the s.t.o.p. campaign student and educator pack · the s.t.o.p. campaign student and educator pack...
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www.1000livesplus.wales.nhs.uk/STOP Page 1
The S.T.O.P. Campaign
Student and Educator Pack
Reducing the risk of infections
through the use of invasive devices
This pack has been created for students and
educators giving them the tools to improve
care in NHS Wales.
Further resources can be found online at:
www.1000livesplus.wales.nhs.uk/STOP
www.1000livesplus.wales.nhs.uk/STOP Page 2
The S.T.O.P. campaign aims to reduce the unnecessary use of peripheral
venous cannulas (PVCs) and urinary catheters in NHS Wales. Patients with these
devices are at risk of infection if the devices aren’t applied or maintained
correctly. It supports the 1000 Lives Plus Reducing Healthcare Associated
Infections programme area. This pack has been created for students and
educators keen to improve patient care through small changes.
The S.T.O.P. Campaign Student and Educator Pack is for use in universities and across secondary care settings. It has been produced with input from the Reducing Healthcare Associated Infections steering group, mini-collaborative, as well as communications officers from organisations across Wales.
The S.T.O.P. campaign is currently being piloted in care homes and the
community, and we will provide you with appropriate materials and resources
for these settings over the next few months.
Visit www.1000livesplus.wales.nhs.uk/STOP for regular updates and new
resources!
Your feedback is important
We would be grateful for your feedback on this pack and the resources which have been produced to support it. Your feedback will inform the development of future resources and ensure the material produced is appropriate. Please send your comments to [email protected].
The 1000 Lives Plus Student and Educator Community is an active network of students and academics enthused by quality improvement and patient safety. Members are part of the 1000 Lives Plus improvement journey, gaining skills and experience to become more effective and practice safer care. www.1000livesplus.wales.nhs.uk/student-educator-community
About 1000 Lives
1000 Lives Plus is the national improvement programme,
supporting organisations and individuals to deliver the highest quality and safest
healthcare for the people of Wales. www.1000livesplus.wales.nhs.uk
The communication resources for this campaign have been made
possible through the support of the Health Foundation.
www.health.org.uk
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What’s in this pack?
1. What they are saying about the S.T.O.P. campaign...
4
2. Improving care through reducing the use of cannulas and catheters
5
3. How you can get involved!
7
4. S.T.O.P. leads in placement organisations
9
5. Using the resources in the pack
10
6. Five simple steps to say S.T.O.P. to infections
11
7. The S.T.O.P. Campaign Checklist
13
8. Appendix
14
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1. What they’re saying about the
S.T.O.P. Campaign... S.T.O.P. has made a remarkable difference to the whole HCAI programme. It was
an idea that I had worked on with a colleague and with the expertise of the
communication team we were able to create a campaign which is changing
practice within NHS Wales. It has brought 3 main ingredients to the programme;
simplicity, safety and endurance. The message is clear.
To date, our results are to be celebrated. Invasive devices in Wales we know are
being used with caution and their use if required is justified. The programme has
empowered nurses of all grades to question the need of either device and in doing
so have reduced the incidences of harm caused by them.
Why include students in the campaign? You are the future workforce. You will
contribute and shape the future of the NHS in Wales. I believe in starting as we
mean to go on, the time for success is now and you are it.
Liz Smith HCAI Programme Manager
The students on the Return to Practice course are very enthusiastic and keen to
address influences on the quality of nursing care provision. This resource harnesses
and channels their efforts in an effective and student-friendly way.
Julie Birrell, Lecturer in Nursing, Bangor University
I applied for the pack to pass on the information that cannulas and other medical
devices need to be assessed regularly for their clinical need, their current
condition, use and if they‟re not required, then to remove them ASAP to prevent
unnecessary infections as an infection could prolong the patients‟ hospital stay.
By using the pack and passing on the knowledge, it made others in the profession
and my fellow students aware of the implications of unnecessary medical devices
and made them aware of regular cannula inspection, signs of infection and of their
clinical need.
Kirsty Butcher, nursing student, University of Glamorgan
Campaigns such as S.T.O.P. increase awareness of patient safety issues, which in
turn helps to reduce infections and harm. By raising awareness, it also allows
patients and nurses to make informed decisions.
Nakita Furmage, nursing student, Glyndwr University
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2. Improving care through reducing use
of cannulas and catheters
Dr Eleri Davies, member of the 1000 Lives Plus Faculty, explains why this
work and campaign is so important.
The use of devices like urinary catheters and intra-venous
cannulas are often an important part of treatment for many
patients.
An urinary catheter is a small tube often inserted into a
patient‟s bladder to relieve them of urine following an
operation or during an illness. Intra-venous cannulas are
inserted into the vein to allow intravenous medicines and fluids
to be given.
Unfortunately, both devices carry a small risk of infection because they can allow
bacteria into the body.
Reducing the risk of infection
That‟s why the work currently being carried out by NHS Wales staff across health
boards to improve the use of these devices, and reduce numbers being used, is so
important. It will ensure we are doing all we can to reduce the risk of infection to
patients.
It has been introduced by 1000 Lives Plus, the national programme which is
supporting organisations and individuals to deliver the highest quality and safest
healthcare for the people of Wales.
I am fully behind this work, as I know from personal experience what can happen
when a cannula is left in longer than necessary.
As a junior doctor, many years ago now, I admitted a patient in acute heart failure
who had heart valve disease.
I knew I needed to give medication to treat the heart failure and that the best way
of doing this was through an intra-venous cannula.
I inserted the device and the patient was admitted to the coronary care unit to be
stabilised and the patient improved.
At this point the patient was well enough to be transferred to a ward and no longer
needed intra-venous medications, so the intra-venous cannula could possibly have
come out.
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This article is available at: www.1000livesplus.wales.nhs.uk/STOP
However, either because the ward was busy or that it was felt that it would be
best to leave the cannula in place in case further treatment became needed again,
it was not removed and the patient developed an infection.
The infection spread rapidly from the cannula into the patient‟s blood and also
infected the already damaged heart valves which meant emergency heart valve
replacement surgery was needed.
Thankfully the patient survived the infection and the surgery, and was eventually
discharged from hospital.
Salutary lesson
The experience however, left an indelible print on my mind and was a salutary
lesson in the unintended harm that can result from medical devices, needed for
treatment, but that can lead to problems if left in too long.
The incident sparked in me a fervent interest in infection control and I am
wholeheartedly behind this new work to improve the way we deliver care.
By stopping, thinking and removing a device when appropriate, we really can help
to save lives and avoid patients suffering unnecessary harm.
Organisations have been implementing two new care bundles – a set of
interventions that work better together than separately – to improve care and
reduce infections.
Checklist
Staff are also being encouraged to use a checklist each time for every patient to
ensure the correct decision is made for them.
The work is already is showing signs of success with fewer devices being inserted
and infections reducing.
There are always going to be times when the insertion of a urinary catheter or
intravenous cannula is the best course of action for patients and on occasions
complications from the use of medical devices may be unavoidable. However we
must minimise the risks as much as possible.
Finally, if you have an idea that you think could support the campaign and
programme please get in touch, your contribution is valuable.
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Did you know?
In a recent survey, 4% of
hospital in-patients in Wales
had a healthcare associated
infection*
Urinary tract infections are the
commonest healthcare-
associated infections in Wales,
and account for 20.9% of all
healthcare-associated
infections*
50% of urinary tract infections
in hospital patients are
associated with the use of a
urinary catheter*
3. How you can get involved!
Frontline staff in all health boards and trusts in Wales are being asked to S.T.O.P.
and assess whether the patient they are caring for needs a device and if one is in
place to question whether it‟s still needed and can be removed.
As students and educators, you can raise
awareness of S.T.O.P. amongst friends,
lecturers and colleagues on placements. Staff
across Wales are already making a difference by
using S.T.O.P. as part of a national campaign,
and you can too!
You can use S.T.O.P. to prompt colleagues to:
Stop and ask why the device is needed?
Think and give the necessary attention
to detail, including clinical indicators for
use.
Consider Options and whether there are
alternatives.
And Prevent healthcare associated
infections by ensuring the use and
maintenance of invasive devices are as
safe as possible.
Put yourself in the patients‟ shoes and ask „why?‟
One of the best ways of considering how to improve care
is to reflect on situations when you have felt that optimal
care was not provided. As a student this might be whilst
on placement; as a lecturer or practice mentor you can
encourage your student to get involved with the work
taking place locally.
The people we care for are at the heart of all we do. The
starting point should always be what is best for the
individual.
There are always going to be times when the insertion of
a urinary catheter or intravenous cannula is the best course of action for patients.
* Welsh Healthcare Associated Infection and Antimicrobial Resistance Programmes: Point Prevalence Survey of Healthcare
Associated Infections, Medical Device Usage and Antimicrobial Usage Report 2011
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But you can also help support staff to provide good quality care as part of the
national S.T.O.P campaign by bringing a fresh pair of eyes and identifying areas
where catheters or cannualas are no longer required.
By stopping, thinking and suggesting the removal of a device when appropriate,
you really can help to save lives and avoid patients suffering unnecessary harm.
To find ways to make a difference, students and educators should discuss the campaign and link with the S.T.O.P lead in the placement organisation.
(L-R) Laura McAteer, Nakita Furmage, Dawn Morgan and
Amy Harrison
Nursing students from Glyndwr University
“The S.T.O.P. campaign is a vital tool in raising
awareness for both staff and patients. This
ensures that procedures are carried out due to
necessity rather than habit.”
Dawn Morgan, Julie Espley, Sam Cross & Trudy
Richards, nursing students from Glyndwr University
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4. S.T.O.P leads in placement organisations Every health board and trust in Wales is involved in the national S.T.O.P.
campaign. Each organisation has a nominated lead for this work and these are the
people who can help you make a difference!
By contacting a S.T.O.P. lead, you‟ll be able to contribute to the teams taking
forward the improvements to reduce infections. Students can volunteer to help
support a national campaign, and learn about the improvement approach used by
teams across Wales.
Organisation Lead for HCAI programme and S.T.O.P. contact
details
Abertawe Bro Morgannwg
University Health Board
Nicola Williams. Assistant Director of Nursing [email protected]
Aneurin Bevan Health Board Moira Bevan Infection Control Nurse [email protected]
Liz Waters Lead Infection Control Nurse [email protected]
Betsi Cadwaladr University
Health Board
Lisa Bradford Infection Control Nurse [email protected]
Cardiff and Vale University
Health Board
Vince Saunders Infection Control Nurse [email protected]
Cwm Taf Health Board Bethan Cradle Infection Control Nurse [email protected]
Hywel Dda Health Board Sharon Evans Lead Infection Control Nurse [email protected]
Tracey Nicholas Infection Control Nurse [email protected]
Powys Teaching Health Board Jane Davies Infection Control Nurse [email protected]
Helen Griffiths Continence Nurse Specialist [email protected]
Velindre NHS Trust Hayley Jeffreys Infection Control Nurse [email protected]
Welsh Ambulance Service NHS
Trust
Julie Hamer, Senior Nurse Clinical Practise Lead [email protected]
Programme Manager for Healthcare Associated Infections; Invasive Devices
Liz Smith [email protected]
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To order more resources, email: [email protected]
5. Using the resources in this pack
You can play a key role in improving care and reducing infections by using the
resources in this pack. They can help you raise awareness of the unnecessary use
of peripheral venous cannulas (PVCs) and urinary catheters in NHS Wales.
The resources are designed to ask frontline staff to S.T.O.P. and assess whether
the patient they are caring for needs a device and if one is in place to question
whether it‟s still needed and can be removed.
The posters and other resources in this pack will help you as students and
educators:
o To quickly raise the profile of the issue with friends, university lecturers and
service staff on placements.
o Support and encourage individuals to S.T.O.P. and consider whether PVCs or
urinary catheters are needed - and to remove them as soon as they are no
longer necessary.
o Try out a small test of change to improve care – along with the support of an
academic lecturer and mentor to help students to make a difference.
This pack includes the following resources (see Appendix):
Banner artwork
Photography to illustrate the use of a PVC in
your communications
Poster
Postcard
Links to Powerpoint presentations
Social media tips
Top Tip: Examples of students making small changes that
have a big impact can be found in the Quality Improvement
Guide for Educators and Students.
Return to Practice nursing students from Bangor University
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6. Five simple steps to say S.T.O.P. to infections!
1. Identify an opportunity to implement S.T.O.P. on a placement – an initial
discussion should always include the relevant lecturer, mentor and student to
gain useful hints and tips. You may also discuss with the HCAI Programme
Manager.
2. Bring in S.T.O.P. as part of your placement experience. Discuss the opportunity
with the team or an individual in the placement organisation – find out
whether there are any quality improvement champions or individuals
interested in improvement or reducing infections that you could approach. Get
in touch with the S.T.O.P. lead in the organisation to find out more. It does
not have to be a big piece of work, the smaller ones usually speak volumes.
3. To monitor the impact of S.T.O.P. in your agreed area, you will need a simple
measure directly related to the campaign. An example is the number of
catheters / cannulas used before and after the introduction of S.T.O.P. The
measure will need to be collected at intervals frequent enough to assess
progress on the campaign. A suggested approach is to use a spot audit and
count the number of catheters / cannulas once a week at an agreed time as
part of a ward round. For measurement for improvement you only need just
enough data. Ideally you would collect 3 data points before using the resources
in this pack. This would be 3 weeks if you do the spot audit weekly. This will
provide you with your baseline.
By continuing to collect data from your spot audits over time, you will be able
to plot the number of catheters / cannulas before the introduction of S.T.O.P.,
during and after the intervention. If you can continue to collect the data for
the duration of your placement you should see an improvement over time. To
find out more about plotting your data in a run chart read the Quality
Improvement Guide for Educators and Students.
4. Display the resources and monitor the usage of catheters / cannulas for the
following week to a fortnight – your data will show if the resources are making
a difference! Identify ways you can promote
them amongst staff, such as sharing an update
at a team meeting.
5. Share your feedback with the team, your
University and 1000 Lives Plus – get involved in
future developments for S.T.O.P.
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7. The S.T.O.P. Campaign Checklist: Ten Things You Can Do!
Action Complete 1. Display posters in appropriate and visible areas.
If you‟re displaying posters as part of a placement, make sure you seek permission from the Ward Manager for the area.
2. Distribute postcards to friends, university lecturers and colleagues on placements.
3. Distribute posters and postcards in break rooms and other communal areas.
4. Use S.T.O.P. literature and resources in your university projects and essays. Access the How to Guide containing up-to-date evidence at www.1000livesplus.wales.nhs.uk/hcai
5. Arrange a meeting with your university lecturer and / or placement mentor to discuss the campaign and how you can make a difference.
6.
Arrange an informal meeting with friends and colleagues to raise awareness of the campaign and share the resources.
7. Become a S.T.O.P. Champion and share with us your experience of engaging others in S.T.O.P. Send 500 words to [email protected] and we‟ll publish your experience on our website and in the 1000 Lives Plus Student and Educator Community e-newsletter.
8.
If you‟re using social media (e.g. Twitter or Facebook) mention the S.T.O.P. campaign and the work you‟re involved in.
A helpful list of tweets is provided to get you started!
9. Discuss within your local Chapter how you can use the resources or even run a S.T.O.P. inspired campaign.
To find out more about setting up a local Chapter visit: www.1000livesplus.wales.nhs.uk/student-educator-community
10 Once you‟ve used all the materials – order more – by contacting us at [email protected]
www.1000livesplus.wales.nhs.uk/STOP Page 13
Appendix: BANNER ARTWORK for use on websites, emails and documents – available at
www.1000livesplus.wales.nhs.uk/stop
PHOTOS to illustrate the use of a PVC in your communications activity.
These photos can be used to support S.T.O.P communications activity on
blackboard, in newsletters and presentations.
We are grateful to colleagues at Velindre Cancer Centre for appearing in these photos.
www.1000livesplus.wales.nhs.uk/STOP Page 14
POSTERS to display these in numerous locations, for example:
Staff rooms
Student common rooms
Nursing station
Store rooms
Supply cupboards and any other suitable areas.
Students may wish to test these locations using a Plan, Do, Study, Act (PDSA)
cycle. They can ask staff or other students if they have noticed the posters and, if
not move them to more visible locations.
Students should seek permission from the Ward Manager for the area before
displaying the materials.
>>>See the end of this pack for an A4 poster you can print out and display today.
POSTCARDS carrying the S.T.O.P. order have also been produced and can be
shared with colleagues. They can also be used in training sessions to provide staff
with a reminder of what S.T.O.P. stands for – Stop, Think, Options, Prevent.
>>>See the end of this pack for postcards you can print out and display today.
Top Tip: Think about „footfall‟ - how many people will walk past a
poster? Is there a way of positioning a poster in a place where people
will walk towards it? For example, on the door of the staff-room?
Top Tip: Arrange a meeting with your friends and colleagues to introduce
the S.T.O.P campaign. Share resources with them and discuss how you can
work together to promote your work as part of the campaign.
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The website contains a POWERPOINT PRESENTATION to help you spread
the word and raise awareness amongst your peers and colleagues:
www.1000livesplus.wales.nhs.uk/stop
The presentation includes:
Background of the Healthcare Associated Infections (HCAI) programme
What are:
Central Vascular Catheters
Peripheral Vascular Cannulae
Urinary Catheters
Consequences of infection
Care bundles
How to use S.T.O.P.
Download the VIDEO CLIPS to help your peers and colleagues understand the
purpose of the S.T.O.P. campaign: www.1000livesplus.wales.nhs.uk/stop
Nurses at the Royal Glamorgan Hospital, Llantrisant explain how they are
targeting infections associated with peripheral vascula cannulas and urinary
catheters.
The infection control team at Velindre Cancer Centre explain why it is so
important to prevent infections in an oncology setting.
Use SOCIAL MEDIA to share your involvement and raise awareness of the
S.T.O.P campaign. We‟ve prepared some suggested tweets to get you started:
S.T.O.P. – Stop, Think, Options, Prevent. Protect patients from infection! http://bit.ly/stop-cpn Please RT!
Preventing infections from medical devices – find out more about the S.T.O.P. campaign: bit.ly/stop-cpn
Up to 40% of patients with indwelling urinary catheters may not need them! It‟s time to STOP! bit.ly/stop-cpn
In a recent survey 4% of hospital in-patients in Wales had a healthcare associated infection. Source: bit.ly/hcai-rpt2011
Catheter-associated urinary tract infections can be reduced by over 50% if catheters are removed promptly bit.ly/stop-cpn
Better use of catheters and cannulas will improve patient care – find out about the S.T.O.P. campaign: bit.ly/stop-cpn
About 60% of hospital patients have a peripheral intravenous catheter – many aren‟t needed. bit.ly/stop-cpn
Preventing infections should be a priority for everyone working in NHS Wales, says Dr Eleri Davies. bit.ly/stop-psc
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Postcard (front cover)
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Postcard (reverse cover)
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