MacLeod McLaren Patient Safety Medal

The NTSP team meet up before receiving the MacLeod McLaren Patient Safety Medal from the Royal College of Surgeons in Edinburgh. We cover the origins of the NTSP and Global Tracheostomy Collaborative, the patient perspective, and the different roles of the member of the MDT. You can read more about the award on the NTSP website via the link below.

https://tracheostomy.org.uk/news/ntsp-wins-prestigious-macleod-mclaren-medal

Transcript

SPEAKER_00 0:07

Hello and welcome to another special edition of Trachee Talk. The National Tracheyosafety Project team has been working for many years to try and improve patient safety. We were honoured to receive an award from the Royal College of Surgeons in Edinburgh, and the McLeod McLaren Patient Safety Award recognises multidisciplinary care towards patient safety, which felt very appropriate for our team because it represents so many different specialties and professions. So before the award, I caught up with some of the members of the team that were able to attend the award ceremony. There's Professor Tony Narula, who's an ENT surgeon based down in London. Mrs. Tanveer Karechia, who's a clinical scientist working in Manchester, but also unfortunately a former patient of ours who ended up with a tracheostomy. Professor Sarah Wallace, who leads our speech and language therapy team, and Mrs. Barbara Bonvento, who's a respirote physiotherapist working in critical care, who leads all of our respiratory physiotherapy work. Missing from the team were several key members, but part of the award was James Lynch, who is an advanced critical care practitioner, and also Mr. Johnny Abbast, who is an ENT trainee who helped us put the award package together. But the award reflected the work that lots and lots of people have done over the years. So I'll hand over to the team as they discuss a little bit about the award and what we've been up to.

SPEAKER_05 1:41

Well, Brendan, it's brilliant to be here with all of the team. It's such a thrill if I reflect that this all started for me over 20 years ago, just doing what seemed like a very simple small-scale audit, measuring the number of trackies we were doing, measuring the number of political incidents, and measurement drives performance because suddenly we realized that things were going in the wrong direction. So we started our first very small tracking team back in the 2000s. We expanded it, we published it, and through publishing it, came to meet a wonderful guy from Harvard called David Robertson, who came to London to talk to me, and he'd been doing similar work in America for the American Academy. And he said to me, This problem is very widespread. We should do something about it. And sure enough, a little while later, he encouraged me and we founded the charity Global Tracheostomy Collaborative with the help of a wonderful speech therapy specialist from Melbourne called Janice Cameron. Then it's through that work I met Brendan, which is now 15 years ago. And I've been very lucky and privileged to be associated with Brendan and the team since then. And I'm really glad that so many of us are here to receive this medal later today. It's going to be a very exciting moment for us all. Couldn't you tell us a bit about the medal, Tony? The Royal College of Surgeons of Edinburgh has a medal called McLeod McLaren Medal, which was endowed by a surgeon in memory of his two aunts. One was called McLeod and one was called McLaren. And they were nurses in Edinburgh 30, 40 years ago, had a lifelong career of working with famous surgeons. And Professor McLeod decided to endow a medal, A, to mark his now deceased aunts, but also to celebrate patient safety. And he felt that it was important to have this kind of event because a lot of stuff goes on in the background, unrecognized, and we're very lucky to have been accepted for the medal this year.

SPEAKER_01 4:03

Yeah, and it's very much a multidisciplinary thing, which is great. So we've got Barbara representing spiritually physiotherapy, sir representing speech language therapy, Tam V, who's a clinical scientist, but also one of our former patients. So it's great that we're all here. We've got uh more colleagues from ENT and then our nursing and ACCP colleagues who can't be here, but we're representing all of them, which is cool.

SPEAKER_03 4:27

So yeah, I was a tracheostomy patient back in the COVID pandemic. So um back in February-March as of 2021 when I was transferred to an ICU unit in Manchester, um, and I although I was um prepared and understood what tracheostomies were from my background and from my work as I work as a clinical scientist at Manchester Foundation Trust, um, I woke up and ended up with a tracheostomy as part of my routine care. And um I have to say, I have very, very fond memories as a patient of being looked after by a really, really professional and um amazing and um nurturing multidisciplinary team. Um some of the members are here today, so I feel really privileged to be part of such a prestigious award that's um that has patient safety at the heart of it. So I'm really grateful to be a part of it, and um it's it's brilliant to be a part of it from a professional side as well because it really um it really encourages um the scientific and innovation aspects of healthcare that I love, um, and also working with a multidisciplinary team who are all a part of of providing excellent patient care.

SPEAKER_01 5:44

Yes, you're definitely the most qualified personal, but sadly we just have to catch COVID in order to see both sides of it. But yeah, you've got a very union aspect of that. Thank you. Which is great for good and bad, obviously. Yes, I'm so glad you could come up with it.

SPEAKER_03 5:58

It's all good, it's all good at this end, at this side of it now. Now, yes.

SPEAKER_01 6:03

And so for speeches, Sarah, yeah, this is a good opportunity to sort of fly the flag for the work of speech and language, isn't it?

SPEAKER_04 6:10

This is such an honour. Um I mean being part of this work for many years, um you know, more than ten years, has really transformed patient care, really changed people's perspectives on you know restoring voice and communication and swallowing in patients, which is so distressing often. Um, but it's really uplifted my profession and really enabled um lots of ICUs and lots of people who work with trackies to do better care. Um, and it's it's inspired a lot of speech therapists to sort of go out there and actually do deliver better care to patients, and and for for my profession, this kind of honour is incredibly rare. Um, and again, for me, it feels like um an example of what you can do if you work um with your colleagues and you collaborate and you really put patients at the heart of what you do and really sort of champion patient care, and and yeah, it's such an honour. Um, and um I feel very lucky uh to have been part of this work, uh, and uh it's been really enjoyable to be able to see how it's transforming patients' lives, not just in the UK, but all over the world now. Um, and yeah, it's uh it's great. Yeah, cool.

SPEAKER_01 7:32

And Barbara, we've been lucky enough to meet lots of different respiratory physiotherapy teams that all do slightly different things around the world. But I mean from your perspective, you know, we see how you get really involved with our patients, and you know, it's it's what what are your reflections on what we've been up to for the last sort of 15 years?

SPEAKER_02 7:49

Well, the our profession has changed as well, and there's a lot of innovation that we've been seeing in the past few years. I always personally been uh really interested in tracheosa and the respiratory side of the job, um, but we uh got more things that we can offer to the patients, so co-faughation or something that didn't exist a few years ago. When I started to be a physiotherapist many years ago, so we are involved with the rehabilitation, obviously, and we're involved with chest clearance, which is like the basis of the team. But I'm really, really glad I'm part of this team because it does help that we get on with each other. But you know, I feel humbled you know by to be near to such like brilliant people like you and seeing you because you you were my patient and senior, you are really, really poor, and senior that is so so fantastic that you're doing so well. It's been it's been amazing, and that you know that makes you think like that's why I do this job.

SPEAKER_01 8:51

That's so you're part of you to do this. I should probably share that whenever we hear like rock music on the ITU, you know, you look out the door and there's um Barbara and the team marching someone using with a tracheostomy connective ventilator down the corridor to their favourite music blasting out. So yeah, you've discovered some pretty innovative ways of getting happening about that.

SPEAKER_02 9:13

Yeah, I think that obviously I asked the patients. Yes. Yeah, I thought we just imposed my face. So and I I also don't mind making a fool of myself. So I've been through some some like dances. So uh I've been doing some Vollywood dances, I've been doing some disco music dances, I've been doing some heavy metal moves. Uh obviously, and the patient got really involved when you make it. Rehabilitation can be a bit dry at times. So if you through some like the playful side of it, you know it does work better. You know the patient much better when when you kind of ask what they like and when you invoke them.

SPEAKER_01 9:54

So if you have your career again, Tony, you know, you need to be an intensivist, that's we need to be working on the ICU where all the friends haven't it? No, Brendan.

SPEAKER_05 10:02

I um had a long and close relationship with the intensive care going back to the early 1980s when I worked in Nottingham, and I would go to the ICU every morning, eight o'clock, and say, any trackies needed today, and bit by bit they realize I was always available.

SPEAKER_04 10:18

Yeah.

SPEAKER_05 10:19

I love working with intensivists, but it's too hard. It's too difficult what you do. I'd rather pick up a scalpel, that's hard enough.

SPEAKER_03 10:29

I would like to also add that um it's an endeavour that is constantly evolving. Um, and with my with my science hat on, um, you know, there's lots of innovation that's ultimately there to provide confidence not just to patients but also clinical staff that are implementing um new innovation within this area and also to families. Um so I think it's it is really providing that confidence you know in a multidisciplinary environment, and um I'm really grateful for that as a scientist and as a former patient.

SPEAKER_01 11:02

Yeah, and having that patient voice, you know, in a you know just having that patient voice where you know we've spoken a lot about you and what your family went through, and and and often as sort of clinical people we often have a bit here on to the next, but actually there's so much more that that that we can do if we hear you know the impact our words have and our actions have, and you know, the things we think about. You know, do you get out of bed today? Is actually a big deal that everyone tells their partners and then family and then you know the granny and granddaughter no on the WhatsApp or not, just walk, you the dance down the corridor anyway. And that that's a big thing that we often don't see the impact, you know. They spoke today for the first time in a month, is actually ripples way beyond our awards and our clinics, and yeah, it's it's it's a really you know, having you at the at the centre of this is just fantastic.

SPEAKER_05 11:55

I'd like to add something to what Tandia said, very important point she made. Right at the outset when we set up the global charity, one of the key drivers was patient and family involvement, and that was that was non-negotiable. And what Tandia has just said kind of underlines how important that is. It's not just the patient, it's the whole family around you. It's a bit like when people get cancer, and all the focus is on the cancer patient, and professionals often forget the knock-on effect on the family, the primary carer, the secondary carer. And we miss that very often. And with trackie care, hopefully we're trying to reverse that.

SPEAKER_04 12:36

And they're part of the team, they're a central part of the team, aren't they? And that uh that we can't deliver that effective rehab, but and and you know, as soon as you get the truck in, we're trying to get it out again, aren't we? So if we can't achieve that, we are now, we used not to be, don't you know?

SPEAKER_05 12:53

If you go back not that long ago, it was we got tracky, that's okay. Now we forget about it. Don't forget that's changed. Yeah, that's changed 20 years ago. Yeah, because we forget about it now, yeah. Until a complication occurs. Yeah. And then everyone says, Oh my god, what happened next?

SPEAKER_02 13:08

Uh, do you remember a patient? We had a patient on the wall that was a lady from a nursery bar, and she had a tracheostomy for a long time. And packages from the nursing. And we were doing our tracheostomy world round. So I don't know why she was admitted to the ward, but I remember I remember clearing her face. Anyway, went to the we were doing our uh world round, we went to see her, and she looked fantastic. So we had like, oh, can I can you try to cough for me please? Really good cough.

SPEAKER_04 13:41

I think we said I remember talking to um Dr. Helps and why asked why has this patient still got a tracheostomy 10 years later? And why has she got a peg she can swallow? And it was like nobody knows. She's just gone to the nursing home and been left. Yeah. And then we were able to decannulate and get it. And it and you know, to the to the patient and the family, it would be performed a miracle. But actually, it was what you were saying is that that ability to follow up patients through their whole journey so that they don't end up.

SPEAKER_05 14:15

You know, so in 2014, when we had a tracheology conference in London for the first time, uh, in the audience, I remember I remember a physiotherapist standing up and saying, I work in a place called World Hospital and Home for Incurables, which was famously a long stay hospital, and he said, We had somebody come and review our trachee patients, and we were able to take half of them out because no one had reviewed them. Yeah, and um that was a shock, lost in the system, and same again next year.

SPEAKER_04 14:47

Yeah, and that whole thing about being able to sort of rehab, decannulate, and get back to walking, talking, meeting as soon as possible is what we're all about, isn't it? Yeah, and that's take as a team.

SPEAKER_03 15:03

That's real sharing of best practice, isn't it? And again, providing confidence to other healthcare professionals that if they come across patients who are in this position to take the initiative and be confident enough to say, you know what, you can have it you can have it out there. Absolutely.

SPEAKER_02 15:23

Yeah, we do a cough being floor now, within within the useful, so we can measure we got an objective measurement for the cough, so we know the first so we know that someone is ready, not just like, oh, that sounds like it's a good cough. No, no, we don't object measurement is a good cough. We can decanize that.

SPEAKER_04 15:45

I think it's what you you're saying about in innovations in treatment and assessment techniques, and we have the same and using fees and things, but I think it's having the courage to actually ask questions and say, Well, can we do more for this patient? Can we push things on a bit? Do we really have to wait for coffee deflation? Shouldn't we get the coffee down early?

SPEAKER_03 16:05

Yes, you know, should we really kind of just try to push as much as we can to get and I think patient involvement as well because I think they are not aware of what is expected of them. And I distinctly remember when I was on ICU with my tracheostomy, and I was I was a little bit delirious, I was st I was you know, right? But I remember I remember doing a little cough, and it was Barry on ICU, and he said, Oh, a cough means that it must be ready to come out. And then I was every time we walked past it, I was making sure that they were really good cut. Because that was that was something that I thought, you know what, I can do that if I communicate that to them, you know, I can get it out. Um and nowadays when it's someone is preparing for surgery, we're always I mean, particularly when it's elective, we're always telling them beforehand what what will be expected of them. And I know often it it is an unprepared scenario when you have tracheostomy, but if you get that communication, it's um I think it's really brilliant to tell the patients, you know, what what is expected of you and what what what the next steps are, what you can look forward to.

SPEAKER_04 17:12

And I imagine a lot of the time for the patients they can't see this. Yes, they can't see the vent face, they hear it, and it's over here. You can't see what what's happening. And we're talking about atrachostomy must feel very strange. And I'm wondering how many times people make the effort of actually showing pictures of like this is what's in your neck, this is why you can't talk at the moment, or this is what we're gonna do. And that whole involvement of it must remove some of the fear if we explain things properly and then work as a team around that.

SPEAKER_05 17:44

So, funny enough, since you mentioned that, we've always, always made sure that someone having a laryngectomy has a pre-counselling with a laryngectomy patient and a speech therapist.

SPEAKER_02 17:56

Yeah.

SPEAKER_05 17:57

Uh of course, tracheosomy is often urgent, and people are critical, that's different. But it's an interesting point you make that um if you're planning a trach, you absolutely should consider what you just said and having giving the patient some mental warning of what to expect. I accept that you can't do it all the time.

SPEAKER_04 18:16

But if it is done in an emergency, at least then trying to explain what what this looks like and what what's happening. Because I had a patient once who I did actually video the interview with him explaining about his or fear because he felt that he thought he'd had a stroke because he couldn't talk. It was just that the cuff on the tube was inflated. So he was forever thinking I've had a stroke, I've had a stroke, and he couldn't communicate that all the time. So that just that little bit of effort as a team to say this is this is a tube in your neck, but it has fairly major consequences for you.

SPEAKER_02 18:58

As a physiotherapist, that's something that I really push. So even when the patient can't move their hands, yeah, I did that and I made them touch it. I said, This is your tracheostomy, this is you know, I made them, you know, it's like a bit of a sensory. So this is your tracheostomy. You cannot, this is the balloon, so I I make them touch it so that you know some some kind of noses, some kind of they know what they what they have. Yeah, absolutely.

SPEAKER_01 19:23

Well, guys, we'll have to wrap this up. We've got an award to go on quite a bit. Yeah, but one of the things that we're gonna do is a quick presentation on what we've been up to, and we're telling the story of the multi-splan routine through the medium of top trumps, uh, where everyone gets a different rate and tongue in cheek for all the different things we bring to the role, and our star top trump player is the painting topics on. I'm really glad Tampa really awfully.

SPEAKER_05 19:49

I've got to tell you, okay. I don't know what top trumps is. Oh, I don't actually, but you can explain to me later.

SPEAKER_01 19:56

You'll know to be fine. You're about to find out. Okay, we better make a later.

SPEAKER_00 20:03

So I hope you found that interesting. That was an insight into the things that we put forward into the Patient Safety Award, and we were delighted to then go and receive that award from the Royal College of Surgeons in Edinburgh. You can find out more on our website, which is tracheostomy.org.uk. Please follow us on our social media channels, which you can find uh linked from the website, and look forward to seeing you next time. Bye for now.