Sticks and Stones may Bend my Bones A QIP for the Management of - PowerPoint PPT Presentation

Sticks and Stones may Bend my Bones A QIP for the Management of Distal Radius Buckle Fractures in Children Dr Sarah Herbert ST7 PEM MBBCh, MCEM, DCH

Why?  Most common fracture  Common presentation to ED  Plasters get wet - reattendance rates high  Inconvenient for child and parent  Uncomfortable for child

Identifying the Problem  Scale  180 patients per year  Nature  Process Map  Telephone Survey

Aims – What are we trying to accomplish?  Improve Comfort  Reduce Inconvenience

What change can we make that will result in improvement?  I knew!!!!!!  Bench Marking  Literature Search  Internet Search – pathways and proformas

Team  Me  PEM lead Consultant  Paediatric Orthopaedic Consultants  ENP lead  CT3/PEM junior

What change can we make that will result in improvement?  No fracture clinic follow up  A removable device for immobilisation  Safeguarding against greenstick fractures - VFC

How will we know the change is an improvement? Outcome Comfort Telephone survey Inconvenience answers (Satisfaction) Process Number of casts applied Data from PACS and Number of splints Zylab applied Balancing Number of greenstick Data from VFC fractures The data collected was plotted on SPC Charts

PDSA cycles  Cycle 1  Pathway  Patient/Parent information leaflet

PDSA cycles  Cycle 2  Patients over 2 weeks seen by PEM junior  New pathway used  Followed up with telephone survey  Worked really well

PDSA Cycles  Cycle 3  Teaching  Information sharing – emails/posters

SPC Chart - comfort scores (outcome) 7 6 5 Comfort Score (1-5) 4 Score Mean 3 UCL LCL 2 1 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Patient Number

SPC Charts – Satisfaction scores (outcome) 14 12 10 Satisfaction Score (1-10) 8 Score Mean 6 UCL LCL 4 2 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 -2 Patient Number

Chart showing number of plasters and splints (process) 6 5 4 Number of Patients 3 Casts Splints Other 2 1 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Week

Balancing  VFC  0 greensticks  Their projects outcome and process measures were showing it to be a success

Sustainability  Working along side virtual fracture clinic QIP  Induction teaching  Online ED guideline  Audit and Governance

Reflection and what I learnt  Try to have an understanding of QIP methodology before you start  Find the problem and then use a team to look for an aim and solution – DON ’ T approach the team with a preconceived solution  Do small, manageable PDSA cycles  Measure what you aimed to change and include process and balance measures  Use your team  Stick to a time frame, use a Gantt chart, keep a diary  Do it in the hospital you are working in

Questions?

Thank you If you do not It is not enough to know how to ask do your best; you the right question, must know what to you discover do, and then do nothing your best If you can’t describe what you are doing as Without data a process, you you’re just don’t know what another person you’re doing with an opinion Quality is everyone’s responsibility