NES Patient Safety
Multidisciplinary Group
(PSMG)
Update for Stakeholders
March 2015
Example NES PSMG outputs, developments and
impacts in support of patient safety
Presented under



Enhance access to and embed learning resources
Developing partnerships and building relationships
Assessing impact – examples from our work
Note: updates can be relevant for several Update headings
http://www.nes.scot.nhs.uk/education-and-training/by-theme-initiative/patient-safety-and-clinical-skills.aspx
1. ENHANCE ACCESS TO AND EMBED LEARNING RESOURCES
(E.g. Help to integrate WHO multiprofessional patient safety curriculum topics
into Scottish patient safety learning resources.)
Example PSMG developments

Jan 2015 PSMG: Our agenda included discussion about a national chronic pain
proposal and patient safety. A number of links were made with NES educational
resources and there are opportunities to enhance service support of chronic pain
management in support of safer care for patients. Dr Rowan Parks discussed the
evolving arrangements in NES for enhanced coordination of work across clinical
skills, patient safety, human factors and QI. Dr John McKay has taken over from
Philip Cachia as chair of the NES Patient Safety Group – the group reviewed
various achievements for the work led by Philip Cachia, Fiona Gailey and
supported by Liz Sutherland and others since 2008, and considered priorities for
NES support of patient safety.

Structured Handover: The PSMG continues to support Dr Ailsa Howie, NHS
Lothian, as clinical lead, rolling out learning about structured handover as part of
Foundation Year Induction Training in the first instance. Structured handover is
an area prioritised by service clinical team leads for further development of
educational resources in our 2013 stakeholder consultation. Facilitator Notes and
other training materials have been developed. A standard feedback form has
been designed in conjunction with NHS Tayside and a LIFT module is now
available for Foundation Doctors to complete. The roll out is gradually extending
across Scotland. AH is working with RRHEAL to allow the teaching to be further
disseminated. We have produced a video of the scenarios being run plus a video
of AH performing the presentation which will be available via the NES website.
Contact: Ailsa.Howie@nhslothian.scot.nhs.uk
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
Sepsis developments: The Jan 2015 NES Sepsis Interest Group previewed
new NES maternity team sepsis educational developments, including a video,
Contact: Helene.Marshall@nes.scot.nhs.uk . The overall aim of this NES Sepsis
Group is to enhance the NES contribution to reducing harm by sepsis, and to
increase awareness of sepsis recognition and management by healthcare staff.
The PSMG is also liaising at SG level to encourage national awareness raising/
health campaign in this area. See also the link to our sepsis page on the Safe
area, QI Hub: http://www.qihub.scot.nhs.uk/safe/sepsis.aspx.

Scottish Patient Safety Programme (SPSP) National Conference: Driving
Improvements in Patient Safety, Edinburgh, 11-12 November 2014: members
of the NES patient safety team attended the conference and NES educational
resources were also disseminated at the exhibition stand. These included
resources in relation to CEL19/2013, Healthcare Associated Infections, and
patient safety stories. We also contributed to the Nov SPSP Sepsis and VTE
event, facilitating sessions and sharing developments about the sepsis app.

Next steps for acute adult safety – patient safety essentials and safety
priorities: Contact: Nancy.El-Farargy@nes.scot.nhs.uk
In support of the Scottish Government’s Point of Care Priorities and Patient
Safety Essentials, reviews of NES resources are now published :
 Sepsis
 Deteriorating Patients
 Venous Thromboembolism (VTE)

Heart Failure
In disseminating NES patient safety resources, Nancy has been
attending/contributing to Acute Adult Patient Safety Programme WebEx’s,
organised by HIS. These reviews are being accessed also from elsewhere
including on the ‘Community Hospitals and Intermediate Care Networks’ website.
PSMG Contacts: Fiona.Gailey@nes.scot.nhs.uk; Nancy.El-Farargy@nes.scot.nhs.uk;
Derek.Boyle@nes.scot.nhs.uk; Sabine.Nolte@nes.scot.nhs.uk
Mark.Johnston@nes.scot.nhs.uk; Philip.Cachia@nes.scot.nhs.uk
Example pharmacy developments in support of patient safety

NES Pharmacy have been in discussion with the School of Pharmacy, University
of Strathclyde in helping to develop a new module within their MSc in Advanced
Clinical Pharmacy Practice in relation to Quality Improvement and patient safety
using Pharmacy SPSP Fellows. The long term plan would also be to include this
training into undergraduate education as well as postgraduate, and at both
Schools of Pharmacy in Scotland.
PSMG Contacts: Anne.Watson@nes.scot.nhs.uk; Leon.Zlotos@nes.scot.nhs.uk
Example Psychology team led developments in support of safer care

Hand Hygiene: The second phase of this work has progressed by making
connections with other medical schools across Scotland. The NES team are
currently analysing this data, which again gathers information on students’ beliefs
and attitudes towards hand hygiene as well as barriers and facilitators to the
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practice. Results of this work, in conjunction with the results to phase 1, will be
fed back to the medical schools and submitted for presentation at the 2015
NHSScotland Event in June.

SPSP mental health: Discussions with individual health boards are taking place
to develop a pilot study to test a draft incident review tool’s impact on harm
caused by restraint incidents and on safety culture in mental health settings.
Discussions are also ongoing to develop a pilot study to trial the tool within critical
care settings in NHS Lothian, where restraint techniques are used to protect
patients in intensive care units from self-harming (e.g. pulling out breathing tubes
and arterial lines) and when patients are demonstrating challenging behaviour
due to delirium.

Aseptic Technique/Renal: This project, carried out in partnership with NES HAI
team, aims to investigate which beliefs attitudes and human factors influence the
consistent practice of defined aseptic technique steps by NHS GG&C renal
nurses during different haemodialysis procedures. A mixed methods approach
was used; focus groups with teams of renal nurses were carried out and
analysed, with the results being used to inform a questionnaire designed to
assess beliefs, attitudes, barriers and enablers of aseptic technique steps. Data
analysis is ongoing with final results expected to be presented to internal
stakeholders in March 2015.
PSMG Contacts: Michelle.Clark@nes.scot.nhs.uk; Lisa.Sutherland@nes.scot.nhs.uk
Judy.Thomson@nes.scot.nhs.uk; Vivien.Swanson@nes.scot.nhs.uk
Dental developments in support of patient safety

Patient Safety for Dental Teams – NES Annual Review Nov 2014: The Dental
Directorate were invited to provide a stand at the NES Annual Review. The
chosen topic was Patient Safety for the Dental Team. This provided an
opportunity to showcase our past patient safety initiatives and update on current
work for NES and external stakeholders in attendance. This was designed to
feature the ongoing work of our Dental infection Control Support Team, providing
In-Practice Training in infection control and decontamination to dental teams
across Scotland.

Enhanced SEA: General Dental Practitioners were given the opportunity to
participate in the NES Enhanced Significant Analysis Initiative. This was a SHINE
project led by NES. Other Professional Groups involved were Community
Pharmacy, General Medical Practice, Optometry and Clinical Psychology across
NHS Scotland. The feedback from dental participants was really positive and, as
a result, NES dental have agreed to establish the enhanced SEA system as the
preferred option for those undertaking and submitting SEAs in the future. The
preliminary work is now complete and will be part of the SEA application process.
This will be included on Portal in early in 2015.
PSMG Contact: Irene.Black@nes.scot.nhs.uk
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Enhancing access to HAI resources in support of patient safety
 The NES HAI Team are preparing to host two national events for all acute and
non acute frontline health and social care staff in Scotland which are scheduled
for 16th April in Aberdeen and 20th April in Glasgow. Strengthening our
Defences are uniquely different and exciting events focussing around a person
with a healthcare associated infection and taking the form of three themes (1) the
person's journey, (2) infection prevention and control in practice and (3)
implementation. Inform, engage and interact are the event aims and will be
delivered though an informal, interactive and engaging programme. Further
information is available on the NES website.
 NES have organised a number of workshops to support the ongoing development
needs of the HAI Quality Improvement Facilitators (QIFs). The HAI QIFs are
working on improvement projects which focus on aspects of patient safety and
standard infection control precautions and poster presentations from their projects
will be showcased at the Strengthening our Defences events.
 As part of the multi-professional team approach to antimicrobial stewardship
there is increasing recognition of the critical role of nurses and midwives in
antimicrobial administration, management and monitoring. NES in conjunction
with the Scottish Antimicrobial Prescribing Group undertook a survey to scope
current understanding of antimicrobial stewardship in nursing and midwifery to
inform the development of an education resource to meet learning needs of this
staff group. The survey results are available on the NES website and the
educational resource is in development.
 The NES HAI Team have published an online survey to ensure that the HAI
website is as user friendly and informative as possible and that we provide the
educational resources health and social care staff need. Closing date for
responses is 10th March 2015. Access the survey here and please distribute the
link: https://response.questback.com/nhseducationforscotland/haiwebsurvey/
PSMG Contacts: Gill.Walker@nes.scot.nhs.uk, Sabine.Nolte@nes.scot.nhs.uk
Fiona.Gailey@nes.scot.nhs.uk
Further examples of NES knowledge services activity in support of safer care

NES is currently tendering for a new source/s of clinical evidence summaries for
use at point of care. This is a key enabler of delivering the Knowledge into Action
strategy which gives a high priority to providing evidence in actionable formats to
support healthcare practitioners in making decisions at point of care. Activities
included focus group sessions and online evaluation with practitioners to gather
requirements on what they would like these resources to deliver, a tender
specification has been sent out to suppliers and some trial access will be set up
for practitioners to test and evaluate in March 2015. All feedback will be collected
and a final decision on which resource to provide access to will be taken late April
2015.
We would encourage NES to communicate information about trials to their
networks of clinicians so that we gather as much feedback as possible.
Contact: derek.boyle@nes.scot.nhs.uk for more information.
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
The Renal Drug Handbook is now available in database format at
http://www.renaldrugdatabase.com/ “Access monograph information through
desktop, laptop or mobile devices, with this new, easy-to-use, frequently-updated
online platform. The fourth edition of The Renal Drug Handbook contains over
800 drug monographs comprising prescribing information for clinical and
medicines information pharmacists.” To register contact ann.lees@nes.scot.nhs.uk
As well as pharmacy staff, this resource may also be of interest to GPs, hospital
doctors.
PSMG Contacts: Derek.Boyle@nes.scot.nhs.uk; Ann.Wales@nes.scot.nhs.uk
2. DEVELOPING PARTNERSHIPS AND BUILDING RELATIONSHIPS
(Including with Scottish Patient Safety Programmes, enhancing support for the international
effort to make care safer.)
Example of Quality Improvement Team Developments

Scottish Patient Safety Fellowship. Cohort 7 of the Fellowship has now
completed two residential workshops, a series of WebEx sessions and two
project surgeries. Planned events include Networking Event on 25 February,
Project Surgery on 26 February and third residential workshop on 18-20 March.
An evaluation of the two “residential” has been undertaken and is being used to
inform planning for the future events.
http://www.qihub.scot.nhs.uk/education-and-learning/patient-safety-fellowship.aspx

Scottish Improvement Leader: This is a new programme aimed at people
leading improvement across organisations in the public sector. The first
residential workshop was held in November 2014. This was led by the
Professional Director for the Programme, and supported by a team of core and
support faculty, most of who are also acting as mentors for the participants.
There is a detailed evaluation planned around all aspects of this first programme.
The evaluation feedback from the first residential was very positive and a
dashboard has been developed to display key data relating to the progress of this
initial cohort.
http://www.qihub.scot.nhs.uk/education-and-learning/scottish-improvement-leader.aspx

Scottish Improvement Skills: Scottish Improvement Skills is an education
programme aimed at people leading local improvement work. The first cohort of
this programme is complete, and two further commenced. Further two cohorts
scheduled to run over the remainder of the year.
http://www.qihub.scot.nhs.uk/education-and-learning/scottish-improvement-skills.aspx
PSMG Contact: Elaine.Pacitti@nes.scot.nhs.uk
Other Psychology partnership activity in support of patient safety
The online module for GP’s in working with medically unexplained conditions is
available via NES website and CPD Connect. Practice Based Small Group Learning
for GPs and Practice Nurses on medically unexplained conditions is now published;
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and DC continues to liaise with GP trainers to support GP trainees in working with
those who have medically unexplained conditions.
PSMG Contact: David.Craig@nes.scot.nhs.uk
Example pharmacy partnership developments in support of patient safety

NES Pharmacy have commissioned the School of Pharmacy at the University of
Strathclyde to undertake (in collaboration with NES) the evaluation of the national
SPSP – Pharmacy in Primary Care (SPSP- PPC) workstream. The project has
been funded by the Health Foundation for a joint bid from NHS HIS, NES and the
University of Strathclyde. The work is due to report in June 2016.

NES Pharmacy link in with the NHS HIS Safer Medicines network for educational
issues for Pharmacy. NES Pharmacy are represented on the Safer Use of
Medicines Network working to ensure that a uniform approach is taken to safer
use of medicines across all four SPSP programmes (Acute Adult, Primary Care,
Mental Health and Maternity and Children Quality Improvement Collaborative).
PSMG Contacts: Anne.Watson@nes.scot.nhs.uk; Leon.Zlotos@nes.scot.nhs.uk
Other new Dental partnership developments in support of patient safety

SafeQuest Questionnaire: A pilot for the SafeQuest Questionnaire in General
Dental Services is underway. The content was modified for dental services and
this has been through a content validation process. Eighty practices were invited
to participate initially with a view to roll out across the service in the future. This
ongoing project is being facilitated by the Scottish Dental Practice Based
Research Network and NES.

Future Patient Safety Projects-National: The Deputy CDO held a meeting in
December with HIS and NES /SDCEP to consider the potential to taking forward
a wider-scale patient safety project in dental services. The initial discussions
were positive.

UK Dental Sector: Patient Safety in Dentistry featured in a recent edition of the
British Dental Journal Volume 217 No7. The articles published covered patient
safety in the context of dental services and current activity to establish patient
safety as healthcare priority in dentistry. Other topics included specific studies in
the hospital sector on the use of checklists and audit for improvement and
measurement of quality in situations where there was a potential risk of harm.
PSMG Contact: Irene.Black@nes.scot.nhs.uk
Other HAI partnership developments

The NES HAI Team have established an integrated Health and Social Care
Healthcare Associated Infections Education Advisory Group to take forward a
strategic view of health and social care HAI education and awareness to provide
consistency for the benefit of patients and clients.
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
Workshops in partnership with the National Association of Specialist Tissue
Viability Nurses Scotland continue to be held across Scotland to implement the
Aseptic Technique and wound care e-learning module in community setting with
a view to providing consistency of application across all care settings.

In conjunction with Health Protection Scotland and on behalf of the Healthcare
Outbreak Advisory Group workshops are being held to increase knowledge and
skills of outbreak management for Infection Prevention Control Teams, Health
Protection Teams and care home staff.
PSMG Contacts: Gill.Walker@nes.scot.nhs.uk, Sabine.Nolte@nes.scot.nhs.uk
New NES knowledge services partnership work in support of patient safety

Getting Knowledge into Action in Education: Needs Analysis Workshop. 9th
March 10am-1pm at Scottish Health Service Centre, Crewe Road South,
Edinburgh This workshop is part of a review of Knowledge into Action activity
across NES. A key aim of the review is to determine NES' needs for knowledge,
research and information work to support its core business of education, currently
and over the next 3 years. This workshop is a fact finding exercise to ascertain
the different ways in which NES staff need to source and use knowledge,
research and information to deliver our core business of education.
Email sandra.campbell@nes.scot.nhs.uk to register interest.

Jan 2015 webex session with the person-centred collaborative Packaging
knowledge to support joint decision-making - Packaging knowledge into
forms which can be easily implemented in day-to-day frontline practice can be
called Actionable Knowledge. Actionable knowledge provides clear and concise
calls to action based on best evidence, and can easily be accessed and
integrated within everyday workflows at point of care. Examples range from a
simple card checklist hung around a workers ID badge to a mobile app with a
National Early Warning Score calculator and Sepsis screening tool. Slides and
more information available from derek.boyle@nes.scot.nhs.uk
3. ASSESSING IMPACT – EXAMPLES FROM OUR WORK
(Support the impact assessment of NES educational resources on reducing harm,
and share outputs as part of the PSMG communications strategy.)
Example PSMG impact developments

Patient Safety Education: What Matters to You? Feedback from our
stakeholders from our service wide consultation on our educational approaches
to reducing harm is included in the PSMG activities section of our website:
It is currently summarised in our Stakeholder Consultation Summary Report,
What Matters to You. http://www.nes.scot.nhs.uk/education-and-training/by-themeinitiative/patient-safety-and-clinical-skills.aspx
o
o
Our Consultation report (pdf), highlighting key findings
With Executive Summary (pdf) also presented separately, including
recommendations.
Thank you for your contributions.
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Fiona Gailey, Philip Cachia on behalf of NES PSMG, 03/03/2015

Driving Improvements in Patient Safety: Views and perceptions from the
workforce (see link). This poster was presented at the national SPSP conference
and outlined the respondents’ views and perceptions on current NES learning
and development resources available to support patient safety.

Patient Safety Training Officer: The Jan2015 PSMG agenda included a report
by MJ, highlighting feedback from delegates and early outcomes from attendance
at the first six months of the new workshop and educational packs in response to
stakeholder priorities: Leadership and Safety Culture within teams. For further
information about these resources: http://www.nes.scot.nhs.uk/education-and-training/by-themeinitiative/patient-safety-and-clinical-skills/patient-safety-training-opportunities/training/training-resourcepacks.aspx.
PSMG Contacts: Nancy.El-Farargy@nes.scot.nhs.uk; Fiona.Gailey@nes.scot.nhs.uk;
Sabine.Nolte@nes.scot.nhs.uk; Mark.Johnston@nes.scot.nhs.uk;
Example Psychology partnership impact / sharing learning

Practice based small group learning module is now subject to full evaluation
within one heath board area; GPs are currently being recruited. Data to include
impact of training upon subsequent management of identified patients (referral to
secondary care, investigations, consultations etc). Core competencies from the
online Medically Unexplained Conditions toolkit being identified to form basis of
COT analysis to analyse GP trainee skills in practice both before and after use of
the toolkit. Findings have been presented at two conferences.
PSMG Contact: David.Craig@nes.scot.nhs.uk

In order to demonstrate human factors in action, phase 1 of the hand hygiene
project was used as the basis of a NES Human Factors learning resource film.
The four min video focuses on the human factors that were indicated during the
study and the negative impact these had on the medical students’ practice of
hand hygiene behaviour. The ultimate message of the film is that human factors
need to be addressed in order to support healthcare staff to practice good hand
hygiene. The film is anticipated to be available for use by March 2015.
PSMG Contacts: Michelle.Clark@nes.scot.nhs.uk; Lisa.Sutherland@nes.scot.nhs.uk
Vivien.Swanson@nes.scot.nhs.uk ; Fiona.Gailey@nes.scot.nhs.uk;

A short vignette highlighting the learning gained during the collaboration
between NES Psychology and BASICS Scotland while developing and
evaluating a behaviour rating scale addressing the non-technical skills of rural
and remote practitioners is being filmed late Feb 2014; and will be shared
following partnership edits.
PSMG Contacts: Deirdre.Holly@nes.scot.nhs.uk; Andrea.Baker@nes.scot.nhs.uk
Example HAI impact work

NES HAI team are working with one health board on a pilot to implement and
embed the aseptic technique arterio-venous fistula module within renal
services. The pilot includes completion of the e-learning modules with pre and
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post observation of practice taking place and assessment of behavioural
patterns through human factors methodology. Results from the pilot will be
available in report and poster presentation form in early April 2015

A user survey for the Cleanliness Champions Programme was undertaken to
obtain feedback to assist in improving the programme and its implementation.
To gain more in-depth feedback regional focus groups are planned for February
and early March 2015. The focus groups will look at the factors that enable or
limit the application of learning from the programme in practice. The results of
the user survey and focus groups will assist NES in identifying and addressing
gaps in the educational provision and areas for development opportunities to
support Cleanliness Champions and their mentors with their ongoing
development needs.

NES and HFS developed a DVD resource for domestic services workforce
which focuses on the HAI elements of the Standard Infection Control Infections
and aligns with the Domestic Services Competency Workbook. Ongoing support
is being provided to support implementation of the DVD resource. NES and HFS
are working with one health board to pilot the evaluation of the impact of the
educational resource in practice to improve knowledge and skills for the benefit
of patient safety. An evaluation report will be produced to assist implementation
across health boards.
PSMG Contacts: Gill.Walker@nes.scot.nhs.uk, Sabine.Nolte@nes.scot.nhs.uk
Example NES knowledge services impact

Knowledge services have been accepted to present a poster at Evidence Live in
April on the Knowledge into Action work on the Sepsis app. The title of the poster
is 'Translating Knowledge into Action in Diagnosis and Management of Sepsis'
More about Evidence Live at http://evidencelive.org/
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