Junior Doctor

Service Improvement Board

Projects 2014-2017

Produced by

Dr Natalie Shields

Background to the Junior Doctor Service Improvement Board

Junior doctors provide a huge amount of direct patient care and as they also rotate between trusts and departments regularly they are well placed to identify how NHS services could be improved. The Keogh review reflected this with a key recommendation describing how Junior doctors and nurses had enthusiasm, ideas and energy for change which should be utilized and supported for innovation and service improvement.

At DVH the Junior Doctor Service Improvement Board (JDSIB) was set up in February 2014 to support juniors with their service improvement projects to ensure real change could arise from their work in collaboration with other healthcare professionals.

The Board is sponsored by the Medical Director, mentored by the Leadership Tutor and chaired by a Junior Doctor Lead. It is supported and facilitated by the Director of Medical Education and the Chief Executive.

Each Project has a Junior Doctor lead and a consultant/senior member of staff as a Mentor or Sponsor. A local pairing scheme was introduced to promote joint working and collaboration on projects. As a result junior doctors and other healthcare professionals are encouraged to jointly lead the projects.

A Project Initiation Document is completed for each project to formalize the process and provide a learning experience for the project leads. All projects are reviewed and followed up at regular board meetings every 2-3months. These provide the opportunity to troubleshoot problems and provide multi-disciplinary support and assistance.

Projects are presented locally to the senior members of the Trust at Leadership Faculty meetings and some projects have also been presented at regional meetings.

We plan to organise an annual summertime project presentation event in June/July 2017. At the end of the academic year arrangements are made to handover projects to ensure continuity.

This booklet aims to showcase some of the previous projects.

Medical Student Projects

Transitional care services for children with long term conditions

Students: Kevin McEwan, Khonji Nedham, Naveed Khan

Mentor: Dr Wijewardena

How to improve children's journey when accessing acute care

Students: Ali Dogan, Dami Olaolurun, Kadean Hawes

Mentor: Dr Suresh Kumar

Delayed diagnosis of tuberculosis

Students: Joss Butters, William Quelch, Taimur Shafi

Mentor: Dr Rekha Balla

TRUS Biopsy Experience

Students: Katharine Thomas, Sandeep Bassi, Angela Liao

Mentor: Prof Sanjeev Madaan

TRUS Biopsy Complications

Students: Claudia Wilde, Mazeda Sultana, Haseeb Moiz

Mentor: Prof Sanjeev Madaan

Acute Kidney Injury

Students: Priya Sharma, Ryan Koay, Sky Liu

Mentor: Dr Andrew Coutinho

MRI Prostate

Students: Jennifer Hawley, Juliette Lamina, Thana'A Mohager Thaker

Mentor: Prof Sanjeev Madaan

Improving compliance of the WHO bundle

Students: Rebecca Anson, Natasha Wood, Joe Searson

Mentor: Dr Relwani and Dr Roxana Sandar

2016-17 New Projects

Iron Deficiency in heart failure and its management

Lead: Sheela Anpalakhan Mentor: Dr Toth

CT head scanning in head injury

Lead: Dr Juliet Booth Mentor: Dr Rashid Suleman

Delirium protocol

Lead: Dr Natalie Shields & Dr Claire Carstairs Mentor: Dr Srikugan & Dr Weekes

Foundations in teaching

Lead: Dr Rebecca Jayasinghe Mentor: Dr Francoise Iossifidis

Virtual on-call

Lead: Dr Rachel Almond, Dr Heather Macfarlane, Dr Catherine Omotayo

Fascia iliaca in fractured neck of femur

Lead: Dr Fionnula Durrant Mentor: Dr Francoise Iossifidis

On-going Projects

Enhanced recovery in obstetrics

Lead: Dr James Jackson, Mentor: Dr Francoise Iossifidis

Mobile epidural

Lead: Dr Amina Sajid, Mentor: Dr Francoise Iossifidis

Completed presentations (poster unavailable)

2014 Paediatric Assessment Unit

Lead: Dr Sabina Mohammed, Dr Pasang Lama, SN Emma Page, Mentor Dr Bokari

Key contacts

Leadership Tutor: Dr Anu Relwani Anu.Relwani@dvh.nhs.uk

Chair JDSIB: Dr Natalie Shields Natalie.Shields@nhs.net

Director of Medical Education: Dr Ali Bokari

Medical Education Officer: Mrs Tracy Jollie Tracy.Jollie@dvh.nhs.uk

Medical Education Officer: Mr Callum Livermore callum.livermore@dvh.nhs.net

2014 Safer Management of Warfarin at Darent Valley Hospital

Leads: Chiko Savieli, Dr Satish Morgan

Closing the loop Following the results of the 2015 audit, it was suggested that all recovery nurses

should attend local resuscitation training, capnography should be available in all 3

recovery bays and the anaesthetic rota coordinator should endeavour to ensure

that a Consultant Anaesthetist (or equivalent) and supernumery Anaesthetist be

present for all day surgery sessions. The standards of care were again re-audited in

2016 where is was found that 100 percent of recovery nurses had attended

resuscitation training and capnography was available for 100 percent of patients.

Whilst anaesthetic support remained variable, there were no further

improvements that could be made at this point. The audit cycle was deemed

complete after a large number of improvements over a 4 year period.

2015 DVH Day Surgery Recovery Facilities Audit (Dec 2010– April 2016)

Leads: Dr E Webb, Dr S Ahmad, Dr B Zaheer Mentor: Dr A Relwani

Background The post-operative period is a potentially hazardous time. Problems with airway, breathing and/or circulation can develop quickly and result in serious complications. Post-operative recovery areas are designed to provide adequate care following either regional or general anaesthesia. Numerous guidelines have been developed to help standardise the services provided, improve care and reduce risk to patients Where did this all begin? Prior to 2010 there were a number of problems with the day surgery recovery facilities including no designated trained recovery nurses and incomplete monitoring equipment. In turn these problems lead to theatre delays and concerns about patient safety. Permanent recovery staff were introduced to day surgery in 2010. Recovery facilities were then audited against standards produced by the RCOA and AAGBI in December 2010. Standards of care were improved by the introduction of the trained recovery nurses and delays in handover of patients to recovery staff were minimal. However, trained recovery nurses were available for only 52 percent of patients and there was still dependence on ward nurses and other theatre staff to help in the recovery area. From this audit it was suggested that an increased number of trained recovery nurses were still required. Furthermore, the results of the audit suggested that a supernumery Anaesthetist and Consultant Anaesthetist should be available in day surgery for emergencies. What happened next? Standards of care in day surgery recovery were re-audited in 2013. Whilst insufficient data was collected to draw formal conclusion, there were some concerns raised by the results of this audit. These included capnography being unavailable, Consultant/ supernumery Anaesthetist only present for approximately two thirds of the time, lack of ALS training amongst recovery staff and insufficient checks to emergency equipment. In 2015 some of these findings were confirmed. Reassuringly, emergency equipment checks were completed over 90 percent of the time and patients were being cared for by trained recovery nurses 85 percent of the time. However, as standards now suggest the presence of at least 2 designated recovery nurses where a patient is not protecting their own airway, staffing levels were still insufficient. Anaesthetic support (supernumery Anaesthetist and Consultant Anaesthetist), capnography and ALS training were also insufficient.

2014 Implementing SBAR at Darent Valley Hospital

Leads: Dr Jon Perry, Dr Nicola Atkins, Matron Sue Cox

2014 Junior Doctor Toolbox

Leads: Dr Samillia Ekeocha (2014) Dr Joanna Baawa (2015) Mentor: Mr Andy Brown

2015—2016 Safer prescribing of electrolytes

Leads: Adam Mohammadally, Dr Hermon Amanuel, Dr Carmen Roessler,

Dr Clare Anderson, Dr Nitika, Dr Chitalia,

2015 PICC line guidelines

Lead: Dr Shrawan Patel

2015 Mobile Epidural

Leads: Dr Sarah Nour, Dr James Peerless, Dr Diana Neely Mentor: Dr F Iossifidis

2015 Obstetric Anaesthesia Database

Lead: Dr Dan Lake, Mentor: Dr Francoise Iossifidis

IMPROVING OBSTETRIC ANAESTHESIA FOLLOW-UP THROUGH JUNIOR

DOCTOR DESIGNED INFORMATION TECHNOLOGY ROLLING OUT ACROSS

THE DEANERY.

Dr Daniel Lake – Anaesthetic ST3 William Harvey Hospital

Intro:

Follow-up of mothers after obstetric analgesia and anaesthesia is vital. It enables us to assess

risk and monitor standards of care, whilst detecting potential problems.

There are no standardised methods of reliably collecting data pertaining to obstetric anaesthe-

sia follow-up. Practice varies considerably amongst trusts and databases can be expensive

with ongoing maintenance contracts with the database designers. Due to cost restraints most

trusts most trusts in the deanery use a book / paper collection technique for recording inter-

ventions and follow-up. This carried inevitable risks of misplacement and breach of confi-

dentiality. It also made audit and retrieval of data difficult. I felt that creation of a password-

protected database linked to our trust network would improve our current practice and being

created by an anaesthetist it would be tailored exactly to anaesthetic needs. This has been

successfully running, with continued development at Medway Maritime Hospital since 2014

and has now been running at Darent Valley Hospital since March 2016. There are currently

plans to adapt and introduce the database at William Harvey Hospital.

Methods:

A retrospective audit of 50 elective obstetric cases in May 2014 was performed assessing

adequacy of log-book recording and follow-up. A secure database was then created and intro-

duced in which was available through the trust network. Retrospective re-audit of 50 elective

cases was carried after introduction of the database.

Results:

Initial audit showed that 39/50 elective cases were recorded in the book with only 58% fol-

low-up. After introduction of the database, 100% were recorded and 80% were followed-up.

Conclusions:

The database significantly improved follow-up rates from 58% to 80% (p=0.017).

Post-Francis report we need to maintain a quality service for our patients in an era where

funds are short. This database, donated to each trust free of charge, has enhanced the quality

of our service delivery, increased availability of data for future audit, and been received well

from all staff involved. Following the success of this audit and the ease of future audit the

database has been tailored to and introduced at 2 hospitals within the deanery. This has sig-

nificantly improved the compliance of audit at a local level and improved ease of completing

national level audits (NOAD).

2015 Paediatric Simulation at Darent Valley Hospital

Leads: Dr Anne Thomas and Sister Denise Aspland

2015 Anaesthetic Drug Cards

Lead: Dr Oli De Brett Mentor: Dr Anu Relwani

2015 WHO huddle

Lead: Dr Dawn Harpham Mentor: Dr Anu Relwani