What is the challenge your project is going to address and how does it connect to your chosen theme?

The NHSCT District Nursing teams (DNT) cover a large, geographically dispersed population within Northern Ireland including rural/ remote locations. Wound management is challenging due to the limited resource of the Tissue Viability Service (TVS). Repeated reassessment/ redressing of wounds can be painful for the patient and increase risk of infection.

Qualified Medical Photography staff have the expertise to photograph wounds but operate 9-5 during weekdays. Quality wound images, securely taken and shared with dispersed clinical teams would support better inter-team referrals and reduce the number of physical visits to the patient. Presently the TVS must triage referrals based on written evidence alone.

Between 2018/19 318 referrals were made to the TVS from DNT Trustwide, waiting approx. 18 days to be seen; supporting images would help to reduce this. While these teams work closely together, reduction in unnecessary patient contact and improved patient experience could be achieved.

What does your project aim to achieve?

This project aims to support the further integration of services by using images to enhance discussion.  By providing the TVS images of wounds taken by key DNT staff at point of referral/ request for review, this should streamline the referral process. Images will be taken on a mobile device and uploaded to a secure storage facility through the use of a third party mobile App.  The procured App will allow all images to be fully accessible by authorised staff to support wound assessment and review.  In line with Information Governance requirements, patient consent will be explicitly collected by the App.

This will reduce a number of wastes including travel time and cost visiting patients at home, redressing wounds and waiting times for (re)assessment.  Additionally, it will greatly enhance communication between DNT and the TVS, and positively impact on patient experience.

Success will be measured through the waiting times to TVS from DNT, and length of treatment.

How will the project be delivered?

If successful, a project team will be set up to consist of all key stakeholders, including the TVS, DNT, Medical Photography, key Q Members, Informatics staff,  and appropriate Management, to assess needs, identify regionally applicable learning and identify best practice. A specified rural area will be used to test the App and refine processes. The project team will provide knowledge and expertise around appropriate images needed to support referral and review, procuring, transfer and  storage of images, budgetary needs according to the project plan etc.  Q Members will ensure that the project uses appropriate project management and improvement methods to oversee the project and test small cycles of change, as well as identifying measures to evidence the impact of each change.  A Risks and issues log will identify owners, mitigation possibilities, and action plans as needed.

What and how is your project going to share learning throughout?

This project has the potential to expand elsewhere in the Trust, therefore learning will be shared through a number of fora, including internal QI meetings and showcasing events, through the Health and Social Care Quality Improvement website and on the Trust’s internal Innovation and Quality Improvement Hub.  Once sustained, site visits could be arranged to share the learning, either to other internal teams, or to external visitors who have an interest in this application.  There will be opportunities to present findings at regional events and patient safety forums.  Q Members will also be able to share the learning with the Q Community, and again offer visits to other counterparts.