Hospital Based Improvement projects

This includes examples of QI projects related directly to care in the acute hospital setting, across all disciplines and services.

Video examples are also available in this section

01 The Healthy Weight Pathway For School Nursing In Northern Ireland (Fi .. (0.9 MiB)
Upload Date: 6th August 2019 Downloads: 70
Aim:


36 Parkinsons Disease Service Improvement (small) (0.3 MiB)
Upload Date: 10th December 2019 Downloads: 9
Aim: Rationale

• Provide a specialist service to all patients.
• Reduce current waiting time
• Improve patient experience and care


5.2 Virtual Spinal Clinic (0.3 MiB)
Upload Date: 10th June 2019 Downloads: 128
Aim: Increase the number of Virtual Spinal Clinic attendances by 50% by April 2019.

Reduce patient journey by providing a spinal surgeon’s opinion within timely manner.

Increase number of patients that can be managed by Orthopaedic ICATS.

Improve communication through collaborative working between the SEHSCT Orthopaedic ICATS and Musgrave Park Hospital Spinal Service.

Monitor and manage spinal referrals to the spinal service effectively and efficiently.


A Novel Education Programme To Reduce The Number (OOH) Packed Red Cells Transfusions In Acute Trauma Wards (0.6 MiB)
Upload Date: 13th November 2018 Downloads: 108
Aim: To educate junior medical staff along with ward staff about OOH transfusions and risks associated
To increase staff confidence and improve medical staff understanding of appropriateness of OOH transfusions
To improve patient safety and increase standards of OOH transfusions
By educating staff and on ward interventions we hoped to reduce the percentage of OOH transfusions (packed red cells) in the OOH setting by 10% across the two acute surgical units within the Belfast Trust


A QI project to reduce cardiac monitors use in Causeway (0.5 MiB)
Upload Date: 6th June 2019 Downloads: 93
Aim: A QI project to reduce cardiac monitors in Causeway


ACUTE MEDICAL UNIT (AMU) NURSING HANDOVE (0.3 MiB)
Upload Date: 3rd January 2020 Downloads: 11
Aim: To reduce the time taken to deliver nursing handover from 88 minutes to 40 minutes by October 2019.

‘For more information regarding this project please contact QualityImprovement.Academy@setrust.hscni.net’.

 

 


Adolescent Asthma Transition Service (1.4 MiB)
Upload Date: 10th May 2018 Downloads: 214
Aim: To create a multidisciplinary service to transition adolescents from paediatric and adult physicians


All 'Bout' Data Collection (0.6 MiB)
Upload Date: 12th November 2018 Downloads: 76
Aim: By September 2018 we want to improve the accuracy of data collection and entry to the Child Health System by 100%


Allied Health Professions Assisting Patient Flow Through the ED (0.6 MiB)
Upload Date: 19th February 2019 Downloads: 90
Aim: The AHP services will improve patient flow in the Emergency Department in the Ulster Hospital through:

Preventing admission if not an emergency

• Appropriate, relevant advice & signposting

Early AHP assessment in ED positively impacting on length of stay & onward referral


Allied Health Professions Assisting Patient Flow Through The Emergency Department (0.6 MiB)
Upload Date: 4th December 2018 Downloads: 88
Aim: The AHP services will improve patient flow in the Emergency Department in the Ulster Hospital through:


  • Preventing admission if not an emergency

  • Appropriate, relevant advice & signposting

  • Early AHP assessment in ED positively impacting on length of stay & onward referral


Ambulatory Care Unit (0.6 MiB)
Upload Date: 2nd July 2019 Downloads: 118
Aim: Increase the number of patient assessments in the Ambulatory Care Unit by 20% by April 2019


Anticipatory Care Plan (0.9 MiB)
Upload Date: 29th August 2019 Downloads: 15
Aim: By May 2019 80% of Patients admitted to HDU with end stage respiratory failure and acute deterioration (despite maximum medical management) will have a Hospital Anticipatory Care Plan in place as per BTS Guidelines.


Anticipatory Prescribing in Palliative Care (1.7 MiB)
Upload Date: 6th February 2019 Downloads: 143
Aim:


  • Increase awareness of importance of planning anticipatory medicines

  • Increase knowledge on what medications and doses to prescribe

  • Improve access to helpful information for prescribers and other staff

  • Improve appropriateness of timing of prescribing

  • Change perspective on these medications; that they should ideally be anticipatory – not reactive


Are we drowning in critical care? (0.8 MiB)
Upload Date: 2nd July 2019 Downloads: 107
Aim: This projects intention was to standardise minimum fluid volumes administered with Intravenous (IV) drugs within Critical Care (Altnagelvin Site, WHSCT), to prevent excessive positive fluid balances. Our aim by 30/06/19, was to reduce by 75% from baseline the volume of fluid administered with IV medications in a 24 hours period.


Are You Sitting Comfortably? (0.7 MiB)
Upload Date: 12th March 2019 Downloads: 94
Aim: To increase the number of patients who receive a comprehensive seating assessment within 72 hours of referral to 50% by December 2018.


Artwork Project - Daisy Children and Young Person Unit (1.3 MiB)
Upload Date: 26th November 2018 Downloads: 106
Aim: Why Is the Improvement Important?
 To make the Paediatric Unit a more welcoming place to be
 Warm Welcome to patients and their parents/carers and staff
 Much better patient experience.
 PIP from the young persons in the local Newry & Mourne Council area and involve the young persons/families from the area to contribute to the local hospital.


Assessing Children With Special Education Needs (0.4 MiB)
Upload Date: 29th August 2019 Downloads: 6
Aim: To improve the clinical experience and satisfaction for the child, parent and clinician to 80% by June 2019.


Assessment of smoking Status and prescription of Nicotine Replacement for Inpatients who smoke (0.7 MiB)
Upload Date: 19th December 2018 Downloads: 131
Aim: To identify if patient is a smoker on hospital admission
Improved Access to Nicotine Replacement Therapy
Increase in Midwives having completed PGD Training
Implementation of Smoke Free Policy
Better patient experience


BCH Anaesthesia Record Update (0.4 MiB)
Upload Date: 13th November 2018 Downloads: 86
Aim: To increase anaesthetist satisfaction with the anaesthetic record keeping sheet to 90%.


Bedside Handover Service User Involvement (0.2 MiB)
Upload Date: 7th March 2018 Downloads: 188
Aim: To implement and ensure 90% compliance with service user involvement in Bedside Handover by May 2016


BHSCT Mortality Morbidity Review System (0.4 MiB)
Upload Date: 13th November 2018 Downloads: 115
Aim: We aim to increase the number of deaths being recorded onto the Trust Mortality & Morbidity
Review system for Emergency Surgical Unit (EmSu) to at least 90% by May 2017


Blood Transfusion ELearning (1.1 MiB)
Upload Date: 18th December 2018 Downloads: 145
Aim: Blood Transfusion is an extremely complicated area of medicine. Learning material for special
components is very slight and indeed no trust specific material exists.
This project was created to aid staff through provision and dissemination of key information from
accredited guidelines, The project was created due to staff desires, SHOT report recommendation in
2017 as well as cost/usage statistics.


Blue Lighting ED TO Hv (0.5 MiB)
Upload Date: 15th April 2019 Downloads: 119
Aim: 100% of all ED notifications are received by the HV within 24 hours by January 2019 for all children 0-4 years who attend the Royal Belfast Hospital for Sick Children


Breast Care Early Supported Discharge (ESD) Pathway (2.5 MiB)
Upload Date: 10th May 2018 Downloads: 172
Aim: To develop an Early Supported Discharge (ESD) Pathway for post-operative Breast Surgery patients


Bronchiolitis, when less is more (1.2 MiB)
Upload Date: 10th June 2019 Downloads: 101
Aim: Increase staff adherence to new NICE guideline for bronchiolitis in Children’s Unit and Emergency Department (ED) by 50% by March 2019.

Decrease unnecessary interventions for infants with bronchiolitis in Children’s unit and ED by 50% by March 2019.


Bronchiolitis, When Less Is More (1.2 MiB)
Upload Date: 29th August 2019 Downloads: 8
Aim: Increase staff adherence to new NICE guideline for bronchiolitis in Children’s Unit and Emergency Department (ED) by 50% by March 2019.

Decrease unnecessary interventions for infants with bronchiolitis in Children’s unit and ED by 50% by March 2019.


Care of women requiring investigation or treatment of pregnancy related problems in first trimester (0.3 MiB)
Upload Date: 2nd July 2019 Downloads: 50
Aim: To improve the care of pregnant women requiring investigation and/or treatment of pregnancy related problems in the first trimester
– To decrease unscheduled care of women attending the gynaecology ward with first trimester problems by 25% by June 2019.


Cathy Curran QI Poster Final - Hospital (0.8 MiB)
Upload Date: 18th October 2019 Downloads: 7
Aim: To improve compliance with the 6 elements of the Sepsis bundle from 80% - 95% in wards 5B & 6B in Ulster Hospital by July 2019.


CD4 Countdown (0.7 MiB)
Upload Date: 16th April 2019 Downloads: 99
Aim: To reduce the percentage of CD4 tests requested outside of guidelines to 30% by January 2019


Challenging our Challenges Aka Bun Fight Friday (0.4 MiB)
Upload Date: 19th February 2019 Downloads: 137
Aim: Increase our capacity for OFC’s by 50% within 9 months.

Test the feasibility of a new model for performing OFC with multiple OFC in one dedicated session, starting with Baked egg and baked milk OFC.


Changing Culture Surrounding Ceilings Of Treatment In End Of Life Care (2) (0.6 MiB)
Upload Date: 1st November 2018 Downloads: 103
Aim: By April 2017, 50% of inpatients within the Belfast City Hospital Respiratory unit, with a level of morbidity where acute deterioration could be anticipated, will have a ceiling of treatment (COT) documented. In addition, 90% of patients with a DNACPR order will have a documented COT.


Children's AHPs Families Working To Communicate Better (0.4 MiB)
Upload Date: 6th June 2019 Downloads: 120
Aim: Providing families and their children with the right information, at the right time, in the right way throughout their AHP journey.


Chronic Productive Cough (CPC) Clinic - A Quality Improvement Project (0.3 MiB)
Upload Date: 1st November 2018 Downloads: 47
Aim: To standardise care for children as per CPC standards based on BTS guidelines.

At least 80% of children attending the clinic to have:
-a structured clinical assessment
-a physiotherapy assessment with microbiology
-a lung function test (>5 years of age)


CLEAR VIEW: Improving Bowel Preparations for Colonoscopy (0.5 MiB)
Upload Date: 3rd January 2020 Downloads: 9
Aim: To decrease the number of repeat colonoscopies due to poor bowel preparation from eight per week to five per week by September 2019 for Outpatient colonoscopies on the Altnagelvin site

‘For more information regarding this project please contact QualityImprovement.Academy@setrust.hscni.net’.


Communicating With Children To Make The Difference (2.2 MiB)
Upload Date: 10th December 2019 Downloads: 0
Aim: Aim

1 ½ hour interactive parent/carer training group session on strategies to facilitate communication development.

1:1 SLT- parent discussion, personalising specific strategies.

A follow-up appointment for assessment and further
intervention as appropriate.


Communication Tool For Safe Transfer Of Patients (0.3 MiB)
Upload Date: 8th March 2018 Downloads: 198
Aim: A communication tool to promote effective communication between the ICU and general ward staff tool


Completing The Outpatient Cycle (0.4 MiB)
Upload Date: 15th April 2019 Downloads: 107
Aim: To tackle the on-going accumulation of Open Registrations within the Belfast Trust starting with Consultant A within the Urology Service


Completion of Dental Core Trainee Call Sheets (0.3 MiB)
Upload Date: 10th June 2019 Downloads: 59
Aim: To improve the completion of Dental Core Trainee call sheets so that 60% of these forms are completed to an acceptable standard by May 2019.


Completion Of Dental Core Trainee Call Sheets (0.3 MiB)
Upload Date: 29th August 2019 Downloads: 6
Aim: To improve the completion of Dental Core Trainee call sheets so that 60% of these forms are completed to an acceptable standard by May 2019

 


Compliance With Antimicrobial Policy (0.2 MiB)
Upload Date: 7th March 2018 Downloads: 209
Aim: To achieve compliance with antibiotic prescription in 100% of patients in Acute Medical Unit (AMU) in accordance with Western Trust's Antimicrobial Policy


Creating A Supportive Environment In Surgery (1.3 MiB)
Upload Date: 10th May 2018 Downloads: 85
Aim: To create a supportive environment in surgery


Critical Care Transfer Of An Infant By NNU Staff Checklist Poster (10.2 MiB)
Upload Date: 8th August 2019 Downloads: 47
Aim:


Day Stay Theatre Utilisation for Maxillofacial Surgery in Downe Hospital DPU (0.7 MiB)
Upload Date: 22nd August 2018 Downloads: 84
Aim: To improve Downe Day Stay OMFS theatre utilisation to 100% by September 2018.


Debriefing Patients After Their Caesarean Section (0.5 MiB)
Upload Date: 1st November 2018 Downloads: 71
Aim: To increase 'total satisfaction' by 50% by May 2017


Delirium Poster Final - Melanie Regan - Hospital (1.3 MiB)
Upload Date: 21st October 2019 Downloads: 8
Aim: The Public Health Agency developed a Regional Bundle for the Prevention and Management of Delirium. This QI project was to continue in rolling out the Bundle carrying on from the past work by the General Ward Collaborative in Ward 22, Ulster Hospital and Ward 2, Downe which produced improvements in the treatment of Delirium in patients within the Trust.


Denise Mulgrew And Julie Hall Poster - Hospital (2.6 MiB)
Upload Date: 21st October 2019 Downloads: 6
Aim: By May 2019, 90% of patients with acute complications of their cancer or treatment (and do not require ED attendance) are seen within the AO Ambulatory Hub, Mon - Fri, 9am-5pm. By March 2020 we will have fully implemented all aspects of the AO Ambulatory Hub, including extended hours.


Develop a patient flow management system "Openward" (7.1 MiB)
Upload Date: 10th May 2018 Downloads: 207
Aim: To make "Openward" the go-to system for patient flow management


Development of an Antrim Hospital Site Management Model (1.6 MiB)
Upload Date: 10th May 2018 Downloads: 87
Aim: To develop a site management model


Development Of Reform Pathways For Patients Referred For A Routine Appointment To A Respitory Outpatient Department (1.6 MiB)
Upload Date: 22nd July 2019 Downloads: 93
Aim: To develop new pathways, with minimal consultant input, for the management of ‘Routine’ referrals for possible OSA, Chronic Cough and Bronchiectasis (i.e. 70% of total routine referrals). These pathways would result in patients being seen and managed in a more appropriate timeframe.


Discharge Letters in General Surgery (0.5 MiB)
Upload Date: 12th March 2019 Downloads: 183
Aim: Electronic discharge letter to record an accurate diagnosis in 95% of cases by August 2018


Discharge Planning in The NNU (1.5 MiB)
Upload Date: 12th March 2019 Downloads: 110
Aim: Process - Value Stream Mapping.

Goal Home By 1pm


Discharge Sticker - Improving The Accuracy Of Immediate Discharge Summaries (1.3 MiB)
Upload Date: 7th August 2018 Downloads: 113
Aim:


Discharge To Assess (0.5 MiB)
Upload Date: 1st November 2018 Downloads: 127
Aim: To implement a data set that will provide statistical information on service effectiveness, capturing length of stay, medical/fracture, age, male, female, onward referrals to social care for packages of care and bed resources.


Do Patients With Positive HIDA Scans Benefit From Cholecystectomy (L) (2) (1.2 MiB)
Upload Date: 7th August 2018 Downloads: 108
Aim:


Doctors Knowledge Of Radiation Dose And Subsequent Risk Of Imaging Studies (2.8 MiB)
Upload Date: 7th August 2018 Downloads: 135
Aim:


E-referrals for Physiotherapy (0.5 MiB)
Upload Date: 19th December 2018 Downloads: 69
Aim: Reduce number paper referrals thus limiting paper waste
Reduce time taken to process referral from point of referral to CBU
Reduce time taken from referral to appointment offered
Improve information on referrals to provide appropriate service in line with ‘right person, right time, right place’


Early Confirmed Discharge Project Antrim Hospital (1.2 MiB)
Upload Date: 10th May 2018 Downloads: 135
Aim: Our Early Confirmed Discharge (ECD) project attempted to reliably identify and process medical patients suitable for discharge by 10am.


Early Intervention In Accident Emergency The Role Of The OT With Emergency Care (1.6 MiB)
Upload Date: 6th June 2019 Downloads: 128
Aim: The Role of the Occupational Therapist within emergncy care.


Early Intervention Team - Model For People Presenting At ED (0.2 MiB)
Upload Date: 7th March 2018 Downloads: 221
Aim: Early Intervention Team (EIT), new model providing a comprehensive multidisciplinary assessment for people presenting at the Emergency Department (ED)


ECGs Are You Doing The Right. (0.4 MiB)
Upload Date: 4th December 2018 Downloads: 169
Aim: To improve the overall quality of ECG practice; in particular to increase the numbers of accurate precordial electrode positions in 12-lead-ECG recordings from a baseline of 4% to 95% by December 2019 within the Medical Assessment Units of the South Eastern Trust.


ECGs… Are you doing them right? (0.4 MiB)
Upload Date: 19th February 2019 Downloads: 118
Aim: To improve the overall quality of ECG practice; in particular to increase the numbers of accurate precordial electrode positions in 12-lead-ECG recordings from a baseline of 4% to 95% by December 2019 within the Medical Assessment Units of the South Eastern Trust.


Effectiveness Of Power Pack Provision Within The NHSCT (1.0 MiB)
Upload Date: 6th June 2019 Downloads: 60
Aim: An audit to identify users of power packs to ensure regular OT review


Electronic Discharge Letters For Paediatric Patients (0.5 MiB)
Upload Date: 13th November 2018 Downloads: 76
Aim: 80% of all surgical & medical children admitted will have an electronic discharge letter completed within 24hrs, leading to improvements in medicine reconciliation, timely discharge & review.


Electronic Triage in Orthopaedic Outpatients (1.1 MiB)
Upload Date: 2nd July 2019 Downloads: 109
Aim: We aim to streamline the referral process allowing us to reduce the time from CCG referral to Consultant triage by 25% by 01 May 2019


Electronic Triage In Orthopaedic Outpatients (1.1 MiB)
Upload Date: 23rd July 2019 Downloads: 67
Aim: We aim to streamline the referral process allowing us to reduce the time from CCG referral to Consultant triage by 25% by 01 May 2019


Elinor Welch - Hospital (1.1 MiB)
Upload Date: 21st October 2019 Downloads: 18
Aim: April – October 2017 saw SET have the highest turnover of staff for the region. Nursing staff shortages are a problem within local, national and global levels, with staff retention being a key factor. To increase the retention of registrant staff by reducing the turnover rate to the regional average by 2021”.


Emergency Sign In Cardiac Arrest (0.3 MiB)
Upload Date: 13th November 2018 Downloads: 141
Aim: The aim of this project was to improve patient safety by allowing responders to attend a medical emergency in the quickest time possible.
We hoped to achieve this by evaluation of the use of the sign on existing wards. To improve it if possible, and then ultimately to roll it out over other wards in the trust.


Enhancing Outcomes In The Neonatal Unit (4.8 MiB)
Upload Date: 6th June 2019 Downloads: 101
Aim: Enhancing Outcomes in the Neonatal Unit


Establishing a Pharmacist Independent Prescriber for Patients in the Elective Admission Ward in CAH (0.2 MiB)
Upload Date: 11th March 2019 Downloads: 166
Aim: 1.0 To determine the effect of a PIP completing a pre-admission
medication history, reconciliation and pre-surgery review in Elective
Admission Ward.
1.1 To record the number of patients reviewed and medications
prescribed by the PIP at the point of admission as a percentage of
the total admissions.
1.2 To improve patient safety by identifying patients at risk of acute
kidney injury and recommending review of relevant medications.


Evaluating The Effectiveness Of Pets As Therapy Group In Carrick 4 Rehabilitation Ward Holywell Hospital (5.3 MiB)
Upload Date: 6th June 2019 Downloads: 106
Aim: The therapeutic benefits of using animals as part of the treatment and rehabilitation of patients with autism and mental health diagnosis.


Exploring the caseload, activities and outcomes of a regional acute oncology service (0.2 MiB)
Upload Date: 11th March 2019 Downloads: 92
Aim: Acute oncology (AO) services have been operating in the UK
since 2010, after it was highlighted that cancer patients faced
unclear and inappropriate care pathways when presenting in
emergency departments1. AO seeks to optimise care for these
patients, with specific remits to reduce length of stay, avoid
unnecessary admissions and improve patient experience for
patients presenting as emergencies with complications of
treatment, complications of disease or a new cancer diagnosis2.


Extending The Scope Of Practice For Ultrasonographers Through Structured In-house Training (3.5 MiB)
Upload Date: 6th June 2019 Downloads: 85
Aim: Extending the Scope of Practice for Ultrasonographers through Structured In-house Training.


Eye Casualty A Clear Point Of Vision (0.4 MiB)
Upload Date: 13th November 2018 Downloads: 168
Aim: Increase patient discharges within 4 hour target from 81% to 90% by June 2018


Finding Frailty - Fighting Frailty (1.0 MiB)
Upload Date: 29th August 2019 Downloads: 7
Aim: To improve recognition and management of frailty at Lagan Valley Hospital (LVH) on general medical wards.


  • Finding Frailty – 50% of patients >75 years admitted to LVH will have documented frailty assessment

  • Fighting Frailty – 50% of frail patients will have a Comprehensive Geriatric Assessment by the Frailty Intervention Team


Follow Your Gut The Path To Developing A Person-centred (1.9 MiB)
Upload Date: 6th June 2019 Downloads: 97
Aim: The path to developing a person-centred gastrointestinal specialist nursing & dietetic service.


GET UP, GET DRESSED, GET MOVING (IQI 2019) [Final Version] (2.9 MiB)
Upload Date: 26th February 2019 Downloads: 133
Aim: This NHSCT campaign was part of the UK- wide EndPJparalysis 70 day challenge (17 April 2018-26 June 2018). The aim of the campaign is to get patients mobilised and dressed in their clothes during daytime hours


Getting A Foot Over The DoorIncreasing Initial Engagement With Clinical Psychology Services (0.6 MiB)
Upload Date: 13th November 2018 Downloads: 94
Aim: Increase engagement with the Clinical Psychology service at first appointment.


HAVE I GOT PPI (1.2 MiB)
Upload Date: 7th August 2018 Downloads: 159
Aim:


Head Over Heels - Falls in Hospital (0.9 MiB)
Upload Date: 1st November 2018 Downloads: 161
Aim: Reduce the number of inpatient falls in Ward 6 South BCH by 25% over a 6 month period from 28th September 2016 - 28th March 2017


Hypothermia Or Not Decision Algorithm HONDA (0.7 MiB)
Upload Date: 1st November 2018 Downloads: 148
Aim: 90% of babies born with a low cord pH (venous <7.1) will have a standardised neurological assessment documented within the first hour of life and at 4 hours of age by May 2017.


ICT Admin Model Office (0.7 MiB)
Upload Date: 18th December 2018 Downloads: 159
Aim: To Develop a Standard Operating Procedures Portfolio for ICT. This will improve ICT reporting systems and develop a consistent integrated model of working across the 7 ICT admin. To develop and utilize the use of Sharepoint for ease of reference to SOP’s and useful templates.


Impact of a Pharmacist Independent Prescriber (PIP) on the Haematology Ward at CAH (0.5 MiB)
Upload Date: 11th March 2019 Downloads: 107
Aim: To evaluate the impact of a pharmacist independent prescriber on patient
care.


Implementation Of A Telephone Triage Tool In Paediatric Haematology Oncology (0.4 MiB)
Upload Date: 1st November 2018 Downloads: 120
Aim: By June 2017 100% of patients will have clinically appropriate follow up after calling the Paediatric Haematology Oncology triage phone


Implentation of communication Buzzers In Ward A2 (5.1 MiB)
Upload Date: 10th May 2018 Downloads: 127
Aim: To help relieve parents and carers anxiety while a child is in hospital


Improve HACCP Compliance In Domesic Services CAH (0.2 MiB)
Upload Date: 8th March 2018 Downloads: 153
Aim: Use of hazard analysis critical control points (HACCP) to manage food safety in hospital domestic services


Improve The Safety Of Systemic Anti-Cancer Therapy (SACT) (0.2 MiB)
Upload Date: 13th February 2018 Downloads: 119
Aim: Safety of Delivery of Systemic anti-cancer therapy


Improvement In The Recording And Quality Of Information In IR1s (1.1 MiB)
Upload Date: 29th August 2019 Downloads: 10
Aim: To enhance the skills of the staff.

To provide clear and concise information to staff.

To promote a learning culture within mental health.

To support staff in decision making.

To value staff as future leaders within the mental health structure.

To educate staff in the rationale in completing forms.

To reduce time wasting in correcting this forms.


Improvements To The Diagnostic Genetic Testing Pathway For Patients With Development Delay (0.6 MiB)
Upload Date: 2nd November 2018 Downloads: 62
Aim: To improve the diagnostic pathway for paediatric patients with developmental delay by reducing the unnecessary genetic tests by at least 50%


Improving Attendance At ADHD Clinics (0.4 MiB)
Upload Date: 2nd November 2018 Downloads: 132
Aim: Reduce DNA rate by 50% in 6 months


Improving DNA Rates In Young Peoples Centre (0.6 MiB)
Upload Date: 2nd November 2018 Downloads: 99
Aim: To decrease the number of DNAs for initial appointments to one a week by June 2017.


Improving faecal calprotectin turn around times (TAT's) regionally (0.6 MiB)
Upload Date: 19th February 2019 Downloads: 58
Aim: To reduce the processing time for Faecal Calprotectin within the SEHSCT, in order to, reduce turn around times for samples from the WHSCT by 50%, by December 2018 


Improving Identification Of The Deteriorating Patient (0.3 MiB)
Upload Date: 13th February 2018 Downloads: 128
Aim: To improve patient safety by increasing the recognition and escalation of the deteriorating patient


Improving Medicines Reconciliation On Admission (0.6 MiB)
Upload Date: 29th August 2019 Downloads: 7
Aim: To increase medicines reconciliation at the point of admission on MAU in UHD by 50%, from baseline, by May 2019

 


Improving Nutrition Of Head And Neck Cancer Patients Receiving Radiotherapy In An Outpatient Setting (1.0 MiB)
Upload Date: 15th April 2019 Downloads: 94
Aim: By March 2019, 25% of patients receieving >20# of radiotherapy and requiring NG feeding will be done as an outpatient


Improving Physiotherapy Triage Process (0.9 MiB)
Upload Date: 18th December 2018 Downloads: 182
Aim: I feel this service improvement will be beneficial to the Physiotherapy service as well as to the Central Booking Unit in order to streamline how the current Physiotherapy triage process is completed on a daily basis across the Southern Trust. I hope this service improvement will produce a reduction in the duplication of work and therefore staff can make more efficient use of their time to meet other service needs.


Improving Physiotherapy Triage Process (0.9 MiB)
Upload Date: 19th December 2018 Downloads: 112
Aim:


Improving The Care Of Patients On AIRVO (2.5 MiB)
Upload Date: 21st November 2018 Downloads: 80
Aim: To reduce the clinical incidents relating to AIRVO by 80% by May 2018 within three pilot wards


Improving The Dermatology Referral Pathway For Switching Patients From Oral To Subcutaneous Methotrexate (0.5 MiB)
Upload Date: 12th November 2018 Downloads: 159
Aim: -Ensure referrals include completed paperwork
-Chart review of referrals Aug-Oct 2017
-Small numbers, short timeframe, stakeholders on-board
-Address departmental treatment goals and Trust values
-Complete by March 2018


Improving the efficiency of daily multidisciplinary ward meetings (0.2 MiB)
Upload Date: 8th March 2018 Downloads: 140
Aim: Improving the efficiency of daily multidisciplinary ward meetings


Improving The Prostate Patient Journey Right Care, Right Place, Right Time (0.8 MiB)
Upload Date: 15th April 2019 Downloads: 98
Aim: 50% of prostate cancer patients will have informed consent in the radiotherapy planning clinic by the Urology CSSR by Feb 2019


Improving time taken to provide discharge medicines to patients discharged from Ambulatory Care Unit (ACU) (2.0 MiB)
Upload Date: 2nd July 2019 Downloads: 131
Aim: To reduce by 50% from baseline the time taken to provide discharge medicines for patients discharged from Ambulatory Care Unit (ACU), Altnagelvin Hospital by 31st May 2019.


Improving Time Taken To Provide Discharge Medicines To Patients Discharged From Ambulatory Care Unit (ACU) (2.0 MiB)
Upload Date: 23rd July 2019 Downloads: 93
Aim: To reduce by 50% from baseline the time taken to provide discharge medicines for patients discharged from Ambulatory Care Unit (ACU), Altnagelvin Hospital by 31st May 2019.


Improving Waiting Times For Children Referred To Child Development Clinic In The Belfast (1.2 MiB)
Upload Date: 2nd November 2018 Downloads: 117
Aim: To improve CDC waiting time in the Belfast Trust by 50% in 1 year


Incorporation of the Warfarin Referral into the Electronic Discharge LeQer (1.1 MiB)
Upload Date: 11th March 2019 Downloads: 87
Aim: Warfarin, a vitamin K antagonist, is an
oral anticoagulant that requires close
monitoring and an individual dosing
regimen for each patient.
In the SHSCT, warfarin is prescribed on
a separate ‘warfarin prescription and
referral form’. This sits along side the
patient’s main medicine kardex. At
the point of discharge this form acts
as a referral form, to ensure
continued safe INR monitoring after
the patient is discharged from
hospital. Anticoagulant clinics are
held in GP practices or hospital based
anticoagulant clinics. The warfarin
form is sent to the patient’s GP, along
with a copy of the discharge letter
and a copy is also sent to the patient’s
anticoagulant clinic.


Increasing Discharges From Podiatry Outpatient Clinics (0.2 MiB)
Upload Date: 13th February 2018 Downloads: 152
Aim: Increase number of discharges from podiatry outpatient clinics by 20% by March 2017


Increasing Joy in work improves staff and patient experiences which improves quality of service. (8.3 MiB)
Upload Date: 2nd July 2019 Downloads: 125
Aim: To increase joy in work to improve the experience of staff in an Ophthalmology out-patient clinic and improve experiences for patients. To reduce the time for patients attending clinics by 30% and have 100% of digital dictations completed by end of clinic time by May 2019


Increasing Joy In Work Improves Staff And Patient Experiences Which Improves Quality Of Services (1.2 MiB)
Upload Date: 23rd July 2019 Downloads: 68
Aim: To increase joy in work to improve the experience of staff in an Ophthalmology out-patient clinic and improve experiences for patients. To reduce the time for patients attending clinics by 30% and have 100% of digital dictations completed by end of clinic time by May 2019.


Information You Provide When Requesting An X-Ray (1.0 MiB)
Upload Date: 6th June 2019 Downloads: 0
Aim: To ensure the safety of the patient in Emergency Department with regards to the appropriateness of referrals received from Medical and Non- Medical.


Introducing The Huddle - Bringing Cardiac Arrest Bleep Holders Together To Improve Communication (0.2 MiB)
Upload Date: 13th November 2018 Downloads: 115
Aim: This project aimed to bring cardiac arrest bleep holders together toimprove communication and leadership at cardiac arrests. This would be achieved through allocation of key roles during a cardiac arrest huddle (a meeting of all cardiac arrest bleep holders) with eighty per cent compliance within eight weeks of launching.


IQUE40 - Reduce The Outpatient Queue In Paediatric Orthopaedics To 40 Weeks (0.6 MiB)
Upload Date: 2nd November 2018 Downloads: 76
Aim: An initiative to reduce the outpatient queue in paediatric orthopaedics to 40 weeks in 1 year


Isn't once enough? (1.4 MiB)
Upload Date: 15th August 2018 Downloads: 96
Aim: By the end of May 2016 95% of Patients in Ward 1A would not be re-cannulated unnecessarily*.
*that peripheral cannula are not routinely replaced every 3-5 days but when clinically indicated.


Jane Patterson - Hospital (0.8 MiB)
Upload Date: 21st October 2019 Downloads: 6
Aim: Through the NIPEC Recording Care Project it was found that the current system of planning nursing care was not ‘fit for purpose’ and did not reflect person centred approaches. It was agreed that broad principles should be used to produce a model of planning nursing care for Northern Ireland which should demonstrate consideration of new technologies and utility for e-records. With approval from the Chief Nursing Officer for Northern Ireland; Executive Directors of Nursing; and the Chief Executive of NIPEC a project work stream was agreed and a spread Plan for implementation across the five HSC Trusts.


Joy In Work (1.4 MiB)
Upload Date: 29th August 2019 Downloads: 17
Aim: To decrease by 50% the issues regarding environment and resources that are causing staff to feel unhappy in work by September 2019.


Joy in Work for AHP Assistants/Support Staff (5.3 MiB)
Upload Date: 6th September 2018 Downloads: 115
Aim: To explore the concept of ‘Joy in Work’ through engagement with support staff from the 5 AHP groups represented on this project.


Junior Doctor Trolley (0.1 MiB)
Upload Date: 6th February 2019 Downloads: 163
Aim: Aims
•S- Reduce time taken to collect equipment for out of hours ward tasks
•M- Time taken to collect equipment for cannulation, catheterisation, obtaining ABGs, obtaining blood cultures
•A- Achievable through teamwork with ward staff
•R- +++, patient care improved, junior doctors happy 
•T- initial PDSA completed during this SQE project


Keep Calm and Sleep (0.4 MiB)
Upload Date: 19th December 2018 Downloads: 93
Aim: Lack of sleep whilst in the Intensive Care Unit (ICU) can have a major long term negative impact on a patient’s recovery from ill health. We, as nurses, can implement significant changes within ICU to improve the sleep experience for our patients.
Sleep deprivation is a major precipitating factor for the development of delirium. Delirium is an underdiagnosed and undertreated condition within ICU and has a huge impact on long term morbidity and mortality of patients.
Any intervention employed to reduce delirium can only have a positive effect for a patients immediate and long term recovery from serious illness.


Keeping Patients Safe In Acute Medicine (0.4 MiB)
Upload Date: 12th November 2018 Downloads: 151
Aim: -Reduce prescription errors
-Improve fluid balance recording
-Improve antimicrobial stewardship
Improve prescription of high risk medicines (Insulin, anti-coagularts)
-Increased focus on EDD (Estimated Date of Discharge)


Know your ABC-the relationship between Attitudes Behaviour Culture and Safety (11.0 MiB)
Upload Date: 26th February 2019 Downloads: 98
Aim: Know your ABC- the realtionship between Attitudes, Behaviour, Culture and Safety. Our Journey….


Lets Deliver and Record Care Together (0.7 MiB)
Upload Date: 22nd August 2018 Downloads: 124
Aim: Improve the effectiveness of the PACE model leading to improved recording of safe, effective and person centred care.


Lets Deliver and Record Care Together (6.8 MiB)
Upload Date: 21st November 2018 Downloads: 61
Aim: Improve the effectiveness of the PACE model leading to improved recording of safe, effective and person centred care


Lets Get Malnutrition Trending (3.8 MiB)
Upload Date: 6th June 2019 Downloads: 106
Aim: Joining Twitter as additional way of connecting with health care professionals and service users.


Lung Function Lab Capacity And Demand Review (0.3 MiB)
Upload Date: 7th March 2018 Downloads: 103
Aim: Pulmonary function tests, demand and capacity lung function laboratory


Make It Count (1.0 MiB)
Upload Date: 15th August 2018 Downloads: 174
Aim: To Improving Recognition and Response to Childhood Obesity in the Outpatient population in the SEHSCT


Make It Count - Improving Recognition of Childhood Obesity in the Outpatient Population (1.5 MiB)
Upload Date: 21st November 2018 Downloads: 124
Aim: To increase childhood obesity recognition by ensuring that 50% of children will have BMI calculated and plotted by May 2018 & To increase staff awareness and knowledge regarding obesity.


Making Restrictive Interventions Safer In Holywell PICU (2.6 MiB)
Upload Date: 7th August 2018 Downloads: 159
Aim:


Making Restrictive Interventions Safer In Psychiatric Intensive Care [Final Version] (3.1 MiB)
Upload Date: 26th February 2019 Downloads: 80
Aim: Project was to develop appropriate restrictive interventions for the management of aggressive behaviour to improve safety for PICU patients and staff.


Management Of Non Screen Detected AAA (0.6 MiB)
Upload Date: 2nd November 2018 Downloads: 81
Aim: By June 2017, develop and test a new pathway for the management of AAAs within BHSCT, consistent with the NI AAA Screening Programme (NIAAASP) protocol.


Management Of Non Screen Detected AAA (0.6 MiB)
Upload Date: 13th November 2018 Downloads: 134
Aim: By June 2017, develop and test a new pathway for the management of AAAs within BHSCT, consistent with the NI AAA Screening Programme (NIAAASP) protocol


Management Of Smear Results At Nurse Led Clinics (0.3 MiB)
Upload Date: 2nd November 2018 Downloads: 59
Aim: 80% of patients will be sent smear results within 4 weeks of test taken by end of June 2017 and 100% within 4 weeks by end of Sept 2017 in line with NHSCSP guidance.


Management Of Smear Results At Nurse Led Clinics (0.3 MiB)
Upload Date: 13th November 2018 Downloads: 139
Aim:


Managing Malnutrition (2.5 MiB)
Upload Date: 6th June 2019 Downloads: 73
Aim: A new led NHSCT led regional prescribing support dietetic team delivering and improving the quality of nutritional care.


Maternity Antenatal Outpatients Ulster Hospital (0.9 MiB)
Upload Date: 4th December 2018 Downloads: 157
Aim: Improve the Antenatal Clinic appointment process by reducing the time spent in the clinic by 25% before April 2018


Maternity Antenatal Outpatients Ulster Hospital (0.9 MiB)
Upload Date: 19th February 2019 Downloads: 130
Aim: Improve the Antenatal Clinic appointment process by reducing the time spent in the clinic by 25% before April 2018


Maximising The Diagnostic Potential Of Cerebrospinal Fluid (CSF) Referre . (0.4 MiB)
Upload Date: 13th November 2018 Downloads: 75
Aim: To reduce the number of CSF specimens received by the RVL that are insufficient for complete molecular testing by 30% in 6 months.


Maximising The Diagnostic Potential Of Cerebrospinal Fluid (CSF) Referred To The Regional Virus Lab (0.4 MiB)
Upload Date: 2nd November 2018 Downloads: 100
Aim: To reduce the number of CSF specimens received by the RVL that are insufficient for complete molecular testing by 30% in 6 months.


Mental Health Resource Centres Review (0.8 MiB)
Upload Date: 18th December 2018 Downloads: 119
Aim: Due to a lack of education about the function of the Resource Centre, referral agents may make inappropriate referrals or refer clients for treatment which is not recommended based on clinical guidelines. There are substantial internal delays within the pathway resulting in service users not being seen for Initial assessment in a timely manner. Due to the lack of knowledge of referrers, service users may also be unaware of the
function of the Resource Centre and why they have been referred.


Montgomery Compliance In Clinical Setting (0.2 MiB)
Upload Date: 16th November 2018 Downloads: 123
Aim: By April 2017 there will be >70% full compliance in the consent process for staff root canal treatments and by October 2017 there will be >90%


National Head and Neck Cancer Review Audit: Northern Irish Results (0.4 MiB)
Upload Date: 11th March 2019 Downloads: 106
Aim: •To assess adherence to ‘Follow-up after treatment for head and neck cancer:
United Kingdom Multidisciplinary guidelines ‘ 2016
•To help us understand current practices, gaps and areas of need
•To examine follow-up practices for head and neck cancer patients in the UK,
with the aim of establishing a research programme to improve current practice
•To develop trainee collaborative links in a cross specialty setting


Nicotine Replacement Resource For Staff And Flowchart For Inpatients Who Smoke (0.6 MiB)
Upload Date: 19th December 2018 Downloads: 81
Aim: Improved Access of Nicotine Replacement Therapy within maternity
Increase Midwives knowledge in prescribing NRT
Implementation of Smoke Free Policy
Better patient experience
Patients given a health improvement message for both them and their family


NNU Record Keeping Audit Promoting Safe Practise (IQI 2019) [Final Version] (4.4 MiB)
Upload Date: 26th February 2019 Downloads: 99
Aim: Promoting good record keeping practices within the Neonatal Unit


Nursing Home Initiative (2.0 MiB)
Upload Date: 6th June 2019 Downloads: 78
Aim: To assess patients with dysphagia (swallowing difficulties) in nursing homes in the Whiteabbey Hospital catchment area.


Occupational Therapy Dementia Friendly Homes (1.4 MiB)
Upload Date: 6th June 2019 Downloads: 111
Aim: Creating a dementia friendly home


OMFS Boarding Cards (0.4 MiB)
Upload Date: 29th August 2019 Downloads: 7
Aim: To improve transfer rate of suitable patients for OMFS Day surgery treatment to Downe Hospital to 75% by June 2019


OPAT (Outpatient Parenteral Antimicrobial Therapy) (0.2 MiB)
Upload Date: 6th February 2018 Downloads: 100
Aim: To establish a multi-disciplinary team approach to delivering IV antimicrobials in the community.


Opening Up the Conversation (5.5 MiB)
Upload Date: 21st November 2018 Downloads: 135
Aim: Improving Collaboration, Communication & Comprehension of Roles & Responsibilities of Paediatric & Anaesthetic Staff in Paediatric Emergencies through CROSS-SPECIALITY simulation


Operative Notes Meeting The Standards Set By The Royal College Of Surgeons A Quality Improvement Project (0.3 MiB)
Upload Date: 2nd November 2018 Downloads: 127
Aim: -To have 80% of operation notes within RVH Vascular Unit meeting at least 10 out of 12 key points taken from RCS Good Surgical Practice by June 2017.
-To introduce a typed electronic operative note to the unit by the end of 2017


OSCAR - Our Staff Can Accurately Record (1.0 MiB)
Upload Date: 13th November 2018 Downloads: 143
Aim: To improve the quality and accuracy of data input by the BCH Dietetic team by 10% by June 2018.


Paediatric Neurodisability (4.9 MiB)
Upload Date: 6th June 2019 Downloads: 124
Aim: Improving patient experience with enhanced role physiotherapy.


Paediatric Pain Scoring At Antrim Emergency Department A Quality Improvement Project (1.4 MiB)
Upload Date: 7th August 2018 Downloads: 58
Aim:


Parkinsons Disease Service Improvement (small) (0.3 MiB)
Upload Date: 17th December 2019 Downloads: 8
Aim: Aim 

• Provide a specialist service to all patients.
• Reduce current waiting time
• Improve patient experience and care


Patient Flow through a Acute Medical Unit: A Quality Improvement Journey (0.4 MiB)
Upload Date: 17th June 2019 Downloads: 169
Aim: To provide high quality acute medical and nursing care including rapid diagnosis, management, discharge or transfer to the appropriate ward in a timely fashion.


Patient flow through Acute Medical Unit : A Quality Improvement Journey (0.4 MiB)
Upload Date: 2nd July 2019 Downloads: 77
Aim: To provide high quality acute medical and nursing care including rapid diagnosis, management, discharge or transfer to the
appropriate ward in a timely fashion.


Patient Information Leaflets (0.5 MiB)
Upload Date: 29th August 2019 Downloads: 8
Aim: Increase patient understanding of their facial fracture management from 60% to 90% by June 2019


Person-centred Dementia Care In The Acute Hospital Setting (0.2 MiB)
Upload Date: 13th February 2018 Downloads: 137
Aim: Provision of dementia companion service in hospital wards to reduce confusion, distress and falls.


Planned Early Discharge SAFER Flow, Ward 2 South West Acute Hospital (0.5 MiB)
Upload Date: 3rd January 2020 Downloads: 9
Aim: Two patients will be discharged by 12 noon each day by 1 October 2019 from Ward 2 South West Acute Hospital.

‘For more information regarding this project please contact QualityImprovement.Academy@setrust.hscni.net

Planned Early Discharge SAFER Flow, Ward 2 South West Acute Hospital


POCUS (0.3 MiB)
Upload Date: 15th April 2019 Downloads: 103
Aim: To have POCUS embedded within my endocrine clinic and to decrease mean time to scan by 10-30% by December 2018


Policy Awareness (0.7 MiB)
Upload Date: 29th August 2019 Downloads: 6
Aim: To ensure staff have appropriate knowledge of SET’s Trustwide Policy Process to eliminate policy error. By May 2019:


  • 50% reduction in avoidable policy queries

  • 20% of staff involved in the policy process will have attended training.


Pressure Assessment For Our Perioperative Patients (1.1 MiB)
Upload Date: 29th August 2019 Downloads: 6
Aim: 100% recording of post operative pressure assessment in theatre 6 by April 2019


Prioritise Pain - Improving the assessment and documentation of pain (0.5 MiB)
Upload Date: 21st November 2018 Downloads: 108
Aim: To ensure that 50% of patients in the identified pilot areas (Wards 5A, 13 and 15) will have their pain assessed and appropriately documented on the NEWS chart


Project OPERA (0.5 MiB)
Upload Date: 15th April 2019 Downloads: 125
Aim: To reduce the percentage of patients undergoing elective bowel resection for colorectal cancer with pre-op HB <130 from 45% to 25% by June 2019


Project Siggy (0.4 MiB)
Upload Date: 15th April 2019 Downloads: 159
Aim: 50% of patients will self administer the phosphate enema at home prior to outpatient flexible sigmoidoscopy by March 2019


Promoting The Management Of Malnutrition In The Community (1.3 MiB)
Upload Date: 6th June 2019 Downloads: 74
Aim: A new led NHSCT led regional prescribing support dietetic team delivering and improving the quality of nutritional care.


PSORT it Out (0.5 MiB)
Upload Date: 2nd November 2018 Downloads: 89
Aim: To establish a consultant-led combined rheumatology/dermatology clinic for the management of patients with psoriasis and psoriatic arthritis by June 2017


Quality Improvement Project To Improve Quality And Efficiency Of Triage In The Emergency Department Of A District General Hospital (0.7 MiB)
Upload Date: 22nd July 2019 Downloads: 154
Aim: To improve the triage process so that 80% of patients were triaged within 15 minutes and 80% of charts had discriminators recorded by September 2018.


Reduce Blood Loss (0.8 MiB)
Upload Date: 2nd November 2018 Downloads: 141
Aim: To reduce the amount of blood loss due to Arterial-Blood Gas Analysis (ABGA), sampling in RICU by 30% by June 2017.


Reduce Staff Absence Rates in the South Eastern Trust (0.7 MiB)
Upload Date: 31st August 2018 Downloads: 164
Aim: Ensure 80% of staff in the Surgical Directorate are seen by the Occupational Health Physiotherapy Service within 2 weeks of absence by August 2018.


Reducing The Amount Of Routine Work Being Done At Weekend (1.5 MiB)
Upload Date: 7th August 2018 Downloads: 96
Aim:


Rehab Pathway For Patients Undergoing Hip Fracture Surgery (0.5 MiB)
Upload Date: 29th August 2019 Downloads: 6
Aim: "To reduce length of stay from 15.2 days to 14.6 days by June 2019"


Relieving The Pressure In ED (1.9 MiB)
Upload Date: 4th January 2019 Downloads: 89
Aim: • Reduce time to catheterisation
• Improve documentation of catheterisation
• Provide patients with written discharge advice
• Consider discharging patients awaiting trial removal
of catheter with an alpha blocker


Renal Service Virtual Review Clinic Model (1.3 MiB)
Upload Date: 10th May 2018 Downloads: 146
Aim: Better manage demand, Maximise resources, Enhance patient experience and Deliver
improved clinical outcomes


Respect everyone's sleep time (1.2 MiB)
Upload Date: 10th May 2018 Downloads: 145
Aim: To ask patients in Antrim, Causeway and the Community Hospitals if their sleep was disturbed at night during their hospital stay and to establish the reasons.


Responding To The Response Bag(1) (0.1 MiB)
Upload Date: 8th January 2019 Downloads: 96
Aim: To ensure that the emergency response bags are fit for purpose and familiar to all health care staff that use them


Review Of Lung Function Capacity And Demand (0.3 MiB)
Upload Date: 8th March 2018 Downloads: 146
Aim: Lung Function Laboratory capacity and demand


Reviewing And Improving The AHP CBU Systems And Processes (0.7 MiB)
Upload Date: 18th December 2018 Downloads: 73
Aim: -To review the demand for work carried out by the AHP CBU for each AHP service.
-To review, agree and adapt the current processes for the core tasks carried out by staff in the AHP CBU.
-To reduce the delay of registration of patients onto the Clinical Manager.
-To review the referral process from referrer to the AHP CBU.
-To improve communication between the AHP CBU and other AHP departments.
-Improve the quality of service provided to patients and service users.


ROAR – Mental health teaching and education in the acute hospital—Reflective Open And Responsive (0.6 MiB)
Upload Date: 19th December 2018 Downloads: 72
Aim: We believe that all service users in the acute hospital should receive the same standard of care and treatment. This should be based on a holistic approach and assessment of the individuals needs. This should not be negatively impacted by their personal history or background including when the individual has existing or newly identified mental health needs.
I want to develop and provide an education program that is reflective, open and responsive to the needs of frontline staff in the acute hospital.


Robust Radiology Error Reporting System (0.8 MiB)
Upload Date: 6th June 2019 Downloads: 0
Aim: To ensure the safety of the patient in Emergency Department with regards to the appropriateness of referrals received from Medical and Non- Medical.


Role Of The Clinical Pharmacy Technician In Seasonal Influenza Programme In Intermediate Care (0.3 MiB)
Upload Date: 4th December 2018 Downloads: 148
Aim: Seasonal Influenza is an annual occurrence, although the exact timing, severity and extent of spread vary from year to year. For this reason a seasonal influenza vaccination programme is initiated in the region to reduce the effects of an influenza outbreak and protect vulnerable patient groups. Those defined as ‘at risk’ include anyone aged over 65 years, even if they feel fit and healthy at the moment. The Dept. of Health (DoH uptake targets for 2018/19 for this patient population has been set at 75%.


Safe Handover (0.8 MiB)
Upload Date: 29th August 2019 Downloads: 8
Aim: Improve quality of handover by reducing interruptions by 20% by May 2019.


Safe Spaces (0.4 MiB)
Upload Date: 15th April 2019 Downloads: 84
Aim: A 10% reduction in the incidents of physical violence in the Killead Ward by March 2019


Safety Briefings At All Paediatric Handovers (0.2 MiB)
Upload Date: 13th February 2018 Downloads: 155
Aim: To have Safety Briefings at all (100%) Paediatric Handovers by 31 May 2017.


Safety Walk Round Checklist For ED Majors Area (0.2 MiB)
Upload Date: 7th March 2018 Downloads: 95
Aim: Accident and emergency safety walkround checklist majors


Scanxiety (2.6 MiB)
Upload Date: 29th August 2019 Downloads: 6
Aim: To reduce patient anxiety (scanxiety) by 10% by October 2019 for primigravida patients attending UHD for the Anomaly scan.


Scil Poster Nicola McCurley (1.2 MiB)
Upload Date: 19th December 2019 Downloads: 8
Aim: To ensure that 80% of transferred OMFS patients who attend Downe Day Surgery Unit for treatment have all of the necessary information present at the time of surgery.

Nicola McCurley Specialty Doctor in OMFS and TPD for Dental Core Training

For more information regarding this project please contact QualityImprovement.Academy@setrust.hscni.net


SEHSCT Maternity Antenatal Outpatients Ulster Hospital (1.0 MiB)
Upload Date: 3rd August 2018 Downloads: 178
Aim: To improve the appointment process by reducing waiting times.


SharonThompson (2.5 MiB)
Upload Date: 19th December 2019 Downloads: 9
Aim: By October 2019, 70% of stroke patients are admitted direct to the stroke unit (DSU) within 4 hours of arrival at the Emergency Department (ED), Ulster Hospital.

Sharon Thompson, Quality Improvement & Innovation Coordinator, South Eastern Health & Social Care Trust

For more information regarding this project please contact QualityImprovement.Academy@setrust.hscni.net


SHO Induction In General Surgery In Antrim Hospital (0.5 MiB)
Upload Date: 8th January 2019 Downloads: 113
Aim: To improve the departmental induction in the General Surgery Department in Antrim Hospital.


Skin Cancer Results Sharing In The 21st Century (0.4 MiB)
Upload Date: 29th August 2019 Downloads: 10
Aim:


  • Inform all skin cancer patients of excision results by phone

  • Reduce number of Outpatient Clinic review visits purely for result sharing

  • Improve Patient Satisfaction and reduce anxiety.


Spinal SIM Success (0.3 MiB)
Upload Date: 15th April 2019 Downloads: 151
Aim: To improve staff confidence in managing a suspected spinal injury by 50% in 3 months using Simulation Training and Provision of Appropriate Equipment


SPOTS In Derm (1.2 MiB)
Upload Date: 29th August 2019 Downloads: 9
Aim: To develop tools to ensure appropriate baseline investigations, patient counselling and monitoring is undertaken when prescribing commonly used systemic treatments in dermatology.


SQW Poster Anxiety Before Dental Surgery PDF (0.6 MiB)
Upload Date: 2nd July 2019 Downloads: 111
Aim:


SQW Poster Discharge Before 11am Pdf (0.5 MiB)
Upload Date: 2nd July 2019 Downloads: 61
Aim:


SQW Poster ED To Ward Waiting Times Pdf (0.3 MiB)
Upload Date: 2nd July 2019 Downloads: 59
Aim:


SQW Poster Paeds Discharge Process Pdf (0.8 MiB)
Upload Date: 2nd July 2019 Downloads: 132
Aim:


Stabilise Or Mobilise -Introducing Documentation For Spinal Cord Compression (0.6 MiB)
Upload Date: 16th April 2019 Downloads: 146
Aim: 80% of all admissions for MSCC have a spinal stability and mobility recommendation completed within 24 hours of Admission by March 2019


Standardised UVB Phototherapists Consent and MED Checklist (0.5 MiB)
Upload Date: 10th June 2019 Downloads: 52
Aim: To have a standardised nurses consent and MED checklist for 99% of patients in LVH by 31st Jan 2019


Standardised UVB Phototherapists Consent And MED Checklist (2) (0.5 MiB)
Upload Date: 29th August 2019 Downloads: 18
Aim: To have a standardised nurses consent and MED checklist for 99% of patients in LVH by 31st Jan 2019.


Star Project (0.9 MiB)
Upload Date: 2nd November 2018 Downloads: 76
Aim: Reduce number of repeat attendances to the Crisis Assessment Intervention Team by 1 visit per month


STOP Decrease Blood Taking (0.4 MiB)
Upload Date: 2nd November 2018 Downloads: 107
Aim: -Decrease amount of blood samples requested by NICU BY 10% by August 2017.
-Decrease number of babies having more than one skin/line break by 5% by August 2017


Takling The Treatment TAIL In Community SLT Clinics (0.4 MiB)
Upload Date: 6th June 2019 Downloads: 73
Aim: Ensuring an appropriate review, review/therapy takes place with the recommended timeframe


Teenage Allergy Clinic, Paediatric Allergy Service, Craigavon Area Hospital (CAH) (0.5 MiB)
Upload Date: 19th December 2018 Downloads: 67
Aim: believe a specific teenage allergy clinic for young people who attend paediatric allergy service at CAH will empower them and their families to effectively manage the risk of anaphylaxis to peanut/nuts into adulthood. Currently teenagers attend multidisciplinary allergy service (paediatrician, allergy nurse and dietitian) at CAH every 2 years to review allergy status. At 16 years of age they are discharged to primary care with no specific allergy follow-up.
A specific teenage clinic will meet recommendations from National Institute of Clinical Excellence (NICE). Any changes will affect the long term development of the service.


TEMP - Thermal Education Management Programme (0.9 MiB)
Upload Date: 2nd November 2018 Downloads: 3
Aim: Increase % of inborn admissions to RJMH with an admission temperature within the normothermic range (36.5˚C – 37.5˚C) by 1st May 2017


The Dietetic Prescribing Support Service (1.5 MiB)
Upload Date: 6th June 2019 Downloads: 134
Aim: The NHSCT led Prescribing Support dietetic team deliver a service to promote the safe and effective prescribing of oral nutritional supplements in primary care.


The Dysphagia DAMES Project (1.0 MiB)
Upload Date: 15th April 2019 Downloads: 51
Aim: We will achieve a safe dysphagia discharge in 60% of patients discharged from stroke unit care by Jan 2019


The Experimenting Of Shared Stores Within Female And Male Medical Wards, DHH (1.0 MiB)
Upload Date: 18th December 2018 Downloads: 173
Aim: -To reduce cost of stores on female/male medical ward by shared ordering of stores items
-Delays in finding the correct equipment wastes staff time and reduces time for patient care.
-Out of date items could be a risk to patient safety.
-An untidy store is a safety risk to staff


The Implementation of a Paediatric Physiological Early (3.6 MiB)
Upload Date: 10th May 2018 Downloads: 137
Aim: Develop NHSCT documentation to support the
implementation of the regionally agreed PEWS,
including escalation processes for the acute
paediatric wards with guidance for completion


The Map App Enhancing The Patient Journey Through Belfast City Hospita . (0.3 MiB)
Upload Date: 13th November 2018 Downloads: 98
Aim: We aim to make the patient journey through wing D Dermatology outpatients as easy as possible, using a map app and leaflet of maps.
We aim to improve communication and reduce patient anxiety and/or stress by providing a clear treatment plan.
We will measure improvement by using patient satisfaction surveys. We are aiming to achieve 80% patient satisfaction by September 2017.


The Role Of Ultrasound In Females With RIF Pain (2.7 MiB)
Upload Date: 7th August 2018 Downloads: 88
Aim:


Timely Investigations Within The ED (0.4 MiB)
Upload Date: 29th August 2019 Downloads: 18
Aim: For 80% of patients attending ED to have all investigations completed within 20 minutes of triage time by September 2019.


To Ensure Timely Referral Of Patients From The Northern Ireland DESP To . (0.3 MiB)
Upload Date: 13th November 2018 Downloads: 152
Aim: The aim of the project is to ensure that by June, 2017, 50% of diabetic patients with urgent positive screening results receive a hospital appointment within 6 weeks of the screening date within the Belfast Trust; to increase to 75% by December, 2017.


To Reduce The Number Of Falls In Ward 40, Altnalgelvin (0.2 MiB)
Upload Date: 13th February 2018 Downloads: 107
Aim: To reduce the number of falls in Ward 40, Altnagelvin Hospital by 10%


To Standardise And Streamline The Triage Process In Genetic Medicine (0.8 MiB)
Upload Date: 16th April 2019 Downloads: 115
Aim: The aim of the project is to increase consistency and streamline the triage process by March 2019. To achieve 100% of the team having a comprehensive understanding of which standard letters exist and where these letters are located


Together We Can Do It (2.3 MiB)
Upload Date: 6th June 2019 Downloads: 81
Aim: Helping Children enjoy, achieve and learn to the best of their ability by implementing a holistic model of service to meet children's needs in the mainstream school setting.


Training On Treatment And Care Of Inpatients With Eating Disorders (0.2 MiB)
Upload Date: 8th March 2018 Downloads: 95
Aim: Further develop and improve nursing staffs knowledge regarding the causal and maintaining factors of an eating disorder.


Unfinished Symphony Improving Discharge Communication From The ED (1.0 MiB)
Upload Date: 13th November 2018 Downloads: 80
Aim: To increase % of discharge letters meeting both standards to 75% within 6 months


Use of Computerised Records for recording patient details at clinics in Lurgan Day Hospital and the development of a form for recording patient details at the daily MD ACHT meeting to improve medical and nursing handover for ACHT patients. (0.6 MiB)
Upload Date: 19th December 2018 Downloads: 122
Aim: Computerised records improve patient care by standardising the recording of patient assessments, reducing the variability of patient care, reducing errors and improving patient safety.
Potentially faster care and decision making responses from MD team.
Improved communication with medical professionals.
Potential for e-prescribing in the future.


Using Telecare In Reablement What Is Telecare (2.0 MiB)
Upload Date: 6th June 2019 Downloads: 135
Aim: Using telecare from the Occupationsal Therapist's Perspective.


Using The Evidence Base In Practice In Community SLT (0.4 MiB)
Upload Date: 6th June 2019 Downloads: 100
Aim: Implementing "Evidence based interventions for school-aged children with language impairment"


Variability of Calcium Measurement following Thyroidectomy: The Need for Consensus (0.5 MiB)
Upload Date: 11th March 2019 Downloads: 60
Aim: Hypocalcaemia following thyroidectomy is a well-recognised and
frequent complication.
It impairs quality of life, lengthens hospital stay and is potentially
life threatening if inadequately addressed
23.5% of patients will develop hypocalcaemia, rising to 35% if a level
VI neck dissection is performed.
Monitoring and management of low calcium levels following
thyroid surgery can be variable between surgeons.
This may cause confusion and variation in management in the post
operative period with potentially detrimental results.
This work aimed to identify these variations in practice so that a
standardised approach could be adopted across all members of the
team to aid safe and effective patient care.


Virtual Spinal Clinic (0.3 MiB)
Upload Date: 29th August 2019 Downloads: 10
Aim: •Increase the number of Virtual Spinal Clinic attendances by 50% by April 2019.

•Reduce patient journey by providing a spinal surgeon’s opinion within timely manner.

•Increase number of patients that can be managed by Orthopaedic ICATS.

•Improve communication through collaborative working between the SEHSCT Orthopaedic ICATS and Musgrave Park Hospital Spinal Service.

•Monitor and manage spinal referrals to the spinal service effectively and efficiently.


Waste Is Not Rubbish (0.4 MiB)
Upload Date: 29th August 2019 Downloads: 17
Aim:  

To improve recycling of cardboard in Downe Radiology Department by 25% by May 2019.

Eradicate the use of polystyrene cups in Downe CT Department by May 2019.

 


Weekend Handover In Acute General Surgical Units In NI (0.2 MiB)
Upload Date: 13th February 2018 Downloads: 129
Aim: To improve continuity and documentation of care in surgical units over the weekend by use of weekend handover sticker


What Matters To Me As An Always Event: Family Integrated Care (FIC) principles in Neonatal Unit and Transitional Care (TC) (0.9 MiB)
Upload Date: 21st November 2018 Downloads: 113
Aim: To enhance parental confidence and facilitate bonding between parents and baby.

Change the culture of parents being seen as visitors.


What To Expect When You Attend Hospital For Planned Surgery (3.4 MiB)
Upload Date: 10th May 2018 Downloads: 151
Aim: expectation
planned surgery educate video communication