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Junior Doctor Service Improvement oard Projects 2014 2017 · Junior Doctor Service Improvement oard...
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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 [email protected]
Chair JDSIB: Dr Natalie Shields [email protected]
Director of Medical Education: Dr Ali Bokari
Medical Education Officer: Mrs Tracy Jollie [email protected]
Medical Education Officer: Mr Callum Livermore [email protected]
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