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Revalidation in Wales

Mock Secondary Care Entry - QIA

These are examples of an SEA and QIA activities treated in three ways, as the previous examples. Again the aim is to try and show how from the same activity different levels of learning outcome and reflection can be gauged from the entry.

Quality Improvement activity (1)

Title Managing the anaesthetic alert database
Dates of activity From January 2019 to present
Description of activity I designed the anaesthetic alert database and now maintain it. I receive reports of anaesthetic issues from colleagues about patients and I put an account of these onto the hospital electronic record.
Changes made I designed a form for colleagues to use for reporting incidents and use a database I made to keep a record. I also got a new letter template approved for use on our electronic patient record to alert others to a possible problem.
Outcomes All patients with anaesthetic problems are now on the CWS system and these can be read by anaesthetic colleagues before they anaesthetise a patient to prevent problems.
Comments This entry is very brief and doesn’t fully express the importance of this improvement. A non-anaesthetist would not appreciate how this system improves patient safety and allows anaesthetic colleagues to have the benefit of another’s experience. As is often the case with QI entries, the doctor seems to be underplaying the innovation and their efforts, sometimes not even categorising it as QI when they enter the evidence. The true value of such an innovation would need to be teased out by the appraiser to contextualise it for the RO and justify the validation of it as QI activity. I always feel that a good QI innovation will usually be self-evident to the appraiser whatever speciality they are from; although the phenomenon of secondary care doctors not citing their own efforts as QI is one that appraisers should be aware of and use the appraisal discussion to try and elucidate confirming evidence of this.

Quality Improvement activity (2)

Title Managing the anaesthetic alert database
Dates of activity From January 2019 to present
Description of activity I designed the anaesthetic alert database and now maintain it. I took over the previous database from two colleagues who had put it into an Excel spreadsheet. I then converted this data to an Access database for ease of analysis. I redesigned the data collection form that colleagues fill in to report anaesthetic issues about patients and I put an account of these onto the hospital electronic CWS record.
Changes made I redesigned the data collection form for colleagues and I also got a new letter template approved for use on our electronic patient record to alert others to a possible problem. I also have a red warning entry put onto the patient’s CWS record that lets colleagues know there is anaesthetic alert on that patient. I also designed and had printed warning cards that we can give to patients to if they are admitted to another hospital not able to access the CWS system.
Outcomes I have now put all patients with anaesthetic problems onto the CWS system, including those collected before I became involved. These can be read by anaesthetic colleagues before they anaesthetise a patient to prevent problems. This should improve patient safety and reduce the incidence of avoidable anaesthetic-related complications.
Comments This entry now puts the QI activity into a clearer focus and allows a non-anaesthetist to see how this database and alerts could be seen as improving a service and patient safety. In secondary care it is probably more important to explain the impact of QI entries to colleagues from other specialities because of the fact that many specialities are only familiar with their own ‘patch’. This would seem less of an issue in primary care as there will be a lot of common ground between fellow GPs wherever they practice in Wales. In secondary care it may be hard for some appraisers to understand that some specialities face problems that need resolution that are out with anything they would encounter in their own daily work.

Quality Improvement activity (3)

Title Managing the anaesthetic alert database
Dates of activity From January 2019 to present
Description of activity The anaesthetic alert database is a record of any patients that have encountered, or are suspected of having anaesthetic-related problems. These include airway issues that may make intubation difficult, episodes of allergic/anaphylactic reactions to drugs or more unusual conditions such as malignant hyperthermia or suxamethonium apnoea. I took over the previous database from two colleagues who had put it into an Excel spreadsheet. I then converted this data to an Access database for ease of analysis. I redesigned the data collection form that colleagues fill in to report anaesthetic issues about patients and I put an account of these onto the hospital electronic CWS record. Now I routinely scan these reports and enter the details onto the patient’s CWS record with a copy of the scanned report. I also have our secretary add a red anaesthetic alert entry on the patient’s main page to warn any colleague accessing that record that there is an entry with possibly important information relevant to anaesthesia. The airway reports are especially useful as they give an account of the patient’s airway management and what technique was successful to achieve endotracheal intubation. This allows a greater degree of safety for the patient and allows their anaesthetists to be ready with the appropriate equipment or assistance.
Changes made I redesigned the data collection form for colleagues to make it simpler and I also got a new letter template approved for use on our electronic patient record to alert others to a possible problem. This alert template is being used by other specialities as well, now. I also designed and had printed warning cards that we can give to patients to if they are admitted to another hospital not able to access the CWS system. These cards give a telephone number they can ring to speak to one of the ABUHB anaesthetic team who can look up the alert on CWS and help that colleague in the conduct of the anaesthetic.
Outcomes I have now put all patients with anaesthetic problems onto the CWS system, including those collected before I became involved. I will continue to maintain this and, leave permitting, usually have an alert on the system within 48 hours. This should improve patient safety and reduce the incidence of avoidable anaesthetic-related complications. In future I am hoping to get these alerts visible on an all-Wales basis and look to align them with the recommendations of the Difficult Airway Society that have appeared since.
Comments This entry is now very explanatory and puts the QI activity into the wider context of anaesthetic practice and patient safety. It also describes all of the different innovations that were needed to be introduced to reach the stage that has been achieved by the doctor. Before MARS was redesigned some of our appraisers would type ‘VALIDATED AS QI ACTIVITY BY APPRAISER’ at the beginning of the discussion entry to make these entries stand out, but now with the appraisers having greater control over the domains etc., if an entry has been defined as QI by the appraiser it is clearly visible as such to the RO.