Launching our project to improve non-invasive ventilation

In December 2022, 24 colleagues from six regional acute hospital trusts and the West of England AHSN came together to launch a new collaborative project focused on improving patient outcomes from non-invasive ventilation (NIV).

Watch our introductory video on Vimeo:

Acute NIV is an evidence based, clinically effective and lifesaving treatment used to manage patients presenting with specific conditions in Type II (hypercapnic) respiratory failure. In 2019, a British Thoracic Society (BTS) audit on adult NIV care reported the inpatient mortality rate was 26%. This was an improvement on previous audits in 2010 and 2013, however mortality rates remained higher than in other countries.

This unique project aims to reduce mortality rates to 10% or lower for patients who require acute NIV for Type II respiratory failure. This will be achieved through a collaborative approach which implements a regional standardised care bundle.

The five bundle elements are:

  • Appropriate case selection – NIV is only recommended in acute Type 2 Respiratory Failure where it is proven to be effective.
  • Treatment Escalation Plan in place – ReSPECT form to be completed with specific reference to suitability for invasive ventilation or NIV as ceiling of treatment.
  • NIV to be started within 60 minutes of decision to treat.
  • Inspiratory pressure of 20cmH₂O to be achieved within 60 minutes.
  • Arterial or capillary blood gas to be repeated within two hours of starting NIV.

Read about the drivers informing our NIV project in a blog from Dr Rebecca Mason.

Dr Rebecca Mason, project Clinical Lead and Respiratory Consultant at the Royal United Hospital, Bath said:

“This new pan-regional project seeks to improve NIV outcomes for patients through the implementation of a regional standardised care bundle, based on the BTS quality standards. In addition, we aim to improve staff knowledge, and competence in use of NIV, along with patient experience through enhanced communication and development of teaching materials”.

Dr Mark Juniper, Medical Director at the West of England AHSN and Respiratory Consultant, Great Western Hospitals, Swindon said:

“It was great to host this event. The energy in the room was invigorating and the enthusiasm of the teams to participate was clear. Getting the Trusts together and designing this project as a group was a really important step forwards.”

An evaluation exploring this project will be completed in Spring 2024. It is hoped this will lead to adoption and spread of the care bundle beyond the West of England.

To find out more, please visit our NIV care webpage, follow #NIVcare on Twitter or contact Senior Project Manager, Megan Kirbyshire.

Regional Perinatal Equity Network celebrates first anniversary

Maternity and neonatal practitioners came together in the South West this month to celebrate one year since the launch of the Regional Perinatal Equity Network, marking the anniversary with talks on perinatal inequalities from speakers including obstetrician Dr Christine Ekechi, author Kim Thomas and the Positive Birth Company.

The Regional Perinatal Equity Network (RPEN), a collaboration between the West of England Academic Health Science Network (AHSN) and South West AHSN came from a growing commitment from those working in perinatal care across the region to work together to address inequality within maternity and neonatal services. The network is delivered by both AHSNs as part of NHS England’s Maternity & Neonatal Safety Improvement Programme.

The milestone RPEN event gave the opportunity to reflect on the aims of the network and what it has to celebrate. Its first year has seen over 250 attendees across four events with a range of distinguished speakers. It is growing steadily as a community, offering a safe space to explore issues which practitioners may not have time to do elsewhere. Recently, Maternal and Neonatal Clinical Lead at the West of England AHSN, Ann Remmers, looked back on a successful first year of RPEN in a blog.

During the anniversary event, attendees heard from several prominent speakers about the positive action that has been and continues to be taken to tackle health inequity in perinatal care.

First to speak was Dr Christine Ekechi, Consultant Obstetrician and Gynaecologist at Queen Charlotte’s and Chelsea Hospital, London, and Co-Chair of the Race Equality Taskforce at the Royal College of Obstetricians and Gynaecologists.

After sharing the shocking statistics from FivexMore’s The Black Maternity Experiences Survey that black women are four times more likely to die in pregnancy and Asian women are twice as likely to die in pregnancy, Dr Ekechi discussed the causes behind and factors contributing to this huge gap in perinatal equity, including social deprivation and structural racism. Dr Ekechi highlighted the positive and inspiring action that has been taken over the last two years, including the setup of organisations and taskforces, provision of resources, and investment.

Kim Thomas, author, journalist and CEO of Birth Trauma Association spoke to the group about postnatal Post Traumatic Stress Disorder (PTSD) and inequalities. PTSD following childbirth affects 1 in 25 women – approximately 25,000-30,000 women in the UK. Partners can also experience PTSD. Poor care is a contributory factor.

Kim’s talk included information and statistics from The Black Maternity Experiences survey on accessing help and why some women don’t seek help, as well as recommendations for improvement.

Charlotte Burrows, Programme Director – Design at South West AHSN, shared the latest findings from research undertaken by SW AHSN’s Perinatal Health Equity Programme. As part of the South West AHSN’s Perinatal Health Equity Programme, Apollo Health Innovations was commissioned to explore birthing peoples’ lived experiences of perinatal care through a series of focus groups, interviews and online conversations. The report is informing the programme in its aim of identifying and spreading innovative practice to close health equity gaps in the South West region.

Our final speaker was Angie Driver, Head of Operations at the Positive Birth Company (PBC), a company whose mission is to make birth education more accessible for all.

Angie used the event to launch the PBC’s new cultural competency workshop. Closing the gap: addressing racial disparities in antenatal services & birth outcomes shares learning for healthcare professionals and is CPD accredited.

Attendees and speakers were thanked for their contributions to the network since its launch, and for their passion, enthusiasm and dedication to champion this cause and work towards making a difference. The event closed with practitioners being invited to share reflections on the last year and make a personal pledge for the upcoming year.

Join our next RPEN event on 25 January 2023. Learn more and register here.

About the Regional Perinatal Equity Network (RPEN)

Our ambition is to serve as a community of practice, exploring the delivery of meaningful, actionable improvements to reduce inequity of outcomes for black, brown and racially minoritized women and families within the perinatal system. Health inequalities are not restricted to race and ethnicity and this network seeks to understand the wider distribution of burden by socioeconomic markers of inequality and the complex interplay of multiple markers of inequity.

The network is open to all working within maternity and newborn services, related organisations or those with a responsibility or interest in reducing inequalities in the NHS. Parents and parent partners are also warmly welcomed to join.

To read more about our Maternal and Neonatal Safety Improvement Programme work visit our webpage or subscribe to our newsletter

Patients in Bath and North East Somerset, Swindon and Wiltshire receiving faster and more reliable asthma diagnoses

A new evaluation has found more patients in Bath and North East Somerset, Swindon and Wiltshire (BSW) are receiving faster and more reliable diagnoses of asthma thanks to an ambitious project designed to ensure adoption and spread of proven innovative products.  A system wide project, led by the West of England AHSN, took place between September 2021 and June 2022, to rollout FeNO devices in a mobile model across the region. The project resulted in 1,896 patients receiving a FeNO test.

FeNO testing is part of the Rapid Uptake Products (RUP) programme to increase uptake of NICE approved products.  FeNO devices measure fractional exhaled oxide in the breath of patients, which provides an indication of the level of inflammation in the lungs.  This can be used to aid in the diagnosis of asthma.  It is a quick and easy test that can be carried out by any healthcare professional that has received training. Benefits of FeNO testing include:

  • improved speed and accuracy of diagnosis for patients suspected of having asthma
  • improved patient care and outcomes, reducing the risk of exacerbations and hospital admissions
  • reduction in inappropriate prescribing and referrals to secondary care

Prior to this project, FeNO testing was not available in primary care settings in BSW and therefore wasn’t always easily accessible to patients.  The project aimed to provide access to FeNO testing in every practice in the region, using a mobile model with devices shared between and moving around multiple sites.  Several Primary Care Networks (PCNs) procured additional devices that were used in a fixed hub model to better meet the needs of their patients and hubs are being considered further following the evaluation.  The project evaluation has found 75% of practices are now offering FeNO testing, which has improved access and reduced travel for patients, with over 80% of patients travelling less than 3 miles for an appointment.  Between September 2021 and June 2022, 1,896 patients were reviewed, with 263 receiving a diagnosis of asthma.

The West of England AHSN supported the application for Pathway Transformation Funding to enable the purchase of FeNO devices and mouthpieces, in addition to backfill for local clinical leads to champion the project in their area and provide support to practice staff.  Bath & North East Somerset Enhanced Medical Services (BEMS) led on the co-ordination of resources and transport in their area.  Project management support was provided by the AHSN to monitor the project timeline, collect and analyse data and record risks and issues.  A new pathway and surveys were co-created and regularly reviewed to measure and continuously improve staff and patient experience of the new service.  As part of the AHSN’s regional FeNO Programme, it co-ordinated the delivery of FeNO testing education webinars that were open to healthcare professionals across the West of England to 95 delegates.

“The FeNO project has been hugely successful and highly appreciated by the staff and patients in primary care.  There has been loads of learning on the way supported by truly dedicated and passionate clinicians.”

Louise Abson, GP Partner Widcombe Surgery and BSW ICS Clinical Lead Planned Care

“It has been great to work collaboratively with the Integrated Care Board, BEMS and so many clinicians on this project.  Implementing FeNO testing in over 60 practices has been such an achievement and wouldn’t have been possible without the support and hard work of primary care staff.  The data from this evaluation demonstrates how patients are benefitting from improved access to FeNO testing.”

Charlotte Hallett, Senior Project Manager, West of England AHSN

New evaluation shows FeNO testing project is supporting better asthma diagnosis across Gloucestershire

More patients in Gloucestershire are receiving faster and more reliable diagnoses of asthma thanks to an ambitious project designed to ensure adoption and spread of proven innovative products, according to a new evaluation.  Three Primary Care Networks in the Stroud and Berkeley Vale locality of Gloucestershire took part in a project, led by the West of England AHSN and delivered by Gloucestershire Integrated Care Board (ICB), which supported practitioners from 17 practices to deliver FeNO testing following face to face training and e-learning modules. The project resulted in 272 patients receiving a diagnosis of asthma.

FeNO testing is part of the Rapid Uptake Products (RUP) programme to increase uptake of NICE approved products. FeNO devices measure fractional exhaled oxide in the breath of patients, which provides an indication of the level of inflammation in the lungs. This can be used to aid in the diagnosis of asthma. It is a quick and easy test that can be carried out by any healthcare professional that has received training. Benefits of FeNO testing include:

  • improved speed and accuracy of diagnosis for patients suspected of having asthma
  • improved patient care and outcomes, reducing the risk of exacerbations and hospital admissions
  • reduction in inappropriate prescribing and referrals to secondary care

Prior to this project, FeNO testing was only offered at a hospital-based clinic that ran sporadically over a 5-year period and therefore wasn’t widely available across the county.  This clinic was re-established for 7 months at the start of the project to provide a blueprint for primary care based FeNO testing. The project evaluation has found during these seven months, 18 practitioners attended the clinic for training from a Senior Nurse Practitioner and to receive a FeNO device for their practice. This enabled the transfer of respiratory clinics from the hospital setting into primary care, with 431 patients accessing a FeNO test in their GP practice between October 2021 and June 2022 and 272 patients receiving a diagnosis of asthma. The evaluation also noted provision of FeNO testing at a local level has improved access and reduced travel for patients, with over 75% of patients surveyed travelling less than 6 miles and waiting less than 2 weeks for an appointment.

FeNO testing has since been rolled out at practice level across Gloucestershire to ensure equity of access as part of a system wide Respiratory Diagnostics Local Enhanced Service (LES).

The West of England AHSN supported the application for Pathway Transformation Funding to enable the purchase of FeNO devices, in addition to the use of the hospital-based clinic as a route to delivering training to practice staff. Project management support was provided by the AHSN to monitor the project timeline, collect and analyse data and record risks and issues.  Surveys were co-created and regularly reviewed to measure and continuously improve staff and patient experience of the new service.  As part of the AHSN’s regional FeNO Programme, it co-ordinated the delivery of education webinars that were open to healthcare professionals across the West of England – these were attended by 90 delegates.

“Having previously offered FeNO testing following referral and seen the improvements in accurate diagnosis, patient education and confidence in self-management, we are now able to offer the test without the delays associated with referral, close to the patient in their GP practice with competent health care professionals in a way that is sustainable in the longer term. We achieved the aims of our project and have also been able to roll out the model across the whole ICB”.

Carol Stonham, Senior Nurse Practitioner – Respiratory, Gloucestershire ICB

“It has been great to work with the ICB on this project, who have really championed the use of FeNO testing in primary care.  The data from this evaluation demonstrates how patients are benefitting from easier access to FeNO testing, which will continue thanks to system wide support”.

Charlotte Hallett, Senior Project Manager, West of England AHSN

Read more about FeNO testing with our patient stories and free implementation resources.

Working with BSW CCG to improve diabetes care

The West of England AHSN and Bath, North East Somerset, Swindon and Wiltshire CCG (BSW CCG) are reaching the end of a 12-month project to improve care for patients with type 2 diabetes.

Since the project launched in February 2021, a community of practice has been established with 174 members from 58 practices alongside secondary care staff.  22 practices have made positive changes as a result of the project thus far, with a further 44 practices continuing to implement changes. Interim results show the percentage of BSW patients with type 2 diabetes in the high-risk category has reduced from 33.3% to 28.9%.

Hear more in this short video from Wiltshire GP and BSW CCG Diabetes GP Champion, Dr Julia Hempenstall:

 

The project used an innovative care framework which aims to support those living with type 2 diabetes. Multiple long-term condition frameworks, developed by UCL Partners, are freely available and they help practices manage large numbers of patients with long-term conditions, whilst empowering the primary care workforce and the patients themselves. This ten-minute summary video from UCLPartners outlines the approach and resources available.

BSW CCG chose to adopt this approach, utilising education and training, as part of a multidisciplinary team, with a focus on supporting practices with the greatest treatment gap and in areas of greatest deprivation. A treatment gap is the actual versus the target % of the population whose treatment has been optimised.

The AHSN have provided project management, developed local implementation resources and facilitated workshops and virtual events.

So far:

  • 58 practices have joined the community of practice
  • Seven BSW primary care networks have all their practices either implementing or engaged with the approach
  • 22 practices are implementing the approach with more planning to start in April 2022
  • 33 delegates have attended motivational coaching training

The community of practice aims to connect clinicians across the CCG to improve their confidence in diabetes management and add a sense of belonging following two years of changes to usual work practices due to the pandemic.  With these improved connections, practice resilience, workforce capacity and integrated diabetes care can also flourish.

Brian Leitch, Commissioning Manager at BSW CCG said:

“As commissioner for diabetes, it’s been great watching practices come together on their own terms in the community of practice, to share information and resources and to discuss how to best support their patients”.

An Advanced Nurse Practitioner working on the project said:

“This has streamlined how we work, reduced the burden on the practice through calls as well as helped support patients to become more responsible for their care. We have identified issues and improved staff and patient awareness of diagnosis as well as treatment of diabetes”

Director of Service and System Transformation at the West of England AHSN, Kay Haughton, said:

“The care frameworks have been a fantastic launch pad for us to support primary care colleagues in BSW. They offer a great opportunity to consider redesigning delivery of care, providing those with diabetes, and other long-term conditions, greater autonomy and support in self-management. It has been a privilege to work with our CCG and primary care colleagues to help transform services for people who have diabetes.”

BSW CCG will continue to progress the improvement programme with longer term impact measures reviewed in the next 12 months, including:

  • Reduced number of practice visits
  • Improvement in patient satisfaction
  • Downward trend in numbers of high-risk patients
  • Changes in medication and potential cost savings

The West of England AHSN will continue to support the roll out of long term condition care frameworks through a new blood pressure optimisation programme. The programme aims to prevent heart attacks, strokes, and vascular dementia in patients with hypertension.

Find out more about the West of England’s work to support those with long term conditions by contacting us.

Regional neonatal units celebrate highest delayed cord clamping rates in England

Maternity and neonatal (MatNeo) units across the South West are celebrating achieving the highest delayed cord clamping rates in 2020 in England, as measured by the National Neonatal Audit Programme (NNAP). On average, units across the South West also achieved the third lowest rates of mortality to discharge, the second lowest rates of necrotising enterocolitis, alongside the fourth highest administration levels of magnesium sulphate (MgSO4) across England.

The NNAP assesses whether babies admitted to neonatal units in England, Scotland and Wales receive consistent high-quality care, and identify areas for quality improvement. The NNAP’s most recent audit shows delayed cord clamping was at its highest level in units in the South West. More than a 20% difference was illustrated between South West units (at 60.6%) and the second highest performing region (39%). Evidence shows that avoiding immediate cord clamping reduces death in preterm babies by nearly a third.

These results follow intensive activity across the region to drive adoption and spread of a range of neonatal interventions, including delayed cord clamping and MgSO4, through a unique care bundle known as PERIPrem (Perinatal Excellence to Reduce Injury in Premature Birth).

Implementing PERIPrem

Launched in April 2020, PERIPrem is a perinatal bundle designed to improve the outcomes for babies born before 34 weeks. The West of England Academic Health Science Network (AHSN) is delivering PERIPrem in partnership with South West AHSN and South West Neonatal Network. The bundle consists of eleven interventions that demonstrate a significant impact on brain injury and mortality rates amongst babies born prematurely.

The bundle was the first of its kind, and co-created by clinicians, MatNeo teams and parents. Since April 2021 PERIPrem has continued to be delivered across the region as part of the NHS Improvement Maternal and Neonatal Safety Improvement Programme. A number of NHS Trusts across England are now implementing care bundles based on the PERIPrem model.

Achieving results

By providing frequent share and learns, 360 simulation videos, toolkits and quality improvement coaching to facilitate the spread of knowledge and best practice, PERIPrem increased confidence in delayed cord clamping. This incudes when babies are extremely premature, require resuscitation at delivery or are part of a twin delivery. Free cord clamping resources can be accessed on the PERIPrem webpages.

The NNAP explains that necrotising enterocolitis (NEC) “is a devastating illness which can follow preterm birth. Bowel inflammation prevents milk feeding and surgery may be needed. Babies who develop NEC typically stay in hospital for a long time. Rates of mortality in babies with NEC are high, at over 20%. Babies who survive NEC can have developmental as well as long-term feeding and bowel problems”. Units in the South West achieved the second lowest levels of NEC (at 4.7%) in England. Rates of NEC are directly influenced by two PERIPrem bundle elements: probiotics and early breast milk.

Learning from PReCePT

Building on the progress made nationally through the AHSN Network PReCePT programme (which was developed in the West of England region), the administration of MgSO4 remained a core intervention of the PERIPrem care bundle.  The administration of MgSO4 to all eligible women in England during preterm labour (less than 30 weeks) reduces the incidence of cerebral palsy. Magnesium sulphate costs from just £1 per dose. Free MgSO4 resources can be accessed on the PERIPrem website.

The focus across a broad range of interventions known to reduce mortality led to the region achieving the third lowest rate of pre-term mortality to discharge home in England (at 5.6%).

Natasha Swinscoe, Chief Executive of the West of England AHSN and Patient Safety Lead for the AHSN Network said:

“To December 2021 over 1090 babies have benefited from the PERIPrem bundle. It is a testament to the hard work of all South West MatNeo staff, and everyone who contributed to our PERIPrem project, that the South West region has the highest levels of delayed cord clamping alongside multiple other positive results which crucially include the third lowest level of pre-term mortality in England.

Launching PERIPrem during a pandemic, and at a time of extreme pressure on the NHS, wasn’t easy but these results illustrate the dedication and enthusiasm to improve the safety and life chances of the most vulnerable babies and their mothers”.

Sarah Bates, Consultant Paediatrician & Neonatologist at Great Western Hospitals NHS Foundation Trust and PERIPrem Neonatal Operational Clinical Lead said:

“Working as part of the PERIPrem team has been an inspiring experience. The results of the NNAP illustrate the impact the bundle is having – it’s particularly striking to see average delayed cord clamping rates in our units at least 21% higher than in other regions. In all my years looking at similar data I don’t think I’ve ever seen such a wide range.

Knowing that PERIPrem has longevity locally and is now being adopted in other parts of England, illustrates the potential it has to change the lives of pre-term babies – that is something everyone who contributed to the project can be very proud of”.

At the 2021 HSJ Patient Safety Awards, PERIPrem was highly commended in the category of Patient Safety Pilot of the Year. PERIPrem was also shortlisted for Provider Collaboration of the Year at the HSJ Awards in 2021.

Read more in our PERIPrem case study.

The full NNAP report and data can be accessed here.

FeNO testing improving asthma diagnosis in region

The West of England AHSN has been supporting several projects to implement FeNO testing in primary care over the past six months.  There are now 16 GP practices across the region that have access to FeNO devices, with a further 60 practices planning to go live in the next two months.  The South West Respiratory Clinical Network has provided funding for a further 7 devices across the West of England region which improves access for patients.

FeNO devices measure fractional exhaled oxide in the breath of patients, which provides an indication of the level of inflammation in the lungs.  This can be used to aid in the diagnosis of asthma.  It is a quick and easy test that can be carried out by any healthcare professional that has received training.  Benefits of FeNO testing include:

  • improved speed and accuracy of diagnosis for patients suspected of having asthma
  • improved patient care and outcomes, reducing the risk of exacerbations and hospital admissions
  • reduction in inappropriate prescribing and referrals to secondary care

Following successful bids for Pathway Transformation Funding, Bath and North East Somerset, Swindon and Wiltshire CCG (BSW CCG) and Gloucestershire CCG were awarded funding to implement FeNO testing and are currently piloting the approach using a number of different models.

In BSW, FeNO testing is being made available to all GP practices in the region and is being supported by locality clinical leads in each area.  Many of these practices are currently using a mobile model and sharing FeNO devices to ensure equity of access for their patients, with some areas trialling a fixed hub model, with a view to comparing the two approaches in a project evaluation.

Nicci Mawer, Nurse at Combe Down Surgery said:

“We have been using the FeNO machine in my practice for a couple of months now.  I started using it with a degree of scepticism but can honestly say it is a valuable tool for aiding the diagnosis of asthma as well as monitoring existing patients who are uncontrolled and needing potential treatment change or can be informed that their current treatment is working.  It is easy to use and clean and can be done in a 10 minute appointment if you are only performing FeNO.  Patients find holding and breathing into the device quick and easy and it proves to patients that there is inflammation that needs dealing with.”

Gloucestershire received funding to introduce FeNO testing in 19 practices across one locality and are implementing this with a hub and spoke model, with staff attending training at a hospital clinic with a Senior Nurse Practitioner before receiving a device to use in their own practice. This has resulted in the CCG funding a wider rollout of FeNO testing across their whole region, with another 41 devices about to be deployed.

Funding and project support available

Whilst providing project management support to the existing FeNO roll out, the West of England AHSN is also able to extend this offer to individual Primary Care Networks looking to implement FeNO testing. The AHSN can co-ordinate training and signposting to educational resources, facilitate clinical pathway design and liaise with analysts around data collection. To promote the benefits of FeNO testing more widely, webinars have been delivered throughout December and January with 63 attendees from across the West of England.

The South West Clinical Network is really pleased to support this initiative as outlined by Adrienne Rogers, Clinical Network Manager:

“We’re delighted to support the extension of FeNO use across the South West Region by the provision of additional FeNO devices to map onto gaps identified from our Primary Care Respiratory Champion programme, plus thousands of mouthpieces to enable greater delivery for the region’s AHSN -supported FeNO projects in primary care.”

FeNO offers an opportunity to support both the early and accurate diagnosis of asthma, as well as monitoring compliance and effectiveness of asthma management. This will all help our regional systems to deliver on their commitment to the NHS Long Term Plan, and support our respiratory populations to access the right care at the right time.”

You can find out more about FeNO testing here.

If you’re interested in implementing FeNO  in your practice and would like to find out more about accessing funding and support please contact Senior Project Manager, Charlotte Hallett.

Find out more about the West of England’s work to identify gaps and priorities and signpost proven treatments and diagnostics through programmes such as Rapid Uptake Products and Med Tech Funding Mandate.

 

 

 

Book now: accredited quality improvement for pharmacy teams launches

The West of England Academy are hosting a new series of five free-to-attend interactive online workshops each Tuesday evening from 1 March. This is the first series of introductory QI workshops tailored specifically by the AHSN for pharmacy teams.

Attendees will gain a basic understanding and practical knowledge of applying Quality Improvement (QI) techniques to real-world pharmacy challenges in healthcare and innovation.

Modelled on our hugely successful QI Summer and Winter Series, this five-week course, held over 90-minutes each Tuesday from 18:30pm can be joined as single sessions or a series.

“This was a fantastic introduction to QI, which is what I needed. I loved how things were explained so clearly and the session was interactive. It really helped my understanding, and I got a lot from the session”.

The accredited workshops have been developed, and will be delivered by, the West of England Academy and Medicines teams alongside guest speakers. Topics include introductions to process mapping, data management and the basics for change management. The series will earn attendees six CPD hours.

Attendees will see how QI can lead to better outcomes for their teams, patients and organisation, gain confidence in applying QI and have time to network with pharmacy colleagues from across the region.

“I am newly appointed as a QI manager so have used all the tools and techniques in my daily work and shared this with other colleagues and teams”.

Attendees can be in any role and/or grade within their pharmacy, and clinical or administration.

Our academy works hard to welcome attendees from a broad range of backgrounds creating a safe and open environment for learning and sharing ideas.

“The practical skills and frameworks are fantastic and such a great way to engage and inspire others. They will definitely help identify why a challenge is a challenge and instigate conversations about how we can overcome and/or improve processes”.

Find out more about the series and book here.

The West of England Academy offers a wide range of free events and resources to healthcare professionals and innovators across the region. To find out more, visit our Academy pages or email weahsn.academy@nhs.net.

QI in pharmacy? It’s a brave new world.

In a new joint blog from Senior Project Manager, Chris Learoyd and Ola Howell, Clinical Pharmacy Lead at the West of England AHSN, we explore the value of Quality Improvement (QI) for pharmacy teams, why it hasn’t really been embedded so far and how pharmacy can get involved.

Bringing together mental health teams to improve patient safety and health equity

On 30 November the South of England Mental Health Quality and Patient Safety Improvement Collaborative (known as the MHC) held an all-day learning event for mental health teams across the South of England. The event – held online – was an opportunity for sharing learning and networking, which has been particularly challenging for large geographic collaboratives during the pandemic.

Hosted by the West of England AHSN, the collaborative was created in partnership with the South West AHSN, and now includes Kent, Surrey and Sussex AHSN, Oxford AHSN, and Wessex AHSN alongside 16 mental health trusts across the south of the country. The MHC aims to improve the quality and safety of services for people with mental health conditions.

MHC learning events enable collaboration across the mental health sector in order to foster quality improvement (QI) approaches to patient safety, drive health equity and review progress against the ambitions of the NHS England Mental Health Patient Safety Improvement Programme (MHSIP), which includes reducing restrictive practice.

The event was chaired by Dr Helen Smith, chair of the MHC and National Clinical Lead for MHSIP with around 90 people joining the event from project teams across the South of England.

The event began with a presentation on experiencing, challenging and addressing inequalities from Chris Lubbe, NHS England. Chris was previously an anti-apartheid activist and acted as Nelson Mandela’s bodyguard. He therefore offered a unique insight into inequalities.

Sussex NHS Foundation Trust then presented on delivering a reducing restrictive project as part of the National Collaborating Centre for Mental Health.

This was followed by a World Café where colleagues from four mental health teams shared their experiences of reducing restrictive practice. This offered a vital opportunity to share learning and consider different approaches.

Presentations then followed from Cornwall NHS Foundation Trust on Reducing Restrictive Practice:  Drivers linked to ‘Seni’s Law’; Creating conditions for learning, and finally QI approaches focused on the live, learn and lead methodology.

Following this event, members of the MHC will continue to meet regularly for QI coaching sessions and all-day learning events.

Feedback from attendees:

“Thank you for such a thought provoking presentation. The take home message for me is to dig deep and speak up and say something”.

“Really good ideas – we will be shamelessly stealing the calm cards in particular! Thank you”.

“What went well? Chris’ presentation to start off the day – an inspirational speaker. Amazing and really highlighted the inequalities within everyday life, including our own services. Also the interactive break out activities”.

If you would like to find out more about the MHC please email weahsn.transformation@nhs.net.

QI in pharmacy? It’s a brave new world.

In this joint blog from Senior Project Manager, Chris Learoyd and Ola Howell, Clinical Pharmacy Lead at the West of England AHSN, we explore the value of Quality Improvement (QI) for pharmacy teams, why it hasn’t really been embedded so far and how pharmacy can get involved, including at our first-ever Pharmacy Showcase on 12 January.

First we hear from Chris…

As the Senior Project Manager for the Medicines Optimisation team at the West of England AHSN, but a former Physiotherapist, I won’t say it was always easy, but I have finally got my head around the wider challenges and issues with safe prescribing of medications.

The numbers are eye watering – circa 237 million medication errors occurring at some point in the medication cycle per year in the NHS in England and 66 million of these considered potentially clinically significant errors. Reducing medication errors can clearly have a significant and immediate effect on patient safety.

We know that as experts in medication management and optimisation, pharmacists and pharmacy technicians are ideally positioned in the healthcare system to improve current processes and reduce avoidable medication-related harm – and that QI approaches are vital to creating lasting change.

As every pharmacy team will know they are being positioned more centrally within healthcare services and have more clinical autonomy. Services such as the Discharge Medicines Service and Community Pharmacy Consultation Service provide a step change to embed pharmacy professionals as an important first point of call for healthcare information rather than traditional settings such as General Practice / Emergency Departments.

Introducing QI

Despite all this, pharmacists often lack the basic tools required to lead on or participate in QI initiatives as they’ve historically not been trained or required to perform QI projects. This is slowly changing, and here at the AHSN we’re working to drive adoption of QI approaches across pharmacy.

Here we’re handing over to Ola who gives details of the reasons for this, the impact and our new offer for pharmacy colleagues….

I’m a clinical pharmacist and over the last 12 years I’ve worked in a community pharmacy (very many of them), a General Practice (very briefly) and a hospital (or three, to be precise). Over those years I have met hundreds of pharmacy technicians and pharmacists determined to ensure their patients got the best (aka safest) care they could.

But I’ve never worked on QI before – what is it?

We are diligent, we are keen, and we are truly brilliant! No need to argue that. The thing that we are not good at is quality improvement. It is not that we don’t do it well, we simply don’t do it enough… And why would we? If you are anything like me and your registration number starts with 20*****, you would, most likely, had never been taught what QI is and how to do it well.

It wasn’t until the last couple of years that I started hearing about the QIPs, the PDSAs and the “driver diagrams”. Maybe I was not expected to know then, but I am now. (And there are masses of free resources on the West of England Academy website to help anyone embarking on QI work – but join our Pharmacy Showcase on 12 January to hear more about free, interactive and tailored support for your team).

Embracing QI to support our profession and wellbeing

Like never before, we are forced to do more and faster with less resources and time. We need to learn how to improve what we do in order to survive. And we need to do it now. The numbers are scary, with every fourth pharmacist reporting feeling ‘very stressed’ at work, mainly due to the increased demand for services and the lack of funding. That is 37% of community teams (up from 17% last year), 20% of hospital pharmacists (up from 10% in 2020) and 14% of GP and PCN pharmacists (up from 5% in 2020)[1]. I anticipate that the figures among pharmacy technicians follow a similar trend. Grim. Burnout alarm bells ringing all over the place.

When I asked around, I wasn’t surprised by the number of suggested solutions to various work problems we come across every day.

Not-a-surprise No. 1: We often know what goes wrong.

Not-a-surprise No. 2: We also often know a solution (or improvement) to the status quo. We sometimes even make that improvement ourselves!

For some reason, however, we rarely document the before and after and so are unable to prove our intervention has worked. “I am not wasting time on the data collection when I have so much to do”, I heard recently from a fellow pharmacist. “But your idea is brilliant! And it saves time, so if other people knew about this, the impact could be huge”, I reply. “Nah, too much effort”, I hear back. I bet this sounds familiar…

Don’t we all roll our eyes when an audit arrives and we need to fill out a spreadsheet, often without pausing for a moment to question what it’s for, and how the results will affect us in the future. Here in lies the answer – capturing our learning and experiences through QI.

Get involved

So come and meet us on the 12 January at our Pharmacy Showcase to hear about the projects our AHSN is involved in, meet the team, network with other pharmacy colleagues and learn more about a free, tailored Pharmacy for QI course coming in spring 2022.

[1] The Pharmaceutical Journal, PJ, November 2021, Vol 307, No 7955;307(7955)::DOI:10.1211/PJ.2021.1.114907