Quality Improvement Zone

This improvement project aims to create a sustainable process for the delivery of clinical supervision and reflection along with an environment that encourages nursing to participate in a meaningful way.

By December 2018, we will be able to effectively evidence a 40% increase (from 30% to 70%) of completion of individual learning actions identified from stage 1 and stage 2 complaints investigations within our KPI of 14 working days.

By 30th November 2018 95% of staff will feel safe on a daily basis working in Radernie Low secure Unit

Aim – 85% of patients will have a diagnosis documented at the point of discharge from Intensive Home Treatment by November 2018.

The aim of my project is to reduce the number of Occupied Bed Days (OBD’s) used by patients in the Guardianship process from the Falkirk area by 10% by December 2018.

By November 2018, ensure that 70% of complaint responses in a sub group of the Surgical Division, Raigmore Hospital include an identifiable action or improvement

For 95% of women admitted to Western Isles Maternity Unit for antenatal in-patient care or delivery to have a VTE risk assessment documented by December 2018.

To improve accuracy of Single Question in Delirium answer for patients in Ward 2 East to 95 % by March 2019.

By end of December 2018, all admissions to the RNI will have achieved 95% or > reliability of the multi - professional assessment and goals for discharge completed by day 3 of their admission to hospital.

95% of children identified as at risk of deterioration in ward 2A will have structured response and review , ensuring that a plan for escalation is in place by December 2018

To achieve 95% reliability in the delivery of a mealtime bundle in critical care at GRI by 1st December 2018.

By December 2018, 95% of morning endoscopy lists will start at 09.00 hours.

By 1st December 2018, 95% of women being induced due to going over the estimated due date, will be able to articulate the induction of labour process following attendance at the antenatal clinic.

Improve early detection and response to clinical deterioration and reduce the number of clinical emergency calls by 10% in ward 109 by December 2018.

To reduce the number of late preterm infant admissions to SCBU by 20% by December 2018. The aim applies to babies admitted for feeding support and/or hypothermia or whose stay is prolonged due to feeding support and/or hypothermia.

A reduction in falls by 50% on ward 14 at BGH by November 2018

By 30 November 2018, Ward 14 in the Vale of Leven Hospital will be able to demonstrate 50% reduction of reported medicine administration errors

By 30th November 2018, 95% of pregnant women within NHS Lanarkshire, at between 20 and 24 weeks gestation, will have received a documented discussion regarding fetal movement that they understand and can use their own words to reaffirm their...

By November 2018 90% of Nursing, Midwifery and Allied Health Professional Staff working within Healthcare Improvement Scotland will be actively engaged with the NMAHP Directorate in the provision of key information regarding their role,...

70% of treatment decisions for children with Nocturnal Enuresis, will be informed by a fully completed nurse led comprehensive assessment. This improvement should be achieved by December 2018.

Two more women per month delivering within a community team will go home in less than 12 hours by November 2018.

Reduction in Falls Within Acute Neurology to no more than two per calendar Month by the end of November 2018

To reduce the number of individual Phlebotomy weekend bloods ordered on patients in an acute Medical Ward to an average of 66 per weekend, by December 1st 2018, through the development of a new systematic approach to blood ordering.

The aim is to demonstrate a reduction in time by 50% whilst reliability is maintained.

By 1st Nov 2018, Ward 3C at Gartnavel General Hospital will demonstrate 85% compliance with the recording of between meal snacks, on the Food and Drink Recording Chart for all nutritionally vulnerable patients who are eating and drinking.

By September 2018 100% Woodend orthopaedic follow up appointments will take place utilising VC where clinically appropriate to do so. Future expansion would include New referrals also.