Releasing Time to Care / Leading Better Care

Releasing Time to Care / Leading Better Care Sharing Good Practice

NHS Board

NHS Lanarkshire

Glencairn Rehabilitation Unit, Coathill Hosp – Mental Health

Details of Improvement

Which module / programme is this case study about?

RTtC Handover Module

What was the particular problem that this case study is about?

No clear process for handover, which is often lengthy due to discussion of unnecessary information and constant interruptions

What were the implemented improvements?

- Concerns and frustration identified, utilising RTC processes and lean methodology - Measurement of current process, using Safety cross, process mapping, timing handover meeting - PDSA approach used to identify areas for improvement and eliminate waste, - Action plan outlining steps, timelines and responsibility, which fed into the unit quarterly Action Plan - Notice for door to explain that the handover was in progress and that staff would be no longer than 20 mins. - Links with other areas of improvement – PSAG Board, Therapeutic Intervention Module - Measurement of new process, using Safety cross - Communication strategy, staff, patients and carers – Structure of handover document, Philosophy of handover document, Newsletters, action plans, and staff notices

Glencairn Unit PSAG Board What is the situation now?

Clearly identified process for Handover utilising the PSAG Board Staff familiar with process and happy to use same Time saved now utilised more productively with patient focussed activities

How is the change sustainable?

Ease to follow, clear process in place that all staff can understand and adhere to. PSAG Board kept up to date with relevant information Safety cross and questionnaires can be used to audit consistency of process and staff /patient/carer benefits. Reiterating and communicating benefits to all – utilising News letters etc. Audit progress and comments section on module action plan and Quarterly action plans.

Measurable outcome

Activity follows Safety crosses – Interruptions before and after process Length of handovers reduced for averaging Early shift – normally 20 mins – no reduction required Lateshift – normally 1 hour aim to reduce to 20 mins Nightshift – normally 20mins – no reduction required Progress re action plans

Example Before and After Safety Crosses re Interruptions Handover Interuptions June 2011 ( Before RTtC Process)

35 30 25 Earlyshift 20 Lateshift 15 10 Nightduty 5 0

Handover Interuptions July 2011 (After RTtC Process)

4.5 4 3.5 3 Earlyshift 2.5 2 Lateshift 1.5 Nightduty 1 0.5 0

What are the patient benefits?

Accurate, appropriate information relayed to staff ensures improved quality patient care. Report takes less time freeing staff promptly to attend to patients needs. Less staff attending handover so more staff available on the floor Designated member of staff allocated cordless phone and responsible for duration of Handover for a) Attending to patient needs during hand over b) Answering telephone queries from relatives etc c) Allowing patients to speak promptly to relatives who phone the unit.

This Helps - reducing patient frustration - Allows for continuous care of patients - Allows for an increase in Therapeutic Intervention time - Reduces patient anxiety and agitation – needs met quicker What are the staff benefits?

Appropriate information discussed at report. Staff shifts now finish at designated time Time released has allowed staff to expand the therapeutic Intervention module. Designated member of staff allocated cordless phone and responsible for duration of Handover for a) Dealing with general enquires

This Helps - allows other nurses on floor to continue with their duties uninterrupted - prevents delays at Handover due to all types of interruptions

What are the organisational benefits?

Timely and accurate reports Increased staff hours for patient care – 243 hrs - mainly due to reduction in time spent at late shift handover Improve quality of care Cost effective care

How did staff feel before the improvement/during the improvement and after the improvement?

Before - Frustrated with handover process due to interruptions - Unsure PSAG Board would contain all the information required to give an accurate handover After – Pleased with the reduction in interruptions during handover Happy that shifts now finish on time Staff less frustrated and pleased to have more time to concentrate on patient focussed activities

What are the lessons learnt and what would you do differently next time? Following the RTtC process allowed us to establish exactly what we wanted to keep and what we needed to change around the Handover Module. The only change I would make would be to have done the process sooner as it was really simple to sort once we had examined the detail.

What plans are there to spread the improvement?

Module process/documents stored on RTtC shared R Drive

Contacts

Name Email Telephone number Annette Annette,[email protected] 01236 Buckmaster 703111 Graham [email protected] 01236 Fell 703111