Submitting your case study

• Remote monitoring to support rapid assessment of vulnerable care home residents

  by Adam Remmer , over 3 years ago

  Background of change and intervention

  Before the pandemic, services in South Tyneside and Sunderland were already adopting digital technology to improve the monitoring of care home residents across the area. During the pandemic, the potential of these digital solutions to empower care home staff to spot the early signs of deterioration and communicate observations across organisations has been widely acknowledged. This case study explores how adoption of these approaches has been further cemented in Sunderland.

  Learning and advice to be shared

  The local deployment of remote monitoring technology has been integrated within clinical practice. In particular, it has been aligned... Continue reading

  Background of change and intervention

  Before the pandemic, services in South Tyneside and Sunderland were already adopting digital technology to improve the monitoring of care home residents across the area. During the pandemic, the potential of these digital solutions to empower care home staff to spot the early signs of deterioration and communicate observations across organisations has been widely acknowledged. This case study explores how adoption of these approaches has been further cemented in Sunderland.

  Learning and advice to be shared

  The local deployment of remote monitoring technology has been integrated within clinical practice. In particular, it has been aligned with tools such as the National Early Warning Signs score to detect and respond to clinical deterioration and “Is my resident unwell?”, a checklist which helps care home staff to pass on concerns to other healthcare professionals.

  The kit involved allows care home staff to measure vital signs, take photos as well as recording these important assessments/questionnaires that support communications between professionals.

  The focus on avoiding unnecessary face-to face contact during the pandemic enabled an acceleration of the ability to embed the routine use of this technology. In a period of three weeks at the start of the pandemic, training was rapidly rolled-out to around a dozen additional care homes. This push ensured that training on the use of monitoring equipment had been provided to all the care homes across Sunderland.

  One of the specific successes has been the way that technology has supported robust communication between care home nurses/other staff and hospital clinicians. The inclusion of structured tools and questionnaires helps avoid any important information being omitted and these assessments are supplemented by evidence through the recording of observations/clinical data. This, especially, empowers care home staff to swiftly and confidently report potential decline to ensure high quality care and better patient outcomes.

  The acceleration of adoption of this digital approach during the pandemic is marked. Prior to the national lockdown 1,800 to National Early Warning Scores were being recorded locally every month. This has now increased to 2,200 NEWS scores every month.

  Would it be beneficial to retain these changes?

  The case for technology-enabled care is clear and existing evaluations were already showing the potential to help avoid non-elective admissions, lower A&E attendance and improve patient outcomes and satisfaction.

  The pandemic has prompted the exploration of additional features within the existing technology. The sharing of images and virtual contact, for example, has reassured and helped to keep care home residents and staff safer by reducing visits. This capability is widely recognised across clinical teams to have ‘opened up a whole new world’. Going forward colleagues in the trust want to examine how the technology might be utilised as a referral platform.

  The vital role of technology in the pandemic has further embedded new ways of working, enhanced the connection between care homes and hospitals and supported colleagues to help deliver improved outcomes for the elderly population.

  For any further detail on this case study or to connect with Adam, please contact england.1professionalvoice@nhs.net

• Digital monitoring of patients during the pandemic

  by Adam Remmer , over 3 years ago

  Stocker R, Russell S, Liddle J, et al

  Experiences of a National Early Warning Score (NEWS) intervention in care homes during the COVID-19 pandemic: a qualitative interview study

  BMJ Open 2021;11:e045469. doi: 10.1136/bmjopen-2020-045469
  
  

  
  

  Stocker R, Russell S, Liddle J, et al

  Experiences of a National Early Warning Score (NEWS) intervention in care homes during the COVID-19 pandemic: a qualitative interview study

  BMJ Open 2021;11:e045469. doi: 10.1136/bmjopen-2020-045469
  
  

  
  

• Short training videos to improve practices in Midwifery

  by Nikki McNulty, over 3 years ago

  Changing the practice of nurses and midwives through use of data and technology and addressing barriers.

  
  

  Front line workers do not always have time to read emails, especially when on shift. We have a closed staff Facebook Page and dedicated MS Teams channel for non social media staff users.

  When an area of improvement is identified the Digital Midwifery team and Midwifery Practice Facilitators work together to create short training videos for all staff groups.

  Here is an example:

  We wanted to improve the Hand Hygiene Audit. We filmed a Midwife caring for a Pregnant woman (Volunteered Support Worker) and... Continue reading

  Changing the practice of nurses and midwives through use of data and technology and addressing barriers.

  
  

  Front line workers do not always have time to read emails, especially when on shift. We have a closed staff Facebook Page and dedicated MS Teams channel for non social media staff users.

  When an area of improvement is identified the Digital Midwifery team and Midwifery Practice Facilitators work together to create short training videos for all staff groups.

  Here is an example:

  We wanted to improve the Hand Hygiene Audit. We filmed a Midwife caring for a Pregnant woman (Volunteered Support Worker) and asked the viewers to count how many touch points were noticed and areas or good practice and poor practice. Staff can comment on the post to monitor compliance and engagement for training.

  We need to think of new and innovative ways aside from sending regularly 'all user' emails to share learning and improvements.

• Loan service of Tablets for women using our maternity services who would not otherwise have devices to access the ePHR.

  by Nikki McNulty, over 3 years ago

  Changing the practice of nurses and midwives through use of data and technology and addressing barriers

  Enhancing person centred practice through use of data, information and technology.

  UHCW Maternity was successful in securing monies for the UTF to purchase 50 ipads for the Digital Midwifery team to own and loan out Ipads which have been set up specifically for pregnant women with the relevant web pages and apps.

  
  This will ensure equitable access to information to support choice and personalisation, easy access to contact details of staff, departments and support groups, appointments dates and times or their clinical care record... Continue reading

  Changing the practice of nurses and midwives through use of data and technology and addressing barriers

  Enhancing person centred practice through use of data, information and technology.

  UHCW Maternity was successful in securing monies for the UTF to purchase 50 ipads for the Digital Midwifery team to own and loan out Ipads which have been set up specifically for pregnant women with the relevant web pages and apps.

  
  This will ensure equitable access to information to support choice and personalisation, easy access to contact details of staff, departments and support groups, appointments dates and times or their clinical care record to view or share. This will also ensure maternity service users have access to their maternity care, advise and appointments at any given time to manage their own health and that of their child more easily in future.
  
  Having a Device Loan Service available for women will help empower groups of disadvantaged women who otherwise would struggle to access their electronic maternity records.

  
  Increasing such women's access to information and clinical documentation will enhance their experience of our services and improving access to information will support their choices and personalisation of their care. Additionally it will improve safety and reduce risk for a group of women who are likely to have complex medical and social profiles.

  Referrals will go into the Digital Midwifery team via the Community Midwife following booking.

  We have a Trust loan device agreement which the service user will sign and will support the Trust retrieving the device back after the postnatal period for others to use.

  We are in the early stages of this project due to the delay in getting the devices via the supplier. We can feedback once the project has progressed some more.

  All Maternity services should consider this project if they are aiming for a paperless maternity record.

• Is there a role for digital technologies in learning disability Assessment and Treatment units?

  by @JessicaLDNurse, over 3 years ago

  The below link will take you to the National Learning Disability Nursing Forum where Jessica Lister- Consutant Nurse Learning Disabilities shares her opinion on the need to modernise Learning Disability provisions and considers the benefits digital technologies could offer in making reasonable adjustments and meeting individuals specialist needs in a person centered way.

  
  

  Is there a role for digital technologies in ATUs? — Learning Disability Nurses' Forum

  The below link will take you to the National Learning Disability Nursing Forum where Jessica Lister- Consutant Nurse Learning Disabilities shares her opinion on the need to modernise Learning Disability provisions and considers the benefits digital technologies could offer in making reasonable adjustments and meeting individuals specialist needs in a person centered way.

  
  

  Is there a role for digital technologies in ATUs? — Learning Disability Nurses' Forum

• Elsie's Story: How genomics can transform life before birth

  by Donna Marie Kirwan, over 3 years ago

  This real life story is about a young family I recruited to the ground-breaking proof of concept 100,000 Genomes Project four years ago, and how through genomic sequencing, they were able to find out a genetic cause for their firstborn Elsie, who tragically died and how through genomics they were able to avoid further harm in future pregnancies. This story has been retold in a number of conferences and webinars such as "Niche to Necessity: Genomics in Routine Care" (webinar 2), with kind permission of Emily and Phil Gregson.

  Emily, at 34 weeks pregnant was referred from her local hospital... Continue reading

  This real life story is about a young family I recruited to the ground-breaking proof of concept 100,000 Genomes Project four years ago, and how through genomic sequencing, they were able to find out a genetic cause for their firstborn Elsie, who tragically died and how through genomics they were able to avoid further harm in future pregnancies. This story has been retold in a number of conferences and webinars such as "Niche to Necessity: Genomics in Routine Care" (webinar 2), with kind permission of Emily and Phil Gregson.

  Emily, at 34 weeks pregnant was referred from her local hospital to Liverpool Women's Hospital (LWH), an inner-city tertiary level maternity service as an emergency transfer. Her baby had become less active and the cardiograph (CTG) which monitors the baby's heart and movements was abnormal. Emily underwent an emergency caesarean section and baby Elsie was immediately placed on assisted ventilation because she couldn't breathe on her own or move her limbs and moved to neonatal intensive care unit (NICU). The consultant paediatrician caring for Elsie was baffled.

  Whilst standard NHS genetic testing was undertaken, the consultant suggested that Emily and her husband Phil think about joining the 100,000 Genomes Project as this may find a genetic diagnosis beyond the capabilities of the NHS tests. I met Emily and Phil on NICU and discussed the project with them and a few days later they made the decision to join the project. Upon receiving their verbal and written consent, blood samples were taken from Emily, Phil and Elsie and sent to Genomics England for whole genome sequencing (WGS).

  Four weeks after recruiting the family to the Project, Elsie’s condition deteriorated, and a decision was made to turn off her life support.

  Results eventually came back from the 100,000 Genomes Project which revealed the cause of Elsie's life-limiting condition. Elsie had inherited an autosomal recessive neurodegenerative incurable condition because of a variant or alteration within the ‘tubulin-specific chaperone D’ (TBCD) gene, located on chromosome 7. Unfortunately, Elsie received two altered copies of the TBCD gene: an altered copy from Emily, and an altered copy from Phil. Together, the two alterations sealed her fate.

  Through the project, the pattern of inheritance enabled Emily and Phil to understand how and why this tragedy happened but provided them with choices for future pregnancies where they knew they faced in each pregnancy a:

  • 1 in 4 chance of an unaffected child
  • 2 in 4 chance the child is a ‘carrier’ (like them)
  • 1 in 4 chance of an affected child

  A year later, Emily and Phil were pregnant again with their second child. Placental tissue taken from a chorionic villus sampling (CVS), was analysed by the molecular genetics laboratory to check for alterations within the TBCD gene. The laboratory found the gene had no changes. Nine months later, baby Beatrice was born healthy and well and not a carrier (like her parents) for the gene.

  Following Beatrice, the couple went on to have Ted. CVS performed during Ted’s development revealed that like Emily and Phil he carries an inherited healthy gene and a an altered TBCD gene. As a carrier, Ted is healthy and well but has the potential as an adult, to pass on his altered gene to his offspring.

  1 comment

• judith.dando

  by Judith, over 3 years ago

  Digital documentation and care planning.

  CNIO Handbook Chapter 6 (digitalhealthnetworks.net). Melanie Robertson is the CNIO, South Tyneside and Sunderland NHS Trust. In this case-study chapter of the CNIO Handbook, In this case-study from the CNO Handbook, Melanie looks at digital documentation and care planning.

  The CNIO role is often seen as a link between nurses working clinically and the IT department, but in my case it also involves being a link between two recently merged trusts covering acute and community services.

  Digital documentation and care planning.

  CNIO Handbook Chapter 6 (digitalhealthnetworks.net). Melanie Robertson is the CNIO, South Tyneside and Sunderland NHS Trust. In this case-study chapter of the CNIO Handbook, In this case-study from the CNO Handbook, Melanie looks at digital documentation and care planning.

  The CNIO role is often seen as a link between nurses working clinically and the IT department, but in my case it also involves being a link between two recently merged trusts covering acute and community services.

• judith.dando

  by Judith, over 3 years ago

  The Tommy’s National Centre for Maternity Improvement: How are we transforming maternity care in the UK?

  [Case-study submitted by The Phillips Ives Review Programme Manager on behalf of Professor Jane Sandall, Midwife - Professor of social science and women's health academic centre of King's College London].

  We are developing a digital tool that will improve maternity care across the UK by better assessing a woman’s risk of pregnancy complications, with a focus on reducing stillbirth and premature birth. Read more here:

  https://www.tommys.org/research/research-centres/tommys-national-centre-maternity-improvement/transforming-maternity-care

  
  

  
  

  
  

  
  

  The Tommy’s National Centre for Maternity Improvement: How are we transforming maternity care in the UK?

  [Case-study submitted by The Phillips Ives Review Programme Manager on behalf of Professor Jane Sandall, Midwife - Professor of social science and women's health academic centre of King's College London].

  We are developing a digital tool that will improve maternity care across the UK by better assessing a woman’s risk of pregnancy complications, with a focus on reducing stillbirth and premature birth. Read more here:

  https://www.tommys.org/research/research-centres/tommys-national-centre-maternity-improvement/transforming-maternity-care

  
  

  
  

  
  

  
  

• judith.dando

  by Judith, over 3 years ago

  Adult nursing: Mainstreaming genomics

  https://www.genomicseducation.hee.nhs.uk/nursing-educators-toolkit/adult-nursing-mainstreaming-genomics/

  Case-study submitted by Phillips Ives Review PMO on behalf of Tracie Miles RGN, PhD, Associate Director of Nursing and Midwifery, NHS South West Genomic Medicine Service Alliance.

  This case-study written by Tracie is about a real patient.

  In this teaching scenario, Louise explains the part genomics played in her ovarian cancer diagnosis, and her nurse provides an update nine years later about how things have changed.

  A woman with ovarian cancer talks about her experience of having two genomic tests: one to inform her treatment options, and the other to identify whether her cancer is... Continue reading

  Adult nursing: Mainstreaming genomics

  https://www.genomicseducation.hee.nhs.uk/nursing-educators-toolkit/adult-nursing-mainstreaming-genomics/

  Case-study submitted by Phillips Ives Review PMO on behalf of Tracie Miles RGN, PhD, Associate Director of Nursing and Midwifery, NHS South West Genomic Medicine Service Alliance.

  This case-study written by Tracie is about a real patient.

  In this teaching scenario, Louise explains the part genomics played in her ovarian cancer diagnosis, and her nurse provides an update nine years later about how things have changed.

  A woman with ovarian cancer talks about her experience of having two genomic tests: one to inform her treatment options, and the other to identify whether her cancer is due to an inherited variant in her DNA. Nine years later, Louise’s nurse explains how things have changed and how mainstreaming genomics is making a difference.

• judith.dando

  by Judith, over 3 years ago

  Libby's legacy - YouTube

  https://www.youtube.com/watch?v=_S3pvXMD3y8

  University Hospitals Bristol and Weston NHS FT case-study submitted by Phillips Ives Review PMO on behalf of Tracie Miles RGN, PhD, Associate Director of Nursing and Midwifery, NHS South West Genomic Medicine Service Alliance.

  A mother whose daughter died from cancer after treatment at the Royal United Hospital (RUH) in Bath has spoken about the value of joining the 100,000 Genomics Project for research and for helping her to come to terms with her grief.

  Diane Woodland’s daughter Libby volunteered for the project after she was admitted to the RUH and diagnosed with a rare... Continue reading

  Libby's legacy - YouTube

  https://www.youtube.com/watch?v=_S3pvXMD3y8

  University Hospitals Bristol and Weston NHS FT case-study submitted by Phillips Ives Review PMO on behalf of Tracie Miles RGN, PhD, Associate Director of Nursing and Midwifery, NHS South West Genomic Medicine Service Alliance.

  A mother whose daughter died from cancer after treatment at the Royal United Hospital (RUH) in Bath has spoken about the value of joining the 100,000 Genomics Project for research and for helping her to come to terms with her grief.

  Diane Woodland’s daughter Libby volunteered for the project after she was admitted to the RUH and diagnosed with a rare cancer. She died aged 25 in August 2018.

  Diane said: “The doctors told us they’d never seen a cancer before like the one Libby had and they didn’t know what treatment to give her. “My deepest fear was that, having produced Libby and her brother George, it was something my husband and I had passed on to her.

  ”Tracie Miles, RUH gynaecology clinical nurse specialist for Gynaecology cancer and legacy genomics practitioner, recruited Libby to the 100,000 Genomics Project through the West of England Genomic Medicine Centre (WEGMC) while she was being treated at the hospital.

  The national project was a major NHS initiative to sequence 100,000 genomes from patients with rare inherited diseases or with cancer and to transform NHS services to include genome sequencing as standard care for future patients. The ambitious aim to sequence 100,000 genomes (DNA sequences) from NHS patients was reached in December 2018.

  The current focus for the local WEGMC teams is on returning results to patients and their families, where appropriate, and also sharing the important impact that this project, and genomic medicine in general, will have on future patients locally, nationally and potentially across the world.