Hey @Emma Richardson I must have missed this previously, but just stumbled across your thread. Did you finish your project on this? I would love to read it if this would be possible please? Sounds really interesting. What were the main barriers and enablers to safer monitoring at night? What improvements were highlighted? So many questions!! ☺️
Great blog as always Claire! I think I remember you saying you've been finding walkie talkies work well when wearing PPE hoods....but since then I can't find the post 🤦🏼♀️. Can you explain this a little more please? Hearing within the hood is something a lot of our team are struggling with. Xx
Thank you, I'm a little late, but only just had a chance to read your fantastic, excellently written blog.
It hugely resonates with me:
"‘work as done, work as imagined’ (Wears, Hollnagel & Braithwaite, 2015) – this shift on paper looks as if it was a ‘good shift’ but in fact......"
I loved learning about this concept at the Patient Safety Congress last year....it's just so true........ and we so need to curb the checklists....they started to help save time and act as reminders, but there are now checklists to check that you have checked the checklist! Does it actually prompt and prove the task is completed?
I also really appreciate how you have explained the uplift experienced following the unusual announcement "we're fully staffed today!!" at handover. Starting a shift with a positive, motivated mindset is key for me.
I can only imagine how morale would suddenly be improved if staffing issues were solved! With better morale....magic happens! Ideas flow and motivation returns and staff are keen to work on positive changes to allow continuous growth.
Have I felt 'unsafe' giving care? Unfortunately yes, and generally due to being over stretched. The best nurses in the world are still only human with one pair of hands. As an Outreach nurse I see too often the corners that are cut to allow the nursing time to be stretched among so many patients at one time. It's destructive on all levels!
I hope we see changes made soon and would love to see safe staffing levels mandated nationally. When considering what makes for "safe" staffing ratios, I sincerely hope that 'work as done, work as imagined' is fully appreciated and blogs like this are read!
Thank you for taking time to write this piece. 🙏
Thank you for sharing!! I was looking for a good human factors reference for my current essay! I have found the book online via my university online library. I now have some references that I was after 👍
Great reply @Claire Cox
I particularly relate to you saying the reporting person usually feels strongly about what has happened and is often motivated to complete the Datix as they want to see a positive change happen.....I have often witnessed staff staying on late to complete these....I'm sure this is a common occurrence everywhere!
It's very true that staff involved in the incidents often have excellent ideas as to how to avoid the same problem in the future. I can imagine adequate staffing is a common solution!!
If a field was added onto a Datix form template (or equivalent) asking for suggested solutions to prevent the problem from recurring in the future, it would potentially provide a wealth of ideas and evidence for consideration? If the same solutions are frequently suggested over and over, would that suggest that the idea is highly worth considering?
I'm not sure if this is common practice elsewhere, but our Critical Care and High Dependency Unit specifically share feedback of incidents among staff, routinely. One of our senior sisters who has a special interest in clinical governance reviews all incidents related to our units. She regularly emails "incident summaries" and associated changes in practice to all unit staff. For specific incidents, a "lessons learnt" document is attached. These are written by various staff and allow us to make positive changes from our incidents. Lessons learned are discussed among staff and displayed on our staff noticeboards (email receipts have even been used to help ensure the information is read).
The Trust have recently started a "Hot Spots" monthly briefing which includes information about important clinical safety issues and staff are encouraged to share at safety huddles, handovers and briefings. Nevertheless.... so far, I have only received one (by email)....but maybe they're in the pipeline.
I am not so sure how the other Datix reports are shared within the rest of the hospital. Your post prompted me to read the feedback received via email following my more recent Datix submissions...... honestly, I wish I hadn't!! Not one feedback provided me with confidence that changes were being made....just acknowledgement of my Datix and a "now move on and bury" type of reply! It would be lovely to have the time to respond to some of the feedback received! I believe the "Hot Spots" is a good start as will likely focus on the most common/important issues.
Better Datix feedback would be encouraging and educational for all involved. Better still, a comment provided, acknowledging staff ideas (if provided), would help encourage the flow of ideas to continue........ and if the solution was not possible (often cost related) perhaps a compromise solution could be discussed. Just maybe, money saving ideas may become more everyone's business as a result.
I'm very interested on how and what Datix feedback is provided elsewhere? For me, dismissive feedback is frustrating and actually discourages future reporting than providing no feedback at all!!
I'm not familiar with who is tasked with the Datix feedback and can appreciate time is likely a hugely limiting factor to carefully consider each response.
Thank you for posting. It's great to reflect on such situations and discuss with other like minded people.
PS: It's not Datix related, but this made me think of our staff suggestions box. Do you have one on your ward? It might be something you and your colleagues find beneficial.
We all notice aspects of our work life that we would like to change (for personal reasons and for our patients/visitors)...... making suggestions for positive changes may help limit some of these gripes and make for a happier workplace in general. We can't always expect our ideas to be materialised immediately and our managers may not have the scope that's required..... but..... often ideas are what spark off bigger things. I often have ideas.....some unrealistic, some achievable.....I am encouraged to discuss these with management who generally share my vision....they help guide me on how I can achieve my goal and support me to make the changes required..... and it's so rewarding when you personally experience your idea soaring!!
Don't ever give up.....remember it will all be worth the effort eventually!
Well done for raising your concerns. ☺️
Thanks @Claire Cox
How frustrating re your phone!! We have similar signal issues in a few places too! Same with our auto electronic-obs alerts in the internet black spots, hence a big reason we have to stipulate a bleep/call referral too.
Good lesson learned/tip to ensure C4C has a voicemail option when helping others set it up the service!! I also find this useful if I am unable to answer the phone straight away. I made sure to highlight in our new leaflet the details we require when leaving a message. We have also found text messaged C4C referrals work well too!! Our laryngectomy patients are encouraged to text us if they need us using the same number.
Did anyone record @Emma Richardson's talk? Well done to her, no wonder they loved it....she's awesome!
PS: totally agree.... would be so great if C4C was the norm and well known in all hospitals!! It's encouraging to see so many asking for advice about setting it up on Twitter....hopefully they will find these threads useful! I made our Leaflet with our sister-Trusts in mind so 🤞 they will set something up if they haven't already.
Sorry I have not been keeping up with the hub recently.... busy busy busy! 🐝
Better late than never, but I wanted to share our We're Listening (aka Call for Concern) Leaflet with you all. It's now fully published and already displayed in multiple areas!! 🙌 (sigh of relief!!) (SEE ATTACHED).
The plan is for it to be displayed in all hospital areas, but it's taking some time to get the news out and ask departments to order and display (they're free from Office Depot).
I have recently started an all hospital audit which is helping to get the word out. Also our Outreach Team are trialing email footers to spread word of things that we feel are important. For those of you who have not seen them, we also write a regular joint CCOT/HOOH newsletters.
An artist helped develop our 'ear' logo which we are trying to use on much of our stationary/correspondents with the hope of the logo becoming associated with the Outreach (CCOT) Team and ultimately our We're Listening service.
All ideas are very welcome on how to improve staff awareness of our service further. ☺️
For those that don't know, we have had a Call for Concern service in place in our Trust for many years, but have given it a huge revamp over the last couple of years....mainly to increase staff and patient/visitor awareness and understanding of it so it can be used effectively.
I keep a record of all calls received. More recently, I have attempted to collect the same data as @Mandy Odell used in her review article and will continue with this going forward. So far, our data is very comparable!!
Hope you are all keeping well.
Hey @Emma Richardson and @Claire Cox
Sorry I have not been keeping up with the hub recently.... busy busy busy! 🐝
Better late than never, but wanted to share our We're Listening (aka Call for Concern) Leaflet with you all. It's now fully published and already displayed in multiple areas!! 🙌
The plan is for it to be displayed in all hospital areas, but it's taking some time to get the news out and ask departments to order some (they're free from Office Depot).
I have recently started an all hospital audit which is helping to get the word out. Also our Outreach Team are trialing email footers to spread word of things that we feel are important.
All ideas welcome on how to improve staff awareness of our service. ☺️
Hope you are all keeping well.
Thanks for sharing @Claire Cox and @Emma Richardson
As you know, I have been working on our C4C patient information leaflet too.
We have had one for many years, but for 18 months, and counting, I have made major changes to this.
It's been a long and drawn-out process due to many NHS hurdles, but it's due at our Document Management Group (DMG) meeting again on 18th Aug. I truly hope they will approve it and I will move on to getting in printed. 🤞
I will share on here as soon as it's been approved!
Hope you're getting on well with the rest of your C4C work. 😊
Just a little update..... I've now made plans to support our new Sepsis Lead @Southend Hospital with some of her plans for World Sepsis Day on 13th Sept 🎉🎈. Plan to also take the opportunity to promote the hub during our visits around the hospital site! 🤞 @Sam @HelenH @Claire Cox ......don't suppose you have any promotional stuff you can send to us please to help raise awareness of the hub?
Look forward to hearing any ideas people are working on.
Our new Sepsis Lead, Tracy, also plans to join our hub community soon too! 🏥
Thanks @Sam and @HelenH for your kind words, glad you liked the post.... hope others find it helpful.
@Margot if you decide to tweet this, please tag our group Twitter handle '@CCOT_Southend'. Thank you. 🙏
Our Critical Care Outreach Team (CCOT) work regular shifts within the CCU and our new high dependency unit (HDU). I believe we are not alone, but at times there is an element of divide across the teams and we wanted to limit the ‘them and us’ culture. Even when we are not working within the units, we need effective teamwork to maintain best practice and, ultimately, patient’s safety. Unlike some trusts, our outreach, CCU and HDU are all managed as one big team.
With this in mind, we brainstormed ideas for the reasons behind this ‘divide' and decided a regular newsletter might help us.
The initial benefits would be:
To keep CCU/HDU staff up to date with our current projects - this was a problem identified during recruitment into the outreach team as CCU staff suggested that they had limited opportunity to become involved in the work of the outreach team. Having the CCU staff become more involved and aware of the ‘extra’ work we do has helped to improve our working relationships; various nurses are now more involved with some of our projects, and others are looking to help with the view of progressing into a future outreach role.
To explain our role as it not always widely understood by some colleagues on CCU.
To offer our support to any individual wanting to work on a QI, but was not sure how to proceed.
To highlight our achievements and hard work and to introduce staff to some of our ‘behind the scenes’ work.
To involve all staff - we regularly asked staff for suggested content that they would find most useful.
The success of the newsletter quickly led us to adapt it to all hospital staff of any discipline or grade:
The above benefits were similar, but now pertinent to a larger audience, including healthcare assistants, students, physios, occupational therapists, speech and language therapists, doctors and management.
Some of our team are relatively new and it is a good tool to introduce them, using photographs to help improve our visibility and approachability within the hospital.
We wanted an ‘educational hot topic’ to be a regular feature to help maintain high quality care and standards amongst staff. We asked readers what topics they wanted to engage with. We now have a number of ‘guest writers’ for this section, from various specialties, to help share their knowledge and expertise. It is encouraging to hear how healthcare assistants, students and associate practitioners have found our newsletter content so educational and helped them to provide better care to the patients (and feel more engaged with the care they are providing).
Every time a new edition of the newsletter is sent out, I have received personal feedback of how useful and interesting it has been. Staff have often personally thanked me on the wards and in the corridor. There is a lot of effort and time that goes into these newsletters, but I feel it is definitely worthwhile. I am a great believer in valuing staff and this has really helped me to keep going, despite the difficulties encountered.
The newsletter is now jointly written with our Hospital Out of Hours (HOOH) team. Although we are two separate teams, our lead, Rhona, is shared. We all work very closely, supporting each other and preach many of the same messaged, so this just made sense.
Challenges and lessons learnt:
Team engagement – not all team members wish to be involved in the newsletter and feel there is little extra time to engage with this extra workload.
The time spent writing and editing is significant and cannot be done within my working hours, so much of this work has been in my own unpaid time.
I have to rely on some sections being written by other professionals. It is difficult to quickly replace sections if deadlines are missed or not already within a requested word limit.
I initially edited the newsletter in Word, but found formatting was very difficult. I discovered Publisher and taught myself to use this. I am sure I can learn much more, but have so far found this much easier to work with.
We wanted to send to ‘All email users’ within the hospital, but were told this was not possible. Instead, I use various groups of staff set up on our work email system.
My first Ward newsletter was only sent out to CCU staff and Ward Managers. This was not always shared with other staff; inboxes were frequently full and therefore emails could not be received; and this method missed vital teams such as physiotherapists, speech and language, doctors, students.
Following my distribution issues, I have since compiled a ‘mailing list’ which I add to regularly (this includes professionals in other trusts who enjoy our newsletter too). The hospital librarian team and individual keen students have personally asked to be added to this list which is encouraging.
Perhaps we could all share our newsletters and stories within our trusts and on the hub and support each other in this patient safety initiative. I’d love to hear from others on ideas for newsletters and how they have overcome some of the challenges I describe above.
CCOT Newsletter to WARDS FEB 2019 Edition 1.pdf
CCOT Newsletter for ITU Staff Edition 1. Feb 2019.pdf
Joint CCOT and HOOH Newsletter 2nd Edition June 2019.pdf
I'm currently working on our latest newsletter edition, which includes a section about the hub with the kind help of @Sam, which I hope by sharing will encourage more and more staff to join the hub network.
Hey @Kirsty Wood
This sounds like a really interesting piece of work you are doing and I'd be very interested to hear what you find. I too feel your frustration with SBAR handovers..... lack of decent information during a referral puts the patients and us at risk.
We have tried using stickers in the notes for SBAR, teaching it, promoting it.....most of the time the only way we achieve anywhere near this is by probing for it.
We use electronic observations which I believe has made nurses more aware of the significance of NEWS scores....but more often than not, we now receive a referral "my patient is scoring a 7 so you need to review" and if we let it, that would be the end of the conversation (the nurse wouldn't even necessarily know what is causing the score of 7!).
Please keep us posted on the nuts and bolts that you find out. Really interested.
Hope we can all put our heads together and improve SBAR everywhere.
PS: how about making your survey electronic and sharing it on Twitter? Think it could open up a wider audience for you and therefore expose more nuts and bolts?
Quite a few teams in our Trust seem interested in doing something; we haven't yet discussed what though. Interested to hear what others have in mind to help get the ball rolling. I have not seen any other mentions of this day other than hearing about it at Patient Safety Congress..... would be a shame to see it pass by unnoticed!
How about asking as many patients, visitors and staff on duty that day to make a patient safety improvement suggestion or pledge..... might take some time to read through all the suggestions though (unless perhaps it could be an electronic version that can be digitally analysed? 🙏)
Thanks for getting the ideas flowing @Jayne Addison @Claire Cox
Only managed to skim-read this, but it looks amazing.....hope this is the future vision for us all. Looks like we can learn so much from the team at Liverpool.
A personal frustration.... can anyone help please....?
We tend to use email a lot to alert us of new policies, reminders, departmental changes, updates, news, team discussion threads etc. I also tend to use my email as a filing system to help me organise my workload (less clinical-related stuff) and often refer back to many emails using the search function when needed. Some emails I keep for revalidation if I have been thanked or praised. I am also reluctant to delete emails as I have had to use them as a form of documented proof on some occasions.
Even though I try to be as ruthless as possible, delete attachments and save large emails to my personal drive on the hospital network, I am always running out of digital space (email and drive space). This then prevents me from sending or receiving important email correspondents. (PS I have already asked IT to increase my space limit).
I have noticed this must not just be a personal problem as I have frequently sent group emails out and received automatic replies that certain email users will not receive my mail as their inboxes are full. This seems like a potential patient safety risk if some users are not receiving certain important information (not to mention the wasted time trying to sift through endless emails in an attempt to delete something less important).
Does anyone have any tips or advice for me please?
Great stuff, I'm working on our next newsletter now so good timing! thank you. I have been spreading the word verbally within our immediate teams and to the staff I meet on the wards whilst completing my Outreach reviews (particularly mentioning it to those who I know are particularly interested in QI and patient safety). It would be great if someone @Sam @Margot could send me a little text which will best promote the 'hub' in my newsletter......ideally this needs to be within about 100-200 words please, if possible. Thank you. I will attempt to combine this with a small personal account of how I'm finding it and how valuable I think it will become and hopefully we will start seeing more and more people getting involved to make it work.
One minor bug-bear currently, is when using the site on my smart phone..... I press the 3 horizontal lines (top right) which links to a 'pop up'. When attempting to use the top 4 functions (activity log, search, notifications, messages) only the activity log and search page work (the notifications and message buttons do nothing). Currently, I find the website easier to use on the laptop, but don't always have this to hand. Will you be developing an App? I find the activity log really useful and have managed to find a few people to follow via this log. I am sure there is probably much easier ways to use the site, but I'm still finding my feet at the moment.
Thank you and speak soon