I am delighted to have another guest blogger at St.Emlyn’s. If you are FOAM +ve you will already know Damian who has done sterling work to promote learning through social media in Paediatric Emergency Medicine (PEM). Damian has a great track record in education and I’m sure will continue to do great things. In 2013 he is intimately involved in a project to transfer learning into patient benefit. This is fantastic and what we should all be aiming for, take it away Damian.
Changed to FOAM? Now for Change from FOAM
I would like to talk about change. In fact making change on one particular day; the 13.3.13 (the keen amongst you will notice this coincides with #SMACC2013) and I would like to do this through the medium of FOAM:
This quote comes Joe Lex and is used in the introduction to FOAM on the “life in the fast lane” website.
The explosion of the concept of Free Open Access Meduction has been remarkable. A previously unmet need to bring together like minded clinicians with free, high quality resources is now spreading fast. However, as with all things educational, translating knowledge to practice is difficult to do, and even more difficult to prove. In this vein I would propose a slight alteration to Joe Lex’s quote above – replacing ‘how’ with ‘should’.
We know that in any health care organisation best practice is rarely followed to the letter. Despite the production of guidelines, protocols, even supporting human decision making with electronic algorithm, evidence based medicine slips through the net. This is not saying that patient care is comprised or that expert decisions aren’t made (suggest reading “why do we always end up here” by Prof. Trisha Greenhalgh and if the editor will permit my own ROLMA matrix article ). On review of any clinical encounter though the clinician may not have practiced in the ideal fashion (even if they thought they did) As an example lets look at some of the information FOAMed has been trying to champion.
The top 10 of FOAMed from 2012 (in stemlyn’s opinion) contained some simple interventions Prescribing Tranexamic acid in trauma and DVT prophylaxis in below knee immobilization are examples. These practices has percolated upwards, been examined and FOAMed has celebrated them.
But do people actually do it?
Can every one of the FOAMed early adopters swear blind they use these interventions day-in and day-out? Even if they do, can you be sure the thousands of other emergency physicians out there will:
- (i) be aware of the evidence? and
- (ii) be so minded as to change their practice and those of their colleagues?
- (iii) finally, and most importantly, in those who are willing to really engage do their environments and systems make change easy?
This is a key implementation difficulty that plagues health care and industry the world over. The most keen and passionate advocates of change can find their enthusiasm for altering practice, even in the most tiny way, blocked by bureaucracy and petty micro-management. I have previously described the NHS as a steam roller, a machine that does not move quickly, it eventually gets to its destination and achieves it goals, but the weight of the journey is slow and painful for those underneath.
So onto change, and NHS Change Day in particular. On the 13.3.13 staff, and the public, will be given the opportunity to pledge to do just one thing a little differently, a little better, that will improve the core values of the NHS. It’s about mass mobilisation, change is difficult, but if everyone is doing it together it becomes that bit easier (if you haven’t seen earth hour as a demonstration of this now is your time to watch the videos).
The opportunities for emergency medicine on change day are huge as FOAMed has already given a battery of pledges. From remembering to give TXA to your trauma patient to tasting the medicines we give to children (Number 5 on the St. Emlyns list) putting FOAM into practice can become a reality.
You could of course do all of these things on any other day (and you should) but NHS change day can provide that much needed togetherness that makes things stick.
Change day hopes to get 65000 pledges, 1000 for each year the NHS has been in existence. So please have a look at the holding site (www.changemodel.nhs.uk/changeday), register, review your favourite FOAM resource and get ready to pledge.
[author] [author_image timthumb=’on’][/author_image] [author_info]Damian Roland
[learn_more caption=”References”]  http://lifeinthefastlane.com
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