Patient safety

Introduction: Effective board rounds improve the patient’s experience and reduce the risks associated with a prolonged hospital stay. Ward C54 at Queen’s Medical Centre is a 30-bedded ward dedicated to the provision of care for older, frail (CFS ≥ 6) patients. Board round on C54 was unstructured and could take over an hour. The project team set out to reduce the duration of board round, improve the quality of information handed over and improve staff satisfaction with board round. 

Method: Pre- and post-intervention data on the daily duration of board round were collected by the junior doctors on the ward. PDSA methodology was then used to test the following interventions: 1. Nerve centre updated daily by the junior doctor responsible for that bay 2. Junior doctors to present information using 4Q approach 3. Staff nurse in each bay highlighting any issues for that bay. Pre- and post-intervention surveys were also distributed to staff working on C54. 

Results: The duration of board round was reduced from an average of 52 minutes to an average of 38 minutes post-intervention. Over 90% of survey respondents believed the board round to be more efficient and over 80% were either satisfied or very satisfied with board round duration. 

Conclusions: The findings have shown it is possible to improve the duration of and staff satisfaction with board round by giving MDT members a framework to help structure handover of written and verbal information. Future considerations include providing teaching sessions to staff on the board round process. 

Between 2016 and 2021, HSC Trust reported 1,383 choking-related adverse incidents, highlighting a pressing concern for patient safety. This Quality Improvement (QI) Initiative was developed within a Nursing Home specializing in caring for residents with learning disabilities who faced an elevated risk of eating and drinking difficulties. The primary objective was to enhance safety during meal times by integrating a structured safety pause, aligned with the "7 Rights" framework. The initiative leveraged various QI tools, including process mapping, PDSA (Plan-Do-Study-Act) cycles, structured observations, and interviews.

Results of the initiative demonstrated a notable increase in patient satisfaction, a boost in staff confidence, and a reduction in near-miss incidents. The success of the program prompted its expansion to other nursing homes, involving families in the process. To further support patient safety, each staff member and family member now possesses a small card outlining the "7 Rights," which can be readily utilized before assisting patients with eating and drinking difficulties. This initiative represents a valuable step forward in safeguarding vulnerable individuals and has the potential to positively impact patient care across various healthcare settings.

Introduction

The UK Parkinson's audit assesses whether patients with Parkinson's Disease (PD) are managed according to standards. Referring patients to physiotherapy (PT) and advising those with daytime sleepiness not to drive are two of these. In our clinic, patients identified as drivers are advised to inform the DVLA and will undergo a MOCA, sleep questionnaire and driving assessment. 

Project Aim

Are we making early physiotherapy referrals and documenting driving status in newly diagnosed outpatients? 

Methods

Online notes of newly diagnosed patients over a 12 month period were reviewed. A clinic checklist was created and displayed in the clinic as a poster with the mnemonic:

Lasting Power of attorney

Driving

Osteoporosis

Physiotherapy

Anticipatory care planning

Following introduction of the checklist a further cycle has taken place. 

Results

In the initial cycle, 34 newly diagnosed patients were identified. 4 were nursing home residents and excluded from results. Of those remaining, 83% had documentation of driving status. 2 patients were drivers and one had evidence of completed driving assessments. 20 patients were referred to physiotherapy and a further 3 patients were offered (76%). 50% of referrals were within the first month of diagnosis. Following checklist introduction, 21 new PD patients were identified over 6 months. The clinic team were sent updated data throughout to encourage ongoing improvements. 95% had documentation of driving status. 9 were drivers. 6 had full driving assessment completed. 16 (76%) patients were referred to physiotherapy. 75% of these were referred within the first month.

Conclusions

Repeat data collection has shown improvement in both driving status documentation and early physiotherapy referral. The checklist reminds us of important aspects of outpatient care in PD that may otherwise get forgotten. Ongoing data collection will hopefully continue to improve.