The National Centre

for Post-Qualifying
Social Work and
Professional Practice

The identified problem

DFT pre-assessment procedures were not effective
in preparing patients appropriately (e.g. blood test
monitoring) or identifying contraindications and
potential complications.
There is little work in the literature regarding
effective pre-assessment procedures for DFTs.
Redesigning the current integrated care pathway
for DFTs was perceived as the solution.

Service
Improvement
Projects
Supporting social work and health practitioners to improve
services one setting and one service provider at a time.
The improvement of services, for the people we
serve, is at the heart of professional practice. This
is why we have designed a Masters degree to
include a focus on service improvement.

The Service Improvement journey at BU is

split into two Masters degree level units:
PSIP and SIP.

PSIP stands for Preparing for your Service

Improvement Project. Successful completion of
PSIP is a pre-requisite for moving on to the SIP
unit. It allows practitioners to develop a service
improvement proposal over a period of about 5
months and is primarily about THINKING.

SIP stands for Service Improvement Project

and is primarily about DOING or implementing

the proposal in practice. This poster is based on a
SIP completed in 2014.

The National Centre for

Post-Qualifying Social Work
and Professional Practice
(NCPQSWPP)
Professional education at the National Centre
for Post-Qualifying Social Work and Professional
Practice is centred on a commitment, passion
and dedication to develop healthcare and social
work practice.
We believe that by improving the quality of
services through partnering with practitioners
and employers across the health and social care
arena we make a vital contribution to society in
general and vulnerable people in particular.
Over 10,000 practitioners have successfully
undertaken our programmes since the year
2000 and we have won a total of 9 prestigious
teaching awards during this time.
Visit us at: www.ncpqsw.com

Aim
The overall aim of this project has been to
improve patient safety and staff compliance with
documentation by creating a new standardised
care pathway for DFTs to identify contraindications,
potential complications and subsequent actions.

Methods:

Patient safety: improving

care pathways for the
defibrillation threshold
test
Author: Alison Parish
Royal Bournemouth and Christchurch Hospitals NHS Trust

Context and rationale

I am an Arrhythmia Nurse Specialist working in secondary care with patients
who have abnormal heart rhythms.
Part of my role is to manage the list for and perform the Defibrillation
Threshold Test (DFT).
DFTs involve inducing a life threatening heart rhythm under general
anaesthetic and then returning the patient back to a normal rhythm.
The DFT process required urgent improvement after 2 adverse incidents that
could have caused harm to patients. Communication, including the use of
documentation, has been identified as contributing to approximately 50% of
all adverse events for patients (Middleton et al. 2005; RCN 2010).

For more information, please visit us at www.ncpqsw.com or phone 01202 964765

All relevant staff were invited for their views

on a draft of the new pathway before it was
implemented.
A before and after questionnaire was developed
using themes identified from the literature review
to audit the new care pathway documentation.
After removing my documentation, I completed the
audit and a colleague outside the team doubledchecked the reliability of my analysis.

Service Improvement
The audit demonstrates considerable
improvements in documenting contraindications
and potential complications and all patients, after
the new pathway had been implemented, had
appropriate pre-assessment preparation.
Colleagues have found the new care pathway easy
to use and no negative views have been voiced.
My team leader comments this [project] has
demonstrated a significant service improvement.

Critical Reflection
Further audit over time is required to determine the
extent of initial project success.
Pre-assessment procedures should be reviewed for
all patients undergoing any electrophysiology and
device procedures to ensure wider patient safety.

References
Middleton, et al., 2005. Reviewing recommendations of root cause
analyses. Australian Health Review, 31, 288-296.
RCN (2010) Record keeping guidance. Available online from: http://
www.nmc.uk.org/Documents/NMC-Publications/NMC-Record-Keeping-Guidance.pdf [accessed 12.9.14].