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.

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

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

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

May 142019

We catch up with Paul Gimson, Medicine Safety Programme Lead, 1000 Lives Improvement to talk about the plans for the Medicine Safety programme.

1.What is your background in medicine safety?

I’m a pharmacist by background so medicines safety is in my blood! I’ve worked in community pharmacy and as a prescribing advisor in local health boards. I’ve was the lead for Medicines Safety at the Royal Pharmaceutical Society.

  1. What are the plans for the Medicine Safety Programme?

The programme is being established in response to both the World Health Organisations Global Safety Challenge ‘Medication without Harm’ and the Welsh Governments Long Term plan for Health and Social Care: A Healthier Wales. We aspire to make Wales the safest place in the World to take medicines.

Our programme will be focussed on addressing four key challenges;

  • Systems – how can we improve the systems and processes that underpin prescribing, safety and medicines management? We will focus on prescribing practices, interfaces of care and applying the evidence base that exists around systems thinking and safety.
  • Harm – how can we tackle specific areas of harm that we know contribute significantly to avoidable admissions to hospital? Areas of concern include admissions due to falls, bleeds and acute kidney injury.
  • Prudent Prescribing – how can we apply the principles of prudent healthcare to prescribing? How can we improve areas such as polypharmacy, medication review and antimicrobial resistance? Can we make better use of the multidisciplinary team?
  • Person Centred-Care – how can we support a more person-centred approach to medicines safety in Wales? How can we best apply the principles of co-production and behavioural change psychology to medicines use?
  1. How do you plan to achieve the key outcomes of the programme?

As the title suggests it will be a challenge, and it won’t happen overnight. I have found myself wondering –what are the elements of a high performing medicines safety system. Is it better use of data? Is it better learning from error? Is it improved multidisciplinary working? What does any of his look like in an improved system?

In order to find out we plan to bring together the improvement expertise of 1000Lives with the knowledge and experience of those in NHS who have an interest in medicines safety, as well as the public, to co-produce a series of high impact interventions that have the potential to transform medicines safety in Wales. We will then test those interventions with a view to spreading them nationally via a national Medicines Safety Collaborative.

  1. Why are you excited to be working on it?

I have been involved in medicines safety all of my career. For me personally it is an opportunity to apply all I have learnt about improvement to a topic that I am passionate about. By bringing together pharmaceutical and improvement expertise we can make a real difference to peoples’ lives through safer and more effective use of medicines.

Paul wants to hear from you – what ideas do you have to improve medicines safety? What projects are you involved in that you want to share? If you want to get involved then please contact him at paul.gimson@wales.nhs.uk

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.

May 112018

Joanna Doyle, All Wales Nurse Staffing Programme Lead speaking at Quality 2018

I attended the IHI Forum in Amsterdam in May 2018 as part of the 1000 Lives team, showcasing the quality and safety work that is being undertaken in Wales. The 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 the nurses time to care for patients sensitively. As Wales is the first country in Europe to legislate on nurse staffing levels, the forum provided the opportunity to showcase the ground breaking work that is being undertaken in Wales, which is generating international interest. As the All Wales Nurse Staffing programme lead, I was delighted to have the opportunity to deliver a poster presentation on the programme of work to healthcare professionals and managers from across the world. The Nurse Staffing Act will prove influential in empowering nurses, providing them with the evidence they need to support their professional judgement when determining the nurse staffing levels they require to deliver safe and effective care to their patients.

The Forum provided the unique opportunity expand my knowledge on a range of quality and safety projects and initiatives. I was able to network with professionals who are actively involved in quality improvement, and have a keen interest in improving the quality and safety of care provided to patients who access healthcare services. The breadth and scope of experience and expertise was extensive and enlightening, providing much food for thought.

I also gained further experience presenting on the national nurse staffing work, this time on an international platform, I was able to talk to delegates from different countries about the challenges they are encountering in relation to nurse staffing within their areas and  how they envisage the Nurse Staffing Programme will benefit patients, nurses and health boards within Wales. Many delegates were keen to find out more about the national programme of work which they acknowledged was a positive way forward with many benefits for stakeholders.

I gained a wealth of knowledge about new and existing quality and safety initiatives that are being introduced in different countries, and this information has provided me with lots of ideas to share with members of the All Wales Nurse Staffing group and colleagues involved in this programme of work.

Aug 292017

Allwch chi gofio pryd aethoch chi i’r theatr? Beth oedd yn gofiadwy ac yn bleserus?
Ydych chi’n edrych ymlaen at ymweld â’r theatr eto?

Petai’n theatr llawdriniaethau, a fyddech chi’n teimlo’n wahanol? Dychmygwch:

  • Pe na fyddech yn deall pam neu beth oedd yn digwydd.
  • Petai’n rhaid i chi wisgo dillad rhywun arall (gŵn ysbyty).
  • Ar eich ffordd i’r theatr, roedd pobl yn syllu/ edrych i ffwrdd.
  • Bod y theatr yn arogleuo a bod y goleuadau’n llachar iawn.
  • Yn y theatr, bod golau’n fflachio ar y peiriannau swnllyd.
  • Nad oeddech chi’n adnabod dim un o’r bobl, a oedd yn gwisgo’r un dillad.
  • Eich bod chi’n parhau i ddweud eich bod chi wedi drysu ac yn ofnus, ond bod neb yn cymryd unrhyw sylw. Eich bod chi eisiau gadael, ond eu bod nhw wedi eich atal chi. Bod y bobl yn ymddangos yn flin?

Byddai’n gofiadwy, ond a fyddech chi eisiau ymweld eto?

Allwn ni amgyffred beth yw profiad unigolyn ag anabledd dysgu o ysbyty? A ydym ni’n deall sut mae profiadau blaenorol yn dylanwadu ar ymddygiad yn y dyfodol? Efallai ei fod yn ddiwrnod nodweddiadol ar gyfer gweithwyr gofal iechyd, ond yn ddiwrnod gwahanol iawn i ddefnyddwyr ysbyty. Mae’n hanfodol ein bod ni’n dangos empathi, tosturi, a deall sut gall yr amgylchedd a’r prosesau mewn ysbyty fod yn anodd iawn i bobl eraill. P’un ai a ydym ni’n ymwybodol yn sgil y pasbort ysbyty anabledd dysgu, ein gwybodaeth, neu oherwydd ein bod ni wedi gwrando ar yr unigolyn a’i ofalwyr, mae’n hanfodol ein bod ni’n bodloni’r addasiadau hanfodol, rhesymol hynny ar gyfer triniaeth.

Datblygodd ein tîm Profiad Lleddfu Pryder Cleifion (Soothing Patients Anxiety) “SPA”, i gyflwyno diwrnod llai gofidus a phrofiad cadarnhaol yn y theatr mewn ysbyty. Cyflawnom hyn trwy ddefnyddio cylchau ailadroddol Cynllunio, Gwneud, Astudio, Gweithredu, a thechnegau eraill a addysgwyd gan y cwrs IQT Arian i sicrhau y caiff ein prosesau eu mireinio’n barhaus. Mae cleifion a/neu eu gofalwyr yn bartneriaid cyfartal wrth gynllunio eu gofal. Mae myfyrio ar bob rhyngweithiad ac adborth cyson yn cynnig dysgu newydd i wella’r gwasanaeth yn barhaus. Cyflawnir diwrnod cofiadwy a phleserus trwy dechnegau tynnu sylw y mae’r claf yn eu dewis, wrth roi’r anesthetig cyffredinol, yr ydym yn ei alw’n “anaesthesia diarwybod neu anaesthesia â thema”, sy’n lleihau/osgoi tawelyddiad a/neu reoli ymddygiad yn gadarnhaol (ataliaeth). Caiff yr holl dechnegau eu hymarfer yn y theatr gyda’r claf a’i ofalwyr cyn diwrnod y llawdriniaeth, sesiwn “ymarfer”.

  • Anaesthesia diarwybod – rhoi’r anaesthetig tra bod yr unigolyn dan sylw yn cymryd rhan yn ei hoff weithgarwch a’r dechneg tynnu sylw dewisol.
  • Anaesthesia â thema – caiff y daith ei hadeiladu o gwmpas hoff beth. Fe wnaeth dyn ag anabledd dysgu wneud sylw yn ystod ein clinig asesu cyn anaesthetig pwrpasol, bod y mwgwd wyneb anaesthetig yn ei atgoffa o beth yr oedd peilotiaid awyrennau ymladd yn eu defnyddio yn ei hoff ffilm, Top Gun. Fore’r llawdriniaeth, gwyliodd ef y ffilm. Wrth gerdded i’r theatr, gwrandawodd ar gerddoriaeth thema’r ffilm. Yn y theatr, cymerodd ran mewn rhestr wirio cyn hedfan/anaesthetig. Aeth i gysgu yn dal ei fwgwd wyneb wrth wylio golygfa hediad awyrol trwy i-pod o’i flaen. Ar ôl deffro, derbyniodd dystysgrif hedfan Top Gun.

Mae’r Gwobrau’n ymgorffori’r cyfle i rannu dysgu a dylanwadu ar ofal y tu allan i’ch sefydliad. Y llynedd, enillodd y tîm Wobr Dinasyddion wrth Wraidd Ail-ddylunio Gwasanaeth GIG Cymru, ac eleni, Tîm Anaesthesia  y Flwyddyn BMJ. Mae’n anrhydedd cael gweithio gyda phobl ag anableddau dysgu a’r cyfle cynhenid i herio normau gofal iechyd. Mae ein defnyddwyr gwasanaeth amrywiol ac unigryw yn sicrhau dysgu parhaus a gwella ansawdd, gan fod pob un ohonynt yn ysbrydoli posibiliadau/dewisiadau newydd ar gyfer defnyddwyr yn y dyfodol.


Beth fyddech chi ei angen ar gyfer ymweliad cofiadwy a phleserus â’r theatr?

I gael mwy o wybodaeth:

E-bost: Paul.Harris@wales.nhs.uk

Aug 212017

Elinore Macgillivray, National Lead Midwife OBS Cymru

It’s an exciting time in any family’s life when a new baby is expected. With all the assurances of modern healthcare, the expectation is for a pregnancy to end with a healthy mum and baby. Still, for 1 in 20 women obstetric blood loss will be 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 (excessive bleeding after childbirth) will result in a baby that goes home without its mother.

Postpartum haemorrhage (PPH) continues to be one of the leading causes that adversely affects maternal well-being (morbidity) in Wales and is in the top 5 quality issues for every maternity unit. OBS Cymru – the Obstetric Bleeding Strategy for Wales is a 3 year national quality improvement project aiming to reduce harm from postpartum haemorrhage. The primary aim of the project is to reduce the number of women suffering a massive obstetric haemorrhage. It also aims to reduce the amount of blood products given, critical care admissions and hysterectomies performed due to PPH.

Over the last 10 years Cardiff and Vale University Health Board has been leading research into understanding the role of blood clotting in PPH. During the sequential research projects undertaken, a reduction in PPH associated morbidity was observed; felt to be not only linked to the impact of the research projects, but to multiple changes in practice.  Following discussion between delivery units across Wales, the themes listed below were identified as crucial to improving mother’s outcomes, and informed the OBS Cymru approach.

How are we going to achieve our aim of reducing harm from PPH?

Wales is in a privileged position of having a dedicated Maternity Network that engages stakeholders from all over country, and provides a forum for sharing ideas, and supporting quality improvement and standardisation nationally. A number of interventions have already been put in place across all Obstetric led labour wards in Wales:

  • Risk Assessment – each woman admitted to an obstetric lead labour ward in Wales will have a standard PPH risk assessment completed, in order to identify those at increased risk.
  • Early identification by means of Measuring Blood Loss – traditionally, we have estimated blood loss following birth, a practice that we are woefully poor at. We are now moving rapidly towards measuring all blood loss following all births, with training supported by the project team.
  • Multidisciplinary Team Working – we have developed a 4 stage PPH management tool which supports a unified approach to multidisciplinary team working. OBS Cymru funds champion teams in each of Wales’ 7 Health Boards consisting of a midwife, anaesthetist, obstetrician and haematologist. These teams have been vital in delivering quality improvement messages.
  • 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.

Of course, in order to demonstrate the positive changes we are expecting, we have a robust system of data collection supported by local OBS Cymru champion teams. This is already beginning to show some positive changes in practice.

Events such as this year’s UK Patient Safety Congress also provide invaluable network opportunities with health professionals all across the UK, and further afield, who share a common interest and commitment to quality improvement in maternity care. These collaborations will allow us to spread improvements across not just Wales, but the rest of the world.

As one of the national midwife leads for OBS Cymru, I passionately believe that this project will have a significant positive impact on reducing harm from postpartum haemorrhage.  After all, no matter what part we play, a healthy mother and baby is what we all strive for.

For more information on OBS CYMRU visit our page