Cutting down on troponin testing at Royal Gwent

Where this happened: Royal Gwent Hospital

Increased levels of troponin in the bloodstream can be an indicator of hear damage after a heart attack. However levels of troponin can also be raised without heart damage and over-use of this test can lead to false diagnosis, more unnecessary tests and longer stays in hospitals for patients. Doctors at Royal Gwent Hospital analysed requests for troponin tests during one week and found that many tests were requested without any clinical justification. They drew up clearer guidelines as to which circumstances troponin tests should be used in and tried to discourage using the test as part of a ‘tick-box’ approach. They audited the troponin tests again once they had taken this initiative and found that the number of tests being asked for had fallen.

Find out more at: http://qir.bmj.com/content/4/1/u204560.w3221?cpetoc

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Saving ENT consultants’ time at East Sussex

Where this happened: East Sussex Healthcare NHS Trust

People who have had surgery on their noses usually go for a follow-up appointment a few months after their operation. However, a lot of patients either don’t turn up to these appointments or tend to not really need them – something that clogs up the rest of the ENT clinic and wastes a lot of consultants’ time. East Sussex Healthcare NHS Trust had the bright idea of getting nurses to carry out the follow-up, telephoning patients three months after their operations. As it turned out only 9.5% of the patients requested an outpatients appointment and all of them were discharged when they had their appointment. The project demonstrated that nurse-led follow up is an “efficient, effective and safe way of managing patient care post-nasal surgery.”

Find out more at: http://qir.bmj.com/content/4/1/u208386.w3311?cpetoc

Buying gloves better

Where this happened: South Yorkshire, Mid-Yorkshire, North Derbyshire

While buying things as an individual can be all-too-easy, buying things as a corporation (procurement) can be surprisingly complicated and the NHS doesn’t always get the best deal for the goods and services it purchases. Buying in bulk tends to lower the price of items so seven NHS trusts in South Yorkshire, Mid-Yorkshire and North Derbyshire got together to buy latex examination gloves. Eight short-listed suppliers bid for the chance to supply gloves to the Trusts for a year – an initiative that saved £400,000 per annum.

Find out more at: http://www.rcn.org.uk/newsevents/campaigns/small-changes-big-differences/success-stories/an-initiative-to-consolidate-examination-gloves-usage-and-save-money-across-trusts

Swap shop saves stock

Where this happened: Derby NHS Foundation Trust

When Stephanie McCarthy started work as a Clinical Procurement Nurse Specialist at Derby NHS Foundation Trust she found that large amounts of clinical stock were being stored, unused, in the hospital. Reasons for this included:

  • Stock not being worth enough to justify the effort and postage to return it
  • Stock being surplus to requirements
  • Stock being incorrectly ordered

Stephanie worked with Pete Charvill, the Theatre Procurement Lead, to set up a clinical products swap-shop in a part of the hospital that was accessible to all staff. They created a catalogue of swappable material which was put on the Trust’s intranet and out-of-date stock was offered to the education teams for training purposes. The scheme accumulated £24,000 worth of stock, £18,000 of which was found a good home on one day. As well as the cost savings removing excess and redundant stock meant that stock rooms became tidier and clearer.

Find out more at: http://www.rcn.org.uk/newsevents/campaigns/small-changes-big-differences/success-stories/setting-up-a-clinical-swap-shop-leads-to-big-savings

Improving dressings in Tower Hamlets

Where this happened: Tower Hamlets PCT

Patients with wounds that refuse to heal are sometimes prescribed dressings. There can be a number of problems with doing this: delays in prescribing can lead to poor patient care; wasted dressings can end up piling up in patients’ homes and there is no standard practice in terms of the choice of dressings patients are prescribed. Tower Hamlets PCT decided to tackle this problem and took 90% of bandages off prescription, meaning that rather than this being done automatically, and without thinking, patients came in to see nurses and doctors and could be given a review of what their problems were and a more personalised solution to them. As the process changed at GP level groups of patients became more visible including:

  • Patients with leg ulcers looking after themselves who were given support, training and appropriate dressings to get them healed
  • Patients with peri-anal abscesses
  • Patients with hidradenitis suppurativa (a skin disease which can cause abscesses and scarring)

The scheme received excellent feedback with patients getting quicker access to dressings and better overall care. They also got more frequent reviews and surveys of nurses also showed that the scheme had led to improved infection control, reduced waste, more standardised treatments and a reduction in wasted time. The financial saving was £600,000 over four years.

Find out more at: http://www.rcn.org.uk/newsevents/campaigns/small-changes-big-differences/success-stories/improving-patient-care-by-standardising-prescription-dressings

Improving continence care in Shropshire

Where this happened: Shropshire Community Health

Using continence pads can raise the risk of pressure sores, particularly when used with all-in-one fixation pants. NHS Supply Chain worked together with Ontex UK and Shropshire Community Health to rationalise the product range of continence pads, reduce the unnecessary use of all-in-one fixation pants and save around £50,000 a year. The Trust wrote to patients telling them about the changes and clinical staff were also trained in using the new products and reducing the use of fixation pants. At the same time the Trust switched to delivering more pads less frequently to cut delivery charges. The project managed to reduce the incidence of pressure sores by reducing the use of fixation pants and is projected to save £111,000 a year.

Find out more at: http://www.rcn.org.uk/newsevents/campaigns/small-changes-big-differences/success-stories/improving-patient-care-through-a-review-of-the-use-of-continence-care-pads

Improving junior doctors’ rotas in Brighton

Where this happened: Royal Sussex County Hospital, Brighton

Junior doctors often feel they have little control over their working environment, including their rotas. In this project junior doctors at Royal Sussex County Hospital, Brighton designed their own rotas. A new rota was needed anyway as the department it applied to had recently been re-organised, a re-organisation that altered the out-of-hours workload for junior doctors. The new rota – drawn up by the junior doctors – proposed an increased number of junior doctors during daytime shifts at the weekends. 32 junior doctors were asked to compare the new rota with the old one and they all said it was safer and that they would be more willing to work it. The new rota was introduced in August 2014 and junior doctors said that they thought it was safe and that it provided improved cover during all of the shifts.

Find out more at: http://qir.bmj.com/content/4/1/u206069.w3327?cpetoc