Collaborative quality improvement research model

Transcription

1 Collaborative quality improvement research model Building Capacity for Research & Service improvement: A collaborative model to build research support, networks and infrastructure to enable nursing leaders to lead clinically relevant research Dr Amanda Roberts Healthcare Researcher Authors: Roberts, A., Kavanagh, F., Korn, B., Prendergast, M., Brady, A-M., Daly, H., Ennis, S., Gallagher, P., Hughes, C., O Grady, J., O Mahony, N., Prizeman, G., Roberts, A. and Quirke, M. NMPDU Conference 15 th September 2016

2 Trinity College Dublin, The University of Dublin

3 Start with us... Trinity Centre for Practice and Healthcare Innovation Trinity College Dublin, The University of Dublin

4 TCPHI: Collaborative research agenda Develop structures & supports to enhance research capacity of the clinicallybased nursing staff Enhance professional nursing practice and healthcare by promoting quality research projects, related to clinical practice, education and management Develop research opportunities, within nursing, health care and nurse-led inter-disciplinary research and source funding for same Identify and form collaborative links between clinical & academic staff for the purpose of conducting collaborative research Trinity College Dublin, The University of Dublin

5 The collaborative quality improvement research model TCD Collaborative partner TCPHI Healthcare researcher Hospitalbased nurse Hospital Steering Group This model aims to support, develop and enhance research activity of hospital-based nursing staff. Trinity College Dublin, The University of Dublin

6 How the model works Trinity College Dublin, The University of Dublin

7 What can TCPHI do for you We can support you to: Define and plan research ideas Plan & implement research projects Analyze & interpret data Co-author conference submissions, reports and peer-reviewed publications Trinity College Dublin, The University of Dublin

8 Current collaborative research model locations Trinity College Dublin, The University of Dublin

9 Activity to date... Nursing disciplines involved in project to date: Accident & Emergency Audiology Cardiology Children s general Critical Care Outreach End-of-life/palliative care Epilepsy (Adult) Epilepsy (Paediatric) Medicine for the elderly Neurology (epilepsy care) Nurse practice development/ clinical placement Oncology Outpatients Pain management Renal care Respiratory Stroke Vascular care Trinity College Dublin, The University of Dublin

10 Activity to date... Measurable Outcomes Active projects 30 Number of TCD academics currently engaged in active projects Number of nurses academics currently engaged in active projects Completed projects 24 Conference posters 21 Conference presentations 20 Peer- reviewed journal articles 10 Non-peer reviewed article 3 Papers (Draft stage) 7 Msc/PhD (registering/registered/in pursuit) 6 Trinity College Dublin, The University of Dublin

11 Activity to date... The collaborative model was shortlisted as a finalist for the Irish Healthcare Awards in the Large/Teaching Hospital Department Initiative of the Year (2014) A project was highly commended at the Quality in Care Excellence in Oncology Awards 2013 and shortlisted as a finalist for the Irish Healthcare Awards. Examples of funding sources for projects to date include: NMPDU, The Irish Hospice Foundation, The Royal City of Dublin Hospital Trust, Vodafone, The Meath Foundation, The Adelaide Society. Trinity College Dublin, The University of Dublin

12 Cross institutional research opportunities Dublin Midlands Group Nutrition & Hydration Initiative Group underway & proposal being advanced Implementation and evaluation of sepsis guidelines Scoping underway with lead for sepsis Dublin Midlands Group in conjunction with three hospitals Trinity College Dublin, The University of Dublin

13 TCPHI Contact details Anne-Marie Brady (Director TCPHI) Healthcare Researchers: Geraldine Prizeman (TCPHI/SJH Hospital) Mary Quirke (TCPHI/Tallaght Hospital) Amanda Roberts (TCPHI/NGH Hospital) Posts are currently funded by Baggot Street (The Royal City of Dublin Hospital Trust), NMPDU, The Meath Foundation. Trinity College Dublin, The University of Dublin

14 Collaborative research model presenters Ms Bettina Korn End-of-life-VOICES Project: A service evaluation and quality assurance study to evaluate bereaved relatives perspective on the quality of hospitals end of life care for patients and their relatives/ friends. Ms Fiona Kavanagh COPD Re-admission Project: Review of 30-day all-cause unplanned readmissions for COPD following an initial unplanned admission for treatment of a COPD exacerbation Ms Meabh Prendergast Out of Hours Project: Evaluate the organisational supports for clinical decision-making Out-of-hours (OOH) in the medical and surgical care settings within Tallaght Hospital Trinity College Dublin, The University of Dublin

15 Bettina Korn End-of-Life Care Coordinator, St. James s Hospital, Dublin bkorn@stjames.ie Ph:

16 End-of-life care is underpinned by:

17 Research study: Dying in acute hospitals care experiences from the perspective of bereaved relatives

18 Research project Setting: 2 large academic adult teaching hospitals MaJam (Mater & James s Hospital) Dual purpose: Survey bereaved relatives quality improvement Test the methodology Survey relatives of patients: Died in our care between 1 st August st January months from the time of death Questionnaire: Adapted from VOICES NHS England 39 questions including 3 opened questions, posting in 3 waves Data Analysis: Quantitative & qualitative findings SPSS & Nvivo software used Response Rate: 46% 4

19 Quality of care during last admission 88% rated the overall quality of care as outstanding, excellent or good; 12% (1 in 8) rated care as fair or poor

20 Benefits of working with health care researcher Structure Solid research expertise Academic network Broad research experience Access to academic journals Access to data analysis software Data collection structure Data analysis Report writing/editing Journal articles Relationship Research discourse Keeping on track Solution focussed Delivery Shared passion & company Benefits from investment in project Different background = widens perspective Reciprocal both benefit

21 What's next? 1. Launch of VOICES MaJam report 2. Further data sub analysis 3. Prepare journal articles 4. Develop survey tool kit for dissemination

22 VOICES MaJam Team Mr. Diarmuid Ó Coimín Ms. Bettina Korn Ms Mairead Curran Ms Margaret Codd Ms Geraldine Prizeman Dr. Sarah Donnelly Acknowledgements Prof. Geralyn Hynes Prof. Tony Fahey We sincerely thank all relatives who responded and

23 Building capacity for research and service improvement: A collaborative model to build research support, networks and infrastructure to enable nurse leaders to lead clinical relevant research in Naas General Hospital (NGH) Kavanagh espiratory, Naas General Hospital avanagh1@hse.ie

24 Research Idea Review of 30-day all-cause unplanned readmissions for COPD following an initial unplanned admission for treatment of a COPD exacerbation

25 Respiratory Department in NGH Staffing The CNS role in NGH Adult Respiratory Services

26 Planning Identifying our sample Identifying Steering Group members Ethics committee Funding application Development of tool edelphi Survey

27 What we hope to achieve? The study objectives Identify a set of measures for a retrospective review Undertake a retrospective review of the records of patients Develop recommendations for a care bundle Make recommendations for a set of standards Us Learning how to conduct research (e.g. framing a research question, planning projects, research methods, disseminating the findings) Confidence to undertake further research

28 A Nurse s Experience of Research Collaboration MEABH PRENDERGAST RGN, BSC (CUR.), PGDIP LIPID NURSE MANAGER, TALLAGHT HOSPITAL & MSC CANDIDATE SCHOOL OF NURSING & MIDWIFERY, TRINITY COLLEGE DUBLIN 1

29 TCPHI & Tallaght Hospital Quality Improvement Project 2 My Background Qualified BSc (Cur.) School of Nursing & Midwifery, Trinity College Dublin, 2008 Working as Staff Nurse in Tallaght Hospital since graduation on Renal Ward and Adult Out-Patient Department Completed Post Graduate Diploma in Specialist Lymphoedema Management, University of Glasgow 2014 Strong interest in Research and Quality Improvement but unsure how to progress this interest

30 TCPHI & Tallaght Hospital Quality Improvement Project 3 ject Background part of continued efforts to improve patient care, Tallaght Hospital wishe examine new approaches to work design in the Out of Hours period (aft m and weekends) lobally the out-of-hours service period has reported an association with le vourable patient outcomes & unpredictable workloads. Evidence, both searched and anecdotal, would suggest that there are often limited pport structures for nursing and medical staff during this time.

31 TCPHI & Tallaght Hospital Quality Improvement Project 4 ject Background irst needed a baseline understanding of how the hospital works out-of- by TCPHI & NPDD and ours arly project proposal was developed ubmitted to a funding call from the Meath Quality Improvement Fund upported by a Hospital at Night Steering Group included senior linicians and nursing management, TCPHI research lead and NCHD Lea

32 TCPHI & Tallaght Hospital Quality Improvement Project 5 ject Background he Project was awarded QI funding ssistant and the team required a Research PDD knew of my interest in research and encouraged me to apply for th ost as offered post as Research Assistant and supported in this by CNMs an DON & was seconded to TCPHI for 19.5 hrs. per week

33 TCPHI & Tallaght Hospital Quality Improvement Project 6 Aim We aimed to evaluate the organisational supports for clinical decision-making during the Out-of-Hours (OOH) period in the medical and surgical care settings within the Hospital.

34 TCPHI & Tallaght Hospital Quality Improvement Project 7 bjectives A baseline understanding of call arrangements, hospital activity and supports for clinical decision-making Insight into the organization and work flow arrangements between nursin and medical staff Understanding of how nurse and doctors communicate and make clinic decisions Understanding of the facilitators, challenges and barriers to effective wo flow and clinical decision-making

35 TCPHI & Tallaght Hospital Quality Improvement Project 8 rdisciplinary Working Model roject team worked closely with NCHD Lead and Nurse Management e recruited two Intern-level NCHDs as Champions they provided aluable access to NCHDs for data collection o ward pilot sites (1 medical 1 surgical ) were included as a presentation of medical and surgical activity in the hospital. e were supported to collect data by the staff, nurse managers and DONs for these areas

36 TCPHI & Tallaght Hospital Quality Improvement Project 9 dy Design ixed-methods Approach Quantitative data on nursing and medical activity was collected using a mobile app and ward based tools Hospital activity levels measured and analysed through use of HIPE Electronic questionnaires sent to hospital departments using Survey Monkey Qualitative data was collected throughh focus groups with Staff Nurses and Interns Individual interviews conducted with Nurse Managers, ADONs, Nurse Specialists and Registrars

37 TCPHI & Tallaght Hospital Quality Improvement Project 10 y Design & Findings e also needed to describe the work processes surrounding the functioning of e hospital itself and key stakeholders involved large amount of descriptive, qualitative and quantitative data was collected nd analysed by the research team ata collection finished in May 2016 ndings have been drafted to a report for the Steering Group which is currently nder review reliminary findings point towards a number of potentially very useful quality provement projects within the hospital

38 TCPHI & Tallaght Hospital Quality Improvement Project 11 itive Outcomes he experience of working with a group of expert Researchers from the TCPHI wh ave a keen interest in Quality Improvement has been invaluable. he experience has challenged me personally and professionally to think more ritically and continue to ask the why? have gained valuable exposure to the mechanics of the Research Process orking with nursing and medical colleagues to achieve a common aim has be n excellent experience, allowed for mutual understanding of our roles and hallenges we each face

39 TCPHI & Tallaght Hospital Quality Improvement Project 12 sitive Outcomes Possibility of developing new QI projects within the Hospital in collaborati with TCPHI Currently completing an MSc Research in TCD Action Research thesis based on this project Paper accepted to 17th Healthcaree Interdisciplinary Research Conferenc at the School of Nursing & Midwifery in November Many more opportunities for further dissemination through publication

40 Conclusion 13 t whoever is in charge keep this simple question in her head (not, how n I always do this right thing myself, but) how can I provide for this right g to be always done? Florence Nightingale ould encourage you to consider new ways in which you and your anisation can support your nursing staff to become involved with the PHI to further develop quality research with excellent academic support nk-you