Engaging with Quality Initiative

Eight projects are currently underway through The Health Foundation’s Engaging with Quality Initiative:

Improving the quality of care for patients who self harm

Around 50 per cent of people who attend an accident and emergency department following an act of self harm are either not offered, or do not wait for, a psychosocial assessment. This leaves them more likely to self harm again. This project compares the provision of care in ambulance, acute and general and mental health services with NICE standards. The results supported by educational materials are fed back to participating clinicians, organisations and local groups. Regional education and training sessions are held to help local services improve.

Project title: The use of regional collaboratives to improves services for people who have self-harmed (Self Harm Project)
Lead organisation: Royal College of Psychiatrists
Partners: Intercollegiate Faculty of Accident and Emergency Medicine, Mind, Royal College of Nursing, Royal College of Psychiatrists Faculty of Liaison Psychiatry
Contact: Lucy Palmer. lpalmer@cru.rcpsych.ac.uk

Improving the care of adult patients undergoing elective surgery

Royal Colleges of Nursing and Anaesthetists (RCN and RCA) guidance says that patients can drink water up to two hours before elective surgery.  However many are still 'nil by mouth' for many hours before surgery, which is uncomfortable for patients and may delay recovery. Evidence also shows that the effectiveness of guideline implementation strategies needs testing. This project has developed three methods to improve implementation of the guidance for fasting before and after elective surgery. These methods are being tested in 19 acute hospitals in the UK. They include standard dissemination, a web based educational package championed by an opinion leader and generation of ideas for change by staff using Plan, Do, Study, Act cycles.

Project title: Peri-operative Fasting Implementation Study Evaluation (POISE)
Lead organisation: Royal College of Nursing
Partners: Royal College of Anaesthetists, Virtual Institute for Research in Health Care Practice Peri-operative Fasting Guideline Development Group  
Contact: Jo Rycroft-Malone. J.rycroft-malone@bangor.ac.uk

Improving the quality of prescribing for serious mental illness

The Prescribing Observatory for Mental Health (POMH-UK) was set up in March 2005 to help mental health services monitor and improve their prescribing of psychotropic medicines in relation to known best practice, such as Healthcare Commission Standards for Better Health and National Institute for Health and Clinical Excellence (NICE) guidance.
Participating mental health services select topics for audit and contribute data. The College team analyse data and provide bespoke reports to participating services and local patient organisations. Local teams are supported to make improvements. They can join regional collaboratives to enable  learning from each other.  

Project title: The Prescribing Observatory for Mental Health-UK (POMH UK)
Lead organisation: Royal College of Psychiatrists
Partners: British Association for Psychopharmacology, College of Mental Health Pharmacists and UK Psychiatric Pharmacists Group, Rethink, Royal College of Nursing, Royal Pharmaceutical Society of Great Britain.
Contact: Amber Shingleton-Smith. ashingleton-smith@cru.rcpsych.ac.uk

Improving the assessment and management of perineal trauma

Torn tissue during childbirth can cause persistent pain, affecting women’s physical and psychological health. This is one of the most commonly reported postnatal problems but pain can be reduced by following best practice guidance on tissue repair. This project has conducted a national survey of students, qualified midwives and education providers to review current practice and training provision in the repair of tissue trauma sustained during childbirth. A baseline audit has been developed and carried out in 20 maternity units. The outcomes of the surveys and audits were used to develop educational packages and training sessions. These are being delivered by facilitators in each unit appointed and trained by the project team.

Project title: Perineal Assessment Repair Longitudinal Study (PEARLS)
Lead organisation: Royal College of Midwives
Partners: Royal College of Obstetricians and Gynaecologists, National Childbirth Trust, Thames Valley University, University of Keele Medical School, University Hospital of North Staffordshire NHS Trust
Contact: Sue Macdonald. sue.macdonald@rcm.org

Improving the quality and effectiveness of hospital care for people with chronic obstructive pulmonary disease

There is wide variation in mortality rates from chronic obstructive pulmonary disease, with small hospitals having mortality rates up to 60 per cent higher than large hospitals. This project uses the results from the Royal College of Physicians’ 2003 national audit and other information to compare the care of patients in acute hospitals with British Thoracic Society guidelines. Participating organisations will visit each other to compare ways of changing services to improve quality. A repeat national audit was carried out following the visits and the results are being analysed.

Project title: The National COPD Resources and Outcomes Project (NCROP)
Lead organisation: Royal College of Physicians
Partners: British Thoracic Society, British Lung Foundation
Contact: Nancy Pursey. nancy.pursey@rcplondon.ac.uk

Improving the quality of care and outcomes from treatment for cancer of the bowel

Mortality rates from bowel cancer are higher in the UK than in other developed countries. There are several established national standards for the management of bowel cancer which are not being met consistently, for instance on the accuracy of diagnosis using colonoscopy. This project is measuring six aspects of performance in the management of colorectal cancer and comparing actual practice to NICE guidelines. Online feedback and specific advice about how to secure improvement is being provided to participating teams. The audit results are being shared with NHS trust chief executives, patients and the Healthcare Commission.

Project title: National Bowel Cancer Audit Programme (NBOCAP)
Lead organisation: Imperial College London, Association of Coloproctology of Great Britain and Ireland
Partners: Bowel Cancer Campaign
Contact: Paris Tekkis. p.tekkis@imperial.ac.uk

Assessing and improving the quality and management of care for patients with epilepsy and for those with community acquired pneumonia

There are an estimated 1,000 deaths per year in the UK due to epilepsy, many of which could have been prevented by long term seizure control. For people with community-acquired pneumonia, meanwhile, inappropriate prescribing and incomplete case records have led to significant gaps in the quality of care. These are two web-based audits which compare current practice with Scottish Intercollegiate Guidelines Network (SIGN) guidelines on the diagnosis and treatment of epilepsy in adults and SIGN and British Thoracic Society guidance on the management of community-acquired pneumonia. The epilepsy project focuses on improving the accuracy and timeliness of referrals to specialists. The community-acquired pneumonia project is focusing on improving the management of the disease in acute hospitals.

Project title: Epilepsy and Community-acquired Pneumonia Scottish National Audit Project (EPI CAP SNAP)
Lead organisation: Royal College of Physicians, Edinburgh
Partners: Royal College of Physicians and Surgeons of Glasgow, Epilepsy Scotland; Information Services, NHS Scotland
Contact: Andrea Patton. a.patton@rcpe.ac.uk

Assessing and improving the quality of services for patients with inflammatory bowel disease

The management of inflammatory bowel disease is complex and there are many opportunities for errors, such as inappropriate steroid therapy, which can result in increased long term illness or even death. This project set up the first national clinical audit of inflammatory bowel diseases, including the development of national standards with which to compare current practice. The first round audit results have been fed back to participating clinicians. Multi-disciplinary regional meetings and visits have been held to help clinical teams improve. A repeat audit was carried out in 2008.

Project title: UK Inflammatory Bowel Disease Audit (UK IBD Audit)
Lead organisation: Royal College of Physicians
Partners: British Society of Gastroenterology, Inflammatory Bowel Disease section, Association of Coloproctology of Great Britain and Ireland, National Association for Colitis and Crohn’s Disease
Contact: Calvin Down. Calvin.down@rcplondon.ac.uk