Step 1: Contact a QI Lead at your Trust
University Hospitals Bristol and Weston
Step 2: Have a look at past and present projects
QI at the Bristol Royal Infirmary
- Providing standby antibiotics to nursing home residents at risk of recurrent infection: Abigail Smith and Amy Hanley 'Active'
Summary: A project to implement the use of standby antibiotics for nursing home patients at risk of recurrent infections (UTI/cellulitis/infective execrations of COPD), registered to The Green Practice, Clevedon. This was prompted by an awareness of pressure on GPs to identify patients at risk of unplanned admissions to hospital. Not yet submitted but will be sent to BMJ quality.
- Audit of IPC stockings in stroke Patients: Fiona Herbert, Susie Waite, Marion Matheson, Rhe Hawthorn 'Completed'
Summary: To assess whether IPC stocking are being used appropriately as the only licensed method of thromboprophylaxis in stroke patients. Presented at the "Bristol Patient Safety Conference" and at the "Quality Improvement in Clinical Practice: Initiatives from a Foundation Doctor" Conference.
- Improving Pre-emptive prescribing to relieve patient symptoms occurring out-of-hours: Fiona Herbert, Amy Orme and Rhys Williams 'Active'
Summary: 2 complete PDSA cycles (3 data collections), to assess whether how many new prescriptions for simple analgesia, laxatives and anti-emetics are being made over the weekends and if improving pre-emptive prescribing reduces these rates (thereby hopefully reducing patient distress and freeing junior doctors up to see unwell patients). Writing up for BMJ Quality at the moment.
- Improving Documentation in Medical Notes: Ayesha Khatib 'Active'
Summary: I audited patient medical notes on a ward to assess compliance with the Trust Policy on documentation. I then highlighted the results and policy to the MDT at the ward Board Round. I plan to re-audit the medical notes to identify whether or not compliance has improved.
- Blood cultures: Ben Masterman 'Active'
Summary: reviewing observations and bloods at time blood cultures taken to ensure they meet recommendations by the Trust. Comparison made with scoring system on previous studies. Likely intervention will involve education and updated guidance on trust DMS.
- Dementia screening in acute surgical admissions: Kirstin McGregor,Tom Nutting 'Active'
Summary: Dementia screening and assessment in our Trust is significantly poorer compared to medical admissions. Interventions introduced so far have included increased awareness with MDT education and PDSA cycles ongoing. Presented at Bristol Patient Safety Conference, writing up for BMJ Quality.
- Improving discharge summaries for enhanced recovery surgical patients: Kirstin McGregor, Specialist nurse Trudy Reed 'Active'
Summary: Enhanced recovery patients have clear pathways for their inpatient stay pre, intra and post operatively. Patients require MDT input for nutrition, mobility, pain and wound care and are often discharged into the community to continue their recovery. Detailed, accurate discharge summaries which reflect the inpatient stay and provide useful information for patients and their GPs is paramount. We are implementing a new approach for the information required in the discharge summary.
- Oxygen prescribing: Giles Dixon ‘Active’
- Warfarin prescription and administration: Rebecca Dyar ‘Active’
- Omitted medications in nil-by-mouth patients: Georgina Casswell ‘Active’
- SBAR communication: Georgina Casswell ‘Active’
- IV fluid prescription: Alexander Carpenter ‘Active’
‘Active’ denotes a project where PDSA cycles are on-going
‘Completed’ denotes a project where all planned PDSA cycles have been completed, and the project is written up
QI at Cheltenham and Gloucester
- Junior Doctors Essentials: Emergency Drug Dose Cards: Dr Joe Hutton and Dr Lisa Hutchinson
Junior Doctors Essentials (adult version) essentially reached end point. Intervention done, audit carried out pre and post, data analysed, presented at various conferences and electronic version introduced to "Treatment guidelines" section on intranet where lead pharmacist updating as needed. Big next step is that Drs / ANPs using them would quite like it in an App format. This would ideally include the paediatrics cards and some of the ED guidance also.
- improving the investigations requested at FY1 Upper GI Pre-admissions clinic: Aislinn O'Malley
Summary – I compared the investigations requested at 1 months worth of pre-admissions clinics to the recommended standard of the NICE guidelines. I found that FY1s routinely overinvestigate patients due to the advice in our current booklet.
- Management of acute exacerbation of COPD in ED: Abigail Nye
We audited the CQUIN outcomes for COPD, and then raised awareness by doing teaching sessions in ED and for the foundation doctors, and by putting up posters. We then re-audited.Poster presentation at Severn Quality Improvement meeting and submitted to BMJ Quality Improvement.
- Assessment and management of acute pancreatitis: Abigail Nye
Summary: We audited whether patients with acute pancreatitis were assessed using the Glasgow score, whether they were appropratiely referred to ITU and what imaging they had. We have designed an admission proforma, and are currently planning to recruit some F1s next year to re-audit.
- Reducing the door to needle time for antibiotics in suspected neutropaenic sepsis by using a clinical pathway – Dr Alex Williams
- Insulin/OHA Safety Project – Dr Nadine Hack-Adams 'Active' project summary available
- Compliance with CQUIN targets, a rolling audit on ACUA – Dr Zoe Jones
- On-line accessible guidelines – Dr Georgina Kelley and Dr Chloe Broughton
- Pain Management in ED – Dr Andrew Weir
- Discharge Summaries – Dr Sophie Foster
- Junior Doctors Essentials: Emergency Drug Dose Cards – Dr Joe Hutton and Dr Lisa Hutchinson
- Reduction of catheters on 4b – Dr Richard Parker
- Gentamicin – Dr Joanna Cooke and Dr Elena Binns 'Active'
- Surgical Weekend Handover: Traffic Light System gets the Green Light - Dr Madeleine Storey
QI at North Bristol
- Phlebotomy handover to junior doctors: Emily Brown, Gabrielle Churchhouse, David Cohen, Katerina Kyprianou, Catherine Hill, Matthew Hartley, Helen Jarrett, Sarah Murphy, Brindley Walker
Summary: A lack of communication between junior doctors and phlebotomists means untaken blood tests are often not recognised until late in a junior doctor's day, resulting in additional hours worked, delays in patient management and potentially avoidable handover of additional work to on-call doctors.
- Vitamin D deficiency identification and treatment in long term amiodarone use: Nicola Jones
It is well known and studied that many patients in hospital are vitamin D deficient. Those on long term amiodarone are told to avoid sunlight which has been shown to further lower their vitamin D. We aim to do a preliminary study of vitamin D levels in inpatient's on long term amiodarone which will be used as a basis for launching a standard protocol aimed at improving the number of patients on amiodarone who have levels checked (this will be a second stage if we establish that patients are often vitamin D deficient).
- Improving the ITU Induction QIP: Sinead Millwood
Summary: Most junior doctors felt unprepared for their job in ITU despite the induction. I used surveymonkey to find out what needed improving and then made a number of changes to the induction. I repeated the survey after the changes were made and found that juniors preparedness for the job increased from 5.1/10 to 7.8/10. I designed a proforma to help guide all future induction planning.
- Improving the Junior Doctor Guidelines Intranet Page QIP: Sinead Millwood
Summary: The previous guidelines page was crowded, disorganised and unfit for purpose. We gathered information from FY1's and FY2's and worked with the audit department to design a new intranet page with quick access to emergency guidelines as well as a more organised way of accessing a wider range of guidelines. We also created a bleep list of all the junior doctors in the hospital to improve communications between the different teams.
- Re-audit of compliance with ICP/ CPP targets in patients with severe traumatic brain injuries in ICU: Sinead Millwood
Summary: This is a rolling audit which looks at the departments compliance with individuals daily Intracranial pressure and Cerebral perfusion pressure targets.
- Improving the quality of surgical discharge summaries for elective surgical patients: Emma Ladds
- Weekend Handover: Christopher Akhunbay-Fudge
- Improving ward based teaching for medical students: Charlotte Hellmich
QI at Taunton
- Improving Oxygen prescription on the wards at MPH: Sebastian Helliar
There have been two staggered interventions which have improved and maintained Oxygen prescription rates (From ~10% to ~65%). The third intervention is being started in July.
- Improving Surgical patient Triage at MPH: Sebastian Helliar
To risk assess all surgical admissions so the most unwell - or potentially unwell, are prioritised to be seen first. This has been very successful and our system is soon to be trialled by Dereford Hospital in Plymouth.
QI at Weston General
- Sepsis 6
- Hypoglycaemia: hypoboxes
- Advanced care planning
- Nil by mouth
- Crash trolleys
- Medical handovers
- CTPAs for PEs
QI at RUH Bath
- Management of warfarin prescribing at RUH – Dr Cornelia Szecsei
- Improving routine nursing to doctor handover out of hours – Dr Emily Hotton
- Active, project summary available
- Implementation of bleep system to improve safety at night – Dr R Gaynor
- Improving patient safety in anaphylaxis – Dr Katherine Binmore
- Active, project summary available
- TAKE 10 – Improvement in the surgical post-take ward round – Dr Amy Tomsett
Contact a Foundation QI Co-ordinator: Lesley Jordan