Transformation and Change Blog - April

04 April 2019


Hello and welcome to the latest Transformation and Change Blog for April 2019. This month we congratulate our 8th Introduction to Improvement Cohort on completing the cohort, look at improvements being made around clozapine prescriptions, and welcome a new member to the team. 

Introduction to Improvement – Cohort 8

We’d first of all like to thank and congratulate those who completed the Introduction to Improvement course in March. There were a great range of projects being put forward from areas across the Trust. These included work on an integrated Single Point of Access for Physical and Mental Health, improving the training of Junior Doctors and Bank Staff, and reducing waiting time for service users awaiting support from the Psychology Team. 

While these projects are still in their infancy, we can’t wait to share the progress of the QI Projects with you further down the line. 

If you’d like to know more about improvement training opportunities then please drop the team an email.

Meet the newest addition to the Transformation and Change Team – Lauren Greenhill, Transformation Project Officer

Where have you joined us from?

Clatterbridge Cancer Centre - however I have worked for the NHS for 5   years and had various posts in various locations. 

What role were you in previously?

Clinical Effectiveness Team Officer – I worked in various areas including   audit, mortality review and specialist radiotherapy treatment data   analyst.

What interested you about Quality Improvement?

I have always had an eye for potential improvements  in my previous   employment over the years, and when I saw the advert for this I had to apply!

What are you most looking forward to getting involved in?

I am looking forward to seeing the different processes and I have never   worked  within a mental health trust before, therefore I am keen to   learn the different types of projects that are happening right now and   working on future ones.

An interesting fact about yourself?

I like to travel. Places I have been include Australia where I lived and   worked for the better half of a year and I have been to America a few times now. So far New Orleans has to be my favourite place to visit by a mile. 

Lauren can be contacted at:

01244 397390

QI Project in Focus – Clozapine Prescribing

The following information has been provided by Lisa Lawrenson, Acting Ward Manager (Bollin Ward):

“Clozapine is prescribed for patients with treatment resistant schizophrenia. These patients have severe and enduring symptoms of psychosis.  Clozapine is used once other anti-psychotics, including A-typicals have been tried and failed.

Clozapine is subject to strict monitoring requirements due to the side effects associated with this drug. These include neutropenia, seizures, myocarditis and cardiomyopathy.

When a patient is prescribed Clozapine nursing staff are required to carry out a number of physical observations.  On the first day of taking Clozapine the patient would be expected to have their physical observations completed, including postural drop 8 times. Thereafter the patient needs to have their physical observations varied out 4 times a day.

When the NEWS form was introduced the Clozpaine monitoring form in the policy was removed due to nursing staff needing to complete all physical observations using NEWS.

Unfortunately with the introduction of the NEWS, the Clozapine monitoring was getting missed. I saw a trend that nurses would complete on average 2 NEWS scores per day which does not follow the Clozapine policy and is not safe practice for our patients.

We had a patient transferred from another ward within our Trust who was being titrated on Clozapine. Having looked at the NEWS form it was clear to see that the nursing staff had not followed the Clozapine policy in respect of monitoring the patient’s physical observations. It was at this moment I realised that this will be a Trust wide issue and we needed to urgently look at something that would ensure safe practice and effective monitoring.

I set to work creating the Clozapine NEWS so nursing staff had a booklet which incorporated the NEWS score but also included the timings to complete physical observations and postural drop. I completed a rough copy of a Clozapine NEWS form and piloted it on Bollin ward. The response from nursing staff was incredible. They loved the chart and the patients were being monitored as per the Clozapine policy.

This has now been rolled out Trust wide and the feedback given to me by education is that the nursing staff really like the booklet and find it easy to use and that their practice has become safer and more effective when titrating Clozapine.

Sadly, every year our patients die of Clozapine related side-effects. Although this drug his highly effective it is also very dangerous. I am certain that the close and effective monitoring nurses can now do will ensure that our patients are safely titrated onto Clozapine. The Clozapine NEWS will pick up early signs that there may be a problem and ultimately will save patients’ lives.”

MIAA Quality Improvement Network

On 12th April CWP will host the MIAA Quality Improvement Network at Sycamore House. This is a free event where you will be able to hear about some of the great work CWP has been doing in more detail and network with other healthcare agencies across the North West.

There’s still time to book following the link below…

Where to find out more

There are loads of great resources that CWP staff can get their hands on. Here’s our pick of the best resources available to you right now.

  • Improvement Readiness – The Transformation and Change Team’s very own ½ day summary of improvement projects. You’ll get more detail on how to use the Model for Improvement, engage with stakeholders and sustain and spread your project. This can be booked on MyESR. For more information feel free to email the team
  • CWP Q Network – Already completed the i2i and want a refresher? Come along to the next CWP Q Network event. We’ll have you on the distribution list, so look out for latest news about events in your inbox.
  • #QI HUB – Available from the intranet and on Twitter, stay up to date with the latest Quality Improvement resources and news from within the Trust.
  • Institute for Healthcare ImprovementThis website is packed with useful resources and news about improvements in the world of healthcare.
  • Q Community (delivered by The Health Foundation)Becoming a national Q Member can have massive benefits. Allowing for interaction between members, visits across the country and excellent e-learning packages, applying to become a member takes a bit of time but you’ll definitely reap the rewards.

Transformation and Change Team:

Safieh Fraser – Transformation Manager

Lauren Connah – Transformation Manager (on Maternity Leave)

Beccy Cummings – Transformation Manager

Mike Babbs – Project Manager

Kyle Blackwood – Transformation Project Officer

Lauren Greenhill – Transformation Project Officer

Please also note that the Transformation and Change Team now have a new email so can now be contacted on cwp.transformation_and_change or by phone on the same number as always (01244397391)


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