Joint working executive summaries

The issue

Patients in care for extended periods are at risk from skin damage. Various factors e.g. nutrition, hydration, nursing procedures, medication, skin dryness, age, underlying skin disease, co-morbidity, patients weight and mattresses can all increase that risk. Development of pressure sores and skin tears are distressing to patients, require expensive and lengthy intervention to resolve and frequently result in extended hospital stays, patient disatisfaction and extended care on discharge. Reducing incidence of care setting acquired skin damage is a desirable outcome for patients and healthcare teams. By adherence to risk assessment and skin care procedures, many if not all of these injuries can be prevented.

To reduce the incidence of care setting acquired skin damage. This would result in improved patient experience, reduced hospital residency time, more appropriate use of tissue viability nurses and reduced financial resource through a focus on risk assessments, training and healthcare intervention.

Conduct baseline audit to assess risk assessment completion and adherence to reccomendations. Implement interventional procedures to address any issues from baseline audit including training. Carry out follow up audit at 6 and 12 months to assess if interventions and training have produced reduced incidence of skin damage.

• Patient centred care
• Using quality and outcomes to shape service
• Focus on prevention
• The provision of care pathway, providing a seamless care to those patients at risk of skin injury
• Avoiding/reducing unnecessary extended stays in hospital. 
• With assessment, care plan and implementation at the care facility, patients will experience improved quality of care and outcomes. 
• Safeguarding the most vulnerable
• Constant care

• Reduced incidence of grade 3 or 4 pressure ulcers and skin tears.
• Reduced patient residency time in the facility. 
• Improved capacity for the healthcare staff.
• Reduced costs in bed time, nursing time and dressings to treat the patients
• Legacy training tools and care packages for the trust to ensure care standards are maintained.
• Demonstration of Integrated care using TVNs, Nurses, Pharmacists, dieticians and clinicians

• Build effective working relationships with the Western HSC trust– to use as a case study
• Build on reputation amongst WHSC Trust & industry
• Audit may be used as evidence to replicate this service model across other areas.
• Evidence of effective use of emollients and of non detergent soaps in skin care.

Active March 2013–March 2014
Contact: Edward Vining, Healthcare Development Manager
Business address: Reckitt Benckiser Healthcare (UK) ltd, Dansom Lane, Hull HU8 7DS
Email: edward.vining@rb.com
Code: UK/E45-NHS/0213/0004

The issue

The Speech Language therapist is well placed to diagnose and treat symptoms of reflux commonly seen in both ENT & Respiratory patient referrals

The challenge

There is a need to provide evidence and data on the effectiveness of SLT intervention in terms of the QIPP principles to support an invest to save model.

Key actions

• Strengthen service set up through project team.
• Conduct audit on past, present, and future potential of service.
• Using evidence from audit to engage stakeholders to support service 

The outcome

Patient benefits

• Audit of this SLT service will identify its true potential to provide an improved level of care to the patient. 
• The Audit will capture the benefits of SLT intervention to improve level of care & treatment of very common condition by showing impact on service and patient outcomes.
• A clearer pathway of care so patient diagnosed and treated effectively
• Patient empowered through better improved understanding on their conditions and treatment options 

NHS partner benefits

• The audit will identify the true potential the SLT service can offer the NHS
• Project will aim to deliver on QIPP Principles
• Produce quality outcomes with a better more effective service and level of care. (measured through reduction of repeat referrals, patient outcome survey & resolution of symptoms)  
• Innovation – clearer pathway of care identified -  to save money and make service more effective
• Productivity - Audit will show rate of unnecessary referrals and readmissions and identify potential cost savings through delivering effective SLT intervention.
• Prevention - Reduced number of readmissions & inappropriate referrals. By understanding their condition, patients empowered to self manage and not left reliant on long term acid suppression.

RB company benefits

• Build effective working relationships with NHS – to use as case study 
• Build on reputation amongst NHS & Industry.
• Audit may be used as evidence to  replicate this service model across other localities
• Documented insight into reflux associated respiratory conditions

Current status

Active Jan 2011 – Jan 2012

The issue

The ENT Head and Neck Cancer Service currently provides a clinic in which all new patients with a suspicion of Throat Cancer are seen by medical staff. An average of between 40 and 50 patients a week are seen in the clinic and over a 100 patients are diagnosed with Throat Cancer annually in the North East of Scotland.

Not all patients with sore throats and voice changes attending turn out to have cancer, and the Head and Neck clinic is becoming overburdened with new referrals of anxious patients. This has a knock on effect on those patients attending the clinic with diagnosed cancer and less clinical time is available and delays are commonplace. Many of these new referrals could be seen elsewhere. Also urgent referrals for assessment of Hoarseness impact on the number of patients seen at the general ENT clinic with an average of 30 patients (2009) per month seen at this clinic.

The challenge

Redesign the ENT and Head and Neck Service to free up valuable time particularly for the cancer patients while still offering a rapid and reassuring service for those patients in whom there is nothing serious.

Key actions

• The project team will ensure that the service supports the needs of the patient
• Audit numbers of patients over a 6 month period where management outcomes and patient experiences will be recorded
• Use evidence from audit to engage stakeholders to support service for longer term

The outcome

Patient benefits

• The SALT (Speech and Language Therapy) led clinic will triage patients so that only those with cancer need to be seen at the Cancer clinic while those with benign pathology can be reassured and managed accordingly
• Avoids unnecessary attendance at a cancer clinic, which can lead to worry and apprehension
• Faster access to appropriate Healthcare personnel and less waiting times

NHS partner benefits

• This joint working project should in the future lead to direct referrals to the Parallel Hoarse voice clinic, bypassing the need for consultant vetting of patients
• Improved service efficiency and free up clinic appointments thus helping to achieve waiting time targets and increase in outpatient clinic capacity
• Cost efficiencies through utilisation of appropriate professional skills and equipment aligned to strict protocol and process
• This service will offer a rapid and reassuring service for those who have suspected cancer therefore ensuring all patients, with or without serious pathology, are treated appropriately and promptly

RB company benefits

• Build effective working relationships with NHS – to use as case study
• Build on reputation amongst NHS & Industry
• Audit may be used as evidence to replicate this service model across other localities

Current status

Active October 2012 to October 2013