Creating better care bundles with BMJ
“We have to make sure we get the best practice on the forms so that we are giving patients optimum care. BMJ had those and that was why they were chosen.” - Jude Kivlin, Clinical Guidelines Manager at The Queen Elizabeth Hospital and King’s Lynn NHS Foundation Trust.
In August of 2012 The Queen Elizabeth Hospital, King’s Lynn NHS Foundation Trust, and BMJ took on the challenge to standardise care and improve patient flow in their emergency divisions. These issues occur across the NHS but were marked as a particular place for improvement in the trust’s Care Quality Commission reports.
Jude Kivlin worked as part of the trust’s project management team. As a result of working with BMJ, they developed concise care bundles for 22 conditions and one procedure. According to Kivlin, “because we had the resources to do it we could explore and experiment. BMJ were incredibly helpful and came down on numerous visits.” In 2013, the concise care bundles, complete with best practice information, dosing system, and clinical guidelines were fully implemented in Ambulatory Emergency care and the Medical Assessment Unit of the Queen Elizabeth Hospital.
“We have to make sure we get the best practice on the forms so that we are giving patients optimum care throughout the duration of their stay. BMJ had that and that was why they were chosen. They standardised the care given throughout the trust and it could be localised to our services and the formulary at our pharmacy” - Jude Kivlin, Clinical Guidelines Manager at The Queen Elizabeth Hospital and King’s Lynn NHS Foundation Trust.
Hospital staff benefitted from the concise care bundles. Junior doctors researched for updates or assisted with creating care bundles for new conditions. They were also able to ingrain best practice by following a step-by-step approach whilst utilising clear printed forms with tick-boxes and a sticker system.
Straightforward patient flow guidelines in the concise care bundles also meant that staff were better able to direct patients to different wards based on their conditions, and this resulted in reducing patients' length of stay. “For example, one of the new reports for asthma show lengths of stay reduced by 1.7 days,” according to Kivlin. For a seasonal condition such as asthma, this reduction makes a huge difference to the 488 bed hospital, which provides services for 331,000 people.
Results from audits before and after the programme’s implementation show positive effects on patients as well. Reports reveal significant progress in a range of measures, including an increase in completions of CHADVASC score in atrial fibrillation (from 21% pre-implementation to 65% post), antibiotics prescribed per protocol in chronic obstructive pulmonary disease (from 96% to 100%), and Blatchford score recorded (from 15% to 95%).
The Care Quality Commission also noted these results and was very complementary of the concise care bundles programme. In the future, the hospital will continue to audit, update and develop its concise care bundles in order to make strides in quality patient documentation and excellence in patient care.