Apr 032019
 

We catch up with Evie Lightfoot, District Nurse from Hywel Dda University Health Board on winning the RCN in Wales Nurse of the Year 2018 and the role Quality Improvement has played in her work.

Evie has developed training to help community nursing staff recognise sepsis in patients.

What does this award accolade mean to you personally and professionally?

I am so privileged to have won this award. At times I felt like giving up as it was quite a lonely journey, juggling the role of being a working single mum of 3 children with a District Nursing caseload and a research internship!

Receiving the award and recognition for my passion and dedication has made it all worthwhile and will hopefully encourage others to get involved in a project that they are passionate about.

The purpose and drive was to improve patient safety and recognition of sepsis and appropriate escalation in the community, by doing this it has enhanced the nursing teams’ knowledge, and skills, and helps to empower them to escalate appropriately.

I hope it has also raised the profile of District Nursing, improving the understanding of the important and often complex role that we have in delivering home based care, highlighting how the role of the District Nurse has evolved into a multi-faceted job caring for patients and their families with often unpredictable and complex health care needs.

On a personal note, winning the RCN in Wales Nurse of the year award 2018 and the RCN Community Nurse of the year award has been very exciting and a great honour. It has given me a platform from which to work with others to promote the role of Community Nurses in the quest to improve patient care. It has brought new opportunities and experiences which will broaden my knowledge and increase my confidence, helping to open up new possibilities for my future career. I am very privileged to have been given this opportunity.

Where did your journey begin?

My journey began almost 7 years ago when I started working as a community nurse. I had previously been employed as a junior sister in A&E and had ITU experience, so was used to assessing unwell patients using NEWS – National Early Warning Scoring System and Sepsis screening.

It was apparent to me straight away that community nurses did not have the appropriate training / education to recognise a deteriorating patient.  NEWS observations were not performed in the community and staff had not had any Sepsis education training. Nor did they have the correct equipment to carry out a full set of observations.

I tried to voice my concerns which wasn’t easy, as at this time it wasn’t recognised that Sepsis was a problem in the community or that there was a need for community nurses to perform NEWS observations. This left me feeling frustrated.

I completed my SPQ District nursing degree and went on to do a research internship where my project was to establish District Nurses current knowledge of sepsis and appropriate escalation. I wrote a bespoke community sepsis education package which I delivered with the help of a colleague from the 1000 lives team. We delivered the training to over 100 nurses across Carmarthenshire, the plan was to then re questionnaire them 3 months later.

This initial project was a catalyst and it uncovered lots of issues that needed to be addressed in order to improve patient safety.

What were some of the challenges along the way and how did you overcome them?

It has been a constant challenge and still is!

There were initial concerns that if I delivered sepsis awareness education and NEWS observations to community nurses that they would suddenly escalate inappropriately and that here would be a large queue of people outside GP surgeries and A&E.  It was also suggested that you didn’t need a score to know if someone was sick.

So I have had to reassure and explain that although NEWS is a valuable tool to detect deterioration and possible sepsis, it does not replace a practitioner’s clinical judgement it, is there to support and enhance it.

The NEWS system is also a common communication language used by the Welsh ambulance service and secondary care. This means that for Community and Primary care if you need to escalate a patient who is deteriorating the use of NEWS will help the process.

Even at an early stage there were practical obstacles such as finding venues to teach, to try and get staff to attend due to staffing problems and even down to the equipment and having to transport and carry a heavy TV and trolley to venues!.

I have worked closely with Chris Hancock and the 1000 lives acute deterioration team for many years involved in the National Out of Acute Hospital RRAILS group as well as Health board Out of acute hospital work.

The support that I have received from 1000 lives has been pivotal to the success of my work, they have been a fantastic team to be involved with and to help drive my initiative.

They continue to be a team that I liaise and meet with frequently to help drive forward the acute deterioration work in the community and I am excited and proud to be involved with the official launch of NEWS into Community nursing this March.

Would you recommend the Quality Improvement approach to others looking to make a change? And what do you think is key to sustaining improvement?

Yes using a QI approach allows a structured system, it prompts you to collect data and see what is working or not, and what needs to be changed. I only wish I had done this from the beginning of the project more diligently, but It’s all a learning process I guess.

I have learnt that with the best will in the world giving education and tools isn’t enough. You have to evaluate what change has taken place to inform future practice.

For it to succeed you can’t be precious, It’s imperative to share ideas and get other people on board so that the change can be embraced by others to ensure that it gains ownership and sustainability to be embedded into practice.

Do you have a plan for building on your success?

I am still collecting data, so currently success for me is measured by the feedback that I am receiving from staff and patients. The Community SBAR tool is going to be launched officially, this will then allow me to measure the outcomes of when patients care is escalated in the community. To evidence the good work that is being done by community nurses.

I am also hoping that with the launch of NEWS nationally on March 21st this will further help to embed best practice within the community nursing teams in HDUHB and nationally.

I am hoping that NEWS and the SBAR approach will be embraced into Primary Care with many interested already from care homes and GP practices.

I have recently set up a task and finish group to redesign our transfer of care document so that it contains more pertinent information that is needed, such as NEWS score, if a DNA CPR is in place etc. This will hopefully improve communication between secondary and community care. The plan is for the document could be used on transfer from hospital or from a care setting or form community, rather than just a discharge letter.

I am also very interested in doing a project in the future to look at post sepsis care and support of patients in the community.

I am currently undertaking further Quality Improvement work to establish how well the NEWS is being embraced by the community nursing teams and to be able to measure the outcomes.

What words of encouragement would you offer to others starting on an improvement journey?

I believe that it’s important to have a strong defined aim of what you are trying to achieve and why, you must keep this in mind throughout the process, to help keep your motivation up and to prevent you deviating.

If your idea to implement change is backed with integrity and a strong desire to improve patient care and the practice then you are on the right track.

Make sure your idea is evidence based and that it is something you are passionate about. You have to gain thick skin and broad shoulders, not everyone will like or agree with your ideas, it’s about developing coping strategies and enhancing communication skills to deal with it!

Learn from the hurdles and obstacles, celebrate the successes even when they small, keep knocking on doors as networking with others is the key to success.

 

Apr 032019
 

Rydym ni’n dal i fyny gydag Evie Lightfoot, Prif Nyrs Iau Tîm Ymateb Acíwt (ART) yn Sir Gâr, Bwrdd Iechyd Prifysgol Hywel Dda, ar ôl ennill Nyrs y Flwyddyn RCN yng Nghymru 2018, a’r rôl y mae Gwella Ansawdd wedi’i chwarae yn ei gwaith.

Mae Evie wedi datblygu hyfforddiant i helpu staff nyrsio cymunedol i adnabod sepsis mewn cleifion.

Beth mae’r wobr yn hon yn ei olygu i chi yn bersonol ac yn broffesiynol?  

Mae’n fraint fawr ennill y wobr hon. Ar adegau, roeddwn i’n teimlo fel rhoi’r gorau iddi, oherwydd yr oedd hi’n daith eithaf unig, yn jyglo’r rôl o fod yn fam sengl i dri o blant sy’n gweithio, gyda baich achosion Nyrsio Ardal ac interniaeth ymchwil!

Roedd derbyn y wobr a’r gydnabyddiaeth am fy mrwdfrydedd a’m hymroddiad wedi gwneud y cyfan yn werth chweil, a gobeithio bydd hyn yn annog pobl eraill i gymryd rhan mewn prosiect y maent yn frwdfrydig amdano.

Y diben a’r nod oedd gwella diogelwch cleifion ac adnabod sepsis, a chynnydd priodol yn y gymuned, trwy wneud hyn, mae wedi gwella gwybodaeth a sgiliau timau nyrsio, ac mae’n helpu i’w grymuso nhw i ddatblygu’n briodol.

Rwyf hefyd yn gobeithio ei fod wedi codi proffil Nyrsio Ardal, gan wella dealltwriaeth o’r rôl bwysig, a chymhleth yn aml, sydd gennym o ran cyflwyno gofal yn y cartref, ac amlygu sut mae rôl y Nyrs Ardal wedi datblygu i fod yn swydd aml-ffasedog yn gofalu am gleifion a’u teuluoedd, gydag anghenion gofal iechyd cymhleth ac anrhagweladwy yn aml.

Yn bersonol, mae ennill Gwobr Nyrs y Flwyddyn RCN yng Nghymru 2018, a Nyrs Gymunedol y Flwyddyn RCN, wedi bod yn gyffrous iawn, ac yn anrhydedd mawr. Mae wedi rhoi llwyfan i mi weithio gyda phobl eraill i hyrwyddo rôl Nyrsys Cymunedol yn y cwest i wella gofal cleifion. Mae wedi arwain at gyfleoedd a phrofiadau newydd, a fydd yn ehangu fy ngwybodaeth a chynyddu fy hyder, a helpu i gyflwyno posibiliadau newydd ar gyfer fy ngyrfa yn y dyfodol. Mae wedi bod yn fraint fawr cael y cyfle hwn.

Ble ddechreuodd eich taith?

Dechreuodd fy nhaith bron i 7 mlynedd yn ôl, pan ddechreuais weithio fel nyrs gymunedol. Roeddwn i wedi cael fy nghyflogi’n flaenorol fel prif nyrs iau yn yr adran damweiniau ac achosion brys, ac roedd gen i brofiad yn yr uned triniaeth ddwys, felly roeddwn i’n gyfarwydd ag asesu cleifion anhwylus gan ddefnyddio NEWS – System Sgôr Rhybudd Cynnar Cenedlaethol, a sgrinio Sepsis.

Roedd yn amlwg i mi ar unwaith nad oedd gan nyrsys cymunedol yr hyfforddiant / addysg briodol i adnabod claf sy’n dirywio. Ni chafodd arsylwadau NEWS eu cyflawniad yn y gymuned, ac nid oedd staff wedi cael unrhyw hyfforddiant addysg sepsis. Ac nid oedd ganddynt yr offer cywir i gyflawni set lawn o arsylwadau chwaith.

Ceisiais leisio fy mhryderon, nad oedd yn hawdd iawn oherwydd, ar y pryd, nid oedd sepsis yn cael ei gydnabod fel problem yn y gymuned, a bod angen i nyrsys cymunedol gyflawni arsylwadau NEWS. Roedd hyn yn gwneud i mi deimlo’n rhwystredig iawn.

Fe wnes i gwblhau fy Ngradd Nyrsio Ardal SPQ, a mynd ymlaen i wneud interniaeth ymchwil, lle sefydlwyd fy mhrosiect i sefydlu gwybodaeth Nyrsys Ardal presennol am a chynnydd priodol. Ysgrifennais becyn addysg sepsis cymunedol pwrpasol, a chyflwynais hwn gyda help cydweithiwr o dîm 1000 o Fywydau. Fe gyflwynom yr hyfforddiant i dros 100 o nyrsys ledled Sir Gâr, a’r cynllun wedyn oedd eu holi nhw eto 3 mis yn ddiweddarach.

Roedd y prosiect cychwynnol hwn yn gatalydd, ac fe wnaeth ddadorchuddio llawer o broblemau yr oedd angen mynd i’r afael â nhw er mwyn gwella diogelwch cleifion.

Beth oedd rhai o’r heriau ar hyd y ffordd, a sut gwnaethoch chi eu goresgyn?

Mae wedi bod yn her gyson, ac mae’n parhau i fod!

Roedd pryderon i ddechrau, petawn i’n cyflwyno addysg ymwybyddiaeth o sepsis ac arsylwadau NEWS i nyrsys cymunedol, y byddent yn cynyddu’n amhriodol yn sydyn, ac y byddai ciw mawr o bobl y tu allan i feddygfeydd ac adrannau damweiniau ac achosion brys. Awgrymwyd hefyd nad oedd angen sgôr i wybod a oedd rhywun yn sâl.

Felly, rydw i wedi gorfod tawelu meddwl ac esbonio, er bod NEWS yn offeryn gwerthfawr i ganfod dirywiad a sepsis posibl, nid yw’n amnewid dyfarniad clinigol ymarferydd, mae yno i’w ategu a’i wella.

Mae NEWS hefyd yn iaith gyfathrebu gyffredin a ddefnyddir gan Wasanaethau Ambiwlans Cymru a gofal eilaidd. Mae hyn yn golygu, ar gyfer gofal cymunedol a sylfaenol, os oes angen i chi uwchgyfeirio claf sy’n dirywio, a bydd defnyddio NEWS yn helpu’r broses.

Yn gynnar, hyd yn oed, roedd rhwystrau ymarferol, fel dod o hyd i leoliadau i addysgu, i geisio cael staff i fynychu oherwydd problemau staffio, a hyd yn oed yr offer a gorfod cludo a chario teledu trwm a throli i leoliadau!

Rwyf wedi gweithio’n agos â Chris Hancock a thîm dirywio acíwt 1000 o Fywydau ers nifer o flynyddoedd, bod yn gysylltiedig â grŵp RRAILS Allan o Ysbyty Acíwt Cenedlaethol, yn ogystal â gwaith Allan o Ysbyty Acíwt Byrddau Iechyd.

Mae’r gefnogaeth rydw i wedi’i derbyn gan 1000 o Fywydau wedi bod yn ganolog i lwyddiant fy ngwaith, maen nhw wedi bod yn dîm gwych i fod yn gysylltiedig â nhw, ac i helpu hybu fy menter.

Maen nhw’n parhau i fod yn dîm rydw i’n cysylltu â nhw ac yn cyfarfod â nhw’n aml i helpu hybu’r gwaith dirywio acíwt yn y gymuned, ac rwy’n gyffrous ac yn falch o fod yn gysylltiedig â lansiad swyddogol NEWS mewn nyrsio cymunedol ym mis Mawrth.

A fyddech chi’n argymell yr ymagwedd Gwella Ansawdd i bobl eraill sydd eisiau gwneud newid? A beth ydych chi’n meddwl sy’n allweddol i gynnal gwelliannau?

Mae defnyddio ymagwedd gwella ansawdd yn caniatáu system strwythuredig, mae’n eich hybu chi i gasglu data a gweld beth sy’n gweithio ai peidio, a beth sydd angen ei newid. Pe bawn i ond wedi gwneud hyn o ddechrau’r prosiect yn fwy dyfal, ond mae’r cyfan yn broses ddysgu, am wn i.

Rydw i wedi dysgu, hyd yn oed â’r ewyllys gorau yn y byd, nad yw rhoi addysg ac offer yn ddigon. Rhaid i chi werthuso’r newid sydd wedi digwydd i lywio ymarfer yn y dyfodol.

Er mwyn sicrhau ei fod yn llwyddo, ni allwch fod yn fursennaidd. Rhaid rhannu syniadau a chael pobl eraill yn gysylltiedig er mwyn i bobl eraill allu derbyn y newid i sicrhau ei fod yn cael ei ddefnyddio a’i fod yn gynalidawy, er mwyn ei ymgorffori mewn ymarfer.

A oes gennych chi gynllun i adeiladu ar eich llwyddiant?

Rwy’n dal i gasglu data, felly ar hyn o bryd, caiff y llwyddiant ei fesur yn ôl yr adborth rwy’n ei dderbyn gan staff a chleifion. Bydd yr offeryn SBAR cymunedol yn cael ei lansio’n swyddogol, a bydd hyn wedyn yn caniatáu i mi fesur y canlyniadau pan fydd gofal cleifion yn cael ei uwchgyfeirio yn y gymuned, i dystio’r gwaith da sy’n cael ei wneud gan nyrsys cymunedol.

Rwyf hefyd yn gobeithio, ar ôl lansio NEWS yn genedlaethol ar 21 Mawrth, bydd hyn yn helpu ymhellach i ymgorffori ymarfer gorau mewn timau nyrsio cymunedol ym Mwrdd Iechyd Prifysgol Hywel Dda, ac yn genedlaethol.

Rwy’n gobeithio y bydd NEWS ac ymagwedd SBAR yn cael eu defnyddio mewn gofal sylfaenol, gyda nifer o gartrefi gofal a meddygfeydd eisoes â diddordeb.

Yn ddiweddar, sefydlais grŵp gorchwyl a gorffen i ail-ddylunio ein dogfen trosglwyddo gofal, er mwyn iddi gynnwys gwybodaeth fwy perthnasol sydd ei hangen, fel sgôr NEWS, a oes gorchymyn DNA CPR ar waith, ac ati. Gobeithio y bydd hyn yn gwella cyfathrebu rhwng gofal eilaidd a chymunedol. Y bwriad yw i’r ddogfen gael ei defnyddio wrth drosglwyddo o ysbyty neu o leoliad gofal, neu o’r gymuned, yn hytrach na llythyr rhyddhau’n unig.

Mae gen i ddiddordeb hefyd mewn gwneud prosiect yn y dyfodol a fydd yn edrych ar ofal ar ôl sepsis, a chefnogi cleifion yn y gymuned.

Rydw i ar hyn o bryd yn cyflawni gwaith Gwella Ansawdd i sefydlu pa mor dda y mae timau nyrsio cymunedol yn defnyddio NEWS, a gallu mesur y canlyniadau.

Pa eiriau o anogaeth fyddech chi’n eu cynnig i bobl eraill sy’n dechrau ar daith wella?

Rwy’n credu ei bod hi’n bwysig cael nod diffiniedig cryf o beth rydych chi’n ceisio ei gyflawni a pham. Rhaid i chi gadw hyn mewn golwg trwy gydol y broses i helpu i sicrhau eich bod chi’n parhau’n frwdfrydig a’ch atal rhag gwyro.

Os yw’ch syniad i weithredu newid yn cael ei ategu gan onestrwydd a dyhead cryf i wella gofal cleifion a’r ymarfer, yna rydych chi ar y trywydd cywir.

Gwnewch yn siŵr bod eich syniad ar sail tystiolaeth a’i fod yn rhywbeth rydych chi’n frwdfrydig amdano. Rhaid i chi fod yn groendew a bod gennych chi ysgwyddau llydan. Ni fydd pawb yn hoffi nac yn cytuno â’ch syniadau. Mae’n ymwneud â datblygu strategaethau ymdopi a gwella sgiliau cyfathrebu i fynd i’r afael â hyn!

Dysgwch o’r rhwystrau, dathlwch y llwyddiannau, hyd yn oed pan eu bod nhw’n fach, parhewch i gnocio ar ddrysau gan fod rhwydweithio ag eraill yn allweddol i lwyddiant.

Feb 212019
 

David Murphy, Programme Advisor – Falls & Frailty, tells us about Falls Awareness Week 2019

Did you know that from Monday 18th February through to Friday 22nd February it is Falls Awareness Week in Wales, sponsored by Care & Repair Cymru, Age Cymru and Age Connects. At 1000 Lives Improvement, Public Health Wales the Falls and Frailty team are lending our support to the campaign and have been encouraged by the wide interest and support of colleagues from across NHS Wales and Welsh Government.

What is a Fall?
A fall is an unwanted event whereby an individual comes to rest inadvertently, either on the ground, or lower level with or without loss of consciousness. (NICE Clinical Guidance 2013)


Are Falls a Common Problem?

Yes. Falls place a significant demand on health and social care services, as well as the third sector in Wales. People aged 65 and older have the highest risk of falling, with 30% of people older than 65 and 50% of people older than 80 falling at least once a year. In Wales alone, an estimated 122,000 older people will fall more than once in their home with around 7,000 ending up in hospital. This creates additional demands on Ambulance Services and Hospital Staff.

The Cost of Falling

Most significantly, the human cost of falling includes distress, pain, injury, loss of confidence, loss of independence and mortality. Falling also affects the family members and carers of people who fall.

Falls have been estimated to cost the NHS alone more than £2.3 billion per year in the UK (NICE 2013). Using a simple population based estimated this could equate to around £110 million for NHS Wales. Therefore, falling has an impact on quality of life, health and healthcare costs as well as impacting on the wider community and economy.

A National Taskforce

That is why a National Falls Prevention Taskforce was established just over 2 years ago, supported by 1000 Lives Improvement in Public Health Wales. The Taskforce focuses on primary falls prevention and management with the ambition to reduce the number of falls experienced by older people in Wales. The national falls prevention campaign is entitled ‘Steady On, Stay Safe’. It incorporates interventions around the 3 Pillars of Strength and Balance Training, Capturing Falls History and Tackling Environmental Factors in order to prevent avoidable harm.

The Chartered Society of Physiotherapists (CSP) note that physical inactivity is a major public health problem and something that needs to be prioritised. For the CSP campaign check out #LoveActivityHateExercise

Launching Falls Awareness Week

Neil Williams of Care and Repair Cymru is the Taskforce Chairman. In a recent article in the Western Mail to launch Falls Awareness Week he noted that falls should not be seen as an inevitable part of growing old. This year’s campaign targets Welsh GP Practices providing leaflets and posters with common sense advice and signposting to relevant services. Some of the key messages to prevent falls include checking that footwear is appropriate and well fitting, ensuring medication is reviewed, testing eye sight, maintaining a healthy diet and stay hydrated. For further information you can follow the link to view the Falls Prevention Resource Hub: http://www.ageingwellinwales.com/en/resource-hub/fp-resources

Feb 212019
 

Mae David Murphy, Ymgynghorydd Rhaglen – Cwympo ac Eiddilwch, yn dweud wrthym am Wythnos Ymwybyddiaeth o Gwympo 2019

Oeddech chi’n gwybod ei bod hi’n Wythnos Ymwybyddiaeth o Gwympo yng Nghymru rhwng dydd Llun, 18 Chwefror a dydd Gwener, 22 Chwefror, a noddir gan Gofal a Thrwsio Cymru, Age Cymru ac Age Connects. Yn 1000 o Fywydau – Gwasanaeth Gwella, Iechyd Cyhoeddus Cymru, mae’r tîm Cwympo ac Eiddilwch yn rhoi ein cefnogaeth i’r ymgyrch, ac wedi cael eu hannog gan ddiddordeb a chefnogaeth ehangach cydweithwyr ar draws GIG Cymru a Llywodraeth Cymru.

Beth yw cwymp?
Mae cwymp yn ddigwyddiad dieisiau lle mae unigolyn yn dod yn ddisymud yn anfwriadol, naill ai ar y llawr, neu ar lefel is, wedi neu heb golli ymwybyddiaeth. (Arweiniad Clinigol NICE 2013)

A yw cwympo yn broblem gyffredin?

Ydy. Mae cwympo yn rhoi pwysau sylweddol ar wasanaethau iechyd a gofal cymdeithasol, yn ogystal â’r trydydd sector yng Nghymru. Pobl 65 oed a hŷn sydd â’r risg uchaf o gwympo, gyda 30% o bobl dros 65 oed, a 50% o bobl dros 80 oed, yn cwympo o leiaf unwaith y flwyddyn. Yng Nghymru yn unig, amcangyfrifir y bydd 122,000 o bobl hŷn yn cwympo mwy nag unwaith yn eu cartref, gydag oddeutu 7,000 ohonynt yn mynd i’r ysbyty. Mae hyn yn creu pwysau ychwanegol ar Wasanaethau Ambiwlans a staff ysbytai.

Cost cwympo

Yn fwyaf arwyddocaol, mae cost ddynol cwympo yn cynnwys trallod, poen, anafiadau, colli hyder, colli annibyniaeth a marwolaeth. Mae cwympo hefyd yn effeithio ar aelodau teulu a gofalwyr pobl sy’n cwympo.

Amcangyfrifir bod cwympiadau’n costio mwy na £2.3 biliwn y flwyddyn i’r GIG yn unig yn y DU (NICE 2013). Gan ddefnyddio amcangyfrif syml ar sail poblogaeth, gallai hyn fod yn hafal i oddeutu £110 miliwn i GIG Cymru. Felly, mae cwympo yn cael effaith ar ansawdd bywyd, iechyd a chostau gofal iechyd, yn ogystal â chael effaith ar y gymuned a’r economi ehangach.

Tasglu cenedlaethol

Dyna pam y sefydlwyd Tasglu Atal Cwympiadau Cenedlaethol ychydig dros ddwy flynedd yn ôl, gyda chefnogaeth 1000 o Fywydau – Gwasanaeth Gwella yn Iechyd Cyhoeddus Cymru.  Mae’r Tasglu’n canolbwyntio ar reoli ac atal cwympiadau sylfaenol, gydag uchelgais i leihau nifer y cwympiadau y mae pobl hŷn yng Nghymru yn eu cael. Enw’r ymgyrch atal cwympiadau cenedlaethol yw ‘Sadiwch i Gadw’n Saff’. Mae’n ymgorffori ymyriadau sy’n ymwneud â’r tri philer o hyfforddiant cryfder a chydbwysedd, nodi hanes cwympo, a mynd i’r afael â ffactorau amgylcheddol, er mwyn atal niwed osgoadwy.

Mae cyflawni gweithgareddau neu ymarfer corff priodol yn bwysig hefyd. Mae Cymdeithas Siartredig y Ffisiotherapyddion yn nodi bodi segurdod corfforol yn broblem iechyd cyhoeddus fawr ac yn rhywbeth sydd angen ei flaenoriaethu. I weld ymgyrch Cymdeithas Siartredig y Ffisiotherapyddion, gwiriwch #LoveActivityHateExercise

Lansio Wythnos Ymwybyddiaeth o Gwympo

Neil William o Gofal a Thrwsio Cymru yw Cadeirydd y Tasglu. Mewn erthygl ddiweddar yn y Western Mail i lansio Wythnos Ymwybyddiaeth o Gwympo, nododd na ddylid ystyried cwympo yn rhan anochel o fynd yn hŷn. Mae ymgyrch eleni yn targedu meddygfeydd Cymru trwy ddarparu taflenni a phosteri sy’n rhoi cyngor synnwyr cyffredin a chyfeirio gwasanaethau. Mae rhai o’r negeseuon allweddol i atal cwympo yn cynnwys gwirio bod esgidiau yn addas ac yn ffitio’n dda, sicrhau bod meddyginiaeth yn cael ei hoedlog, cael profion llygaid, cynnal diet iachus a bod yn hydradol. I gael mwy o wybodaeth, dilynwch y ddolen i weld y Ganolfan Adnoddau ynghylch Atal Cwympiadau: http://www.ageingwellinwales.com/en/resource-hub/fp-resources

Feb 192019
 

In this Blog, Richard Desir, Senior Workforce Transformation Nurse, Aneurin Bevan University Health Board and All Wales District Nursing Workforce Operational Lead shares the journey of the development of an evidence based workload and workforce tool and Interim Nurse Staffing Principles for District Nursing.

The All Wales District Nursing workforce and workload group is tasked to develop a District Nursing Workload and Workforce Tool that has been evidenced within the Welsh context, that would assist Health Boards in community nursing workforce planning. This important work will positively contribute to the delivery of care to patients in their own home and help shape the workforce by ensuring the safe and effective deployment of district nurses to meet the needs of the populations they serve.

A triangulated approach will be used when calculating the number and skill mix of nurses required within District Nursing Services, which takes into account:

  • Patient acuity and dependency
  • Quality audit
  • Professional judgement

The group has undertaken a staged approach to developing the learning and evidence base with each stage of the development of the Quality Audit tool and the Welsh Levels of Care, using service improvement methodology Improving Quality Together 1000 Lives (2014), each phase follows the Plan, Do, Study, Act (PDSA) cycle.

Under the leadership of Paul Labourne, Richard Desir and Katrina Rowlands the All Wales District Nursing workforce group have embarked on a remarkable and ambitious journey to journey to create the evidence to:

  • Determine what is quality and how this can be measured and articulated?
  • Develop and test an acuity and dependency tool to help assess workload.
  • Explore how professional judgement is used to inform decision making the associated factors

Throughout 2017/18 over 600 frontline District Nurses and management teams have engaged in workshops held across Wales to explore how the ‘Welsh Levels of Care’ could be used as an acuity tool within district nursing and sessions have been held to inform the further testing of the District Nursing Quality Audit.

The testing of the quality audit tool has resulted benefitted patients and district nursing teams by triggering:

  • Systematic roll out of National Early Warning scores within district nursing
  • Systematic roll out of “what Matters to me “ framework
  • Systematic improvement to equipment available to district nurses
  • Systematic capturing patient outcomes and experience to inform service improvement
  • The early digitalisation of capturing data and using that data digitally
  • Creating new evidence
  • Energising the district nursing workforce

The Chief Nursing Officer in Wales requested that an interim set of guiding nurse staffing principles for district nursing be developed and implemented to support the preparation for extension of the Act while the work to develop an evidence based workforce planning tool for District Nursing is undertaken. In September 2017 the District Nursing Staffing Principles were launched. These are monitored biannually and individual feedback provided to each organisation involved.

The implementation of the district nursing staffing principles has enabled a baseline assessment of services to understand where service development is required.  Enabling district nursing teams to be well defined, well led, and well supported.  They have highlighted areas where demand and capacity may be mismatched and further work is required.  It has introduced additional skill mix to district nursing such as administration support that has released time for patients.  The iterative assessment of the principles and the feedback given is supporting organisations with their development of the core universal nursing care at home service recognising the unique contribution district nurses play in the management of population health, improving public health and keeping the patient at the centre of care.

If you would like to find out more about the work undertaken by the District Nursing work stream  please email richard.desir@wales.nhs.uk or Katrina.Rowlands@wales.nhs.uk

Feb 192019
 

Yn y blog hwn, mae Richard Desir, Uwch-nyrs Trawsnewid y Gweithlu ym Mwrdd Iechyd Prifysgol Aneurin Bevan ac Arweinydd Gweithredol Gweithlu Nyrsio Ardal Cymru-gyfan, yn rhannu’r daith o ddatblygu offeryn gweithlu a llwyth gwaith ar sail tystiolaeth, ac Egwyddorion Staff Nyrsio Dros Dro ar gyfer Nyrsys Ardal.

Gwaith y grŵp gweithlu a llwyth gwaith Nyrsio Ardal Cymru-gyfan yw datblygu Offeryn Gweithlu a Llwyth Gwaith Nyrsio Ardal, sydd wedi cael ei amlygu yng nghyd-destun Cymru, a fyddai’n cynorthwyo Byrddau Iechyd o ran cynllunio’r gweithlu nyrsio cymunedol. Bydd y gwaith pwysig hwn yn cyfrannu’n gadarnhaol at gyflwyno gofal i gleifion yn eu cartrefi eu hunain, ac yn helpu ffurfio’r gweithlu trwy sicrhau y caiff nyrsys ardal eu lleoli’n ddiogel ac yn effeithiol i fodloni anghenion y poblogaethau y maent yn eu gwasanaethu.

Defnyddir ymagwedd drionglog wrth gyfrifo nifer a chymysgedd sgiliau’r nyrsys sydd eu hangen ar gyfer Gwasanaethau Nyrsio Ardal, sy’n ystyried:

  • Dibyniaeth a chraffter claf
  • Archwiliad ansawdd
  • Barn broffesiynol

Mae’r grŵp wedi defnyddio ymagwedd raddol at ddatblygu’r sail dystiolaeth a dysgu gyda phob cam o ddatblygu’r offeryn archwilio ansawdd a lefelau gofal Cymru, gan ddefnyddio methodoleg gwella gwasanaeth, Gwella Ansawdd Gyda’n Gilydd, 1000 o Fywydau (2014), ac mae pob cam yn dilyn y cylch  Cynllunio, Gwneud, Astudio, Gweithredu (PDSA).

O dan arweinyddiaeth Paul Labourne, mae Richard Desir a Katrina Rowlands, a’r grŵp gweithlu Nyrsio Ardal Cymru-gyfan, wedi dechrau ar daith ryfeddol ac uchelgeisiol i greu’r dystiolaeth i:

  • Bennu beth yw ansawdd, a sut gellir ei fesur a’i fynegi?
  • Datblygu a phrofi offeryn craffter a dibyniaeth i helpu asesu llwyth gwaith.
  • Archwilio sut defnyddir barn broffesiynol i lywio gwneud penderfyniadau a’r ffactorau cysylltiedig.

Yn ystod 2017/18, mae dros 600 o Nyrsys Ardal rheng flaen a thimau rheoli wedi cymryd rhan mewn gweithdai a gynhaliwyd ledled Cymru, i archwilio sut gellid defnyddio ‘Lefelau Gofal Cymru’ fel offeryn craffter ym maes nyrsio ardal, a chynhaliwyd sesiynau i lywio profi archwiliad ansawdd nyrsio ardal ymhellach.

Mae profi’r offeryn archwiliad ansawdd wedi bod o fudd i gleifion a thimau nyrsio ardal, trwy sbarduno:

  • Cyflwyno’n systematig sgorau rhybudd cynnar cenedlaethol ym maes nyrsio ardal
  • Cyflwyno’n systematig fframwaith “Beth sydd o bwys i mi”
  • Gwella’n systematig yr offer sydd ar gael i nyrsys ardal
  • Dal yn systematig ganlyniadau a phrofiadau cleifion i lywio gwella’r gwasanaeth
  • Digideiddio dal data yn gynnar a defnyddio’r data hwnnw’n ddigidol
  • Creu tystiolaeth newydd
  • Ysgogi’r gweithlu nyrsio ardal

Gofynnodd Prif Swyddog Nyrsio Cymru am i set dros dro o egwyddorion staff nyrsio arweiniol ar gyfer nyrsio ardal gael eu datblygu a’u gweithredu, i gynorthwyo paratoi ar gyfer ymestyn y Ddeddf, wrth i’r gwaith i ddatblygu offeryn cynllunio’r gweithlu ar sail tystiolaeth gael ei gyflawni. Ym mis Medi 2017, lansiwyd Egwyddorion Staff Nyrsio Ardal. Caiff y rhain eu monitro bob chwe mis, a rhoddir adborth unigol i bob sefydliad cysylltiedig.

Mae gweithredu’r egwyddorion staff nyrsio ardal wedi galluogi asesiad sylfaenol o wasanaethau i ddeall ble mae angen datblygu’r gwasanaeth. Bydd yn galluogi timau nyrsio ardal gael eu diffinio’n dda, eu harwain yn dda, a’u cefnogi’n dda. Maen nhw wedi amlygu meysydd lle efallai nad yw’r galw a’r gallu yn cydweddu ac mae angen mwy o waith. Mae wedi cyflwyno cymysgedd sgiliau ychwanegol at nyrsio ardal, fel cymorth gweinyddol, sydd wedi rhyddhau amser ar gyfer cleifion. Mae’r asesiad ailadroddol o’r egwyddorion a’r adborth a roddwyd, yn cefnogi sefydliadau i ddatblygu’r gwasanaeth gofal nyrsio yn y cartref cyffredinol craidd, gan gydnabod y cyfraniad unigryw y mae nyrsys ardal yn ei wneud o ran rheoli iechyd y boblogaeth, gwella iechyd cyhoeddus, a chadw cleifion yng nghanol gofal.

Os hoffech ddarganfod mwy am y gwaith a gyflawnir gan y ffrwd gwaith Nyrsio Ardal, anfonwch neges e-bost at richard.desir@wales.nhs.uk neu Katrina.Rowlands@wales.nhs.uk

Jan 172019
 

13 District General Hospitals in Wales are working collaboratively with the 1000 Lives Improvement service at Public Health Wales to improve the care they provide to patients undergoing emergency laparotomy surgery (emergency bowel surgery).

This work is part of an all wales quality improvement programme called Emergency Laparotomy Cymru (ELC) launched in July 2018.

ELC focusses on a patient’s care, from the time of the individual presenting to hospital, throughout their perioperative journey and during recovery.

Hospitals are using a 6-step evidence-based care bundle approach to deliver improvements.

A data collection system known as NELA (the National Emergency Laparotomy Audit) is used, to better understand individual standards of care and use data to make improvements.

Three clinical leads have been appointed to progress the work across local regions.  Over the next few months, they will be sharing their thoughts over why this programme is so important and will discuss how it’s developing.  Each lead will be working closely with other members of a multi-disciplinary team from each hospital within their region. This will consist of staff across emergency departments, radiology, theatre, critical care and surgical wards.

 In this first blog, we speak with Dr Babu Muthuswamy, South East clinical lead. Babu is a Consultant in Anaesthesia and Intensive Care and Clinical Director for Critical Care at Aneurin Bevan University Health Board.

 In your opinion, why is ELC so important?

In Wales, a number of hospitals have good clinical pathways to improve the care and outcomes of patients undergoing emergency laparotomy but there is still variation in processes and outcomes for patients having this high-risk surgery.

ELC has been launched to support NHS Wales in improving patient outcomes across Wales. We are striving to ensure that outcomes and satisfaction levels, for patients and their wider family members, rank as some of the best in the UK.

What made you want to get involved?

I have been part of the NELA audit since its roll out 2014 and have been the lead for the Royal Gwent Hospital throughout this period. There have been numerous challenges along the way in relation to improving the processes of care to emergency laparotomy patients. Being part of a national project like this helps to raise the profile of this work and to highlight the high-risk nature of this surgical procedure. It also helps to focus the minds of multi-disciplinary teams in each hospital to work towards one aim which is improving care and patient outcomes.

 What do you hope it will achieve?

Through ELC I am hopeful that we can improve patient outcomes from:

  • Having evidence-based practice guidelines as elements of the ELC bundle;
  • Providing a support network for the NELA leads in each of the hospitals involved;
  • Improving the scope of research to refine current practice; and
  • Disseminating successful clinical pathways that have been adopted in other hospitals (across the UK).

ELC is following a UK model that has been tried and tested, having achieved successful results.

For further information:

Email:  National ELC Programme Lead:  Margaret.Rennocks@wales.gov.uk

Website:  http://www.1000livesplus.wales.nhs.uk/elc-cymru

Follow the conversation on Twitter #EmergencyLaparotomyCymru

Jan 172019
 

Mae 13 o’r Ysbytai Cyffredinol Dosbarth yng Nghymru yn cydweithio â 1000 o Fywydau – Gwasanaeth Gwella, yn Iechyd Cyhoeddus Cymru, i wella’r gofal y maen nhw’n ei ddarparu i gleifion sy’n cael llawdriniaeth laparotomi brys (llawdriniaeth brys ar y coluddyn).

Mae’r gwaith hwn yn rhan o raglen gwella ansawdd Cymru gyfan, o’r enw Laparotomi Brys Cymru (ELC), a lansiwyd ym mis Gorffennaf 2018.

Mae ELC yn canolbwyntio ar ofal cleifion, o’r cyfnod y daw’r unigolyn i’r ysbyty, trwy gydol ei daith amdriniaethol, ac yn ystod ei gyfnod gwella.

Mae ysbytai’n defnyddio ymagwedd pecyn gofal ar sail tystiolaeth 6 cham i gyflwyno gwelliannau.

Defnyddir system casglu data o’r enw NELA (Archwiliad Cenedlaethol Laparotomi Brys) i ddeall safonau gofal unigol yn well, a defnyddio data i wneud gwelliannau.

Mae tri arweinydd clinigol wedi cael eu penodi i ddatblygu’r gwaith ar draws rhanbarthau lleol. Dros y misoedd nesaf, byddan nhw’n rhannu eu meddyliau ynghylch pam mae’r rhaglen hon mor bwysig, a byddant yn trafod sut mae’n datblygu. Bydd pob arweinydd yn gweithio’n agos ag aelodau eraill o dîm amlddisgyblaeth o bob ysbyty yn eu rhanbarth. Bydd yn cynnwys staff ar draws adrannau brys, radioleg, theatr, gofal critigol, a wardiau llawfeddygol.

Yn y blog cyntaf hwn, rydym ni’n siarad â Dr Babu Muthuswamy, arweinydd clinigol y de-ddwyrain. Mae Babu yn Ymgynghorydd Anaesthesia a Gofal Dwys, a Chyfarwyddwr Clinigol ar gyfer Gofal Critigol ym Mwrdd Iechyd Prifysgol Aneurin Bevan.

 Yn eich barn chi, pam mae ELC mor bwysig?

Yng Nghymru, mae gan nifer o ysbytai lwybrau clinigol da i wella gofal a chanlyniadau cleifion sy’n cael laparotomi brys, ond mae amrywiaeth o ran prosesau a chanlyniadau cleifion sy’n cael y llawdriniaeth risg uchel hon.

Lansiwyd ELC i gefnogi GIG Cymru i wella canlyniadau cleifion ledled Cymru. Rydym ni’n ymdrechu i sicrhau bod canlyniadau a lefelau bodlonrwydd cleifion a’u haelodau teulu ehangach ymhlith y gorau yn y DU.

Pam yr oeddech chi eisiau bod yn gysylltiedig?

Rwyf wedi bod yn rhan o archwiliad NELA ers ei gyflwyno yn 2014 ac mae wedi bod yn arweinydd ar gyfer Ysbyty Brenhinol Gwent trwy gydol y cyfnod hwn. Mae nifer o heriau wedi bod ar hyd y ffordd mewn perthynas â gwella prosesau gofal i gleifion laparotomi brys. Mae bod yn rhan o brosiect cenedlaethol fel hwn yn helpu i godi proffil y gwaith hwn, ac amlygu natur risg uchel y weithdrefn lawfeddygol hon. Mae hefyd yn helpu i ffocysu meddyliau timau amlddisgyblaeth ym mhob ysbyty i weithio tuag at un nod, sef gwella gofal a chanlyniadau cleifion.

 Beth rydych chi’n gobeithio y bydd yn ei gyflawni?

Trwy ELC, rwy’n gobeithio y gallwn ni wella canlyniadau cleifion yn sgil:

  • Cael canllawiau ymarfer ar sail tystiolaeth fel elfennau o’r pecyn ELC;
  • Darparu rhwydwaith cymorth ar gyfer arweinwyr NELA ym mhob un o’r ysbytai cysylltiedig;
  • Gwella cwmpas ymchwil i fireinio ymarfer presennol; a
  • Lledaenu llwybrau clinigol llwyddiannus sydd wedi cael eu mabwysiadu mewn ysbytai eraill (ledled y DU).

Mae ELC yn dilyn model y DU sydd wedi cael ei brofi, ar ôl cyflawni canlyniadau llwyddiannus.

I gael mwy o wybodaeth:

E-bost:  Arweinydd Cenedlaethol Rhaglen ELC:  Margaret.Rennocks@wales.gov.uk

Gwefan:  http://www.1000livesplus.wales.nhs.uk/elc-cymru

Dilynwch y sgwrs ar Twitter #EmergencyLaparotomyCymru

Dec 072018
 

Dr John Boulton, Interim Director of NHS Quality Improvement and Patient Safety, 1000 Lives Improvement

It’s been a busy few months since I joined Public Health Wales in the summer – although I’m not complaining! When I first arrived, I was also part time in my role as Executive Director of Continuous Improvement in the Aneurin Bevan University Health Board and so was effectively wearing two hats. Now, a few months in to the full time role, I continue to be astounded by the volume of work going on and commitment of the team within 1000 Lives Improvement.

The last several months really has been a journey of discovery and information gathering and I have met many stakeholder groups in order  to gain an in depth understanding of an organisation that’s already in its tenth year – I’m hearing some really great things.

In going through that journey, however, there is a clear recognition that the 1000 Lives team need to evolve the way that they support Quality Improvement within Wales. I think 2019 is going to be an exciting time for 1000 Lives Improvement. We are looking at what we do and how we do it to enable us to support NHS Wales and Social Care to improve services and achieve the vision set out in Welsh Government’s A Healthier Wales: our Plan for Health and Social Care (2018).

Responding to The Parliamentary Review of Health and Social Care in Wales (2018), the plan sets out a long-term future vision of a ‘whole system approach to health and social care’, which is focussed on health and wellbeing, and on preventing illness. It calls for transformation to an integrated system, with new models of seamless local health and social care and we’re developing plans around how we can support you to deliver this transformation. The 1000 Lives team is well placed to support this.

To inform our thinking, we’d like to hear from all staff and services about your service improvement experience and what you’d like help with moving forwards. Please share your thoughts with us via our online survey.

We’ll be feeding back in the New Year about what we learn and how we can support you moving forwards – keep an eye on our website, newsletter and social media for the most recent updates.

Dec 072018
 

Dr John Boulton, Cyfarwyddwr Dros Dro Gwella Ansawdd a Diogelwch Cleifion y GIG, Gwasanaeth Gwella 1000 o Fywydau

Mae’r misoedd diwethaf wedi bod yn brysur ers i fi ymuno ag Iechyd Cyhoeddus Cymru dros yr haf – ond nid cwyno ydw i! Pan gyrhaeddais i am y tro cyntaf, roeddwn i hefyd yn gweithio’n rhan-amser yn fy swydd fel Cyfarwyddwr Gweithredol Gwella Parhaus ym Mwrdd Iechyd Prifysgol Aneurin Bevan, ac felly roeddwn i’n gwisgo dwy het mewn gwirionedd. Bellach, ychydig fisoedd ar ôl dechrau’r rôl amser llawn, rwy’n parhau i gael fy synnu gan faint o waith sy’n cael ei wneud ac ymroddiad tîm Gwasanaeth Gwella 1000 o Fywydau.

Mae’r misoedd diwethaf wedi bod yn daith o ddarganfod a chasglu gwybodaeth, ac rwyf wedi cwrdd â nifer o grwpiau rhanddeiliaid er mwyn cael dealltwriaeth ddofn o sefydliad sydd eisoes yn ei ddegfed flwyddyn – rwyf wedi clywed pethau da iawn.

Yn ystod y daith honno, fodd bynnag, cafwyd cydnabyddiaeth gref bod angen i’r tîm 1000 o Fywydau ddatblygu’r ffordd y maen nhw’n cefnogi Gwella Ansawdd yng Nghymru. Rwy’n credu y bydd 2019 yn gyfnod cyffrous i Wasanaeth Gwella 1000 o Fywydau. Rydym ni’n ystyried ein gwaith ar hyn o bryd a sut rydym ni’n ei wneud er mwyn ein galluogi ni i helpu GIG Cymru a Gofal Cymdeithasol i wella gwasanaethau a chyflawni’r weledigaeth a roddir yng nghynllun Llywodraeth Cymru Cymru Iachach: ein Cynllun Iechyd a Gofal Cymdeithasol (2018).

Mae’r cynllun yn ymateb i’r Adolygiad Seneddol o Iechyd a Gofal Cymdeithasol yng Nghymru (2018), ac mae’n nodi gweledigaeth tymor hir ar gyfer y dyfodol, sef ‘iechyd a gofal cymdeithasol yn cael eu darparu drwy un system gyfan ddi-dor’, sy’n canolbwyntio ar iechyd a lles, ac ar atal salwch. Mae’n galw am drawsnewid yn system integredig, gyda modelau newydd o iechyd a gofal cymdeithasol lleol di-dor, ac rydym yn datblygu cynlluniau o gwmpas sut gallwn ni eich cefnogi i gyflenwi’r trawsnewidiad hwn. Mae tîm 1000 o Fywydau mewn lle da i gynorthwyo hyn.

Er mwyn llywio ein ffordd o feddwl, hoffem glywed oddi wrth yr holl staff a gwasanaethau am eich profiad o wella gwasanaethau, a sut hoffech chi helpu gan edrych at y dyfodol. Rhannwch eich barn gyda ni trwy ein harolwg ar-lein.

Byddwn yn rhoi adborth yn y flwyddyn newydd ynghylch beth a ddysgwyd a sut gallwn ni eich cefnogi chi wrth symud ymlaen – cadwch lygad ar ein gwefan, cylchlythyr a’r cyfryngau cymdeithasol i weld y newyddion diweddaraf.