: The impact of the COVID pandemic on pledge themes made as part of Human Factors training

Dr Jennifer Macallan, Mrs Jenny Sutcliffe and Dr Suzi Lomax. SCReaM Team, Royal Surrey County Hospital

Introduction & Problems

In order to provide safe and high-quality care, it is imperative that staff ensure that they look after themselves physiologically and psychologically first.

This has been particularly important during the COVID pandemic. The huge burden of patient care and demands on staff, combined with new ways of working and unpredictability, has perversely meant this self-care has been often overlooked by staff. This leads to burnout& sickness and therefore impacts patient care.

Aims & intervention

The SCReaM Human Factors (HF) and Team Resource Management Programme at the Royal Surrey NHS Foundation Trust, as part of its remit,delivers multi-disciplinary Human Factors (HF) training. Part of our SCReaM HF training is ensuring that staff are placed at the centre of patient safety, requiring them to implement self-care as a priority.

To empower our delegates to translate their learning into practice, they undertake a pledge after their course -something that they have taken away from our HF training thatthey wish to try out to improve their working lives.

In March 2020, at the start of the pandemic, we aimed to empower staff to recognise and implement ways to improve their physiological and psychological wellbeing. We did this using the for and the previous QI work we had undertaken to translation of learning into practice after classroom training prior to the pandemic.

Change ideas & measures

To accomplish this staff empowerment, we developed a number of change ideas and undertook PDSA cycles to adapt and improve delivery of our HF training during the pandemic. We transitioned from a classroom to a virtual format, refreshed both our course content and pledge sessions to increase the translation of self-care related learning into practice.

The measure that we used was the number of completed self-care themed pledges made after each course. We looked at the impact of our change ideas following March 2020.

Plan Do Study Act

Continue HF training during the pandemic

Delivery via a virtual platform to enable ongoing training during the pandemic at home with no work interruptions. Several IT issues noted.

Difficult to facilitate interactive conversation in virtual environment.

Improve frequency of comfort breaks. Improve IT planning & support. Improve interactive discussion relating learning to daily working lives.

Lessons learnt

New structure to enhance interactive discussion about life on the frontline and to improve relevance of self-care to working lives

Give delegates to make the focus of their pledge selfcare

Changes to pledge mentor session

Results

Alter structure and content of programme for increased short comfort breaks. Relevant self-care content to tailor to need during pandemic. Introduce course expectations to enhance safe

Delegates given peer examples of self-care related pledges. Used a professional duty approach

Smaller breakout groups for pledges with mentors

Increased interactive discussion and engagement.

Delegates wanting to put learning into practice regarding selfcare, but felt disempowered to.

Perception of whether awas acceptable

Some delegates found it more acceptable to undertake self-care based pledges in feedback. Missed opportunities in mentor groups noted by faculty

Increased self-care pledges made on course. Smaller groups enabled delegates to sound out self-care ideas and receive support in planning and actioning

Number of completed pledges before March 2020: 81

Number of completed pledges after March 2020: 99

Identify ways of improving acceptability use pledges to provide staff with an opportunity toe.g. peer examples of selfcare pledges during training and change of approach to self-care as a professional duty

Use mentor groups to capture opportunities and further enhance acceptability

Expand awareness of acceptability of self-care and challenging perception that self-care is a professional duty rather

We saw more than a five-old increase (5% to 28%) in pledges related to selfcare after March 2020, following implementation of our change ideas.

Change idea testing has allowed us to set up robust facilitative style HF trainingvirtually, enabling continuation of HF training opportunities during the pandemic.

Tailored mentor sessions increase the number and quality of self- control. Givingstaff the permission,that they believe to be required, is a priority to change their perception of self-care from Providing past examples of self-care themed pledges gave staff the acceptability that they need to on their own oxygen mask

Next steps

Embedding the virtual model of training in the future alongside our classroom training to make HF training more accessible to a wider audience. We aim to empower staff to implement changes related to self-care. By celebrating the positive impact of the changes that people have noticed through their self-care pledges, this -care within the Trust.

We have reflected onpledge process and are developing further change ideas to look at barriers to completing pledges, particularly those related to self-care.

Who can drive home from the hospital?

Assessing healthcare professionals’ knowledge and understanding of DVLA guidelines in relation to substance misuse within Greater Manchester secondary care.

Aim

To ensure pa5ents with substance misuse and dependency issues are correctly informed of driving safety informa5on as per DVLA guidelines.

Objec5ves

1.To assess and improve healthcare professionals’ knowledge and understanding of DVLA guidelines in rela5on to substance misuse.

2.To improve the recording of driving safety advice for pa5ents with substance misuse and dependency issues on discharge leGers.

Introduc5on and Ra5onale

• In 2019/20, alcohol-specific conditions were accountable for 347,761 hospital admissions in England, (equivalent to 2%).1 Twenty-seven percent of adults living in the North West consume more than the weekly recommended amount, making this the second highest region in England for excessive alcohol consumption.1 Drug use is also increasing in Greater Manchester; over the last decade, there has been a 74% rise in drug related deaths within the region.2 Hospital admission rates for alcohol-related conditions are around 53% higher in Greater Manchester than elsewhere in England.

• The DVLA requires individuals with certain medical conditions to self-report, as their ability to drive safely may be affected.3 The General Medical Council (GMC) states that it is a medical practitioner’s responsibility to ensure patients are aware of this requirement 3 The DVLA have published guidance outlining which medical conditions require DVLA notification which includes substance misuse/dependency issues.4 Previous research has demonstrated that there is poor awareness of these guidelines amongst healthcare professionals and patients. 5

Although 12 to 15% of all NHS A&E admissions are alcohol related, and drug use amongst adults increasing, previous research conducted has demonstrated a lack of awareness amongst both patients and healthcare professionals regarding the impact of substance misuse on driving safety.5 Although results from papers consistently show that UK doctors’ awareness of DVLA guidelines (in particular in relation to substance misuse/dependency) is limited, very few studies have been published, with many conducted over 5+ years ago. No recent studies, audits or QIPs on this topic have in the North West, although this represents the second highest region for alcohol excess.1

DVLA substance misuse reportable condi5ons

• Alcohol misuse

• Alcohol dependence

• Alcohol related disorders such as: hepa*c cirrhosis with chronic encephalopathy alcohol associated psychosis, cogni*ve impairment

• Alcohol related seizure

• Drug misuse or dependence

• Seizure associated with drug use

Plan

Baseline data collected to determine current practice within AMU with additional survey to establish healthcare workers’ knowledge and understanding of issues.

Planned future PDSAs

Educa5on of pharmacists who check TTOs with aim to flag missing safety informa5on to clinicians

Posters to raise awareness of DVLA guidelines placed near computers in AMU

Driving safety information question added to electronic discharge proforma

Proposed interventions for target-group formulated and timeframe over which to deliver (6 months).

Act

Reflect upon results and determine effectiveness of intervention and strategize and adjust future interventions.

• Departmental teaching not that effective –numerous team members unable to attend. Will likely need repeated refreshers delivered at end of other teaching sessions especially due to rotation of staff.

• Group WhatsApp messages able to reach all team members.

• Appears more effective in reminding staff to check and document.

Take home messages

• Research has demonstrated poor awareness of DVLA guidelines amongst healthcare professionals in relaAon to substance misuse

• The survey results reflect this and this has translated into poor documentaAon of driving safety informaAon in discharge leEers

• Although change can be slow and takes Ame and perseverance, text reminders have shown a posiAve improvement

• Future PDSA cycles are necessary to gain a beEer picture of data overAme to determine which intervenAons are most successful in creaAng change

P S A D

Initial survey results

• Over 90% of healthcare workers have daily/frequent contact with patients with substance issues

• However almost three-quarters ‘rarely’ or ‘never’ enquire about driving-status

• Case-based questions concerning driving and substance misuse/dependency averaged a 44% incorrect response-rate

Baseline data

• Over a two month period, 60 patients admitted to AMU had DVLA reportable substance issues

• Only 2/60 (~3%) of discharge letters contained driving safety information

• The information for both letters was in relation to alcohol withdrawal-seizures

First intervention: Departmental teaching

Second interven5on: WhatsApp messages

Reminder WhatsApp messages sent on AMU WhatsApp group containing all AMU junior doctors

Study

• Data collected following each interven5on.

• Daily acute-take list examined to detect pa5ents admiGed with substance misuse and/or dependency issues.

• Discharge leGers further inspected to assess for inclusion of driving safety informa5on for those mee5ng DVLA criteria

First intervention: Departmental teaching

• Marginal improvement

• Around 7% of discharge letters contained driving safety information for patients admitted and discharged from AMU over 14 day period

Second intervention: WhatsApp messages

• Data collected over 14 day period.

• 30% of discharge leGers for pa5ents contained driving safety informa5on for pa5ents discharged from AMU

References

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