Building on the Best in Scotland Barbara Kimbell Project Manager – Botb Scotland

Botb in Scotland Oct 2016 – Sept 2018 3 sites: Dundee, Edinburgh, Paisley Shared decision-making and information handover Acute Medicine & GI/Liver wards Staggered approach

Scoping of current practice Conducted by Botb Project Manager Observation of current practice via ward rounds, handovers, MDT meetings Review of documentation and leaflets Staff interviews Informal conversations with ward staff Patient and carer feedback (interviews, patient experience survey)  Feedback to ward teams  QI

Ninewells Hospital Large teaching hospital on the western edge of Dundee Small team of Palliative Care consultants and specialist nurses plus 3 specialist palliative care beds Status: Scoping plus feedback – Acute Medicine; Scoping completed – GI/Liver

Shared findings Ward rounds: Conversations generally focused on acute treatment Lack of nurse presence during ward rounds Little involvement of junior and nursing staff in difficult conversations Perceived variance in the quality of communication Conversations generally not well documented Discharge letters tend to lack ACP-related information

Early ideas for QI activities (AMU) Develop a ward-specific communication strategy, including relevant staff education Improve ‘difficult’ conversations through testing draft staff communication guides/lanyards Develop role of Healthcare Assistants in difficult conversations Review clerking and transfer documents to improve the recording of goals of care/conversation information Review ward round arrangements to increase nurse involvement

Wins & walls Wins Buy-in from key ward staff (consultants, senior charge nurse) Staff recognise need and keen to contribute their views Good cross-team discussion of issues and potential solutions Walls Local operational reorganisation of service provision Competing priorities Staff shortages

Next steps Feed back to GI/Liver team and discuss opportunities for QI IdentifyQI activities in both wards Scoping of current practice at next site under way...