Tourniquets: tightening the grip on quality. Rachelle Alty

Transcription

1 Tourniquets: tightening the grip on quality Rachelle Alty

2 Small Changes, Big Impact What is change? Carnall (2007) describes change as a series of steps from a vision to an implementation. (Carnall, 2007: 63) NHS Institute for innovation and improvement (2009) identify; * 70% of change programs fail * 70% of those that fail do so because cultural barriers impede successful implementation (NHS, 2009) Why is it important to change? Change is a fundamental component of continuous quality Improvement (NHS Modernisation Agency, 2005) By identifying ways to change practice, as professionals we are providing a high standard of practice and care to our patients, thus fulfilling our professional duty to our profession. (NMC, 2009)

3 Presentation Overview Small change A pilot study was undertaken by a 3 rd year student nurse to implement the use of disposable tourniquets The study was performed within the community setting, where 4 district nurses would use a variety of disposable tourniquets for a 2 week period The tourniquets were used to perform the venepuncture procedure on patients who used community services 20 patients were involved in the study, all of which were elderly and house bound

4 Improvement opportunity How was the clinical need identified? Stored: tourniquets were stored in the back of cars along with a dog blanket or in the nurses pocket alongside their used tissues Used: this clinical piece of equipment was used on several clients, but how was the reusable tourniquet to be decontaminated between use? Attitude: after use tourniquet s were disregarded with as much disregard as a pen or any other object with no clinical significance Hygiene: Alcohol Gel was a more dominant form of decontamination rather than soap and water. This poses a problem as alcohol gel can only be used up to 8 times consecutively until it becomes ineffective. (Local Trust Policy, 2007)

5 Lets talk dirty With all these factors in mind, my concerns were directed towards the risk of patience acquiring a healthcare associated infection (HAI) The National Audit Office published a reported on HAI in February 2000, declaring that these infections may be responsible for 5,000 deaths per year (DOH, 2005) Around 320,000 HAI occur every year * Costing the NHS an estimated 1 billion annually * About a third of these infections could probably have been prevented. (NICE, 2003) The Health and Social Care Act 2008 is a piece of legislation which aims to reduce the number of healthcare associated infections within a variety of NHS settings to benefit service users (section 21) (DOH, 2010)

6 Patient Perspective I wonder if the nurse has washed her hands? But who am I to doubt the professionals The doctor works so hard and seems very busy I wont bother her with my silly questions Many clients within the community wouldn t question the procedure being performed Some felt embarrassed to ask the nurse to communicate at a level that they can understand As the workload of the nurse increased the amount of time with the client decreased

7 Patient s Perspective We look but do we see? We hear but do we listen? Oh I do hope the doctor comes back soon, there were so many questions I forgot to ask him I just want someone to talk to Within the community, district nurses would mostly visit house bound, elderly adults On occasions this could be the only social contact the individual would have This client group, many of which suffer with poor hearing, vision and mobility and therefore heavily depend on healthcare professionals for support

8 Improvement tool The PDSA cycle allows for safe and effective testing of new change ideas on a small scale before implementing them across the board. (NHS Institution for Innovation and Improvement, 2008) As the cycle breaks the change process in to 4 components so it is easy to identify at what point, any problems occur. The changes brought about by the cycle are immediate which stimulates more enthusiasm especially during the do phase, thus promoting positive working relationships amongst those involved. (NHS QIS, 2009)

9 The outcome The results from the studyshowed; The InterVene sample was the most preferred tourniquet amongst service users as, * It provided the most comfort and appeared the most professional. All 4 nurses identified InterVene as * The easiest disposable tourniquet to use within the trail All of the nurses stated * They preferred the InterVene disposable tourniquet to their reusable tourniquet * And would be happy to use this make of tourniquet in their future practice The nurses preferred this sample as it was similar to their reusable tourniquet previously use

10 The Outcome cont The InterVene sample received favourably comments by staff on; * The individual wrapping that kept the sample hygienic prior to use * They believed this sample was the only true disposable tourniquet due to the locking clasp The Vene-K and Tournistrip samples were also a popular choice of amongst the 4 nurses however, some service users commented negatively upon their appearance and comfort. The majority of staff found the BD, Medisavers and Lesmar Pharma samples difficult to fastening they became slack thus not providing adequate circulatory restriction.

11 What happened next? Conclusion: After the pilot study the Intervene disposable tourniquet was not adopted by the district nursing team despite the positive response from both staff and patients On reflection I now identify there was a large cultural barrier impeding the successful implementation of this change Some nurses adopted the attitude, If its not broken why fix it? response Whilst others wouldn t dare to part with their lucky tourniquet So If one small change cannot be brought about, how can we bring forth big changes?

12 Small change, big impact? Maybe it is achieved through personal reflection? Due to this study I now realise, Working together to achieve a common goal can improve professional relationships amongst staff This study has enabled me to analyse my own practice and to question how things can be changed for the better Everyone can bring about change and identify ways to improve practice I now have the knowledge to turn an idea into an implemented change Finally To tighten the grip on quality we must remember The Smallest of changes can have a greatest impact on the quality of care our patients receive

13 End of presentation If you want to truly understand something try to change it (Kurt Lewin) You must be the change you wish to see in the world (Mahatma Gandhi) Thank you for your attention

14 Carnall, C. (2007) Managing Change in Organizations 5th Ed. Prentice Hall. Gosport References Carnall, C. (2007) Managing Change in Organizations 5th Ed. Prentice Hall. Gosport Department of Health (2005) Reducing Health Care Associated Infections gitalasset/dh_ pdf [7 June 2010] Department of Health (2010) The Health and Social Care Act 2008: Consultation on a Code of Practice for healthcare, including primary care, and adult social care on the prevention and control of infections and related guidance. [Gateway Ref: 13879] d 6 June 2010] Local Trust (2007) Hand Washing Policy Identification no: 5 e/024_hand%20washing%20policy.pdf [accessed 7 June 2010

15 References National Institute of Clinical Evidence (2003) Clinical guideline on community infection control [accessed 7 June 2010] NHS Institute for innovation and improvement (2009) Inspiring Change in the NHS: Introducing the five frames %20NHS.pdf [accessed 10 June 2010] NHS Modernisation Agency (2005) Improvement Leaders Guide to: Process Mapping, analysis and redesign Crown. Ipswich. Nursing & Midwifery Council (2009) The code in full [accessed 1 June 2010]

16 References NHS Improvement (2008) Change ideas and PDSA Cycles es/pdsa.html [accessed 7 June 2010] NHS Quality Improvement Scotland (2009) The plan, do, study, act cycle (PDSA Cycle). from=/model-forimprovement [accessed 7 June 2010]