeth’. Cyn bo hir, bydd gwasanaeth 1,000 o Fywydau yn trawsnewid i Gwelliant Cymru, a bydd ein cylch gorchwyl yn ehangu i gynnwys gofal cymdeithasol lle nad oes gan ‘ddiogelwch cleifion’ lawer, os unrhyw, ystyr o gwbl. Dyma gwestiwn eofn i Bennaeth Diogelwch Cleifion ei ofyn, ond a yw’n bosibl dadlau bod yr amser wedi dod i newid y ffocws o ‘ddiogelwch cleifion’ i ‘ddiogelwch’ neu ‘ddiwylliant diogelwch’?

Ysgrifennodd Liam Donaldson yn rhagair Canllaw Swyddogion Diogelwch Cleifion IHI (2009) “na ddylai diogelwch cleifion fod yn faes ar wahân, yn hytrach dylai fod yn rhan annatod o faes a diwydiant gofal iechyd”1.

Mae mwy o ffocws wedi bod ar Ddiogelwch Cleifion yn y DU ers lansiad yr Asiantaeth Diogelwch Cleifion Cenedlaethol (NPSA) yn 2001. Ar y pryd, amcangyfrifwyd bod 840,000 o ddigwyddiadau a chamgymeriadau yn digwydd yn y GIG bob blwyddyn.

Y syniad tu ôl i NPSA oedd creu system ddysgu sy’n defnyddio offer a ddatblygwyd mewn diwydiannau eraill lle mae diogelwch yn hollbwysig, e.e. y diwydiant awyrennau, niwclear, rheilffyrdd ac ati, er mwyn gwella diogelwch sefydliadol a lleihau niwed osgoadwy. Mae’r offer hyn wedi bod yn llwyddiannus o ran creu a chynnal diwydiant ‘diogelwch’ yn y diwydiannau lle cânt eu defnyddio, ac maen nhw wedi cael cryn lwyddiant ar draws y GIG ers 2001.

Hyrwyddwyd yr agenda diogelwch cleifion ymhellach yng Nghymru gyda lansiad ymgyrch 1,000 o Fywydau yn 2008. Roedd yr ymgyrch yn seiliedig ar ymgyrch ‘Saving 100,000 Lives’ yn America, a hyrwyddodd defnydd a monitro ‘sypiau gofal’ seiliedig ar dystiolaeth er mwyn lleihau niwed osgoadwy mewn nifer o feysydd penodol, ac mewn ysbytai yn gyffredinol. Roedd y rhain yn cynnwys Niwmonia Cysylltiedig ag Awyrydd, Thrombosis a Ddaliwyd mewn Ysbytai, Toriadau Cesaraidd Is ac eraill.

Defnyddiwyd y term ‘diwylliant diogelwch’ am y tro cyntaf yn dilyn adroddiad cychwynnol yr Asiantaeth Ynni Atomig ar drychineb Chernobyl (IAEA, 1986). Er y bu llawer o astudiaethau, cyhoeddiadau, erthyglau ac adroddiadau yn ymwneud â diwylliant diogelwch dros y blynyddoedd, nid oes diffiniad cytûn yn bodoli hyd heddiw. Mae rhai o’r diffiniadau yn cynnwys2:

  • ‘Y ffordd y caiff pethau eu gwneud yn y fan hyn’ (Cydffederasiwn Diwydiant Prydain (CBI) 1990);
  • ‘Set o agweddau, credoau neu arferion’ (Turner, 1989);
  • ‘System adeiledig o ystyr (neu gyd-ddealltwriaeth) ar gyfer deall peryglon y byd’ (Pidgeon, 1998);
  • ‘Egwyddor diogelwch’ (Wert, 1986).

Yn fy marn i, mae rheswm arall pam y dylwn ni ddechrau canolbwyntio mwy ar ‘ddiwylliant diogelwch’. Yn bwrpasol, rhaid i ni gynnwys y staff sy’n gweithio yn y meysydd hynny, yn ogystal â’r perthnasau a’r contractwyr sydd hefyd yn gallu rhyngweithio â’r system: Fel arfer, nid yw ffigyrau niwed gofal iechyd yn cynnwys y gweithlu! Yn ogystal â’r anafiadau corfforol posibl y gall y gweithlu eu dioddef, yn aml caiff unigolion eu heffeithio’n negyddol o fod yn rhan o ‘niwed’ y claf. Gall y niwed seicolegol hwn arwain at arwahanu, iselder, hunan-niweidio a hyd yn oed hunanladdiad mewn achosion eithafol.

Yr unig ffordd o sicrhau nad yw “cleifion” a’r gweithlu’n cael eu niweidio yw trwy ddiwylliant diogelwch cadarn a system ddysgu sefydliadol wedi’i hymgorffori’n llawn.

Felly, fel rhan o feddylfryd newydd Gwelliant Cymru, byddwn yn dychwelyd at bwysleisio’r chwe Pharth Ansawdd Gofal Iechyd, yn unol â disgrifiadau’r Sefydliad Meddygaeth ym 19993. Maent yn datgan bod rhaid i unrhyw system ansawdd neu welliant fod yn Ddiogel, Amserol, Effeithiol, Effeithlon, Cyfiawn ac yn Canolbwyntio ar Unigolion, gyda ‘Diogelwch’ bob amser yn cael ei ddangos fel Egwyddor rhif 1!

Does dim amheuaeth bod creu diwylliant diogelwch yn dechrau ar y brig. Rhaid i’r Bwrdd a’r Uwch Dîm fod yn gyfrifol am osod y weledigaeth a’r cyfeiriad ar gyfer y sefydliad, a dyma faes arall y byddwn yn ei gefnogi, mewn cydweithrediad â’n rhanddeiliaid. Mae’n amser cyffrous i 1,000 o Fywydau / Gwelliant Cymru, ac rydym yn cydnabod bod rhaid i ni addasu ein dulliau er mwyn sicrhau ein bod yn berthnasol i bawb rydym yn gweithio â nhw.

Felly, a ddylwn waredu’r geiriau ‘diogelwch cleifion’? Rwy’n dechrau credu mai dyna’r peth cywir i’w wneud.

Beth amdanoch chi?

1Institute of Healthcare Improvement: The Essential Guide for Patient Safety Officers: Leonard M, Frankel A, Federico F, Frush K, Haraden C (editors). Chicago: Joint Commission Resources with the Institute for Healthcare Improvement; 2009)

2http://safetyculturetoolkit.rssb.co.uk/safety-culture-information/what-is-safety-culture.aspx accessed August 2019

3Institute of Medicine (IOM). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C: National Academy Press; 2001

Mae mwy o wybodaeth am drawsnewidiad 1,000 o Fywydau i Gwelliant Cymru ar gael fan hyn.

Sep 122019
 

David Wastell is a Registered Nurse and Service Improvement Manager within the Acute Deterioration team in 1000 Lives Improvement.

We spoke to him about the ongoing roll out of Community NEWS in Wales –  a key part of the  *1000 Lives Improvement response to the challenge included in the ‘A Healthier Wales’ plan to improve management of acute illness across the whole system pathway.

Tell us a bit about your background

I qualified in Sydney Australia 21 years ago. My background has predominately been working in Intensive Care Units, I was fortunate to be involved in the ‘Between the Flags’ Programme in New South Wales and the implementation of colour coded charts in the health board in Northern Sydney. This was my first exposure to a chart that aided staff at the front line in identifying Acute Deterioration (AD).


How are charts being used in Wales?

I returned to Wales in 2014 and was amazed to find that colour coded, scoring observation charts were being widely used in the acute care sector and were a key element in identifying patients with Sepsis.   NHS Wales has since been internationally recognised through the ‘Global Alliance Award’ (2016) for embedding a standardised approach to identifying Sepsis in acute settings through NEWS.

Until 2017, the primary focus for the Acute Deterioration team was working within acute settings. However, the emphasis has recently shifted in line with the ‘Healthier Wales’ agenda, and we are now focussed on working with staff in community settings to embed NEWS in practice. This is with the aim of making NEWS the single language for identifying patients at risk of acute deterioration across all parts of the health and social care system together.  Through the implementation of NEWS and the early warning scoring system for Acute Deterioration, discussions around ceiling of treatment, escalation of care and Advanced Care Planning can be at the forefront of the individuals needs thus potentially providing care closer to home.

What’s the scale of this work in the community?

It’s huge – there are over 170 teams across Wales and together that totals over 1500 district nurses alone.  We are also working with GPs, and Acute Response Teams across every health board as well as First Responders (Welsh Ambulance Services Ambulance and St John’s Wales). My role is to assist individuals and teams to look at their systems and processes in relation to acute deterioration and implement standardised improvement measures and tools across their teams to improve the identification of patients at risk of acute deterioration (including Sepsis).

What improvement measures and tools do you mean? 

Working within the new Improvement framework we have supported community teams with the Model for Improvement, stakeholder engagement and forcefield analysis and using data collection and analysis tools. Utilising interactive maps of Wales we are able to plot the progress of the teams with a traffic light system. As the various teams have become NEWS Ready (Amber) to NEWS Active (Green), it is a visual representation of the improvements teams and health are making. Vitally important has been the monthly Programme Leads days, it has provided the opportunity for shared learning, in a supportive and non-judgemental environment. We have also developed  tools such as NEWS charts, sepsis screening tools and Acute Kidney Injury bundles.  You can download these from the 1000 Lives Improvement website or request copies from any members of our national team.

Why did the focus shift to community settings?

The success of NEWS in acute settings shows that it provided the basis for a unified and systematic approach to the first assessment and triage of acutely ill patients. It is a simple track-and-trigger system for monitoring clinical progress for all patients – reflected by its use today in 60 hospitals in Wales, as well as by the Welsh Ambulance Service (WAST).

However, there appeared to be a gap between what was happening in the Acute Care Sector and that of the Community. I had the opportunity in 2017 to undertake some work with Eve Lightfoot (RCN Nurse of the year 2018), to get involved with District Nurse training around Sepsis awareness and acute deterioration. I quickly realised that teams had obvious enthusiasm and desire to utilise NEWS but appropriate education around AD and Sepsis recognition was missing. At the same time, teams had limited resources yet their workload and complexity of patients’ needs was increasing dramatically.

I spent a lot of initial time shadowing District Nursing Leads and teams across Wales where I observed varied cases; from daily visits to check blood ketones and catheter flushes, to complex leg dressings and abdominal wound packing.

The focus was to observe the number of patients having a full set of observations and from that having a baseline NEWS score.  This was not happening regularly.

The need to provide care closer to home for the people of Wales was fully supported by the Welsh Government and in particular the “Healthier Wales” strategy document made it a priority. In March 2019 the Chief Nursing Officer (CNO) mandated that NEWS should be rolled out and be implemented by all district nursing teams across Wales.

 What difference would NEWS have made to changing outcomes in the cases observed?

If NEWS had been available in many of the cases that I observed, it would have provided a subjective measure of any deterioration and perhaps trigger the question around possible Sepsis.  It also became very evident that staff did not have all the necessary equipment to provide a NEWS assessment. Training was needed to be provided around the recognition and response to Acute Deterioration in the community, and at an-all-Wales level.   That became our programme focus.

How do you think improvement knowledge and training will make a difference to staff and patients?

Personally, I have seen in two continents the impact of embedding a systematic approach in identifying an unwell patient, underpinned by an improvement mind- set and desire to change. NEWS in the Community Sector in Wales will have a massive impact on how we communicate to patients and families. I believe NEWS will greatly improve the care we give, putting the person at the centre of everything we do.

For professionals, in particular more junior staff members, it will offer them the skills, tools and training resources they need to make changes that give them a greater sense of personal and team achievement.  On that level, NEWS is an empowering tool.

For the first time we now have a common sickness language that connects all parts of the health and social care system together in Wales. Through NEWS, everyone is speaking the same language for identifying Acute Deterioration and sepsis, and at the earliest point in time which we know makes a huge difference. This is exciting for everyone, most of all our patients!

*1000 Lives Improvement is re-launching as Improvement Cymru – the new all-Wales improvement service for health and social care.  Join us at the launch In November. Read about it and sign up here http://www.1000livesplus.wales.nhs.uk/news/51535

Sep 122019
 

Mae David Wastell yn Nyrs Gofrestredig a Rheolwr Gwelliant Gwasanaeth gyda thîm Dirywiad Acíwt 1,000 o Fywydau.

Siaradom ni ag ef am gyflwyno’r Sgôr Rhybudd Cynnar Cenedlaethol (#NEWS) mewn cymunedau ledled Cymru – sef rhan allweddol o ymateb 1,000 o Fywydau i’r her oedd yn rhan o gynllun Cymru Iachach i wella rheoli salwch acíwt ar draws y llwybr system cyfan.

Dywedwch ychydig wrthym am eich cefndir?

Cymhwysais yn Sydney, Awstralia, un mlynedd ar hugain yn ôl. Mae fy nghefndir yn bennaf wedi bod yn gweithio mewn Unedau Gofal Dwys, ac roeddwn yn ffodus i fod yn rhan o’r Rhaglen ‘Rhwng y Baneri‘ yn New South Wales, a chyflwyno siartiau â chodau lliw ym mwrdd iechyd Gogledd Sydney. Hwn oedd fy mhrofiad cyntaf o siart a gynorthwyodd staff rheng flaen i adnabod Dirywiad Acíwt (DA).

Sut mae’r siartiau yn cael eu defnyddio yng Nghymru?

Dychwelais i Gymru yn 2014 a chefais sioc i ddarganfod bod siartiau arsylwi a sgorio lliw â chod yn cael eu defnyddio’n eang yn y sector gofal acíwt a’u bod yn elfen allweddol wrth adnabod cleifion â sepsis. Ers hynny, mae GIG Cymru wedi cael ei gydnabod yn rhyngwladol trwy’r ‘Wobr Cynghrair Byd-eang’ (2016) am ymgorffori dull safonol o adnabod sepsis mewn lleoliadau acíwt trwy’r Sgôr Rhybudd Cynnar Cenedlaethol (NEWS).

Tan 2017, prif ffocws y tîm Dirywiad Acíwt oedd gweithio mewn lleoliadau acíwt. Fodd bynnag, mae’r pwyslais wedi symud yn ddiweddar, yn unol ag agenda Cymru Iachach, ac rydym ni bellach yn canolbwyntio ar weithio gyda staff mewn lleoliadau cymunedol er mwyn gwreiddio NEWS yn ymarferol. Y nod yw sicrhau mai NEWS yw’r iaith sengl ar gyfer adnabod cleifion sydd mewn perygl o ddirywiad acíwt ar draws pob rhan o’r system iechyd a gofal cymdeithasol. Trwy gyflwyno NEWS a’r system sgorio rhybudd cynnar ar gyfer dirywiad acíwt, bydd modd sicrhau bod triniaeth, gofal a chynllunio gofal uwch yn cael lle blaenllaw mewn anghenion unigolion, gan arwain at ddarparu gofal yn agosach at adref.

Beth yw graddfa’r gwaith hwn yn y gymuned?

Mae’n anferth – bellach, mae dros 170 o dimau yn weithredol ledled Cymru, sydd gyfwerth â dros 1,500 o nyrsys ardal. Yn ogystal, rydym yn gweithio â meddygon teulu a thimau ymateb acíwt  ar draws pob bwrdd iechyd, yn ogystal ag ymatebwyr cyntaf (Gwasanaeth Ambiwlans Cymru ac Ambiwlans Sant Ioan). Fy rôl i yw cynorthwyo unigolion a thimau i graffu ar y systemau a’r prosesau mewn perthynas â dirywiad acíwt a chyflwyno mesurau ac offer gwelliant safonol ar draws eu timau er mwyn gwella’r broses o adnabod cleifion sydd mewn perygl o ddirywiad acíwt (gan gynnwys sepsis).

Pa fesurau ac offer gwelliant ydych chi’n eu golygu? 

Gan weithio o fewn y fframwaith gwelliant newydd, rydym wedi cefnogi timau cymunedol gyda’r Model Gwelliant, ymgysylltu â rhanddeiliaid a dadansoddi maes grym a defnyddio offer casglu a dadansoddi data. Gan ddefnyddio mapiau rhyngweithiol o Gymru, gallwn blotio cynnydd y timau gyda system goleuadau traffig. Wrth i’r gwahanol dimau ddod yn NEWS Barod (melyn) neu’n NEWS Weithredol (Gwyrdd), mae’n gynrychiolaeth weledol o’r gwelliannau y mae’r timau ac iechyd yn eu gwneud. Bu’r diwrnodau Arweinwyr Rhaglenni misol yn hanfodol bwysig, ac maent wedi darparu cyfleoedd i ddysgu ar y cyd, mewn amgylchedd cefnogol ac anfeirniadol. Yn ogystal, rydym wedi datblygu offer yn cynnwys siartiau NEWS, cyfarpar sgrinio sepsis a phecynnau anafiadau arennau acíwt. Gallwch lawrlwytho’r rhain o wefan 1,000 o Fywydau neu ofyn am gopïau gan unrhyw aelod o’r tîm cenedlaethol.

Pam gwnaeth y ffocws symud i leoliadau cymunedol?

Mae llwyddiant NEWS mewn lleoliadau acíwt yn dangos ei fod wedi darparu’r sail ar gyfer dull unedig a systematig o asesu a blaenoriaethu cleifion sy’n ddifrifol wael. Mae’n system tracio a sbarduno syml ar gyfer monitro cynnydd clinigol pob claf, a chaiff hynny ei adlewyrchu gan y ffaith ei fod yn cael ei ddefnyddio mewn 60 o ysbytai yng Nghymru heddiw, yn ogystal â Gwasanaeth Ambiwlans Cymru.

Fodd bynnag, roedd bwlch amlwg rhwng yr hyn a oedd yn digwydd yn y Sector Gofal Acíwt ac yn y gymuned. Yn 2017, cefais gyfle i weithio gydag Eve Lightfoot (Nyrs y Flwyddyn Coleg Nyrsio Brenhinol 2018) a chyfrannu at faes hyfforddiant nyrsys ardal mewn perthynas ag ymwybyddiaeth sepsis a dirywiad acíwt. Sylweddolais yn gyflym fod gan dimau frwdfrydedd ac awydd amlwg i weithredu NEWS, ond roedd addysg briodol ynghylch cydnabyddiaeth dirywiad acíwt a sepsis yn brin. Ar yr un pryd, roedd gan y timau adnoddau cyfyngedig, er gwaethaf y ffaith bod eu llwythi gwaith a chymhlethdod anghenion eu cleifion yn cynyddu’n aruthrol.

Treuliais lawer o amser yn cysgodi Arweinwyr Nyrsio Ardal a thimau ledled Cymru, lle cefais y cyfle i arsylwi achosion amrywiol; o ymweliadau dyddiol er mwyn gwneud gwiriadau cetonau gwaed a charthu cathetrau i rwymo coesau cymhleth a phacio anafiadau abdomenol.

Y nod oedd arsylwi sawl claf a oedd yn cael set lawn o arsylwadau ac, o hynny, pennu gwaelodlin NEWS. Nid oedd hynny’n digwydd yn rheolaidd.

Cefnogwyd yr angen i ddarparu gofal yn agosach at adref i bobl Cymru yn llawn gan Lywodraeth Cymru ac, yn benodol, roedd y ddogfen strategaeth “Cymru Iachach” yn ei gwneud yn flaenoriaeth. Ym mis Mawrth 2019, gorchmynnodd y Prif Swyddog Nyrsio y dylid cyflwyno NEWS a’i weithredu gan bob tîm nyrsio ardal ledled Cymru.

Pa wahaniaeth fyddai NEWS wedi’i wneud o ran newid deilliannau yn yr achosion a arsylwyd?

Petai NEWS wedi bod ar gael yn nifer yr achosion a arsylwais, byddai wedi darparu mesur goddrychol o unrhyw ddirywiad ac, o bosibl, wedi codi cwestiynau am sepsis. Yn ogystal, daeth yn amlwg iawn nad oedd gan staff yr holl offer angenrheidiol i ddarparu asesiadau NEWS. Roedd angen darparu hyfforddiant o ran cydnabod ac ymateb i ddirywiad acíwt yn y gymuned ac ar lefel Cymru gyfan. Daeth hynny’n ganolbwynt i’r rhaglen.

Sut ydych chi’n meddwl y bydd gwybodaeth a hyfforddiant gwelliant yn gwneud gwahaniaeth i staff a chleifion?

Yn bersonol, rydw i wedi gweld effaith gwreiddio dull systematig o adnabod claf afiach ar ddau gyfandir, yn seiliedig ar feddylfryd gwelliant a’r awydd i newid. Bydd NEWS yn y sector cymunedol yng Nghymru’n cael effaith sylweddol ar y ffordd rydym yn cyfathrebu â chleifion a theuluoedd. Yn fy marn i, bydd NEWS yn gwella’r gofal rydym yn ei ddarparu, gan roi’r unigolyn yng nghanol popeth rydym ni’n ei wneud.

I weithwyr proffesiynol, yn enwedig aelodau staff amhrofiadol, bydd NEWS yn darparu’r sgiliau, offer ac adnoddau hyfforddi angenrheidiol iddynt i wneud newidiadau a fydd yn rhoi mwy o ymdeimlad o gyflawniad personol a thîm iddynt.

Am y tro cyntaf erioed, mae gennym iaith salwch cyffredin sy’n cysylltu pob rhan o’r system iechyd a gofal cymdeithasol gyda’i gilydd yng Nghymru. Trwy NEWS, mae pawb yn siarad yr un iaith ar gyfer adnabod dirywiad acíwt a sepsis, a hynny ar yr adeg gynharaf, sy’n gwneud gwahaniaeth enfawr. Mae hyn yn gyffrous i bawb, yn bennaf oll ein cleifion!

* Mae 1,000 o Fywydau yn cael ei ail-lansio fel Gwelliant Cymru – gwasanaeth gwelliant Cymru gyfan ar gyfer iechyd a gofal cymdeithasol. Ymunwch â ni yn y lansiad ym mis Tachwedd. Darllenwch amdano a chofrestrwch fan hyn: http://www.1000livesplus.wales.nhs.uk/newyddion/51536