How the improvements were made A divisional review to transform services using QIPP principles looked at strategies to improve patient experience and nutrition service efficiency. The initial focus was to explore how admissions could be avoided for patients with blocked feeding devices. Once admitted these patients could wait several days before being seen by a consultant gastroenterologist, their route of feeding re-established and discharged home.
Both inpatient and outpatient nutrition services were re-designed by speech and language therapists, dietitians and nurses. The redesigned service aimed to provide better care and treatment for patients in hospital with early support and rapid access to clinics following discharge for advice, trouble shooting and day care to prevent further admissions.
The new service team required practitioners to have a range of ‘expert’ clinical skills and to be confident in autonomous decision making. Given this was a new role for members of the nursing team, a programme of staff development including support, close working and mentorship was designed. The service was initially launched as a five day service. Following a service review and patient interviews, a consensus was reached that patients needed access to experts who knew them and their devices across the whole week, so the service was expanded to seven days. ‘Developing a seven day service was the right thing to do for our patients, a Monday to Friday service for these complex patients just doesn’t work for them’. The service was also expanded to allow for further developments to support patient care such as streamlined direct new referrals and providing IV electrolyte monitoring and day case replacement for high risk patients.
What was achieved?
• Rapid access to a nutrition nursing team is now available from 8am – 6pm seven days a week
• Daily ward rounds for complex patients and out of hours regimes for patients requiring feeding
• Home provision and support for patients receiving parenteral nutrition
• Dedicated helpline for patients and staff seven days a week
• Provision of a single point of access for patients who are artificially fed, who can receive day care treatment and support from specialist teams
• The service has recently been awarded ‘highly commended’ in the trust’s quality awards.
What was the impact?
• Supported early discharge and reduced length of stay for patients with difficult feeding routes and high risk condition, with access to early follow up should problems occur
• Admission avoidance for patients who now have access to a seven day service, including ‘one stop’ clinics for assessment and treatment in one visit – avoiding admission in 99% of over 1000 patients seen in clinic in 2014
• Provision of expert nutritional assessment and advice to clinical teams within 24 hours of referral – 4,325 inpatients seen in 2014 over seven days
• Pioneering trust wide use of Nasal Bridle with a 30% increase in patients who go on to normal eating again
• PEG mortality rates have reduced from >25% in 2005 to 4%.
For further information contact Tracy Earley, Consultant Nurse Lancashire Teaching Hospitals NHS Foundation Trust [email protected]
You can read further details here http://www.nhsiq.nhs.uk/media/2661120/lancashire_nutrition2.pdf