In-Patient Support and Information Rounds

University Hospitals of Leicester NHS Trust In partnership with NHS England Cancer Collaborative and LLR Alliance

Contact: Janice Brown - janice.brown@uhl-tr.nhs.uk

Organisation

University Hospitals of Leicester are a large teaching hospital base across three sites with many specialist areas or expertise. It employs 15000 staff. We are based in caring for cancer patients.

General

Winner 2019 – CPES (Cancer Patient Experience Survey) Category

This initiative is part of a National Cancer collaborative initiative to provide in-patients with cancer to have the opportunity to discuss their worries and fears with staff. The initiative involves an information and support mobile outreach team to visit patients on the wards to offer them the opportunity to help themselves to written information from the trolley, and /or have the opportunity for a one-to-one conversation surrounding any worries and fears they may have. The team have identified the need for the service by looking at the National Cancer Patient Experience Survey (NCPES) which has for the past three years identified a 5% below the national average in our survey results for this concern. We have a involved a patient representative and a volunteer with lived experience of cancer services.

We have used data collection, PDSA cycles of change and an overarching driver diagram to implement the initiative. Team relationships have been built with ward staff as well and they have had training and education as part of the initiative. The initiative has been evaluated positively by patients and it is aimed to be rolled out to a wider area in the next few months.

Rationale

The aim of the initiative is to improve opportunities for in-patients to discuss their worries and fears. UHL patients surveyed as part of The National Cancer Patient experience survey results demonstrated that only 48% of patients felt they had the opportunity to discuss their worries and fears with staff, against the national average score of 53%. The initiative is a Pilot scheme which involves a weekly mobile trolley-based patient and information support round on a 19 bedded oncology ward. This ward was chosen as we know from the cohort of patients that are sent the survey were predominately cared for in an oncology ward when they were an inpatient. The bespoke information trolley used on the ward rounds has been populated with written information tailored to the top concerns that patients identified as part of Electronic Holistic Needs assessments which are offered to all patients diagnosed with cancer.

Planning

The team were formed by The Lead Cancer Nurse. She led the bid to be part of the National Cancer Collaborative. The Cancer Collaborative provided us with study days, coaching calls and number of toolkits to help implement the initiative. A patient representative gave advice and a volunteer joined the team to collect patient feedback via IPAD questionnaire. The team also consisted of a Deputy Chief Nurse for patients experience. She led on formulating a patient questionnaire and data collection tools. A Deputy Lead Cancer Nurse co- ordinated the team and arranged fortnightly team meetings as well as email communications to keep the initiative on track. She was responsible for PDSA cycles, communication of the project and feedback co-ordination from the Team who visited the patients. The team who visited the patients were a Macmillan Support and information officer and an Oncology Matron. They regularly gave feedback at the team meetings and helped in communicating with ward staff and collecting patient opinions, stories and data.

Impact

Success was measured by patient feedback. They were surveyed after each mobile information and support ward round. Staff were also regularly asked about their thoughts and knowledge of the initiative. The impact of the round was that 60% of patients thought the ward round and speaking to someone was useful, The mobile information was also evaluated by 40% patients as useful. Narrative comments found that those who didn’t find the trolley of benefit had been in hospital before or had a long history of cancer and had already had their needs addressed in the past. Staff feedback was positive and good relationships were forged with the information and support team, as well as educating the staff of available services for patients.

Relevance to Others

To continue to provide the service and roll out the initiative to the other oncology wards, a sustainability model was completed and PDSA cycles were initiated. The plan is to ensure that the round happens weekly alongside the tea and chat rounds which take place on the other wards. This allows ward staff to be involved, it is aimed to raise awareness for them as well and means it doesn’t rely on a small team to deliver the round, it will have more staff trained and involved. We will continue to monitor patient feedback through our in-patient surveys.

It will has been reported on the National Cancer Collaborative forum as part of the project we are involved in. It has also been communicated as above. It will be reported to our patient user group as well.

Standing Out

This is a simple project on a small scale which is easy to roll out to other areas.

It makes a difference to a patients well-being in all senses and gets them the help that they may not have had the courage to ask for before as an in-patient.

Guidance and toolkits from taking part of the National Cancer Collaborative project has helped keep it on track. The team itself have really engaged and enjoyed the new way of reaching out to patients. Excellent communication and regular meetings have kept the momentum of the initiative going. Using patients experience, a volunteer and patient feedback as also helped keep the project to a patients’ point of view.

Ward staff have engaged equally as they can see the benefits for patients and it has raised their awareness of services and support available for their patients.

Key Learning Points

 

  • Keep the project small, with a focussed aim.
  • Ensure you involve patients at the beginning and all the way through, collect data.
  • Have regularly planned meetings to assess the need to change tact if needed.
  • Use excellent communication skills with the team and the ward staff to engage them and seek their feedback as well.
  • Communicate the project widely so everyone knows what is happening.
  • Use toolkits such as PDSA/SPC/Sustainability models to help evaluate and roll out the initiative to a wider area.