Especially when the electricity is off and the fans aren’t working

Week 4 – 6th July 2015

Dear all,

So my final week.

As I mentioned last time, this week lots of actions started earlier on came together and this week, rather than writing chronologically, I’ll try and show a few things that were changed as a result of our work together in the maternity unit.

Patient privacy

One of the issues that we had raised on a post-it note by the night shift was that it was possible to see into the ward at night. Although the ward has tinted windows, which work during the day, in the night, when the lights are on inside but it is dark outside, people can see in. Different options were discussed: curtains were one possibility, but putting them inside meant the chance of them getting blood on them quickly, meaning lots of additional laundry, which wasn’t ideal. Another option was shutters on the outside but this would reduce the air flow and, especially when the electricity is off and the fans aren’t working, this isn’t desirable. In the end we went for a very low cost but effective option: sticky back plastic on the window panes. I had spotted this earlier in the visit, whilst trying to find tools and boxes in a small department store. First a pilot was carried out on three panes, to see if the plastic would stick to the glass and also if it would allow sufficient light through. It worked: the pale colour meant that light could get in during the day, the fact that the plastic was applied to individual panes of glass meant that they could still be tilted to let air and light in and to see out if desired but they blocked the view of anyone standing outside when tilted up at night. After successful testing, we applied it to all the windows along one side of the ward (the back of the ward doesn’t have any walkways). The staff were very happy with this development.

Emergency Boxes (PPH / Eclampsia)

I mentioned in earlier notes about emergency boxes that had been put together by the team to help with rapid response in the case of emergencies. It is important that these boxes are correctly stocked and as such, are regularly checked. Errors are often found and so I worked with one of the MCAI trainees, Dr Kanteh, who had implemented the system, to see if the concept of a ‘visual standard’ could help. We carefully went through the required contents for each box and took pictures of all the ideal equipment and medicines. Then we used the photographs to label what is required and set up a simple audit form to be used by staff when checking. We also replaced the wooden boxes, which were prone to damp due to being stored on the floor, with smaller plastic boxes that could be stored on shelves, enabling easier cleaning of the floor.

One of the challenges that the team face, is that sometimes, the only place that a particular piece of kit e.g. a specialised catheter, can be found is in the emergency boxes, meaning they sometimes use them out of necessity, leaving the box short. Ideally, in the future, checking won’t be required because there will be enough stock elsewhere and the visual standard will just be support for the restocking procedure after use.

Sterilisation Area: Packing Sets of Instruments

One of the issues that I mentioned in an earlier blog was that of sets of instruments being put together, sometimes with the wrong combinations of tools. Here we decided to see if a visual standard could also help. I worked with the doctors to develop pictures of the ‘ideal’ sets and we labelled these and posted them directly in the area where the staff are doing the packing.Several staff said that this was helpful, especially those learning about the sets.

Sterilisation Area:Ergonomics, Storage and Flow

A number of pieces of furniture were modified in the sterilisation area to help the staff work through the disinfection and sterilisation procedures more easily. One example is the trolley that I mentioned in earlier notes, which had shelves fitted to store things straight out of the (cooled) oven. We repurposed a set of coat hooks that we found in an office to create a set of drying hooks for tubing. We also built, from a piece of metal that we found in the grounds, a small table. This we used to place two buckets of bleach and water on, which had previously been on the floor, requiring a lot of bending to properly clean things.

Overall in the area, the team decided where they wanted things to be to ensure the smoothest flow through the area and we labelled up to show visually where things needed to be, using trays and boxes to create ‘homes’ for each key piece of equipment.

Staff Areas

As well as working on lots of things relating to making it easier for the staff to work, I was also keen to see some improvements to their areas of the ward. Two areas came out when we asked the team for ideas:

• the area for storing their belongings during work (pictured)

• the rest area, where food and drink and breaks are taken, where a new fan, shelf for storing mobile phones and fridge were installed.

There are many other things that I worked on with the team and as this is my last set of notes I’d like to say a huge thank you to them for working with me so openly to make the changes that they wanted happen. Both the doctors, Gemma and Alice, as well as being involved practically in the work, have given me a lot of their time to explain how things work so that I was able to understand how the department operates and what their priorities were. The wider maternity unit team spent time giving their ideas, testing out proposed solutions as well as practically helping with sorting, organising and implementing changes. I also want to give particular credit to Babucaar, the maintenance officer, who came up with so many creative ways of solving practical problems whilst I was here.

I feel very privileged to have had this opportunity and wish the team every success with continuing with the training programme and the improvement work that they are still doing. I was glad to be involved in a small part of it and I hope that it’s not the last time that I’ll get to work with them.

Pictured here are Gemma, Cheryl and Alice - All volunteering for MCAI

If you have any questions or comments, please drop me a note: cheryl.anderson@engineer.com.