by Samantha Lignelli

Poster Download

Background & Problem:

Working within the A&E Department for 6 years, I took on the role of one of the Major Incident Link Nurses – it occurred to me at one of my training sessions that my colleagues would not know what to do if an External Major Incident was to occur.

Therefore I decided to complete an anonymous questionnaire to see what knowledge they had and where there are gaps in knowledge. I decided to focus on Registered Nurses (Band 5 and Band 6) as if a Major Incident occurred they would be the ones to co-ordinate and ensure the safety of the department.

Although my Quality Improvement project did not involve patients directly, it was paramount that I addressed the issue to ensure staff and patient safety in a Major Incident.

The baseline data showed that Registered Nurses did not know their role within a Major Incident, did not know who the link nurses were for the department, had not attended any Major Incident training over past 12 months and felt that the department lacked educational resources.

This was the same findings as Wong et al (2006) who looked at Major Incident preparedness across England – 25% of hospitals did not do any teaching on Major Incidents and had no introduction sessions to new staff. They discussed ways to improve this – Briefing of staff, regular Major Incident rehearsals and local education resources to plan for any future Major Incident.

Wong, K., Turner, P.S., Boppana, A., Nugent, Z., Coltman, T., Cosker, T.D.A. and Blagg, S.E. (2006) Preparation For the Next Major Incident: Are We Ready?. Emergency Medicine Journal. 23, pp. 709-712


S – To ensure 50% of Registered Nurses (Band 5 and Band 6) have the knowledge and skills of what to do in an external Major Incident by March 2020
M – To measure staff knowledge before and after educational resources are introduced – this will be done with an anonymous questionnaire
A – Due to shift patterns and large nursing team, it is only achievable to enhance knowledge of 50% of Registered Nurses within the next 5 months
R – The aim is for all band 5 and band 6 Registered Nurses to complete the initial anonymous questionnaire to ascertain knowledge levels prior to educational resources within the first 4 weeks, this will then give time to implement resources over next 4 months
T – By March 2020


Questionnaire results in form of bar graph to clearly identify any gaps in knowledge at beginning of project. Repeat bar graph questionnaire at end of project to see if knowledge had been improved by implementation of selected educational resources and tools (changes).

Driver diagram was used after initial questionnaire to identify change ideas to improve the problem.
Regular PDSA cycles were used to implement and test after every implementation of the educational resource and pre-alert form.
Project team members:
- Kathy Agg – assisted with collecting photographs and information for flow chart educational resource.
- Kate Treadgold – assisted with ‘METHANE’ pre alert form design and information for example sheet.


The results of the post questionnaire showed that:

Q1 - I know the difference between internal and external Major Incidents – 15/15 now compared to 11/15 at start of project
Q2 - I feel confident on my role within Major Incidents – 12/15 now compared to 5/15 at start of project
Q3 - I know who the Major Incident link nurses are within the department – 15/15 now compared to 8/15 at start of project
Q4 - There are adequate educational resources within the department on External Major Incidents – 13/15 now compared to 4/15 at start of project

Lessons Learnt:

- Staff engagement at beginning of the project – staff only completed knowledge questionnaire when it was supported and encouraged by senior staff/management. The online questionnaire was preferred by staff due to short time it took to complete and user-friendly approach.

- Educational resources and micro-teaching sessions are both vital to embed knowledge in to practice – also ensures it is adaptable to different types of learners (visual, auditory, etc.)

Next steps:

Link nurses/Stakeholders to continue with project in my absence due to secondment job.

  • Ongoing regular micro teaching sessions in the department
  • Induction book to be created for new starters to the department to ensure they are aware of their role in Major Incidents
  • Yearly mandatory face to face major incident training for all staff
  • Educational resources to be reviewed/updated as local and national guidelines change

Quality Improvement Presenter
Samantha Lignelli, Professional Educator for TNA and HCA Care Certificate, Professional Education GHNHSFT
Quality Improvement Team
Kate Treadgold, Emergency Nurse Practitioner, A&E CGH
Kathy Agg, Senior Sister, A&E CGH