Learning from failure: lessons from the Checklist project in Wessex – by Dr Kate Lyle and Professor Catherine Pope

Dr Kate Lyle is a Research Fellow based in Health Sciences at the University of Southampton

Professor Catherine Pope is Deputy Director NIHR CLAHRC Wessex

Dr Kate Lyle is a Research Fellow in Health Sciences at the University of Southampton and Professor Catherine Pope (right) is Deputy Director of NIHR CLAHRC Wessex

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As academics, practitioners, and users of healthcare services we are all used to hearing about examples of successful interventions that have improved health services and care.  Indeed one of the core aims of the NIHR CLARHC programme is to improve patient outcomes locally and across the wider NHS. Here in Wessex we have been working hard over the past 5 years to do just that, spreading best practice and evidence based research throughout the NHS.

But what about the things that don’t work? Attempts at service improvement or innovation that went nowhere? Often these are the things we don’t hear about.  Yet, arguably there is as much to learn from our failures, as there is from successful innovations.

Right idea? Wrong time

Why might nurses miss people’s ‘danger signs’ at night? – Dr Jo Hope

We know that nurses miss or delay taking patients’ vital signs (such as pulse, temperature and blood pressure) at night. Until now, no one knew why.

The NHS expects hospitals to use ‘Early Warning Scores’ to measure how ill someone is. These are based on the observation of ‘vital signs’ – measurements of things like pulse, temperature, blood pressure and breathing speed. The higher the score, the more often someone’s vital signs should be checked. This is so staff can spot the early danger signs of someone becoming very unwell, in time to help them.

Your local hospital will probably have an ‘early warning protocol’ that says how often people should be checked according to their early warning score. At higher levels observations will need to be done in the middle of the night. Despite this, we know that nurses are much less likely to do the observations that are expected to be done at night.

What are we missing here? (Are at risk older people spotted early enough in hospital?) – Dr Kinda Ibrahim, Research Fellow at Academic Geriatric Medicine

Nearly two thirds (65%) of people admitted to hospital in the UK are aged over 65 years old. Many of them are frail and at high risk of poor healthcare outcomes – like staying longer in hospital, reduced physical abilities, becoming dependant, going to a care home, and even death.

National recommendations suggest that these high-risk older individuals should be routinely identified when they are admitted to hospital to allow healthcare teams to provide appropriate individual care that meets patient’s needs (1).  It is unclear whether and how those people are identified in hospital. Therefore our study looked at the current practice in one hospital with regard to identification of patients at high-risk of poor healthcare outcomes. To do that, we reviewed a random sample of patient’s clinical notes and interviewed staff members who worked at five acute medicine for older people wards (2).

The movement behind saving our antibiotics

This week has been World Antibiotic Awareness Week to be followed tomorrow (Friday 18 November) by European Antibiotic Awareness Day. So what all the urgent action?

Well it’s well documented that resistance by bacteria to the existing supply of antibiotics is growing. The World Health Organisation has estimated that by 2050 deaths caused by antibiotic resistant bacteria could number 10 million people a year.

 

This week NIHR CLAHRC Wessex hosted the Southampton Premiere of the award winning short film Catch, which tells the story of a family broken apart and facing difficult choices in a post antibiotic world.

Should Wessex implement ReSPECT process? – The NIHR CLAHRC Wessex hosted event May 11, 2017

The event in Southampton attracted organisations* from across the Wessex region and beyond and a wide range of people including the public, paramedics, nursing staff, clinicians, managers and researchers.

Many stakeholders were represented bringing together 44 delegates, all there to examine and reflect on whether the ReSPECT approach to decision making for emergency care should be adopted.

Making the patient central: Mark Stafford-Watson Public Contributor and PPI Champion

Article by Martin Simpson-Scott, PPI Coordinator NIHR CLAHRC Wessex

Mark Stafford-Watson

Mark Stafford-Watson is one of our NIHR CLAHRC Wessex public contributors. He’s also ‘PPI Champion’ for our Theme 1 research team (Integrated Respiratory Care) – of particular personal relevance to Mark, as he has a long-term respiratory condition.

Prioritising the fundamentals of care with patients, professionals, carers and the public – Anya de Iongh

As PPI Champion for the Fundamentals of Care theme within NIHR CLAHRC Wessex, I’ve a great experience and opportunity to be an equal member of a team developing the research priorities for this area of work. Crucially, these weren’t priorities that we developed together in a closed room, but rather they were co-produced at several stages.

Are some social networks better for self-management than others? Dr Ivaylo Vassilev, Senior Research Fellow

The everyday management of a long-term condition is almost never done by individuals in isolation from others. The networks of relationships around people may include family members, friends, neighbours, colleagues, health professionals and even pets all of who play an important role in the management of long-term conditions. This is through, for example, their knowledge, support, help with accessing services, resources and valued activities.

Where the NHS stops and online takes over – Chris Allen

Chris Allen is a Research Fellow and a nurse in Southampton

There comes a point in everyone’s life when they get news that changes their life…of course it’s not always bad. Think “you’ve got the all clear” or “you’re going to have a baby”.

But what if that’s not so good. “You have diabetes” or “you have developed COPD”. In those cases firstly you might ask the doctor or nurse- “what can you do?” and “how is it going to affect me?”

NATIONAL CONSULTATION ON EMERGENCY CARE AND TREATMENT PLAN: IMPLICATIONS FOR THE TREATMENT ESCALATION PLAN (TEP) PROJECT? Professor Alison Richardson

Having conversations about the best course of action in the event a person’s condition deteriorates is difficult for everyone involved, whether it is the patient themselves, their family or carer and the clinician.

After an initial study on Advance Care Planning (A. Richardson, S. Lund¹), research into the current application of treatment escalation plans across the country, and early engagement with some of the acute trusts in the Wessex region, it was apparent there was a desire to improve this process.