Reducing the incidence of deep vein thrombosis

9 - Simone BrowningSimone Browning, lead nurse for the hyper-acute stroke unit at UCLH, is the project manager for the NHS IQ IPC sleeves roll out. This was a fantastic opportunity to really make a difference to patient care.

In May 2013, the UK medical journal, the Lancet published the results of the CLOTS3 Trial, which indicated that the use of Intermittent Pneumatic Compression (IPC sleeves), inflatable sleeves which wrap around the legs and are attached to a pump, significantly reduced the incidence of deep vein thrombosis (DVTs) and improved the overall survival rates of stroke patients. There had been no previous clear guidance on the prevention of DVTs following acute stroke prior to the publication.

NHS Improving Quality (NHS IQ) secured £1m in funding to supply all stroke units in England with a six month supply of IPC sleeves as part of a major national programme to improve outcomes and reduce mortality in stroke patients. The aim was to help Trusts to adopt the innovation quickly by removing cost as a barrier whilst at the same time testing a model of implementing evidence-based interventions at scale and pace.

In London, NHSIQ worked with the London Strategic Clinical Network (SCN) and UCLPartners, the Academic Health Science Network (AHSN), to deliver this project. As the lead nurse for the hyper-acute stroke unit at UCLH, I felt very privileged to be seconded to the role of project manager for the IPC roll-out, this was a fantastic opportunity to really make a difference to patient care.

I met with Lucy Grothier the Assistant Director of the SCN at the beginning of the project to discuss how the outcomes proposed by NHS IQ could be delivered across London. We quickly realised that we were unaware of any other accelerated programme aiming to bridge an evidence practice gap at speed. We also recognised that the reconfiguration of stroke services in London meant that there would be 24 hyper-acute stroke units and acute stroke services to collaborate with; a real challenge given the three month deadline for implementation. However, keen to take on the challenge and learn new skills, we sketched out a plan, and met with all key stakeholders involved in the project to discuss how stakeholder groups could collaborate to facilitate the project.

Having a shared purpose and carefully aligned objectives between NHS IQ, the AHSN and SCN, IPC sleeves and pumps were successfully delivered to 21 out of the 24 stroke units in London within the three months.

Of the three stroke units who did not take part in the programme, one is reviewing the London uptake of IPC and considering providing IPC in line with the CLOTS3 trial. Another unit agreed to take part in the initiative but only after the deadline for inclusion had expired. The remaining unit has negotiated with their procurement department and hopes to roll out the IPC initiative in the Trust in the next few months.

The success of the project in London was due to many factors. As project manager, I took the opportunity to visit the stroke units and explain the project face to face with staff working on the units. Due to the time constraints I initially had telephone conversations with all of the stroke units to identify the key stakeholders in their stroke services. This helped to build rapport, create relationships and gave teams the forum to have critical discussions about previous and current evidence for DVT prevention in stroke patients. As the project progressed I was able to build a knowledge base on the practicalities of using IPC sleeves in a clinical setting and shared this with the stroke units.

Visiting the units, it was clear that there was a very clear desire to talk, share and network with stroke colleagues, so I am setting up a Stroke Nursing Forum with support of the SCN to discuss clinical outcomes and best practice, across the whole stroke pathway.

On reflection as the project manager, I noted how transferable my skills were as a lead nurse of a clinical unit to rolling out a London wide project. A large part of my daily work is to talk to and collaborate with the wider clinical team, so calling them up to discuss an initiative was not daunting. I know how busy clinical teams can be and from personal experience I know how to engage staff and what information helps their decision making. I am frequently on the other end of the scenario with information coming to me.

The most amazing thing about being involved in the programme across London was the support from the key stakeholders who were able to free up my time from an otherwise jam packed clinical schedule. This allowed me to further develop my skills and deliver the project, with the help of a number of incredibly talented and interesting people. I realised that we are not always aware of the resources around us that can support our work. A lasting consequence of this change project has been that the organisations that I worked with, NHS IQ, the SCN and AHSN, are now collaborating on more projects to benefit patients.

The NHS needs to change to meet the changing landscape of health and social care delivery. NHS Change Day allows people to stop and think of what they can do to add to this journey. Making a pledge adds some accountability to delivery. What we have demonstrated here is that change, even on a large scale, is possible if you have the right people with the right skills and the right attitude.
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