Implementing an Always Event® to improve the information needs of children and their families

How did the journey start?

Increasing patient, family and carer involvement is a strategic aim of Manchester University NHS Foundation Trust. The organisation has recently developed an experience and involvement strategy with a commitment to co-produce services and were keen to incorporate the Always Events® approach into their quality improvement work. The Trust joined the Always Events programme in January 2020 and hospitals were invited to express an interest in taking part in the programme.

What mattered most to patients?

A point of care team was established for Ward 84 which included multi-disciplinary staff members and a representative on behalf of the Teenage Cancer forum patients who prior to Covid-19 had regular meetings. To understand what mattered most to patients and their families, feedback was gathered via a short three-question survey which was promoted via posters on the ward, Twitter and the use of a QR code.

A key theme to emerge was the need for improved communication and further feedback was sought to understand what aspects of communication mattered to patients and families. This identified that communication on the daily blood count results, which impacts on daily treatment plans for children, was something that needed improvement, along with having a reminder of the name of their daily nurse. Patients and their families also said it would be useful to be given this information in a timely manner, given the importance on the blood count results for treatment.

I will always receive written daily updates about my/my child’s care plan, and this will include information about which nurse is looking after me/my child each day.

Vision Statement

Implementing change

As families were keen to have information on their child’s blood count results first thing in the morning, the point of care team decided to develop a sheet, known as the Patient Information Update, and worked with families to establish what information should be included.

The Patient Information Update sheet consists of key information such as blood count, temperature, name of designated daily nurse, along with other information families and patients felt were important. As blood test results are often available in the early hours the night staff complete the forms and distribute to the patients’ bedside around 7am.

Due to Covid-19, piloting the change initially involved 3-4 beds in the ward. Feedback was sought from families during testing and the Plan-Do-Study-Act (PDSA) cycle which showed where small improvements to the form could be made. Further PDSA cycles were carried out in a wider area before the Always Event was implemented across the whole ward.

What helped with implementation?

Staff engagement and commitment

Frontline staff were engaged and enthusiastic to make a positive difference to patient and family experiences and feedback was collected from them throughout the process too.
The Patient Information Update was easy to embed in their daily work and was not considered a burden.

Teenage Cancer Youth Worker

Links with the Teenage Cancer Youth Worker throughout the process was key to ensuring teenage patients and their families were involved and that the document included what was important to them.

Senior staff support

The commitment and support of the management team (especially the Head of Nursing and Matron for Patient Experience) was seen as a key enabler to implementation. Their support of the Always Event carried down to the front-line staff who were implementing the improvement.

Dedicated staff time

The Patient Experience Programme Lead for the trust was a dedicated person within the oversight team for the Always Events programme to provide support to the point of care team and liaise with NHS England and Improvement (NHSE&I).

Oversight team reports

There is one oversight team for all Always Events in the trust that meets monthly and the Executive Lead is the Deputy Chief Nurse. This ensures the programme has good visibility and senior-level commitment.

Standing agenda item

The Always Event programme is a standing item on the agenda of the Patient Experience and Quality Heads of Nursing Forum that meets monthly.

Central support

The consistency of the support from NHSE&I, including the coaching calls, was felt to be a key enabler to implementation.

Achievements

Before the Always Event changes were implemented, an audit of the ward showed 65% of parents had not received written information about their child’s blood count. To check on the reliability of implementing the Always Event change, the ward manager or nurse in charge checked during the morning handover huddle that the Patient Information Update had been handed out to patients.

A two-week audit of every patient took place after implementation which identified the Patient Information Update was always being provided and subsequently, the team have implemented intermittent twice-weekly audits with a small number of patients’ families.

Despite Covid-19, the point of care team were able to progress with the rollout of the Always Event and the process of handing out the Patient Information Update is now embedded in daily practice. The team on Ward 84 continue to monitor the success of their Always Event with the aim of providing evidence of implementing a programme which meets all the Always Event criteria, to receive a Recognition Award from NHS England.

Positive impact on patients and staff

The implementation of the Patient Information Update sheet received positive feedback from both staff and parents. A post-implementation survey showed that 67% of patients and their families rated the Patient Information Update as ‘excellent’ (33% rated it as ‘good’) and 81% said they ‘definitely’ found the information helpful. Parents appreciated the information as it helped them to better understand their child’s health. Some commented that having the daily blood counts has enabled them to understand when their child needs further treatment. Others mentioned finding it useful to be informed of a daily plan or simply knowing the names of the nurses looking after them.

Improving the families’ experiences in this way, has also improved staff experience. Staff felt that by building this sheet into their daily task has enabled them to plan their day more efficiently. The communication of the information is done in a more organised way, with it being completed first thing, rather than as and when a patient or parent/carer may request it. Some staff also mentioned that it is easy to complete and is not a burden on their workload.