National Leadership & Innovation Agency for Healthcare

Conference Abstracts 2005

Health Technologies Category only

Table of Contents Introduction 1 HT2 E-HEALTH GOVERNANCE FRAMEWORK 2 HT4 SUSPENDED IN TIME – TACKLING SUSPENDED PATIENTS 3 HT5 A SINGLE CASE STUDY INVESTIGATING THE EFFECTIVENESS

OF COMPUTERISED RESPIRATORY MUSCLE TRAINING IN A PATIENT SUFFERING FROM CHRONIC ASTHMA

4

HT6 REPEAT PRESCRIPTIONS ON-LINE 5 HT7 REFERRAL AND DISCHARGE COMMUNICATION PROJECT 6 HT8 EXPANDING THE BOUNDARIES OF EVIDENCE: THE WELSH E-

LIBRARY FOR HEALTH 7

HT9 PRODUCTION OF A HIGH QUALITY CD ROM TRAINING PACKAGE ON BURNS MANAGEMENT FOR THERAPISTS

8

HT10 DEVELOPMENT OF AN INTEGRATED CARE PATHWAY FOR CHRONIC OBSTRUCTIVE AIRWAYS DISEASE- PHASE 1 PRIMARY CARE

9

HT11 SPECIALIST HEALTH INFORMATICS LEARNING PACKAGE 10HT13 MATERNITY RECORDS PILOT – LINKED TO MY HEALTH

ONLINE 11

HT14 A WEB BASED TRAINING MANAGEMENT SYSTEM THAT WORKS

12

HT15 ELECTRONIC HEALTH RECORDS IN A MATERNITY SETTING 13HT16 CLINICAL PORTAL PROJECT CARDIFF AND VALE NHS TRUST 14HT17 DEVELOPING AN ELECTRONIC ‘TO DO’ LIST TO IMPROVE

BOOKING AND WORKFLOW 15

HT18 ELECTRONIC REFERRALS IN NORTH WEST WALES 16HT19 CHANGING FROM DICTATION TO SELF TYPING DISCHARGE

LETTERS 17

HT20 MOVING TOWARDS A JOINT, ELECTRONIC PATIENT RECORD 18HT21 THE REDESIGN OF A CLINICAL MEDICAL PHOTOGRAPHY

SERVICE BASED ON THE PRINCIPLE OF LEAN THINKING 19

HT22 ONLINE WITH LEARNING (OWL): SUPPORTING EXCELLENCE IN PATIENT CARE

20

HT23 AUTOMATED PHARMACY DISPENSING SYSTEMS 21HT24 GP DIRECT ACCESS CARDIAC INVESTIGATIONS SERVICE FOR

TORFAEN 22

HT25 PROVIDING QUALITY E-LEARNING ON A SHOESTRING 23HT26 A NOVEL METHOD TO ASSESS SURFACE DISINFECTION IN

HOSPITAL PHARMACY ASEPTIC DISPENSING UNITS 24

HT27 AN ONLINE LEARNING SYSTEM FOR GP APPRAISAL AND CPD 25HT28 “OVER THE ETHER” – WIRELESS ACCESS TO CLINICAL

INFORMATION 26

HT29 DEVELOPMENT OF A USER FRIENDLY APPLICATION FOR CAPTURING LIVE BED STATE INFORMATION ON WARDS

27

HT30 TRAFFIC LIGHT SYSTEM TO MONITOR 4 HOUR WAITS IN A&E 28HT31 DEVELOPMENT OF A TOOL TO IMPROVE DATA QUALITY &

IDENTIFY DUPLICATE RECORDS ON PATIENT SYSTEMS 29

HT32 ELECTRONIC DISCHARGE SYSTEM 30HT33 THE SHAKERSCOPE 31HT34 IMPLEMENTING NATIONAL GUIDANCE AT NORTH

GLAMORGAN NHS TRUST 32

HT35 ‘SICKNOTE OR BUST’. INSIDE THE FITNESS FOR WORK CONSULTATION. THE DEVELOPMENT OF AN E LEARNING PROGRAME FOR GENERAL PRACTIONERS

33

HT36 A COMPUTERISED PHOTOTHERAPY RECORDS SYSTEM 101 34HT37 ELECTRONIC WEB SELF-ROSTERING – A TOOL FOR

WORKFORCE EMPOWERMENT 35

HT38 BEATING THE BLUES: A COMPUTERISED COGNITIVE BEHAVIOUR THERAPY (CBT)

36

HT39 THE PEACE OF MIND PROJECT 37

1

INTRODUCTION Managers and clinicians in health and social care in Wales were invited to submit abstracts for oral or poster presentations at the National Leadership and Innovation Agency for Healthcare Conference 2005, in the following categories. CLIMATE AND CULTURE

• Creating an improvement culture in an organisation. • First hand accounts of changed attitudes, approaches and priorities.

COMMISSIONING

• Use of commissioning to plan and change the delivery of services. • Innovative approaches for managing chronic diseases. • Joint planning and commissioning between NHS and local government or

between neighbouring LHBs. • Network approaches to planning and providing emergency services.

HEALTH TECHNOLOGIES

• Case studies that demonstrate an accelerated and improved use of technology which supports the delivery of service improvement.

• Case studies that demonstrate an integrated approach in bringing together leadership learning and/or innovation in service practice using technology, i.e. use of e-learning, modern learning solutions etc.

• Case studies that demonstrate improvements in patient care as a result of better use of information and supporting technology.

LEADERSHIP IN INNOVATION (ANN LLOYD AWARD)

• Leadership - Clinicians, professionals and managers leading and shaping services together, that drive change and deliver high standards of care with a focus on continuous quality improvement e.g. new models of care, leading networks, service reconfiguration, improved clinical outcomes.

SERVICE DEVELOPMENT

• Moving the big dots. • Service (and workforce) reconfiguration (to incorporate service

reconfiguration, education, training and workforce). • Novel approaches to the design and provision of services.

2

HT2 E-HEALTH GOVERNANCE FRAMEWORK Author Edward Keith Jones, AIM Project manager Organisation North West Wales NHS Trust Contact Edward.jones@nww-tr.wales.nhs.uk Aims: •Enable staff to uphold professional, personal and service standards. •Increase the sense of achievement and pride that comes from doing the job well. •Provide and be seen to provide a systematic way for staff to express their concerns and take control of the situation. •Enable ground level staff to take control, shape and influence the quality of care within each location. •Clearly define the standard of care required and monitor performance accordingly. •Provide the opportunity for self-governance within each locality. Methods Used: In April 2003 Minor Injuries within the Trust became nurse led. It was essential that nurses working in these departments receive appropriate training supervision and clinical advice was to be sought from the nearest DGH via video conferencing. This ensured that patients were treated in the most appropriate setting by the appropriate person. Results and Discussion: Since its introduction in June 2004. Nurses have seen, treated and discharged 4,000 patients. Weekly clinical teaching sessions have been developed between units. There have been no clinical adverse incidents or complaints received. Conclusion: High efficiency clinical assessments with the reduction of patients attending the main A&E at the nearest DGH. 75% of the caseload was seen, treated and discharged by a nurse.

3

HT4 SUSPENDED IN TIME – TACKLING SUSPENDED PATIENTS Author Jonathan Baglow, GtGP Project Manager Organisation Bro Morgannwg NHS Trust Contact jonathan.baglow@bromor-tr.wales.nhs.uk Aims: 1. To adopt best practice in relation to the management of suspended orthopaedic inpatient and daycase patients (at March 2005 66% of all suspended patients were orthopaedic with 35% suspended for over six months). 2. To address the recommendations of the Audit Commission report 2002 “Waiting for Elective Admission” by stopping patients being added to waiting lists prematurely, by regularly reviewing patients to determine an appropriate provision of care and by ensuring patients are reinstated onto the live waiting list in a timely manner. Methods Used: Interrogation of information systems, including statistical analysis to identify key issues. Working through PDSA cycles with individual clinicians and administrative staff to review and amend processes to achieve a standardised approach to managing these patients, either to add them to the live waiting list or return to the GP. Results and Discussion: Initial results highlighted gaps in data capture which led to enhancements to the patient administration system. Detailed analysis determined reasons for suspension were either medical (51%) or social (49%) and highlighted the validity of the suspension. As a result of the PDSA focus the number of suspended orthopaedic patients fell from 148 in March 2005 to 52 in August 2005 and overall suspensions for other specialties continue to reduce significantly month on month due to raised awareness of the issue permeating throughout the Trust. Conclusion: GPs and patients are happy with the new process. Protocols have been established to ensure all suspensions are authorised by the relevant directorate manager with the aim of achieving the target of no more than 5% of patients suspended at any one time. Key personnel involved in the management of suspended patients now have electronic access to information. The next steps are to address early additions to the suspended list. Reporting of progress against the target is now one of the Trust’s Critical performance Success Factors.

4

HT5 A SINGLE CASE STUDY INVESTIGATING THE EFFECTIVENESS OF COMPUTERISED RESPIRATORY MUSCLE TRAINING IN A PATIENT SUFFERING FROM CHRONIC ASTHMA Author SJ Annetts, Physiotherapy Lecturer and K Chatham, Clinical Specialist Physiotherapist Organisation Cardiff University and Cardiff and Vale NHS Trust Contact Annetts@Cardiff.ac.uk Aims: 1.To investigate if lung function (FVC and FEV1) change as a result of respiratory muscle (RM) training 2.To investigate if breath sounds change as a result of RM training 3.To investigate if RM strength and endurance change as a result of RM training Methods Used: Patient A used computerised RM training for six weeks. The equipment used was the TIRE (Test of Incremental Respiratory Endurance). Each time the equipment was used the patient made a maximum inspiratory effort in order to form a template unique to that individual. To train the inspiratory muscles this curve was reduced by 20% to an 80% target template. The training consisted of 6 levels of 6 breaths. Level A had a 60 second rest period between breaths. This was decreased to 45, 30, 15, 10 and 5 seconds at level B through to F. This training was perfomed three times a week. On the remaining 4 nights of the week the patient trained at 40% of the target template with 20 second intervals until she felt that she had cleared any sputum present. Results and Discussion: Lung Function: At Onset After 6 Weeks Percentage Increase FEV1 2.1 litres 2.2 litres 4.76% FVC 3.1 litres 3.45 litres 11.29% Breath Sounds: At commencement of the programme there were coarse inspiratory and expiratory crackles and a low pitched inspiratory wheeze in both bases. After six weeks the chest was clear. RM Strength and Endurance: At Onset After 6 Weeks Percentage Increase Maximum Inspiratory Pressure

91cm 105cm 15.38%

Accumulated Area (indicating work capacity)

14292 19312

35.12%

Conclusion: 1.There was an increase in both FVC and FEV1. 2.There was an improvement in breath sounds. 3.There was increase in RM strength and endurance

5

HT6 REPEAT PRESCRIPTIONS ON-LINE Author Hanna O’Connor, Project Facilitator Medicines Management Collaborative Organisation Cardiff Local Health Board Contact hanna.o’connor@cardifflhb.wales.nhs.uk Aims: To promote easier access for working and housebound patients by providing convenient access to the medicines management service and reduce waste by providing a more robust system. Methods Used: Software was installed in 3 GP practices to enable patients to order their repeat medication on-line from their own homes without having to come into the surgery, telephone or send a stamp addressed envelope. The principle design requirements of the intended software are: - security - confidentiality - ease of use whilst retaining control within the practice - promoting easier access for patients - providing patients with a simple but highly communicative facility for the request of repeat medication Results and Discussion: The three practices are in different socio-economic areas of Cardiff. Looking at the system across three different areas will allow the local project team to identify a true need and value which will help future service and financial planning. There are already 400 patients registered to use the service including many of the over 60’s. Feedback has been overwhelmingly positive. Comments have included: "Really Good", "Efficient, saves time," "Quick and slick," "24hr turnaround rather than 48." Conclusion: This facility allows patients to request repeat medication at any time without having to phone or visit the surgery. In addition, patients are able to direct the prescription to a pharmacy of their choice, for example housebound patients may choose a pharmacy offering a script delivery service. The system encourages patient feedback and facilitates the updating of personal information on registration.

6

HT7 REFERRAL AND DISCHARGE COMMUNICATION PROJECT Author Dr Chris John and Dr SK Gupta Organisation National Public Health Service (NPHS) Primary Care Quality and Information Team (PCQIT) / Carmarthenshire NHS Trust Contact Martin.Holloway@NBPHS.Wales.NHS.UK Aims: It was envisaged that Primary and Secondary care Clinicians in Carmarthenshire would benefit from greatly improved communication, by receiving accurate and timely information across the Primary Secondary interface. e.g. -Reduce time spent by doctors and staff chasing information -Reduce the level of clinical risk, especially in the medication section -Decrease the risk of re-admission Methods Used: Referrals - An SHO was identified by the Acute Trust to assess the completeness of data against the standard. A sample of 500 referrals were checked for compliance against the SIGN guidance and the NPHS PCQIT analysed the data. In addition a Standardised Referral template was devised and implemented within GP Practices which could be automatically populated from the GP Clinical Systems. Discharge - Primary Care nominated three Practices to collect the discharge data and the LHB funded staff time. The Clinical Audit Department devised a database which mirrored the Discharge Advice Letter. The Trusts IT Department assisted by linking the three Surgeries to populate a joint database. This was extremely innovative and greatly facilitated this complex audit. Carmarthenshire NHS Trust Audit Department undertook the analysis of a sample of 667 Discharge letters. The Trust reviewed the SIGN guidance and considered issues which included: -There was different practice in the two main hospitals in the Trust with completely different discharge advice letters. -The discharge advice letter was not computerised so multi-copies were required i.e., GP, Pharmacy, coding and patient notes. -Changes were needed in the medication section. -Extra sections had to be included to allow for the latest cancer standards e.g., Safehaven fax and 10 day cancer rule. Following appropriate approval a standard discharge advice letter was launched. Results and Discussion: The team's goal was to introduce a standardised referral and discharge letter to improve communication between primary and secondary care which would ultimately improve patient care. This has been achieved. Conclusion: We have been able to highlight issues to be addressed to ensure relevant information is transferred on referral and discharge and working together has proved to more effective in the re-design and change of practice

7

HT8 EXPANDING THE BOUNDARIES OF EVIDENCE: THE WELSH ELIBRARY FOR HEALTH Author R A Richards, Project Manager and Barker J, Finn S Organisation Informing Healthcare (Welsh Assembly Government/Bro Morgannwg NHS Trust) Contact roger.richards@ihc.wales.nhs.uk Aims: The Health of Wales Information Service (HOWIS) e-Library for health has developed in an ad hoc and incremental way, but has been largely successful. The Access to Knowledge (A2K) Project at the Informing Healthcare programme is currently implementing a planned expansion of the e-library so that patient benefits can be obtained through vastly increased evidence based practice, there is a repository of knowledge to interface with the forthcoming Individual Health Record and NHS staff are empowered and motivated by resources to support their practice and lifelong learning. Methods Used: Prior to the inception of large scale procurement and implementation from autumn 2005 on, a pilot phase of delivery has been completed. The ‘quick win’ exercise developed methods to prioritise and recommend new resources (e.g. e-books, e-journals, e-databases) during the period March – September 2005. NHS Wales Librarians and knowledge specialists formed a ‘Quick Win’ review panel to appraise content for subsequent procurement and addition to the e-library. Results and Discussion: Most new e-resources are too recent to be evaluated, though anecdotally have been very well received. Examples are the e-BMJ online, Turning Research into Practice (TRIP+) database, Royal College of Radiologists Referral Guidelines or the MIDIRS midwifery database. However there are early usage statistics on two of these - the Oxford e-textbook collection and 20+ British Medical Journal ejournal titles – with a rapid growth in searches and web sessions between May 2005 to July 2005 (from 2,836 to 7,590 and 1,594 to 3,885 per month respectively, base of zero). The July 2005 figures constituted 13% of all databases searches and 6.6% of all web sessions across the entire HOWIS e-library. Conclusion: The pilot has demonstrated a significant and rapid national take up of only a small proportion of the planned e-library expansion. It has helped fine tune methodologies for evaluation and through delivery has increased stakeholder confidence and participation for content procurement, and underpinning project groups covering education and training and the development of a new e-library portal.

8

HT9 PRODUCTION OF A HIGH QUALITY CD ROM TRAINING PACKAGE ON BURNS MANAGEMENT FOR THERAPISTS Author Menna Davies. Clinical Specialist Physiotherapist Organisation Welsh Centre for Burns and Plastic Surgery, Swansea NHS Trust, Morriston Hospital, Swansea Contact Menna.Davies@swansea-tr.wales.nhs.uk Aims: Devise an evidence based easily accessible training resource medium on the management of burns for non-specialised therapists presented in an innovative and visually stimulating way. Methods Used: A questionnaire survey to therapists within our region highlighted the need for an evidence based resource medium that would be readily available in each physiotherapy and occupational therapy department. There is nothing currently available aimed at therapists that would address this. An interactive CD Rom was chosen as the best medium to combine literature review, illustration of burn wounds and scarring using photographs and videos. In order to provide structure and navigation of the CD Rom it was decided to utilise a web page format allowing the individual to click onto each topic and utilise the training tool to their specific needs, allowing time for reflection and further study. Conclusion: The multidisciplinary feedback received supports that

• This development provides an excellent training programme in an innovative way that is of particular value to such a visual speciality as burn care

• The CD Rom is an excellent way of using modern technology in an user-friendly format for learning

• The CD Rom can be utilised as a medium for training by other disciplines • The CD Rom has the

potential to be distributed both nationally and internationally.

9

HT10 DEVELOPMENT OF AN INTEGRATED CARE PATHWAY FOR CHRONIC OBSTRUCTIVE AIRWAYS DISEASE- PHASE 1 PRIMARY CARE Author Nicola Davis Organisation Swansea Local Health Board Contact nicola.davis@swansealhb.wales.nhs.uk Aims: The aim of this innovation is to establish evidence based care for people with COPD within primary care across the whole of Swansea: • By improving gains in patient treatments • Increased patient quality of life by reducing exacerbations • A reduction of emergency admissions to secondary care • Improvement of communication across primary and secondary care Methods Used: Swansea Local Health Board set up a multi agency steering group with key stakeholders. The current process was mapped out and compared across different areas. Local evidence and evidence from Nice, British Lung Foundation and GMS contract was gathered. The group met three times to establish benefit outcomes. One practice with a GP and Nurse with an interest in Respiratory medicine agreed to share their current IT template which was based on the GMS contract template. The LHB ICP Manager and Data Analysist included further quality outcomes to this Template and a variance tracking system. It was then piloted in seven practices and data compared for unplanned emergency admissions in secondary care. The experience and gains from this pilot will be used to develop other electronic ICPs across Swansea for Primary Care. Results and Discussion: Using the GMS contract template as a starting point has been useful to sell the concept to GPs and Practice Nurses. The whole systems debate between primary and secondary care has been of great benefit. Conclusion: Depending on the final data eICP will be rolled out to all Practices in Swansea to ensure patient care will be of high quality everywhere in Swansea. It will be updated depending on its acceptance and following any new evidence for COPD.

10

HT11 SPECIALIST HEALTH INFORMATICS LEARNING PACKAGE Author Alison Johnstone, Health Information Resource Officer – NHS Direct Wales Organisation NHS Direct Wales Contact Alison.johnstone@nhsdirect.wales.nhs.uk Aims: To pilot a Health Informatics Learning Package in 2006, designed to provide Health Information Advisers at NHS Direct Wales with additional skills, which will assist in developing a core team of staff with specialist health informatics expertise and knowledge. Methods Used: After identifying the need for the Learning Package, the Project Management Team sought advice and support from various organisations, Higher Education and Health Professionals. It will be based around self-directed learning and e-learning, with additional support from other Health Professionals: Clinical Specialists, Information & Communication Technology Specialists, Governance Specialists and Higher Education Lecturers. The course content has also been endorsed by UK Chip. The content of the Learning Package has been divided into modules: •Are you up to date? •The History and developments of Health Informatics •Developing Research Skills •Information and Communication Technologies •Governance •Reflection and Evaluation Students will meet set Learning Outcomes for every module, and will be expected to create a Professional Portfolio of reports, briefing papers and evidence of performance. Work carried out will be supported by lectures, training manuals and a specialist Library of textbooks. Results and Discussion: Health information is constantly evolving. There is now a recognised need for health information alongside the delivery of many other forms of healthcare. The Health Information Team at NHS Direct Wales will play a large part in the ‘information revolution’ currently underway, with the specialist skills to provide the public and health professionals with accurate, up to date, evidence based, appropriate knowledge and information. It is also becoming evident that the field of Information & Communication Technologies (ICT) is going to play a large part in the future of the NHS. This has seen the development of the term ‘health informatics’, which is now becoming more established. Conclusion: If NHSDW is to remain competitive within the health informatics revolution, it is crucial that we are able to provide callers, health professionals and the expert patient with accurate, evidence-based responses to more complex enquiries. Building on the current knowledge, skills and tools which enable information to be collected, managed, used and shared to support the delivery of healthcare and promotion of good health will allow us to create a Centre of Information Excellence within NHS Direct Wales.

11

HT13 MATERNITY RECORDS PILOT – LINKED TO MY HEALTH ONLINE Author Deborah El-Sayed, Principle Project Manager and Jane Manley Midwife Organisation Carmarthenshire NHS Trust Contact jane.manley@carmarthen.wales.nhs.uk Aims: This project aimed to study patient/client held electronic health records in a maternity setting. We aimed to investigate linkage with maternity data systems and to evaluate the support this approach might give to antenatal screening. From this we hoped to get an understanding of how such records might be used in other settings across NHS Wales. This study was undertaken as part of a broader project within Informing Healthcare – the NHS Wales information and management technology programme. Methods Used: Clinical teams and patients/clients in Carmarthen will work together to develop data sets that can be accessed through web based forms. This system will replace the current patient/client held paper based booklet. Both expectant Mothers and their carers will be able to access the data. The success of the project will be assessed using patient/client satisfaction and confidence evaluations. Results and Discussion: To be presented when the trial is completed. Conclusion: Project in progress

12

HT14 A WEB BASED TRAINING MANAGEMENT SYSTEM THAT WORKS Author Helen Thomas, Training & Development Manager Organisation North Glamorgan NHS Trust Contact Helen.Thomas@nglam-tr.wales.nhs.uk Aims: Prior to the introduction of this in-house development, the marketing, administration and recording of training and development programmes was disjointed, onerous and often incomplete with no ‘smart’ means of identifying the training needs of the various staff groups within the organisation. The aim therefore was to maximise efficiency by: • Providing an electronic means of marketing, booking and administrating

training programmes • Providing an electronic training record for all staff which was easily

accessible • Proactively respond to the changing training needs of staff throughout the

organisation • Share training resources gaining economies of scale and effective multi-

disciplinary co-operation Methods Used: An in-house development resulted in the production of a web based, real-time approach to the entire process of marketing, booking, recording and reporting of training and development throughout the Trust. Results and Discussion: Using the intranet site, staff can view all training and development programmes, select a suitable course, select a preferred date, then book themselves directly onto that course. The system automatically generates a confirmation e-mail that is immediately forwarded to both the person booking the course and their line manager. This is a completely paperless system that involves no administration and provides the means to link training programmes to the Knowledge and Skills Framework (KSF). As well as providing a flexible and real time solution for staff, the administration section of this database has also been specifically designed to provide maximum support to the trainer. A printed attendance sheet is automatically generated and, in addition, an electronic attendance sheet enables the trainer to automatically update the individual’s training record. This interactive solution enables the training department to proactively support the varied staff groups during periods of change and modernisation. The use of this interactive web based development has provided a saving to the organisation of at least £30,000 per annum in administration costs. Conclusion: This on-line solution supports the modernisation agenda and has provided the first step between alignment to ESR and e-KSF. Staff within the Trust have become both familiar and competent using ‘self service’ and real time environments, thus ensuring ‘buy in’ and hopefully ease of transition to the new technological environment of the modern NHS.

13

HT15 ELECTRONIC HEALTH RECORDS IN A MATERNITY SETTING Author Deborah El-Sayed Principle Project Manager Informing Healthcare and Jane Manley Midwife Organisation Carmarthenshire NHS Trust Contact jane.manley@carmarthen.wales.nhs.uk Aims: This project aimed to study patient/client held electronic health records in a maternity setting. We aimed to investigate linkage with maternity data systems and to evaluate the support this approach might give to antenatal screening. From this we hoped to get an understanding of how such records might be used in other settings across NHS Wales. This study was undertaken as part of a broader project within Informing Healthcare – the NHS Wales information and management technology programme. Methods Used: Clinical teams and patients/clients in Carmarthen will work together to develop data sets that can be accessed through web based forms. This system will replace the current patient/client held paper based booklet. Both expectant Mothers and their carers will be able to access the data. The success of the project will be assessed using patient/client satisfaction and confidence evaluations. Results and Discussion: To be presented when the trial is completed Conclusion: Project in progress

14

HT16 CLINICAL PORTAL PROJECT CARDIFF AND VALE NHS TRUST Author Ruth Chapman, Project Manager and John Peters, Gary Bullock, Rob Jones Organisation Cardiff and Vale NHS Trust Contact Ruth.Chapman@cardiffandvale.wales.nhs.uk Aims: Access to different patient systems requires numerous passwords and patient searches. The Clinical Portal is a web gateway to these systems, but requiring only one password and one patient search. The aim is to present a user friendly, secure system, accessible from more PCs and bringing together new and existing clinical data and letters from several sources. This data is to be made available to General Practices. Methods Used: A web based system has been developed internally using Oracle Portal. A User can search various lists, eg inpatient lists, consultant schedules and can also search data for individual patients. These include waiting list details, outpatient appointments, inpatient admissions, diagnosis and procedures, A and E attendance, results and reports, clinical letters and x ray imaging. Users apply online for a password which can be authorised online without the need for paper forms. Mandatory Online Training is built into the system. Results and Discussion: A functionality Pilot concluded the system was useful or very useful (100% of responses); 81% said it saved time, 94% said it was easy or very easy to use, 70% said it had more or a lot more patient data. All would use in preference to existing systems. Initial responses from General Practitioners is very encouraging. Conclusion: This system provides extra clinical data to more people and will bring additional benefits when rolled out to General Practice. It provides a user friendly front end to which more clinical systems can get added over time.

15

HT17 DEVELOPING AN ELECTRONIC ‘TO DO’ LIST TO IMPROVE BOOKING AND WORKFLOW Author Janine Cochrane (Service Improvement Manager), Andy Warburton (Software Developer), Tony Bater (Head of Software Development). Organisation Velindre NHS Trust Contact Janine.Cochrane@Velindre-tr.wales.nhs.uk Aims: 1.To develop a ‘real time’ waiting list and clinic management system that was easy to use, promoted consistency and featured alerts. 2.To increase the reliability in managing clinics and referrals. Methods Used: The concept for development of the ISCO Today Sidebar was to bring investigation results to the attention of clinicians in real time to facilitate the electronic sign off of the results. The use of it in this project was an extension of that concept. Velindre has developed an electronic medical record known as ISCO. Through the CANISC project this has been extended for use by other Trusts to record cancer diagnosis and treatment information for all patients in Wales. The ISCO Today Sidebar is designed to sit down the side of the ISCO medical record screen. Initial development focussed upon ensuring that newly referred patients were booked promptly into clinics. Following demonstration to 8 secretarial and clerical staff, the ISCO Today Sidebar was expanded to include other features that would save time, act as reminders and increase data validation. A prototype was provided to 5 secretaries for a period of 4 weeks. Modifications and bugs were identified by staff and addressed quickly by the software developer. A training package was written and 1hr training was provided to the remaining secretarial and clerical staff (total of 25). Results and Discussion: Involving staff in the development of the ISCO sidebar resulted in the addition of a number of excellent features. The ISCO side bar now includes: 1. A list of patients referred without appointments (0-14 days show green, 15 – 28 days show orange, 29 days plus show red) 2. A list of patients suspended from waiting (at 14 days before end of suspension, patient name shows red). 3. Alerts for patients that DNA’ed 4. Alerts for unprocessed clinics. 5. A list of recently reported deceased patients Conclusion: The ‘real time’ nature of the report means that secretaries (and cover) are able to monitor their own Consultant team work flow. Data quality issues are being picked up quickly by staff that can correct an error. Involving staff in the development of the software has provided a more complete product, designed to meet their needs as well as addressing the reporting needs for consistency, accuracy and timeliness.

16

HT18 ELECTRONIC REFERRALS IN NORTH WEST WALES Author A MacDonald - North West Wales Trust, J Irwin - Anglesey LHB, H Adams - Gwynedd LHB Organisation Gwynedd LHB Contact Angus.Macdonald@nww-tr.wales.nhs.uk Aims: The ICT Foundation programme successfully connected all GP Practices to the VPN. This enabled exploration of ways of communicating electronically between Primary and Secondary care. An area for improvement was the sending of referrals from Primary to Secondary care. Referrals start life as electronic documents, which are then printed and sent by post to the Trust. The project group wished to establish the practicalities of emailing such referrals directly to the Trust via the VPN. Methods Used: The system developed uses a "virtual printer" model to ensure compatibility with Windows and clinical software. Following installation of client software in General Practice, any document may be "printed" to the E-referrals system, where it is automatically encrypted and despatched via email to the relevant Trust office. A service component in the Trust decrypts the incoming documents, stores details in a database and makes the documents available to authorised users. Trust reception clerks print the documents and process them according to standard policies. The system was piloted with Practices using different clinical systems in Gwynedd and Anglesey. As a result of the pilot, changes were made to the applications. Based on positive evaluation from the pilots and Trust, the application is being rolled out in North West Wales. Results and Discussion: Trust staff processing medical records have a more consistent flow of work, referrals are now printed at the Trust which makes them easier to handle. General Practice likes the immediacy of the system, having confirmation of both delivery and processing. Because the system requires Practices to adopt an electronic referral template, it encourages Practices to standardise processes around information management and make better use of available IT infrastructure. The success of the project has been recognised across North Wales and it is envisaged that similar solutions will be implemented by neighbouring health communities. Conclusion: Although the project did not have a designated budget, it did have the will of all parties to make it succeed. The Trust contributed technical expertise, while LHB staff engaged with General Practice and subsequently implemented the solution. It is seen as the first step towards further development of electronic information interchange between Primary and Secondary care which could include e-discharge.

17

HT19 CHANGING FROM DICTATION TO SELF TYPING DISCHARGE LETTERS Author Janine Cochrane (Service Improvement Manager), Wendy (ISCO Software Trainer), Debra Hogg (Senior Secretary) Organisation Velindre NHS Trust Contact Janine.Cochrane@Velindre-tr.wales.nhs.uk Aims: 1.To reduce the delays in sending discharge letters to GPs from 20 plus days to 48 hours. 2.To reduce the time required by all staff to write, check and sign the discharge letter. Methods Used: The dictation, typing, checking and signing of discharge letters was unacceptable. 50% took longer than 5 days to be dictated by the SHO (from the day patient discharged) and 50% took longer than 20 days to be typed. The new process was to for the SHO to generate discharge letters using the ISCO electronic medical record (this feature was available, but not used). Fields are automatically populated from ISCO e.g. diagnosis, admission and discharge. The SHO types the clinical information using a preformatted layout. It is anticipated that the new process is completed as close as possible to discharge. The training for using the discharge letter was added to the standard ISCO training in August 2005. Results and Discussion: The reduction in delay in sending discharge summaries went from 13% completed within 7 days to 95% completed within 7 days. 40% of the discharge summaries were completed within 48 hours of discharge (compared with 0%). The SHOs have not found the task of typing into ISCO onerous, as most use email and are familiar with typing. They report that they like the procedure and it is usually completed at one time. It is estimated that the time taken in dictating a letter is similar to typing for the doctor. The time for checking and signing is reduced because no time is required to re-find the notes. It is suspected that the accuracy is enhanced as there is no time delay between discharge and final checking of the letter. Conclusion: Removing multiple steps and staff from the process of clinical documentation can reduce delays. The argument for Drs not typing into an electronic medical record (because a secretary should do this) needs to be re-evaluated in certain instances. The time SHOs spend on non clinical work needs to be monitored however. It is hoped that voice recognition software in the future will mean that dictation directly into an electronic medical record can happen in the very near future.

18

HT20 MOVING TOWARDS A JOINT, ELECTRONIC PATIENT RECORD Author J. Anderson, Programme Lead ICM & AIM Organisation Pembrokeshire & Derwen NHS Trust, MHLD Division Contact jayne.anderson@pdt-tr.wales.nhs.uk Aims: Timely access to paper based clinical records in a fast, developing, 24 hour, geographically wide spread Mental Health & Learning Disability Service has been found to be increasingly difficult. The introduction of an electronic clinical system that can not only be accessed across the Division, but can also monitor outcomes, was felt to be the way forward. This would assist in and ensure access to records and outcomes, in order to aid clinical decision making. Methods Used: • The availability of a system that could support this process was explored • A paper version of the assessments was piloted and gradually introduced

across all Mental Health Services, with users advising on the further development of the tools. A further pilot within Learning Disabilities is due to commence shortly.

• A Project Initiation Document, Project Plan, Test Plans and an Action Plan were developed, in order to aid the introduction of the electronic system. These included a planned roll out of the hardware, software and training.

• Early discussions were undertaken with all stakeholders and links to other drivers, strategies and developments were ensured. This included linking in with the introduction of CPA, UAP, IHC, ECDL .

• An interface was developed between the Patient Administration System and the chosen clinical system. In advance of the new system going live, ready for the gradual introduction of users.

Results and Discussion: Initial Stages of the roll out ensured that there was a consistency in the documentation being used across the Division. Due to the complexities of introducing hardware, software and training the roll out has been slower than originally anticipated. However, early implementors are now completing assessments, care plans and patient contacts on line. Conclusion: Initial findings indicate that the introduction of a unified and electronic system will allow clinicians / practitioners to access and update records in a timely manner and save time. This will in turn enhance the care provided for service users.

19

HT21 THE REDESIGN OF A CLINICAL MEDICAL PHOTOGRAPHY SERVICE BASED ON THE PRINCIPLE OF LEAN THINKING Author Paul Crompton Organisation Cardiff and Vale NHS Trust Contact paul.crompton@cardiffandvale.wales.nhs.uk Aims: Clinical medical photography has the potential to play an important role in patient care when used as an objective benchmark for monitoring the visible signs of a condition. Conventional film-based photography struggled to fulfil this potential due to the time delay between taking the image, processing it and returning it the patient record. The aim of this project was to re-engineering the whole medical photography process based on the benefits of digital photography thus realising its potential to make a genuine, active contribution to patient care. Methods Used: Through a series of formal and informal discussions with key users of the medical photography service the core notion of “value” as defined by the principles of Lean Thinking was identified. At the same time the processes by which clinical medical photographs were produced and distributed was mapped identified. The process was then redesigned around the benefits of digital photography, eliminating, what Lean Thinking would describe as “waste” and adopting changes in processing, distribution and culture. Results and Discussion: The new production process reduced the turn-round time for clinical photography from an average of 14 days to 2, with over 85% of requests completed and returned to the requester in less than 2 days. This increased the value of the photographs in the on-going treatment of patients, as exemplified by the adoption of photography as routine for patients admitted to Cardiff & Vale NHS Trust hospitals with pressure sores. Conclusion: The success of this project proves the value of process redesign working hand-in-hand with the introduction of new technology. Without the identification of value from the client’s perspective and the redesign of the process, the benefits brought about by the introduction of digital photography might not have been realised.

20

HT22 ONLINE WITH LEARNING (OWL): SUPPORTING EXCELLENCE IN PATIENT CARE Author Sarah Morley, Training & Development Manager Organisation Gwent Healthcare NHS Trust Contact sarah.morley@gwent.wales.nhs.uk Aims: The need to deliver high quality, effective training in a flexible and creative way has never been greater. Meeting statutory requirements within Health and Safety places a particular challenge on all public sector organisations. In response to this challenge, the Trust has developed an innovative e-learning programme that responds to both the strategic and operational agendas. The specific aim of this project was to design and deliver e-learning that responds to both service and patient needs, ensuring a high return on the investment required in terms of both quality and cost. Methods Used: E-learning is a method of providing, supporting or enhancing learning via the Internet/Intranet, or standalone computer. The Trust had limited use of e-learning, mainly using CD-ROM within departments locally. The Trust employs over 12,000 staff with demand for statutory training clearly outstripping supply. A project group was established involving both internal and external stakeholders. A comprehensive pilot and phased implementation took place. This was supported by a marketing campaign to prepare the organisation for the culture change required. Results and Discussion: • Staff has undertaken over 9,500 online training programmes. This has

made a significant impact on statutory compliance. • Offers greater accessibility/flexibility outside of conventional working hours

contributing to equality of access for part-time staff • Significant numbers of staff from groups who had not previously accessed classroom based statutory training have now taken advantage of this e-learning opportunity.

• Feedback from clinical staff indicates that they value the ease of access of elearning and the extra time it enables them to spend with patients. This initiative enables the Trust to report on training activity, complimenting the move towards performance management frameworks enabling a proactive approach in identifying targets for improvement.

• Substantial financial savings compared to traditional classroom based training.

• Evaluation identified unanimous support for the launch of further elearning programmes within Health and Safety and clinical skills training

Conclusion: The project has achieved its aims. Its success has been disseminated across Wales. This has resulted in formal presentations to a wide range of organisations. It has been used as a model to develop an All Wales e-learning initiative, which aims to transform the delivery of statutory training to the Local Health Boards.

21

HT23 AUTOMATED PHARMACY DISPENSING SYSTEMS Author John Howes, Project Manager Organisation Health Solutions Wales Contact john.howes@hsw.wales.nhs.uk Aims: In November 2001 the Audit Commission published ‘A Spoonful of Sugar’ - its report on medicines management in NHS hospitals. The commission highlighted the incidence of medication errors and drew attention to their human, organisational and financial costs. The commission recommended that additional pharmacy staff time needs to be invested at ward level to help reduce the incidence of medication errors but recognised that this would be impossible to achieve against the current workforce situation: it therefore recommended the automation of hospital pharmacy services. Methods Used: During 2003 and 2004 the Welsh Assembly Government has provided funding to procure and install automated pharmacy dispensing systems in the following hospital pharmacy departments: Llandough, West Wales General, Ysbyty Glan Clwyd, Royal Gwent, Princess of Wales Hospital, Bridgend and the Royal Glamorgan. Results and Discussion: Introduction of the pharmacy ‘robots’ has led to substantial reductions in dispensing errors, the release of pharmacy technicians to ward level and improvements in dispensing rates. The introduction of automation has also proved beneficial in helping Trusts to recruit pharmacy staff. Conclusion: All the benefits initially envisaged are now being realised. Trusts in the rest of the UK are now looking to follow the Welsh lead and also introduce automation. The installation of these systems mirrors the recommendations of the Wanless report in using technology to improve service delivery. A further three systems are currently being procured, with the remaining pharmacy sites in Wales following suite.

22

HT24 GP DIRECT ACCESS CARDIAC INVESTIGATIONS SERVICE FOR TORFAEN Author Jean Hughson, Long Term Conditions Manager Organisation Torfaen Local Health Board Contact jean.hughson@torfaenlhb.wales.nhs.uk Aims: Evaluation of the patient pathway for cardiology investigations indicated a long and complicated process which included the GP writing a letter of referral, reviewing of referral letters by cardiologists and attendance to a hospital outpatients department, outside the locality, a minimum of three times before the patient received a diagnosis. This process for the more urgent patients taking up to 18 weeks and over a year for non urgent cases. The aim was develop locally based cardiology investigations service with streamlined referral mechanisms, which gave GPs direct access to clinic appointments and improved information flows between care sectors and patients. Methods Used: One stop heart failure and angina diagnostic clinics were established in the local community hospital administered electronically through a new computer system developed by the Health informatics Team at Swansea University. This uses the very latest web services technologies available as a result of investments made in the NHS network infrastructure throughout Wales. This enabled the team in Swansea University to provide state-of-the-art computer based tools to assist in the delivery of healthcare locally, the first of its kind in the UK for heart failure patients and second in Wales for chest pain patients. The computer system was established on GP and local hospital clinical systems. Hospital administration staff were trained to use the system by the Health Informatics Team. Clinical staff and GPs were trained by members of Torfaen LHB Long Term Conditions Team, who oversee and co-ordinate service implementation. Results and Discussion: Torfaen GPs can directly access cardiology clinic appointments from their own computers, cutting time-consuming letter writing. Patients wait no longer than four weeks to see a cardiologist. GPs receive the patients management plan from the cardiologist electronically within 24hours of the patient attending clinic. Patients attend the local community hospital for cardiology investigations instead of having to travel outside the area to a district general hospital. Instead of attending three appointments patients attend a “one stop” clinic where the necessary investigations are undertaken, they are assessed by a cardiologist, informed of the test results and spend time with a specialist cardiac nurse where diagnosis and treatment is explained and information to support effective self management is provided. Conclusion: This service demonstrates how improved technology can support the delivery of service improvements to provide high quality, efficient and effective care. It is only the beginning and opens up a range of possibilities for many other disease areas in the future.

23

HT25 PROVIDING QUALITY E-LEARNING ON A SHOESTRING Author Mark Williams. Community IT Trainer Organisation North West Wales NHS Trust Contact mark.williams@nww-tr.wales.nhs.uk Aims: The technology available for the treatment and care of patients is becoming increasing complex and varied. The North West Wales Trust needed to produce some training to help nursing staff become familiar with products provided for the care of patients with tissue viability complications, and in particular pressure relieving mattresses. The Trust is geographically widely spaced and it is neither effective nor efficient to drag staff away for training and neither will this method provide suitable opportunities for reference and support. E-learning would appear to be the solution but with commercial suppliers charging up to £30000 per learning hour, changes to preferred suppliers and little in the way of spare resources, we need to pull something different out of the bag. Methods Used: With the willing support of a specialist supplier, a camcorder, some video editing software, Microsoft Office 2003 and plenty of time, the training dept of North West Wales Trust has produce a piece of e-learning that meets all requirements. The use, care and maintenance of the specialist equipment was recorded and edited into sequences, imported into PowerPoint and supported with appropriate texts. We have provided simple interactions in a learner centered piece which is accessible and straightforward to use. Results and Discussion: We have produced an effective piece of learning that can be easily updated to incorporate changes to product ranges or suppliers. It can be used by a beginner, as a refresher and as a reference source. It was produced at a fraction of the cost of commercial packages and maybe deployed by CD or over the Intranet (provided appropriate bandwidth can be released). It was created with readily available tools and required no specialist knowledge other than that available in most training departments. Conclusion: Although still in the final stages of development, we have a piece of learning of a reasonable quality that will meet the needs of the Trust and we also have a process for the production of new resources. Whilst it cannot track the learners or test their competencies, it does have the knock on effect of introducing technology to part of the workforce who have traditionally, been resistant to the idea of IT in the workplace.

24

HT26 A NOVEL METHOD TO ASSESS SURFACE DISINFECTION IN HOSPITAL PHARMACY ASEPTIC DISPENSING UNITS Author Sarah Hiom, All Wales Specialist Pharmacist-V Research Development and Lowe, C: Oldcorne, M. Organisation Cardiff and Vale NHS Trust Contact Sarah.Hiom@Cardiffandvale.wales.nhs.uk Aims: Current methods used to validate surface disinfection (swabbing and contact plates) during hospital pharmacy aseptic preparation procedures are insensitive and are not suitable for reflective practice or for determining best disinfection practice. We therefore proposed to develop and implement a sensitive inhouse disinfection validation method. Methods Used: A novel method to accurately and sensitively enumerate bioburden on the surface of preparation items before and after disinfection was investigated. A benchmarking exercise was then actioned using this novel method to investigate current disinfection practices in three aseptic units across Wales. Methods to enhance implementation of this novel method across Wales were also investigated. Results and Discussion: A novel sensitive method has been developed. It consists of items being placed inside a sterile bag, recovery diluent being added and the bag then being shaken for 2 mins. The recovery diluent was then removed and passed through a 0.45µm filter. Broth was then added to the filter before it was incubated for three days. Visual colonies were then enumerated. Validation of this novel method (using a known concentration of S.epidermidis) showed a recovery rate of 87%. Benchmarking results indicated that during disinfection a wipe phase was critical in reducing bioburden, that dust caps on vials could shield the septum from disinfection and that aerosol disinfectants may penetrate below these dust caps better than trigger alcohol sprays. A kit, encompassing all the equipment needed to complete this transfer validation procedure, has been developed with a commercial company. Initial piloting of this kit has proved successful. Conclusion: A novel sensitive method to assess bioburden and disinfection transfers has been developed and validated for in-house use in pharmacy aseptic units. Data collected using this technique allows benchmarking of bioburden and analysis of trends both within and between all types of units and provides a tool to assist with the training of staff and the determination of 'best practice'. A kit (SteriVal), to assist implementation of this novel test, has been developed and marketed (Helapet).

25

HT27 AN ONLINE LEARNING SYSTEM FOR GP APPRAISAL AND CPD Author K Evans, Organisational Lead, Appraisal CPD and M Lewis Organisation School of Postgraduate Medical and Dental Education, Cardiff University Contact evanskm1@cf.ac.uk Aims: To develop a web-based system to manage and deliver appraisal for all GPs in Wales. The system will allow for management of a single, quality-assured system of appraisal which is easily accessible to GPs, appraisers and other stakeholders across Wales. It will allow for easy data analysis and will inform needs-based delivery of Continuing Professional Development (CPD) programmes. Methods Used: The School has developed a state of the art web-based appraisal system to manage and deliver appraisal for all GPs in Wales. All GPs in Wales are required to register with the system and enter their personal and professional details in order to select an appraiser and access their virtual appraisal folder. Appraisers can communicate with GPs and view their appraisal folders online prior to the face to face appraisal discussion, and agree the GP’s appraisal summary and Personal Development Plan online after the discussion. Results and Discussion: The online system has been embraced by GPs and other relevant stakeholders. 2394 GPs have registered with the online system and engaged with the appraisal process. The system enables the Section to monitor uptake of appraisal which is regularly reported to the Local Health Boards (LHBs). It generates an up to date database of GP details which is currently being reconciled with the Performers List. The system enables information sharing about the education and performance of GPs in accordance with strict protocols, which facilitates ensuring effective links between appraisal and clinical governance. Large quantities of data are collated and analysed automatically. Data relating to service constraints identified by GPs can be reported back to LHBs to inform planning of local services. Learning needs are collated and analysed on a regular basis and have been used to inform local, regional and national programmes of CPD. Initial evaluations indicate that this needs-based educational provision is well attended and well received. Conclusion: An online system is acceptable to GPs, appraisers, managers, LHBs and other stakeholders. Benefits include improved efficiency and consistency of process and reduced bureaucracy. There is a tremendous potential to generate and analyse data which can inform delivery of planned services and ongoing needs-based CPD for GPs.

26

HT28 “OVER THE ETHER” – WIRELESS ACCESS TO CLINICAL INFORMATION Author John Hallam, Head of Records Strategy, Anne Bayliss, Health Informatics Project Manager Organisation Gwent Healthcare NHS Trust Contact john.hallam@gwent.wales.nhs.uk Aims: - To enable clinicians on ward rounds to have real time access to results - To save the time of junior doctors - To improve real time access at ward nursing stations - To identify and realise further benefits. Methods Used: A comparative study of how doctors spend their time was commissioned by the Informing Healthcare Programme in association with the Gwent Healthcare NHS Trust. The study reported and quantified the potential benefits from the introduction of wireless PC carts on wards to access the Trust’s Clinical WorkStation software. The Trust funded a limited pilot implementation of two carts and supporting wireless infrastructure. This was positively evaluated in August 2004. A case for a full implementation was developed by the Trust in October 2004. This case was supported by the Informing Healthcare Programme, who funded the costs of implementation. The carts were implemented. Results and Discussion: All wards, and some departments in the Royal Gwent Hospital and Nevill Hall Hospital are now using wireless PC carts for clinical information access. The equipment and wireless infrastructure is proving robust. Conclusion: All the aims outlined above have been achieved. - Wireless technology provides secure and reliable access to clinical information. -The success of this technology is dependant on the quality of the applications and information that it can access. -Planning suitable space for storing / recharging PC carts on wards should be a new requirement in hospital design. -Clinicians are likely to call for printers to be installed on carts.

27

HT29 DEVELOPMENT OF A USER FRIENDLY APPLICATION FOR CAPTURING LIVE BED STATE INFORMATION ON WARDS Author Jo Williams, Assistant General Manager and Matthew John; Helen Thomas Organisation Bro Morgannwg NHS Trust Contact ian.phillips@bromor-tr.wales.nhs.uk Aims: To improve patient flow, management of beds and discharge planning by implementing a live Admissions/Discharges/Transfers system managed at ward level, with the facility to record and update expected dates of discharge (EDDs). Methods Used: Historically, inpatient activity was captured via ward books and entered onto the patient administration system retrospectively by a central department. This meant that there was no live bed state, no information on patient whereabouts, and no knowledge of imminent discharges. Building on the lessons learned from developing a ‘traffic light’ system for the Trust’s A&E Department, this web based system - ‘PIMS+’, was developed using the same concept. The system had to be simple to use and required the minimum of information to be entered when admitting, transferring and discharging patients, whilst still retaining data integrity. In collaboration with ward staff and hospital management the system was successfully implemented in July 05. To date, classroom and ward based training has been provided to over 1,000 staff. Results and Discussion: This application displays a live view of inpatients by hospital, ward and by expected date of discharge. The majority of wards are keeping the information up to date and are also completing the expected date of discharge. Bed managers and are now able to see how many empty beds there are and where, whether expected transfers/discharges have happened and where elective patients are booked to come in. The EDDs are being used to improve patient flow and Discharge Lounge usage. The system is also being used by the Pharmacy Department to chase take home medicine prescriptions, which is an unforeseen benefit. Conclusion: PIMS+ provides a live view of inpatient activity to enable the Trust to make best use of its available beds. This application will not manage the discharge process and it is not the system which is discharging patients - but does provide clinical staff with a focus on expected discharge dates, and provides the ability to plan the patient pathway and prepare for discharges.

28

HT30 TRAFFIC LIGHT SYSTEM TO MONITOR 4 HOUR WAITS IN A&E Author Lynn Davidson, Programme manager WECAC and Helen Thomas, Matthew John Organisation Bro Morgannwg NHS Trust Contact ian.phillips@bromor-tr.wales.nhs.uk Aims: During the early work of the WECAC collaborative within Bro Morgannwg, it became evident that one of the major constraints to delivering the 4-hour target in A&E was the lack of ‘live’ information which would assist staff in proactively managing the patient journey through the department. The IM&T Department aimed to develop a simple, user friendly system for clinical staff to use which would support the process. Methods Used: Utilising the information in the existing system in the Trust’s A&E and LAC departments, an application was written to display the patients who are currently booked in and waiting within the department (a facility not available on the current system). The patients are displayed in chronological order and use traffic light colours to alert staff to patients who are approaching the 4 hour target. Results and Discussion: Changes in working practice were necessary in order to get the benefits from the system which were dependant on “live” information. Driven by clinicians from within the A&E department, working processes were changed in order to capture outcome information and track patient location as part of the clinical process. Tracking details are used to provide a visual aid to assist with the patients’ journey and identify potential bottle necks in the process. Other benefits have been improved data quality as staff see the ‘live’ results of their “patient flow” efforts. Conclusion: The system is now used in both the A&E and LAC departments and is part of the routine operational processes. A&E staff have been able to improve the overall patient journey and significantly reduce the number of patients exceeding the four-hour target. Information contained on the system also highlights peaks in demand and assists in planning the deployment of resources. This Patient Duration Monitoring (PDM) system has directly influenced the internal development of a similar live tracking system for in-patients. PDM has been enhanced to also “push” patients who need to be admitted on to the inpatient system as part of the recording of outcomes. This highlights the imminent arrival of a patient at ward level and minimizes data entry by ward staff.

29

HT31 DEVELOPMENT OF A TOOL TO IMPROVE DATA QUALITY & IDENTIFY DUPLICATE RECORDS ON PATIENT SYSTEMS Author Ian Phillips, Associate Director of Information and Matthew John; Helen Thomas Organisation Bro Morgannwg NHS Trust Contact ian.phillips@bromor-tr.wales.nhs.uk Aims: To develop a new application which provides a repository of patient demographic information whilst ensuring data quality is maintained in order to share data across systems. This will reduce duplication and improve the accuracy and quality of information throughout the patient journey and reduce clinical risk. Methods Used: The team identified best practice in matching records in order to develop robust patient matching algorithms used on every record fed into the central patient index (CPI). A user friendly administrative tool was also developed to view and deal with potential duplicate records in different systems which can not be matched automatically and, therefore, need a ‘manual decision’. Records from the Trust’s main patient administration systems were loaded in the first instance and duplicate records amalgamated accordingly. The system is used to identify potential matches on departmental systems to ensure duplicate records are identified and dealt with before the live interface link with the CPI is put in place. This ensures that data quality on the CPI is maintained. Results and Discussion: Development of the CPI is complete. An ongoing programme of work is now in place to link the CPI to key departmental systems and work through the physical amalgamation of patient records. Case note amalgamations are carried out under strict procedures. This programme of work has been accelerated by IHC funding. Links to the Trust’s e-mail system alert the relevant admin staff to the identification of a potential duplicate appearing on the system which needs further investigation. In addition, interfaces between the CPI and departmental systems have reduced duplicate data entry of demographic information, saving staff time and resources. Conclusion: Implementation of the CPI has created a demographic repository for the Trust which is key to the development of an electronic health record. The matching algorithm has proved to be a robust and standardised method of identifying potential matches. In the past year over 12,000 duplicate case notes have been amalgamated and in the past 6 months, 34,000 potential duplicates have been identified and dealt with by the Duplicate Records staff.

30

HT32 ELECTRONIC DISCHARGE SYSTEM Author Helen Griffiths Organisation Swansea NHS Trust Contact Helen.griffiths@swansea-tr.wales.nhs.uk Aims: The hospital discharge system is a tool used to communicate patient information between hospital and General Practitioners. Prior to the introduction, the standard of information had been variable, delayed in arriving at the GP practice and at risk of errors in prescribed drugs. As a consequence of their many other commitments, the time taken for doctors to write a discharge prescription has been shown to be time consuming, accounting for up to 40% of the total discharge time. Methods Used: An electronic discharge template was introduced on the medical wards. A modified inpatient medication chart was also introduced which allowed the doctor to indicate, by ticking the boxes, the drugs that were required for discharge. Pharmacy personnel transcribed the medication onto the electronic discharge system. The discharging Doctor would then complete the discharge summary details. Meetings were set up with the doctors and pharmacists to ensure they were able to use and access the programme. Ward staff and their roles were discussed. Problems were initially highlighted on a daily basis. Close contact was maintained with the IT staff, dealing with these problems as they occurred. A copy of the electronic discharge summary is given to the patient to hand to the surgery, a copy sent by post to the surgery and a copy kept in the patients’ notes. Future plans are to fax these documents using “safe haven” fax processes to the GP practices. Receptionists and nursing staff were informed about the programme and fax machines have been provided to the medical wards. Staff can access the system from all areas of the Hospital. Results and Discussion: A recent audit has shown that 15% of doctors electronic summaries are completed on the day of discharge. It is acknowledged within the Division of Medicine and Elderly Care that the provision of electronic discharge information, on the day of discharge is poor, however there is a commitment to improve this, and the initial audit findings will serve as a baseline on which to measure further improvements. Technician transcribing of take home medication has also demonstrated reduced delays in patient discharge. Conclusion: A rolling induction programme is available to ensure new doctors are able to use the programme. Close monitoring of the process and re-audit in 6 months are planned.

31

HT33 THE SHAKERSCOPE Author Dr. David Williams FRCA and John Dingley FRCA Organisation Swansea NHS Trust Contact davidjwilliams@doctors.org.uk Aims: The ophthalmoscope is an essential piece of medical equipment; however its design has a number of serious disadvantages. It contains batteries which require regular replacement and may leak or corrode during storage, and incandescent light bulbs which may burn out or break causing injury. We present a novel device which overcomes these problems. Methods Used: The ShakerScope is a compact kinetically powered light source providing illumination for a range of essential medical instruments. It consists of a handle which generates and stores electricity when shaken using Faraday’s principle. This is then used to illuminate a high intensity white Light Emitting Diode. The light from this is then guided to the ophthalmoscope head via a fibreoptic light guide. Results and Discussion: Inspired by Trevor Baylis’ “Freeplay” clockwork radio, the robust design, low cost infinite light source and lack of disposables make it ideal for use in developing countries and difficult environments such as major disasters and military, aviation and exploration medicine. Its utility is further extended by the use of interchangeable instrument heads (eg. otoscope, laryngoscope, sigmoidoscope etc.), which dock with the light source via a clip mount on top of the handle unit. A patent has been filed for the device (UK Patent Office No. 0511802.1). Conclusion: Bench studies show that the prototypes perform well, and the design is currently undergoing further modification and testing with a view to future production.

32

HT34 IMPLEMENTING NATIONAL GUIDANCE AT NORTH GLAMORGAN NHS TRUST Author Arlene Shenkorov, Clinical Audit & Effectiveness Manager and Leanne Cunningham, National Guidance Facilitator Organisation North Glamorgan NHS Trust Contact arlene.shenkorov@nglam-tr.wales.nhs.uk Aims: The purpose of the project is to outline the mechanism for the implementation of NICE Technology Appraisal Guidance for North Glamorgan NHS Trust. It describes how the Trust is working with its partners to transform the delivery of care in primary, secondary and community settings to improve access to services and produce consistently better outcomes for patients. Methods Used: The Trust’s Ten Step NICE Implementation process is systematically applied to each piece of NICE Guidance received. This process ensures that the Trust has an effective policy to disseminate, implement, audit and monitor guidance received from NICE. For implementation of Technology Appraisal 73 an Implementation Steering Group (ISG) was established comprising of a lead clinician and a multi-disciplinary team. The guidance was scoped by the Implementation Steering Group to obtain a local clinical view. Provisional proposals for implementation were made and developed into an action plan by the lead clinician. Each stage of the plan included milestones with dates for completion, which was essential for monitoring purposes. Also a costing template identifying the cost of implementation was produced to inform the financial process. Results and Discussion: • A pilot Myocardial Scintigraphy service commenced on 9th May 2005 which is

currently working efficiently. • Better provision of service has been provided for patients. • Further training being carried out by cardio-pulmonary staff to enable the

carrying out of Pharmacological testing. • Education, training and continuing professional development have been

crucial elements of successful implementation of the guidance. The Trust continues to make good progress on implementation of published NICE guidance. This is made easier by the support and commitment demonstrated by all health care professionals and managers involved in the process. There is clear evidence of changes occurring as a result of NICE implementation in terms of access to services and an increase in the proportion of evidencebased care being delivered.

Conclusion: A multi-disciplinary and partnership approach to implementation involving all key stakeholders will continue to be pursued. A range of strategies will be used to aid and support the implementation of NICE guidance and linkages with Local Health Board’s will be further strengthened to enable challenging timescales to be met. The Trust’s NICE Implementation model continues to be identified as best practice by NHS Trusts and Local Health Board’s which is shared across the NHS in Wales and England.

33

HT35 ‘SICKNOTE OR BUST’. INSIDE THE FITNESS FOR WORK CONSULTATION. THE DEVELOPMENT OF AN E LEARNING PROGRAME FOR GENERAL PRACTIONERS Author Dr. Debbie Cohen and Prof. Steve Rollnick Organisation The Communication Skills Unit and Unumprovident Centre for Psychosocial and Disability Research, Cardiff University. Contact cohenda@cf.ac.uk Aims: The consultation about fitness for work is surrounded by potentially competing interests for both the doctor and patient. Research shows that prolonged absence tends to lessen the likelihood of return to work and the key to change is early intervention. GP attitudes to the fitness for work consultation vary. Recent studies have highlighted resistance to managing the consultation. Understanding what goes on inside the consultation around fitness for work has not yet been studied. The Department for Work and Pensions has commissioned Cardiff University to develop and evaluate a software intervention based on motivational interviewing that addresses the challenges of the fitness for work consultation. This learning programme once evaluated will be available to all GPs and trainees through the Corporate Medical Group website. Methods Used: Phase I of the study, completed in July 2005 used five focus group meetings to research GPs attitudes to the management of the consultation around fitness for work. This included presentations about the literature, motivational interviewing, GP, patient and DWP perspectives on sickness certification. Video observations using simulated patients. Tape recorded transcripts reviewed and analysed. Results and Discussion: The focus group responses initially reflected many of the currently held beliefs and values voiced by GPs. However as the group progressed it moved from a position of ‘resistance’ into ‘change talk’ that lies at the heart of motivational interviewing. Overarching principles for good practice were established and were then integrated into Phase II, the development of the learning programme, which focuses on changing the behaviour of practioners. Phase II to be completed in October 2005 guides the practioners through a video rich environment with simulated patient consultations. During the programme, practioners will be asked to rate consultations and highlight best practice. The intention is for the programme to be endorsed by the Royal College of General Practioners. Conclusion: Development of e learning programmes offer efficient and standardised methods of training that can be flexible to different learning styles. This project will now be piloted across England, Scotland and Wales to evaluate attitudinal change using a questionnaire based on behaviour change.

34

HT36 A COMPUTERISED PHOTOTHERAPY RECORDS SYSTEM Author C. Edwards, Consultant Medical Physicist, Dermatology Directorate and A. Charles, Windows Development Manager and A. Anstey, Consultant Dermatologist Organisation Gwent Healthcare NHS Trust Contact cedwards2@gwent.wales.nhs.uk Aims: Ultraviolet (UV) phototherapy is an extremely effective symptomatic treatment for severe psoriasis, eczema, and other photoresponsive skin conditions. Patients have a course of 18-24 treatments using increasing doses of UV. Treatments must be optimised for each patient to ensure maximum disease clearance with the least number of treatments, while minimising immediate adverse events (mainly skin burns) and long-term risks of skin cancer and skin aging. Approximately 500 treatments are administered per month, and treatment details and outcomes of each of these are recorded on paper. We therefore developed a computerised system to record treatment details, to compute current and cumulative doses, and to record adverse events. Methods Used: Our existing phototherapy regimens and record forms were used as the basis of the data input screens of the new system. The IT department of Gwent Healthcare NHS Trust designed a web-based system using Microsoft software development technologies such as ASP.NET/VB.NET and the industry standard MS SQL Server 2000 database management system (DBMS). The user interface was developed using browser technologies to give an intuitive look-and-feel of a typical windows application. It can be used via a touch screen interface and or a standard keyboard and mouse. The system incorporates dosimetry calculations usually performed by the phototherapist, and also a system of checks which warn if patient doses are selected which fall outside preset safety limits. Current doses and lifetime cumulative dosages are calculated and displayed. The system generates a daily summary of treatments which would allow continuing treatments if the computerised system were not available. A patient treatment summary is available on any networked computer for clinical review. Clinical governance reports compile patient numbers over any timescale by disease, treatment modality and referring clinician. Adverse events summaries are also reported. Results and Discussion: The system will be implemented on our phototherapy unit at St Woolos Hospital on 1st October 2005. After a period of initial assessment we intend that it will replace our existing paper records. In the longer term, this system will enable the design and implementation of a Welsh National Managed Clinical Network for Phototherapies. Conclusion: A secure computerised system has replaced our unwieldy paper records. It is a tool for the safe administration of Ultraviolet treatment and will facilitate clinical audit.

35

HT37 ELECTRONIC WEB SELF-ROSTERING – A TOOL FOR WORKFORCE EMPOWERMENT Author Sam Hooi, Senior Nurse and Rob Bolger, Mike Ware, Brett Mitchell Organisation Cardiff and Vale NHS Trust Contact sam.hooi@cardiffandvale.wales.nhs.uk Aims: To improve the environment of care through workforce empowerment by providing nursing staff with electronic web self-rostering system. This allows nurses to improve their work life balance using flexible self rostering tool. Methods Used: By introducing HMT RosterPro® electronic web self-rostering system for staff to self roster themselves requiring minimal intervention from managers. A pilot project to evaluate the benefits was introduced in 2004 on a general Medical Ward with 40 nurses and on the Critical Care Directorate with 160 nurses. Pre-pilot and post pilot baseline data and staff opinion questionnaires were used to assess the benefits. Results and Discussion: The reported benefits from both pilot sites were: • Improvement in the work life balance of nurses by self rostering • Increased choice, flexibility and fairness in working patterns of staff • Improvement in effectiveness and efficiency in duty roster planning of

nurses • Reduction in sickness rates • Reduction in use of bank and agency shifts • Improvement in recruitment and retention • Reduction by 75% (4 to 10 hours per week) in nursing management time

associated with rostering by requiring minimal management intervention • Reduction in paper records and paper flow by staff using web

rostering • Availability and easy access to powerful staff management information • Improved computer literacy of nurses Conclusion: The Web-based self rostering is an innovative powerful workforce empowerment tool which will have a major contribution to service modernisation, HR work life strategy and improvement to the environment of care to patients. The staff involvement demonstrates that staff are valued and would result in staff motivation and increased morale.

36

HT38 BEATING THE BLUES: A COMPUTERISED COGNITIVE BEHAVIOUR THERAPY (CBT) Author Dr Bob Colter Organisation Gwent Healthcare NHS Trust Contact bob.colter@gwent.wales.nhs.uk Aims: Beating the Blues is an effective 8 session PC based programme of CBT for Depression and/or Anxiety. Clinicians select patients, patients attend weekly sessions with the PC, and work through the programme. Clinicians review progress after it has been completed. Methods Used: NICE guidelines on the treatment of Depression and Anxiety recommend CBT as a major component. This has increased awareness and demand for CBT resulting in longer waiting lists. BtB is an eight session programme of CBT that has been developed by Ultrasis PLC and the Institute of Psychiatry. It employs a user friendly mix of audio-visual presentations, tasks, goal setting and homework, in which the patient joins a “virtual group” on the PC. No prior PC experience is necessary. In RCT’s it has been shown to produce improvements that are comparable to face to face CBT. The BtB service has been operating in the Newport CMHT base at Gold Tops Newport for the past three years, with very good results. It has increased the public’s access to CBT, reduced waiting times for patients attending it, and provided a significant proportion of patients with an effective psychological therapy. Some patients have required face to face work after attending the programme, but clinicians have usually found that they are easier to work with because they have had “prior” experience of CBT from the BtB programme. Newport LHB has funded this scheme, and is funding further PC’s/ licenses to make it available to Primary Care. Results and Discussion: It costs approximately £6,000 for an annual license, plus the costs of a dedicated PC. There needs to be administrative staff to book patients in to “see” the PC, and a clinician to select patients, be available if the patient has any difficulties e.g. is suicidal, and to review progress on completion. Conclusion: It is likely that this programme could be of use to other Divisions in the Trust.

37

HT39 THE PEACE OF MIND PROJECT Author Jeanette Munn, Development Manager Alzheimer’s Society Swansea Organisation Alzheimer’s Society Swansea Contact jeanette@alzswansea.org.uk Aims: Older people with dementia and their carers are often concerned about safety and loss of independence. People with dementia need to be given the choice to live at home in familiar surroundings. The project aims to offer them just that by promoting the independence of people with dementia, by identifying risk factors and offering a possible solution with the installation of telecare equipment in their own home environment, providing peace of mind to their carers. Methods Used: Funding was secured through ‘The Older People’s Strategy’ and ‘Supporting People’. A ‘task and finish’ steering group was set up involving the statuary, independent and voluntary sectors to decide the direction of the project. The equipment is available to anyone with a diagnosis of any form of dementia and who has a carer able and willing to respond to a call. Referrals can be made by anyone within the multidisciplinary team. Training was offered to professionals to enable them to recognise the potential benefits of assistive technology whilst completing a unified assessment. Individual needs assessments are carried out by the Alzheimer’s Society; who is able to provide an individual tailored package. A few examples of the devises that could be installed are: wandering client, which provides an early warning that the person has left their home and not retuned, gas shut off valves or flood detectors for those who forget to turn off appliances. The reason for completing an individual assessment is that only the devises that are needed at that time will be installed; further equipment may be added as the needs arise. Funding was made available to have a demonstration “Smart House”. Ty Conway was an obvious choice as it is a day centre for people with dementia. A range of non-intrusive smart sensors, which offers a comprehensive way of managing risks were installed. Ty Conway is open to visitors from all sectors who wish to see the benefits that assistive technology can bring. Results and Discussion: Eight people currently have assistive technology installed in their homes. Monitoring and evaluation is ongoing. Professionals have visited Ty Conway, feedback is very positive, with people finding the visit useful. Conclusion: Project still in its infancy, although the benefits of installing technology to enhance the lives of people with dementia and their carers are evident.