27Th March 2019 Experience Day 2: NHS Lanarkshire

International Forum on Quality & Safety in Healthcare Experience Visit to NHS Lanarkshire - 27th March 2019

Experience Day 2: NHS Lanarkshire – Quality in a health board setting NHS Lanarkshire is the third largest health board in Scotland, serving a population of 655,000 across rural and urban communities in Lanarkshire and employing around 12,000 staff working in communities, health centres, clinics and offices and at our three district general hospitals – University Hospital Hairmyres, University Hospital Monklands and University Hospital Wishaw.

During this visit, delegates will learn about a number of projects in different care settings, including person-centred visiting, sepsis improvement, frailty at the front door and a range of primary care and mental health transformations.

We are committed to delivering high quality, innovative and person-centred health and social care. Our aim is that everyone is able to live longer, healthier lives at home, or in a homely setting.

Find out more on our plan for person-centred, innovative healthcare to help Lanarkshire flourish.

NHS Lanarkshire Experience Day – Option 1: University Hospital, Hairmyres

8.30am: departure by coach from SEC

9.30am: arrival at University Hospital Hairmyres. Delegates to be met by Mrs Frances Todd, Nurse Director, Acute Division, NHS Lanarkshire

09.45am: Welcome from Dr Jane Burns, Medical Director, NHS Lanarkshire

10.15am - 11.00am: Presentation: Distress Brief Intervention. Speaker: Dr Linda Findlay, Medical Director, South Lanarkshire Health & Social Care Partnership

Distress Brief Interventions (DBIs), which emerged from the Scottish Government’s work on the Suicide Prevention and Mental Health strategies, are an innovative way of supporting people in distress.

The DBI programme is hosted and led nationally by Health and Social Care North Lanarkshire (H&SCNL) and South Lanarkshire Health & Social Care Partnership (SLH&SCP), on behalf of the Scottish Government and is being piloted until March 2021 in four sites across Scotland including North & South Lanarkshire as above.

The programme is nurturing and delivering a shared vision for connected compassionate support, through a large and far reaching national and regional distress collaboration between health and social care, emergency services and third sector, putting citizens at the centre, providing early intervention, reducing duplication, increasing efficiency and improving outcomes and experience for people experiencing distress and those providing support.

11.00 – 11.45am: Mobilisation in an Intensive Therapy Unit Setting, Dr Sanjiv Chohan Delirium and weakness are common consequences of critical illness. Early mobilisation and rehabilitation are recommended as standards of care within critical care services. We aimed to introduce a standardised staged mobilisation process for our patients. Using iterative testing, and informed by feedback from patients and staff, we tested the introduction of an early mobilisation process 'The Daily Dangle' in our ICU. Although this led to more work for staff, co designing the process led to the dangle being valued both by patients and staff. Data showed that the new process was safe, and also associated with a decrease in the incidence of delirium, an important complication of critical illness.

12.00: Buffet Lunch and Market Stalls – Foyer Area

There will be various market stalls where Lanarkshire health and social care staff will be available to discuss improvements they are making to improving quality and safety for the people of Lanarkshire including:

Primary Care Improvement Team Lead: Judith Cain, Senior Improvement Manager Primary Care Delegates will learn about how Lanarkshire’s Primary Care Improvement Team oversees the implementation of the Primary Care Improvement Plan which supports the delivery of the General Medical Services (GMS) contract 2018. The contract refocuses the role of GPs as expert medical generalists, leading multi-disciplinary teams to provide healthcare in the community. Specific tasks currently carried out by GPs will then be carried out by other members of the wider team – where it is safe, appropriate and will benefit the patient. These substantial changes to primary care services will ensure that more people can be cared for in their own communities.

Mental Health and wellbeing Lead: Jenny Hutton, Public Mental Health Development Manager Improving the mental health of the population is a national priority for Scotland, and a local priority for Lanarkshire. Achieving good mental health for all requires diverse, co-ordinated action and an ambitious, innovative approach. We believe in a mentally flourishing Lanarkshire where mental health inequalities are neither acceptable nor inevitable. Delegates will learn of innovative approaches across a number of areas, including:

· Social prescribing · Early intervention in mental health · Stigma Free Lanarkshire · Building Recovery Communities · Suicide Prevention · Lanarkshire Green Health Partnership

QI within Children, Young People and Families Leads: Vivian Boxall IHI Improvement Advisor, Louise Graham Senior Nurse and Sandra MacInnes Improvement Coordinator Delegates will learn, via four brief poster presentations, how practitioners have developed their skills as improvers and are using the model for improvement within children's services. The focus is on addressing child poverty, reducing the inequality gap in the uptake of the 27 month child health review, coproduction with parents to reduce exposure to second hand smoke, and improve language skills in early years. These presentations will be of interest to any colleagues working with children, young people and families and a desire to learn about the practical journey of taking projects to scale and sustaining the gains.

Telehealth and Telecare Lead: Morag Hearty, Lanarkshire Telehealth and Telecare Manager As a major partner in the National Technology Enabled Care programme, Lanarkshire’s Telehealth team, are changing the way people access health and care services. Delegates will learn about how team have introduced remote health monitoring and video consultations (VC) to a wide range of services. Remote monitoring of long term conditions has improved condition control and saved appointments, VC in care homes has improved quality of life for residents and the use of VC by acute, specialist and community teams has improved communication. Overall it has achieved considerable savings in travel and time for citizens and staff. This supports all national health and wellbeing outcomes.

1-1.45pm: Presentation: Think Activity in a Community Hospital Speaker: Lianne McInally, Senior Improvement Advisor, Quality Directorate, NHS

The #Think Activity improvement journey originated in Kello Community Hospital, Biggar, to improve physical and mental wellbeing outcomes for patients. The initial project was a collaboration between NHS Lanarkshire, Healthcare Improvement Scotland and Glasgow Caledonian University. Improvements encouraged an active ethos on the ward, incorporating a self-management approach to goal setting and increasing activity levels that put patients at the centre of the process, giving them control over goals set and how they were achieved.

The project has involved patients, families, staff and the wider community in the improvement approach including local spiritual support, volunteers and Biggar primary and secondary schools.

There has been national and international interest in the use of the Activity Passport at scale both in hospital and community to support people to ‘Think Activity’.

1-45-2.30pm: Presentation: Care Home Continence Promotion Speaker: Jean Donaldson, Associate Director of Nursing, South Lanarkshire Health & Social Care Partnership

Research has identified incontinence as a risk factor that increases skin damage, infection and falls in older people. That has a detrimental impact on people’s lives and, in turn, places increasing pressure on the health and care system. Working in partnership with care homes and using improvement methodology a continence promotion care bundle has been developed.

This has led to marked improvements including a reduction in falls by 65%, urinary tract infections being reduced by 50% and skin damage reduced by one third. The number and absorbency levels of continence pads used have also reduced. Health economist analyses demonstrate a potential saving to the NHS of £250,000 in one care home over nine months. This multi award winning project which involved two care homes is now being spread and implemented in care homes across Lanarkshire.

2.30-3.30pm: Clinical Area Visits Delegates will visit one of the following areas and have the opportunity to meet staff who have carried out improvements in quality and safety in healthcare in NHS Lanarkshire. Visit 1: Frailty Team Visit 2: Medical Assessment Unit Visit 3: Theatre Hub Visit 4: Emergency Department 3.30-4pm: Session: Reflections on the day Chair: Frances Dodd, Director of Nursing, NHS Lanarkshire This session will be an opportunity for delegates to share insights on their visit to NHS Lanarkshire and share learning and experiences.

4pm: Session: Closing the day

Speaker: Irene Barkby, Executive Director of Nursing, Midwifery and Allied Health Closing remarks and an invitation for future connections.

4.30pm: return to SEC by coach

NHS Lanarkshire Experience Day: Option 2 - University Hospital Wishaw

8.30am: departure by coach from SEC

9.30am: arrival at University Hospital Wishaw. Delegates to be met by Mrs Marjorie McGinty, Head of Improvement, NHS Lanarkshire

09.45am: Welcome from Mrs Irene Barkby, Director of Nurses, Midwives and Allied Professionals, NHS Lanarkshire

10.15-11am: Presentation: Hospital Anticipatory Care Plans Speaker: Professor Robin Taylor, Consultant in Respiratory Medicine, NHS

The NHS Lanarkshire Hospital Anticipatory Care Plan is a communication tool to be used for patients who are potentially clinically unstable and/or nearing the end of life. It is designed to minimise harm due to inappropriate medical interventions at times of acute deterioration in a patient's condition, especially out of hours and at weekends.

The Hospital Acute Care Plan should be used whenever a Do Not Attempt CPR order is being applied. It is also very helpful when patients are being referred for palliative care.

11-11.45am: Presentation: Deterioration & Sepsis Speaker: Martin Carberry, Nurse Consultant, Critical Care, NHS Lanarkshire

NHS Lanarkshire is committed to improving the safety of patients suspected of having sepsis. We are approaching this is a variety of different ways including; raising awareness of sepsis to the general public so that they know what to be looking for and how to act quickly to respond, clinical education in primary care with community teams regarding recognition and escalation of patients who may have sepsis; clinical education in acute hospitals regarding the recognition, escalation and response to sepsis.

We are also working with our medical staff who work in the community both during normal hours and also during the out of hours period on the process for recognition of the deteriorating patient and pre alerting for sepsis.

12.00pm: Buffet Lunch and Market Stalls – Foyer Area

Cumbernauld Community Nursing Team Lead: Gemma Nolan, District Nursing Team District Nursing Team based at Kenilworth Medical Centre, managing over 300 patients within Cumbernauld North Locality.

The team noted a moderate to high level of acute admissions from our patient groups. Our aim was to increase the use of structured response by 80% in community patients by February 2019, and all our patients will have baseline observations carried out as standard. This work has proven to have a positive effect on reducing unnecessary acute admissions for many of our patients, and also reducing the referrals to Hospital @ Home team by Cumbernauld GPs, as the district nursing team are now taking a more structured approach to assessment of the deteriorating patient in the community, by carrying out structured response, and therefore supporting GP sustainability and putting in place appropriate shared plans of care. We are continuing to collect data via the daily safety brief, which includes the numbers of structured response assessment being carried out, and the number of hospital admissions from our case-loads over the month. We will also consider and review the admission, with a collective view as a team as to whether the admission could have been avoided, and reflect on what may have been done different (if anything), to avoid further unnecessary acute admissions. From a team lead perspective, I am satisfied that this has changed and improved practice, quality and safety, and this is now embedded as routine within our team.

use of VC by acute, specialist and community teams has improved communication. Overall it has achieved considerable savings in travel and time for citizens and staff. This supports all national health and wellbeing outcomes.

Reduction of the National Stillbirth Rate by 35% The impact of stillbirth on women and their families is immeasurable. It is therefore important that women are not only told about, but actually understand the importance of recognising and monitoring their baby’s unique pattern of movement. The use of the “teach back” method enables the midwife to confirm whether the woman understands the information she has been given and allows the opportunity to reiterate any information that has not been fully understood. The process measure being a documented discussion of fetal movement using the teach back method. The “Nurture Ribbon”, is a visual prompt given to women at their 22 – 24 week antenatal appointment along with an information leaflet. The intention is that the woman will place the ribbon somewhere that she will see it every day, (eg.car keys) and it will prompt her to think about her baby’s movements. By the end of January, we had 90% compliance with women receiving a nurture ribbon and teach back being used to confirm her understanding of fetal movement.

1-1.45pm: Presentation: Hospital Standard Mortality Ratio (HSMR) Mr Hakim BenYounes, Chief of Medicine, University Hospital Wishaw, NHS

HMSR Reduction at University Hospital Wishaw. University Hospital Wishaw has shown commitment to improving services and reducing harm to patients, participating in all national harm reduction programmes and is leading the way in Scotland with a 29% reduction in Hospital Standardised Mortality Ratio (HSMR). This reduction has been a result of strong teamwork, leadership, changes in culture and many strands of safety and improvement work coming together to effect whole system change. This presentation will detail the range of approaches which have been taken to achieve this result.

1.45-2.30pm: Presentation: Dementia Care and Quality Improvement Speaker: Gillian McAuley, Chief Nurse, NHS Lanarkshire

Improving the care and experience for patients with dementia is a priority for NHS Lanarkshire. The numbers of patients in Scotland over 75 years is set to increase by 30% by 2026 and approximately one third of patients in acute hospitals have dementia, which will increase. We were the first hospital in Scotland to sign up to John’s Campaign, which supports the rights of relatives and carers to be with their loved ones 24/7. This led to the introduction of Person Centred Visiting. The concept of relative and carer involvement in care was developed further with the introduction of Theatre Buddy, which supports relatives and carers to accompany their loved one with dementia to theatre and be the first person to greet them in them in recovery. Both initiatives

have reduced stress and distress for patients, reduced the need for anti- psychotic medication and improved patient experience. 2.30pm: Clinical Area Visits Delegates will visit one of the following areas and have the opportunity to meet staff who have carried out improvements in quality and safety in healthcare in NHS Lanarkshire. 1. Meaningful Activity Club 2. Bedside Handover Ward 6 3. Hospital Anticipatory Care Plans Ward 7 4. Emergency Department/Emergency Receiving Unit 5. Maternity 3.30-4pm: Session: Reflections on the day Chair: Heather Knox, Deputy Chief Executive This session will be an opportunity for delegates to share insights on their visit and share learning and experiences.

4-4.30pm: Session: Closing the day Speaker: Dr Jane Burns, Medical Director, NHS Lanarkshire Closing remarks and an invitation for future connections.

4.30pm: return to SEC by coach