The Academy of Fabulous Stuff
You would think, based on the alarmist witterings of the media,
that the NHS is on its way to hell in a handcart and that all it’s staff are pushing said cart.. However, this simply isn’t true; the NHS is full of enthusiastic, clever, keen, passionate people with a strong sense of vocation. They want to do the right thing and to do things right. Now there is a platform that enables and facilitates sharing of your innovative ideas to make your patient’s NHS journey better.
How it began
With many years in the NHS as a manager, Roy Lilley is known to most for his enthusiastic support of the NHS and his views on those people and systems that frustrate and thwart innovation or even simple care delivery. But rather than just ‘harumphing’ a lot, he put his energy into building something new and exciting – the Academy of Fabulous Stuff (http://www.fabnhsstuff.net/).
As Roy himself states;
…For as long as I can remember I have been dreaming of a time when all the good things, ideas, innovations and concepts, that are the backbone of the NHS, could be shared. The Academy of Fabulous NHS Stuff is proof; dreams can come true.
…I want to make the Academy the first port of call to show off (why not), to make us proud and put a smile on the faces of the people working right across the NHS; to make services better, more efficient and above all fun. If you have a problem you can bet someone else is facing the same challenge. You can almost guarantee, somewhere in the NHS somebody has an idea or a solution that will help…Five years of writing editorials for nhsManahers.net has filled my in-box with people offering readymade solutions, ideas and answers to the questions we all face. It’s time to pass them on.
The ideas don’t have to be huge and service wide, they can be local, niche ‘the way you do it’.
The Academy of Fabulous NHS Stuff is an opportunity to turn dreams into action.
The other people behind the Academy include Dr Terri Porrett, a clinical nurse specialist who was also involved in setting up the Apollo Nursing resource, an online resource to enable specialist nurses to articulate the value of their role and amplify the voice of specialist nurses (http://www.apollonursingresource.com), and Jon Wilkes, Managing Director of UK HealthGateway Ltd and all-round good egg. Nick and Fran Maher take care of all the technical bits.
How it works
The site is easy to navigate in order that you can both read about and submit your own innovations and ideas. To find great stuff on this site you can either click on the tag cloud words and browse the categories that most interest you, or click on the Search Fab Stuff page.
If you would like to rate submissions and contribute to the site’s repository, you need to register. You can then submit your fab stuff (500 words and up to 3 pictures). It’s as simple as that! We then review and will notify you when the submission is live. As a contributor you can develop your profile and enter an optional short biography snippet and links to your Twitter and Linked-In profile. You can also send and receive private messages from other registered contributors, so that you can get in touch and get more details.
You can also give your feedback to others using a star rating system. Simply click the stars to give your rating. Every 5 star submission will be entered into the Awards.
Some examples of innovative practice posted on the site are shown below.
Using social media to improve patient care
Technology enabled care provides practices with opportunities to improve the quality of care their patients receive, as well as reducing costs and demands on their services. In Stoke-on-Trent we believe that practices should commit to using social media as one of their modes of technology enabled care. So not only are patients in 20 or so of our 52 practices using social media now, but they are also chatting to each other about health related issues online. This may range from positive discussions about leisure and health services that are running in their area or complaints about local hospitals or GP access.
Why Facebook? So to influence the conversations they are having we can’t do that if we are sat outside looking in – our GPs and practice teams have to be part of it. Although we may be nervous about our practice having a Facebook page, the fact that any one of our patients can already comment on us online –for instance NHS Choices- that can be seen by other patients makes whether we want to use the internet or not, irrelevant. With this in mind our CCG supported practices to take the plunge with social media 18 months ago, and we have not looked back since.
We started small – just eight practices – and sought the help of an external social enterprise organisation to help us set up and build our audience. Once we were up and running, word got round other practices and more of them have joined in too. Who’s using it? Facebook has invariably become the channel of choice in the 20 or so practices that are actively participating, regardless of whether or not they use it in their private lives.
A 2014 Ofcom report noted that Facebook remains the default social networking site for almost all UK adults who are online – 96%. The figures are staggering with between 30-33 million people using Facebook in the UK. When we have delved further into our data for Stoke-on-Trent practices we found that 86% of users are female and 65% aged between 35-65 years. More patients are engaging with us on Facebook aged over 55 years than under 25 years. Any claims that Facebook is for younger people are not supported by our data. So it makes sense to use this channel to share important health messages as well as information relating to our practices.
The impact is impressive too. A video promoting the services available in one practice with a 10,000 list size, reached over 12,000 people, had 2,400 views and was shared by over 100 patients.
Facebook for weight management: The idea for a Facebook weight management group came from practice nurses themselves. The purpose of the group was to enable nursing staff to provide valuable information and self help tips to patients, whilst creating online communities of likeminded patients to support each other. Messages posted to patients vary and range from exercise routines and diet advice to information on other services available. Key differences between the Facebook pages and groups we run is that every patient in the group will receive the post, whereas not every person who likes a page will get the update. So once we had agreement from patients to join the group we had a captive audience ready to receive our information.
Getting through to our patients: The beauty of using social media is that it provides direct access into the homes of our patients. It isn’t without its risks, which is why we’ve managed it carefully. Practice staff have been trained and supported and we’ve developed a helpful social media toolkit for staff.
What next? Our challenge is now to double the number of practices actively using social media in Stoke-on-Trent to over 40. Then we firmly believe we’ll reach a tipping point where the remainder will want to participate in social media too and learn from the wealth of knowledge and experience amongst existing practices.
Multidisciplinary review of medication in nursing homes: a clinico-ethical framework
A multidisciplinary team approach developed by Northumbria Healthcare FT has optimised medicines use in care homes, ensuring that residents or their families are fully involved in any decisions around prescribing and de-prescribing and provided better care for less. Medicines use in care homes has been identified as an area of concern, with poor prescribing, lack of structured review and little resident involvement being highlighted.
- excess medicines (sometimes inappropriate)
- lack of structured review of medicines
- patients unaware of what treatment they are on and why
It is estimated that between 10% and 71% of elderly patients take medicines that are not suitable or have the potential to cause harm. Some patients experience minor side effects from medicines that have a profound effect on their quality of life. Whilst there are clear guidelines for starting medicines, there is less guidance for stopping medicines. This project, funded by the Health Foundation, involved an innovative care home medication review service, where residents and their families were involved in decisions about medicines. Fourteen care homes were recruited and multidisciplinary teams established. Detailed medication reviews were carried out, which involved questioning the appropriateness of prescribing, and ensuring that all medicines prescribed had a clear and documented indication, and were safe and clinically beneficial.
Together we asked the following questions:
- is the medication currently performing a function?
- is the medication still appropriate when taking co-morbidities into consideration?
- is the medication safe?
- are there medicines missing that the patient should be taking ?
- 422 resident reviews carried out.
- 1,346 interventions made, the majority of which were to stop medicines.
- 1.7 medicines stopped for every resident reviewed.
- the main reasons for stopping medicines were no current indication or residents’ request to stop.
- the net annualised savings were £77,703, or £184 per person reviewed.
- for every £1 invested in the intervention, £2.38 could be released from the medicines budget.
- a 17.4% reduction in the medicine burden freed up staff time and enabled more contact with residents.
- early analysis suggesting that a multidisciplinary SHINE review is also preventing admissions: 172 admission pre- and 110 admissions post-SHINE intervention (p=0.004)
One of the key concerns GP practices had was the capacity to release GPs to attend the reviews. Therefore four models of GP involvement were developed. Analysis showed that direct GP involvement in the reviews resulted in the greatest interventions Case study: Ethel, an 85 year old lady was bedbound as a result of multiple strokes and end stage dementia, she was unable to communicate or make decisions for herself. She was prescribed 11 regular medicines, including medicines to prevent a fracture, and medicines to prevent cardiovascular disease. Each day nursing staff would administer these medicines by lifting her head and pouring the solution into her mouth. This lady was also taking antidepressant, hypnotic and antipsychotic drugs medicines for agitation. On stopping her preventative medicines her agitation resolved and in time her clinicians were able to stop medication for her agitation.