Test of change in NUH NHS Trust

What were we trying to accomplish ? We wanted to increase number of patients taking part in SC so involving them in doing own observations was the way of engaging people in doing simple tasks. We have planned to encourage patients to take own observations prior to HD in the waiting room. We tried to be realistic and thought that if we aim for 60% of the patients it can be achievable.

How did we expect to demonstrate improvement? Patient feedback –verbal comments (recorded) Staff feedback – verbal comments (recorded) Run charts based on audits – collecting BP slips by the staff and inputting data onto spreadsheet

What changes did we actually make? We had to: re-organize waiting room set up ‘observation station’ purchase BP monitors, thermometer organize the trolley for equipment provide slips and pens to record the readings We re-designed our shared care board and included some information on how to perform BP check, what is a Dry Weight.

Observation station – 1st edition

Observation station – 2nd edition Added visual instruction on how to perform BP check It was done following staff suggestion as they felt some of the patients did not remember all the steps so displaying pictures may be a solution.

Posters encouraging patients to perform their own observations were placed on the wall next to the scale with directions to the ‘observation station’ so they knew what to do next. This was also suggested by the staff as they felt that gentle reminder could direct the patients to ‘observation station’

Patients required training so we had to allocate nurse to do the teaching in the waiting room. Email was sent to the staff to ensure patients have enough time to do observations, we’ve asked our colleagues not to rush the patients.

We have also asked staff to ask the question ‘have you done your BP/Temp?’ if patient said ‘no’ staff were to reply: ‘did you know/have you noticed there is BP/Temp monitor in the waiting room if you would like to learn how to perform your observations’

What difficulties or challenges did we face and how did we resolve them? Staff resistance – encouraging/training

Patients resistance – encouraging/offering SC Resources: BP monitors/cuffs missing (waiting for new ones), pens missing (replaced with pencils as last longer), lack of slips (more staff taking owner ship of this/slips in master copies folder) Missing/forgotten slips – affecting audits Patients unwell/forgot

How do we feel we’ve made the difference? Is there any evidence to show improvement? Patients are proud of themselves as it is a big achievement for some of them, they can save a bit of time and go on machine quicker. Staff appreciate it as they can spent more time with vulnerable patients. They see it is happening. Run charts based on observation slips + survey.

What has helped us with our change? Coffee mornings – recommend to all units Meeting with the patients out of their dialysis time keeps them more engaged, motivated and educated. Helps to build stronger relationships with the patients and makes them more keen to participate in Shared Care. Nurses become more trustful. It also helps to engage and motivate staff.

We have included teaching on how to perform BP and Temp check on first coffee morning but actually at this point most of our attendees already were comfortable with these tasks.

Winner of ‘Whose hands are cleanest’ competition

What did we learn on the way & how has the Learning events helped Be patient, consistent, do not let anyone discourage you Do not expect miracles in a short period of time, every change is a long term process and will not take place overnight Take small steps as this is the best way forward

Concentrate on building your team as you need it for the change to last Learning events have given us motivation, empowerment and encouragement to move things forward We’ve gained some skills to actually make a change We’ve realized that learning from experience of others is very valuable

What would we do differently if we’ve had the time again? It has actually worked the way we have done it so probably we would go similar way but with greater number of staff involved. We did not make the mistake that took place 5 years ago: initially it was too much and too fast – we were overambitious then.

We have noticed that patients are now promoting SC among themselves, it seems natural. They teach each other and help each other. Staff members say: ‘It is a culture’ ‘It is a routine’ ‘It has never been like this before’ ‘Buzz of activities happening in the waiting room during the day’ ‘It makes me happy when they learn’ ‘It is lovely to see them doing things’

Patients say: ‘I feel like I’ve achieved something’ ‘This is easy to do’ ‘I don’t understand why some of the patients do not do it’ ‘I don’t feel helpless’ ‘I feel like I less rely on staff’ ‘I feel more in control’ ‘I like to get involved and to know what is going on’