Posted on: 30 July 2024
The Urgent Community Response teams provide urgent care to people in their own homes to avoid unnecessary hospital admissions and to enable people to live longer independently.
The service provides responsive care to residents of Milton Keynes 24 hours a day, seven days a week.
The team recently started a project to improve safety processes in the service. This followed an incident last year where a patient had to be hospitalised following a change of catheter in the community.
While the investigation did not flag any issues with the clinical care provided, the patient and their family said that they had not been given full advice on the risks associated with the procedure. The UCR team met to discuss the processes they had in place on providing safety netting advice to patients and identified that there were areas of variation across the team in how and when this was done. They also recognised that documentation, often done in a time pressured context, often did not give detail of what information was discussed or provided.
The Team agreed to use Quality Improvement methodology to structure the work to address this issue with the project aim that: By September 2024, all staff will feel confident that patients get the information they need to stay safe every time.
This was defined further to mean that the team would look at developing consistent advice and material for patients and families, provided by staff either on the phone or in person, for the main issues that the team deal with. This includes working with care home staff who provide day to day support for patients who may have been under UCR care.
The Project has now developed into 3 strands
- Patient information on core conditions to be used face to face;
- Patient information for care homes;
- and patient information for phone consultations.
The team used QI methology know as ‘Plan Do Study Act cycles’(PDSA) to test a number of ideas. At present they have identified 5 PDSA ramps, and we are actively testing 3 of them:
- One page, condition specific information helps patients (on cycle 3)
- Information leaflet for care homes (cycle 3)
- Ways of engaging with the full staff group (cycle 2)
They will also test:
- Updated patient record system template for consistent triage
- Updated template for consistent advice over the phone
- Pocket sized, staff quick reference guide
How has QI made a difference?
The QI approach helped us to focus in on this piece of work. While this took time, the feedback we received has had an impact on our next steps. For example, if we hadn’t used PDSAs, we would probably just have issued it out to all care homes and assumed people used it. Direct feedback challenged this view and forced us to think differently about our approach.
The service hope to complete this part of the project by September, when they will review progress and think about our next steps.