Our Journal - autumn/winter

Pain team present at

Patient experience improvements

in National Audit of Care at the End of Life (NACEL) - our next steps

Our focus on supporting patients who experience cardiac arrest

Neonatal Unit team work towards UNICEF Baby Friendly Initiative

Improving antibiotic usage at PAHT - how you can support

Team attend maternity safety conference to keep up to date with latest national developments

Supporting our dementia research with patient outcomes at the heart of our plans for the future

Nurse recognised for improving the experience for children and young people with mental health issues

Welcome

We are pleased to share the second edition of Our Journal - a publication written by our clinical people, for our clinical people, at PAHT. Our Journal, published four times a year, includes:

y Focus features on clinical issues/ improvements and the impact on patient care

y PAHT 2030 – celebration relating to care pathways and measurable improvements to patient care

y Quality and safety agenda – progress and updates on the implementation of the quality and safety strategy

y Research updates – new trials being undertaken at PAHT and results of clinical trials nationally and their meaning to patient care at PAHT

y Awards/clinical recognition – about our people and their teams

y Summary of research contributions and papers published by PAHT clinicians

y Conference reviews/updates

y Clinical leadership successes

y Clinical audit projects

y Clinical transformation updates

y Charitable work and charity events linked to PAHT

y Input from external contributors

This edition features an update on our #PAHTPeople contributing to vital COVID-19 immunity research; our pain team presenting at a prestigious international conference; and the results of national audits. We also focus on the Neonatal Unit team's work towards the UNICEF Baby Friendly Initiative; the family and women's services team's attendance at a maternity safety conference; and how Cassie Burke, paediatric emergency department sister, has been recognised for improving the experience for children and young people with mental health issues. Additionally, we cover antibiotic usage at PAHT and how you can support to raise awareness and understanding; the latest on dementia and delirium care; and more.

Our Journal provides an amazing opportunity for us to showcase the wonderful work we do – please share it widely and let the communications team know which developments we can profile in the next edition of Our Journal at paht.communications@nhs.net.

Best wishes

Dr Fay Gilder Medical director

Sharon McNally

Director of nursing, midwifery and allied health professionals and deputy chief executive

Dr Fay Gilder

Sharon McNally

Our #PAHTPeople contribute to vital COVID-19 immunity research

By Chris Cook, head of research, development and innovation

Our #PAHTPeople have contributed to vital COVID-19 immunity research by taking part in the SARS-CoV2 Immunity and Reinfection Evaluation (SIREN) study throughout the pandemic.

The SIREN study has provided valuable evidence on immunity following SARS-CoV-2 infection and COVID-19 vaccination and surveillance data on infection and emerging variants. This evidence has played a critical role in informing the national COVID-19 response.

A research paper, ‘Protection against SARS-CoV-2 after COVID-19 Vaccination and Previous Infection’ has now been published in the New England Journal of Medicine, demonstrating the impact of this study.

Abstract from the study

Background

“The duration and effectiveness of immunity from infection with and vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are relevant to pandemic policy interventions, including the timing of vaccine boosters.

Methods

“We investigated the duration and effectiveness of immunity in a prospective cohort of asymptomatic health care workers in the United Kingdom who underwent routine polymerase-chain-reaction (PCR) testing.

"

Vaccine effectiveness (≤10 months after the first dose of vaccine) and infection-acquired immunity were assessed by comparing the time to PCR-confirmed infection in vaccinated persons with that in unvaccinated persons, stratified according to previous infection status.

“We used a Cox regression model with adjustment for previous SARS-CoV-2 infection status, vaccine type and dosing interval, demographic characteristics, and workplace exposure to SARS-CoV-2.

Results

“

Of 35,768 participants, 27% (9488) had a previous SARSCoV-2 infection. Vaccine coverage was high: 97% of the participants had received two doses (78% had received BNT162b2 vaccine [Pfizer–BioNTech] with a long interval between doses, 9% BNT162b2 vaccine with a short interval between doses, and 8% ChAdOx1 nCoV-19 vaccine [AstraZeneca]).

"Between December 7, 2020, and September 21, 2021, a total of 2747 primary infections and 210 reinfections were observed. Among previously uninfected participants who received long-interval BNT162b2 vaccine, adjusted vaccine effectiveness decreased from 85% (95% confidence interval [CI], 72 to 92) 14 to 73 days after the second dose to 51% (95% CI,

22 to 69) at a median of 201 days (interquartile range, 197 to 205) after the second dose; this effectiveness did not differ significantly between the long-interval and short-interval BNT162b2 vaccine recipients.

"

At 14 to 73 days after the second dose, adjusted vaccine effectiveness among ChAdOx1 nCoV-19 vaccine recipients was 58% (95% CI, 23 to 77) — considerably lower than that among BNT162b2 vaccine recipients. Infection-acquired immunity waned after 1 year in unvaccinated participants but remained consistently higher than 90% in those who were subsequently vaccinated, even in persons infected more than 18 months previously.

Conclusions

“Two doses of BNT162b2 vaccine were associated with high short-term protection against SARS-CoV-2 infection; this protection waned considerably after 6 months. Infection-acquired immunity boosted with vaccination remained high more than 1 year after infection.”

The SIREN study at PAHT

The SIREN study was originally set up and running at PAHT in September 2020. The study recruitment phase ended on 31 March 2021 – at this point no further colleagues could join the study, however they are followed up fortnightly by the research team for swabs, with bloods being taken monthly.

The original plan was for all

participants to be followed up for one year from the point of their recruitment into the study.

However, the study results were so informative to the government and health officials, that we were given the opportunity to extend for another year, which we have done. Some participants have left the study for various reasons, such as workload, leaving PAHT etc., but many have remained in situ, and for this we are very grateful.

374 participants were originally recruited into the trial between September 2020 and 31 March 2021. As of 21 September, there are 154 participants who remain on the study. Some are currently being offered the opportunity to remain on the study and consent to the trial until 31 March 2023, with all being invited to be part of a sub-study called VIBRANT.

Once consented to the substudy, the participant has the opportunity to answer some questions, and some are invited to have blood tests which can detect the early onset of various diseases. As the head of research, I have chosen to participate in both and extend my stay until next year.

We have also shared the Patient Research Experience Survey (PRES) with participants, and subsequently have 'You said – We did' posters in the waiting room for the SIREN clinic.

You said – It would be helpful to have study clinics set up across other sites within the organisation.

We did – We have clinics that run once a fortnight from St Margaret’s Hospital and Herts and Essex Hospital.

You said – You would like an easy way to contact the team should you have any queries regarding your SIREN appointment.

We did – We set up a specific SIREN study email address –paht.siren@nhs.net

You said – A consistent location for the study clinic would be appreciated.

We did – We sourced a permanent location for the SIREN study in the main outpatients' area.

All of the above is raw data taken from the National Institute for Health and Care Research (NIHR) Patient Research Experience Survey (PRES). This has been shared with North Thames Clinical Research Network as best practice and is being shared across all hospitals within that catchment area.

Thank you to everyone involved for your support. For more information, please contact me at chris.cook6@ nhs.net.

Pictured: The COVID virus.

Pain team present at prestigious international conference

By Dr Huw Griffiths, anaesthetist; Dr Dev Dutta, consultant anaesthetist; and Sarah Taylor, acute pain team

lead clinical nurse specialist

In the pain team, we were proud to present our work to improve patient experience at a prestigious international conference last month.

We were invited to share our research at the Association of Anaesthetists of Great Britain and Ireland (AAGBI)’s Annual Congress from 14-16 September at ICC Belfast, following a competitive review of abstract submissions.

Our work centres around local anaesthetic infusion pumps to aid post-operative pain relief,

which in turn has been shown to improve patient satisfaction and help with patient flow.

The annual congress allowed us to showcase the wonderful work carried out here at PAHT. The conference was attended by leads in the field of anaesthesia that had the opportunity to review our research. Those unable to attend can now read the published abstract in the Journal of Anaesthesia (ranked number one anaesthetic journal in the world).

The anaesthetist/surgeon uses a device called On-Q which is an elastomeric pump delivering a set rate of local anaesthetic into a tissue plane. By utilising targeted local anaesthetics, it reduces opioid consumption and aids with the multi-modal approach to pain relief. It can be used for any patient with somatic pain secondary to a surgical incision. It is most commonly used in this hospital for patients undergoing laparotomy surgery to numb the nerves innervating the abdominal wall.

Our research and experience stems from its use in the adult population, in particular those undergoing laparotomy surgeries. This shows that the use of On-Q resulted in earlier return of bowel function,

reduced opioid consumption and reduced length of stay compared to the group who used predominantly a morphine patient controlled analgesia (PCA) pump. Opioids have many side effects which slow down recovery. A multi-modal analgesic approach with a local anaesthetic infusion has been shown in our study not only to reduce length of stay, but it was also associated with very high patient satisfaction scores.

From the data collected (87 patients) the On-Q had 75% of the patients stating a good or very good satisfaction score, with 32% of that being very good. The PCA patients did not have a very good satisfaction at all, 15% of these patients said that their satisfaction was poor, and 55% stated it was average. Research carried out in other institutions has also found the On-Q pump to

provide excellent analgesia and reduced side effects, compared to the traditional high opioid model. It is a relatively new technique but has been around for a few years now which has allowed a database to occur showing its efficacy and good safety profile.

Some hospitals have adopted this technique not only in general surgery, but other specialties such as orthopaedics. We are trying to

promote even greater usage in general surgery as it will not only benefit patients but has the potential to significantly improve patient flow.

The acute pain team moving forward aims to promote even greater usage of this device, not only in general surgery but possibly other specialties, in particular those undergoing complex procedures or whom suffer chronic pain - watch this space. Thank you to all of the team for your contributions.

Abstract from the study

For more information, please contact me at huw.griffiths2@ nhs.net.

Pictured: photo one - Dr Huw Griffiths (left) and Dr Dev Dutta (right) at the conference. Photo two - the acute pain team, from left to right: Sophie Nalwadda, acute pain clinical nurse specialist; Mini Thomas, acute pain clinical nurse specialist; Sarah Taylor, acute pain team lead clinical nurse specialist; and Dr Dev Dutta, consultant anaesthetist.

On-Q local anaesthetic infusions for laparotomy surgery: a district hospital experience S. Taylor, M. Thomas, A. Mann, F. Ejtehadi, H. Griffiths and D. Dutta, The Princess Alexandra Hospital NHS Trust

"Laparotomy surgery is a common procedure to treat a variety of intra-abdominal pathologies. The main factors hindering recovery are postoperative pain and delayed return of bowel function [1].

"The On-Q pump is an elastomeric pump that continuously delivers local anaesthetic via catheters placed in close proximity to the surgical wound. We present our experience of this technique when placed under direct vision by the surgical team.

Methods

"All laparotomy patients treated at The Princess Alexandra Hospital during November 2020 and April 2021 were included. An exclusion criterion was anyone unable to communicate. The pain team assessed these patients for three days postoperatively and were able to obtain additional data via the online (Nervecentre) records. The following variables were recorded: analgesia type, pain score, bowel function, opioid consumption and length of stay.

Results

"A total of 87 patients were included in the study (74 emergency and 13 elective). The three commonest analgesic modalities were (i) On-Q (n = 40), (ii) regular oral or intravenous (‘pro re nata’ (PRN)) analgesia (n = 34) and (iii) opioid (systemic) patient-controlled analgesia (PCA; n = 12). Only four patients had an epidural and three had a combination of On-Q and PCA. On average, the oral/intravenous group required 60% greater opioid usage compared to On-Q and had longer time to passing flatus (57% by day three compared to 78% in the On-Q group); however, length of stay was similar (11 days postoperatively). The PCA group fared worse in all assessments compared to On-Q particularly length of stay (11 vs. 18 days).

Discussion

"Local anaesthetic infusions near the operative wound resulted in earlier return of bowel function, reduced opioid consumption and comparative length of stays compared to more traditional analgesic techniques. The PCA group fared badly in all domains, which reflects the downside of systemic opioid usage.

"Laparotomy pain is both visceral and somatic in nature and although an epidural is a better analgesic option, it is often plagued with safety and side effects and not commonly used in our hospital.

"The On-Q pump allows the somatic pain to be targeted as part of a multi-modal strategy, with the localised infusion resulting in minimal adverse effects. The limitations of this study are the small sample size (elective work impacted by the COVID-19 pandemic) and being observational in nature. Despite the limitations, this study highlights the benefits a local anaesthetic infusion catheter can aid the postoperative recovery post-laparotomy."

Reference

1. Liang SS, Ying AJ, Affan ET, et al. Continuous local anaesthetic wound infusion for postoperative pain after midline laparotomy for colorectal resection in adults. Cochrane Database of Systematic Reviews 2019; 10: 1465–858.

Patient experience improvements demonstrated in National Audit of Care at the End of Life (NACEL)our next steps

By Dr Jane Hegarty, consultant in palliative medicine, and Gill Hutchinson, former clinical lead, Macmillan specialist palliative and end of life care team

The National Audit of Care at the End of Life (NACEL) is currently carried out by the Macmillan specialist palliative and end of life care team (pictured overleaf).

Originally, it was commissioned in October 2017 on behalf of NHS England to include three annual audit rounds up to 2020.

The overarching aim is to improve quality of care of people at the end of life in acute hospitals. The audit monitors progress against five priorities of care, 'One Chance to Get It Right', and The National Institute for Health

and Care Excellence (NICE) quality standard 144, which addresses the last days of life. Data collection for the National Audit of Care at the End of Life (NACEL) due June to October 2020 was cancelled, due to the impact of COVID-19 on priority clinical commitments.

Feedback from round three of the NACEL audit 2021-2022 showed that communication/ documentation with the dying person had improved from previous rounds; involvement of patient(s) in decision making was

better and anticipatory end of life (EoL) medications were prescribed and used appropriately

Learning points from round three include that although there is better completion of end of life care (EOLC) documentation since the last audit round, this still falls below the national average; that recognition of the dying patient still falls below the national average and that there are gaps in staff training specific to EOLC (within the past three years).

Actions from this include:

y New Sage & Thyme initiative across PAHT to provide a template to introduce difficult conversations, including those related to food/fluid decisions as a patient approaches end of life

y Although engagement with EOLC documentation has improved, there is still room for further improvement - the mandatory EOLC training module due to be released shortly gives direction on accurate completion of these documents, which include prompts for discussions around food/ fluids considerations

y A greater specialist palliative care team (SPCT) physical presence across wards to engage and teach our people around the fundamentals of EOLC will be aimed at addressing gaps in confidence and knowledge

A fourth round of NACEL is currently in progress, with data

collection from June to October 2022. There are four main components to the survey as follows:

1. Organisational level audit

A hospital/site overview is to be completed once per submission. This will focus on activity questions and specialist palliative care availability.

2. Case note review

This is completed for inpatient deaths only. Deaths which are classed as 'sudden deaths' are excluded and only adult (18+) deaths are included. A sample size of 50 case notes has now been agreed for NACEL round four.

y Acute hospitals should aim to audit 25 consecutive deaths between 1 April 2022 - 14 April 2022 and 25 consecutive deaths between 9 May 2022 – 22 May 2022

3. Quality survey (carers survey)

A quality survey letter should be sent to the nominated person(s) of patients fitting the inclusion criteria who died in our hospital/site between 1 April and 31 August 2022.

4. Staff reported measure An online survey sent to our people who are most likely to come into contact with dying patients and their loved ones. The NACEL audit includes all of our people who have patient contact at PAHT. It is important that everyone completes the online survey so that a true reflection of end of life care is recorded.

Please contact the specialist palliative and end of life care team for any further information on Alertive (palliative care clinical nurse specialist), on 01279 827846, or

paht.macmillanspec palliativecare@nhs.net.

Our focus on supporting patients who experience cardiac arrest

By Matthew Ibrahim, lead resuscitation practitioner

We participate in the National Cardiac Arrest Audit (NCAA) that looks at in-hospital resuscitation events.

The audit captures data on the cardiac arrest process and outcome.

The resuscitation service, working in collaboration with the Intensive Care Unit (ICU) audit lead, collects data on each adult who is treated in cardiac arrest.

This audit is an ongoing process, with both monthly and quarterly data capture accuracy feedback from NCAA. We consistently receive positive feedback on data capture accuracy.

During this audit period, 91% of patients had an initial rhythm that was non-shockable. This is in line with national reported data sets (pictured, top right).

Data from this audit also showed that 84% of cardiac arrest activity occurred in patients aged between 6190+, with the remaining 16% occurring in those that were younger (pictured, bottom right).

This audit helps us plan how we support areas of higher patient acuity and allows us to benchmark our progress with other trusts locally and nationally.

Additionally, my PhD is focusing on the development of a cardiac arrest risk prediction tool, which if successful, could be used nationally. I will update on this in future editions of Our Journal.

Thank you to everyone involved in the ongoing collection of this data to inform treatment for patients who experience cardiac arrest.

For more information, please contact me at matthew. ibrahim@nhs.net

Neonatal Unit team work towards UNICEF Baby Friendly Initiative

By Clare Abela, neonatal infant feeding lead

At the Neonatal Unit, we are currently at the start of our UNICEF Baby Friendly Initiative journey (UNICEF BFI). Last month (September) was Neonatal Intensive Care Awareness Month and it is an apt time to share our next steps.

The importance of the Baby Friendly Initiative (BFI) on the Neonatal Unit is to support parents to have a close and loving relationship with their baby. We aim to enable babies to receive human milk and for women and birthing people to breastfeed where possible.

We value parents as partners in care and these standards are achieved by ensuring positive parent-baby relationships are supported and developed.

Parents have unrestricted access on the unit and are encouraged to have frequent and prolonged skin to skin contact. This integral part of care nurtures the baby's physical and emotional development, has a positive impact on love and attachment, and helps to build a healthy milk supply.

Our team supports mothers

and birthing people of sick and preterm babies to initiate and maintain lactation through early and regular expressing, providing breastmilk to baby and then in to the transition of breastfeeding to responsive breastfeeding. We also support parents who are formula feeding, helping them to feed safely and responsively. We have a family centred approach and we encourage parental participation in their baby's care during ward rounds, and for medical and nursing care.

At present we are working towards stage 1 of the UNICEF BFI Accreditation and we are building a firm foundation. The accreditation includes having written policies and guidelines to support the standards; an education programme that will support our team to implement the standards in their role; and a process for implementing, auditing and evaluating the standards, abiding by the International Code of Marketing of Breastmilk Substitutes.

It is very important that the neonatal service achieves accreditation. The BFI is one of the most important developments in the care of newborns and it is based on extensive and resounding evidence regarding the importance of breastfeeding. It is helping to create a new normal in health services,

where babies and families are put at the heart of care, and are given the best start.

All of our team are involved with the BFI and we are currently working on embedding these standards. We will update you with our progress in a future edition of Our Journal. For more information, please contact me at clare.abela@nhs.net.

Improving antibiotic usage at PAHT - how you can support

By Shayi Shali, lead pharmacistantimicrobials

Recent data (pictured above) shows us that we are the highest prescriber of antibiotics as defined daily dose (DDD) per 1000 admissions in the East of England, and second highest in England.

We need your support to raise awareness and understanding of our antibiotic usage at PAHT, and to increase antibiotics compliance and improve our practices, in line with our guidelines >

Why is it so important to reduce our antibiotic usage?

y Antimicrobial resistance

Inappropriate prescribing of antibiotics causes antimicrobial resistance (AMR)

y Global health threat

AMR is one of the top ten global public health threats

facing humanity as reported by the World Health Organisation

y Improving patient safety

Appropriate antibiotic prescribing and administration reduces AMR, medication errors, reduced bloodstream and skin or soft tissue infections

y Improving capacity and flow across the hospital

Data has shown that prescribing and administering antibiotics, in line with our guidelines, can help to reduce patient length of stay

y Releases more time for our clinical teams to care for our patients

y Reduces unnecessary cost

Key actions for you

y Please cascade this message to your teams and lead by example

y Indication, duration and requesting clinician must be recorded under the antibiotic indication and duration note on JAC

y Move patients from IV to oral antibiotics after 72 hours or less, where possible

y Think ahead to carefully select which patients require antibiotics - this will support our efforts to reduce antimicrobial resistance and healthcare associated infections

y Familiarise yourself with the AWARE acronym (right)

which details the antibiotics that should only be used in exceptional circumstances (under the watch and reserve category), where clinically required.

The MicroGuide Appdownload now

Please ensure that you have downloaded the MicroGuide App from your smartphone App store. Alternatively, you can scan the QR code (pictured right), or visit this link to download the App >

The App allows you to access our antibiotic guidelines and policy on your smartphone at any time.

Thank you for your support with this critically important improvement project, which is essential in our efforts to improve patient care, experience and outcomes.

For more inforamation, please contact me at shayi.shali@ nhs.net.

Team attend maternity safety conference to keep up to date with latest national developments

By Alex Field, divisional director for family and women's services, and consultant obstetrician and gynaecologist

On 22 September, I attended the third National Maternity Safety Conference, organised by the Baby Lifeline Charity in Birmingham (pictured left), with Giuseppe Labriola, director

of midwifery, (pictured right, previous page), Erin Harrison, head of maternity governance and assurance (pictured, second left), and Anna Croot, fetal monitoring lead midwife (pictured, second right).

This national event featured speakers from across the UK including Donna Ockenden, who led the independent review of maternity services at the Shrewsbury and Telford Hospital NHS Trust, the final report of which was published earlier this year.

Other speakers included Dame Ruth May, chief nursing officer for England, and Professor Jacqueline Dunkley-Bent, chief midwifery officer for England, as well as the respective leaders of both the Royal Colleges of Midwifery and Obstetrics and Gynaecology.

We heard from some of the bereaved families involved in the Ockenden Review into the maternity care at Shrewsbury and Telford, as well as the ongoing review at Nottingham.

It was extremely powerful hearing the first hand testimony of those affected and particularly their experiences of not being listened to, both by their care givers and afterwards in the subsequent investigations.

In the afternoon we heard a service user’s experience of systemic racism whilst receiving maternity care, again, not being listened to, not receiving pain relief and

the fear of realising she was four times more likely to die in or after pregnancy compared to an equivalent white patient.

This led smoothly into a session by the renowned Professor Marian Knight on maternal mortality and morbidity and its association with race and ethnic background.

The keynote speaker was Professor Michael West, who talked about promoting a compassionate culture and what compassionate leadership looked like: lots for us to reflect on ahead of a difficult winter period.

There was a frank discussion around the difficulties in maintaining safe staffing, recruiting and retaining staff and poor morale. The profound anger at the most recent NHS pay settlements was acknowledged and we were assured would continue to be raised at a ministerial level.

Overall, this was a great conference with the patient experience at the heart that has given the team attending lots of ideas to take away.

This included the importance of transparency and external oversight when things go wrong and ensuring that patients and their families are heard throughout the process.

We will be reviewing our handling of complaints and investigations to put the patient’s voice at the centre

and examining how we work with the medical examiner's team and coroners.

Patient involvement and co-production are key to transforming safe maternity care and making sure we hear a diverse group of voices is essential.

For more information, please contact me at alexander. field@nhs.net.

Supporting our dementia research with patient outcomes at the heart of our plans for the future

By Caroline Ashton-Gough, dementia clinical nurse specialist

I am looking at what works well in dementia and delirium care and how relationships between our people and family carers may enhance patient outcomes.

I am a doctorate in health research student at the University of Hertfordshire and I have just received ethical approval to start my data collection. The title of my research is: ‘Caring for hospital patients with delirium superimposed on dementia and their family carers: an appreciative inquiry’

Very little is known about what helps our people and family members to work together to support people living with dementia when they are admitted to hospital.

Being in hospital is stressful, if you are living with dementia it can be distressing and confusing, sometimes leading to people becoming delirious. The goal is to gain a greater understanding of what the experience of delirium superimposed on dementia may be. It is also to understand what currently

works well when supporting patients with dementia and delirium and their family carers. I will be recruiting our people who have regular contact with patients living with dementia, and also carers who have a family member with dementia at PAHT as part of this research.

If you would like to participate, you will be asked to take part in an interview that will take approximately one hour. This interview can either be faceto-face at a comfortable and convenient place and time of your choosing or, if you prefer, the interview can be carried out by telephone, video or email.

Additionally, I am seeking participation in the National Audit of Dementia (NAD) The NAD is a clinical audit programme commissioned by the Healthcare Quality Improvement Partnership on behalf of NHS England and the Welsh Government, looking at quality of care received by people with dementia in general hospitals.

For this, I am aiming to capture the views of family carers who are supporting patients with dementia. Between 20 October and the 17 November, I will be collecting data for all patients admitted to PAHT with a diagnosis of dementia

or probable dementia. The data will look at reason for admission, delirium, type of dementia, length of stay, pain score and more. There is an opportunity for carers of people living with dementia to complete a survey. Part of the process also includes the completion of the annual dementia statement, which collects information about the hospital relating to care provision and monitoring of the quality of care for people with dementia.

The output is a series of statements demonstrating the achievement and progress the hospital has made in its work to ensure a good standard of care. For more information and if you are a junior doctor who could assist with data collection, please contact me at caroline.ashton5@nhs. net.

Nurse recognised for improving the experience for children and young people with mental health issues

By Cassie Burke, paediatric emergency department sister

In October 2021, I was appointed to be project lead for the NHS England funded We Can Talk (WCT) project.

We Can Talk is working to improve the experiences of young people who attend hospital due to mental health issues and the teams who support them. It is co-produced with young people with lived experience of mental health issues, hospital staff and mental health experts.

Over the past year, I have been tasked to launch and implement the core curriculum training platform across PAHT. To date, over 200 colleagues have signed up to the project. This is now mandatory at trust induction within medical and nursing divisions. Upon completion of the WCT training, our people can claim their pin badge.

28% of all mental health attendances across the whole emergency department (ED) are children aged up to 16

years old, and 47% if you include young people up to the age of 25 years. The average wait in past years has rapidly increased, well above the government’s 15 minute target; at worst at the end of 2021 the average was 62 minutes. We had to do better.

With support from the We Can Talk team, I implemented a quality improvement initiative within our children’s emergency department (ED). Having worked in the department for the past decade, I felt looking at children and young people’s

(CYP) journey, I had to consider it systematically, starting at the beginning. The quality improvement aim was to mark a positive beginning of each CYP journey to ED when attending in crisis. A rapid access card was developed whereby simply showing the card alerts reception colleagues that a child or young person is struggling with their mental wellbeing. A confidential discussion with a nurse then follows.

The card also signposts to services and support, and highlights to go to ED/call 999

if a child or young person is not currently in the department and is in a mental health crisis and unable to keep themselves safe.

An audit demonstrated that that 90% of children and young people had received a card prior to discharge and wait times were reduced down to a maximum of 25 minutes. The most impactful quantitative feedback we have received so far has been a mother saying that when she saw the poster, she felt her reasons for bringing her child were validated and she was reassured, despite it being a hard and challenging decision.

The project has given me a fresh platform to inspire colleagues with a passion for supporting mental health. I

thrive not only on team support but also the autonomous license it’s given me. To be a creator of your own path and interest is rare. It has evoked a thirst for progression, learning and challenging myself to make changes and be heard.

I was awarded an Inspiring Leader Award during the International Nurses’ Day celebrations here at PAHT in May and in August I received the Chief Nursing Officer’s Silver Award from Dame Ruth May, chief nursing officer for England (pictured, previous page, left, with me, centre, and Sharon McNally, director of nursing, midwifery and allied health professionals and deputy chief executive, right).

This was fantastic recognition for the importance of this work

to support the mental health of children and young people.

I am now looking forward to commencing my new role as a children and young people’s mental health liaison nurse. This is a new role within PAHT, but has seen much success in other trusts, and is an opportunity to further improve the experience for our young patients. For more information, please contact me at cassie. burke@nhs.net

Showcase your work in the next edition of Our Journal

Articles published by our #PAHTPeople...

Take a look at some examples of the range of articles published or contributed to by our people since the last edition of Our journal - a fantastic achievement. Full information of authors and articles are available from the library team: paht.lib.desk@nhs.net

y Abnett, H., et al. (2022). "Early introduction of the multi-disciplinary team through student Schwartz Rounds: a mixed methodology study." BMC Medical Education 22(1): 523.

y Ahmad, M. S., et al. (2022). "Changes in the Emergency General Surgery Operations in the Setting of COVID-19 and Impact of Strategy of NonOperative Management on Outcomes in Acute Appendicitis." Cureus 14(8): e27552.

y Akter, N. and A. Abousamra (2022). "Education: Retinal racemose hemangioma arteriovenous malformation investigations, clinical course and management." Acta Ophthalmologica.

y Aras, C., et al. (2022). "In vivo generated autologous plasmin assisted vitrectomy in young patients."

International Journal of Retina and Vitreous 8(1): 36.

y Arif, S. and J. Wong (2022). "Quality assurance in cellular pathology." Diagnostic Histopathology 28(8): 364-368.

y Bamunuarachchi, K., et al. (2022). "A Case of Exogenous Lipoid Pneumonia Caused by Inhalation of Baby Oil." American Journal of Respiratory and Critical Care Medicine. Conference: International Conferenceof the American Thoracic Society, ATS 205(1).

y Becher, G., et al. (2022). "A Retrospective Real-World Study of the Effectiveness and Tolerability of Tildrakizumab in UK Adults with Moderate-toSevere Chronic Plaque Psoriasis." Dermatology And Therapy 09: 09.

y Chapman, R., et al. (2022). "Acute kidney injury following induction of chemotherapy: Diagnosis and management in critical care." Journal of the Intensive Care Society.

y D'Angelo, A., et al. (2022). "An update on antibodydrug conjugates in urothelial carcinoma: state of the art strategies and what comes next." Cancer Chemotherapy & Pharmacology 90(3): 191205.

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