Storyboard Entry Form 2015
Main author:
Email:
Telephone:
Rachael McQueen
[email protected]
01633 431731
Follow the detailed instructions in this template for writing your storyboard. Add your
information in each section below and save this completed storyboard document.
Please not amend this template.
Follow the instructions in the Information Guide for Authors to submit your
storyboard.
The word limit is 1500 words including references. Your storyboard will not be
accepted if you exceed the word limit.
1. Storyboard title: a clear concise title which describes the work
Clocks -It’s My Turn
The development of a visual prompt for all clinicians for
repositioning patients
2. Brief outline of context: where this improvement work was done; what sort of
unit/department; what staff/client groups were involved
This project has taken place in a ward that cares for patients that have experienced
General Surgery procedures i.e. Ears Nose and Throat and Urology procedures. The
ward is set within a busy District General Hospital within Aneurin Bevan University
Health Board (ABUHB) and has a high patient throughput. The majority of patients
who are on the ward are elderly, with a high level of confusion many of whom have
poor levels of mobility both before and after operations. The innovative idea was
developed by a Health Care Support Worker on the ward in order to
decrease/eliminate the number of pressure ulcers within the ward.
3. Brief outline of problem: statement of problem; how you set out to tackle it;
how it affected patient/client care
Prior to this project clinicians were required to look through patient notes in order to
establish the number of times a patient was required to be repositioned in bed and
the frequency in which this should take place. The reason for this was in order to
support the prevention of pressure sores. Due to the complexities of the patient
needs within this clinical environment and the other demands placed upon nursing
staff the repositioning of patients would take a longer time than was expected or in
some instances be omitted.
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A Health Care Support worker on the ward came up with the idea of a visual prompt
being displayed above a patient bed which could be used to remind clinicians and
family members of the need for patient repositioning to take place. The prompt is a
simplistic approach to a complex problem that can in some instances lead to patients
being kept in hospital for longer lengths of time and increase anxiety for carers and
family members.
4. Assessment of problem and analysis of its causes: quantified problem; staff
involvement; assessment of the cause of problem; solutions/changes needed to
make improvements
 Cost to patient - pain, extended hospital stay, in the most severe cases possible
death.
 Estimated cost of treating pressure ulcers in the UK is estimated at between £1.4
- £2.1 billion annually – 4% of total NHS expenditure (Bennett, 2004)
 Cost of treating one Category 4 pressure ulcer is estimated at £10,551 (Bennett,
2004).
 Annual spend on dressing materials by the NHS is £89 million (DoH, 2005).
 It’s envisaged that the number of patients with pressure ulcers will increase
(EPUAP, 1998).
 Two key components have proven especially effective in minimising pressure
damage:
1. Repositioning patients
2. Support Surfaces and Other Devices for Pressure Ulcer
5. Strategy for change: how the proposed change was implemented; clear client or
staff group described; explain how you disseminated the results of the analysis and
plans for change to the groups involved with/affected by the planned change; include
a timetable for change
The ward manager had previously discussed the idea of placing a laminated clock
upon each patient’s casebook, similar to the work that had been undertaken with
dementia flower. However a small test of change identified that the clock was still
missed in several cases, therefore a proposal from the Support Worker for a
laminated clock was adopted.
In order to ensure that all of the multi-disciplinary team were informed of the project
and understood the requirements of the laminated clock above every patient bed, a
small awareness session was developed. Not all of the clinicians on the ward fully
embraced the change so the project was developed with the early adopters in the
first instance.
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The project began in May 2014 and when results of the early adopters were
discussed during patient handover and ward meetings more clinicians became
involved in the scheme. The general feedback from the ward staff has been positive
and amazement has been expressed that something so simple had such a positive
impact on patient care.
6. Measurement of improvement: details of how the effects of the planned
changes were measured
Number of pressures ulcers on Ward
2
Issue with New Starters
Further training given
1
Number of pressures ulcers
0
May-14
Jun-14
Jul-14
Aug-14
Sep-14
Oct-14
As the above graph illustrates during the first 6 months of the project the pressure
ulcers on the ward dropped significantly. In September 2014 a Category/Grade 1
ulcer Non Blanchable redness of intact skin was identified and further investigation
was undertaken, it was identified that there had been a number of new staff within
the ward who had not been made aware of the Clocks visual prompt. Remedial
action was undertaken and early indication shows that there have been no cases
since.
7. Effects of changes: statement of the effects of the change; how far these
changes resolve the problem that triggered the work; how this improved
patient/client care; the problems encountered with the process of changes or with
the changes
As the measurement illustrates the effects of the change has had a significant impact
upon the ward. The investment of the visual prompt has had an impact for patients
and their carers/family members. As the prompt is above the patient bed,
carers/family members are empowered to ask nursing staff to reposition the patient
if there is any delay.
There is a need to ensure that all new staff on the ward are educated to understand
the significance of the clock and the impact on patient care. The ward continues to
evaluate the project and if the initial results are sustained the clocks prompt will be
shared with other clinical areas.
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8. Lessons learnt: statement of lessons learnt from the work; what would be done
differently next time
 We wish we had thought of this sooner
 Make the prompts coloured so that they stand out more and are easily seen
 Get the support of the multi-disciplinary team
 Do not under estimate the need to re-assure patients and carers, because the
prompt can cause concern with carers as they are new and need to be explained.
 The importance of an A3 chart for tick box, so clinicians, carers and patients have
reassurance that the repossessing has taken place.
9. Message for others: statement of the main message you would like to convey to
others, based on the experience described
 Patient care improved and patient feedback is positive
 Small tests of change can makes a big difference to patient care. Trail it and have
a go.
 Do not dismiss any improvement ideas no matter how small/simple
10. Please summarise how your entry reflects the principles of prudent
healthcare:
you
can
find
out
more
about
prudent
healthcare
at
http://www.prudenthealthcare.org.uk/
Do no harm
www.1000livesi.wales.nhs.uk
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The NHS Wales Awards are organised by the 1000
Lives Improvement service in Public Health Wales.