Innovation Adoption and Diffusion
Mariani Tanton from NHS Kirklees was a finalist in this category with ‘The Dewsbury Feeding and Swallowing Screen’.
Mariani designed and developed The Dewsbury Feeding and Swallowing Screen package which comprises two parts:
- The screen: Was designed for early and accurate identification of life-threatening feeding and swallowing problems in patients, whatever the diagnosis, in a variety of locations. It is an observational checklist to capture the patient’s eating and drinking capabilities and safety in as functional setting as possible assessing both fluids (the most likely consistency to cause problems)and diet (which is often overlooked in other screening tools). It is quick, but comprehensive and is easy to use, even for those with little or no experience in this area.
- The Training package takes the place of training and competence checks previously delivered by the author. It comprises a main manual containing information on causes and risk factors in dysphagia, the background of the screen’s development, details about each test item and administration and scoring details; a DVD showing 12 normal and abnormal swallows; a short DVD manual containing 12 completed screening forms relating to those assessments on the DVD.
In practice it has been in use at Dewsbury and District Hospital since 2003. It is used on 5 wards, according to individual remits, at the time of the first food and drink given. Further wards wish to adopt it. It has been adopted, for the Stroke Pathway, by hospitals in Wakefield and Pontefract. The author is to present the Screen within a dysphagia lecture in June, to local Care Homes - many already expressing an interest. Kirklees Independent Sector Workforce Adult Services - Commissioning and Planning have assisted in advertising the Screen locally. A number of other Care Homes throughout the have purchased the package.
Liz Webster from Leeds Metropolitan University was a finalist with her innovation ‘Getting Sorted: Our Way’.
The ‘Getting Sorted’ Programme for diabetes is a model of self-care that is based on the views of young people with Type 1 diabetes about what impacts on their lives and what they want in a self-care programme. The ethos is to actively engage young people at every stage and for young facilitators with Type 1 diabetes to innovatively deliver 5 workshops and develop the programme within the region. The workshops are unique, active, informative and young person centred. They are aligned to current National Drivers relating to the Expert Patient Programme, the key objective being to enable young people to increase their understanding and self manage their diabetes in ways that suit them, thereby reducing the risk of long term complications. To date, the programme has been delivered in 5 PCTs in Yorkshire and the Humber as part of the SHA Pilot, capturing the views of 100 young people with diabetes. During the SHA pilot workshops were adapted and developed based on feedback from young people.
The originality of the project was based around an idea formulated over 20 years of experience working in practice, through observing the positive benefits of peer support, through working with young people with complex health needs. This was achieved through engaging with 3 young adults with type 1 diabetes, developing their skills as young researchers, who facilitated the ‘talking groups’ (name given by young people for focus groups), analysing data through listening to the development and delivery of the programme. It was found that the emphasis of a self care programme should be designed; created and written ‘by young people for young people.’
The intention now is to roll out the diabetes ‘Getting Sorted’ Programme across more PCTs in the region and embed it as part of mainstream service provision.
Joanne Mangnall from NHS Rotherham was a finalist with her innovation “NHS Rotherham - Continence Prescription Service”.
This service has been established with no increased costs to the PCT. Prescribing responsibility was transferred from GP practices to the continence service along with financial responsibility for the prescribing budget. A centralised telephone contact point was established within the existing nurse led continence service. Patients were given one number to ring to order prescriptions or access help or advice. A triage template was developed to sit within the patient electronic record. The template guides the prescription co-ordinator through a telephone triage consultation. If the patient gives a positive response to any of the questions a referral to the nurse is generated for review before a prescription is issued. Use of the electronic patient record ensures patient safety as real data is collected. This centralised approach has enabled us to achieve more efficient product use which has resulted in cost savings which have been re-invested in two additional continence nurses.
This approach has enabled NHS Rotherham to establish a nurse led continence service which ensures all patients, that use prescribed continence products receive an annual review as outlined in Good Practice in Continence Services (DH 2000). Different team members were responsible for different elements of the project implementation process. Stuart Lakin, Head of Medicines Management took overall responsibility for transferring the prescribing budget from the GPs to the continence service. Kate Midgley, Senior Medicines Management Technician was responsible for identifying over 1,000 patients in GP practices who were prescribed continence products and safely transferring their data to the new service database. Joanne Mangnall, Clinical Nurse Specialist was responsible for ensuring the template within the electronic patient record was clinically effective. The service went live on 1st April 2009. The project team continue to work together to ensure ongoing service developments are effectively implemented.
John Stoves from Bradford Teaching Hospitals NHS Foundation Trust was a finalist with “Electronic consultation (e-consultation) in Bradford and Airedale”.
Traditionally patients presenting to their GP with symptoms of mild to moderate chronic kidney disease (CKD) are referred to a renal specialist via a paper/telephone referral. This communication process can be lengthy causing delays and inconvenience for patients. Identifying eligible patients who require specialist referral is also a problem. Often patients are inappropriately referred, impacting upon the workload of the renal specialist. These patients could be better managed in primary care.
In collaboration with colleagues from Bradford and Airedale Teaching Primary Care Trust (BAtPCT) I have co-developed a CKD electronic consultation (e-consultation) advisory service using a networked centralised IT system, SystmOne®. The service allows GPs to send electronic referrals and share patient electronic health records (EHRs) with a renal specialist in secondary care after first obtaining verbal patient consent. GPs use locally agreed criteria to ‘request advice’ or ‘question the need for hospital clinic review’. The renal specialist is able to open the patient’s EHR and view important clinical details. A decision is then made as to whether a patient should be referred to clinic, undergo tests or interventions in the primary care setting, or continue to be monitored and treated by the primary care team. Physician time is saved by using pre-set ‘auto-consultation’ responses. Responses are saved in the patient’s EHR and also sent as tasks to alert the referring primary care team.
I have co-led the introduction of e-consultation into 17 general practices across Bradford and Airedale, and respond to GP requests for specialist advice and support. I have worked alongside colleagues to adapt the IT system to meet our requirements, refining it as required. I have co-developed educational materials and conducted educational events in the district to encourage the adoption of this innovation. I have also conducted an evaluation study of this innovative service.