QIdeas - Care Group Ideas

Care Groups

Administration Improvement Ideas

Maternity: triangulate all feedback from service users

Dear Team

I am hoping you may be able to help or point me in the direction of someone who can.

I have started a new working party within maternity to triangulate all feedback from service users. This come from many different sources and is not currently pulled together, rather reviewed in isolation. It has been suggested that a smart sheet may be the best tool to use for this.

Is this something you can guide me on?

Driver Diagram Support SJ Pedler is embarking on a new QI project within maternity and would like support with a driver diagram.

Took support request to the QI Team meeting and Tamsyn Brown will be in touch with SJ to support.

Women Children & Sexual Health Management

Update Unit 4 so delivery name and destination can be added

An electronic out-patient board. This would get rid of paper lists and improve staff and patient expericence by making clinics more efficient.

When you place an order on Unit 4, you cannot add a specific name or delivery place. we spend hours looking for lost or wrongly delivered items. For example we use acute Paed Budget code, this covers a large area, someone on a ward opens the box, put away the delivery thinking it was for them, or just puts it in a cupboard never to be seen again!!!

I have an idea to improve the patient experience while enhancing efficiency of clinics for staff. This would benefit the reception staff, the nursing staff and the consultants. It would also cut down our carbon footprint as we would not be using paper clinic lists. We currently have print outs of all of the clinics which are confidentially held at reception, the nurses station and in the clinic rooms.

I have spoken to other out-patient areas and they all do the same. It seems in this day and age that we are behind the times with this. I would love to develop an electronic board that links reception, nursing staff and clinic rooms. The board would show all the necessary staff what clinics were running that day. If you then go further into that clinic it would show if the patient had arrived in reception. This would then alert nursing staff and the patients obs could be carried out. This would then be inputted onto the board and the clinician would know that their patient was ready to be called in. Once the patient had been seen the clinician could either discharge home or have them awaiting investigations needed that day. This in turn could be audit trailed and further improvements could be made if necessary.

As I said I don’t believe we have anything like this for out-patient areas at RCHT and when I have spoken to staff who work at other hospitals they don’t appear to have anything either.

In our department our reception is not linked to the nurses station and so there is a lot of time walking to and fro to see if patients have arrived and so wasting precious time that could be spent carrying out jobs elsewhere. It would aid the efficiency of the clinic and in turn enhance the patient experience.

It would be fantastic to develop a tool such as this but I’m struggling to link in with the right people to help me.

Is this something you could help me with or point me in the right direction of who to speak to.

I look forward to hearing from you and seeing if this is something that we could work on to develop.

Women Children & Sexual Health Management

Child Health Directorate Office

Gwithian Unit

Culture Improvement Ideas

Endometriosis Friendly

Employer

Idea via FB page from Madeline Watson: HDC picked up.

Hi Madaleine,

I hope you are ok and don’t mind me reaching out My name’s Haydn and I work within the QI Team (Quality Improvement) where we focus on helping to make improvements across thew Trust. I saw your post on the staff page and might be able to point you in the right direction with RCHT becoming an ‘Endometriosis Friendly Employer’. This fits nicely under the EDI Team (Equality, Diversity and Inclusion). I have cc’ed in India who is the Trust’s EDI lead and might have some more thoughts about how we can make this a reality.

There is also Gilly Macdonald who is the specialist nurse (which you may or may not know!) and she is very active within the Cornwall Endometriosis support group and I’m sure this is something she would be keen to support along with Dr SmithWalker as a specialist consultant who may or may not have some thoughts.

India – I’m happy to help Madaleine/you in taking this forward as its something I have been directly affected by.

Please feel free to reach out if you want to chat more at all.

Thanks, Haydn

Women Children & Sexual Health

Management

Patient Care Improvement Ideas

Photo's to be taken of babies 1st moments whilst the mother is under GA

White boards in theatre - takes a long time to complete plus difficult for some team members who struggle with spelling ie of cesarean

Photo's to be taken of babies 1st moments whilst the mother is under GA. This links to a printer so pictures of 1st moments can be captured

To put permanent options on which can be circled rather than hand written each time ie, type of procedure (cesarean/ trial/pph/repair of tear)

Delivery Suite

Delivery Suite

Parents recognising feeding cues Attach a 'wipe clean' label/ sign to each cot which lists feeding cues, in order that women have an instant visual reminder, so promoting responsive feeding

Failure to consistently inform parents of infant feeding plans and medication care plans, length of stay and pathway of care for condition.

To involve parents as partners in care, and ensure a full handover takes place between settings, handover of care of a baby should be done clinician to clinician with the parentat bedside. This should be documented in the infant notes and signed or stickered by the giving to receiving carers.

New Pathway - Endometrial Cancer further support Hi,

We rolled out a new pathway for referrals with suspected endometrial cancer 18 months ago, prompted by the pandemic, with the aim of reducing patient footfall in the hospital. We changed from 4 face to face clinics a week to a single weekly virtual clinic. I have evaluated the service over 12 months, analysing outcomes of over 1200 patients, showing the new pathway is safe. The department are supportive of keeping the new pathway in place as it is cost saving.

I would like support on 2 tasks:

1. Building a desktop app that would replace the paper forms used in the virtual clinic. This is to make the clinic more efficient, as our referral rates are up by 250% and the admin time spent dealing with paper forms and mailing is becoming unmanageable. Scott Mungles, Application Development Lead, has worked with me since October 2021 and is struggling to build something that will add patient demographics and GP address from PAS or MAXIMS to the form. Do you have any IT expertise within QI hub to support me? May you signpost me to teams that have created successful apps already?

2. Patient feedback on the new pathway. So far, we are guided by letters of praise and complaints, and speaking with patients with confirmed cancer of their experience when we meet them in clinic. May you guide me on how to collect patient feedback, particularly from patients discharged from the pathway straight from the virtual clinic (so no clinician every sees them, they just receive a series of leaflets and letters).

Wheal Fortune Ward

Obs & Gynae Staff

MidwiferyCentral CornwallNewquay

Coloured fetal scalp electrodes

On delivery suite we regularly use fetal scalp electrodes in labour. These are black/ grey. If they were coloured and had different coloured sections then we would be able to see (vaginally) if the electrode has lengthened, which would show that there has been descent of the fetal head. This would help midwives and obstetricians with a visual cue which could form part of decision making in labour.

Feedback pathway To pull all areas of staff and patient feedback into one place with one action plan. We currently have a number of feedback avenues, but we are not capturing themes well in this way. I suggest a wider team, not just maternity to ensure this feedback is collated properly. This would include patient experience, H&W, complaints, F&F, individual feedback, ward meeting feedback, birth reflections service user feedback etc.

This would align with national recommendations of improving complaints procedures, families gaining the feedback they need and an understanding of themes and our real areas of concern. This will aim to improve transparency, patient care and staff wellbeing

Obs & Gynae Staff

Re-invigorating Dolphin House, RCHT

The Children’s Community Therapy Service, based in Dolphin House, RCHT have, over the past 25 years, supported 1000’s of children and young people in Cornwall. These children, who may have a significant developmental disability or vulnerability have been empowered and supported through tailored therapy in Dolphin House to lead happier and more fulfilling lives.

Our plans, which will be in collaboration with the children and young people, include the re-decoration of the front entrance, internal clinic rooms and therapy areas; landscaping of the external spaces, in a sea-theme to provide an inviting, child friendly and calming environment for the children.

Many of the children we see, some with life limiting conditions, attend multiple clinic and therapy sessions throughout their, sometimes shortened, childhoods and we want them to have the best experience and care that we can provide whilst they are with us in Dolphin House.

The sea theme would start at the entrance and continue through reception and waiting areas to corridors and clinic rooms and into therapy areas and the outside play spaces. We are keen to work in partnership with local businesses to provide an accessible and sensory area for children and young people.

App for RCHT Guidelines Dear QI team,

My name is Caolan and I'm a paediatric registrar who has started working back in the trust this month, I've been working on project that the Paediatric consultant faculty suggested I talk to yourselves about, I'd be interested in your feedback, and if you had time a moment to talk it through with yourselves. It's a way of searching and accessing hospital guidelines, through an App that I have built, This app is built using NHS mail, and logs in through NHS mail, and works on all PCs in the trust as well as personal phones/tablets/PCs, (anywhere NHS mail works). I had built this in my spare time to make it easier to access guidelines while working in a different trust and have adapted this to work locally. This link opens the app directly (PC or Mobile, NHS login): https://apps.powerapps.com/play/4406ceef-a2ba-4e0f-9d04-e4230eb7fdb5? tenantId=37c354b2-85b0-47f5-b222-07b48d774ee3 We have shared this with the 'Web Team' locally (Jaime Smith), who have given positive feedback, We have discussed this in our paediatric consultant guidelines meeting, and are planning to start using a bespoke paediatric version ourselves. As I am running this as a QI project and would value your help to facilitate this and in collaboration with the Web team to expand this to the whole trust if it proved useful to the clinical team.

Kind regards, Caolan

Community Paeds Department

Midwifery

Polkerris Ward

Staff Wellbeing Improvement Ideas

covered walkway from carparks

Time to Test Cervical Screening

a covered walkway from sandpit/carparks by helipad. benefits staff get to work dry as minibus no longer in use

You may know that September is Gynaecological Cancer Awareness Month. The charity Jo’s Cervical Cancer Trust has launched a campaign for employers called Time to Test and I am getting in touch in the hope that we can join.

Cervical screenings (smear tests) save lives, but 1 in 4 do not attend their appointments when invited. The test isn’t always easy at the best of times, but research from Jo’s shows that getting and attending an appointment can be an additional challenge for those who work.

They found that only 20% of those who work full time could get a convenient appointment last time they tried to book.

They are asking employers to sign up to Time to Test. This means supporting employees in attending these vital health appointments if they can’t get a test outside of working hours, and empowering their team to look after their cervical health.

Signing up to Time to Test can benefit our organisation by: Demonstrating to the team that our health is important to you Showing the organisation’s commitment to cervical cancer awareness Playing a part in preventing cervical cancer

Promoting a culture that empowers, values, and supports employees in looking after their health

Helping reduce the stigma around cancer, and dispelling myths about the disease

Vicki put off her appointment for over a year, telling Jo’s that “work can be quite funny about time off and it was difficult to book appointments that fit around a full time job - I was worried about upsetting my manager.” Vicki needed surgery to remove high-grade cell changes, but has now thankfully been given a clean bill of health.

Hayley was diagnosed with Stage 2 cervical cancer after delaying her cervical screening. “I was a single, working mum of three at the time and I often could not get an evening appointment so, as life got busier, making the appointment to go for a smear test ended up being something I completely forgot about.” Following chemotherapy and radiotherapy, Hayley received the all-clear, but still suffers from lymphoedema and long-term bowel issues as a result of her cervical cancer and treatment. Cervical screening can help detect cell changes at the earliest stage and stop cervical cancer from ever developing. Giving employees the time to attend cervical screening can help make this happen.

To find out how our organisation can get involved with Time to Test, find out more here: https://www.jostrust.org.uk/get-involved/campaign/timetest

Please do get in touch with me, or Jo’s at media@jostrust.org.uk if you have any questions.

Yours faithfully, Lee

Gynae Outpatients

Neonatal Unit

Sustainability Improvement Ideas

on delivery suite

Recycling

We need to identify items that we could recycle on delivery suite and provide receptacle's for this at convenient points throughout delivery suite

Pocket amnesty boxes for each ward

At the end of every shift nurses and midwives and support workers have often collected bits and pieces in their pockets throughout the day. These are often left on the side in the changing rooms lying round or are thrown away. Lots of this could be put back into circulation and reused. Paracetamol, syringes, tempadots, gloves, plasters etc... If each ward had a pockets amnesty box in each changing room then staff could put items into box and at the end of the week the box is emptied and items that are reusable and not used can go back into circulation; thus reducing waste and saving money.

Delivery Suite

Sustainable alternative to plastic single use SteriBreath mouthpiece

Following on from the Innovation Scouting session which I recently attended I think I may have a little idea. Now this isn’t going to change the world however thinking sustainability and the drivers associated with making the NHS Greener.

As part of the Long Term plan, there is a national drive to reduce the smoking rate by 2030 (I can provide the official blurb if you need it). I am specifically leading on the Smoke Free pregnancy project with looks to reduce smoking in the pregnant population to 6%. To put things into perspective, without boring, our rates in Cornwall sit around 12%!!!!! So there is lots of work to do. An element of this project looks at Carbon Monoxide readings, these readings are taken using a Smokerlyzer. A Dpiece is then attached to the monitor and SteriBreath mouthpiece (straw) is attached. The SteriBreath mouthpieces are plastic (I hear you cry, BOOOO) and single use.

To put this in numbers we care for around 4,500 pregnant women a year, each woman is seen around 10 times and the gold standard is to take her CO reading at each contact. This is in excess of 45,000 plastic mouthpieces used and disposed of each year.

So I was thinking, can we make a cardboard mouthpiece? What do you think? It’s a very small change but CO monitoring will soon be part of every routine assessment, not only for our pregnant population but also for all acute admissions. From my primary investigation I have not found anywhere that makes a sustainable option.

Team Working/Communications Improvement Ideas

MaternityChanging our Communications to Patients expecting

Within a Brilliant Data Quality Cafe, Robin Martin provided QI idea to improve maternity services communications to expecting parents as currently is information overload and has some ideas to make this better.

Haydn offered to support (as was leading the session) and has reached out to take next steps.

Capturing here to log QI support request/QIdea.

Women Children & Sexual Health Management

Midwifery

Community Midwives

Bespoke tailored training delivered to 3 areas within W&C to identify QI opportunities and drive improvement. Request changed following in depth discussion to ad hoc support in one area for QI methodology and potential bespoke training in other area.

Other Improvement Ideas

Bespoke tailored training delivered to 3 areas within W&C to identify QI opportunities and drive improvement. Request changed following in depth discussion to ad hoc support in one area for QI methodology and potential bespoke training in other area.

To create a survey/ encourage staff cooperation and engagement.

Service Redesign for Bariatric Service Pathway

Poster Presentation Software query

To create a survey/ encourage staff cooperation and engagement.

Service Redesign for Bariatric Service Pathway

Poster Presentation Software query

Support/refresher to enable QI Ambassador to deliver QI workshop/training.

Support in identification and collation of measurements for continuity of care Midwife project

Optimal Birth Projectscoping, setting aims, measures; applying QI methodology to the Project.

Optimising Births

Support/refresher to enable QI Ambassador to deliver QI workshop/ training.

Support in identification and collation of measurements for continuity of care Midwife project

Optimal Birth Project - scoping, setting aims, measures; applying QI methodology to the Project.

Optimising Births

Birth Centre - alternative pain relief options

Paediatric BP Chart

Birth Centre - alternative pain relief options

Paediatric BP Chart

Dental Care in Pregnancy TBC

Administration Improvement Ideas

Excess Funds to be pooled and shared

I witnessed an asbestos inspection in wch. When I asked the inspector I was told they knew from a previous inspection that there would not be any asbestos. But that there was funding allocated to the buildings aspect and if not spent it would be lost. What a useless exercise to redo what is not needed, when other departments or areas are lacking resources. This has got to change.

Patient Care Improvement Ideas

Poster Hi

I was wandering if I could have a poster of Swab-ready for home? please.

I am going to be discharge co-ordinator for the new Wheal Vor ward and this would be great to have on the wall.

Sign Language Courses Would it be possible for the Trust to fund some sign language courses for staff? This could better enable us to speak with hearing impaired patients and broaden our communication efforts. I asked around my current department and found 6 interested members of staff in one day. Additionally it would be nice to learn a new skill.

CT scanning in post COVID anosmia

Anosmia is an indication for CT head scanning. Anosmia is a known symptom of COVID-19 infection, which may persist for weeks to months following infection. Under current guidelines, post COVID patients with anosmia receive a CT scan. In practice, this usually yields a normal result. We propose a multi-centre audit of patients with post COVID anosmia who underwent CT head scanning, to determine the incidence of detected pathology. We envisage that the results of this audit will then be used to inform best practice on whether patients with post COVID anosmia should undergo CT head scanning as per current guidelines.

Specialist Services & Surgery

Marking teeth before extractions and other surgery

The innovation is a product that can be used for marking one or more teeth in patients undergoing extractions and other dental surgery. The product comes in single-patient packs with an integral applicator allowing it to be painted on to the tooth/teeth being operated on. It can be removed by thorough brushing or using an alcohol-based swab or mouthwash.

Specialist Services & Surgery

ENT Staff

Endoscopy Unit Treliske

Supporting Rheumatology department in some improvement work

Bespoke QI tailored training for dermatology staff following recent Never Events

ERCP service improvement changesmaking changes to the service

Other Improvement Ideas

Supporting Rheumatology department in some improvement work Specialist Services & Surgery

Bespoke QI tailored training for dermatology staff following recent Never Events

Dermatology Unit

ERCP service improvement changes - making changes to the service Specialist Services & Surgery

Breast Service redesign Breast Service redesign

change to bowel prep for colonoscopy procedures

Discussion around QI toolkit, methodology and hands off support regarding Breast Surgery Service re-design

MSc project

change to bowel prep for colonoscopy procedures

Discussion around QI toolkit, methodology and hands off support regarding Breast Surgery Service re-design

Specialist Services & Surgery

Endoscopy Unit Treliske

Specialist Services & Surgery

The research seeks to determine if a short vestibular rehabilitation session improves patient outcomes.

UGI Project

his is a retrospective study looking at patient data and may involve phone calling the patients at some stage and ask to fill a questionnaire about quality of life post operation. It consists of two studies:

1) A retrospective study to compare Emergency vs elective laparoscopic common bile duct exploration.

2) A review of patients records retrospectively and send a questionnaire to fill or a phone call to ask few questions from the patients about the quality of life after the operation.

Audiology

Endoscopy Unit Treliske

Rhinology Registry

CAVI-T Project

Cornwall Rhinology Registry

Patient registry for the prospective collection of data

ENT Staff

TBC ENT Staff

'Challenge NHS' Badges for Ward Clerks

Culture Improvement Ideas

As Ward Clerks, like any member of staff, we have the right to challenge somebody in our area. I have to query a few staff members not wearing ID badges and sometimes get ‘a look’ as to why I am challenging them.

I wondered if we are able to bring in a pin badge of some type. I am thinking along the lines of those you see in pubs/shops with the challenge 18/21/25 signage that they have. Just something simple that says ‘challenge nhs’ or similar. It just gives us an aid to validate why we are challenging people on our Wards sometimes, and to perhaps remind people that they should be carrying their ID on show at all times.

Operational Improvement Ideas

Interventional Cardiology Surgical Field

Flexible contoured working area to assist with management of interventional cardiology guidewires

Cardiac Dept

Care Unit

Sustainability Improvement Ideas

Reupholstery of chairs

Hi,

This is something I passed to Caz Vinnicombe some time ago, it was forwarded to QI pre pandemic.

I know there is somebody in the Trust that deals with sustainability, but wasn’t sure who that was.

Is there a way that the Trust can look into having our office chairs recovered. As we are in a clinical area, these have to be the blue ‘wipe clean’ chairs, not fabric. They end up with rips in them frequently and cost £110 each to replace. I didn’t know if they could incorporate a role within estates, or outsource to a company to reupholster them?

As we are all trying to do out bit for the environment, would it not make more sense for the Trust to be able to upcycle them, rather than dispose of them? It’s just something that came up in conversation the other day, and I thought this may be something else you could perhaps look at.

Coronary Care Unit

Re-usiform Service

A way to bring in your old/no longer needed/wrong size/coloured uniforms in good quality condition. To help with sustainability and recycle where we can uniforms that can have a further life span. it would be great to have a rail in the linen room perhaps, so the items can be laundered and returned to begin the process.

Coronary Care Unit

Reclycle more plastics

Reclycle plastic caps etc from dialysis line packs also 10 ml N/saline empty vials

Coronary

Renal Unit RCH

Improving the referral and vetting process for GP ECHO referrals.

Patient Care Improvement Ideas

The covid era has led to changes in the way we do things and has highlighted the need for good quality triage to ensure we can act fast for those with greatest need. Especially in an era of high demand and long backlogs.

The current GP ECHO referral system needs improving and updating and at present poses a risk of patients receiving lower priority and lengthier wait for their ECHO appointment due to insufficient referral information. It is also a very time consuming and frustrating process for highly trained staff.

The benefits would be a fairer and safer allocation of appointments for patients and a more streamlined process for staff freeing up more time for patient care.

Volumatic spacer for Inhalers that can concertina.

People who take a metered dose inhaler can get 10-25% more of their inhaled dose by using a volumatic spacer but these come in 2 pieces and are big and cumbersome. I would love to have a volumatic spacer that concertinaed making it more portable and helping people take their inhaled medications especially when they are very SOB and unable to hold their breath, this would potentially decrease the overuse of fast acting bronchodilators ( such as Ventolin) - helping the user and decreasing cost.

I would also love a colour chart for sputum!! A great deal of respirator patients naturally produce a lot pf phlegm on a daily basis. These patients are frequently on oral antibiotics and steroids.

I feel if patients had a colour chart to look at their normal sputum colour it would give them the tools to help identify when the had a chest infection and when to start their rescue pack of antibiotics and steroids. Again it could help reduce over use of medications.

Team Working/Communications Improvement Ideas

Technology Improvement Ideas

Virtual Tours I thought it would be a real game changer if we had a tool that gives you a virtual tour of a ward/department. This is something that could be really useful for recruitment. I also work on the bank, and it would be nice to see what areas are like and get a feel for them, as we don’t always know the different areas of the Trust. In light of our current restrictions, it isn’t always possible to go for a look around.

Coronary

Care Unit

Trop testing Rapid Rule out Myocardial Infarctions in ED - Trop testing Cardiology Medical Staff

Cardiac Dept

Respiratory Department

REACH-HF Manual and DVDs to help self-management by heart failure patients

Cardiac Dept

Rapid Rule out Myocardial Infarctions in ED - Trop testing

Develop information pack/virtual video link for improved communication between patients & relatives currently inpatients

Other Improvement Ideas

Rapid Rule out Myocardial Infarctions in ED - Trop testing Cardiology Medical Staff

Develop information pack/virtual video link for improved communication between patients & relatives currently inpatients

Wellington Ward

Culture Improvement

Request for initial support with QI thinking

Andrew requested support via email for initial support with QI thinking. - Sue Preston is supporting. CSSD Department

Quality Improvement Guidance Hi Team, I hope you don't mind us contacting you. We have recently been appointed to advanced practice roles within the hand unit and were wondering whether we might request some guidance please? The roles are fixed-term (a year), during which time we will be devoted to the development and delivery of safe, effective and quality care to patients accessing the hand unit - Emma and Kate will be working in an elective setting and my role will be in trauma.

Therapy Services

Operational Improvement Ideas

Interventional Cardiology Surgical Field

The positions have been developed primarily to improve patient flow and timeliness of care for patients accessing both sides of the service. Due to the nature of the injuries/conditions we manage, this presents challenges in different ways - the waiting time to be seen in a trauma clinic is much shorter than elective, though the clinical urgency is much greater, and any delay may impact negatively on the patient's outcome. The waiting list for the elective service is pretty epic and rising all the time - this too will have an impact on patient outcomes but also creates an ever-increasing demand on meeting the RTT targets. We would expect each position to have a significant impact on reducing the waiting times for patients accessing each service. We also envisage there to be a postive correlation between reduced waiting times and improved clinical outcomes (and patient satisfcation levels).

Flexible contoured working area to assist with management of interventional cardiology guidewires Cardiac Dept

From a clinical perspective, our roles will involve the autonomous management of patients presenting with selected injuries/conditions of the hand and wrist - we will be involved in assessment, diagnosis, treatment planning and treatment implementation. From a non-clinical perspective, we will be heavily involved and responsible for developing, implementing and auditing the service, with responsibilities stretching across the 4 pillars of advanced clinical practise.

From a governace perspective, this will involve the development of a competency framework, which will focus on the safe and effective management of patients presenting with the injuries and conditions we will be expected to manage. We have already started the process of considering how this will be achieved and feel reasonably happy with continuing with this work, although we would certainly value your opinion and guidance with this.

Sustainability Improvement Ideas

From a leadership and management perspective, we will continue to provide support to the members of the hand therapy team continuing this work whilst we are on secondment. This will involve provision of daily support through case discussions, in-service training and clinical supervision. We shall also be taking the lead in hand related training for fracture clinic, minor injury units and g.p practices.

One of our main objectives throughout the pilot phase is to ensure we capture the most useful and relevant information for proving the value of the service to the service users and Trust. I think this may be where we would most benefit from your expertise if possible please? We are still working in our substantive posts and are a little uncertain about the exact starting date for each position. However, with such a short timeframe for the pilot, we are keen to have a framework in place for capturing all metrics from day one.

We look forward to hearing back from you and value your support with this upcoming project. If possible, it would be great to have the opportunity to discuss our plans for the project and hear any advice or guidance you may have. In the meantime, I've attached some further information from a handout that went alongside my interview presentation.

Ward accreditation

Training compliance, KPIs, hand hygiene audit, recent incidents, FFT surveys.

Make wards able to be compared with each other, make them compete to be the best. Give the managers a reason to get their staff performing at their best (awards ceremony? One of this corporate ceremony awards stuff? A golden star next to the name badge? Personalised signatures for their emails? A £20 voucher for M&S?)

Small things like that could make the wards try to be better at delivering care, include doctors too, check documentation (spot checks, auditing ward round documentations?) encouraging the managers, from ward sisters to matrons to work hard to be the best.

Similar ideas worked in other trusts.

It is sad to see RCHT not been “brilliant”.

Blood Sciences

Administration Improvement Ideas

Paperless Nuclear Medicine requires recording of multiple data sets. Historically this has been paperwork that gets scanned onto individual patient records. For some patients this will be 3+ paperwork for each patient and takes up a considerable portion of the pathway navigator time.

Paperwork includes; injection sheets, pregnancy signing sheets, GFR worksheets, white cell study worksheet, Potassium Iodide tablets sheet, comforter and carer signature sheet and therapy sheets. We need to utilise our navigator more effectively, booking appointments etc rather than endless scanning of paperwork.

Where we can, we have amalgamated paperwork to reduce this but ultimately, digital versions that would link to their CRIS record should be an option to aim for. Any help with this would be much appreciated.

Reducing DNA rates for initial appointments.

I am an Occupational and I run the Splinting and Bracing Service at West Cornwall Hospital. We have noticed a increase in DNA rates for initial appointments. Having missed one appointment a second appointment is then offered and then frequently DNA-ed again. This is having a significant impact on waiting times.

In light of our long waiting list (approx 29 weeks), would it be possible for us to send a letter to these patients explaining that they have missed an appointment and asking them to contact the Booking Team if they would like an appointment within a set period of time (perhaps 14 working days). The letter would need to include the reason for the appointment and if no contact is made they they would be discharged and a letter sent to the referrer.

I only have 5 new appointments per week as the rest are follow-ups and out of the 3 new appointments so far this week, 2 have DNA-ed.

We are a very small service and we would be very happy to run a trial to see whether the DNA rates decreases.

I would be grateful for your thoughts.

QR code portable boards to provide patient information leaflets to tablets or phones at the bedside

Hand held, cleanable display boards with multiple QR codes for patient information leaflets would enable patients with smart phones or tablets to be provided with patient information at the bedside.

A Board/ sheet of codes for different disciplines that could be obtained from and returned to a central point in each ward and out patient area could be colour coded or have appropriate symbols to make finding the right code(s) to provide to the patient to scan and download the required leafelets(s) quick and easy.

This would reduced infection risk, be more sustainable than paper information leaflets, be easier to locate and make it easier for patients to retain the information provided for future reference, particularly if being discharged.

To include "Receiving a blood transfusion"; this leaflet should be provided as part of the consent process for all patients receiving blood components in the non emergency situation (as described in the transfusion administration competency assessment). Currently, printed leaflets are ordered from NHSBT by the Transfusion Practitioners on an ad hoc basis as and when required. Each clinical area has a stock that is replenished when needed by the TPs.

To also include patient information leaflet RCHT 1326, "Following your blood transfusion" this is found on the document library and clinical areas should print their own copies to provide patients being discharged after having blood/blood components. It is likely that compliance with this is currently low.

- WCH

Patient Information review and update for Clinical Imaging

Clinical Imaging would really like to discuss some support to improve patient communication. This includes:

- Patient appointment letters

- Patient Information leaflets

- Patient communications in alternative formats

Due to the vast amounts of information used by the service we would like support with the project to improve and review current documentation to ensure it is easy for patients to understand using an agreed trust format/style. It would be our hope to reduce our reliance on paper etc and where possible move to a more digital and/or streamlined approach. It would be helpful to have someone who would be able to help pull this together with the service and support actions alongside the imaging teams.

Therapies

Blood Sciences

Clinical Imaging Staff

Quality improvement - assisting staff in training for Point of Care Medical IVD diagnostic devices

Good Morning,

I work with the Point of Care testing team – and we would like a little assistance in producing an innovative way of delivering the training required for the IVD Point of Care (POCT) testing devices around the trust. These pieces of equipment produce numerous pathological results near the patient bed side, and therefore have an impact in the rapid diagnosis of patients. Currently we are in the process of networking these devices to push results into Maxims. (please see the spreadsheet poccelerator phase 2 to indicate the scale of this project, and the equipment we manage). We are also soon to expand and move more equipment into the CFT domain as well as RCHT.

Currently we are having issues delivering training – as we are a team of four. This makes doing Face to Face training very difficult. We have approached L&D and we have had no success moving this training into ESR. Ideally, we require easily accessible training for users – that once completed produces an email notification that goes into a generic email account. An example of GOOD training we have in place is for the Glucometers, which is available here :- https://bit.ly/GLUCOMETER

And is also hosted on the trust website under the A-Z under DIABETES (which does confuse people!!)

When a person completes this training, we have an email arrive the next working day that indicates their name, email, and their score. We can then update their competency on a server, and they then get 2 years competency from that date.

As we as a team fall under Pathology, we have been told by our service lead that our quality manager must liaise directly with CITS to make any changes to the intranet website. This means we have an extra hoop to jump through – and it makes it difficult to use this as an option.

It would be great to have our training, and some basic documentation (like forms to request supplies) available easily for staff to quickly access. Clinical staff don’t have time to search for training and documentation, and they are already bombarded on ESR with mandatory requirements. However, this training is a requirement under both MHRA and the ISO 22870:2016 requirements e.g :- Only personnel who have completed the training and demonstrated competence shall carry out POCT. Records of training/attestation (or certification) and of retraining and re-attestation (or recertification) shall be retained. It would ideally need to be manageable by the POCT team so, if we need to make amendments to this training – it can be done easily. We have investigated managing some training with existing systems – and we can demonstrate these if required.

I have also attached a training PowerPoints for the Siemens Clinitek (multistix and clinitest) that we have produced for training purposes as examples.

Any assistance we can get would be appreciated. We have a LOT of equipment and a very small team. We really want to improve the way we work with clinical staff and offer the best service to the teams who use the equipment we manage. This would also go a long way to supporting our teams efforts to attaining UKAS accreditation eventually!

I have attached my line managers email address – if you need any more information please don’t hesitate to contact us. The direct lines, and generic email address for our team are also in my email signature.

Unwanted map with prescriptions Please, please,please stop printing the map with every outpatient prescription. Not one single patient wants them. They are a waste of ink and paper and if the patient does not keep them then they have to go into confidential waste to be destroyed. A frustrating waste of money all round. For every outpatient prescription you will save 1 piece of paper and loads of ink. What an amazing Financial saving and many trees.

AI SPA projectDevelop artificial intelligence to aid diagnosis of metaphyseal fractures in children aged 2 and under from suspected physical abuse. (Short title: AI SPA).

Hi, I am working with UEMS and RCHT R&D on the above project. Gina Townley has advised to get in touch with you and/or Frazer Underwood with regards to intellectual property on the project. Is this something that I need and you can help me with?

Thanks Chrissy

Points of Care Testing -

RCHT

Pharmacy - Lloyds

Clinical Imaging - GI

Operational Improvement Ideas

Reliable Trust Service - Porter/Driver with SSD

"Hi, a colleague and I have an interesting idea that needs a bit of QI input to check our thinking. It links - tenuously - with an enquiry that I made earlier this year and had some really useful feedback from Judith and we've seen that idea make some great progress. Any chance I could have a chat with someone over it?"

I work as a Porter/Driver with SSD, we move clinical sets about the Trust, in bulk quantities of around 20-30 sets at a time. There are occasions when one or two sets are in the wrong place, or needed at a different theatre, often quite urgently. For times when the SSD Driver is not available for these urgent tasks the Trust has a contract with a local taxi firm to convey these sets as part of the larger staff-transport contract.

However, we know from speaking with theatre staff over the past two years, this back-up service has failed, leading to cancelled operations. Taxi drivers have refused to carry some sets due to their weight, many have a poor grasp of English, have mislaid sets as they do not have access to theatre reception areas, or have taken up to three hours to travel from Hayle to Truro, picking-up a fare along the way. I've recently submitted a FoI request to ask how many journeys the Trust has paid-for, and of those how many lead to a cancelled procedure. Surprisingly, the department at the Trust that submits the requests to the taxi company hasn't been able to quantify the journeys that RCHT have paid-for. It also appears that the Trust is unable to put a number on the procedures affected by delays in delivering clinical equipment, but we know that it's more than just a financial 'cost' as patients suffer considerable distress at having a procedure cancelled, staff are inconvenienced, and there are knock-on effects to bear in mind.

We are aware that the contract is due to expire in November of this year. My colleague and I are considering how we can provide the Trust with a more reliable service to the Trust, dedicated solely to transporting clinical equipment, by staff trained in this task, using suitable vehicles and not private hire taxis. To that end it would be beneficial to have access to a copy of the contract with A2B Taxis (Truro), and we'd be grateful for your assistance in this. It would also be beneficial if you could provide us with a rough figure of how much the Trust loses each year on cancelled procedures - I've no doubt that this sum will be known, somewhere.

We have an opportunity to provide the Trust with a service, replacing a failed system that has seemingly gone on for some years draining financial resources and causing harm and distress to patients, and inconvenience to staff, at a time when fiscal constraints are considerable, and your assistance in this matter would be greatly appreciated

CSSD Department

E-learning

Off the back of COVID and the social gatherings limitations, RCHT Blood Transfusion Department has designed an e-learning package, hosted on the ClinicalSkills.net platform. This self directed learning is available to all RCHT staff, possibly to CFT staff in the future and it has been shared with other NHS Trusts (Sheffield) in the country as example.

Alan Macleod suggested to record that fact with a QI form.

Blood Sciences

Opioid stewardship programme

It is recognised that opioids (weak and strong pain killers) are overprescribed in non-cancer pain. The evidence for benefit is not great and the evidence for harm is clear (side effects as well as possible dependence / addiction). Reducing use of opioids is being tackled in primary care and there must be an opportunity to reduce use in a hospital setting as well.

There are parallels with the antibiotic stewardship programme - need clear guidelines for use (and alternatives), need clinical champions, feedback of usage data to clinical teams, is there a role / capacity in pharmacy or even on ward (eg buy nurses) to monitor suboptimal prescribing.

In the ideas category below, I would suggest this is culture and operational and patient care and team working

Theatre Spot Checks

The CQC inspection back in September 2018 stated:- The management of medicines could be improved to ensure best practice. Not all controlled drug records were completed in accordance with trust policy.

We therefore want to work with theatres to be able to improve the recording of controlled drugs and to be able to get CD's removed from the risk register.

We will do this by improving training for theatre staff on what is legally required and what is considered good practice. We will also carry out monthly spot checks of all theatres and provide this to the CQC Inspection team and Theatres to show compliance and give feedback to the theatre staff if there are areas that require improvement.

PharmacyTreliske

PharmacyTreliske

Transport

for

Radiology Patients Good morning,

I have been mulling over an idea for my QI project as part of my preceptorship course and am a bit stuck on where to go with it. Am I picking something which is massive, or even been looked at before? I am a bit stumped as to where to direct my questions to see if my idea is even an issue.

I am a newly qualified radiographer and one area within our department which I have pinpointed which could be improved is around Transport Patients.

We have patients bought in for x-ray via hospital transport. Sometimes these patients are only for x-ray and if we are able, this can be achieved quickly. If the patient is only for x-ray, is there an option for the transport to wait with the patient - is there a maximum time? This can mean that the patient is left in our small waiting room for quite some time waiting to be collected.

On other occasions, patients come to us as part of their visit and we are advised transport will collect them, and in some cases, transport have been unable to locate them, as the patient is not where they were dropped off. My concern is that the patients are mostly unable to mobilise easily if at all and can sometimes be left for a time in our waiting room, which when the department is busy it is not always easy for us to check on them regularly, plus we don't have a public toilet in our department.

My idea was for central location where transport patients wait for their return transport, perhaps with a someone overseeing them in case they need something.

Interventional Radiology

Mandatory Nutrition and Hydration Training

Malnutrition is a common cause and consequence of illness, particularly in older people. The number of malnourished people leaving NHS hospitals in England has risen by 85% over the past 10 years.

Whilst we all know that good nutrition and hydration is key for recovery often the very basics of supporting our patients at mealtimes are missed and our patients become more poorly, impacting on their care needs and often increasing the length of their hospital stay.

The MUST screen, Food and Fluid charts, Food First approach and Nutritional supplements are all key to combating Malnutrition in a hospital setting however managing nutrition and hydration needs is not part of the mandatory training programme for our nursing and wider teams including Catering/Hosts

I would like to propose that we design and deliver (using the knowledge of our dietetic and SALT teams) a mandatory training session for all staff, potentially starting with all newly qualified nurses, HCAs and apprenticeships to promote better care and better outcomes for our patients

Therapy Services

Localised clinicslocalised parking for community staff

The old Edward Hain building is being bought back by the St Ives community for the benefit of the health and wellbeing of the people of St Ives and parish. Its an accessible building with parking on the edge of town.

Please can the Trust look at renting back some rooms /parking for community staff/ social care staff to relieve pressure in finding parking for Home Visits in the area- for CN and Therapy teams ?

A local equipment store room run there would also help therapists and cn teams to provide needed daily living equipment etc for patients quickly and reducing petrol miles for delivery.

Blood donation clinics, x rays and mammograms, falls clinics, etc held there would enable local people to reduce travel times and petrol miles .

Networked rooms for Adult Social Care and NHS staff would help us become truly integrated in our services.

There is a rise and fall bath there -and we are looking at a cafe provider - facilities for older people to meet is so badly needed locally since our Day Centre closed.

Thanks for considering the use of our building and helping keep our services locally delivered and locally connected. Would reduce waiting times and duplication of services. Thankyou ! It fits many of the improvement categories below - operational, patient care, staff wellbeing, sustainability, team working / comms.

Care and Support Community

Your patient, my patient, our patient?

This idea will:

- Help to improve patient flow through the hospital, speeding up discharges.

- Reduce inpatient stay.

- Help the 'criteria led discharge' to be defined.

- Give some continuity of care

- Improve patient experience

Currently, consultants have a huge workload of patients when they are at work, having to look after dozens of patients. This causes decision-making to be tricky and it promotes bed blocking decisions, like 'We'll see him tomorrow in ward round...'

In other NHS hospitals, the patient workload is allocated by 'on call' days. Example: All new admissions on Monday will be my patients, and they will continue to be on my list until they get discharged.

During the days that I am not working, the team will see my patient in ward round but decisions will be mostly taken by the allocated consultant.

As a patient, you know who is your consultant (not consultant for the day) and your steps towards discharge (criteria led discharge), will be clear. Every day you will see a consultant, maybe not yours, but someone from the team. This will make the patient journey a better experience.

Just an idea. I personally consider the current system to be ineffective based in incidents, discharges, etc. So maybe we need to reconsider how the hospital works?

Thanks,

To run a weekly hydrotherapy and gym session for ankylosing spondylitis (AxSpA) patients

A routine weekly class focussing on range of movement and strength, balance and mobility would greatly benefit patients with AxSpA. The research evidence has shown that is reduced unemployment, stiffness, risk of falls, osteoporosis etc. The research has also shown musculoskeletal benefits preventing contractures and spinal fusion.

I would like to run a group at RCHT using the hydrotherapy pool and potnetially the therapy gym. The group could be self funding and follow the procedures given by the National Ankylosing Spondylosis Society (NASS). They state the group has to be run by at least 1 physiotherapist. Such a group could be run at the end of the day, out of clinic hours, with a rotation of staff helping weekly.

Pre-covid the hydrotherapy pool allowed AxSpA patients to use the pool daily, in NHS clinic time. This service was stopped during the pandemic and can not be restarted in clinic time due to the extensive waiting list. The patients greatly need a similar service to start up again.

Standardised Phlebotomy Trolley SOP

Background: Each ward across the trust organises phlebotomy and cannulation equipment differently. This means that when on-call doctors attend an unfamiliar ward it can take a lot of time to find the necessary equipment. This leads to a delay in treatment of potentially very sick patients in which rapid response time is critical. It may also lead to other unsafe practices such as carrying phlebotomy equipment from ward to ward, and utilising crash trolley equipment for the sake of preventing delay.

Proposal: Have a standardised phlebotomy trolley on every ward across RCHT, that junior doctors and other ward staff can readily access, in order to minimise the delay in treatment of unwell patients. This QI change will be supported by a Standard Operating Procedure to ensure the change is protocol-driven, endorsed by senior management, and exists in a reference document that is readily available for all wards to access. This means that the QI can then be audited to monitor and improve adherence.

Clinical Support

Clinical Fellow

Patient Care Improvement Ideas

Nuclear Medicine department - Mood Lighting

I was hoping for some guidance on a project that I wish to complete to improve our patient experience here in the nuclear medicine department. Many of our patients undergo scans that can last between 30 - 80 minutes at a time and they are often very anxious even before they have set foot in the imaging room. Our patients are often claustrophobic, elderly and or oncology patients who are concerned about the outcome. We also have weekly paediatric patients who would benefit greatly from this project.

To improve this experience, I wish to have mood lighting implemented that many other imaging modalities have and receive extremely great feedback from. This is known to calm and lower anxiety levels especially as we are unable to stay in the room with the patient for prolonged periods of time due to the radiation emissions.

Below is a link to the kind of lighting ideas that we would be looking at installing:

https://www.gehealthcare.com/-/ jssmedia/7500475e59fc44c3827bf9c80252fe07.pdf

I plan to obtain quotes from the company who installed our cameras who provide the lighting equipment and wondered how I go about obtaining the funds for this exciting project and any other aspects that I may need to consider such as installation and safety etc.

Any advice would be hugely appreciated.

Audit in time taken for blood culture to reach incubators

Dear QI team,

I am one of the current FY1s who has just completed a placement in clinical microbiology. During my time in the department, I have carried out an audit evaluating the time taken for blood cultures to reach the incubators in the department after being taken within the hospital. I have compared this to national guidance which advises blood cultures should be incubated within 4 hours to ensure organisms do not become dormant and to ensure they are detected quickly/at all. My audit identified that only 46% of our cultures are making it to the lab within 4 hours, likely causing delays to patients receiving appropriate antibiotic therapy and ultimately having the potential to affect patient outcomes particularly in the context of sepsis.

I would be interested in taking this further into a quality improvement project and have some ideas for how I would start to do this, but would be grateful for some advice with regards to implementation and logistics if possible.

Introducing PreAssessment Clinics for Patients Attending for CT Colonoscopy

CT Colonoscopy examinations: Currently patients arrive for their examination and undertake consent and checklists immediately prior to their CT examination. The project team plan to pilot the introduction of pre-assessment phone appointments with patients in order to establish all the necessary consent and patient information/ details before their arrival. Pre-assessment clinics should improve the following:

Improved Patient information prior to examinations

Informed consent-prior to the patient arriving

Risk/benefit conversations are improved

Improved medicines dispensing and medicines safety: checks can be made prior to prescribing/ dispensing

Faster CTC examination times leading to a potential for increased CT scanning appointment capacity

Better individual patient care

Implementation of electronic consent and documentation processes

Potential for decreased patient DNA rate and decrease in unsuccessful / abandoned examinations

Establish better relationship between the patient and the Radiographer prior to patient arrival, possibly leading to less phone calls in the booking teams.

Nuclear Medicine

Pathology Directorate Budget

LINKING MEDICAL DEVICE ASSET DATABASE TO RADAR

We currently have no link to Radar and believe it would be beneficial from the point of clinical teams to be able to see live statistics about the maintenance and compliance of the medical devices that are being used in their wards and departments. Currently we manually create reports and send them to the management teams of each care group. I believe that having access to live information would enable clinical staff to manage the medical devices more efficiently and have a real impact on ensuring that devices are safe to use.

Medical Equipment Library

One-stop Transport Shop?!

We have such difficulty with patient transport and this is not a new problem. It's NEVER on time for patient appointments and ALWAYS delayed for the return part of the patient's journey. I can't imagine that Nuclear Medicine is alone in having these difficulties with outpatients.

Certainly a look at/overhaul of their IT system is long overdue. The lost hours in waiting for patients to arrive or staff having to wait in department so that a patient is not waiting on their own, is not an effective use of clinical time.

Would it be easier for centralised areas in Tower AND Trelawney sides for Transport to drop-off and pick up? Use of a discharge-type lounge? Transport staff could have a quicker turnover and staff could collect from the centralised areas. Patients could be taken there as a drop-off point after tests are complete.

Volunteers could be used for onward transport to wards/departments if clinical staff are busy?

Nuclear Medicine

Electronic ECGs

Patients referred for Myocardial Perfusion Scans (MPS) in Nuclear Medicine often have no ECGs recorded or filed in notes for assessment.

MPS scan involves pharmacological 'stressing' to investigate inducible ischaemia.

A baseline ECG is recorded for this study and compared to the most recent ECG to assess whether it is safe to continue the test. Any new, significant ECG changes, make the test unsafe to continue and should be cancelled until evaluation by Cardiology teams.

Despite best efforts, patient notes do not always arrive, and ECGs in the notes are often several years old.

This makes assessment of the baseline ECG difficult, especially if there is no ECG for comparison.

We do not have access to ECG recorded at GP surgeries and RACPAC assessments are often by telephone only. Nephrology and Cardiology never complete any for their patients, though surgical pre-assessment for surgery DO record and scan onto MAXIMS for us.

More electronic recordings of ECG, available to necessary teams.

Nuclear Medicine

Improve service at UTC West Cornwall at night

Dear QI, I am a staff nurse that works in the Urgent care center at West Cornwall hospital.

Years ago West Cornwall hosted a casualty department. Over the years services were stripped back and centralised to ED much through the retirement of many key figures (consultants and such). Now the service runs as a UTC fit with a doctor from 9-10 and a minor injury unit at night staffed by an Emergency nurse practitioner and a staff nurse with the x-ray facilities at UTC close at 11pm.

The significant pressures during the pandemic, particularly in the ED department, I believe are unsustainable. I struggle to believe the situation getting any better over the next few years.

What I propose is a return to West Cornwall hospital providing increased services over the night in order to reduce pressure in RCHT.

During the night the x-ray department and CT scanner are shut. Having these open with radiographer cover combined with a qualified doctor based in UTC over night I believe would contribute to increased patient safety, reduced ED pressure and improved patient outcomes.

Urgent Care

Patient Information and appointment letter

Good morning,

I am currently on a preceptorship course and in need of some help with an idea I have for the quality improvement project we are doing. I work in Camborne and Redruth Community Hospital as a Radiographer. I am looking at improving the content of the patient letters that get sent out to include helpful information on how to dress appropriately (no metalic clothing). We experience this issue with almost every patient that walks through the door, I genuinely believe if they were made aware of this issue prior to arriving at the hospital we could improve the patient experience and timeframe it takes for the imaging appointment. I have looked at the letter we send out and there isn't any information on this currently. I'm not able to obtain a blank format of the letter template without patient details on and I was signposted to yourselves for help on how to proceed with this idea.

Does BMI affect U/ S EFW accuracy

To collect retrospective data for 300 women who underwent growth scans during their pregnancy from 36 weeks to delivery. Along with the EFW and the gestation this was obtained I would also like to collate the actual weight at birth (and at what gestation) as well as the patient BMI.

I then plan to calculate the percentage error between the two weights and assess whether BMI had any influence on these error scores.

Aim is to see if we are unnecessarily scanning lots of extra patients as we are unable to detect SGA/FGR babies. We are known to have higher error than average and I want to try get a better understanding of why this is.

Ultrasound Guided Cannulation in Clinical Imaging

QI idea – US Guided Cannulation Introduction

Clinical Imaging at RCHT, inserts countless numbers of cannulas for venous access across its imaging modalities- in particular, CT, MRI, Nuclear Medicine, and Interventional Radiology. Often the patients that present come with difficult venous access, often with little or any warning. Cannulation, even by the most skilled of practitioners can present a huge challenge when veins are neither visible nor palpable. Staff members often find themselves having multiple attempts, sometimes taking hours, or failing completely. Patients can find this process painful, stressful and if unsuccessful can lead to a sub-optimal scan or having to be completely rebooked. The time it takes can remove a radiographer/nurse/technician from seeing other patients, delaying lists, and often leaving other areas of the department short of personnel.

The obvious and widely accepted solution to this problem is Ultrasound guided cannulation. Vascular Access have been using ultrasound for the insertion of venous access for many years, but heavily focussing on central lines- PICC, Midlines etc. These are sterile procedures where the operator uses a local anaesthetic and sterile pack to insert a long-term line. US guided cannulation is all about gaining quick access for short periods of time, on patients that the traditional palpation and sight technique fails on.

Blanco (2019) found that the success rate of cannulation increased from 2530% in difficult patients to an astounding 90% success rate!

The Idea

Clinical Imaging needs an ultrasound machine dedicated to peripheral venous access. With training (given by the Vascular Access Team) practitioners could use US as the first line of attack for patients with known difficult venous access. This would decrease pain to the patient; increase comfort; decrease the time it takes and improve patient flow.

Clinical Imaging could share one machine with a base in Nuclear Medicine/ Newlyn Unit that can be loaned to each department when needed. Training would initially be given by the Vascular Access team (based in the Newlyn unit) and then cascaded to other key team members (as deemed appropriate).

Conclusion

We really do believe that this could be a fantastic jump forward in patient care, and in the years to come transforming into a service that will speed up the journey and comfort of patients through Clinical Imaging.

Imaging Staff

Clinical

Clinical Imaging Staff

Transfusion Take Down Tag

A durable, wipable, reusable large tag (that complies with infection control) that can be hung on the drip stand with a unit of blood to clearly display when the unit needs to be taken down with a dry wipe panel to write the time. This simple idea will reduce the risk of a transfusion being attached to the patient for too long by acting as a visual prompt to increase shared awareness and empower all staff (regardless of transfusion training status) and the patient, if able, to alert someone to take the blood unit down in time.

There is a requirement as per BSQR 2005 to complete blood transfusions within 4 hours of removal from cold chain to ensure patient safety and reduce risk of bacterial infection.

Breaches put patients at risk and there is an implication for the trust as any occurrences >5hours are reportable to SHOT (Serious Hazards of Transfusion) and the MHRA.

Improving patient access to services

The Problem:

The Therapy department is based in the PAW (this is not on the drop down list below?). Our patients are often disabled and / or elderly and with conditions that cause fatigue and mobility problems. There is insufficient disabled parking at PAW and this is used for patients to access the Tower Block, Dermatology and services accessed via the link corridor. This has resulted in patients being treated in the car park, patients calling the department in tears to say that they have been in the car park for 2 hours and are unable to park nearer enough to get into the building and therefore missing their appointment, patients walking from the main car park with mobility problems who are then so fatigued they are unable to engage with their treatment and the walk from the car park has a detrimental effect on their condition. They are unsteady and liable to fall walking the distance required.

Possible Solution: Would it be possible for patients to have a 'golf cart' transfer such as they have in train stations and airports and other hospitals I believe. This could be picked up from Trelawney and possibly staffed by a volunteer?

TherapiesWCH

Sustainability Improvement Ideas

Energy saving Ask cleaning staff to leave lights off in clinic rooms after cleaning them. Our cleaners often put the lights on in rooms that will not be used that day which is a waste of electric and if no one checks they can be left on over the weekend.

Light sensors in staff a changing rooms

Working a lot of nights I see a lot of lights left on rooms when barely in use for example staff rooms and changing rooms which is not only damaging for the environment but also given the current cost of energy a massive waste of money for the trust.

If automatic light sensors were placed in rooms such as those named above and I'm sure many other types of room like out patient departments/ corridors it would solve the problem of lights being left on as people are very unreliable at switch lights off when not in use.

TherapiesWCH

Clinical Imaging Staff

EPMA Trolley Trolley specifically designed for EPMA with raised laptop shelf PharmacyTreliske

3D Hand Splint System for precise replication of bespoke Thumb splint for patient with EhlossDanloss syndrome where skin too fragile to mould against Therapy Services

Staff Wellbeing Improvement Ideas

gp service for staff on site

i have something as simple as b12 deficiency and live in wadebridge. therefore its very difficult for me to get appoinments at my gp around work and have had to use my annual leave for it. i think having a gp service or maybe allowing occupational health to carry out routine things like bloods and b12 injections would be highly beneficial as i know i am not the only one finding it difficult to take care of their health when their gp is far from the hopsital.

Blood Sciences

RCHT Childcare

It would be great if there was a dedicated centre on RCHT grounds for childcare- this would be a quality improvement, as it would mean that nurses could drop their children off at the centre at the hospital- resulting in less time being taken off due to no childcare being available

PharmacyTreliske

Designated rest break areas

Within the department there is a real shortage of space for staff to have a well deserved break. It is something everyone is aware of and a problem within the trust especially with poor morale, health and wellbeing, let alone covid.

In the summer there is outside green space we can access but when it is raining this cannot be used. My idea thus is for some funding for covered bench areas, gazebo/hut style where there is benches and tables with shelter included so these can be used year round for a designated space to have a break without being interrupted or interrupting others working.

These could also be used for private conversations whereby there is also a shortage of private space.

Local companies could be contacted to see if they could build/ supply at a discounted rate for NHS or come out or charitable funds.

It is something that would make a massive difference for staff, being able to sit outside in the fresh air, away from work for a little bit of time without getting in someone else's way or increasing infection risk, and feeling refreshed.

i have attached a picture of the idea i am thinking of and one could be supplied to this department as a trial.

PharmacyTreliske

why don't we stop cake Wednesdays?

Allows: save money for the Trust and use elsewhere for staff - free coffee voucher once a fortnight instead? Money into staff rest areas instead.

Greater staff wellbeing - cake every week isnt good for everyone and gets wasted.

PharmacyTreliske

Team Working/Communications Improvement Ideas

Use of "toilet cards" to disseminate important Trust information to clinical staff

To consider use of “toilet cards” in staff ward areas for highlighting key information.

Consists of a wipe clean plastic wallet on toilet doors (like you get in motorway services) which is updated frequently with key Trust information. More likely to get information noticed by staff as opposed to emails, ticker tapes which aren't seen by all staff in clinical areas.

Use of these cards in other Trusts was very warmly received and positive feedback from the clinical staff.

Haematology Laboratory

Secondment opportunities

It would be great if some QIdeas projects were selected and the staff member leading on those projects was briefly seconded to work with the QI team to get these improvements implemented faster and with the support of the QI team. It might provide some back fill opportunities in departments to try new roles or act as a backup where currently there noone who can do this. It would help staff to implement QI methodolog improve culture of Q.I. Staff also get a break from their longstanding roles and may come back feeling more enthusiastic and recharged?!

Clinical Imaging - GI (Tower Xray)

Improvement to glucometer practice locally

Need to escalate the glucometer audit data through the trust. This has both a sustainability and a cost improvement outcome. The trust achieved 22% total compliance from this audit with the largest issues surrounding dating of reagents in use (this does form part of training)39% compliance, and cleanliness of devices - 76% compliance.

Looking at the data from December 2022 - potential wastage from nondated pots could, at the absolute maximum have wasted £6,625. This is a 6 month audit with a repeat in July (ish) of this year. This means we could be wasting £12,000 from staff not simply dating pots of reagent into use! I can offer a full audit of locations involved as required.

We would also like to celebrate locations who have achieved 100% compliance too - something to congratulate staff on good practice etc.

Is there a better way to communicate these two outcomes to staff so that in the next audit our compliance is higher?

Pathology Directorate Budget

Central Stores locations for modalities RCHT

Perhaps there should be a few designated stores area for services that don't have a central location i.e. Imaging when items are delivered. This week £5,000 equipment part was unable to be located, it was delivered and signed for by someone called Rachel but no one can find it and the engineer had to leave without foxing an essential piece of Imaging equipment. The Imaging leads discussed at huddle and we wondered if there could be designated drop off zones for stores items that haven't got a home i.e. anything for Imaging goes to Tower X-ray , and then this map of drop off points well communicated and sign posted. The problem is that some areas of Imaging are closed at weekends and nights so specific items get delivered to the wrong area. There have been many reported missing items , all valuable and never found and we wonder if these inefficiencies are more Trust wide. Searching for them is like looking for a needle in a haystack.

Clinical Imaging Staff

Technology Improvement Ideas

Video explanation for diagnostic test

Nuclear Medicine has a large backlog of patients for myocardial perfusion stress tests. The patient explanation takes a large chunk of the appointment time for these cardiac studies and if we could reduce this, then we could get through more appointments in the day and reduce the backlog in a shorter period.

What I'd like to do, in an ideal world, is to have a video that the patients watch, prior to their appointment that is exactly what we currently say to each patient, in the stress room. This would reduce staff fatigue from giving this in-depth explanation many times per day (especially in a mask) and if it were available on a platform such as YouTube, the patients could be sent a link in their appointment letter to watch it prior to attending.

Any patients who do not have access/have not watched prior to appt, could be given the department iPad (more iPads would be better) and watch the presentation/video explanation in the waiting room.

This would reduce the appointment time by at least 15minutes per patient.

Use of RFID tags to prevent ward drug keys being accidentally taken away from a ward and to track wheel chairs on site

Consider active use of RFID tags for ward drug cabinet keys as there is a frequent problem of staff leaving with keys in a pocket- I have observed posters/signage on ward exit doors in some areas and heard a recent personal recount of a nurse who completed a particularly challenging shift over the festive period and was so tired she drove 20 miles home before realising she needed to return to her ward with the keys (which meant waking her young child up and taking them with her too).

Passive use of RFID tags could also be used to track the location of wheelchairs within the trust as there seems to be a frequent plee for their return to specific clinical areas or entrances. https://www.rfidjournal.com/wp-content/uploads/2019/07/565.pdf

Other Improvement Ideas

RFID - Tracking equipment

The impact of the Critical Care AHP outlier service on patient outcomes

Complications of excess weight (CEW) clinic national evaluation

Nuclear Medicine

Blood Sciences

RFID - Tracking equipment Medical

We have a new AHP team on Critical Care. Our service has expanded to review patients on the general wards and even occ at home. We are also starting an Critical Care discharge clinic. We would love to be able to prove the worth of this service and the impact of having a fully funded AHP service on Critical Care. We are looking at outcome measures for patient

We'd love someone to give us some guidance

Cornwall is one of 21 clinics nationally who are testing what works regarding interventions for children and young people who are living with excess weight and associated complications. I work at the Clinical Lead for this programme of work in the national CYP transformation team at NHSE. The call out for research partners (funded by NIHR) is now live and I've shared the info link with Frazer as I understand the team might be interested in bidding for the work.

MSc project The project involves collecting retrospective data for 300 women who underwent growth scans during their pregnancy from 36 weeks to delivery. Estimated fetal weight and the gestation were obtained. The concept of this project is to collate the actual weight at birth (and at what gestation) as well as the patient BMI.

Moreover, the project aims to calculate the percentage error between the two weights and assess whether BMI had any influence on these error scores.

Equipment Library

Therapy Services

Therapy Services

Administration Improvement Ideas

Peer Reviewing Issues - across multiple teams.

Others looking at others issues or how they work etc. – Peer reviews (from different departments, or clinical/non-clinical looking at each others work.

In particular, Procurement – 3 different books + stickers for how orders enter the workplace. Maybe could use a Time-motion study? Clinical/non-clinical to look at how the process works and how things come into the building, where improvements could be made etc. Streamlining processes.

Apparently something is coming, but nothing has ever been put in place.

RCHT structure charts

I often need to contact service manages, matrons, ward sisters etc but don't always know the name of the person I need. For example, I might need the Opthalmology service manager, or the nurse in charge of Kerensa ward. This information should be easy to find but never is! This information must be kept somewhere like in ESR and must be updated whenever people move, so can the Trust produce a key post structure chart and upload it to the intranet so people know who to contact???

Quality Improvement Hub (QI)

Special Interest Group Katie requested support with a driver diagram directly via email for 'Special Interest group - Library - Assist with Driver Diagram'. Lisa Mewton is assisting.

Improve Standard of Documentation

QI Project/ Smartsheets

Dear Team, Following Safer Surgery today we have identified a possible QI project to improve the standard of documentation in the surgical patient pathway.

I wondered if we could follow up as this feels like a really great QI project and we know will be a CQC action from the follow-up visit.

Good afternoon QI team

I am in the process of developing a new spreadsheet to allow tracking/theming of our Datix incidents, something that the Datix platform itself does not do very well. I’ve heard that a ‘smart sheet’ may be useful for creating something like this, but other than a fancy name for an Excel spreadsheet I’m not sure what this is. Do you know anything about this or should I see if CITS have any clever ideas?

Quality Improvement Hub (QI)

K/SPACWLL Health Library Services

Clinical Governance

Clinical Governance

Admin & Clerical: Inpatient Services

To provide a supportive management team for Band 2 Ward Clerks akin to that currently in place for Band 2 outpatient admin staff; this support to be provided by managers with knowledge and experience of what is required for the ward clerk role.

To provide ward clerk training to a high standard (currently there is no training) and to ensure staff work accurately to achieve a significant reduction in errors which has been causing issues and loss of revenue for over 10 years.

To provide comprehensive support with the imminent changes rolling out that will affect the ward clerk job role - eNotes, EHR, Patient Hub, New PAS, to name a few. They will need ongoing training and managers that can answer their queries (ward managers just do not know the ward clerk role and are busy supporting clinically).

To provide adequate HR, attendance management support and raise staff morale eg: providing cover when staff take their annual leave.

In turn a better ward clerk service will allow clinical ward staff to devote more time to patient care instead of managing without a ward clerk and answering the telephone and locating notes; better cover is also essential for the prompt action required with eNotes.

Other

Charity database approach Develop charity database approach Research Admin Team

Desk Booking System - tRUST wIDE aPPROACH

Using PDSA cycles/capturing improvements in Clinical Coding

Colour coding of Files within Shared Drive

TR11 - Patient Transport

All over the trust individual team have implemented their own desk booking systems. However, should we have a standard tool to do this ?

There is a new piece of software that has been developed by NHS England via Office 365. This is something that we should adopt.

https://support.nhs.net/knowledge-base/desk-booking-app/

Following a QIA follow up with Katie Fairhurst, she has asked for some support with capturing her teams improvements and PDSA cycles. Haydn has offered to support this work and is waiting to hear from Katie as to next steps.

Submitted via QIdeas to capture the QI request.

Patient Transport have a file within their S Drive used for administration of Specialised Transport bookings, linked with invoicing.

Each journey requires a separate folder to be created and saved. These are currently titled in a way to help identify those matter that are 'live' and requiring action, those that are 'Live' awaiting completion and outstanding Funding enquiries, which are slower time actions.

The ability to change the Folder icon colour would make management of this busy and dynamic folder that much easier.

The request supported by Line Manager [Rebecca Green] is for a program to be installed that allows Folder icons to be customised to alternative coloured folder icons. At present the feature that allows customisation of icons within Windows appears to have been deactivated, however it is not know whether this feature allows simple icon colour changes or not?

There are a number of free downloadable programs that would enable this feature to be installed on Windows based systems, but if such a program was inappropriate to be installed on Trust systems, then a more suitable alternative program would need to be sourced to afford the same customisation ability.

This simple change would afford an ability to colour code Folder icons so that the status of work tasks could be instantly recognisable, aiding workflow and workload prioritisation.

Finance

Information Services

Patient Transport

Examination of the process for new starters/ leavers

I have found we seem to spend a lot of time as managers filling out R forms, chasing up errors in staff being moved on ESR, having to duplicate work because there is poor communication between HR/Payroll/L&D/Rostering. I'm sure there is a better way to centralise this work?

As an example, my latest hire didn't have her appointment paperwork sorted properly within HR, so she's been paid from someone else's budget, it took 5 months for me to be able to view them on ESR, and I had to submit the request to add her to our roster myself. To sort the budget out I'm now having to submit a CAF, but it's not something that I should have had to do if it was sorted via the recruitment process. Surely we can make this process slicker?

Medical Physics

Patient Transport SOP Flow Charts

Our New starter, Danny Kay, has started training this week within the department. He came to the supervisors and raised that our SOP's on the system, used for his training had not been updated for a while.

He has suggested that the SOP's be updated, into flow charts, that also enable us to use them for training our extra 2 new staff members.

This will enable us as a department to improve our training programme, as well as update our SOP's into a more user friendly format for our training.

Addition to Induction Content for all staff

Medical Secretary Forum

we would like to create a way of recording information we gather for each student TNA

We continue to find that staff lack understanding of finance and procurement processes at the Trust, in particular around medical equipment. We have considered doing some Comms around this but it's such a crucial bit of knowledge I wondered if it could be considered as a project to introduce to Inductions and get some feedback on whether teams find it useful? Just an idea! Would save lots of stress and miscommunication when trying to buy things.

A forum to enable medical secretaries to have a voice and come together to highlight issues and challenges that could lead to better ways to improve pathways and processes for the benefit of patients.

Working as practice educator for Trainee Nursing associates. Currently we record clinical visits on an excel document which is not sufficient for us. We need to create either a website or different/ secure way to record information to share amongst our team in learning and development but I am not tech savy enough

Medical Physics

Learning and Development

Patient Transport

Kernowflex

Culture Improvement Ideas

for personal development

Recruitment

I think that the recruitment process at the trust should include someone who is not closely connected to the role. Not only could this help encourage staff to follow best practice for recruitment, it would help the person who would not necessarily be on the panel to gain an insight into being on 'the other side of recruitment' and provide a different perspective for the panel.

I've seen this work before at a small charity I used to work for. They used to use service users of the different services provided, such as parents who used the nursery, or those who had benefited from their temporary or supported housing. I appreciate it might be challenging to apply this model to the trust, even if incorporated with volunteering, but I'm sure it could be done if it was done at this other organisation. They used it for all recruitment levels. I found it inspiring being interviewed by a service user, as it showed the charity cared about the people who used their services, and it benefitted the service user, as they learned invaluable tools about shortlisting and being on an interview panel.

If service users are not appropriate in this context, I would suggest encouraging a pool of staff to enrol for the opportunity to take part in recruitment for roles not necessarily linked to their work. It could be part of the staff member's personal development, and provide staff who would not normally shortlist to gain the experience and perspective of being on a recruiting panel. It could help staff improve their understanding of recruitment, and hold the core panel to account.

Best practice in recruitment is there for a reason, and I think this could help encourage staff to strive towards it.

Trust Head Office

Why do staff comply? A mixed method study to determine what motivates staff to adhere to policy and standards within an acute healthcare setting.

The idea is to use data collected from hand hygiene and PPE audits to highlight compliance to policy. Following this questions will be put to a number of staff to try and determine what makes them comply to policies and standards, (or not). Using this data suggestions can be made that will hopefully be used to increase compliance and reduce hospital acquired infections.

This is for my MSc dissertation. I am looking to gain approval from the trust. I have discussed with the research dept and used their online tool. It does not come under research.

Infection&Contro l (IPAC)

PhD in Social Science - How Pandemics have impacted on society through the ages.

I would be interested in a Sociological study of how ancient civillisations up to present ones, have been impacted by Pandemics. This would be a study of how societies and communities through the ages have thrived against a backdrop of plague, famine, disease, and Pandemic - with a view to considering what history has to teach us, from Biblical times, to Homer's Iliad, and other classical literature, the plague of the middle ages to Covid.

RCHT Covid Vaccination Project

Operational Improvement Ideas

Same Day Discharge SMH

Request for Discussion/Support received direct to Sara Morgan/Sue Preston in QI Team from Naomi Burden:

'Hi Sara,

Joanna is now working on her AHP future leader project which is same day discharge for unicompartmental (partial) knee replacement and it’s really exciting!

I wondered if you might be able to add support (it’s moving fast) and it also fits to model hospital too.

Clinical Effectiveness

Patient Transport Booking Accelerator

Clinics write to patients with details of appointments with information of starttimes, and expect the patient to contact PTS if they require transport. Many of the calls PTS take are from patients who do not qualify for ambulance transport according to KCCG criteria who are then re-directed to TAP or Volunteer Cornwall car transport or taxi. Many of those who do qualify for ambulance transport have no information on how long their appointment will take, therefore PTS are unable to book transport, so the patient now has to call the clinic to get a return time, call PTS, and the booking process can re-commence. PTS is currently operating well below established staffing, calls for their services are increasing, patients and staff are inconvenienced, manual-overheads increased.

Suggestion 1. Include the KCCG leaflet explaining qualifying criteria in the appointment letter.

Suggestion 2. Add the anticipated duration of the appointment in the letter to the patient.

Patient Transport

More Weekend Physios

Could there be a more robust rota put in place for weekend cover for physios? Speaking from experience, my Nan couldn't be discharged from RCHT on Friday as no Physios were available to visit her. We were then told there is limited physio cover over the weekend, so she wouldn't be going home until Monday at the very least and until then, she is to remain in bed, no walking allowed etc.surely this is counter productive? the longer people stay in bed, the more damage it will do to strength of muscles etc?

Surely this is "bed blocking" at its finest?!

Different Type of Prescriber Hi QI Team

I have been doing some work on CLD today and have 1 more idea- sorry for lateness

A delay to discharge and a source of frustration for all is awaiting TTO’s to be written, they can’t always be done in advance due to changes on blood work on the day I think the survey which I am working on may pinpoint that TTO’s are an issue and it may be worth exploring a different type of prescriber for discharges? It may not be safe to have a prescriber coming in outside of the team to do this but worth exploring?

Patient Experience

Infection&Control (IPAC)

Patient Transport Management System

We have such difficulty with patient transport and this is not a new problem. It's NEVER on time for patient appointments and ALWAYS delayed for the return part of the patient's journey. I can't imagine that Nuclear Medicine is alone in having these difficulties with outpatients.

Certainly a look at/overhaul of their IT system is long overdue. The lost hours in waiting for patients to arrive or staff having to wait in department so that a patient is not waiting on their own, is not an effective use of clinical time.

Would it be easier for centralised areas in Tower AND Trelawney sides for Transport to drop-off and pick up? Use of a discharge-type lounge? Transport staff could have a quicker turnover and staff could collect from the centralised areas. Patients could be taken there as a drop-off point after tests are complete. Volunteers could be used for onward transport to wards/departments if clinical staff are busy?

Patient Transport

Patient TransportTaxi Booking System

In patient transport, we book all the patient taxi's, TTO, equipment, renal patients, discharges from all the hospitals etc and more.

For this we used a Taxi booking database that was linked in with A2B Taxi, where we would receive a request, and we would then transfer the details into the system. Once complete, we would submit the request and the database would generate a docket number relevant to the user. It would also then generate an email with all the information that A2B require, with the docket number, which would then be sent via email to the command centre for A2B.

Since the 365 update, we have been unable to use the system and have had to send the forms directly to A2B, causing confusion, missed taxi's and failed transport for patients being discharged.

We use another system to booked ambulance transport called Cleric, which is run on a web browser, where we can book journeys, find patient details, track crews and cancel journeys etc.

I am wondering, with the right tech savvy person, whether in a similar fashion, RCHT could run a booking system that would generate docket numbers as before, but would be browser run off the internal RCH servers. Access would be given to those who have log in details, as we do for the MPT system, Cleric system and the database system before it crashed. When using cleric, once we submit the journey details, it will generate a unique booking reference number for that patients transport, which also then appears on the controllers system to book.

If we had the browser based booking system, we could transfer the information securely from the RCH servers, and then submit the information to A2B in a uniformed, understandable format that also generates unique booking numbers relevant to that patient's journey on a specific date and time.

We could then employ a better service to our patients and staff who are under immense pressures to get patients into the appropriate beds, nursing homes or discharges home throughout the whole county.

MS TEAMS and

Results

Patient TransportOutpatient Letter Amendments Idea

Teams is a pretty powerful toolkit that could be used to make things a little easier. Is there a way to link new pathology and radiology results to it? Essentially it would ping requestors a message to say a new result is available. This would stop many sitting in front of maxims hitting refresh.

One of the Transport Co-ordinators Tracey Cass has highlighted today that a large number of car suitable patients have been calling into our office to book transport. However, we then have to signpost the patient to TAPS Volunteer car service. This has resulted in a number of frustrated patients and increased call volumes within the team. Tracey took the initiative and investigated as to why we were getting these calls.

She discovered that the outpatient letters patient's were receiving stated that if a patient required transport, they were to call our number. Usually Transport deal with non emergency ambulances, and outsource car journeys to TAPS or A2B Taxis.

She then came to the management team in Transport and explained that if we corrected the information on the letters before they were sent out, we could reduce call volumes into the office, as well as provide a more streamlined and professional service to our patients. As a result, the Outpatient Management team have been contacted to collaborate with Transport to improve the service. I believe this comes under the 15s30min initiative that the QI hub are running.

Her email is t.cass@nhs.net

No QI support is needed - but I would like to highlight that this improvement is happening.

Patient Transport

Medical Staffing

Funding for Kernowflex staff to work in a supernumerary capacity to be able to relieve substantive staff to complete training

One of the biggest barriers to staff completing their training, is insufficient staffing. Staff are exhausted and morale is low leaving many people not able/not wanting to complete their mandatory training.

My idea is to have a small budget for nurses and HCA's to cover staff in areas where their compliance is the lowest so that they can have some protected time to complete their training.

Alternatively, it could be integrated into an already existing role such as time given to Practice Educators as part of their role to cover nursing care duties to relieve colleagues .

Learning and Development

Speciality Ward Patient criteria

For base speciality wards eg Lowen for onc/haem, Roskear for cardio etc, each speciality base ward would have a clear criteria of which patients they would accept and therefore patients with those conditions are prioritised to the correct speciality wards and more general patients are outlied to general areas, eg decompensated liver cirrhosis would only be able to be sent to GLU in the same way patients on BiPaP for T2RF secondary to COPD would go to RHDU. Each speciality would be involved in generating a clear criteria list and site co would then be required to use those criteria and would not be allowed to overrule the clinical set requirements by putting less appropriate patients just to fill the beds. This may lead to initially some reduced flow but ultimately would lead to better flow by patients being moved to the correct places to get the correct clinical attention and review. Compared to current short-termist set up.

Supporting Ward Clerks with MPT's

To provide mentoring and training to Ward Clerks throughout the RCHT and CPFT to better understand the information needed on Medical Patient Transport requests to improve patient flow and providing patient transport to service users. To understand how we in Patient Transport interpret the information the ward clerks provide and how we use that to determine eligibility and to provide our service within KPI. This would involve one to one or group mentoring at Royal Cornwall hospital and then one of our experienced team members visiting ward clerks at Community hospitals to provide the mentoring required.

MPT Video Hello Team,

I’m the Service Manager for Patient Transport at RCHT, I was hoping we could work on a project in coming year.

I have some big plans for the new year in terms of developing applications and software within the team and I’m already working with Ian Nicholls on a few things. However, I’m a big believer in getting the basics right first, the electronic booking system we have in place is called MPT and that’s how the hospital staff request transport, both RCHT and CFT, staff request access and then follow the booking instructions – however often information can be left out or inaccurate –such a patients weight for example, the application team have already fine tuned it as much as possible but unfortunately it boils down to user failure.

What I was hoping is that we can create a step-by-step video of filling out an MPT correctly and a voice over explaining the steps and how to take them. This could then be shown at inductions and made available on the in intranet. I’m hoping this will reduce errors and overall provide a better patient experience and support the flow in, flow out strategy.

Please let me know if this is something you think you can help with and possibly book a meeting in.

Clinical Team

Patient Transport

Patient Transport

Alternatives to SDMA

A number of patients are referred to SDMA but don't require the SDMA service eg attending for bloods could be done by medical OP phlebotomy, eg attending for a scan which could be requested routinely as an OP scan

the focus of the project could be:

- auditing current referrals

- identifying inappropriate referrals that may be better directed to alternative pathways/services

- advertising/education directed to areas of multiple inappropriate referrals

- supporting SDMA nurses who receive the referrals to feel empowered to redirect the referrals to more appropriate service/pathway

- develop an oncology based MDU for their patients given high demand

Clinical Team

Robotic Process Automation

Can we look at a QI idea potentially using RPA, Robotic Process

data cleansing eDischarges on Maxims.

Automation for

As part of the current clearance work on the eDischarge Project, it has been identified that there are duplicated episodes held within Maxims that have had a Discharge Summary sent but not on the correct episode. Hence the records remain in Maxims as though they have not been started and distort the reported figures.

RPA could identify these records and remove them using a regular overnight data cleansing process. This would help with the data quality of Maxims (and subsequently RADAR reporting) and remove laborious manual intervention and checking by ward staff.

If we could explore this as a QI idea we could improve our clinical system quality but also data cleanse for onward transition to new IT systems in the future (EPR for example)

Quality Improvement Hub (QI)

Technology Improvement Ideas

Assett Tagging for Important original documents

Introduction of a barcode style asset tagging system that can be used to identify individual documents(or other assets) which can be attributed to a location again identified by a barcode. This system would enable multiple locations to be set and increased/amended as required.

This would permit a documents to be scanned on receipt at a location and a database style enquiry could be used to either identify a document location or confirm all documents at a specific location(stock take/audit function)

IntroPitch (NHS Recruitment App)

My idea is about offering a video pitch for either recruitment saving time on shortlisting by sifting through videos, or for sharing info with patients through video i.e. introduction for service patient might receive - intro to the doctor who will be seeing you and their expertise or some tips for post-op or pre-op preparedness but with the personal touch of seeing someone through video - bringing leaflets to life

eRIC (promoting commercial research opportunities)

App to link members of public with potential clinical trials and then providing detailed information to recruited trialists

Research

& Development

Commissioning, Performance and Intelligence

Research & Development

Patient Care Improvement Ideas

Sleep Disturbance Localised Ward improvement project - sleep disturbance Medical

Hospital Ward Walkers/

Guider

Hi, on 27/01/2022 I had to take my lap top to be fixed and on my way back through Trelawney entrance I was stopped by three different patients most of them were elderly, confused and didn't know where the department was that they needed.

One patient asked for Fracture so I walked her to Reception, another patient asked for Fibroscan which is also Outpatients by fracture and the other gentleman asked for ENT which I gave him directions.

I know that we have Receptionists, Security and no volunteers but I think we need ward walkers/guiders to be able to take elderly patients to their appointments or point them in the right direction.

I know with Covid at the moment may not be possible.

Multiple Ideas Hi QI team

I hope I’m just getting this email in on time. I have a few ideas that are new and others that are continuations of practices/processes we continue to embed and I wanted to share with you. I have been with CFT mainly for the last year so apologies if some of this has already been adopted or suggested.

• The whiteboard process (but on nervecentre)- this is something we tried to embed when we launched the safer bundle for the second time. ensuring that the clinicians identify who ideally needs to be transferred to the speciality bed, those patients that will be in longer than 24 hours, that need the specialty input and that will have a reduced length of stay if they are on that speciality war. This not only increases the standard of speciality care for patients it also improves job satisfaction and wellbeing for the nursing and medical teams. Succeeding with specialty patients being pulled into the right bed ensures the outliers are reduced, less mobility around the hospital for the teams and ensures the specialist have specialist practice. I note that the site team are leading on right place, right patient, its how we get the consultants documenting in the central area the priority of patients for transfer.

• 4 ECIST questions- we had a successful project as part of the safer bundle with the 4 ECIST questions, the successful area was Roskear (probably 3 years ago). The patient complaints reduced considerably. The 4 ECIST questions were printed and laminated on each patient table. Every afternoon a member of the team explained to the patient the update on those questions so the patient was prepared and informed- of course this would be preferable on ward round, and patients don’t always take in the information from the ward round. Repeating it in the afternoon ensures full team and patient awareness (I can share what we used if that’s helpful)

• CLD- I am meeting with Mandy Gorton next week to work on the hearts and minds of teams to embrace CLD. This will include the benefits to the patients, the team and the system if we use CLD, ensuring that its recognised CLD will not solve the current issues, however it will make it better for some patients and ensuring that specialty patients are pulled into that bed from the early discharge will be beneficial to the medical and nursing teams. A benefit I think that would be appealing is the earlier ability to review the new admission to the specialty bed (may reduce LoS) but also will ensure they are not being contacted for late afternoon reviews from patient transfer- improving productivity and possibly work/life balance.

• It may well already include it, I think adding CLD or not appropriate for CLD to the night plan would be helpful.

• The general public still may not know what’s available to them to support their family members. Every service is stretched they have been struggling for months and they have broken down. I wonder if a video that includes every option available with some patient stories including a story of how a family were able to provide care for relatives at home with volunteers, with specialist nursing in the community, with the personal payment. This could be supported by radio Cornwall and possibly the ITV west country news.

• Teams were created in ITU to provide proning and this has been successful I believe. When wards are busy, short staffed and focusing on the most acute of priorities (lifesaving treatment), the basics will be getting missed., This leads to deconditioning, reduced mobility, HAP, increased morbidity and undoubtedly increased length of stay. A roving preventing deconditioning team, may be useful/an idea to explore. We certainly need to promote the importance of preventing deconditioning, mobility, activity, mouthcare and positioning in preventing further illness and delayed recovery whilst being mindful ward teams are at their limit.

Infection&Control (IPAC)

Staffing

Knowledge SPA

The aim we have agreed is for 100% of PSR section 2 commissioned from 1st July 2022 to be signed off within 40 working days.

Fluid Restriction Labelling

To look at how we can ensure patient safety reviews are timely and meet quality standards to identify learning and improvement.

This relates to PSIRF: We are trying to see if we can be much slicker in our timeframes and also drive up quality. In terms of support, we have a bit of plan but as you know I’m really terrible at capturing everything! I think as a group we need some QI discipline and an objective voice!

Fluid restricting certain patients is a common treatment protocol however it doesn't appear to be very uniform in how patients are identified as fluid restricted. Some have it written on the board behind their bed and others have laminated sheets on the end of the bed. Whilst it's good to identify it clearly in the bed space perhaps it should be something prescribed on EPMA?

Clinical Governance

App development to calculate chest wall injury scores

Awareness Icon Magnets

Developing a simple app to calculate a chest wall injury score to reduce clinician time spent calculating. Potential link to Nerve Centre. Chest injury score can be found on page 2 of attached chest wall injury SOP.

My husband was recently in hospital and he is transgender (FtM). He was placed on the male ward (which is correct) but there was no icon/visual aid for staff members to have this awareness and therefore understanding that patients can or may feel uncomfortable, unsafe or more stressed/anxious etc.

This got me thinking about certain circumstances when it would be beneficial to have a visual icon/magnet/sticker that could attach to the backboard behind a bed. These would be a small range of icons that would only be produced/used if they have a direct link on how patients/staff interact and patients safety/wellbeing whilst in hospital with a key focus being on EDI. Not only would this improve the patient experience, but support staff in their working day and could reduce complaints.

Thinking initially these would be (sticker/magnet etc):

- Gender (transgender/non-binary etc)

- Mental Health

- Incontinency

- Disability (ranging)

These could link really well with EDI work for the Trust along with Patient Experience and help provide a better experience.

On a quick google search, I couldn't find anything similar to what I am thinking, although I'm aware that the Trust may not want a myriad of icons being used on the back boards, hence why thinking it would be limited to xyz. I'm unsure if there is such a range of magnets that are already in use.

Medical Staffing

Other

Quality Improvement Hub (QI)

Discharge Support -Going Home Bags plus patient welfare calls (FREE)

Going Home Bags provide basic nutrition items, plus volunteer follow up' Hello - how are you call (entered onto IQUVIA so wards can asccess commets.) Patients can be refered onto Inclusion Matters for 6 weeks welfare calls and practical support as appropriate. We need your help to improve awareness and take up of this service.

Overview

This initiative arose from the Covid 19 pandemic review of services which led to a member of staff developing a Discharge Basics pack (nutritional groceries plus toilet rolls) - this was renamed a ‘Going Home Bag in late 2020- to be provided as a gift to frail, elderly, vulnerable patients at the point of discharge. The wards identified the appropriate patients, and completed a request form, or simply phoned through a request. Funding was generously provided by RCHT Hospital Charity .

Experienced volunteers based at home, are provided with patient contact details of those who had been gifted a going home and make a one-off phone call. The patients who are successfully contacted are pleased (even delighted) to receive a call. For them, this contact from the hospital reinforces the care and concern that the hospital has for their patients. The Going Home Bags and follow on calls have been well received. Comments include; “it made all the difference to my discharge home” “made coming home a lot easier” “that was really good thanks, very grateful for the phone call and the pack” “the pack was really really welcome as I went home later in the day” “thank you so much for the phone call and chat”

Patients can now be referred onto Hospital Discharge Inclusion Matters officer . Their volunteers offer 6 weeks welfare support calls and can provide more practical support

Chaplains and Voluntary Services

Creation of an Order Note on Paediatrics to screen for URTI

Creation of an order set in paediatrics to ensure children presenting with an Upper respiratory tract infection get both a viral and bacterial swab ordered at same time.

They are located in different sections on MAXIMS and more often than not children have one swab and not the other, and when eg bacterial swab is negative a viral swab is also then requested causing longer admissions in hospital. Both are recommended at present due to the rise in bacterial Strep A this year and the rising prevalence of Influenza, RSV and other winter viruses in circulation.

To improve efficacy of both the service and for healthcare workers creation of an order set o Maxims would save time (following evidence based research to order both is timely.

Furthermore it would have a two fold benefit for screening for chronic respiratory patients who require both a bacterial screen on admission regardless.

Other

Tags that go in the patients' lockers and back boards to remind nurses to give back patients CDS.

We have to send back to pharmacy a lot of patients own Controlled Drugs as people always forget to give them back to patients, if we have a tag like the new blood transfer tags. We could use them as a prompt that goes in the patients' lockers and back boards to remind nurses to give back patients CDS.

Pts get there medication back and trust saves

Other

A study of extravasation in diagnostic nuclear medicine

We propose to look at the ability to detect relevant extravasation rates using a number of different methods: visual appearance/patient reported, scanning on the gamma camera and with a medical device designed specifically for this purpose. (The medical device will be loaned to us for a period of time to allow us to complete this part of the project.)

Extravasation of radiopharmaceuticals can reduce the quality of the images produced in nuclear medicine. As administrations involve very small quantities of radiopharmaceutical (<5 ml), the usual signs of extravasation are not always present. If the extravasation goes unnoticed until the time of scanning (2-3 hours after administration) and the images are deemed undiagnostic, the patient may have to return on another day.

On the other hand, extravasation can sometimes resolve in the time between administration and imaging through lymphatic clearance. In this case, if a second administration was made, this would be an unnecessary additional radiation dose to the patient.

By better understanding extravasations - frequency, type, causes and contributing factors - we hope to reduce their numbers. Additionally identifying any features which are associated with significant extravasations, i.e. those that could result in undiagnostic or misleading images, we hope to reduce the number of repeated scans or unnecessary re-administrations of radiopharmaceutical.

Patient Tracker

So, my idea is born from experience, and it is actually something I submitted in early 2019 via Improvewell. I didn't hear much back; I think it was going to a meeting - Knife to Skin? but I had no outcome. I thought I would submit again under QIdeas.

As I said, born from experience. In early 2019, my mum was diagnosed with cancer for the umpteenth time. She needed to go for an operation but as a family, we were not kept informed of what time she went in for her operation, when she was out of theatre, when she was moved to the ward, which ward etc. The staff on the ward that she was supposed to return to said they would call us (we did not mind if it was in the early hours, we just wanted to know she was ok!) but, no call came. We actually went to the hospital to find out if she was ok, only to be told she had been on the ward recovering for hours - why did we have no communication? It was very distressing as you can imagine, we knew it was tricky surgery due to past operations and there was a higher risk of mortality, but we were left not even knowing if she was alive.

I had the same experience when my husband had his wisdom teeth out. I sat in the waiting room for hours waiting for him (pre COVID times of course) with no communication. It got to the point where the shutters were being pulled down on reception and staff were leaving. Finally, at about 17:50, I was called down to recovery as they were having trouble waking him up from the general anaesthetic! Just thinking about the time and hours I spent there (almost 3!), I could have gone into town, or even home!

So, that’s the background of it. My idea is effectively the same as waiting for a pizza from Dominos. Once you place your order, you then get a little animation (picture included) which shows where your order is in the system; when the order is received, being prepped, completed cooking and is out for delivery. So why couldn't an app be developed to emulate this for patients and their families? For example:

-Patient arrives at theatre

-Patient leaves the theatre and goes to recovery (you could include a number to call for an update in the spirit of improving communication!)

-Patient arrives on ward (details given of which ward, location within the hospital, visiting times, mealtimes, numbers etc.)

-Patient ready for collection/ discharge

Thinking about my experience within the Patient and Family Experience Team here at the Trust, communication is our top theme in our complaints and our survey feedback; "communication could have been better", "I didn't know where my relative was in the hospital" and so on. Imagine a world where we do not have to answer complaints about keeping families informed - bliss!

I believe patient wristbands are scanned before drugs are provided etc – Scan4Safety?? Maybe the QR codes could link in, therefore not making extra work for our already busy staff. I’m not sure of what is already out there, whether the idea is already in the pipeline or being researched in other NHS Trusts, but I wanted to put it out there again as I believe it could improve patient, family and carer experience within the Trust, cut down the number of calls our wards receive and even improve flow out of the hospital when thinking about discharge timing. To trial it, you could use low risk areas like Oral Surgery Theatres, or any Day Case unit. And, you could call it “Pat Trac”

Experience

Next of Kin updates

Nursing staff are often spending time updating patients relatives or Next of Kin. Perhaps particularly for our elderly patients there could be a tablet at the bed with an app, when the patients obs are taken the clinical team completes some check boxes that is submitted for the next of kin to pick up and prevent them from phoning in. Perhaps some key headings with some drop downs covering:

Mood Food Sleep Pain Diagnosis

Anticipated discharge

The patients and next of kin register a number to the app for the regular updates. This would help relatives feel connected and updated and prevent nursing staff spending time on phones with relatives than with patients.

Patient

Financial Management

Staff Wellbeing Improvement Ideas

NHSE Generational Vanguard Retention Programme

I have taken over a project from an experienced lead as they were no longer able to commit to it due to unforeseen circumstances. I am in my first year on the NHS Graduate Management Training Scheme and have no project management, admin or other related skills and feel that the project won't achieve its full potential in its current form. Would there be anybody that could give me some advice on how to tackle it please? The project is the NHSE Generational Vanguard Retention Programme and looks at all stages of the career cycle. I am focusing the main attention on:

• 'welcome to the Trust' 0 -12 months: designing care group specific welcome packs, guidance for managers on welcoming and retaining staff etc

• mid-career: career coaching/advice/'itchy feet' conversations etc

• Menopause: training/awareness/policy guidance etc

• Retirement/pension/retention piece

• Full review of the exit interview process and forms, and possible implementation of an automated system.

Director

Mental Health Promotion

After moving from CFT to RCHT this year it has become increasingly apparent how out of touch staff and management are with mental health and how to recognise when someone may be suffering from mental ill-health. I feel it would be extremely valuable to roll out some training to management to enable them to recognise when their teams may be struggling and how/ when to intervene.

Mental Health First Aid training could provide all of this to a manager. Recognising when a colleague may be struggling when they don't even seeit themselves could massively benefit the trust and enable early identification of any potential issues and early support to an individual.

I have seen first hand negative comments towards mental health since joining RCHT and feel a small amount of education would benefit everyone when it comes to mental health in the workplace.

Estates Operations Staffing

Adding the restaurant weekly menu to the comms emails.

I feel that the Royal's weekly menu should be added to the comms emails that are circulated at the beginning of the week so that staff are able to plan their lunches each day.

Currently, if someone working on the outskirts of the hospital needs lunch then they have to spend most of their break walking over to the Royal to find out what the lunch options are. If they don't like any of the options, then they're out of luck!

Also, if the weekly menu was circulated at the beginning of the week, staff would be able to plan their lunch accordingly rather than not bring their lunch in one day and taking a chance that the Royal is serving something they like.

I think this would greatly benefit the morale of staff members and therefore the care and work they provide as well-fed staff are happier, more efficient, and deliver better outcomes.

HR

Trust HQ Management

Hour lunch breaks

Hi team, my idea is for staff to have an hour's lunch break instead of 30 minutes.

Even as a non clinical staff member, I often find it difficult to get/prepare and eat my lunch, relax from work pressures (and have a comfort break!) within 30 minutes. This must be even more tricky for clinical staff who may have to walk to the restaurant/staff room, queue for food and then rush back to their clinics/wards. This can't give staff the rest and recharge that they need to go back and face the rest of their busy day.

Benefits would be improved wellbeing of staff, with enough time to properly step away from work, relax, eat, drink, and revitalise. This would have a direct benefit for patient care, as staff would be more refreshed after their breaks.

Being an accountant, I recognise that this would come with practical issues to overcome - probably a huge rostering issue, and to avoid increased costs would mean that the staff members' days would be extended so that 37.5 hours (or equivalent for medical staff) are still worked - I'm guessing we can't change to a 35 hour working week because of Agenda for Change?

It may be a radical idea, but thought I'd raise it just in case we could make a difference to our staff and patients. Thanks, Alaina

Financial Management

Food Information

I recently visited St Barts Heart Centre in London with a family member who was having a procedure. I was really pleased to discover that they have the calorie count next to all food and drink options in their coffee shops and canteen (it was a long day, I visited both). This made me far more aware of my choices (ended up having an americano rather than a mocha!).

Speaking for myself, and I am sure I am not alone, I have struggled to lose the 'covid stone'. I would be amazing if we could implement this at RCHT. Having this information readily available could help us to make more informed choices. A lunch time walking group would also be fantastic!

Other

Food ordering

An app to order and pay for food from the canteen. The customer can select what they want and the time they will collect it. They can then just walk to the restaurant to collect the food and no longer lose time in the queue for ordering or paying for food. They could even give their order code to a colleague who could collect it on their behalf. This will save staff wasting break time and they can then have more time eating the food, having a walk or whatever else they want to do with their time. Wellbeing improvement to support reset and recharge.

Financial Management

Sustainability Improvement Ideas

Forehead Thermometers - Reducing Plastic Waste

Properly organised and separated Recycling Bins for all communal areas

I wish to explore changing the ear probe thermometer to forehead thermometers for use in the clinical areas. I was looking at this from the issues of reducing the plastic waste from the ear probe cover but also the cost element.

I have a presentation that I'm willing to share with you.

I have noticed that in most of the catering areas and also in student common areas, such as the library and student common rooms, lecture theatres etc (Knowledge Spa especially) that there are no clearly marked recycling bins and there is only ones for plastic and cans (what about cardboard,paper and foil?)

Most food comes in cardboard packaging or, if you bring it from home it has foil mostly so why not have all 5 bins available in all communal areas through the hospital and in different colours so it is distinctive. It is very depressing to see the overflowing general bins with cardboard, paper etc when it could be recycled. Schools have this system, why not ALL the hospital buildings?

I have asked about getting recyclable bins from our budget to Unit 4 but have received no reply when I could not find them on the cataloguesurely this is something that all departments should have and, therefore, be readily available on the Unit 4 catalogue. I know that it is not a huge priority being non-clinical but as we are working toward a net zero NHS I feel it is important to start at the basics.

Learning and Development

K/SPACWLL Health Library Services

Inhaler casingdoes it have to be plastic?

Carbon Calculator

Inhaler casing is disposed of with the used inhaler rather than being reused for the next prescription of drug. Could this casing be made from either a recyclable/recycled plastic, or an alternative such as card/bamboo?

Carbon Calculator representing Carbon saved by RCHT through converting OP aptmts to Non Face to Face. The report is available for all users within RADAR.

Team Working/Communications

Improvement Ideas

MS Teams for Junior Doctors

Currently, most juniors are members of different groups (usually cohorts) and use different tools to communicate (eg WhatsApp). The idea would be to create a single place for junior doctors to communicate. Channels could be utilized for general discussion, new ideas, calls for assistance, FAQs, etc.

Quality Improvement Hub (QI)

Information Services

Medical Staffing

TV information screens for staff areas

Roll out of TV screens in staff rooms to disseminate communication and patient safety messages, potentially live-streaming of training sessions, as well as video news and updates.

A number of screens are already in storage with CITS but there is no project management resource identified to support the roll out.

There will be a revenue cost for any necessary power and network connect, as well as installation/mounting of TV screens

Screens could carry a combined on local and corporate messaging managed to an online platform such as Screencloud, for which an annual subscription would be need.

Overall control would be through the communication team with moderated admin rights at local level.

Our recent mini survey indicated that colleagues are keen to receive more information through easy to access digital channels and this would be a part of a reset and recharge of our existing communication tools.

Communications & Engagement

Dedicated Relatives' Phone lines on the Wards

Idea submitted on behalf of Caroline Wise, Clinical Matron, Specialty Medicine.

"I have been thinking about how we can improve communication with relatives after a recent coroners inquest and I thought a dedicated line and telephone for relatives to call to get an update on their family member would be really helpful for relatives and carers.

It could be a direct line with a different phone and different ring tone with a sign over it saying

“Direct Relatives telephone – please answer”

To ensure everyone knew that it was a relative calling.

I have spoken to Patient Experience and Patient Complaints, and they feel it’s a great idea and I am very happy to try this on Roskear ward if we want to pilot this anywhere.

I am hoping for QI support to get this pilot off the ground and my general Manager – Rachel Pearce has given me the green light to pursue this.

Other

Colocation of communication and engagement team

There is considerable merit in co-locating the current functions in the communication and engagement team - media/comms, digital, graphic design, patient information - to foster creativity and the effectiveness of our internal and external communications. Work such as campaign planning and graphic design is made easier through spontaneous discussion and collaboration.

Due to the nature of our activity, onsite working is required by all members of the team for at least some of the week.

There is an opportunity to vacate space at Pendeen House (potential for 10 desk spaces) and Bedruthan House, with a preference to relocate the entire team to Pendower. We would also look to offer a base for the staff engagement team and hot-desking for the communication lead for strategic estates. In total 14 people.

This would also offer to opportunity to create a ready-to-go studio facility close to the executive team, to support our plans for increased vlogs and other video content from senior leaders, including the triumvirates. This could also be used for photography and 'green screen' visuals.

Communications & Engagement

Subtitles and BSL On Training & Mandatory Updates

I just wondered if somebody would be interested to look into the above. I have noticed with some of the mandatory training and videos, that there are no subtitles or BSL input. Being that we are all for inclusion and there are staff with hearing impairments, if this was something that could be looked into? I don't even think this is something done for the Trust Induction. Classroom learning rarely takes place, so I imagine those with impairments perhaps struggle with e-learning. Happy to discuss if anyone would like to contact me.

Further details: I have to be careful about how much I share, at this point This case is very sensitive as it resulted in a fatality and the investigation is on going.

The main issue I have currently are How to we ensure all staff including agency and k flex are kept up to date with all policy changes and safety briefs How do we improve our documentation process Is there a safety improvement that can be made too antibiotic prescribing. Can it be followed up to ensure it is reviewed and also re prescribed

Change of process

for porters to include handling patient property in extreme circumstances

I recently spoke with a preceptee, who frankly, had the night shift from hell.

She was newly qualified and Nurse in Charge of a very acute area (only qualified three months), working only with one other agency nurse. This nurse worked tirelessly to maintain the safest possible environment for her patients and the demands on her were enormous.

During this shift she discharged five patients, however, their property was dispersed throughout the hospital depending on which admissions area they came from. The patients were on EPOC but their property was as far as Eden ward- quite a trek and very time consuming. The nurse did not have the physical capacity to collect the property for the patients and she couldn't leave the other patients. She contacted the porters, but the response was 'no, porters don't handle patient property'. The nurse had no choice but to direct the patients to the property and ask them to retrieve it themselves. Having had major surgery, this is quite unacceptable, I think.

While I am sure there is a very good rationale for porters not handling patient property, could this not be reviewed considering scenarios such as this? Under unusual/emergency circumstances, could they not help with the unbearable pressures put on nurses and other staff? I do appreciate that porters are worth their weight in gold, and are also very busy, but situations such as this really require a team approach.

Could property be 'bagged and tagged' if a matter of infection control? Or if it is for the purpose of tracing property, could a confirmation phone call not be made to confirm the property has been received where it is expected? I am happy to help develop a process if you think this may be possible.

Learning and Development

Strategic Estates Project Assurance System - Smartsheet

A combination of various reports, trackers, and systems, into a single place to aid the Project Managers with the workloads, outstanding items/actions/ risks, whilst auto-generating reports for Trust Governance Boards each project reports to.

Strategic Estates

PSII Support assistance required to make safety process improvements following PSII

Corporate Nursing Dept

Other Improvement Ideas

Project management Support for revamping Corporate induction

Catheter Project

Localised Ward improvement project - sleep disturbance

Develop charity database approach

QI project - COVID & leave in psychiatry

Identification of Delirium on a surgical ward

COVID - 19 Leaflet

To use FolksLab within certain Care Group teams that have challenges to help solve issues and potential problems.

Scope of POD/PID for IFIT Quality Huddle project

QI input into EOL QI project

Support Investment request and Busicass case submission for Falls Practitioner

Venuous Access & collection trolley

Patients with spinal chord injury

Just Culture involvement

Falls sensor for side rooms

Development and validation of a Confidence Scale for Older People living with frailty: The C-ScOPe Study

Project management Support for revamping Corporate induction People & Organisational Development

Catheter Project Learning and Development

Localised Ward improvement project - sleep disturbance Medical Staffing

Develop charity database approach

QI project - COVID & leave in psychiatry

Identification of Delirium on a surgical ward

COVID - 19 Leaflet

To use FolksLab within certain Care Group teams that have challenges to help solve issues and potential problems.

Corporate Nursing Department

Medical Staffing

Medical Staffing

Medical Staffing

Information Services

Scope of POD/PID for IFIT Quality Huddle project

QI input into EOL QI project

Support Investment request and Busicass case submission for Falls Practitioner

Venuous Access & collection trolley

Patients with spinal chord injury

Just Culture involvement

Falls sensor for side rooms

RfPB Application

This research study proposes to create a measurement scale to measure confidence levels in older people. This scale will be developed and have its validity tested so it can be used in future research studies created to improve confidence in older people.

Corporate Nursing Department

End of Life Care

Corporate Nursing Department

Medical Staffing

Safeguarding Services

Clinical Effectiveness

Trust HQ Management

Corporate Nursing Dept

MSc project

This project focuses on decompensated liver disease bundle.

• KPI 1 - Antibiotic prescription in acute variceal bleeding 24 hrs either side of gastroscopy

• KPI 2 - Ascitic tap in emergency admissions with ascites.

• KPI 3 - Albumin and Antibiotic prescription in patients diagnosed with SBP within 12 hours of diagnosis.

• KPI 4 - % of acute admissions with decompensated liver disease seen by a gastroenterologist/Hepatologist within 24 hours of admission.

C-ScOPe Study

RfPB - Application

Post-PhD plan to move the 'Concept of Confidence' as experienced by older people living with frailty, to a valid and reliable measurement scale. This will enable future interventional studies to be conducted withy an effective outcome measure.

The study will use 'Classical Scale Theory' to develop the measurement scale.

Three documents attached logging different post-doc bridging award applications (unsuccessful) exploring different ideas to scale development. 'Cover Letter v0.3' most relevant now.

This concept is logged with the innovation team and there is unique intellectual property connected to its development.

Pictures and words: a photoelicitation study of the experiences of NHS nurses and midwives in their first postdoctoral year

4.1 Research questions:

• What are the lived experiences of NHS nurses and midwives who have recently been awarded a doctorate?

• How can these lived experiences and insights shape future support for doctoral graduates in line with the Chief Nursing Officer for England’s national research strategy?

4.2 Research aims:

• To describe through pictures and words the first postdoctoral year’s experiences of NHS nurses and midwives

• To understand how these experiences and insights can shape future support for doctoral graduates

4.3 Research objectives:

• To use photo-elicitation methods to gain new understanding of this experience.

• To use individual narratives to highlight common themes experienced by the participants

4.4 Research outcome:

• For individual images and narratives of post-doctoral nurses’ and midwives' experiences to expose challenges and opportunities for clinical academic working the NHS.

• For their experience to stimulate ideas and connections to the current national research strategy for nurses to be shared to influence future strategy delivery opportunities at national and local levels.

• To highlight common themes to inform future support and development needs for doctoral graduates in the NHS.

Director of Nursing Services

Cloth nappies in maternity

Produce a cloth nappy, suitable for hospital laundry processes, to use within the maternity dept.

Director of Nursing Services

Quality Improvement Hub (QI)

Post Graduate Centre

Administration Improvement Ideas

ESR Warden/ Ambassador

I believe the development and exciting opportunities that a ESR warden / ambassador will bring a wealth of benefits to all managers and staff at RCHT.

Same Day Medical Assessment

Sepsis Trolly Emergency Department

Guideline for Acute Ischaemic Stroke BP control/ target

We cannot find a RCHT protocol on how to manage blood pressure/ hypertension in the context of acute ischaemic stroke. It would be helpful to have one on the stroke section of clinical documents,

Culture Improvement Ideas

improving positioning and handling in acute stroke

As a therapy team we have noticed a reduction in stroke patients being appropriately positioned, and some poor handling techniques, impacting care and patients recovery potentially. This I feel is related to staff levels, knowledge, skills and high staff turnover.

My plan would be to audit positioning on the ward over a period of one to two months to collect data. Then to run some staff training sessions on the ward to target these areas and get feedback from staff.

plan would then be to re audit this data to measure improvements or change practice using feedback from staff.

This would potentially be a sensitive area in regard practices, staff skills/knowledge and so would appreciate only communicating via contact below.

Emergency Department

Payroll Giving Scheme

NHS

Many companies offer a Payroll Giving Scheme which would allow NHS staff members to set up a payment to a charity, pre-tax, which goes straight from their paypacket

Same Day Medical Assessment

Operational Improvement Ideas

Curtains To The Curtains

Please could you look at replacing the curtains /well mainly the hooks that attach the curtains to the rails around each bed ,where they should be able to easily pull around the bed space this is definitely not the case ,a task which should take seconds takes minutes ,which if you are seeing patients consistently through out the day ,sometimes if you are a nurse could be at least 10 times a day if not more could be nearly an hour or more on some days wasted pulling curtains and this is for one nurse on one shift ,so think of the weekly total and multiply with the number of staff you have on daily ,not only is this time consuming it is frustrating ,when there is an emergency in the bay being able to draw the curtains quickly is important ,also having to tug and pull on these curtains could cause injury to staff re shoulder injury . In this day an age surely we can find a curtain that glides along the rail easily with little effort ,well I,m sure this was a cost saving effort ,it has ended up costing the RCHT money in wasted man hours .I,m sure if you did a staff survey of things that frustrate you about the wards this would be one of the tops things, as most staff moan about this daily ,this would greatly improve working lives .This could pull us together ,draw an end to this [excuse the puns ]

Phoenix Stroke Ward

Kerensa Ward

Patient Care Improvement Ideas

Foundation Doctors knowledge of the radiology legalisation (IRMER regulations) and radiation exposure of common investigations

Junior doctors commonly request a number of radiological investigations to diagnose and treat their patients. However, such investigations expose the patients to radiation which can be potentially harmful to them in the long term. Consequently, the potential risks of the radiological investigation need to be balanced with their benefits of performing the investigation.

As such The Ionising Radiation (Medical Exposure) Regulations were developed in 2017, to enhance awareness regarding the risks of radiological investigations, in order to prevent the unnecessary scan which expose patients to unnecessary doses of radiation. However, several published studies have shown poor knowledge on these regulations and the doses of radiation patients are exposed to when undergoing common radiological investigations.

As knowledge of these regulations and the doses of radiation we are exposing patients to when requesting such investigations is important for patient's long-term health, it is necessary to improve awareness of this.

The aims of this QI project will therefore, be to firstly survey the current foundation year 1 and 2 doctors to ascertain their knowledge of the above and compare it against that of the literature. Then, if a deficit is identified, the plan will be to develop an educational initiative to embed within the postgraduate curriculum (e.g. lecture, E-learning resource). Then re-audit to see if this results in an improvement in knowledge.

Withholding nephrotoxic drugs to prevent contrast nephropathy

- Current RCHT protocol for preventing contrast induced nephropathy suggests holding nephrotoxic medications e.g. ACei/ARB/metformin/NSAIDs in 24-48hrs around contrast CT to reduce risk of contrast induced neprhopathy

- From audit this happens approx 11.1% of the time.

- Propose a checkbox tool on maxims where requestors of contrast Ct are reminded and must check that they have reviewed nephrotoxic medications prior to request.

- This should improve compliance with protocol and thus aim to reduce contrast induced nephropathy

Emergency Department

Forever FitFalls prevention

Public Health England's (2021) report 'Wider impacts of COVID-19 on physical activity, deconditioning and falls in older adults' highlighted the impact of COVID 19 on the older population, especially the populations listed below.

• who shielded

• living with multimorbidity

• living with dementia

• living in social care settings

• from more deprived backgrounds

The report highlights that deconditioning leads to falls, the consequence of which have a high impact on acute services https:// assets.publishing.service.gov.uk/government/uploads/system/uploads/ attachment_data/file/1010501/HEMT_Wider_Impacts_Falls.pdf

My idea is to give any patient over the age of 65 who attends ED (or younger if they have a pre existing medical condition that puts them at risk of falls) a booklet on falls prevention and keeping active including advice, balance improving exercises and local services, with the aim of reducing falls and admissions. Two examples of falls prevention leaflets produced by imove icare and saga. We currently offer no advice to older population that attend the ED after falls, or who have balance problems or who are socially isolated.

Emergency Department

Care of the Elderly Staff

Dietetic Service within Diabetes foot clinic set up

I'm a Specialist Diabetes Dietitian for RCHT. Our CCG has released temporary funding to support dietetic provision for the Diabetes Foot Service. This is an exciting developmental opportunity using multidisciplinary team (MDT) working to improve the lives of people with diabetes by preventing the incidence of diabetic foot ulcers and providing tailored nutritional counselling to optimise wound healing in ulcerative foot conditions. The project aims to reduce diabetes related amputations which cause profound effects on quality of life as well as significant cost implications to the NHS.

As far as I am aware no Diabetes Foot Services in the England have allocated dietetic provision. My aim is to demonstrate improved outcomes for people with diabetic foot ulcers who have timely access to a Specialist Diabetes Dietitian.

I aim to set up, deliver and evaluate the impact of the Diabetes Dietetic Foot Service with the hope that the funding will be continued after the twelvemonth project time. I intend on disseminating the project outcomes with the hope that other Trusts may be able to strengthen services through sharing good practice.

The project is very much in the early stages, and I would welcome any guidance that may be available, particularly with collating outcomes measures and patient/ public involvement. I wondered if the Research , Development and Innovation Team would be able to offer any support

Kind regards Tarna Morrison Diabetes and Acute Dietitian

Emergency Medicine Office

Training Idea Idea for Training Emergency Department

Reduction In Cannulation In The Emergen-

cy Department

We are planning to audit the use of cannulae in the emergency department, in terms of the number used as well as the indications. Through the development of a cannulation indication protocol we are hoping to reduce the use of cannulas to reduce the department's environmental impact, save money, save time and reduce pain, discomfort and complications in patients.

UET Staff

QIP IdeaFood Insecurity

Dear QI Hub team,

I am one of the new ACCS EM CT1 doctors starting in ED. I am hoping to do a QIP looking at food insecurity in the Emergency Department as it's something I'm really passionate about.

I have attached the article that I did recently for the EMJ supplement about food insecurity and I have also put together a word document which outlines my idea for a QIP. I think the 'phase 2' is a little bold but would love to try and compare the levels of food insecurity between a London and Cornish population - I think there may be more similarities than anticipated.

I have discussed with Stephanie Rennie (the Consultant ED who is in charge of QIP) who advised that you would be a good port of call to see if there is anything similar going on in the hospital or if you have any advice for how this could be effectively rolled out.

I was considering giving members of the public the questionnaire when they get their notes from reception and putting dropboxes for patients to put their answers in when they are waiting in the reception area to allow anonymity.

Emergency Department

Anaphylaxis update guidance

New NICE Guidance on anaphylaxis. Clinical effectiveness team require evidence of compliance. We would like to develop a patient leaflet and teaching tool for autoinjector, plus consensus on onward referral. This would ensure a standardised level of care and optimal patient engagement in managing a life threatening illness.

Emergency Department

Tintagel: Preventing Deconditioning, Encouraging Mobility and Ending PJ Paralysis

I have started a QI project on Tintagel ward aiming to prevent deconditioning, encourage mobility and ending PJ paralysis.

I am currently doing my first cycle of data collection measuring: a) whether the patients mobility status is visible at the bedside b) whether the appropriate mobility aid is at the bedside c) whether patients are in hospital clothing or their own clothes d) the location for their lunch e.g chair or bed.

I am doing 4 days of opportunistic data collection over the next four weeks as this hopefully measure a range of patients as movement through the ward is currently slow.

My hope for this is that once I have been able to analyse the data, I will be able to make some improvements (e.g placing whiteboard pens on the boards so mobility status can be recorded, doing some staff training/education on why encouraging mobilisation is important, family information on why ending PJ paralysis can help with their rehabilitation and bringing in own clothes may support them with discharge) in order to hopeful improve activity levels on the ward, and prevent deconditioning in our long-stay patients.

This quality improvement project has been inspired by hospital only discharge collaborative frailty and deconditioning event three. (Accessible on Youtube)

I hope that I will be able to do multiple cycles and create a meaningful change on the ward. I am required to be involved in QI as part of my training, but have chosen a topic that I am passionate about.

Updating the ACS protocol on EPMA

The current EPMA protocols are used widely by junior doctors to save time and to ensure all relevant medications are started. The ACS protocol is out of date, so does not match up with current guidelines for most ACS presentations. Andy Gale and I would like to update the protocol and add extra options depending on the type of ACS/type of patient presenting. We have spoken to pharmacists and audit lead Saira Shabli, who both agree this would be beneficial.

Emergency Department Triage Change our how we triage patients in the emergency department to a more robust, safe and efficient process

DAR Procedures

RCEM Mental Health QI

To create procedure cards and kit trays for Difficult and Rare procedures carried out in the Emergency Department. These can then be used for resus drills for teaching so senior Doctors and staff know where to find kit and how to perform the procedures.

RCEM National QI project to improve and standardise the initial assessment of patients presenting to the ED with self harm. This is RCEM's response to recommendations made by the Healthcare Safety Investigation branch. Areas of focus are triage, clinical review and risk assessment, and review by psychiatric liaison services.

The aim would be to demonstrate improvement in the care this group of patients receive, improve working relationships with the PLT, and improve patient experience.

The data to be collected has already been determined by RCEM, but we have the opportunity locally to use this data for improvement. We plan to work closely with psych liaison to take a MDT approach to improve care.

https://rcem.ac.uk/wp-content/uploads/2022/10/Mental_Health_SelfHarm_QIP_Information_Pack_2022-24_FINAL.pdf

ED EOL

Improving the confidence and competence of medical and nursing staff in providing EOL care (decision making, prescriptions and medicines administration, difficult conversations, fast track etc)

Improving environment - accessible equipment/medications/paperwork

Improving relative care - Ambient settings in relative room and in patient bedside, follow up care

Providing training for all categories of clinical staff specific to their skill set

Plan to conduct a retrospective and prospective audit (6 months for each) including patients attending ED who were discharged to the mortuary, and metrics will include: Prescription of anticipatory medications, Commencement of blue book, Use of syringe driver, Referral to CNS Palliative care, Time in department, Use of side rooms. Exclusion criteria for those who are dead on arrival, arrive with ongoing CPR and time of death < 30 mins after cessation of resuscitation, ? < 18 yrs.

Care of the Elderly Staff

UET Staff

Emergency Department

Emergency Department

Emergency Department

Emergency Department

Staff Wellbeing Improvement Ideas

Recharge and re focus After attending a stroke conference at the start of December , Phoenix ward will be looking into resets and recharge staffs energy and re focus there minds and thoughts while on a shift.

We are looking at given one of our rooms an uplift to add wellbeing along with buying an energy pod which enables staff to take a good break from the heavy work load.

Our mind and own health is the most important thing we have and we need to protect ourselves.

Sustainability Improvement Ideas

Terracycle at the RCHT

There is a company called Terracycle that spacialises in recycling items that are not acceptes by kerb-sode recycling or even many recycling centres. These include pens, razors, crisp packets, coffee pods, chocolate wrappers, and many more items. As these are not widely recycled they often end up in landfill and our oceans.

A busy DGH like the RCHT will produce alot of this non-recyclable plastic waste and I believe it would be a great step towards lessening our footprint on the environment if we adopted these services.

For example, we are often given plastic pens at conferences and other events that we never use. It would be good to have a place everyone can bring these pens to, and then get a freenpen whenever they need one at work. Once it is finished they can dispose of it in a terracycle bin provided by the RCHT.

Pen Sharing and Recycling programme in ED.

The emergency department uses more new plastic pens than any other department in the hospital. While these are relatively cheap, they do represent a steady stream of new plastic that is being used for a short period and then either leaves the department or goes in the bin and is incinerated.

In this project pens that staff members have at home/receive at conferences will be pooled in a communal box so that anybody who needs a pen can find one. Alongside this will be a collection box for empty/broken pens that will then go to the TerraCycle programme for recycling.

Other Improvement Ideas

Extra-Corporeal Shockwave Therapy for Chronic enthesopathy / tendinopathy

Awaiting CCG approval to try it but

• Used elsewhere in the NHS with good effect.

Emergency

Department

Emergency Department

• 6-12 month pilot study to see the efficacy of ESWT for chronic tendinopathy / enthesopathy with a view to allowing the treatment to be part of the options for NHS patient in Cornwall

• Machine purchased or rented through the CCG or Charitable funds (Paul Sylvester already approached)

• Treatment provided at SMH by Practitioners or maybe named Physios

• Suitable patients vetted by Practitioners within orthopaedics from ERS referrals

• If fit inclusion criteria then concurrent Physio and Podiatry input arranged.

• SOPs, clinical guidelines available from my previous Trust.

• 3 sessions of shockwave 1 week apart on consecutive weeks – plans to be put in place to cover leave etc. Specific clinic created.

• 3, 6 and 12 month PROMS (up to 5 years would be good)

• Completion of audit in line with NICE guidelines / suggestions.

Emergency Department

Trauma & Orthopaedics Treliske

Phoenix Stroke Ward

Team Working / Communications Improvement Ideas

Improving ED Discharge summaries

Everyone writes a different amount in the ED discharge summary box, and actions for GP are often unclear, and there is no standardisation, this also makes it hard for ED Consultants to identify if the right information regarding abnormal results, referrals etc have been declared.

Standardising the summary box will make it easier for GPs to identify actions required abnormal bloods and investigations, frailty fractures, medications changed or stopped/started, and referrals made or required, including clearly the diagnosis and whether any community action is required in the first place. This would hopefully help in preventing missed results and improving onward care for patients.

Emergency Department Induction

We provide an induction day for all new rotating doctors on placement in ED. Informal feedback has suggested that the induction programme is informative but doesn't always prepare the doctors for working in the department. It is a day full of mini-lectures and often information overload.

In the past year we have sought to be more innovative in our approach and design an induction programme that is practical, informative and inspiring to our newest members of the team. We have included a round-robin of practical procedures, and a scavenger hunt which have been well-received. We aim to continue to improve our programme and ensure that it is fit for purpose.

Technology Improvement Ideas

To reduce unnecessary CTPA scans, limb dopplers and anticoagulation of patients with suspected venothromboembolic disease

Venous thromboembolism (VTE) remains one of the most over investigated but under diagnosed medical conditions.

Possible changes we can make are:

1) encourage use of WELLS score to aid pre-test probability.

2) Change MAXIMS request to prompt WELLS score

3) Introduce an age related DDIMER score (more detail below).

One of the tools in the ED, following a Wells score, is the DDIMER. This test is very sensitive, meaning it is effective at ruling out VTE, but is not specific, meaning a positive result does not mean VTE is present.

A positive DDIMER will need to be followed up with some form of radiological investigation, usually a CTPA for PE, or US doppler for DVT, and the patient will require anticoagulation until that test either confirms or refutes the diagnosis False positives therefore carry an economic cost in terms of tests performed, travel for tests, and testers time, and also potential harm in terms of being unnecessarily anti-coagulated (although the time frame for this is short).

One potential change is the age adjusted DDIMER (AADD) in patients over 50. Baseline DDIMER increases with age. Therefore the number of false positives increases as patients age. NICE guidance now suggests using an AADD to help reduce false positives (once past the age of 50). Evidence suggests that AADD tests offer marginally reduced sensitivity (96% [0.94, 0.97] vs 98% [0.98, 0.99]) and marginally increased specificity (30% [0.19, 0.43] vs 14% [0.08, 0.25]) compared to unadjusted D-dimer tests, although the confidence intervals for specificity overlap. (Evidence from 13 retrospective studies with up to 48,379 participants comparing age adjusted and unadjusted D-dimer tests)

A NICE committee agreed that the small increase in false negatives is worth the larger decrease in false positives and hence subsequent anticoagulation and scans, in both DVTs and PEs. A more recent study showed that simply changing the reporting of DDIMERs to an age adjusted value reduced the number of CTs ordered by 4.4%, without any need for an education drive or other intervention.

I am working with Dr Jo Bareham on this project at the moment, and we are currently collecting data on DDIMERS ordered from the ED and whether a WELLS score was considered, and whether an age adjusted DDIMER would have been suitable.

There is scope to redesign the VTE pathway in time working with haematology, thrombosis team and respiratory team.

Emergency Department

Emergency Department

Emergency Department

Administration Improvement Ideas

Fast track referral pathway alerts on Maxims for Clinicians

When clinicians request certain vascular studies examinations via Maxims it would be useful if a pop-up alert was triggered to highlight Rapid Access referral pathways/contact details which may be more appropriate for their patients, such as the outpatient DVT Clinic or Rapid Access TIA clinics. This would:

1) Ensure patients are offered access to the most expedient imaging for their conditions

2) Reduces delays to imaging/diagnosis/treatment.

3) Allow patients to benefit access to dedicated specialist pathways which offer the best quality service in terms of diagnosis/treatment/ patient management.

4) Lead to a reduction in work for the VSU team who presently have to contact the referring consultant to inform them of the correct referral pathway.

5) Reduce the clinician's workload by accessing the correct pathway first time.

Vascular Scanning

Roster Templates after Recruitment

Currently we submit a request to recruit that is signed off at DVRG or EVRG. This includes a finance check and check on the staff in post. When a new person starts in post we have to do a Roster Template form to get them added to ERoster. This form then requires sign off at Band 8C level and finance. If it is a new post name, this then needs signing off by the Director of Nursing.

It seems that we are asking for the same checks twice. For example, we have a new starter that commenced in January and we still do not have her shits on the rota. As a Band 7 we have the responsibility for overseeing this without the authority.

Improvement for staff personal files

Currently we rely on paper files to be set up by recruitment, due to shortages in that team we only appear to get files if we ask for them, this can take a while and if we don't remember or keep track its not until the staff member moves on that we realise, we have no recruitment/appointment paperwork on the file. If the staff member moves around internally its not always easy to track the person who holds the file to request it.

Please can we look at a database for staff files, paperwork can then be uploaded directly by recruitment and the supervisor can have access to upload paperwork relating to their role. It would also be useful if we can have a tracking facility so that we can easily find where the person is located and the current supervisor. If this could be linked in someway to ESR that would be fab but i'm not sure if that's possible?

This would save admin hours, be more environmentally friendly, save space and possibly cost savings as not having to send and pay for storage?

General Surgery & Cancer

Operational Improvement Ideas

outside prescriptions

Patients to receive outside prescriptions on discharge and have designated 24 hr pharmacy for patients to use/drive through. This would prevent patients waiting for prescriptions, improve patient flow, put less stress on nursing staff and pharmacy and increase patient satisfactory.

The Cove

Pendennis Ward

Human Factors

Patient Care Improvement Ideas

I would like to look at the bank of datix events recorded in the hospital and correlate these to areas of hugh intensity working, low staffing and specific times of day.

By accessing the datix database and viewing when incidents were logged, by whom and what kind of event occurred I think it would be useful in identifying the causes and effects of human factors in our day to day roles.

I find that towards the end of the day I am catching myself almost making simple mistakes more. If this can be correlated with areas or times of high stress or staff not taking breaks e.g. decision fatigue, it will provide a strong basis of evidence to encourage interventions such as exception reporting and ensuring breaks are taken.

I believe that, being backed up by evidence, this has the potential to change how we work in the trust to reduce errors attributed to human factors and to improve patient safety.

General Surgery & Cancer

App for Vascular Access Devices

The Headland Unit have been approached by infection prevention and control about trialing a national initiative using a patient booklet to record usage/ access of their vascular access device. The booklet would be carried by the patient between home and the hospital to allow documentation to be accessible to both hospital staff and community teams. We have used different booklets for the same purpose over the years and they always fail for a variety of reasons.

My idea is to create an app for the same purpose. In the same way school apps for children have a school/pupil and parent log in - we could have a professional/patient log in to upload and record data at the point of care allowing for safer more effective care. Or perhaps this element could be added to the NHS app. During the summer we have had lots of tourists attend for complications relating to their lines - having this data to hand in an app format would make resolution of these problems more efficient. Like the scan for safety initiative this could be included with a scan of the line product when it is initially put in so can be traced back should their be any future problems.

Cancer Services

SACT Infusion Administration Alert Tag (Systemic Anti-Cancer Therapy)

A tag to identify/alert staff to administration restrictions for SACT infusion bags.

Need: This is to alert staff to not re-programme infusion pumps once SACT infusions have been commenced. The need for an alert has come from an increased number of pre fill bags being released from PTSU with a recommended volume for infusion for correct dose for the patient.

Colour: A yellow and purple tag (colour code associated with SACT/cytotoxic waste)

Text: "This pump is programmed to an infusion volume which differs from the diluent volume.

DO NOT REPROGRAMME PUMP Once pump alarms that infusion has completed, take down immediately"

Benefit: To mitigate risk of overdosing patients with SACT. Improving patient safety.

Cancer Services

Directory of medication list in the medication cupboards

It is a medication list consists of drugs in forms of capsules, tablets, injections, internal liquids, inhalers, ointments, creams and reagents. Each cupboard has its own list of medications and it is categorized accordingly in the rack where they are being stored. for example, cupboard A has all the medication tablets and capsules. Each tablets are stored in different racks and each rack has its own label like A1, A2,A3,A4 etc. if you want to find a medication , just look at the medication list posted in the medication cupboard according to the rack where it is stored. for example,

ST. MAWES - CUPBOARD E TABLETS AND CAPSULES

ALLOPURINOL 10MG TABLETS- E2 CEFALEXIN 500MG CAPSULE-E3

benefits: the medications are easy to locate saves time in doing drug rounds makes a nurse more efficient and effective minimize the risk of drug errors proper monitoring of the ward stock the medications are well organize

Comms Screen in Mermaid Centre

Mr Ian Brown has given an idea that would enhance patient experience in by having a screen in the waiting room that introduces all staff and all the great things the team at Mermaid can offer. Sarah Zee and Mr Brown would be the contacts.

MySunrise App App to provide Trust-specific information for cancer patients including pathways and embedded videos

Cancer Services

Cancer Services

Staff Wellbeing Improvement Ideas

Staff able to self refer to Occupational Health

Since the introduction of the new Occupational Health referral system, staff are no longer able to self refer. This feels a backward step and does not promote self management. It also means that Managers are required to spend time completing referral forms when it was not required previously.

Proposal to reintroduce RCHT staff to be able to self refer for support services such as counselling and DSE assessments.

The Cove

Endometriosis Champions

Sam Webb - CAL has come forward and asked if we can put Endometriosis Champions in place following being an Endometriosis Friendly Employer. Haematology Clinic

TheatresGeneral

SW Urology Area Network

Team Working/Communications Improvement Ideas

South West NHS trusts (UHP, Torbay, RDE, UHB) are attempting to form a SW Urology Area Network. Part of this will mean we have an increase of cross trust working and the creation of a investigation hub where diagnostics or treatments could be undertaken by any trusts Urologist with results going back to local Urologists. One key issue highlighted was accessibility of electronic notes and histology/imaging results depending on which organisation sees the patient. This can cause delays in patients care and receiving diagnosis and treatments. It would be helpful to explore options of an integrated system that is accessible to all organisation, perhaps this already exists?

Finance/ Procurement delivery address correlation

Goods regularly go missing or delivered to the wrong area causing delays in receiving them or having to reorder because they cannot be found. This takes a lot of time for staff to chase and also has a financial impact on the Trust budgets with duplicate orders going in and goods not being received. Perhaps the QI Hub would be able to check that all delivery and invoicing information is all up to date and correlate which may go a long way to saving money and people's time. This is a generic idea rather than something I personally want to take forward as I am not part of Finance or Procurement.

Urology Clinic

Nervecentre ward round rollout assessment

Cancer Services

Technology Improvement Ideas

Hi Catherine. I wonder if you could help out me in touch with someone in QI hub who can help to develop a feedback questionnaire for the Nerve Centre Ward round assessment piloted on Theatre Direct before it is rolled out across the trust. There are some valuable insights that our teams have gathered during the pilot which would be good to feedback to the appropriate executives. I am keen to get this up and running by the end of this week if possible. Do you have a feedback questionnaire template that I could use? Many thanks James

11th May 2021 Catherine: I advised Christiern Francis for staff questionnaires, and Jess Saunders for patient questionnaires

24th May 2021 Catherine: James asked for direct help this week. I'll talk to him to see what he is after.

Management General Surgery & Cancer

Other Improvement Ideas

Improving surgical Patient Experience Improving surgical Patient Experience

Improving Cancer Collaborative Improving Cancer Collaborative

To undertake a QIP to improve clinical skills in haematology for doctors, specialist nurses and medical students alike. (Creating a free educational website and videos)

Improvement in lymph node detection in endometrial cancer

Sharps Bin Safety (QI Guidance)

To undertake a QIP to improve clinical skills in haematology for doctors, specialist nurses and medical students alike. (Creating a free educational website and videos)

General Surgery & Cancer Services

Cancer Services

Haematology Clinic

Improvement in lymph node detection in endometrial cancer

Sharps Bin Safety (QI Guidance)

Pre optimisation Treatment Pre optimisation Treatment

Guidance for QI re idenitfying risks at handover

cornwall stoma survey

Guidance for QI re idenitfying risks at handover

Cornwall has had for many years a peer support group for people with a stoma run by themselves. Over the lockdown period it has stopped.

I am keen that we dont loose this peer to peer support- I have been meeting with a patient who may take this on but she is keen to ask patients what support they want. propsal enclosed.

I need guidance on how we can go about doing this together

Oncology Medical Staff

Surgery Medical Staff

General Surgery & Cancer Services

General Surgery & Cancer Services

Stoma Care

MSc project

Introduce a pathway/algorithm (which already exists nationally) for lower GI bleeds, to try and prevent unnecessary admissions

Endometrial Cancer Review

UK Renal Audit

IBEX Study

Surgery Clinical Nurse Specialists

TBC Cancer Services

They are looking to collect data from approximately 15 centres around the UK where they will be looking at anonymized data looking at outcomes for patients based on

- Treatments given

- Patterns of metastatic disease

- Atypical histology

This would be centres collecting their data locally and then sharing it with John to analyse.

Investigating assessment of Bone health from wrist imaging, and then expanding to other areas of the body

Cancer Services

Cancer Services

Anaesthetics, Critical Care & Theatres

Patient Care Improvement Ideas

CHRONIC MUSCULOSKELETAL PAIN TREATMENT PATHWAY

Primary aims

1 Optimise the use of consultant clinic time by reducing the demand for straightforward follow up appointments

2 Digitise outcomes data to allow analysis and drive improvement

Secondary aims

Standardise patient treatment

Standardise follow up and decision making

Gains

• With regard to “Optimise the use of consultant clinic time by reducing the demand for straightforward follow up appointments”

This policy represents a transformative change of practice because of a multiplier effect which means that for every one patient seen by a pain consultant at least two consultant follow up appointments will be avoided. The number of follow up appointments avoided beyond this is difficult to estimate as it will depend on the patient condition and response to treatment.

• With regard to “Digitise outcomes data to allow analysis and drive improvement”

Patients will move along protocolised care pathways that enable quick, robust, almost automated decision making, and the outcome data for the protocols will be collected and analysed in real time and then any areas for improvement identified and acted upon.

Ancillary gains

This policy change provides an opportunity for:

Reducing “new patient” waiting times

Reducing patient “follow up” waiting times

Providing “service-equivalence” across our consultant body

Reducing reporting bias during injection assessment

Establishing what works and doesn't work so we can streamline good care

And thus, make our service more equitable, reliable, and safe thereby improving patient experience.

Indications

Patient must have chronic musculoskeletal: 1) Lower back pain 2) Shoulder pain 3) Knee pain 4) Neck pain

Concept

Patients will move along protocolised care pathways that enable quick, robust, almost automated decision making and the outcome data for the protocols will be collected and analysed and then any areas for improvement identified and acted upon.

Before procedure

A pain consultant or extended scope physiotherapist should assess the patient All patients should be offered appropriate holistic, multidisciplinary, and multimodal care according to the generic treatment pathway prior to injection treatment

A letter template could be used to copy and paste text into Dragon which outlines the generic treatment resources available locally

Injection treatment should be booked as a day case procedure at a separate appointment

A copy of the relevant Trust patient information leaflet should be provided before the day of the procedure when available (see “Injection treatments” section on Trust website: https:// www.royalcornwall.nhs.uk/services/pain/information-for-patients/)

Patients should be booked using consistent terminology terms such as “diagnostic” or “therapeutic” injection to facilitate communication between doctors and nurses, and electronic data retrieval

After the procedure In the injection suite

Patients should be given a pain diary prior to discharge

A nurse-led telephone appointment should be booked in either 4- or 12-weeks’ time depending on whether a diagnostic or therapeutic injection has been performed

A letter template could be copy and pasted into Dragon

The nurse-led appointment can be booked by adding instructions to the administrative staff in your letter such as: “Address letter to patient, copy letter to GP and “add to K/J’s clinic list for diagnostic injections” or “add to K/J’s pending clinic list for therapeutic injections”

Follow up Nurses will conduct assessment using the “Nurse led injection procedure follow up” MSform This seeks to categorise the presence, extent and duration of any pain relief as well as record any functional improvement.

Nurses will generate a letter template recording the assessment and outcome

Not every idea suits everybody I get frustrated when patients ring and say they cannot understand how to access "I've arrived" system. Some patients only have a mobile phone to just use in emergencies and don't necessarily know how to use them in any other way. As our population in Cornwall is 25% over 65's, and those who cannot use their phones in this way, why does this application get passed as a one size fits all?

Patient Controlled Analgesia online teaching video availability for 3 yearly pump update.

Patient Controlled analgesia (PCA) is used for many patient's;

1 - following invasive surgery to help optimise pain relief 2 - as a form of analgesia if a patient is NBM, and 3 - if increased IV analgesia is required to help maintain patient dignity and comfort .

As this device allows patients to self administer strong opioid medications it is classified as a high risk medical device requiring specific knowledge and monitoring. Therefore, to be able to offer this form of analgesia nursing staff are required to complete stages of training before being assessed as 'PCA' competent allowing them to safely care for these patients.

These are:

1st stage - an online theory pack with an assessment which requires an 80% pass rate, 2nd stage - a face-to-face pump training session - with 3 yearly update sessions 3rd stage - a final competency sign off following assessment on ward.

As a team we have discussed how we could further enhance compliance within RCHT. Initial introductory face-to-face training will need to be completed by us as a team to cover any initial concerns/questions and to assess suitability. However, updates are required every 3 years and it has proven difficult to maintain these competencies due to nursing staff being released from the wards to attend this training due to short staffing issues.

This led us to think of ways to help facilitate trust compliance and improve patient safety by producing an accessible training video which nursing staff could access for their 3 yearly update only. This would be followed by a short assessment to ensure completion with the provision of a completion certificate for nursing staff evidence.

Is this something we could have assistance with to ensure this complies with all trust governance requirements please?

Technology Improvement Ideas

Benefits: make calculations safer, make calculations faster, improve communication with patient and GP, improve record in medical notes, reduce referrals to pain clinic from primary care, enhance shared care between primary care, pain clinic and addiction services.

maxims available on the work phones

Analgesia Pump Training Video

maxims to be able to be viewed on the work mobiles - being able to edit there would be helpful but viewing would make life more simple and save having to log on to a new computer in every ward thus saving time

High risk medical devices such as Patient Controlled Analgesia (PCA) and Epidural pumps require 3 yearly update training. Due to staffing issues, staff engagement and the perceived importance of the device training, compliance has fallen. Our idea is to video one of our training sessions for each and make it available to staff to view to complete their update training. Staff attending the video device update will be experienced in their use. Initial training must remain face to face. There will be a quiz to complete at the end of the video as evidence of completion.

Pain Clinic

Pain Clinic

Critical Care Unit

Pain Clinic

Psychological Support for Patients

Other Improvement Ideas

Psychological Support for Patients Pain Clinic

Idea for Staff well being Idea for Staff well being

COVID19 coinfection in bronchiolitis

Do children with bronchiolitis have greater disease severity when they are coinfected with SARS-CoV2?

A retrospective observational study of hospitalised patients.

Primary outcome measure

Disease severity: stratified by hospital LOS in days (and total duration of symptoms before discharge), requirement for PHDU/PICU admission, requirement for ventilatory support (including HiFlo nasal O2).

Secondary outcome measures

Maximum documented FiO2, hospital re-admission in following 30 days. Logistic regression analysis using end points of i.) HDU admission and ii) Requirement for advanced oxygen therapy (nasal hi flow/cpap) and incorporating independent variables of Covid-19, prematurity, immune disease, cardiac disease, resp disease, and parental smoking. (Format pending statistician discussion).

ITU - Non Clinical

Care Unit

Critical

Administration Improvement Ideas

FOLLOW PATIENT INFORMATION

SO CURRENTLY IM WORKING AS WARD CLERK

ive come up with an idea . its very simple..

Follow Patient Information F.P.I

When the patient has been inputted via pas. all the enotes or legacey folders will be on the system saving money its a one step systmem or stepping stone .there is a process to .. and its all via their C.R number or NHS ..

Staff Wellbeing Improvement Ideas

Water fountain on wards I have been on quite a few wards throughout RCHT and have noticed that neither Medical Ward 1 or Medical Ward 2 at WCH have water fountains in which to refill patient jugs and staff bottles. Having these out in will improve working environment for staff to be able to get fresh chilled water and will be beneficial to patients as the water will be chilled. It will also benefit patients who are MFFD and are gaining their independence.

Medical 1 (WCH)

Sustainability Improvement Ideas

Plant Based Milk and Palm Oil

I wondered whether the use of plant milk options for steamed milk coffees could be explored as that would make the WCH coffee pod offer more inclusive to those who don't want cows milk. Also could a supplier of sandwiches which doesn't use palm oil be investigated, as this would be a really positive step for sustainability and would sit well with what most people are trying to do at home these days.

Other Improvement Ideas

Study of surgical team communication.

My BSc. dissertation aims to explore qualitative aspects of surgical team communication in relation to safer surgery checklists.

It is intended to add to the understanding of discourse within surgical teams, and possibly suggest improvements to staff experience and enhanced team activity.

WCH - General Office

WCH - Surgical Unit

Penlee Unit

Administration Improvement Ideas

Multi skill our admin workforcd

Is there any way that when new admin staff start that we could multi-skill them on a continual basis so that in times of crisis i.e. Covid, snow etc then they can just be redeployed straight away rather than all the work that is continually having to be done. i.e. be released to do ward clerk duties if that isn't their normal role and keep updated with the relevant training, reception duties, booking etc. I know everyone says we don't have time but it should become mandatory to do this. An idea I had previously mentioned but the person has since left is that when managers come into the Trust particular those who do not have an NHS background is for them to be allocated a mentor with a manager of the same level and maybe from a different care group as that gives them an overview from a different perspective and can bring back learning/new ideas to the Care Group they are working in. All new staff should perhaps be allocated a named person in their appointment paperwork from Jobs or on the day they start as it makes them feel more valued as some inductions to their role are not great.

Patient Care Improvement Ideas

Proforma Change

We (the higher level care doctors at SMH) are currently using a proforma that we would like to change, maybe as a QI project. We have had a discussion about the things we like and dislike about it (P) and how we could improve it. We have made a mock-up of a new checklist to replace it (D).

1. Do we need to gain anyone’s approval to be using a new type of sticker/checklist in the notes?

2. Do you think this could be run as a QIP? If so, how? I can discuss it in more detail if this is something relevant to you. If not don’t worry!

Theatre Red Tie Tidy

Proposal: to make a sterile cardboard counting strip “red tie tidy” for theatres to have available in order to secure their red ties and make counting easier. Ties are secure and safe and at the time of counting, the ties are no longer tangled making it easier and quicker. The whole item can be discarded at the end of the procedure after the final counts have been completed and therefore not sent to CSSD accidentally.

SM Administration Office

Trauma & Orthopaedics St Michaels

St Michaels Theatre

RCH Internal Urgent Transfer Ambulance

Operational Improvement Ideas

A patient transport vehicle equipped to deal with the quick urgent transfer of patients (who are already in our care) with urgent care needs, where they need to be monitored and supported during transit from the RCH satellite hospitals WCH/SMH to RCHT for urgent attention. This is not an emergency ambulance nor a patient transport, this is filling in an inbetween gap that neither swast nor our regular patient tranpsort services fill and it seems needed.

The aim is to respond to the appropriate hospital to begin urgent transfer of the patient within the first hour of being called and to complete the transfer to RCHT main site within two and a half hours from being called whilst continually providing ‘as appropriate as possible’ care and monitoring ability. This should not be hard and fast timeline, but a guide in order to encourage legal and safe driving standards.

Due to the current strain on the swast services, sourcing emergency transport to RCHT is difficult.

Note: I cannot speak for WCH staffing or support availability.

SMH has no additional support past the nurses and hcas on shift and the RMO, yet has Trauma patients, Elective orthopedic patients and neuro rehab patients. The services needed by patients in declining health are simply not at SMH, and i believe to an extent, not at WCH. So when patients health declines such that they need to be sent to main RCHT, we have no furthur support available and regular patient transport is not suitable as the staff are not medically trained or equipped and so would not take them anyway. Waiting up to fourteen hours for an ambulance means the patient declines furthur.h

This Urgent Transport Ambulance enables the satellite hospitals to get the patient to RCHT as quickly and safely as possible, without comprimising care and without waiting protracted periods for an ambulance and being a strain on the already stretched swast services, whilst the patients health declines.

There have been several (that i am aware of, so there are likely more) patients recently that have been in need of urgent transfer from SMH to RCHT. Regular patient transport is unsuitable and therefore wont and cant take them. Often, swast 999 resources have been unavailable and they have not shown up for upto 14hrs, due to them grading the patient as lower priority due to being in a hospital setting. Despite that current hospital setting being highly inappropriate for their current care needs.

The patient is then not recieving the necessary and appropriate treatment and care they deserve and that we strive to give and often declines. Therefore the trust is failing them in delivery of service.

Rcht could speak with swast about procuring a former patient transport vehicle or small ambulance, perhaps at discount or loan. Equipping the vehicle would be a discussion to be had by more knowledgable staff.

Staffed with either:

1)1 experienced nurse, 1 experienced hca, 1 nonclinical staff member as driver.

2)2 experienced nurses, 1 experienced hca as driver.

Two staff with the patient is to ensure highest possible care with their complimentary skillsets throughout the journey.

Staff are trained as deemed appropriate/necessary. They are not paramedic trained but can recieve furthur releavant training from what they already have if deemed needed. (HCAs possibly trained to swast ECA level achieving same qualifications/ skills).

Not necessarily a bluelight emergency vehicle, would require extra training for the driver(s). This training is attainable if deemed needed.

The vehicle could be staffed in cooperation between SMH and WCH with each site taking its turn to staff and maintain the vehicle. The reason why the vehicle should NOT be stationed at RCHT is to eliminate the unnecessary travel time from truro to either hayle or penzance. This is minimalised by siting the vehicle at WCH/SMH already. Also, RCH have no need for this vehicle themselves.

St Josephs Ward