Customer: North West Boroughs Healthcare NHS Foundation Trust (NWBH)
The borough of Knowsley is the fifth most deprived in the country and suffers from marked health inequality. Employment opportunities and income are some of the lowest in any local authority district in England. The expected healthy life expectancy is 59.2 years for males and 58.8 years for females: 3 years below the national average for each.
Aqua was commissioned to work with two NWBH Trust’s teams to build capability to deliver personalised care which inspires patients to take ownership of their treatment and health.
The two teams were the Healthy Knowsley Team, a non-clinical service team providing lifestyle and advice to encourage healthy behaviours; and the Community Therapy Team, which comprises occupational therapists and physiotherapists who work with patients with complex long-term conditions.
Key challenges included reservations from clinicians that they would not have the time and appropriate training to successfully build a personalised approach into their work. There was also feedback that patients were unwilling to buy in; that they were dis-engaged and overwhelmed when asked to co-design their own care, feeling it should be solely the practitioner’s job.
Aqua reviewed feedback from focus groups and one-to-one interviews which the Trust held with stakeholders and team members. Knowledge gaps and misconceptions about delivering personalised care were identified and used to design bespoke training sessions. These sessions also covered the Patient Activation Measure®, a well-evidenced, reliable tool to assess and track patient readiness to engage with co-designed personalised care.
Initial factors leading to practitioner resistance and reservation were taken onboard. A common theme arising from early engagement sessions was that a ‘one size fits all’ approach wasn’t appropriate for two very different teams, treating patients with differing levels of engagement.
Bespoke training was designed and delivered to allay these concerns. All practitioners from both teams attended between four and five training sessions. These sessions conveyed that, properly utilised, PAM® identifies behavioural characteristics about a patient’s beliefs and knowledge around their healthcare, supporting tailored conversations about share-decision making.
Training sessions were rated 9.5 / 10 on average with almost all attendees immediately implementing PAM® in their own work. Post-training feedback was universal in praise for its bespoke nature. One clinician noted: “You have been the most helpful people we have engaged with in the last year. You have definitely listened and that has really helped.
“The training has worked because it has been tailored to the needs of the service.”
Of the 178 patients discharged during the period April – August 2019 where a final PAM® was undertaken, more than half had an improved rating.
Qualitative comments from practitioners included that PAM® had helped to “break down barriers, educate and change the mindset of patients”
Both teams have embedded PAM® within initial and final appointments as the preferred outcome measure. They have the tools and framework to continually improve and refine the training in line with the most current thinking on personalised care.
The programme has helped the Trust to deliver on its 2019-21 Quality Strategy and wider rollout across other health and care teams within the borough is being explored.
AQ: Improving Care for Patients with Sepsis in an Acute Trust
Southport and Ormskirk Hospital NHS Trust provides acute hospital services to 258,000 people across Southport, Formby and West Lancashire. Acute care is provided at Southport and Formby District General Hospital and Ormskirk and District General Hospital. Sepsis accounts for around 1,200 acute admissions to the trust each year.
AQ: Aintree Improvement Journey for Patients with Alcohol Related Liver Disease
Aintree University Hospital NHS Foundation Trust joined the Advancing Quality (AQ) programme at its launch in 2008 and is currently participating in eight clinical focus areas (CFA), this includes Alcohol Related Liver Disease (ARLD).
AQ: Reducing Avoidable Harm through Patient Assessment & Escalation
In patients who are, or become acutely unwell in hospital, there is evidence that deterioration is not always recognised or it is not acted on rapidly enough (NICE, 2007). The Walton Centre NHS Foundation Trust wanted to improve observation recording, recognition and response to deteriorating patients using the NEWS assessment tool.
AQ: Reducing Mortality in Community Acquired Pneumonia (Liverpool University Hospitals NHS Foundation Trust)
The NICE (2014) guidance publication ‘Pneumonia in Adult: Diagnosis & Management’ covers diagnosing and managing Community Acquired Pneumonia (CAP) in adults. Its aim is to improve the accurate assessment and diagnosis of pneumonia to help guide antibiotic prescription and ensure that people receive the right care. It estimates a mortality rate between 5% and 14% for patients admitted to hospital with CAP.
AQ: Serum Lactate in the Treatment of Sepsis
he Royal Liverpool & Broadgreen University Hospitals NHS Trust (RLBUHT) identified an opportunity to improve the early diagnosis of patients with sepsis. Evidence suggests that the sickest sepsis patients have high levels of serum lactate. Timely measurement of serum lactate levels in patient pathways can improve early diagnosis which will lead to improved outcomes.
AQ: Embedding Early Assessment In Out of Hours Primary Care
Sepsis and deterioration is a huge clinical problem and 70% of sepsis cases originate in Primary Care. In the last five years we have experienced a culture shift in primary care; from seeing sepsis as an acute condition that is difficult to detect, to recognising the need to actively assess patients where infection could be causing significant illness or deterioration.
AQ: Effective Management of Frailty in Hip & Knee Replacement (Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust)
NHS England defines frailty as ‘where someone is less able to cope with and recover from accidents, physical illness or other stressful events’1. As the population ages, so frailty rates increase, presenting challenges to care systems. Elective hip and knee replacement patients undergo pre-surgical checks to ensure they are able to cope with their procedure.
AQ: Improving the Management of Acute Kidney Injury (AKI)- Role of the AKI Pharmacist
The 2009 NCEPOD report, Adding Insult to Injury, reviewed outcomes for patients with acute kidney injury (AKI) in hospital. The report found that medication was the most common AKI risk factor not assessed and only 15% of patients had their medication altered to renal doses. The national AKI programme Think Kidneys advises that medicines optimisation is essential to reduce the risk of AKI and mitigate its severity if it occurs.
Sepsis is a life-threatening condition which has in recent years become a high priority for healthcare providers. Early recognition and prompt management of sepsis can improve outcomes for patients, reducing the risk of mortality and morbidity. This could potentially save 14,000 lives and result in 400,000 fewer days in hospital for patients every year, according to estimates by the Sepsis Trust.
AQ: A Collaborative Approach to the Management of Acute Kidney Injury (AKI)
Southport and Ormskirk Hospitals NHS Trust has established a steering group to improve care for patients with AKI. The group is using the care bundle data from the Advancing Quality Alliance (AQuA) Advancing Quality (AQ) AKI programme to monitor care delivery for patients with AKI and to provide a framework for improvement.
AQ: Improving the Ultrasound Scanning Process for Patients with Acute Kidney Injury
Acute kidney injury (AKI) may sometimes be caused by an obstruction in the urinary tract, which can require treatment with a nephrostomy. It is important that people with AKI who are suspected of having a urinary obstruction receive an ultrasound scan early in their management, as outlined in national guidance (NICE, 2019).
AQ Insight Reports: Case Study
More patients are admitted to hospital as a result of pneumonia in the north of England compared to the south. In the North West in 2019, the rate per 10,000 population was 58.5. To help reduce unwarranted clinical variation and health inequality, capture best practice and share evidence-based insights to AQ members across the North West, the AQ team created ‘Insight Reports’.