Main title slide page By Caroline Attard In-patient Nurse Consultant Co-brand logo here By Caroline Attard In-patient Nurse Consultant Berkshire health foundation trust Using Innovate Technology to monitor physical observations following Rapid tranquilization

What is Rapid tranquilisation ? “Rapid tranquillisation is when medicines are given to a person who is very agitated or displaying aggressive behaviour to help quickly calm them. This is to reduce any risk to themselves or others, and allow them to receive the medical care that they need.” (NICE, 2015)

RT

Welcome Main title for slide set Optional sub title or name Co-brand logo here Rapid tranquillisation (RT) is a high risk clinical intervention in terms of potential physical health complications. PHYSICAL MONITORING  Blood Pressure (BP)  Pulse  Respiratory rate  Temperature using tympanic device  Oxygen saturation levels via pulse oximeter  Resuscitation equipment  Blood glucose level Welcome Main title for slide set Optional sub title or name

Welcome Main title for slide set Optional sub title or name

Human Factors Theory Inappropriate Response Inappropriate Activities Overload Environmental factors (equipment) Internal factors (emotional stress) Situational factors (unclear instructions & risk level) Inappropriate Response Detecting a hazard but not correcting it Removing safeguards from equipment Ignoring safety Inappropriate Activities Performing tasks without training Misjudging degree of risk involved with a given task

Welcome Main title for slide set Optional sub title or name Co-brand logo here AIM PRIMARY DRIVERS SECONDARY DRIVERS Welcome Test new equipment Main title for slide set Optional sub title or name New technology or equipment to make process easier Train in using new equipment Increasing the amount of RT monitoring on one ward in 12months by 80% Increase awareness re need, why and rational, risks etc Education around RT and risks involved Taking one nurse one patient approach to cascade learning Safe and reliable use of equipment Reliable and safe RT physical monitoring Safe, reliable and timely able to identify problems arising

How I engaged the team Caroline

Predictions: Lose equipment, ipad disappearing Difficult to test as numbers of RT are small Nurses wont use it Although easy to use will technophobes use it?? ….Or even try it Wifi connection letting us down

Welcome PDSA Testing Ramps Main title for slide set Co-brand logo here A P S D DATA FEEDBACK TO FRONTLINE STAFF PDSA Testing Ramps Welcome Main title for slide set Optional sub title or name 1E: Collate information review PDSA Cycle 1D:using info in MDT, handovers etc to triangulate info Cycle 1C: RT monitoring book Cycle 1B: in house training re RT Cycle 1A: Intro new equipment Ipad, cuff and oximeter etc

Welcome Measurement Number of incidents against numbers of RT monitor Co-brand logo hee Measurement Welcome Main title for slide set Optional sub title or name Number of incidents against numbers of RT monitor First of all do we have reporting right so did a safety cross Wanted already collected data to help reduce time RT monitor book

using info in MDT, handovers to triangulate info RT monitoring book introduced RT monitoring training New equipment

Co-brand logo here Update Welcome Started in March 2016 from 0% RT monitoring to 100% FROM June till October 2016. We are still testing (we keep finding obstacles) that we did not predict at first Engagement of the team (new staff ) Culture change (student example) Patient engagement Risks reduced Main title for slide set Optional sub title or name

Welcome Benefits to patient and staff Main title for slide set Co-brand ogo here Benefits to patient and staff Staff Easy to use Takes away the hassle of going with a trolley Tells you if something is wrong Don’t disturb the patient Safe “ I don’t have to be intrusive to the patient following a difficult restraint” sometimes patient is still angry at staff Less patients are refusing to cooperate Less awkward Its brilliant Didn’t know that when a patient is sleeping it’s the most risky time at least now we use our equipment Patient “Its cool” “I don’t know why other wards don’t use it” “ I know they are doing it for my own good but having them in my room after they jumped on me is not nice like this they can leave me alone” Welcome Main title for slide set Optional sub title or name

Welcome Key improvement message learnt Main title for slide set Optional sub title or name

Future Spread to other wards Look at other aspects of RT ( prescribing part etc) Look at patient refusal why and how to improve Better technology