IQIPS Update 2022

IQIPS – Another Vascular Service achieves Accreditation 

The Vascular Studies Unit of University Hospitals of Leicester NHS Trust have recently received the news that they’ve met the standard for IQIPS accreditation. This is a fantastic achievement, especially as they elected for assessment against the new 2020 standard with its additional requirements in terms of quality and “uncertainty of measurement” management. 

Joanne Walker is the manger of the Unit and has very kindly agreed to answer some questions about their achievement. 

How long did it take to prepare the department for IQIPS accreditation? 

It took over 3 years to get the approval and buy-in from the Trust with regards to financing the process, but as most of the IQIPS standards cover your current practice, the main bulk of work was over 18 months to ensure that the systems we put in place for ensuring and monitoring quality had been running for sufficient time to demonstrate effectiveness.  Once you have the staff engagement you can delegate areas of the preparation and this way the whole team will be familiar with the systems and processes which helps towards a unified approach. 

What was the hardest part? 

As the updated IQIPS V2 required a Quality Manual (QM) and a fair amount of new over-arching audit processes, it was a learning curve in the understanding and development of these.  Understanding how to apply different monitoring or auditing techniques (such as utilising vertical and horizontal audit methods) to different areas of the QM took time, and then developing a whole over-arching audit policy and effective schedule was challenging.   

As the V2 also covers “uncertainty of measurement” (UOM) this presented us with an opportunity to see how to apply this to ultrasound and physiological measurement, as currently this is more widely understood and defined in laboratory settings.  We have now updated our ultrasound QA to try and measure and define our probe resolutions using certain applications, and acknowledge this in our protocols. There is still a lot more work which we can do with ongoing UOM, and we are now also thinking about how to introduce flow phantoms during QA to start to understand our UOM with regards to Doppler flow recordings. But that’s a whole big project for another day… 

And anything that was surprisingly easy? 

Err…. Is it ever easy?! 

Well actually, if you have already got protocols which are current, document controlled, and aligned with SVT guidelines, this helps. As well as ensuring standard management of a service is in place with regards to appraisals, mandatory and specific job training is up-to-date, and local procedures, policies and risks are documented.  If you are already recording images and reports electronically and monitoring quality here, this will help too. 

What is different in the new 2020 standard and why did you decide to go straight for this rather than transitioning through the original standard? 

The new areas in V2 are the need to have a QM, overarching audit, and “uncertainty of measurement” considerations for the whole service.  I think also what is different is having to audit a larger scope, as all of the QM sections have to be assured by monitoring or auditing systems. 

It wasn’t really an option not to go for V2, as the transition period would be very close, and I felt that it would be more difficult to have to change over than get aligned to V2 from the outset. I think now all new applications to UKAS will be straight into V2. 

Your service is provided at 2 different hospitals and in multiple locations – did this present any challenges to achieving IQIPS accreditation? 

No, it wasn’t really a problem, as most of the preparation of documents will be the same for the service wherever it is delivered. The way the service is delivered should meet the same quality and standard in each location, follow the same processes and either share or use duplicated documents. There will be a few small differences on a local level, as well as having to demonstrate audit or monitoring of more locations with regards to facilities and local risks and suchlike, and ensuring correct staff skill mix cover at each location.  Ideally you want conformity across all areas.  If there are satellite services which are encompassed into other management groups, then this is sometimes more complex. An example is our TIA clinic scan room based on another site is under the management of stroke services with regards to footprint of facilities and clinic processes, but our activity and staffing within the room is our own VSU standards and procedures.  You just have to ensure that both services are engaged with IQPIS and can provide evidence where required to assure the assessment team about the combined services. 

What was it like on the day of assessment for yourself as manager and also for staff scanning in clinics? 

If anyone can remember setting their AVS practical exam, we all felt a bit like this, despite both myself and the assessors reassuring the staff that this is not what it is about and to relax into normal daily practice!  The assessment team consists usually of a Specialist Technical Assessor for Vascular, a Lay assessor, and an Assessment Manager who leads the whole assessment. Our Lay assessor chatted to the clinical and admin team as well as a few patients, and also looked at the patient environment. The Technical Assessor selected a range of examinations to observe across different rooms and sites, and had the opportunity to talk to the clinical staff after the scan to assure that conformity to the protocols was achieved and query any unexpected findings to processes, as well as looking at the clinical facilities and equipment. The Assessment Manager spent most of the time going through our service documents with me, where I had the opportunity to explain or clarify processes or help find information or evidence that was not easy to find or understand what our process was. 

Any advice for other departments preparing for their own accreditation? 

Ensure the whole team is engaged with the preparation and also embed processes into normal daily practice so that there is nothing different when it comes to assessment. Remember that the assessment ensures you attain a level of quality but it also notes that services are under continuous development and improvement. There will always be mandatory and recommended findings at the end of the assessment, and these will help highlight areas for improvement or action needed to reach compliance with IQIPS standards.  The whole team should not take these findings as a negative outcome, but use this to go from good to great! 

You are trained as an IQIPS technical assessor, did this help in your department’s accreditation journey? 

Training as an IPQIS assessor (many years ago it seems now) was definitely invaluable for helping me prepare for our own IQIPS assessment and I would still recommend this, but as a trained technical assessor I was not fully prepared for the other areas of assessment with regards to the overarching management of the service. So actually having a thorough read of the UKAS guidance is also very helpful: 

https://www.ukas.com/wp-content/uploads/2021/12/IQI-4000-IQIPS-V2-Standard-Statements-Guidance.pdf 

Thank you Jo for your very comprehensive and helpful comments. 

The list of currently accredited Vascular Services is available on the United Kingdom Accreditation Service (UKAS) website Improving Quality in Physiological Services (IQIPS) (ukas.com).