Kirsty Wood

We are looking into introducing a new device to deliver CPAP at ward level into our trust. Currently we use NIPPY machines which can deliver some PEEP when in a selected mode, however the downfall to this is, it can only produce an oxygen concentration of around 50%. Often, the patient groups that require this intervention are on high oxygen requirements and so particularly in the early stages would benefit from a device that could deliver both. I have previously worked with Pulmodyne 02-Max trio which allows up to 90% oxygen and PEEP up to 7.5cmH20. Majority of patients responded very well to this treatment. I wondered whether any other trusts/ team have any other experiences/ devices that they may use and recommend? @Danielle Haupt@Claire Cox@Emma Richardson@Mandy Odell@PatientSafetyLearning Team@Patient Safety Learning@Patient safety Hub@CCOT_Southend

I agree Claire, it becomes extremely difficult to screen those patients that have high NEWS but are stable with a plan and those that may not fit into certain categories that are at great risk of deterioration. Part of the reason, I think, is because of the high quantity of patients that score NEWS throughout the day, and nursing staff feel they need to alert CCOT for majority of them, not because they are worried necessarily but because it says in the policy and they are worried that if they don't they will be held responsible. In turn, we are conditioning the nursing population to move away from using nursing intuition and losing the confidence to make clinical decisions. In some ways, they are relying on electronic systems to tell them what to do with their patients instead of their nursing experience and knowledge kicking in. We are receiving more and more referrals where staff members don't really know why they are referring, just that the 'policy says so'. And we are seeing less conversations where staff are aware of their patients scoring, have assessed the patient themselves, had a medic review them and are happy that there is a plan in place. Whether this is the new generation of nurses we are seeing, or due to the transition to electronic systems/ devices, the fear of litigation or the lack of time for nursing staff to care for their sick patients. We provide training about the CCOT and all aspects deteriorating patients varying from nursing students, medical students and all grades which should off set some of the difficulties. Despite this, the route of the problem is still unknown and so I do not have any magical solutions. Sorry. Would love to find out if anyone else is having similar experiences and/or if anyone has any suggestions to help?

Great blog, fascinating content. Looking forward to reading more.

Our Call 4 Concern leaflet is in the very early draft stages, will post when finalised.

Thanks for your response @Danielle Haupt The survey, through surveymonkey, has gone out to staff members direct to their emails and on our shared facebook page for the trust. Fingers crossed I get a decent amount of responses. It is an interesting though putting it on twitter and finding out what the wider audience think, at this point I would need to gather data from my trust in particular, but after that could be an interesting option.

@Danielle Haupt Great idea to put in your newsletter! @Sam We are just setting up our own newsletter and would love to put about the hub in there. Would you be able to provide us with some text too?

Thanks @Claire Cox, I've posted a new topic in the 'how to engage for patient safety' forum, hope this okay?

Morning all, As a Critical Care Outreach nurse of many years, one of my greatest bugbears is SBAR handover, or there lack of! Within my trust, there is an SBAR proforma attached to the NEWS2 chart, which appears to be fit for purpose currently. (We are still on paper obs charts, moving to e-obs by the end of the year) SBAR is taught and embedding in all our teaching and training, the candidates at the time of the courses are all able to giver perfect SBAR handovers in simulation but as soon as they walk out the door all of that seems to disappear. It is all too often we receive poor handovers for referrals, the lack of information and clarity means that we cannot prioritise patients effectively. I am currently looking at the nuts and bolts of why this is and what we need to do to address the issues. I have started by sending a survey out to all registered nursing staff so that we can get feedback from those who should be using it. Hopefully, from the responses this may mean we can formulate a plan to improve this. Does anyone else have the same issues/ concerns in you line of work? Has anyone got anything that they do in their trust that works?

Hi All, As Dani has already mentioned, the CCOT team at KGH are undertaking many QI projects and have been truly inspired both on this forum and through twitter. It is providing us with great insight and most of all inspiration to push through. As we all know, spearheading change and QI is not an easy task! We definitely need all the help we can get, and so will lap up all of the invaluable experiences other trusts have. And hopefully, in turn can use this forum to share our experiences. All the best, and looking forward to seeing more posts. Kirsty @AIRTeam_KGH