QI Activity

This page provides information on QI Activity registered with the QI Department and some examples of QI work undertaken in NHS Forth Valley. QI activity can be registered at the link below.


A summary of improvement work supported by the NHS FV Quality Improvement team is available in the QISS Annual Report


QI Projects List

Hydration Matters. Improving fluid management in Acute and Community Hospitals


In response to national and local drivers to manage hydration as a core element of safe and compassionate care, NHS Forth Valley undertook a baseline audit of practice relating to fluid monitoring.The organisation now has risk assessment, ongoing review and care planning tools in place. This ensures all patients who are at risk are identified and supported with their individual hydration needs. Other tools, including fluid balance monitoring charts, intake only monitoring charts and fluid volume measures have been unified and adapted for use across acute and community care settings ensuring a consistent approach to recording. The policy and tools have had input from a wide range of nursing staff and have been adapted to ensure it is operationally applicable to areas previously excluded including theatres and ambulatory care.

Medicines Reconciliation in Community Pharmacy


Undertake pilot work with a group of Community Pharmacies to develop and implement a process for a Community Pharmacist to produce an agreed list of medication with a patient and GP following discharge from hospital. It is intended to extend the medicines reconcilation process to all Community Pharmacies in NHS Forth Valley.

Playlist for Life


The aim of this project is to implement and evaluate whether the use of music personal to the patient has an effect on their social engagement or interaction such as eye contact, vocalisation or touch and the value of this to both patient and relative during visits. Testing the use of Playlist for Life will inform us of the suitability for roll out using Quality Improvement methods and support to the remaining 3 community hospitals within Forth Valley.

Effect of Liaison Psychiatry on Patients with Dementia in FVRH


Two thirds of patients admitted to an acute hospital are aged 65 or over. Over 60% of them will have a mental health problem. Comorbidmental illness can impede treatment, rehabilitation and successful discharge. This study aims to show that early intervention by specialist liaison services and collaborative working with acute hospital staff can improve the patient journey and result in better outcomes, by reducing length of stay and increasing the opportunities for home discharge.Collaborative working has resulted in reduced lengths of stay, increased likelihood of home discharge and improved patient experience. The study has demonstrated an average reduction of 4 beddays per patient with dementia in the acute hospital. Based on estimates of 700 patients with dementia per year admitted to the acute hospital, input from the liaison service could potentailly save NHS Forth Valley 1.4 million pounds.

Strategies for Improving 5th Digit Coding in Heart Failure


ISD data for 2014 demonstrated high usage of unspecified HF codes in NHS Forth Valley, which impairs quality of data for service planning and patient folllow up. A continuous approach to intervention between medical and coding staff has shown success in improving heart failure coding with significant increase in specified 5th digit use 4 months affter initial intervention.

Reducing Waste in Preoperative Echocardiography - A Multidisciplinary Quality Improvement Project


Heart murmurs are common. However, routine preoperative echocardiography for all murmurs is unnecessary, delays surgery and is a strain on the echocardiography service.We have a evolved a new guideline that minimises over investigation without significantly effecting clinical management or patient outcomes. The majority of echocardiograms requested still demonstrate minor valvular disease that will not influence perioperative care, but by exclusion of serious pathology this may still be valuable. Increasing guideline specificity and the associated reduction in testing, risks decreased sensitivity and failure to identify significant occult valvular heart disease. However, only one patient has been cancelled on the day of surgery over this 3 year period as a result of lack of an available echocardiogram.

Renal Dietetic Database: Innovative Use of Desktop Software to Increase Diabetic Patient Facing Time with Hamodialyis Patients


To develop a Renal Dietetic Database to meet key drivers including Releasing Time to Care and the Healthcare Quality Strategy. Support the conversion from paper to electronic records. The Dietetic service to Haemodialysis patients was streamlined resulting in an increased efficiency in service delivery and a significant increase in patient facing time of 20 hours per month. Use of the database evaluated extremely well with staff and patients reporting positive experiences. Numerous benefits and key outcomes were identified and many link with the six dimesions of healthcare quality.

Mental Health Training for Local Operational Police Officers (Clackmannanshire)


The project has built relationships between mental health staff and local police, allowing for improvement in communication and a change in processes. By increasing the police officers mental health knowledge, individuals presenting to police with mental health issues are more likely to have a good experience, receive a compassionate response to their distress, feel safe and are signposted to services which can support them to achieve a positive outcome.

STOP! Let's huddle


This project's aim was to institute a daily afternoon huddle in the Combined Assessment Unit. This was to improve patient flow and also to alter the clinical environment to create another line of defence to reduce the contribution that latent factors can have to the occurrence of adverse events.

Preparing Patients for Pacemaker Implantation


The team realised there was scope for improvement in the information delivered to different patient groups. Patients being transferred for angiography recieved verbal and written information routinely. Pacemaker patients did not receive this and importantly we did not record whether crucial advice about driving had been given.The whole Cardiology became invovled and a PSDA model of change was adopted to improve reliabilty in providing information and resouces to patients.

Macmillan One to One Project in Forth Valley


Supporting patients with cancer to "live a new normal" should be viewed as a priority in the provision of cancer services. Collaboration and partnership working is essential with assessment, communication and person centred care planning crucial to ensuring excellence in quality. The One to One project is a good example of how we can achieve this.

Chest Pain Assessment Unit; Effective, Safe and Person Centred


Chest pain accounts for a significant proportion of Acute Medical Admissions (approx 25% in NHS FV). Of these presentations, most are not Acute Coronary Syndrome. The average length of stay for these patients was 24 - 36 hours. Delays were evident in many parts of the patient journey. This represented a significant cost to the Health Board, had a negative impact on bed capacity but most importantly was not offering a streamlined and seamless service to patients. Delivering better healthcare includes providing services which are equitable to access and are available to every patient, every time where and when needed.

Medicines Reconciliation in Acute Psychiatric Inpatients


We learned about the importance of multidisciplinary team-working in the management of medications. We also learned about potential barriers to 100% medicines reconciliation, as we were able to identify specific areas that did not meet 100% compliance. This allowed us to tailor local interventions.

Scottish Patient Safety Programme in NHS Forth Valley


The Scottish Patient Safety Programme was launched in 2008 with an initial focus on Acute Adult Care. The programme has subsequently expanded to encompass primary care, mental health, maternity, paediatrics and neonatal care. The programme in NHS Forth Valley aims to - Reduce HSMR and Hospital Infections - Promote reliable care for the deteriorating patient - Embed a safety culture through safety briefs and theatre brief and pause - Ensure the reliable use of medicines - Reduce avoidable harm in mothers and babies by 30% by 2015 - Increase % of women satisfied with their experience of maternity care to > 95% by 2015 - Reduce the harm experienced by individuals in receipt of mental health services - Develop safety culture and achieve reliability in 3 high risk areas by 2016 in Primary Care

The Final Barrier: Error Capture before Surgery


This is the first UK data to examine error capture during surgical briefing and checklist procedure. Local theatre teams are feeling enthusiastic and motivated by results which show systems are working well and preventing harm. The data has identified local up-stream processes, most notably listing procedures, which require strengthening. Similar data could play a role in quality assurance processes - ie if the underlying incidence of particular errors were established then a robust briefing/checklist and reporting process should expect to identify x number of errors within a given population.

Reduction in time to admission to critical care following redesign of services in a new hospital


There was a significant fall in number of total admissiions to ICU after the move as well as a significant increased proportion of patients admitted on day 0. This change has happened with the move to the new site and new ways of working.

Multiagency Crisis Management Plans for Mentally Ill Frequent Attenders to Accident and Emergency


The introductuion of crisis management plans, with graded risk management plans, for frequent attenders to A&E, which share need to know information proactively and collaboratively with all partner agencies has improved person centred care by providing an individualised approach to the whole person pathway 'door to door' which is safer, more consistent and more efficient. It also reduces the need for repeat story telling when in emotional crisis, thus reducing non value steps in the patient pathway. This type of graded, multidisciplinary crisis management has utility in other specialty care areas for high risk complex cases.

Developing a Safe, Effective Theatre Department: Adopting a Quality Improvement Model


Implemented changes include:- The use of 'sterile cockpit' during challenging theatre procedures to minimise distractions. Modification of WHO checklist to include pressure areas checks and strategies for movement prevention during surgery. Patient feedback. Development of shared surgical and anaesthetic post-operative management plans.

This Bundle Saves Lives


In the two months prior to the bundle introduction zero patients (0%) had all 3 elements of the bundle completed. After implementation data was collected weekly and 100% compliance with all elements of the bundle in all patients was achieved. We measured readmissions, length of stay, in-hopsital and long term mortality before bundle introduction and after reliable compliance. The bundle reduced readmission and mortiality rates. Median length of stay was increased.

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Projects in Forth Valley
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