NHS Quality Improvement Scotland Research Articles

Ten minutes with Dr Iain Wallace, Medical Director, NHS Louisa Jordan Hospital, Scottish Events Campus (SEC), Glasgow

![Graphic][1] ### Biography Iain Wallace studied Immunology and Medicine at the University of Glasgow and later gained an MBA from Strathclyde Graduate Business School. He practised as a GP principal...

The administration of blood components: a British Society for Haematology Guideline.

The administration of blood components: a British Society for Haematology Guideline.

Catheter securement: a need for the right device

Nursing and Residential CareVol. 18, No. 5 EditorialCatheter securement: a need for the right deviceAnn YatesAnn YatesSearch for more papers by this authorAnn YatesPublished Online:20 Apr 2016https://doi.org/10.12968/nrec.2016.18.5.252AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Bierman S, Carignan M (2003) The prevention of adverse events with urinary tract catheterisation. Managing Infection Control 42–7 Google ScholarCarignan M (2004) Mechanical reduction of catheter – associated urinary tract infection risk. http://bit.ly/1ZjcUGK (accessed 21 March 2016) Google ScholarEuropean Association of Urology Nurses (2012) Evidenced – based Guidelines for Best Practice in Urological Health Care – Catheterisation Indwelling catheters in adults – urethral and suprapubic. http://bit.ly/1RuvPyq (accessed 21 March 2016) Google ScholarFreeman C (2009) Why more attention must be given to catheter fixation. Nurs Times 105(29): 35–6 Google ScholarHanchett M (2002) Techniques for stabilising urinary catheters. Am J Nurs 103(3): 44–8 Crossref, Google ScholarHealth Protection Surveillance Centre (2011) Guidelines for the prevention of catheter-associated urinary Tract Infection. http://bit.ly/1Zje9Wo (accessed 21 March 2016) Google ScholarLoveday HP, Wilson JA, Pratt RJ et al. (2014) Epic 3 National Evidenced-Based Guidelines for Preventing Healthcare – Associated Infections in NHS Hospitals in England. J Hosp Infect 86(Suppl 1): S1–70. doi: https://doi.org/10.1016/S0195-6701(13)60012-2 Crossref, Google ScholarNHS Quality Improvement Scotland (2004) Urinary catheterisation and catheter care. Best Practice Statement. NHS Quality Improvement Scotland. http://bit.ly/1Zb2aeP (accessed 21 March 2016) Google ScholarNational Institute for Health and Care Excellence (2012) Infection: prevention and control of healthcare – associated infections in primary and community care. Clinical Guideline 139. http://bit.ly/1CK83Vv (accessed 21 March 2016) Google ScholarRoyal College of Nursing (2012) Catheter care – RCN guidance for nurses (2nd edition). http://bit.ly/1pvmtpi (accessed 21 March 2016) Google ScholarSpinks J (2013) Urinary incontinence and the importance of catheter fixation. http://bit.ly/1ReoPAc (accessed 21 March 2016) Google ScholarWound, Ostomy and Continence Nurses Society (2012) Indwelling Urinary Catheter Securement: Best Practice for Clinicians. http://bit.ly/1Ly0ubi (accessed 21 March 2016) Google ScholarYates A (2008) Urinary Catheters part 5 – catheter drainage and support systems. Nurs Times 104(43): 22–3 Google Scholar FiguresReferencesRelatedDetails 2 May 2016Volume 18Issue 5ISSN (print): 1465-9301ISSN (online): 2052-2932 Metrics History Published online 20 April 2016 Published in print 2 May 2016 Information© MA Healthcare LimitedPDF download

Urinary catheter fixation devices: an essential part of catheter management in the community.

Within community, residential and nursing homes, urinary catheter fixation devices are usually used on an ad hoc basis. Adhesive tape is often used to secure and anchor an indwelling catheter in place, although some complications have been identified in the literature (see, for example, Bierman and Carignan, 2007) including: w Adhesive tape failing to adhere to external catheter surface w Tape loosening quickly and frequently w Cumbersome for patients to manage w Adhesive build-up, creating potential bacterial colonisation w May cause too much or not enough traction on catheter to stop movement w Skin integrity can be compromised (Hanchett, 2002). Although fixation devices have been identified as an important part of the management of indwelling urinary catheters by national guidelines (Royal College of Nursing (RCN), 2012; National Institute for Health and Care Excellence, 2012; Loveday et al, 2014), they are rarely used routinely. Health professionals are sometimes unaware of the different types of fixation devices and the benefits they can provide to patient care. The Wound, Ostomy and Continence Nurses Society (WOCN) (2012) specify the indications for use of these devices as follows: ‘to prevent the catheter or its retention balloon from exerting excessive force on the bladder neck or urethra’. This principle is also supported by the Health Protection Surveillance Centre (2011) and NHS Quality Improvement Scotland (2004), who state that: ‘the catheter and attached drainage systems should be well supported in a comfortable position for the individual at catheter insertion to prevent complications’.

A survey of reporting of colorectal cancer in Scotland: compliance with guidelines and effect of proforma reporting

AimsThe main purpose of the study was to present a baseline audit of reporting of colorectal cancers resection specimens in Scotland, audited against the Royal College of Pathologists (RCPath) standards...

AUDIT OF HEADACHE REFERRALS FROM PRIMARY CARE TO A REGIONAL HEADACHE SERVICE

IntroductionHeadache is the most common neurological symptom with which patients attend their GPs and is also the commonest reason for referral to neurology outpatient clinics. The Neurological Services Task and...

Standards for NHS Scotland Chaplaincy Services

A scoping group established by NHS Quality Improvement Scotland and the Healthcare Chaplaincy Training and Development Unit, (HCTDU, now part of NHS Education for Scotland (NES)) was asked to scope awareness and provision of Spiritual Care in NHS Scotland. The group produced a report covering a survey and literature research. Following a seminar May 2005 in which this report was discussed along with some current research, a further group began work on chaplaincy service standards. A consultation conference held on 27 th June 2006 brought much support and many comments on the standards document. Despite some hesitation in trying to measure things spiritual, these standards should be a useful audit tool and an aid for future work on competencies and help development towards national standards or good practice statements on spiritual and religious care in NHS Scotland.

The 2012 British Association of Neuroscience Nurses Annual Conference

British Journal of Neuroscience NursingVol. 8, No. 6 BANN PagesThe 2012 British Association of Neuroscience Nurses Annual ConferenceNeal Cook, Mary BraineNeal CookSearch for more papers by this author, Mary BraineSearch for more papers by this authorNeal Cook; Mary BrainePublished Online:27 Sep 2013https://doi.org/10.12968/bjnn.2012.8.6.358AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Bennett MI, Smith BH, Torrance N, Potter J (2005) The S-LANSS score for identifying pain of predominantly neuropathic origin: validation for use in clinical and postal research. J Pain 6(3): 149–58 Crossref, Google Scholar Grisso T, Appelbaum PS, Hill-Fotouhi C (1997) The MacCAT-T: a clinical tool to assess patients' capacities to make treatment decisions.Psychiatr Serv 48(11): 1415–9 Crossref, Google Scholar Lehmann N, Joshi GP, Dirkmann D et al. (2010) Development and longitudinal validation of the overall benefit of analgesia score: a simple multi-dimensional quality assessment instrument. Br J Anaesthesiol 105(4): 511–8 Crossref, Google Scholar Mioshi E, Dawson K, Mitchell J, Arnold R, Hodges JR (2006) The Addenbrooke's Cognitive Examination Revised (ACE-R): a brief cognitive test battery for dementia screening. Int J Geriatr Psychiatry 21(11): 1078–85 Crossref, Google Scholar NHS Quality Improvement Scotland (2009) Neurological Health Services. Clinical Standards ∼ October 2009. NHS Quality Improvement Scotland, Edinburgh Google Scholar FiguresReferencesRelatedDetails 1 December 2012Volume 8Issue 6ISSN (print): 1747-0307ISSN (online): 2052-2800 Metrics History Published online 27 September 2013 Published in print 1 December 2012 Information© MA Healthcare LimitedPDF download

Early warning systems in the UK: variation in content and implementation strategy has implications for a NHS early warning system

The Royal College of Physicians report Acute medical care: the right person, in the right setting--first time advocates the introduction of a standardised NHS Early Warning Score (NEWS). Recommendations for the optimum scoring system have been released by NHS Quality Improvement Scotland (NHS QIS) and the National Institute for Health and Clinical Excellence (NICE). This study reviewed clinical practice in London and Scotland against national guidelines. All hospitals responsible for acute medical admissions completed a telephone survey (n = 25 London; n = 23 Scotland). All used an early warning system at point of entry to care. Eleven different systems were used in London and five in Scotland. Forty per cent of London hospitals and 70% of Scottish hospitals incorporated the minimum data set recommended by NICE. Overall, Scotland was closer to achieving standardisation. If NEWS is implemented, consideration of the NHS QIS approach may support a more consistent response.

A service review of dietetic input for chronic obstructive pulmonary disease patients on long-term oral nutritional support

Background: Patients with chronic obstructive pulmonary disease (COPD) often require long-term oral nutritional support and concomitant dietetic input, secondary to commonly associated weight loss and malnutrition (Batres, 2007). There are approximately 100 000 people in Scotland living with COPD(NHS QIS, 2009). Due to current demands on dietetic services, this retrospective case review looked to explore the number of dietetic reviews provided and the consequent change in nutritional status in a group of COPD patients. Methods: A retrospective case review of the 26 COPD patients known to the community dietetic department at the time of the study was carried out (12 females, 14 males). The patient's ranged in age from 44 to 73 with the mean (SD) age of 64 (7.5) years. Their reported heights were recorded and each patient had their weight measured on Tanita scales at each contact. Initial BMI and current BMI were then calculated, together with the number of dietetic reviews that had been provided. The results were then analysed using SPSS statistics software. Recorded BMI data was parametric therefore a paired sample T-Test was used. Results: The median number of dietetic reviews was 6 (IQR 3, 10). From this, two patient groups were formed, those receiving six or less dietetic reviews and those with over 6. The T-Test indicated a significant increase between the initial BMI and current BMI for the group receiving six or less reviews (P = <0.005). This was not significant for the group who received over six reviews. Table 1. Mean (SD) body mass index (BMI) according to number of dietetic reviews BMI on referral (kg m-2) Current BMI (kg m-2) P value Six or less dietetic reviews (n = 14) 18.1 ± 3.3 19.6 ± 3.4 ≤0.005 Over six dietetic reviews (n = 12) 18.5 ± 1.9 18.2 ± 2.3 0.424 Discussion: This review supports previous research that dietary counseling and food fortification has a positive impact on the nutritional status of COPD patients (Weekes, 2009). It indicates that dietetic input is valuable, however, due to current demands on dietetic services, it is not beneficial to continually review this patient group long-term, once nutritional stability has been established, e.g. <5% weight loss in 3–6 months (BAPEN, 2004). Due to the clinical nature of the study, the limitations included the variable timescales for dietetic reviews. Conclusion: Dietetic input has a positive effect on BMI status in COPD patients however more efficient dietetic practices need to be implemented for long-term oral nutritional support patients.

Scottish Antimicrobial Prescribing Group (SAPG): development and impact of the Scottish National Antimicrobial Stewardship Programme

In 2008, the Scottish Management of Antimicrobial Resistance Action Plan (ScotMARAP) was published by the Scottish Government. One of the key actions was initiation of the Scottish Antimicrobial Prescribing Group (SAPG), hosted within the Scottish Medicines Consortium, to take forward national implementation of the key recommendations of this action plan. The primary objective of SAPG is to co-ordinate and deliver a national framework or programme of work for antimicrobial stewardship. This programme, led by SAPG, is delivered by NHS National Services Scotland (Health Protection Scotland and Information Services Division), NHS Quality Improvement Scotland, and NHS National Education Scotland as well as NHS board Antimicrobial Management Teams. Between 2008 and 2010, SAPG has achieved a number of early successes, which are the subject of this review: (i) through measures to optimise prescribing in hospital and primary care, combined with infection prevention measures, SAPG has contributed significantly to reducing Clostridium difficile infection rates in Scotland; (ii) there has been engagement of all key stakeholders at local and national levels to ensure an integrated approach to antimicrobial stewardship within the wider healthcare-associated infection agenda; (iii) development and implementation of data management systems to support quality improvement; (iv) development of training materials on antimicrobial stewardship for healthcare professionals; and (v) improving clinical management of infections (e.g. community-acquired pneumonia) through quality improvement methodology. The early successes achieved by SAPG demonstrate that this delivery model is effective and provides the leadership and focus required to implement antimicrobial stewardship to improve antimicrobial prescribing and infection management across NHS Scotland.

A future for pathways in mental health care in Norway: a discussion paper based on El-Ghorr et al. (2010)

We have read the paper by El-Ghorr et al. (Int J Care Pathways 2010;14:57-64) on Scotland's national approach to improving mental health services with great interest. The paper described the strategy developed by NHS Quality Improvement Scotland (NHS QIS) in which integrated care pathways were used as tools for redesign and continuous quality improvement. In our opinion, a similar national effort is also necessary in Norway. In particular, pathways would help bridge the ‘gap’ between primary and specialist services. We point to which elements of the Scottish programme it is that would be relevant to implement in Norway in future. Furthermore, we discuss factors that are already present in Norway upon which authorities, health leaders and professionals could build on in a future national-level implementation of pathways in mental health care.

A Future for Pathways in Mental Health Care in Norway: A Discussion Paper Based on El-Ghorr et al. (2010)

We have read the paper by El-Ghorr et al. (Int J Care Pathways 2010;14:57-64) on Scotland's national approach to improving mental health services with great interest. The paper described the strategy developed by NHS Quality Improvement Scotland (NHS QIS) in which integrated care pathways were used as tools for redesign and continuous quality improvement. In our opinion, a similar national effort is also necessary in Norway. In particular, pathways would help bridge the ‘gap’ between primary and specialist services. We point to which elements of the Scottish programme it is that would be relevant to implement in Norway in future. Furthermore, we discuss factors that are already present in Norway upon which authorities, health leaders and professionals could build on in a future national-level implementation of pathways in mental health care.

Patients’ views on topical negative pressure: ‘effective but smelly’

Topical negative pressure (TNP) is increasingly being used in both the UK and internationally, on wounds of acute, chronic and surgical origin. However, little is known about patients' experiences of this therapy. NHS Quality Improvement Scotland undertook a health technology assessment on TNP in 2009-2010. This assessment considered clinical and cost-effectiveness, patient issues, and organizational issues. This article describes the primary research undertaken for the patient issues section. Qualitative methods were used to attempt to understand patients' perceptions and experiences of TNP. A focus group and individual interviews were held in Glasgow, recorded, and transcribed verbatim. Data were analysed thematically. The themes which emerged as being important to patients receiving TNP were healing, smell, embarrassment, pain, nurse training, self-care, information provision, getting out of hospital, and returning to normal life. Implications for practice are suggested for manufacturers, service leads and nurses.

Reconciling the perspective of practitioner and service user: findings from The Aphasia in Scotland study

It is widely accepted that service users should be actively involved in new service developments, but there remain issues about how best to consult with them and how to reconcile their views with those of service providers. This paper uses data from The Aphasia in Scotland study, set up by NHS Quality Improvement Scotland to identify the direction of the development of services for people with aphasia in Scotland. It examines the views both of those who provide and of those who receive those services. The study integrated findings from a questionnaire to all speech and language therapists treating people with aphasia across Scotland with findings from focus groups with service users and aphasia practitioners. Three themes were identified: (1) public and professional awareness of the impact of aphasia on the individual and their family; (2) current service provision and gaps in services; and (3) directions for the future development of services and barriers to change. Although the impact of aphasia is well recognized amongst most professionals (that is, not just speech and language therapists), considerable concern was expressed about the level of knowledge amongst professionals who do not specialize in stroke care and about public awareness of aphasia. Service providers indicated a shift in the model of service delivery of which the service users were largely unaware. Although the majority of speech and language therapists spend most of their time providing one-to-one therapy, and this is valued by service users, there is undoubtedly an emerging shift towards a focus on broader social function and the inclusion of the person with aphasia in supportive social networks. This creates tensions because of the existing pressure for individualized models of delivery. Concern was expressed by practitioners, although not echoed by patients, about the transition from the acute sector to primary care. Practitioners also expressed concern about the introduction of more recent services like NHS 24 and e-health initiatives, which rely on means of communication that may be particularly challenging for people with aphasia. The findings from this study indicate that although there are clearly common perspectives, the views of people with aphasia about services do not necessarily coincide with those of service providers. This is an important consideration when initiating consultation and highlights the need for clarity on the part of practitioners in identifying the aims and objectives of their services as far as people with aphasia are concerned.

Using a Delphi survey to identify priorities

Background and aims: Through the implementation of a Delphi consultation survey, the aim of the study was to identify the key priorities and opportunities for NHS Quality Improvement Scotland (QIS) to support NHS boards and community health partnerships (CHPs) to improve the quality of care in primary healthcare services in Scotland. Methods: A three-stage Delphi survey was undertaken involving a panel of clinicians, managers, academics, professional bodies and voluntary organisations working in community and primary healthcare services in Scotland. Results: Following three rounds of the Delphi survey, where the panel scored their level of agreement with suggested topic areas, a number of priority areas have now beenidentified where NHS QIS support could add the most value to community and primary healthcare services. Conclusions: The Delphi process has enabled NHS QIS to gather feedback quickly and efficiently from a wide range of geographically dispersed primary care clinicians, managers and academics across Scotland. The feedback received through the Delphi has been extremely valuable in informing the development of the future NHS QIS community and primary care work programme.

PW01-137 - A model of accreditation developed to support NHS boards in Scotland acheive standards for integrated care pathways for mental health

ObjectiveHaving been tasked with developing Standards for integrated care pathways for mental health (ICP), successfully publishing in 2007, NHS Quality Improvement Scotland (NHS QIS) now supports NHS Boards in developing and implementing these standards. Support is available via three National ICP Coordinators and local ICP facilitators.The main objective is for Boards to achieve ICP accreditation, resulting in demonstration of a robust and responsive mental health system through implementation of their local ICPs supporting continuous cycles of quality improvement embedded in a culture that ensures delivery of person-centred care and reflective practice.MethodsA model of and process for accreditation was developed considering: § Developing the project plan§ Reaching consensus on the goal of the accreditation initiative.§ Defining incentives for stakeholders in having ICPs accredited § Reviewing literature on existing accreditation systems in UK and internationally § Developing a range of options§ Carrying out an option appraisal§ Agreeing one preferred option § Obtaining NHS QIS and Scottish Government approval for preferred option§ Further development of support mechanisms and implementation of a longer term accreditation frameworkResultsA phased and incremental accreditation system was developed.The first phase - “foundation level” - focuses on ensuring that appropriate infrastructures are in place to support full ICP development and implementation in NHS Board.ConclusionsAll 14 NHS Boards in Scotland achieved foundation level accreditation.Reflection on this first phase are helping to inform NHS QIS on how best to structure future levels of accreditation and ongoing support over the next few years.

P02-122 - Piramhids - positive and innovative resources: a mental health interactive database (Scotland) (www.piramhids.com)

ObjectivesFollowing the National Review of Mental Health Nursing in Scotland (2006), an action plan was developed to improve recovery focused mental health services. It was advocated that a method of sharing evidence based, positive and innovative practice in mental health be created. NHS Quality Improvement Scotland supported by the Scottish Government, was tasked to develop the database and successfully launched the PIRAMHIDS resource in September 2008, now providing the platform to share information at local, national and international levels.MethodsPIRAMHIDS ensures equitable opportunity to share examples of practice from statutory, non statutory services and the voluntary sector. Contribution to the database is made easy by an intuitive online submission process. A quality assurance process is then followed in achieving publication approval. Submissions are passed to an external review body. External reviewers consist of professionals from a range of disciplines including Psychiatry, Mental Health Nursing, Occupational Therapy, Higher Education, service improvement, etc. The selected reviewers consider the submission in context of the publication criteria which includes:Practice summary:Detail of practice deliverableEvidence base-current/existing or potential to inform evidenceChallenges and resolvesQuality assurance considerations and impact assessment on the patient experienceResults/conclusionsPIRAMHIDS is the resource to share your practice. In addition there is an online forum encouraging networking, up to date mental health information feeds and direct links to other useful resources such as Integrated Care Pathways for mental health toolkit. Now accessed by thousands world wide, take the credit and share your care.Contribute today.

Out for consultation.

NHS Quality Improvement Scotland is seeking feedback on a draft set of standards for the management of chronic obstructive pulmonary disease (COPD).

How well do search filters perform in identifying economic evaluations in MEDLINE and EMBASE

Health technology assessment (HTA) agencies assessing the cost-effectiveness of healthcare technologies seek evidence from economic evaluations. As well as searching economic evaluation databases, researchers often search MEDLINE and EMBASE, using search filters whose current performance is unclear. We assessed the performance of search filters in identifying economic evaluations from MEDLINE and EMBASE. A gold standard of economic evaluations was compiled from National Health Service Economic Evaluation Database (NHS EED) records for 2000, 2003, and 2006. Corresponding records were retrieved in MEDLINE and EMBASE. Search filters were identified from the InterTASC Information Specialists' SubGroup Web site and from Canadian Agency for Drugs and Technologies in Health (CADTH) Information Services. The sensitivity and precision of search filters in retrieving gold standard records from MEDLINE and EMBASE were tested. A total of 2,070 full economic evaluations were identified from NHS EED. Of these, 1,955 records were available in Ovid MEDLINE and 1,873 were available in Ovid EMBASE. Thirteen MEDLINE and eight EMBASE filters were identified. NHS Quality Improvement Scotland (full and brief filters), the NHS EED and Royle and Waugh filters achieved over 0.99 sensitivity in MEDLINE. NHS Quality Improvement Scotland, CADTH, Royle and Waugh, and NHS EED filters achieved greater than 0.99 sensitivity in EMBASE. Filters demonstrated low precision. This research provided new performance data on search filters to identify economic evaluations in MEDLINE and EMBASE. It demonstrated that highly sensitive economic evaluation filters are available, but that precision is low, yielding perhaps 5 relevant records per 100 records scanned.