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Unlocking the potential: how student led projects can improve service delivery and enable workplace based education on Human Factors. Kimberley Begg Lorraine Armstrong Kirsty Mcneil Elaine Mccleary Pam Cumming Sarah Macpherson. C.A.U.T.I Daily review Record in the icu. Kimberley Begg
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Unlocking the potential:how student led projects can improve service delivery and enable workplace based education on Human Factors Kimberley Begg Lorraine Armstrong Kirsty Mcneil Elaine Mccleary Pam Cumming Sarah Macpherson
C.A.U.T.I Daily review Record in the icu Kimberley Begg Staff Nurse NHS Forth Valley 19/03/2014 Beardmore Conference Centre
Introduction • Background • What we did • Daily Review Record in practice • Did it make a difference? • Implications for future practice
Background • 2010 - Initially created at University • 2010 - Letting people know • 2010 - PDSA cycles in ICU whilst a student • 2010+2011 - Attended SPSP conferences • August 2012 Staff education Implementation in ICU
So... What is it? • Single sheet document called ‘CAUTI Daily Review Record’ • Follows the patient’s catheter – (bundle) • Full of prompts and tick boxes • Works in conjunction with a label on the drainage bag
Why is the change needed? • Reduce incidence of CAUTI • Improved catheter maintenance/management • Inconsistency with what is accepted as sufficient documentation • Reduce extended hospital stays • Financial benefits PROMOTES PATIENT CENTRED CARE AND PATIENT SAFETY
What we did • Pre-implementation audit • Staff education (inc NA and StN) • Implementation of CAUTI Daily Review Record and Labelling technique • Staff support • Feedback/PDSA cycles/improvements made that were unique to ICU • Poster updates – staff involvement • Post-implementation staff compliance – 98%
CAUTI Daily Review Record in practice • Fairly well received • Better knowledge of when catheter due out/drainage bag changes etc
Implications for future practice • lectures on my journey through quality improvement project to encourage students • Aim to spread hospital wide – education pack, currently being trialled in theatre • Staff will have improved awareness of their patient’s catheter, - insertion date, removal date, drainage bag renewal date etc.
Conclusion • Importance of quality improvement in undergraduate curriculum • Students now have QI projects as part of their final placements • In order to pass the course students are expected to complete IHI modules • Promotes personal development
Improving the identification and diagnosis of delirium Kirsty McNeil 3rd Year Medical Student
Project Background • Delirium is under recognised in acute care • The project was carried out in the Acute Medical Unit of Ninewells Hospital • We looked at the prevalence of delirium in patients 75 and above and how many of these had been diagnosed as having delirium • Only 10.5% of patients with delirium were identified
Changes • Feedback of Background Data • Visual Aids • Education Sessions for All Staff • Implemented the 4AT tool • Trialled a Delirium Pathway designed by a team within NHS Tayside Nurse educations sessions carried out Feedback Sessions carried out Implementation of delirium pathway
Students and improvement • The data collected by students has prompted a team within NHS Tayside to continue with the delirium work • Getting Students Involved: delirium awareness week, ongoing improvement project • Big Projects need time and people
Human Factors for a Safer Scotland Elaine McCleary and Pamela Cumming Student Nurses University of Dundee
Improving early recognition of delirium using SQiD(single question to identify delirium) • Our aim was for 95% of multidisciplinary staff to incorporate SQiD into daily practice in the Acute Surgical Receiving Unit of a large teaching hospital, by the end of an 8 week period. • During a test, this was achieved, although the project changed direction several times.
How did the experience help us as health care professional students? • We gained an understanding of undertaking Quality Improvement in the 'real world' and the continual cycle of professional and personal development and improvement. • We also developed an understanding of human factor science in this process, recognising how teamwork or communication, for example, influences the trajectory or success of a project.
What did we learn about how students can help the NHS to improve health care? • Quality Improvement science provides the tools to enable students to initiate, test and improve systems and processes. Awareness of Human Factors science is necessary to help understand the factors which either positively or negatively affect the success of such systems. • We understand it is everyone's business and is a way of thinking.
Quality improvement projects create further opportunities…. IHI 25th International Forum, Orlando, Florida. December 2013
Improving the efficiency and start time of trauma theatre at the Royal Alexandra Hospital Sarah Macpherson 5th year medical student
Project Background • Project done as 2nd year student • Busiest trauma theatre in Scotland • Evening sessions proposed to deal with workload • Currently inefficient, many delays • Running theatre costs £1200/hour • Late start main problem
Example Plan Do Study Act Cycle List to be taken to trauma theatre by theatre coordinator nurse by 8am Team decision for nurse to take list to theatre reception area to avoid this problem ACT PLAN STUDY DO Theatre coordinator nurse had inadequate time to change into theatre scrubs Not achieved
Results • Theatre start time improved by average 30mins • NHS saving of £600 per day • Average 1 more operation every day • Benefits for patients • Scheduled staff breaks as planned
How can students help the NHSto improve healthcare? • Fresh eyes • Useful part of project team • Less time pressure than employed staff • Can directly contribute to improved healthcare systems and efficiency and thus saving money • Investment in human factors training is valuable to promote improvement
How did the experience help me as a medical student? • Gained in confidence – solid grounding for clinical years • Better understanding of the patient experience from patient shadowing • 1st experience in quality improvement • Will be better prepared to initiate changes where required in future