1. Building on the Best in Scotland
Barbara Kimbell
Project Manager – Botb Scotland

2. Botb in Scotland Oct 2016 – Sept 2018
3 sites: Dundee, Edinburgh, Paisley
Shared decision-making and information handover
Acute Medicine & GI/Liver wards
Staggered approach

3. Scoping of current practice
Conducted by Botb Project Manager
Observation of current practice via ward rounds, handovers, MDT meetings
Review of documentation and leaflets
Staff interviews
Informal conversations with ward staff
Patient and carer feedback (interviews, patient experience survey)
 Feedback to ward teams  QI

4. Ninewells Hospital
Large teaching hospital on the western edge of Dundee
Small team of Palliative Care consultants and specialist nurses plus 3 specialist palliative care beds
Status:
Scoping plus feedback – Acute Medicine;
Scoping completed – GI/Liver

5. Shared findings Ward rounds:
Conversations generally focused on acute treatment
Lack of nurse presence during ward rounds
Little involvement of junior and nursing staff in difficult conversations
Perceived variance in the quality of communication
Conversations generally not well documented
Discharge letters tend to lack ACP-related information

6. Early ideas for QI activities (AMU)
Develop a ward-specific communication strategy, including relevant staff education
Improve ‘difficult’ conversations through testing draft staff communication guides/lanyards
Develop role of Healthcare Assistants in difficult conversations
Review clerking and transfer documents to improve the recording of goals of care/conversation information
Review ward round arrangements to increase nurse involvement

7. Wins & walls
Wins
Buy-in from key ward staff (consultants, senior charge nurse)
Staff recognise need and keen to contribute their views
Good cross-team discussion of issues and potential solutions
Walls
Local operational reorganisation of service provision
Competing priorities
Staff shortages

8. Next steps Feed back to GI/Liver team and discuss opportunities for QI
IdentifyQI activities in both wards
Scoping of current practice at next site under way...