Improving the documentation of mobility status for patients with metastatic spinal cord compression (MSCC)
Kate Baker, Head of Therapies, Velindre University NHS Trust
Introduction
Healthcare professionals at Velindre Cancer Centre identified that unclear and delayed documentation of mobility status for patients with Metastatic Spinal Cord Compression (MSCC) was leading to challenges in providing safe and timely care. This resulted in inappropriate or delayed mobilisation, increasing risks such as pressure ulcers, infections, and falls.
Nursing staff highlighted that they were often unsure of how the patients should be mobilised, resulting in prolonged bed rest for patients. A retrospective audit revealed that 62% of patients admitted with MSCC lacked documented mobility status within four hours, confirming inconsistent practices. The goal was to ensure 100% of MSCC patients had documented mobility status within four hours of admission within six months.
Methods
- Model for Improvement framework was utilised and stakeholders identified through a stakeholder mapping exercise.
- Senior leadership support was obtained from key nursing, therapy, and oncology leads. Strong senior clinical leadership influenced change and embedded improvements into standard practice.
- A multi-disciplinary team was formed, creating process maps and a driver diagram to guide interventions.
- Two workstreams with three PDSA cycles each were developed.
- Continuous data collection informed ongoing changes.
- Implemented staff education sessions.
Outcomes
- PDSA 1: Updated handover checklist documentation and implemented staff education sessions resulted in 82% admissions with documented mobility status.
- PDSA 2: Minor checklist amendments and improved accessibility raised rate to 87.5%.
- PDSA 3: Embedded handover checklist in ambulance booking and continued staff education increasing the rate to 91%.
- Each cycle showed progressive improvement increasing from baseline measurement of 38% to 91%.
- Despite not achieving 100%, this was a significant improvement through simple change interventions.
- Positive staff feedback on the handover checklist and education sessions.
Learnings
- Addressing mobility status documentation was crucial to prevent complications from prolonged immobility.
- Despite COVID-19 challenges, the QI approach led to significant progress in improving documentation.
- Key factors: effective multidisciplinary collaboration, simple handover checklist changes, improved accessibility, and ongoing staff education.
- The project team gained valuable QI methodology experience, inspiring future improvement projects for MSCC patient care.
What next?
- Findings shared through MSCC groups, AOS teams, national conferences, and local training sessions.
- Future research ideas include assessing the impact on patient outcomes, patient and carer experiences, staff satisfaction, and education effectiveness.
- Further work will explore staff perceptions of MSCC management and identify any training needs.
