The use of an IV to PO clinical intervention form to improve antibiotic administration

"This project focused on the appropriate conversion from intravenous (IV) to oral (PO) antibiotics. The purpose of the project was to determine whether antibiotic prescribing patterns improved following the implementation of an IV to PO conversion clinical intervention form."

The use of an IV to PO clinical intervention form to improve antibiotic administration in a community based hospital
C Thompson, M Zahradnik, A Brown, DG Fleming, M Law
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u200786.w2247

Read more here.

How to improve prescription of inhaled salbutamol by providing standardised feedback on administration

"The effectiveness of inhaled salbutamol in routine care depends particularly on prescribed dosage and applied inhalation technique. To achieve maximum effectiveness and to prevent drug-related problems, prescription and administration need to work in concert."

How to improve prescription of inhaled salbutamol by providing standardised feedback on administration: a controlled intervention pilot study with follow-up
MP Neininger et al.
BMC Health Services Research 2015, 15:40  doi:10.1186/s12913-015-0702-x

Read more here.

Patient-Reported Measures

"As health care organizations focus more on keeping people healthy and delivering value, incorporating patient-reported measures (PRMs) as part of their overall performance improvement measurement system will be crucial."

Patient-Reported Measures
L Savitz, K Luther
Healthcare Executive, 2015 Jan;30(1):74-77

Read more here (free registration required).

Undetermined impact of patient decision support interventions on healthcare costs and savings

"Although there is evidence to show that patients choose more conservative approaches when they become better informed, there is insufficient evidence, as yet, to be confident that the implementation of patient decision support interventions leads to system-wide savings."

Undetermined impact of patient decision support interventions on healthcare costs and savings: systematic review
T Walsh, PJ Barr, R Thompson, E Ozanne, C O’Neill, G Elwyn,

BMJ 2014;348:g188

Read more here.

Improving safety through the establishment of a Hospital Alcohol Liaison Service

"The message to others is to ensure that in establishing a new service, this should be done with complete staff engagement in respect to understanding the direct effect of service change on creating a positive patients pathway with sustained positive clinical outcomes. The frontline workforce are key in delivering changes, therefore it is imperative that they are fully involved in the process."

Improving safety - through the establishment of a Hospital Alcohol Liaison Service (HALS), alongside the launch of a therapeutic Chlordiazepoxide prescribing Detoxification Regime
Tameside Hospital NHS Foundation Trust
NICE Shared learning example
January 2015

Read more here.

Ensuring appropriate use of monitored dosage systems

"This initiative aims to reduce the inappropriate use of monitored dosage systems by ensuring they are only issued on a case-by-case basis to address specific practical problems of medicines adherence."

Ensuring appropriate use of monitored dosage systems: reducing unnecessary pharmacy workload: QIPP Case Study
Taunton & Somerset NHS Foundation Trust
NICE Quality and productivity collection
January 2015

Read more here.

Leadership and organizational change for implementation

"The present study provides support for the development and deployment of active strategies to improve EBP [evidence based practice] implementation in health and allied healthcare organizations."

Leadership and organizational change for implementation (LOCI): a randomized mixed method pilot study of a leadership and organization development intervention for evidence-based practice implementation
GA Aarons, MG Ehrhart, LR Farahnak, MS Hurlburt
Implementation Science 2015, 10:11  doi:10.1186/s13012-014-0192-y

Read more here.

Exploring patterns of error in acute care using framework analysis

"In order to improve the management of acutely unwell patients by junior doctors, medical educators must understand the causes of common errors. Adequate knowledge alone does not ensure prompt and appropriate management and referral."

Exploring patterns of error in acute care using framework analysis
VR Tallentire, SE Smith, J Skinner, HS Cameron
BMC Medical Education 2015, 15:3 doi:10.1186/s12909-015-0285-6

Read more here. 

Joining up health and social care personal budgets: Key points on implementation

"Joint health and care personal budgets offer a potential model for delivering integrated care from the bottom up, at the level of the individual person. This briefing outlines the key themes from a workshop for senior professionals on joining up personal budgets, held at the King’s Fund. It also sets out a series of practical approaches to implementation that might be considered by local
leaders as they develop their approaches to integrating personal budgets."

Joining up health and social care personal budgets: Key points on implementation
NHS Confederation Briefing
January 2015 Issue 280

Read more here.

Organisational culture and post-merger integration in an academic health centre

"Our findings have important implications for the integration of health care
providers and the promotion of NHS/University partnerships that deserve further research. It
might examine staff engagement strategies and cultural interventions to manage cultural
diversity and expectations."

Organisational culture and post-merger integration in an academic health centre: a mixed-methods study
PV Ovseiko, K Melham, J Fowler, AM Buchan
BMC Health Services Research 2015, 15:25  doi:10.1186/s12913-014-0673-3

Read more here.

Tool to improve the speed, efficiency, and documentation of physical examination in new psychiatric inpatients

"The baseline measurement from this audit demonstrates a clear failure to meet audit standards regarding the physical examination of psychiatric inpatients. When reviewing the patient admission clerkings, it was clearly evident that there was no standardised approach to the documentation of physical examination in patients' medical records."

The psychiatric inpatient physical health assessment sheet (PIPHAS): a useful tool to improve the speed, efficiency, and documentation of physical examination in new psychiatric inpatients
A Pettipher, R Ovens
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u206294.w2558

Read more here.

Nutritional assessment in elderly care

"We believe that improved patient outcomes and significant savings to the trust can be achieved, not only by ensuring that every patient has a MUST score documented, but that it is calculated correctly and the appropriate interventions are implemented."

Nutritional assessment in elderly care: a MUST!
M Frank, A Sivagnanaratnam, J Bernstein
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u204810.w2031

Read more here.

How is the NHS performing? January 2015

"Slightly more than 4 out of 10 trust finance directors forecast an overspend by the end of this year – the highest proportion since our survey began in March 2011 – and just over three-quarters say they are fairly or very concerned about staying within budget by the end of the next financial year."

How is the NHS performing? January 2015: Quarterly Monitoring Report
J Appleby, J Thompson, J Jabbal
The King's Fund

Read more here.

Confusion: delirium and dementia - a smartphone app to improve cognitive assessment

"The results of this study suggest that the introduction and use of a smartphone app for junior doctors increases the likelihood of older patients receiving a cognitive assessment for detecting delirium and dementia on specialist elderly and orthopaedic trauma wards."

Confusion: delirium and dementia - a smartphone app to improve cognitive assessment
S Sangha, J George, C Winthrop, S Panchal
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u202580.w1592

Read more here.

Adverse events in patients with return emergency department visits

"We recently implemented an electronic system enabling automated detection, investigation and statistical analysis of Emergency Department return visits. The objectives of this study were to determine what proportion of triggered return ED visits represented adverse events and what patient and visit factors predicted these adverse events"

Adverse events in patients with return emergency department visits
L Calder, A Pozgay, S Riff, D Rothwell, E Youngson, N Mojaverian, A Cwinn, A Forster
BMJ Quality and Safety 2015;24:142-148 doi:10.1136/bmjqs-2014-003194

Read more here.

Self-reported patient safety competence among Canadian medical students and postgraduate trainees

" Generally, medical students were most comfortable with aspects of clinical safety, such as hand hygiene, infection control and safe medication practices. They were less confident in what they learned about sociocultural or contextually dependent aspects of patient safety, such as teamwork, managing safety risk and culture of safety."

Self-reported patient safety competence among Canadian medical students and postgraduate trainees: a cross-sectional survey
P Doyle, EG Van Den Kerkhof, DS Edge, L Ginsburg, DH Goldstein
BMJ Quality and Safety 2015;24:135-141 doi:10.1136/bmjqs-2014-003142

Read more here.

Advancing the science of measurement of diagnostic errors in healthcare: the Safer Dx framework

"We posit that the Safer Dx framework can be used by a variety of stakeholders including researchers, clinicians, health care organizations and policymakers, to stimulate both retrospective and more proactive measurement of diagnostic errors. The feedback and learning that would result will help develop subsequent interventions that lead to safer diagnosis, improved value of health care delivery and improved patient outcomes."

Advancing the science of measurement of diagnostic errors in healthcare: the Safer Dx framework
H Singh, DF Sittig
BMJ Quality and Safety 2015;24:103-110 doi:10.1136/bmjqs-2014-003675

Read more here.

Technology Enabled Care Services: Resource for Commissioners

"The Technology Enabled Care Services Resource for Commissioners has been developed by NHS commissioners to identify practical tools that can help maximise the value of technology enabled care services for patients, carers, commissioners and the whole health economy"

Technology Enabled Care Services: Resource for Commissioners
NHS Commissioning Assembly
January 2015

Read more here.

Collaborative Care and Support Planning

"The Collaborative Care and Support Planning programme aims to encourage a shift in general practice to bring the person with long term conditions (LTCs) to the centre of the decisions which are made about their care, working in partnership with the practitioner."

Collaborative Care and Support Planning
Royal College of General Practitioners
January 2015

Find out more and watch a video about the programme here.

Developing MSK networks: a resource pack

"This resource pack provides commissioners of MSK services with a framework for planning and developing a local MSK network, and signposts to a wide range of additional materials which may be useful as they undertake this task. "

Developing MSK (muscoloskeletal) networks: a resource pack
ARMA, NHS England MSK Clinical Network Project
January 2015

Read more here.

Delivering Higher Value Care Means Spending More Time with Patients

"Attempting to improve a physician’s productivity by placing arbitrary limits on length of appointments or setting high targets for the numbers of patients that he or she should see each day lowers costs at the front end of a care cycle. But they incur much higher costs later in the cycle when preventable complications are treated in emergency rooms and intensive care units."

Delivering Higher Value Care Means Spending More Time with Patients
DA Haas, YC Krosner, N Mukerji, RS Kaplan
Harvard Business Review
December 2014

Read more here.

European Collaboration for Healthcare Optimisation Atlas reports

"ECHO performance Atlases report unwarranted differences in health systems performance across ECHO countries. Atlas reports on cardiovascular care, lower value care and potentially avoidable admissions have been yielded. These reports feature international and in-country variations in performance, its evolution over-time, the effect of socioeconomic gradient, and provide some policy messages derived from the results."

European Collaboration for Healthcare Optimisation Atlas reports
February 2014

Access the Atlases here.

Improving the quality of initial management of self harm and suicide patients in A+E

"This audit cycle has shown an initial poor compliance to the NICE guidelines on initial management of self harm and suicide attempts in the James Paget A+E, which has been improved greatly with simple interventions."

Improving the quality of initial management of self harm and suicide patients in A+E at the James Paget Hospital
B Cracknell
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u207272.w2919

Read more here.

Reducing pre-operative length of stay for enterocutaneous fistula repair with a multi-disciplinary approach

"We started this project with the aim of reducing the pre-operative length of stay for assessment of complex surgical patients in a tertiary-referral centre. Through the instigation of a weekly multi-disciplinary team meeting and a formalised patient pathway including referral process, we have demonstrated a reduction in length of stay from 30.1 to 5.7 days that would result in an annual saving of over £177,000 on bed-day costs alone."

Reducing pre-operative length of stay for enterocutaneous fistula repair with a multi-disciplinary approach
M Chamberlain, R Dwyer
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u204075.w1773

Read more here.

Warfarin prescription and administration: reducing the delay, improving the safety

"Through introduction of a "warfarin box" we were able to improve the number of doses given within an hour of the recommended time and the daily average of administration time."

Warfarin prescription and administration: reducing the delay, improving the safety
R Dyar, S Hall, B McIntyre
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u204509.w1983

Read more here.

Bipolar disorder clinical audit tool (NICE)

"This clinical audit tool can be used to carry out a clinical audit project that aims to improve the short and longer term management of bipolar disorder in adults in social care."

CG185 Bipolar disorder (update): clinical audit tool
NICE
December 2015

Access the tool here.

Advice from NICE on Medicines Optimisation of Key Therapies

NICE have released a number of evidence-based Key Therapeutic Topics to support medicines optimisation. Access them below:

• Antibiotic prescribing – especially broad spectrum antibiotics (KTT9)
• First-choice antidepressant use in adults with depression or generalised anxiety disorder (KTT8) 
• Low-dose antipsychotics in people with dementia (KTT7)
• Hypnotics (KTT6)
• High-dose inhaled corticosteroids in asthma (KTT5)
• Omega-3 fatty acid supplements (KTT4)
• Lipid-modifying drugs (KTT3)
• Renin-angiotensin system drugs (KTT2)
• Wound care products (KTT14)
• Non-steroidal anti-inflammatory drugs (KTT13)
• Type 2 diabetes mellitus (KTT12)
• Minocycline (KTT11)
• Three-day courses of antibiotics for uncomplicated urinary tract infection
• Laxatives (KTT1)

Leadership and organizational change for implementation

" Although leadership in general has been shown to support effective implementation, the LOCI [Leadership and Organizational Change for Implementation] intervention highlights specific strategies that leaders can use to improve the climate for implementation in their teams."

Leadership and organizational change for implementation (LOCI): a randomized mixed method pilot study of a leadership and organization development intervention for evidence-based practice implementation

GA Aarons, MG Ehrhart, LR Farahnak, MS Hurlburt
Implementation Science 2015, 10:11  doi:10.1186/s13012-014-0192-y

Read more here.

NHS Innovation Accelerator Programme

"The NIA invites leading healthcare pioneers from around the world to bring their tried and tested innovations to the NHS. The programme aims to select a broad range of innovations – products, processes and technologies – to be more rapidly developed and scaled across the health service, to improve patient care, and reduce costs."

Find out more and apply here.

Inclusive integration: How whole person care can work for adults with disabilities

"This report provides an empirical evidence base to demonstrate how whole person care should meet the needs of working age disabled adults. It explores how integrated care outcomes for working-age disabled adults might be formulated to take account of wider health inequalities within a social model of disability."

Inclusive integration: How whole person care can work for adults with disabilities
Angela Broadbridge
December 2014

Read more here.

Maximising Older People's use of Personal Budgets

"The overarching aim of the programme was to ‘improve social care outcomes for older people using personal budgets’. Within this overall aim, the programme had a number of specific objectives based on the development of an ‘innovative volunteer-delivery model’"

Maximising Older People's use of Personal Budgets (MOPPU): Project Evaluation Report
A Ellis Paine, R Taylor, C Needham, R Littlechild, H Buckingham
Age UK
October 2014

Read more here.

Improving early recognition of delirium using SQiD

"Following awareness raising activities, the awareness and use of SQiD increased from 12.5% to 83% and 20% respectively. Incorporating the SQiD question into the care round form delivered 100% awareness and 50% use during testing."

Improving early recognition of delirium using SQiD (Single Question to identify Delirium): a hospital based quality improvement project
E McCleary, P Cumming
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u206598.w2653

Read more here.

Traffic lights: putting a stop to unsafe patient transfers

"we feel that our tool could be developed for use for all intra-hospital transfers at Watford General Hospital, and could be more widely used in acute hospital trusts under similar pressures to increase patient flow, reducing the clinical risks associated with patient transfer."

Traffic lights: putting a stop to unsafe patient transfers
A Parbhoo, J Batte
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u204799.w2079

Read more here.

Improving patient flow in pre-operative assessment

"This improvement project sought to decrease waiting times for patients at a pre-operative assessment service at Raigmore Hospital in Inverness, and to increase the proportion of patients who were seen on the same day as the decision to operate was made."

Improving patient flow in pre-operative assessment
C Stark, A Gent, L Kirkland
BMJ Quality Improvement Reports 2015;4: doi:10.1136/bmjquality.u201341.w1226

Read more here.

An Illustrated Look at Quality Improvement in Health Care (video)

This video provides a practical and motivating introduction to quality improvement in healthcare.

Dr. Mike Evans Video: An Illustrated Look at Quality Improvement in Health Care
Institute of Healthcare Improvement

Watch the video here.

Outcomes-based commissioning reading list

"This essential reading list highlights how people are facing up to the challenges of commissioning for outcomes, the only way forward, difficult though it is."
Outcomes-based commissioning: A Reading List produced by NHS Right Care
N Pearce-Smith, M Gray
December 2014

Read more here.

Reducing Care Utilisation through Self-management Interventions

"Very few self-management support interventions achieve reductions in utilisation while compromising patient outcomes. Evidence for significant reductions in utilisation were strongest for respiratory disorders and cardiac disorders."

Reducing Care Utilisation through Self-management Interventions (RECURSIVE): a systematic review and meta-analysis
M Panagioti, G Richardson, E Murray, A Rogers, A Kennedy, S Newman, et al.
Health Service Delivery Research 2014;2(54).

Read more here.

RCN Safe Staffing Report 2014

"With a renewed focus on safe staffing levels after the Francis report most London trusts have increased their budgeted nursing establishments this year. The link between staffing numbers, skill mix and patient safety is now inescapable."

RCN Safe Staffing Report 2014
Royal College of Nursing
December 2014

Read more here.

The Flex Track: Flexible Partitioning between Low- and High-Acuity Areas of an Emergency Department

"Using discrete-event simulation, we have shown that adding some flexibility into bed allocation between low- and high-acuity can provide substantial reductions in overall patient waiting and a more efficient ED [Emergency Department]."

The Flex Track: Flexible Partitioning between Low- and High-Acuity Areas of an Emergency Department
LF Laker, CM Froehle, CJ Lindsell, MJ Ward
Annals of Emergency Medicine. 2014; 64(6): 591–603. doi:  10.1016/j.annemergmed.2014.05.031

Read more here.

Identification of promising strategies to sustain improvements in hospital practice

"Joining a quality improvement collaborative may not be enough to achieve long-term normalisation of transformed care, and additional investments may be needed. The findings suggest that certain post-implementation strategies are valuable in sustaining implementation successes achieved after joining a quality improvement collaborative."

Identification of promising strategies to sustain improvements in hospital practice: a qualitative case study
SMC Ament, F Gillissen, A Moser, JMC Maessen, CD Dirksen, MF von Meyenfeldt, T van der Weijden
BMC Health Service Research, 2014; 14(1): 641. doi:  10.1186/s12913-014-0641-y

Read more here.

Understanding quality improvement at scale in general practice

"Improvement guidance derived largely from hospital-based studies is, for the most part, applicable to improvement efforts in primary care settings, although large-scale change in general practice presents some particular challenges. These need to be better understood and addressed if improvement initiatives are to be effective."

Understanding quality improvement at scale in general practice: a qualitative evaluation of a COPD improvement programme
M Marshall et al.
British Journal of General Practice, 2014; 64(629): e745–e751. doi:  10.3399/bjgp14X682801

Read more here.

The impact of a large-scale quality improvement programme on work engagement

"The findings demonstrate how QI activities, like those integral to the Productive Ward programme, appear to positively impact on the work engagement (the vigour, absorption and dedication) of ward-based teams."

The impact of a large-scale quality improvement programme on work engagement: Preliminary results from a national cross-sectional-survey of the ‘Productive Ward’
M White, JSG Wells, T Butterworth
International Journal of Nursing Studies 51(12),  2014, pp.1634–1643

Read more here.

Leadership academy programmes

The Leadership Academy provide a number of courses designed to develop better leadership for NHS employees at all levels of experience, many of which are free or fully funded. These includes programmes specifically designed for nurses and midwives, as well as those for clinicians.

Find out more here.

Choice of provider and team in mental health care

"This guidance has been developed with colleagues from across the mental health sector. It seeks to promote a common understanding of what mental health patients’ legal rights are, where they apply, and what they mean in everyday practice. It should enable consistency in the application of these rights, while also acknowledging the need for clinical judgments and decisions according to the circumstances of individual patients."

GUIDANCE:Choice of provider and team in mental health care
The NHS Constitution
NHS England
December 2014

Read more here.

Best practice in Memory Services

"With the increase in the interest in dementia and the need for high quality services, memory services have an important role to play in the assessment, diagnosis and management of people with suspected dementia."

Best practice in Memory Services: Learning from across England
A Burns, A Wilkinson, S Peachey
NHS England
December 2014

Read more here.

Insulin pump therapy: clinical audit tool

NICE have published a cost saving audit tool to assist in comparing practice against the NICE technology appraisal guidance for insulin pump therapy.

TA151 Diabetes - insulin pump therapy: clinical audit tool
NICE
December 2014

Read more here.