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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.

How you can contribute

  • The Expert - others who use systems such as these in their Health Trust could provide useful insight into their findings, issues, and potential problems.
  • The Investor - As funding may be required for other aspects of the project (outside of the £30,000 requested) any additional resources would be beneficial to the success of this project.
  • The Promoter - Champions to help us share our work and particularly to promote success
  • The Collaborator - While this project is in its infancy, there are many opportunities to use this app for cross trust working, particularly within specialised services, therefore very happy to consider collaborating with others.
  • The Networker - Would be beneficial to link with those who are going through a similar project to learn from one another
  • The Critical friend - all our ideas are just that, any constructive criticism is welcome

Plan timeline

9 Dec 2019 Review Information Governance requirements
6 Jan 2020 Procure App from provider
27 Jan 2020 Train the Trainer training commences
10 Feb 2020 Training commences for all other staff
2 Mar 2020 Begin Trial of App with TVS and DNT
20 Apr 2020 Commencement of second PDSA Cycle
7 Dec 2020 Establish Project Team/Board

Comments

  1. Hi Stephanie, I think this is a terrific proposal with the potential for great impact. Happy to be a champion of this and help share your work and promote success where helpful.

    1. Thanks Tresa, we would really appreciate that.

      Stephanie

  2. Hi team, good luck with this! I’m sure it will be a really valuable service. When we used a photo app in a community TVN service we found that  there were several unintended benefits including improved record keeping and consistency of wound size grading. What benefits do you think this programme will bring and how are you planning to capture them?

    best wishes

    Anna

    1. Hi Anna, thanks for your comment.

      I do believe that an App like this will bring a number of benefits to the patient/ service user, and also to the service as a whole.

      From a service user perspective, this App should reduce the number of times a wound is reviewed by different services, and the number of times a wound is redressed, which is not only painful but can also lead to infection.  An audit before and after the App is implemented would capture this, e.g. number of times a wound is redressed and the reason for this.

      As mentioned in the bid, the Tissue Viability nurses are triaging referrals based on written referrals but accompanying images could enhance the triage process, and also lead to earlier intervention.  The time from referral to treatment would be used to capture this.  I also believe that a staff questionnaire would also identify whether these images support better triage/ earlier intervention, and why.

      By managing the wound remotely, this should reduce on the amount of time spent by Tissue Viability nursing staff travelling to and from the service users home; this should positively impact on clinical capacity and save on travel costs, which will be captured through activity and travel spend.

      This App should promote the integration of Community and Corporate services and improve communication between these teams, particularly given the limited resources and the large rural/ remote area that is covered by the Trust.  Whilst these services work well together, this App should make better use of the time spent with the service user, and provide the right care at the right time.

      Other benefits that may be harder to measure are the savings in redressing, and reduction of treatment needed if infection occurs as a result of ongoing review.

      Kind Regards

      Stephanie

       

  3. A much needed development - practical  and useful.  Totally support this.

    1. Thanks Gill, I agree.  This application could really improve patient experience and improve existing interfaces with our services.

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