Sep 132016
 

tdg-tronThe first time I ever saw or heard of Sepsis it was on a death certificate. The death certificate was my brother’s. I remember squinting across the registrar’s table at this little word next to “primary cause of death.” It meant nothing to me.

My brother was… is… Mark. He was 41 years old, married with a 3 year old daughter. He had a family and a future.

At midday on Thursday 31st May, 2012 Mark walked into A&E (London) with stomach pains. By 17.15p.m. he had suffered a cardiac arrest. By 19.00p.m. he was on a ventilator with a 50/50 chance of survival. By 01.00a.m. on Friday 1st June, his kidneys had failed, his odds had shortened and his family were on the M4 having received the phone call nobody wants. The next morning his heart was too weak for dialysis. We know now that he was in septic shock. Multiple organ failure. He fought hard on his last day as did all the ITU staff. Everyone gave everything but sepsis won. He died peacefully lunchtime on Saturday 2nd June.

We couldn’t believe how this had happened. He had a stomach bug. How could we have lost a son, a brother, a husband, and Sophie a dad? Well, what I know now which I didn’t know then is that it can happen, it does happen and it happens far too often. In fact it happens 44,000 times a year in the UK. 2,200 times in Wales. I thought we were one in a million. We were not.

Sepsis is a car crash illness. It is indiscriminate and can affect anyone. It kills nearly a third of all the people it touches. That’s more than breast, bowel and prostate cancer combined. Shocking isn’t it? You know what’s also shocking? If spotted early it’s treatable and preventable.

It’s fair to say that sepsis changed my life. It does that to lives.

Not long after Mark died I met Ron Daniels of the United Kingdom Sepsis Trust and began raising awareness in Wales. I’m now Executive Director of UK Sepsis Trust in Wales. I’ve met Ministers, cycled from West Wales to Westminster fund raising, I speak in schools, at hospitals, to the people in shops and on buses. We have engaged Welsh Government in our work, a cross-party group has been established.  People are listening.

I listen too; to survivors and how they have struggled post sepsis, to the bereaved and how they struggle too.

Awareness and education is everything. People need to know what sepsis is and what it can do. We need to get to a stage where public and health professionals alike are thinking about and recognise sepsis. They need to see it coming because it hides really well. As Mohammed Ali said, “His hands can’t hit what his eyes can’t see” Ironically he recently died from sepsis.

I’ve been helped along the way by some wonderful people both inside and outside healthcare. .  I am on the RRAILS steering group.   As such, I’ve seen first-hand the incredible hard work of dedicated NHS Wales staff committed to improve practice to improve outcomes. The programme is doing some great work striving to educate NHS Wales staff on Sepsis.  We want the same thing.

We’ve even won an award for it! It was fantastic for The Global Sepsis Alliance to recognise and reward NHS Wales for its awareness and education initiatives.

But..

We cannot afford to lose momentum. There can be no resting on laurels. We should celebrate what has been done, be proud but also continue to challenge and champion what still needs to be done. For me, there has to be a collective effort from Community to Cabinet. We need a common language for patients and practice. The patients need a pathway, an All Wales pathway. If we speak about sepsis the same, we can think about sepsis the same. It brings us together and as we say here in Wales… “together, stronger”.

Want to get involved?

@TCTRON

terence@sepsistrust.org

https://www.justgiving.com/fundraising/cycle4sepsis16

Aug 262014
 

All of our processes contain variation. Understanding variation is vital when deciding how to improve our processes and services.

David Williams

David Williams

Variation is the natural fluctuation that we see in our processes. For example, the number of times the phone rings at work a day is never constant. The differing number of times it rings a day is the variation we see in this process.There are two different types of variation, “common cause” variation and “special cause” variation.

An example of how variation works…

Every day I drive to work. It normally takes me about 55 minutes, if there are no unusual occurrences, but this does vary. It rarely takes exactly the same time to drive to work due to levels of traffic, weather, or the timing of traffic signals. These time differences are expected. It is common cause variation.

One day, there was an accident on the Motorway. My journey to work took 94 minutes. This is special cause variation. If this happened to you, would you change your route to work every other day just because of this single occurrence?

Continue reading »

Jul 152014
 
GrantRobinson

Grant Robinson

Cwm Taf Health Board was a worthy winner of the Improving Patient Safety category at this year’s NHS Wales Awards for its project on patient flow.

By coordinating actions to make sure patients don’t wait unnecessarily for the care they need, health board staff have significantly reduced the time people spend waiting in ambulances and in the accident and emergency departments.

They’ve been able to demonstrate improved patient outcomes and experience, sometimes in areas they didn’t expect, and the changes have been sustained.

The Unscheduled Care Improvement Programme in Wales is designed to make it easy for people to get the right emergency and urgent care when it is needed, and to make sure that no-one has to wait unnecessarily for the care they need, or to go back to their home.

Continue reading »

Jul 012014
 

PeteStraw Image1A beautiful, sunny Llandudno greeted us on our arrival at the highly-anticipated 1000 Lives Improvement National Learning Event, a fantastic opportunity for healthcare practitioners and students to meet and discuss the notion of prudent healthcare and quality improvement within the NHS in Wales.

Welcome coffee and pastries lined the stomach for the launch session delivered by Professor Matthew Makin (Medical Director, BCUHB) and Dr Alan Wilson (Director, 1000 Lives Improvement), who introduced the concept of prudent healthcare – built on the three pillars of reducing avoidable harm, appropriately minimising intervention, and promoting co-production of health between service users and providers.

Continue reading »

Jun 092014
 
Marcus Longley

Marcus Longley

Prudent healthcare is a big idea, or it is nothing.

But big ideas are not always welcome in public policy – they tend to disrupt ‘business as usual’. While we are spending our precious, finite thinking time on what the big idea really means, we might just neglect all those other equally vital, but more pressing, objectives, like safer care and balancing the books… And anyway, big ideas come and go, don’t they?

Public services know how to deal with latest Ministerial big ideas. The time-honoured approach is to thank the Minister profusely for providing vital new direction and insight, talk about it a lot in conferences organised for that purpose, include the new catch-phrases in every possible document… then re-badge all the things you were doing already using the new label, and get back to the day job.

But before health boards and trusts kill off prudent healthcare in this way, let’s just recognise that its three key planks cannot just be swallowed up into business as usual.

First, a prudent healthcare system will really empower people to maximise their own wellbeing, often recognising that that there are no clinical fixes. Chronic conditions are often, by definition, incurable, and good healthcare is about helping people to minimise their impact on what matters most to them in their lives. So people with chronic conditions – most of our patients – should routinely be offered a wide menu of support, from information and skills training, to individual and peer group support, often provided by the third sector, so that they can find things which work for them. Choice and diversity here are vital – one size will not fit all.

Second, when it comes to clinical intervention, prudent healthcare depends on patients really choosing what’s best for them. That means finding new ways of supporting patients really to think through what would be best for them, and creating the expectation that they will often say “No”.  And if they say “No”, we have to have alternatives to offer them (see above).

Third, it means re-defining what good care means. Under prudent healthcare, the key issue is what patients think about their care, not as they leave the hospital, but months down the line. A perfect operation which the patient wishes they hadn’t had two years later, is a huge waste of time and effort, on so many counts.

So … All we need, then, is a whole new swathe of non-clinical service provision, supported but not provided by the NHS; a re-thinking of the clinical encounter, with new systems to support that; and a new way of measuring our performance, with patient-defined and reported outcome measures routinely collected and compared on thousands of clinical interventions.

That’s not ‘business as usual’.

We need to hear the managerial squealing of brakes across NHS Wales, as our leaders realise that this is big change, fit for a big idea, requiring a new direction.

For further information, read Achieving prudent healthcare in NHS Wales or visit the prudent healthcare section of the 1000 Lives Improvement  website.

Marcus Longley is Director of the Welsh Institute for Health and Social Care and Professor of Applied Health Policy

Jun 092014
 

 

Professor Peter Bradley

Professor Peter Bradley

Achieving prudent healthcare in NHS Wales is a new paper published by Public Health Wales which outlines the findings of four workshops set up to test ‘prudent healthcare’ in the real world. 

What is prudent healthcare? The Minister has defined it as, “Healthcare that fits the needs and circumstances of patients and actively avoids wasteful care that is not to the patient’s benefit.” In practice this looks like safe, effective care delivered without delays. I think we’d all agree we would like to be guaranteed healthcare like that.

In the paper, we have summarised the principles of prudent healthcare as:

  • Minimise avoidable harm.
  • Carry out the minimum appropriate intervention.
  • Promote equity between the people who provide and use services.

The workshops raised several points of interest, but there was general agreement form the staff and service users present that the current system’s faults and occasional failings could be fixed by applying these principles.

The third one is key to successfully applying these principles. We know that when people are involved in their healthcare, and are given complete information and genuine choice, they often choose the less risky options, which usually are the least expensive. For example, if we advise people about pharmaceutical side-effects, they are more likely to want to try changing their lifestyle rather than being prescribed medicines.

The workshops also looked at some specific questions:

  1. What happens now that does harm or little good?
  2. What happens now in an expensive way, which could be done in a more cost effective way?
  3. What would the pathway look like if organised around the minimum intervention principle?

There are huge gains to be made in quality, improved patient outcomes and cost-effectiveness from reducing delays in the system. We sometimes automatically put people through the system because we are set up to deliver certain treatments or interventions rather than offering people a lower level of intervention that would be of equal benefit to them, and possibly more!

The perspective of the people who use our services is vital. They can alert us to delays and wastage in the system and have an equal role to play in ensuring they receive the treatment that is right for them. We have to learn to listen and involve them more. The future of our health service depends on it.

For further information, read Achieving prudent healthcare in NHS Wales or visit the prudent healthcare section of the 1000 Lives Improvement website.

Dr Peter Bradley is the director of Public Health Development in Public Health Wales. Follow Peter on Twitter @pbradley1965

May 132014
 
Angela Williams

Angela Williams

During my work as a Nursing Lecturer at Bangor University, I am always delighted to see students from the School of Healthcare Sciences feeling enthusiastic about quality improvement and patient safety.

So I wanted to highlight three ways that I’ve seen student nurses inspiring one another recently, and hopefully they will inspire you too! Continue reading »

Apr 222014
 
Dr Simon Noble

Dr Simon Noble

62% of people in Wales believe that air travel is the main cause of blood clots, according to research we worked on for the Ask about Clots campaign. And it’s a damaging misconception – because there is a far greater risk of develop a clot when in hospital.

In fact, you are 1000 times more likely to develop a clot during or in the 90 days following hospital treatment. That’s why the misconception is a fatal one, because blood clots can cost lives.

Through my work with Lifeblood, we’ve tried to raise awareness that blood clots are the most common cause of preventable hospital deaths. And the more people know about clots, the more likely it is we’ll be able to prevent them.

Ask about Clots Infographic 3 Parts Continue reading »

Apr 072014
 
Ruth Hussey

Lloyd Evans

Clots. A word many have heard of, but I wonder how many understand the effect this five-letter word has on the health and wellbeing of our population.  The answer according to the Ask about Clots campaign launched last week: not enough!

As a final-year medical student approaching the start of a career within the NHS, I attended the launch of Ask about Clots with the realisation that in a little over four months, this topic would well and truly be hitting me square in the face.  Despite years of lectures, tutorials, and clinical attachments, I was taken aback by the facts: Continue reading »

Mar 052014
 
Andrew Cooper

Andrew Cooper

Meet Chris Hancock. He’s passionate about helping colleagues in NHS Wales to identify and treat sepsis. He wants to see as many lives as possible saved from a condition that kills more people than breast cancer, prostate cancer and HIV/AIDS combined.

Last year, Chris added Twitter and blogging to his skill set to help him in his work. And since then, he’s joined – and started – conversations about sepsis with individuals and organisations in Wales, across the UK and around the world.

Those conversations have informed and shaped his thinking on the subject. They have enabled him to tap into the latest national and international research, build strategic relationships – as well as share the ground-breaking work colleagues in Wales are leading to address the challenge of this deadly condition. Continue reading »