Poster Group E - QI in Progress - BPSC2023

Improving mouth care standards within our physical health, mental health & learning disabilities inpatient areas

Sylvia Jellyman and Julie Lerigo

Background

During the delivery of the Care Certificate we identified variations and inconsistencies with the mouth care practice within our inpatient areas, combined with the use of non-standard equipment leading to a lack of assurance about the standards of mouth care practice and the quality of care our patients expect.

PDSA cycles

ü Produced mouth care policy with action cards

ü Standardised Mouth care equipment

ü Developed admission and weekly mouth care assessments

• Roll out mouth care to all inpatient areas in progress.

ü Devised and rolled out training

ü Created mouth care champion roles

ü Developed clinical competency

ü Developed electronic patient records oral assessments for both physical health and mental health systems

ü Product information sourced from Mouth Care Matters and other NHS Trusts

ü Attended MCM training.

Our SMART aim

To improve the quality of mouth care for our inpatients, reducing variation and using current recommended products across selected sites by 29 September 2023.

Measurement

ü Positive staff feedback about training and products used

ü Positive knowledge improvement from questionnaires

ü Amended eLearning

ü Yellow resource folders for all inpatient areas

ü Intranet page created

Lessons learnt

x

ü Staff able to recognise an unhealthy mouth

ü Weekly audits showed varying levels of compliance and engagement

ü Many patients do not have a dentist

ü Feedback collated from trialling equipment and implemented

ü A3 poster of what equipment to use and when.

ü Yellow lanyards for champions

ü Both Reg/Non-Reg staff to complete weekly assessment

ü Pause, observe, understand

• Dental referral pathway

ü Product guide produced

• Removal of pink foam sponges

Next steps

• Continuous encouragement and reminders to ensure staff complete the mouth care admission and weekly assessments to implement and imbed the process so it becomes "the norm"

• Empowering people along our mouth care journey to see parity of esteem

• The importance of networking with other NHS trusts and organisations sharing practices and supporting each other

• To continue the motivational drive by engaging with all inpatient areas especially within mental health enabling the project to fully roll out

• To begin rolling the project out within our community setting

• To review and update the Adult inpatient mouth care policy making it relevant to all areas including community

Quality Improvement Project For Patient

Discharges at 3pm

Dr Muntasha Quddus – FY1

Introduction

Earlier discharges are safer for patients, especially in the elderly population. The Leeds Teaching Hospitals Trust’s discharge collaborative team have set 3pm as the deadline for when patients should ideally be discharged by. This way patients can be home in daylight, with any support needed and they can eat and sleep at home. It also improves the flow of beds in the hospital, further improving patient care. Overall earlier discharges can help both patient care and safety and with the curre nt pressures in the NHS it is imperative we do all we can to manage the increased demands safely.

After discussion with fellow junior doctors and the discharge co-ordinators it was identified that the limiting factor to timely discharges is completing the discharge medication prescription (eMeds) on our electronic discharge advice note (eDAN). Only once this has been completed by medics can the pharmacist access it, check it and dispense the medication. Therefore I wanted this project to tackle this issue and to investigate how we could ensure that the eMeds can be done in a timely manner for patients who are or are approaching a medically optimised for discharge (MOFD) status.

Aim

Increase patient discharges by 3pm to 80% in J14, an elderly medicine ward, over 3 months.

Cycle 1

Study

Act

• Trying to get the discharge medications prescription completed as soon as possible

• Therefore allowing time for pharmacists to check and dispense the medication

• Up to 45% of discharges took place before 3pm .

Do

Reflections and further plans

• At the beginning of MDT we would always identify the MOFD or approaching MOFD patients so we could prioritise they discharge prescription.

• Within a month 45% of the patients were discharged by 3pm

• This was only slightly above the trust average as highlighted on Fig 1

• Even though we had limited data it was quickly identified that we needed a better way to keep track of patients who could have their eMeds completed.

Plan

• Identify patients during are MDT either approaching MOFD or those who are MOFD

• Unlikely their medications will change so trying to prioritise their discharge medication prescriptions

• Making a mental note of those patient who are MOFD or approaching MOFD and completing their discharge medication prescriptions.

• Usings the trusts bi-weekly data sets to assess progress

Act

• Need a more permanent way to address which patients can have their discharge medications completed.

Study

• In the second month 82% of our discharges were before 3pm!

Cycle 2

Plan

• Identify during MDT which patients were MOFD and would not have changes to their medication

• Adding an extra eMeds box to the ward discharge board

• Ticking off this box when the discharge medication prescription has been completed

Do

• Allocation a team member to complete the discharge board (Fig 2).

• Ensuring this is ticked off once completed so other doctors are aware which one are completed and which one still need to be done

Reflections and further plans

• The ward already had a discharge board, so I decided to add an eMeds box that could be seen by all to remind us to prioritise the discharge prescription ( Fig 2).

• This was a quick, cheap and easy intervention without making MDT any longer.

• My team also made a real effort to keep that board up to date by allocating someone to complete it during MDT.

• This paid off as 82% of our discharges were before 3pm in the second month (Fig 3).

• However, in the next month 68% of our discharges were before 3pm

• The discharge board had been effective but more needed to be done

• For the next cycle I will investigate individual patients who were discharged after 3pm to identify why that may have happened and use that data to develop a new plan to tackle those issues.

Fig 1. Cycle 1 - J14 Discharge Data

Fig 2. J14 Discharge board

Fig 3. Cycle 2 – J14 Discharge Data

Reducing Time Taken to Gather Equipment for Venepuncture and Cannulation

1) Understanding the Problem & Setting our Aim​

• Timely and efficient gathering of equipment for basic procedures including venepuncture and cannulation is critical for doctors and other healthcare professionals, particularly when on - call, during emergencies and on unfamiliar wards.

• At our hospital, the Royal Devon & Exeter (RD&E), we have had frustrating experiences trying to find equipment in a timely manner (figure 1).

• We performed a root cause analysis to understand the reasons for the excessive time taken and hoped to rectify the situation (figure 2).

• We aimed to reduce the time taken to gather equipment for venepuncture or cannulation to twenty seconds by June 2023.

(1) You go to the blood trolley:

SCENARIO:

You are the overnight F1 on call at a cardiac arrest. You need to urgently get bloods.

(2) You open the blood trolley:

(3) You go to the storeroom:

4) Learning points

• Implementing changes can be challenging due to human factors; such as resistance of staff to change. This highlighted to us the importance of stakeholder involvement and ensuring recruitment of the "early adopters."

• Starting with a small change and assessing its effectiveness before expanding on a larger scale ensures sustainability and high motivation by valuing "small wins" (Weick, 1984).

5) Next Steps

• Establish sustainable method of stocking trollies by involving stakeholders and early adopters on the ward, including the clinical matron.

• Educate staff on presence of trollies and encourage engagement and maintenance.

• Put up clear signage to try and encourage visitors to the ward to use the trolley.

• Expand to acute wards hospital - wide

(5) And blood bags are in the sluice!

(4) To get more butterflies:

2) Setting up measurements

• A suitable ward was identified – a surgical ward which has a preexisting stock trolley to provide a good base for improvement.

• Across several days, medical students and other volunteers were observed and timed collecting equipment for both venepuncture and cannulation using the existing set - up.

• Photos of current stock were taken and subjective feedback gathered.

"This is rubbish"

"I can't find anything – it is useless!"

Two quotes from a surgical F1 doctor.

3) Implementing Changes

• We created a driver diagram to try and understand what factors may lead to an improvement (figure 3).

• This informed each part of the Plan - Do- Study- Act (PDSA) cycles (figure 4) and implementation of a new trolley layout (figure 6).

• Results showed median time for equipment collection was reduced from 141 seconds pre - intervention to 18 seconds post - intervention for venepuncture (figure 5) and 137.5 seconds to 18 seconds for cannulation.

with support of the transformation teams, divisional cluster managers and clinical matrons.

Dr Luke Glover, Dr Luna Nedic, Dr William Cuthbert, Dr Rebecca Myers, Dr Ryan Smith, Dr William Butterfield Royal Devon University Healthcare NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW

Figure 2: a root cause analysis identifying reasons and systems factors behind excessive time taken for equipment gathering.

Figure 1: a pictorial process diagram showing the (frustrating) process of gathering equipment for venepuncture and cannulation.

Figure 4: graphical representation of three PDSA cycles as we worked towards achieving our aim. Cycle 1 included measurements and initial data collection to target our intervention. Cycle 2 included creating the new trolley, labels and measuring the effect. Cycle 3 included ongoing strategies to support restocking of the trolley.

Figure 5: bar chart illustrating the improvement in time taken to gather equipment for venepuncture from 141 seconds pre-intervention down to 18

post-intervention.

Figure 6: a photograph of the redesigned cannulation/ven epuncture trolley, with standardised layout, clear labels and optimised workflow for speed of equipment gathering.

Figure 3: a driver diagram exploring primary, secondary drivers and ideas for intervention. Blue = in

Quality improvement of information provision to Foundation

Doctors in preparation for new rotations within Oxford University Hospitals NHS Foundation Trust

Background:

A high-quality induction is key for safe trainee changeover and maintained quality of patient care 1. We carried out a survey on 05/09/2022 and asked current Oxford University Hospitals (OUH) NHS Foundation Trust Foundation Doctors:

1. How well prepared did you feel for your latest OUH rotation?

2. How strongly do you agree that you were provided with enough information to be well prepared for your latest OUH rotation?

3. How useful did you find the information you were provided with before your latest OUH rotation?

4. How strongly do you agree that the information you were provided before your latest OUH rotation was role-specific?

Responses showed average scores of 5.4/10, 5.7/10, 6.2/10 and 6.8/10 respectively (N=36).

Aim:

To improve the quality of information provision to OUH Foundation Doctors in preparation for changeover to new rotations. We aimed to achieve this by August 2023 (end of the training year) with achievement of quality improvement indicated by increased scores out of 10 compared to baseline scores.

Methodology:

Intervention: FELS (Foundation Education Leads Group) OUH rotation fact-file

Induction booklets have been shown to have a positive effect on quality of junior doctor induction and patient safety 2,3 ,this was therefore considered an appropriate intervention.

The fact-file was designed based on what information current OUH Foundation Doctors said they wanted to know before a new OUH rotation (Template shown by Figure 1). It was then created using information from OUH rota coordinators and human resources teams, and current OUH Doctors.

Results:

PDSA (Plan-Do-Study-Act) Cycles:

Act: Further improvement of fact-file achieved

Study: Feedback form and repeat of initial survey

Baseline and repeat survey score results are shown in Figure 2

Plan: Design of OUH Rotation factfile Version 1

Do: Creation and release of Version 1

PDSA Cycle 1 - No improvement in score for any of the survey questions (N=10).

PDSA Cycle 2 – Improvement in score for all survey questions (N=5).

PDSA Cycle 3 - Further improvement (so far) for all survey questions (N=7).

Feedback:

How useful did you find the FELS OUH rotation Factfile?

Scores: Version 1: 8.4/10 Version 2: 9.2/10 Version 3: 9.2/10 (so far)

Learning Points:

• Foundation doctors felt better prepared for starting their new rotations having read the fact-file, with eased rotation changeovers

Limitations:

Act: Aim achieved but further factfile improvement possible

Study: Feedback form and repeat of initial survey

Plan: Design of OUH Rotation factfile Version 2

Do: Creation and release of Version 2

• Poor survey response rate from all current OUH Foundation Doctors limits the generalisability of our data

Conclusion:

Act: Further improvement of fact-file achieved

Study: Feedback form and repeat of initial survey

Plan: Design of OUH Rotation factfile Version 3

Do: Creation and release of Version 3

An OUH rotation fact-file can be used to improve the quality of information provision to OUH Foundation Doctors in preparation for new rotations

References:

1. Academy of Medical Royal Colleges, NHS Employers, 2013. Recommendations for safe trainee changeover.

2. Thomas N, McGrann E, Zammit L, et al. Junior doctor-designed induction booklet to improve future junior doctor experience in a new post. Future Healthc J 2019;6(Suppl 2):17. doi:10.7861/futurehosp.6-2s-s17

3. Ross D, Petrie C, Tully V. Introduction of a junior doctors' handbook: an essential guide for new doctors. BMJ Open Quality 2016;5:u209167.w3822. doi: 10.1136/bmjquality.u209167.w3822

Dr Marianne Beach and Dr Lucia Lazzereschi

Figure 1. Rotation information page template

Figure 2. Survey Results

Enhancing patient safety by improving the specimen self-collection

process in a GP surgery

Hui Mei Wong1 , Prasanna Balavigneswaran2

1 North Middlesex University Hospital, 2 Fernlea Surgery

Introduction

The COVID pandemic has accelerated the use of virtual consultations in General Practice surgeries. Whilst this has improved access to GPs, remote consultations limit a clinician’s ability to examine patients and collect investigation samples, thus relying largely on patients providing self-collected specimens to aid the diagnostic process. However, the self-collection process is susceptible to errors and samples are more likely to be rejected when compared to samples collected by clinicians. We designed this quality improve ment (QI) project in response to clinicians raising concerns around the frequency of rejected self-collected pathology samples, leading to patient frustration and delayed diagnoses, both of which negatively impacted patient care.

Our primary aim was to reduce the proportion of rejected self-collected samples by 20%. Our secondary aims were to improve the self-collected specimen process by improving confidence of the reception staff providing the specimen bottles, and reducing the time taken for clinicians to request a self-collected specimen.

Self-collected specimen process map

Factors contributing to rejected specimens

PDSA cycle Results

Conclusion

• Reception staff confidence increased from 6.2 to 9.0 (on a 10 point scale)

• The mean time clinicians took to complete a full test request form decreased from 73.2s (range: 53.0s-94.0s) to 40.3s (37.0-44.0s)

Next Steps

• Sending text message reminders to patients with instructions on selfcollection; consider including instructions in multiple languages.

• Consider pre-labelling specimen pots

• Consider removing the ‘emailing’ process from the process map

This QI project resulted in a 36% reduction in the number of rejected self-collection samples. Our QI project reduced delays in the diagnostic process, thus improving patient safety and patient experience. We were also able to improve the administrative team’s confidence in providing the correct specimen bottles and almost halved the time it took for a clinician to order a self-collected specimen. We learnt that by engaging the wider multidisciplinary team and patients, we were able to minimize errors in the process. Following this PDSA cycle, we propose several changes that could be implemented to further improve this process.

Understanding Medical Students’ Perceived Barriers to Examining Paediatric Patients

In previous academic years, paediatric clinical teaching fellow team noted students were examining far fewer patients than expected

1. Understand common barriers to examining paediatric patients

2. Identify means to help students overcome these barriers

3. Evaluate weekly undergraduate bedside teaching sessions

Bedside teaching sessions were invaluable opportunities to examine children and receive constructive feedback

• 17 respondents

• Confidence level at start of placement 2.6 vs end of placement 3.6

• Mean number of patients examined by each student was 26

• To improve, Year 4 medical students fed back wanting more bedside teaching sessions, didactic teaching, time on the wards, and longer paediatric placement

Main barriers are expressed in the word cloud

• An online questionnaire was sent to three cohorts of students (n=45) focussing on confidence and barriers to examining children

• Responses were graded from 1 -5 on Likert scale where 5 represented ‘Most Confident’ and 1 represented ‘Least Confident’

Itfeelsunnecessarytosubjectchildren toanexaminationwhichisn'tclinically neededandmaycausethemdistress

• Medical students report a lack of confidence needed to examine children

• Other research also identifies confidence as a reason students fail to examine patients (1).

• Only a modest increase in confidence despite 6 bedside teaching sessions and students examining 26 patients

• In response, we:

• Have implemented mandatory examination record sheet

• Continue to deliver weekly 2:1 bedside teaching sessions for every student

• Emphasise student-patient interactions during bedside teaching

Dr Azedah Yunus1, Dr Erin Jones1, Dr Mia Ottman1, Dr Alison Kelly2

Adult Weight Management Service

Understanding the Problem

The assessment process for the Adult Weight Management Service (AWMS) does not meet the needs of the patients in a timely and efficient manner, indicated by the high number of appointments before patients were referred to services other than dietetics. With the overall AWMS increasing its multidisciplinary service offers, this problem is likely to get worse and impact every patient referred to the AWMS.

Measures: How will we know a change is an improvement?

The Theory of Constraints was demonstrated using the Cause and Effect (fishbone) diagram, data and process map with the project team and wider stakeholders to understand the problem and identify the potential change ideas represented in the driver diagram below:

Changes: What changes can we make that will result in and improvement?

100% of patients have had their primary needs identified at their 1st appointment since the introduction of the biopsychosocial assessment but the more efficient way of triaging and identifying needs has led to an increase in demand and waiting times. A recovery plan was enacted to tackle this utilising QI methodology and the PDSA approach.

This project will address key components of the 6 domains of Quality in Healthcare: Patient Centred, Efficient, Equitable, Timely

Involving others

The main stakeholders were the clinicians working within the WM team, administrators, patients and those referring into the WMS. The project team reported back to the wider WM team and sought their feedback and opinions on the proposed changes. The administrators were included as part of the project team as their role was key to the successful implementation of the project. Feedback was provided to referrers via primary care cluster meetings. Patients views on the changes to the assessment process will be sought as part of the project evaluation.

The project teams consisted of the Weight Management Clinical Pathway Lead, Lead Clinical Psychologist for WM, Lead Dietitian, WM Administrator, 3 Dietetic Assistant Practitioners and an Assistant Psychologist, supported by a Quality Improvement Practitioner.

The improvement was a co-design among professions with the intention of engaging service users, to inform the development of the service.

Aim: What are we trying to accomplish?

To reduce the number of appointments needed to correctly identify individual patient needs within the AWMS to 1 appointment within 6 months.

Reflection and the next steps

Improving Perioperative Pathways for Undiagnosed Obstructive Sleep Apnoea

Introduction and aims

Obstructive Sleep Apnoea (OSA) is a common pathology that often goes undiagnosed. It increases the risk of a range of perioperative complications, with undiagnosed OSA being particularly dangerous.

We aimed to improve perioperative screening, diagnosis, and treatment of OSA through development of a novel perioperative pathway in a central London preassessment clinic (PAC).

Initial audit data in a focus group of patients (those undergoing major gynaecological surgery) found that just 14.3% of patients with a BMI of ≥30 had a STOPBang score + subsequent sleep study performed (17/01/22-17/02/22).

The main aims of the project were-

• Primary project aim: Achieve a 40% rate of optimal management of high-risk patients as per our novel pathway shown below

• Secondary aims: Improve referral rates for possible undiagnosed sleep apnoea from PAC

Results and future actions

Number of patients with moderate/severe OSA referred to sleep team

Novel pathway – developed Jan 2022 Audit data after one month of pathway implementation revealed 21.4% of patients managed optimally.

Across 11 months in 2022, 27 patients were referred to the sleep team with confirmed, clinically significant OSA. This was an increase from 4 patients in 2021.

In November 2022, we achieved 40% of patients being managed optimally as per the pathway. The PDSA cycle with the most significant and consistent shift in correct percentage referrals was implementation of a nursing champion.

Barriers to implementation included unfamiliarity with new technology, increased workload, and understanding of pathophysiology of OSA.

Future plans involve teaching within the PAC, funding for more WatchPAT sleep studies, utilisation of the WatchPAT direct service, changes to the PAC patient proforma and dedicated pre-operative sleep clinics.

Dr Rory Cairns1 , Dr Rachel Solomons1 , Dr Thomas Chambers 1,2

PDSA Cycles

Learning from Excellence:

Rewarding excellence in the workplace and boosting morale

L Elliott, A Watson, B Geers, S Knipe, E Gibbs, J Porter, O Rides Royal Devon & Exeter Hospital, Exeter, UK.

Background

The NHS Staff Survey 2022 identified low morale and high levels of burnout amongst NHS staff, with 34.0% feeling burnt out because of their jobs (1). Despite efforts to increase morale and improve wellbeing in recent years, only 42.1% of staff feel satisfied to the extent their organisation values their work (1). In a 2016 survey by the Royal College of Physicians, 50% of junior doctors identified low staff morale as a significant factor negatively impacting patient safety (2).

Learning from Excellence (LfE) is an initiative across Royal Devon University Healthcare Trust to improve morale and recognise excellent practice amongst staff. Staff members nominate others for actions that we can learn from, positively improve the work environment and patient care. Recipients receive a letter detailing their achievement and a thank you card.

Project Aim

We aim to increase the number of Learning from Excellence (LFE) staff nominations by 50% per month in the trust by March 2023 compared to March 2022.

PDSA Cycle 1:

Increase active awareness of LfE through in-person events at the Royal Devon and Exeter Hospital.

- Attendance at hospital ‘transformation hubs’

- Staff canteen stall

- Ward-based interventions

PDSA Cycle 2 (in progress):

Introducing a feedback form on nomination letters to measure the impact on staff morale.

Results

The number of nominations in March 2022 was 13. Following our first intervention (PDSA cycle 1) in early January 2023, nominations increased to 28, 36 and 54 in January, February and March respectively. This constitutes a 415% increase in nominations in March 2023 compared to March 2022.

Nominations increased to 30-60 per month for the first quarter of 2023.

Use posters and attend monthly ‘transformation hubs’ to ensure nominations remained high and to remind staff of the platform.

Conclusions & Future Work

We have collected preliminary ‘ad-hoc’ qualitative feedback from nominees. Responses included:

“It made me feel seen for all my hard work…it made me cry” - ward clerk.

“After a hard weekend on call, receiving a thank you card made me feel valued by my colleagues” - junior doctor.

Our interventions have increased nominations significantly within the trust. Next stages of the project include:

1. Maintain an LfE presence at monthly transformation hubs

2. Ward-based interventions to continue to raise awareness amongst staff

3. Collection of qualitative feedback to measure the effect of increased nominations on morale

4. A patient-facing form, allowing us to directly measure the link between LfE and patient experiences.

Improving Gentamicin Prescribing and monitoring at HDFT

Introduction

Gentamicin is an antibiotic widely used within the General Surgery department at HDFT and globally It is an highly effective antibiotic that is often used in combination with amoxicillin and metronidazole for broad spectrum cover, due to its excellent gram negative action Due to its narrow therapeutic index it has potentially serious side-effects including nephrotoxicity and ototoxicity As such it is vital to prescribe and monitor Gentamicin correctly

Methods

All in-patients under the General Surgery team receiving Gentamicin were included in this audit

Study periods:

• 01/04/2022 – 27/04/2022 (first cycle)

• 01/05/2022 – 27/05/2022 (second cycle)

Data for 26 patients were collected for the first cycle, and 18 patients for the second cycle. Patients on the paediatric ward were excluded Data was collected using Handover lists, ePMA , WebV, and ICE systems.

Measured 8 criteria, based off the ‘Extended interval Gentamicin Protocol at HDFT’ guidelines We would aim for 100% compliance in each of these categories

Henry Hill

Aim

As an FY2 in the department we noticed shortcomings of serum level monitoring for patients in the department, with many being missed or timings not communicated We sought to assess the compliance in each of the 8 parameters of the Extended interval Gentamicin Protocol within the General Surgical department at HDFT. These are shown in bold withing the trust policy below.

Extended Interval Gentamicin Protocol

Gentamicin prescribing and monitoring is done according to ‘Extended interval Gentamicin Protocol at HDFT’ The main points of this guideline include:

1. Indication for therapy should be documented and correct

2. Gentamicin should not be prescribed if CrCl<30mL/min

3. Initial dosing is done using patient’s IBW, measured using gender and height, or patient actual weight documented

4. Serum gentamicin measurement should be taken 6-14 hours post first-dose. This level is used to determine dosing interval and when repeat levels are required

5. Urea and electrolyte blood tests to be taken daily

6. Gentamicin should be used for a maximum of 5 days

Results & Interventions

The first round of analysis suggested significant shortcomings in the quality of prescription and monitoring. Only 50% of levels were taken in the correct timeframe. We implemented an education session following the first round and added a section of the handover to write level timings.

Despite an improvement in timely attainment of 1st serum levels, which was our initial reasoning for the audit, overall no significant improvement was noted between the two cycles. We believe this may in part have been due to a new rotation of Doctors. It also highlighted the need for further interventions or education

Recommendations & Follow up

• Place posters in Surgical doctor’s office and around Doctor’s mess to further promote adherence to guidelines. (Completed June 2022)

• Aim to implement protocol onto ePMA to include mandatory input of height/weight and indication, prompts for gentamicin level, and prevention of administering further treatment without serum level. (Completed August 2022) Ensure functionality to mandate eGFR from blood results is put into the prescribing information.

• 3rd Audit cycle is scheduled to be undertaken this April/may to correlate the EMPA change with performance with the department from 2022.

Use of MicroGuide application for improving education, efficiency and stress level for foundation year trainees.

Dr. Kristie Hing Chi Leung , Dr. Valliammai Muthuganesan,Dr. Ruby Lawrence, Dr. Monika Patel

INTRODUCTION

MicroGuide is a national online and mobile application utilised by doctors of all grades to access local guidelines and ensure patients are treated consistently, effectively and appropriately. Initially developed for antibiotic guidelines, it has expanded in Brighton and Sussex University Hospitals Trust to contain management algorithms as well as logistical information.

AIMS AND METHODOLOGY:

Data was collected through surveys before and after the implementation of the changes.

Feedback from foundation year doctors suggested that information on MicroGuide was difficult to access, and that adding further information on specialist rotations, ePortfolio and referral pathways would be useful.

At its third PDSA cycle, five interventions were implemented

ANALYSIS

Following our interventions, there is a statistically significant increase in visits to MicroGuide (p<0.001) and awareness of the available ‘survival guides’ (p<0.001). Meanwhile, the subjective rating of the length of time required to find information required to complete tasks (p=0.01) and feeling of being stressed or inefficient (p=0.001) has been reduced.

WHAT DID WE LEARN?

Aim 1: Increase awareness of the resources available to foundation doctors.