#CatheterCare Tweetchat

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#CatheterCare Tweetchat

On Thursday 15th June, the Health Innovation Network hosted a Tweetchat on #cathetercare with @WeNurses. We wanted to know about people’s experiences of catheter care in their workplace, examples of good practice and challenges around catheter care. We were also interested in finding out about innovative solutions that people were using to overcome the barriers and stigma associated with catheter care and how we can increase awareness of catheter care with patients, healthcare professionals, carers and the general public.

An interesting blog about the evidence and practice around urinary catheters can be found here.

Good examples and challenges around catheter care

There was lots of discussion around the challenges associated with catheter care, and it being a huge part of workload, particularly for district nurses. Another challenge that presented was that lots of people have long-term catheters without any information or clinical reasons as to why. These discussions were met with suggestions around increased education for patients and the catheter passport was raised as a means of educating patients, as well as being able to provide healthcare professionals with discharge information.

#CatheterCare: The word cloud generated from our Tweetchat

#Cathetercare: The word cloud generated from our Tweetchat

Overcoming the barriers and stigma associated with Catheter Care

Educating clinicians on good catheter care practice was a strong theme throughout the chat. I felt this was particularly relevant as there is a national push to prevent healthcare-associated gram-negative bacterial bloodstream infections – CAUTIs being a main cause. More on that here.

Many people felt that a short video to depict a patient’s experience would be a powerful educational tool, as well as teaching junior staff ‘in the moment’. To that end, the Health Innovation Network has developed an animation for healthcare professionals, which they are more than happy for people to use. Find it here.

A highlight of the chat for me was hearing from @NurseDeJaeger about a great initiative around increasing patient advocacy and awareness through a weekly nurse and patient catheter cafe, called ‘Meet the TWOCcers’. So simple yet so clever, and a great way of de-stigmatising catheters.

Increasing awareness around Catheter Care

The challenges around urinary catheters and reaching more people to increase awareness were identified as ongoing issues. Through collaboration with passionate people, sharing good practice and initiatives and learning from one another as a community, we can make a difference. Keep the conversations going by following #cathetercare and letting @HINSouthLondon know about anything you think people may be interested in.

To coincide with #WorldContinenceWeek, we are running #CatheterCare Awareness Week (19-23 June) and aim to tackle the stigma around catheter care and breakdown the associated barriers.

For more information and resources, including our animation, pledges cards, posters and several short videos click here

If you have any questions, please email hin.southlondon@nhs.net.

Smartphones among digital tech transforming London’s NHS

Smartphones among digital tech transforming London’s NHS

Digital technologies – from smartphone apps that help people successfully manage their diabetes, avoid “no shows” at hospitals, to tools that save time for nurses and paramedics – are beginning to transform London’s NHS services.

For the first time, NHS providers in London have revealed the extent to which smartphones, the Internet and Bluetooth are improving patient care and look set to save the capital’s NHS millions each year.

Guy’s and St Thomas’ NHS Foundation Trust expects to save £2.5 million each year by reducing missed appointments through an app called DrDoctor which gives patients much more say in selecting a date and time of their choice, resulting in “no show” rates falling by 40%.

Health chiefs are also using smartphones to tackle a looming health crisis with London boroughs tackling type-2 diabetes.

Programmes run by the North West London Collaboration of Clinical Commissioning Groups, covering eight boroughs, are successfully tackling diabetes through digital technology. OurPath links an app to a fitness wristband and 3G connected weighing scales to provide clients with realtime updates that help tackle type-2 diabetes, and in studies has achieved an average 5.3kg weight loss, while Oviva has seen more than 200 people complete the online programme with an impressive 90 per cent completion rate.

Dr Tom Willis, diabetes clinical lead for the Collaboration, said: “GPS are by nature very busy, naturally sceptical and want evidence.”

The London Ambulance Service, which was praised for its speedy and high quality care to the victims of the recent London Bridge terrorist attacks, is a key adopter having helped adapt the Perfect Ward audit tool specifically for its ambulance stations. The city-wide service has also developed Perfect Kit Prep and cuts out medicines paperwork for faster ambulance care, these are being implemented across over 70 ambulance stations in the capital.

In Chelsea and Westminster another tool links a stoma bag, used to collect faeces and urine for more than 13,000 people who undergo surgery each year nationally, through Bluetooth to users’ smartphones. A discrete device called ostom-i Alert Sensor, developed by a patient innovator, provides alerts when the bag is full so users have more control over their daily life and, importantly, greater dignity.

A new report ‘Digital Leadership in London’s NHS’ reveals that within eight months the 31 start-ups and digital companies backed by an organisation called DigitalHealth.London have achieved strong uptake within the capital.

Download the report here

A Tariff for Innovation

A Tariff for Innovation

It’s one thing to innovate. It’s another to spread that innovation across the NHS and that’s exactly what a new tariff system could do, says Tara Donnelly

A new tariff came into play in April this year and for the first time we have a payment scheme to encourage the spread of innovation within the NHS. This is significant, laudable and we need to do everything in our power to ensure that we make the most of the opportunity. Even better, the focus of the tariff in its first year is innovations that make hospital care safer.

Most of the devices that are eligible for the tariff have been developed by innovative clinicians who saw opportunities to improve care – making it safer and more effective.

Dharmesh Kapoor, a consultant obstetrician at Bournemouth Hospital invented scissors that make childbirth safer; Maryanne Mariyaselvam, a doctor in training working in research in Addenbrookes, came up with a device that prevents tragic accidents with blood lines; Peter Young, a consultant anaesthetist at King’s Lynn Hospital created a ventilation tube that prevents the most serious complication of ITU care; Simon Bourne, a consultant respiratory physician at Portsmouth Hospital devised myCOPD an online platform that helps patients self-manage with dramatic results; Robert Porter, a consultant microbiologist at Queen Alexandra Hospital has developed a treatment that cures Clostridium difficile through faecal transplantation.

Accelerating the uptake of innovation

We should be proud that as a country we are not only inventing these superb devices, we are also designing systems to help accelerate their uptake. NHS England’s Innovation and Technology Tariff (ITT) enables NHS Trusts in England to use these patient safety innovations either for free, or to claim a charge per use.

The 15 AHSNs have lobbied for a tariff to support innovation for some time, and it was the NHS Innovation Accelerator – a national programme supported by all 15 AHSNs – which was a key influencer in its development. The AHSNs therefore are delighted with this development, and are working to support uptake of these innovations within their geographies.

Obstetric Anal Sphincter Injuries (known as OASIS) during childbirth is the leading cause of faecal incontinence in women in the UK. It is a devastating injury, requiring surgical repair, with 30% of women having some level of symptoms a year later. OASIS costs the NHS approximately £57 million annually in repair and litigation costs and is on the rise. Dharmesh developed guided mediolateral episiotomy scissors, known as EPISCISSORS-60 that minimise the risk of obstetric injury, they are set to 60 degrees, the optimal angle to avoid serious injury. A number of studies have proven their efficacy.

Maryanne’s non-injectable arterial connector (the NIC) enables conventional arterial line sampling for patients in theatre or intensive care with the huge bonus that it is not possible to accidently inject medicine into it. This prevents wrong route drug administration, which, while rare can have terrible consequences including in the most extreme circumstances, amputation.

Peter’s PneuX invention has also been proven in studies to reduce the rate of ventilator acquired pneumonia (VAP). In its guidance, NICE quotes a plethora of studies including a recent UK randomised control trial which found that PneuX tube halved the rates of VAP after cardiac surgery from 21% to 10.8% patients. Bearing in mind VAP has a 30% mortality rate this is very good news, and would mean many more ITU beds available across the NHS.

Chronic Obstructive Pulmonary Disorder or COPD is the second most common reason for hospital admissions in the country costing the NHS over £800m in direct healthcare costs. Studies have also found that 90% people with COPD are unable to take their medication correctly. Simon’s support system known as myCOPD, has educational, self-management, symptom reporting and pulmonary rehabilitation aspects, all delivered online.

Robert’s innovation helps people with Clostridium difficile, a serious bacterial infection affecting the digestive system, who have a one in six chance of dying within 30 days. Antibiotics are the first treatment and cure the condition in many cases. But for a proportion – about 20 per cent – antibiotics do not work. A frozen microbiota transplantation will cure 90% per cent of these patients.

UroLift is an alternative surgical procedure for the treatment of the common condition of benign prostatic hyperplasia, where the enlarged prostate makes it difficult for men to pass urine, leading to urinary tract infections, urinary retention, and in some cases renal failure. It is considerably less traumatic than existing surgical treatments.

Guidance on the new tariff

Guidance came out from NHS England recently, circulated to Finance Directors. However it will be important to others such as CEOs, COOs, Medical, Nursing, Midwifery and Clinical Directors, Operational Managers and Patient Safety leads are aware so that high rates of uptake can be achieved quickly.

We have in the past bemoaned that the NHS doesn’t support clinical entrepreneurs, and that the period between discovery of an innovation and its widespread uptake at the often quoted time of 17 years is too long.

Here we have a handful of fantastic inventions that improve safety and reduce cost, devised by UK clinicians who have been hugely supported by the NHS to date. Increasing uptake is now down to all of us. What about getting over 50% uptake in 17 months instead of 17 years? Are you up for ITT?

ESCAPE-pain training package launched

ESCAPE-pain training package launched

Our training course will give you the confidence on how to successfully set-up and deliver the ESCAPE-pain programme.

ESCAPE-pain is a rehabilitation programme for people with chronic joint pain. It is suitable for patients with hip or knee pain and integrates self-management education and coping strategies with exercise individualised for each participant over six weeks (12 sessions).

Traditionally, ESCAPE-pain has been delivered by physiotherapists in outpatient physiotherapy departments within NHS settings. More recently, ESCAPE-pain has been successfully delivered in leisure centres and local community settings, improving patient access.

To support the spread of ESCAPE-pain and assuring the implementation of best-practice, the MSK team have launched two training packages – a one-day course for clinicians and a two-day course for fitness instructors.

The clinicians’ training course covers:

  • Overview of osteoarthritis management, including NICE guidelines
  • The fundamentals of ESCAPE-pain, including clinical and economic evidence
  • Supporting behaviour change, motivational interviewing and group facilitation
  • Setting up and delivering ESCAPE-pain
  • Adapting and developing ESCAPE-pain to work within different settings.

The fitness instructors’ training course covers:

  • Overview of MSK, physical activity and osteoarthritis
  • National Policy and overview of ESCAPE-pain, including ESCAPE-pain in the community
  • Understanding the psychology of pain
  • Principles of self-management, motivational interviewing, health behaviour change and group facilitation
  • Group exercise management
  • Healthy eating guidance
  • Methods of managing pain
  • Sustaining physical activity and other health behaviours.

Feedback from the first cohort of clinicians and fitness instructors has been overwhelmingly positive. Below are some quotes from participants:

“Great programme that isn’t too prescriptive and utilised physiotherapist’s skills”

“Brilliant and excited to be involved”

“Easy to follow, relaxed and very informative atmosphere”

“Very good, excellent knowledge to pass onto current client base”

Upon completing a training course, participants receive full access to course materials and other ESCAPE-pain implementation resources.

We will be running regular training courses in London. If you’re interested in attending a training course or would like more information about setting up ESCAPE-pain, email hello@escape-pain.org.

To learn more about ESCAPE-pain, visit www.escape-pain.org, or download the ESCAPE-pain app for Apple and Android devices.

Self-managing chronic pain with the Joint Pain Advisor

Self-managing chronic pain with the Joint Pain Advisor

Fay Sibley, Senior Project Manager for the musculoskeletal theme, writes about how the Health Innovation Network’s Joint Pain Advisor helps those with osteoarthritis.

The increasing burden of an ageing population on NHS services is well documented. GPs are struggling to cope with the ever increasing demand on services; lacking both capacity and expertise to support people to change their behaviour and adopt healthier lifestyles.

Patients with long term conditions, such as osteoarthritis (OA) often tell us they feel GPs are unable to help, at best they are prescribed palliative medication which they tell us they don’t like to take and at worst they are told it is just part of “getting older”. Despite this patients are unsure of where else to turn for advice and support.

Self-management is a hot topic in healthcare at the moment, often heralded as the answer to some of the NHS’s most complex problems. But does it really work?

At the Health Innovation Network, we have been focusing on helping people to self-manage their chronic joint pain and have piloted a new approach to managing osteoarthritis (OA) in Primary Care – the Joint Pain Advisor.

The Joint Pain Advisor takes the form of up to four 30 minute face-to-face consultations between the advisors and people with hip or knee OA. People attend an assessment where they discuss their lifestyle, challenges and personal goals and then jointly develop a personalised care plan that gives tailored advice and support based on NICE guidelines for the management of OA. They are then invited to attend reviews after three weeks, six to eight weeks and six months to access further tailored support and advice.

To date over 500 patients have used this service and reported less pain, better function and higher activity levels. A high satisfaction rate was achieved which included reduced BMI, body weight and waist circumference and has led to fewer GP consultations, investigations and onward referrals.

Have a look at what some of the 500 participants who have undertaken the programme say, in our Joint Pain Advisor film.

In our original study we used physiotherapists as Joint Pain Advisors but recently we have worked with health trainers and coaches. We think that the Joint Pain Advisor could significantly reduce the cost of helping people with chronic joint pain.

If you would like to find out more about Joint Pain Advisor, join the webinar we are holding on Friday 24 March. To register for the webinar please click on the link below. Once you have registered you will be sent a calendar invite containing details on how to join. Please note there are limited spaces for this webinar so attendees will have to register on a first come first served basis.

Register

You can also contact us at the Health Innovation Network, by emailing Fay at fay.sibley@nhs.net.

Implementation Science Masterclass

Implementation Science Masterclass

Insight

The Implementation Science Masterclass is a two-day course for health professionals, researchers, patients and service users who aim to ensure health services routinely offer treatment and care that is based on the most recent research evidence and quality improvement principles.

The Masterclass includes lectures from world-renowned experts in the field, small group workshops facilitated by leading researchers, and advice on how to work more effectively on your own implementation projects. If you are a researcher, health professional, patient or service user involved in an implementation project within health services, or planning to carry out, or to evaluate one, then this Masterclass will be of interest to you.

The Masterclass is organised by CLAHRC South London, a research organisation working to improve health services and funded by the National Institute for Health Research (NIHR).

When: Tuesday 11 and Wednesday 12 July 2017
Where:
King’s College London’s Waterloo Campus
Cost and register: The course fees are £475. Email clahrcshortcourses@kcl.ac.uk  to register your interest. Further details about how to book will be available in early 2017.

Find out more here.

Going digital: What it’s like for less tech savvy communities to use healthcare services

Going digital: What it’s like for less tech savvy communities to use healthcare services

Rahel Gerezgiher, Health Innovation Network Communications Project Support Officer, writes about what it’s like for less tech savvy communities to use healthcare services.

More and more we hear about the move into digital; not only within the NHS, but also in commercial sectors. Although there are many positives that come with moving into a more digital realm, such as having a wider reach, easier and more streamlined use of services, we also need to be aware of the downsides, which could potentially alienate members of the public who regularly use health services.

Case Study

My mother’s first language is not English; she is currently in college trying to improve on her speaking skills as she finds it easier to understand but struggles with responding. My mother is able to use her smartphone for the basics such as making and receiving calls, messages, using Viber to call abroad and WhatsApp. She also has arthritis and Type 2 diabetes, which require regular trips to her GP.

If the NHS brings digital technology into every aspect of healthcare, I believe my mother would struggle to get to grips with this new technology. She is not the most tech savvy, but there is also another challenge – English is not her first language. I’m sure that this would be a concern for others, including those who may be intimidated by technology.

Some points to consider:

  • As we move into digital healthcare, it could be useful to have training opportunities in primary care settings for patients to learn how to use digital systems, such as classes on ‘How to book an appointment’ or ‘How can I check my results?’
  • Without such training opportunities, which would show people how to use the new system, this could put pressure on family members and friends to help their less tech-savvy relatives.
  • The move into digital could result in more easily accessible materials, and a wider selection of translated materials would be a positive benefit. I am fluent in Tigrinya and so is my mother, but at present we rarely come across materials translated into our language. This is something to be considered going forward.

Those who are not tech savvy will not be the only group of individuals who will not be keen on moving into the digital realm. There will be some groups who prefer not to use technology and still prefer face-to-face interaction. By increasing the reliance on digital, are we pushing these groups up against the wall?

This group may not only prefer face-to- face communication, but they could also be worried that their information may be easily accessible. How do we reassure this group that their information is safe, and could they have the choice to opt out if they preferred?

I think that the move into digital is imperative for the NHS, as there are a number of opportunities that can come from it. However, if the move will not be utilised by all groups we really need to put provisions in place for this to ensure that we are catering to all groups, such as running training sessions or still having a main point of contact in primary settings, so that we are giving people the option to use the service, which is more in line with their wants and needs. After all, the NHS is there for everyone, so it’s only right that there is tailored accessibility for all.

Accelerating Access

Accelerating Access

The NHS has huge potential to be creative and innovative yet the system as a whole is slow to adopt innovation and best practice. Academic Health Science Networks – AHSNs – exist to speed up this process, to improve patient care and reduce system inefficiencies.

We act as honest brokers within our region, mobilising expertise and knowledge across the NHS, academia and industry to help improve lives, save money and drive economic growth through innovation. Our regional partnerships are helping to deliver system transformation locally, described by the Five Year Forward View. As 15 AHSNs we work together in ways unprecedented across health and care, delivering improvement at pace and scale. This is having real impact through our collective work including the successful NHS Innovation Accelerator – now reaching 388 organisations within the NHS Patient Safety Collaboratives and the Innovation Pathway; improving health and driving economic growth.

The latest work to recognise the unique role that AHSNs can play is the Accelerated Access Review, (AAR). This was an independently chaired review of innovative medicines and medical technologies, led by Sir Hugh Taylor and supported by the Wellcome Trust and the Office of Life Sciences, which published its final report in late October 2016.

It contains a series of recommendations to the NHS, which will need to be properly considered by NHS England and others, but encouragingly, the report contains a letter from Simon Stevens, where he commits: We’ll support the AAR’s streamlined pathway to identify high value innovations. We’ll then help pull them through into mainstream care – building on our AHSNs, innovation testbeds, and our new Innovation and Technology Tariff. And where it makes sense, we’ll be increasingly open to agreeing innovative win/win product-specific reimbursement models …” (Taylor, 2016, p.10).

The report outlines how the UK can make far more of its Life Sciences and research expertise, speed up clinical trials and subsequent endorsement and adoption of new drugs, medical devices and digital technologies. The AAR’s approach is shown in Figure 1, below.

It also considers the lessons learnt from when we have got this right, the triumph of the speed of development and dissemination relating to Ebola is rightly highlighted as a fine example of this, with the MHRA’s Clinical Trials Unit fast tracking Ebola studies, Expert Advisory Groups and trial sponsors.

Figure 1: A summary of the Accelerated Access Review’s proposed approach (Taylor, 2016, p.14, reproduced with permission)

The report is well worth a read and is available here. From the 70 pages I’ve précised the top 10 areas for AHSNs and summarised these.

Accelerated Access Top 10 Changes for AHSNs

Key changes for us from the review include:

1 Strengthening of remit: The report calls for “A new mandate for AHSNs should support the local spread of adoption and enable as standard framework for local evaluation” (Taylor, 2016, p.50). It is described as a “new, strengthened remit for AHSNs” (Taylor, 2016, p.50) and that AHSNs – among others – will “drive and support the evaluation and diffusion of innovative products” (Taylor, 2016, p.12).
2 Clarity of role through a Charter for Innovation Support:AHSNs, with their existing local networks that include NHS providers and commissioners, academia and industry, should play a vital role in supporting the testing and diffusion of technologies in the NHS. This role should be set put in a new charter with input from NHS England and NHS Improvement which clearly articulates what is expected from AHSNs and enables them to be held to account for local delivery” (Taylor, 2016, p.50).
3 Strengthening of our National Network of 15 AHSNs: The offer to innovators will include “access to a strengthened AHSN network which can facilitate local evidence-collection and adoption of innovation” (Taylor, 2016, p.13).
4 Better funding: AHSNs should be funded to a level that allows them to fulfil the role outlined in this report (Taylor, 2016, p.51), and there follows a recommendation to provide between £20million and £10million to AHSNs baseline budgets from 2017.
5 Providing capacity: the review proposes an additional role for AHSNs in providing capacity and capability locally to NHS organisations who require it, in order to make the most of new innovations. This new role would require funding of around £30million a year, and there is a suggestion that AHSNs that are able to generate match funding through working with charities or industry partners could access these resources (Taylor, 2016, p.52).
6 Creation of Innovation Exchanges: AHSNs should galvanise and support local innovation partners to create a network of “innovation exchanges” responsible for diffusing clinical and cost effective technologies across the system” (Taylor, 2016, p.50).
7 Supported more strongly: We also recommend that NHS Improvement plays a greater role in leading AHSNs, including supporting them to undertake these activities (Taylor, 2016, p.51).
8 Link to Test Beds: AHSNs have been supporting the national Test Bed programme where combinatorial innovation is being explored. The Test Bed we support in the London Test Bed, CareCity, which is bringing together technologies to keep people with dementia as safe as possible. “AHSNs should build on their current involvement in the Test Beds programme by using this learning for their own evaluation role and seeking to collaborate to promote mutual recognition of local evaluations using the national framework” (Taylor, 2016, p.51).
9 Testing and dissemination: AHSNs are noted to be “ideally placed to play a role in post-CE mark testing and dissemination of medical technologies, diagnostics and digital products in particular” (Taylor, 2016, p.51).
10 Horizon scanning: In Digital Health AHSNs are seen to have a key role in the earliest stages where “AHSNs identify unmet needs” at the ideas generation and identification phase (Taylor, 2016, p.26).

The following figure shows how the AHSN Network will embed within the system to enable speedier spread and uptake of innovation.

Figure 2: Local and national spread of innovation (Taylor, 2016, p.51, reproduced with permission)

At the Health Innovation Network we, along with colleagues across the other 14 AHSNs, warmly welcome the Accelerated Access Review and are keen to progress its findings at scale and pace, to speed up the best in health and care, across the country.

 

Reference
Taylor, H. (2016). Accelerated Access Review: Final Report. Department of Health, available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/565072/AAR_final.pdf