Carmel Thomason examines how NHS staff can use the QIPP collection on NHS Evidence as a resource for high-quality examples of best practice
Innovation has always been a key component of delivering high-quality healthcare.
In tough financial times, innovation must not become a luxury that can’t be afforded. Which is why, more than ever, it has become important to share working examples of successful and cost-effective innovative practice.
To help organisations share local best practice more effectively, NHS Evidence - a service provided by the National Institute for Health and Clinical Excellence - has created a central resource through which staff can access this type of information.
The quality, innovation, productivity and prevention collection on NHS Evidence is part of the wider Department of Health initiative designed to meet the challenge of saving £15-20bn though increased efficiency by 2014.
Examples in the collection have been assessed for NHS Evidence against strict criteria. The approved practices range from one-off studies from single organisations to robustly tested large-scale changes that have been replicated in multiple organisations.
NHS Evidence also has an innovation and improvement section which provides information resources, including best available evidence, tools and techniques, case studies and policy on all aspects of innovation and improvement of health and social care services.
By seeing what is possible elsewhere, staff can learn from others and explore where savings can be made in their own organisations without compromising quality. The aim is then to encourage these ideas - if they are implemented and proved effective - to be shared, so that they will become part of a comprehensive and continually evolving national evidence base.
The new warfarin-loading protocol at Northumbria Healthcare Foundation Trust is a clear demonstration of how focus on quality can also result in cost savings.
The initial idea for the project emerged from a trust-wide initiative to reduce its harm rate. After attending the Leading Improvement Patient Safety programme, consultant cardiologist Dr Daniel Higham returned to Wansbeck General Hospital to look at how the trust as a whole was loading the anticoagulant drug warfarin.
“Anticoagulants are high-risk drugs,” Dr Higham explains. “Bleed rates at our trust were within expected levels but I wanted to see what we could do to reduce them. I looked at what we were doing across the trust and, because we are a merged trust, there were three or four ways of loading warfarin.”
At about the same time, Paul Barbieri joined the team as anticoagulation manger and the pair began working together on a new protocol based on a simple scoring system.
“We devised a system which was easy to follow, but which allowed those at risk of bleeding to be given a reduced dose,” he says. “Our aim was to reduce INRs (international normalised ratio) greater than 5.0 in the first weeks of therapy, as this is a risk for bleed. So far only one patient has had an INR greater than 5.0, compared with 10 per cent rate of INRs greater than 5.0 with old protocols.”
Dr Higham adds: “We are measuring the time to target INR and the number of patients who exceed an INR of 5.0 as surrogates for potential bleeds. These numbers have definitely improved but we are actively trying to get them even better.”
The new protocol, which takes the same length of time as the previous protocols, involves scoring patients according to age, weight, existing conditions and interactive medication. It was trialled first in a general cardiology ward.
Once there was strong evidence that the new dosing system was working, the results were shared and the protocol is being rolled out across the trust.
“We are training nurses on each ward as we go and, so far, we are fairly certain that no-one has had a bleed on the new protocol,” says Dr Higham.
“The issue is primarily one of patient safety but by reducing our adverse bleeding events we will save on length of patient stay as well as on treating those events.”
Estimating an average bed day costs £300, this one initiative could release annual efficiency savings across the trust of £21,000, which if expanded nationally has the potential to release £2.1m across the NHS.
“We think we have developed a much safer and efficient protocol that’s better for our patients and we are happy to share this with other hospitals,” Dr Higham says. “We are not saying it’s the best we can get it but it’s a great improvement on where we were”.