QUALITY REPORT
APRIL 2013
In this report
A Spotlight on the Trauma Service
page 3
A patients story
page 4
Patient Experience
page 5
Quality & Safety Indicators
page 7
Quality Walkabouts
page 12
Mystery Shopper feedback
page 13
Patient And Family Centred
page 13
Research
Introduction
The April Quality Report shines a spot light on the Trauma Service. It provides an update on the Trust’s key Quality and Safety indicators, including some of the lessons learnt from complaints .
The report highlights the outcome from recent Quality Walkabouts and outlines the feedback from recent Mystery Shoppers.
A Spotlight on The Trauma Service
26th March 2012 saw the formal launch of the UHNS Major Trauma Centre. Following the launch, 773 patients were treated between 26th March 2012 and 31st March 2013. In October 2012 our partners at Betsi Cadwaladr University Health Board aligned their three Trauma Units in Wrexham, Glan Clywd and Bangor. 59 trauma patients from Wales have since been seen at UHNS.
Patients arrive at UHNS via land ambulance and by helicopter predominately, utilising the perfectly placed helipad, situated directly outside of the Emergency Department resuscitation room door. Partners from a wide range of Air Ambulance services have joined forces with UHNS from as far afield as Leicester and Rutland along with the Sea King crews from RAF Valley in Anglesey. On arrival patients have immediate access to emergency CT scanners, MRI scanners and plain film X-ray and Ultrasound suites. The patient journey may then continue for immediate surgical care in theatres or Interventional Radiology before being cared for in Critical Care or on one of our wide range of specialty wards. Our Major Trauma Rehabilitation service now operates from day one at UHNS, meaning that all patients have a planned period of recovery from the moment they arrive until they complete their recovery period. Some of our patients require Specialist Rehabilitation, which is delivered on an inpatient basis at Haywood Hospital. This partnership has proven pivotal in ensuring the best outcomes for our patients.
A large amount of data is collected around trauma patients, which is made anonymous and submitted to the Trauma Audit Research Network (TARN) in order to ensure that the best outcomes are achieved for this group of patients. UHNS has scored very highly, consistently placing us in the top 5 Major Trauma Centres in the country and with the best outcomes in the East and West Midlands. Our figures show that for every 100 patients that are seen at the Major Trauma Centre, 2.8 more patients survive than are predicted to do so. This is fantastic news for our patients and shows that all of the hard work and dedication of our range of specialties involved in the delivery of trauma care is paying off.
The major trauma team is now fully formed consisting of a Service Manager, a Clinical Lead, two senior acute care nurses, two rehabilitation coordinators, two Consultants in Rehabilitation Medicine and two TARN Data Coordinators.
Sheila’s Story
Sheila was admitted to the UHNS from the local
psychiatric hospital as she had stopped eating and
drinking. Sheila had a long history of both mental
and physical health problems and she had been
admitted to hospital several times over the previous
few months for the same reason, each time
becoming gradually more unwell.
On this admission Sheila was initially assessed by the
medical and nursing teams who thought that she
was dying. Initially, the view was that Sheila should
not have active treatment and that she should be
transferred a palliative care bed in the community.
However, Sheila did not have the capacity to
contribute to the decision about her treatment and
the psychiatrists involved in her care felt that she
should be actively treated, despite all the tests
indicating that Sheila was physically deteriorating. As
a consequence Sheila underwent further tests, a drip
was started and a tube was passed into her stomach
to feed her.
Sheila had no family but she did have a friend called
Paula who knew her well. Paula did not have
authority to make decisions about Sheila’s
healthcare but did know that Sheila had made a will
in which she made it clear that she did not want to
be resuscitated. Paula felt that Sheila would not have
wanted active interventions and that it was clear to
her that Sheila was dying.
Sheila was referred to the Hospital Palliative Care
Team to manage her care. Sheila received
medications to manage her symptoms, but was still
being actively managed despite her deterioration.
Discussions were held between the ward team,
hospital palliative care team and psychiatrist and 14
days after admission to the UHNS a best interests
decision was made to stop all inappropriate
interventions, and to ensure Sheila remained pain
free and comfortable.
Sheila was now too unwell to be transferred to a
palliative care bed and died at the UHNS 4 days
later.
Sheila’s story is an example of how difficult it can
be for clinical teams to identify patients who may
be dying and for them to arrange a suitable and
timely plan of care or treatments to ensure that
they are cared for in the appropriate
environment.
At the UHNS there is a plan to implement a new
care plan which helps clinicians to identify
patients who are deteriorating, clinically
unstable, with limited reversibility and at risk of
dying within the next 1-2 months. The new care
plan ensures that there are clear levels of care
for these patients and that the plan of care is
clearly and regularly communicated to patients
and their families.
“
When we care for the dying, we have only
one chance to get it right….”
Ellershaw 2011
What other patients are telling us about their care
“I have been in hospital nearly 6 weeks and have no-ticed everything. The staff on the ward are excellent. They do an amazing job and all need medals. They don't stop at all. Professional expertise delivered in an extremely warm and friendly manner. We feel that we could not have been looked after if we had been royalty. Thank you very much”.
“The staff were brilliant, no complaints at all. The food was not very good at all, Could not eat it”. “Having had my baby here pre- term and unexpectedly, I feel very fortunate to have been supported by such a kind and compassionate team of staff. I cannot thank them enough for the level of care and personal support they have all offered throughout”.
Patient Experience
Complaints
Chart 1 shows the number and type of complaints received by quarter. During April 2013 the Trust received 63 formal complaints, with 52.3 complaints per 100 admissions. The Trust has noted the increase in complaints during 2013.
44% of all complaints relate to all aspects of clinical treatment (Chart 2) which are evenly distributed between medicine and surgery. Whilst the graph shows no particular trends it demonstrates that there has been a gradual increase in the number of complaints received
relating to clinical treatment. What other patients said about the care they
received:
“Everyone was most kind and friendly and helpful. This was most appreciated. also they were very prompt in responding to calls”.
“Staff were exceptionally efficient, I felt they were under pressure and under paid. I wondered if they had help with their own health. If the staff are looked after then the patient is”.
“What a fantastic ward of staff they were friendly and helpful. I would not hesitate to say to a patient who comes in this ward how good it is.”
“Our treatment was exceptional, I thought we had booked in for a private visit by mistake. Staff were brilliant. It was that good I shall come again”
Chart 1—Complaints received per month
PALS
PALS have been contacted on 82 occasions during April 2013. These contacts also include compliments
However, unlike complaints the most
common concern raised related to appointments.
Quality of the care/treatment was the 2nd highest
reason for contacting PALS following appointments and general enquiries.
53 64 57 65 65 37 73 73 39 57 55 69 63 4 5 .4 49.4 48.3 5 1 .2 5 2 .0 3 1 .4 5 6 .2 5 5 .2 3 2 .7 4 4 .8 48.9 5 6 .2 5 2 .3 0 10 20 30 40 50 60 70 80 A pr -1 2 Ma y-12 Ju n-1 2 Ju l-1 2 A ug -1 2 Se p -1 2 O ct -1 2 N o v-12 D ec -1 2 Ja n -1 3 Fe b -1 3 M ar -1 3 A pr -1 3 Ma y-13 Ju n-1 3 Ju l-1 3 A ug -1 3 Se p -1 3 O ct -1 3 N o v-13 D ec -1 3 Ja n -1 4 Fe b -1 4 M ar -1 4
Compla ints Compla ints ra te per 1000 episodes Trend (Complaints)
Chart 2— Complaints by Subject (April 2013)
45 76 94 123 106 108 101 176 88 115 104 89 82 0 50 100 150 200 20 12 04 20 12 05 20 12 06 20 12 07 20 12 08 20 12 09 20 12 10 20 12 11 20 12 12 20 13 01 20 13 02 20 13 03 20 13 04
Chart 3— Number of PALS per month
Al l a spects of cl inical trea tment
44%
Admi ssion, tra ns fer & di s charge a rra ngements 14% Appointment, delay/cancellation (outpatients) 9% Communication/Information to
patients (written and oral) 9% Attitude of Staff 7% General Nursing 7% Aids and appliances,
equipment premised (including access)
5%
Appointment, delay/cancellation (inpatients)
4%
Patients' property and expenses 1% Appointments/ procedures 38% Quality of clinical care/medical care/practice/treatment 18% General Enquiries 14% Communication 10% Admission, transfer and discharge arrangements 6% Results/reports 4% Aids, appliances and equipment 2% Parking 2% Patients property and expenses 2% Staff attitude/behaviour 2% Waiting times 2%
Chart 4— PALS by Subject (April 2013)
Patient Experience
continued
Learning From Complaints
One of the most important aspects of the complaints process for the Trust is to learn lessons and make changes to enhance the experience for our patients, carers and relatives. The section below describes what the outpatient department is doing to improve their services based on what patients are telling them. While many of the changes may appear minor, it is often the ‘little things’ which can make the difference between a good and a poor experience for our patients along with a shift in culture to one where the
attention to detail does matter.
Lessons learnt from Out Patient Comments
The Outpatient Management team have been reviewing their complaints against other sources of patient and carer feedback to identify areas where improvements can be made. This has led to a number of developments within the clinic areas.
Issues were raised by patients that reception staff didn’t look up from what they were doing, made no eye contact, talked to a colleague whilst patients were waiting and patients could hear the staff talking about personal issues. Clearly they felt this wasn’t appropriate.
The management team worked with Healthcare Skills Academy to develop a programme of education which included all aspects of customer care. The training started in November 2012 and initially a 3 session course was delivered to build relationships with nurs-ing staff and reception staff based on the theory that ‘happy staff = happy patients’. This programme was developed into a shorter 2 hour course to meet service needs. It is anticipated that all reception staff managed within Outpatients will have completed this training by the end of May 2013. Staff will be expected to attend yearly thereafter.
Patients have reported that nurses in clinics have been talking amongst themselves and appear to be doing too much administration work leaving patients feeling unnoticed. There have also been issues over the way patients have been addressed. The team have also received comments about the general appearance and demeanour of the staff. In response to this the Matron has developed a code and standards of behaviour. All nursing staff are aware of the standards and understand what is expected of them, how they should behave and how they address patients.
Mary’s Story
“I am a retired teacher who used to teach primary school children with special needs. I retired a few years ago at the same time as my husband, we both spend most of our time in the garden where we enjoy growing vegetables. I had never been ill before until I started to rapidly lose weight without reason and my husband urged me to go to the GP.
I was diagnosed with bowel cancer, I underwent surgery, had a stoma formed and had chemotherapy. Whist investigating the bowel cancer, I was told I also had Lung cancer.
In 2012, I was admitted for a Lung wedge resection and then re-admitted for a lobectomy. The first time I came here I found the UHNS hospital too big and impersonal. Maybe due to the fact that I am used to my local hospital which is a lot smaller. I was a long way from home and having surgery for cancer didn't help my feelings.
Despite undergoing major lung surgery, I felt happier being at the UHNS. I felt that the staff were helpful, kind, caring and really did go out of their way to deliver excellent care, whilst at the same time working very hard without being appreciated. I am extremely pleased with the care that I have received from my consultant. I thought that he was honest about my cancer and the treatment which I needed and he gave me all the information I needed so I could decide whether or not to undergo the lung surgery.
However, not all of my experiences were good. Following my wedge resection, I had a haematoma and wound infection. I was admitted to A&E where I was very sick and my stoma was " playing up". The doctor in A&E told me " you have cancer and I can't do anything for you. I have booked you an ambulance, so go home, eat what you want and sleep when you want".
Quality and Safety Indicators
Adverse Incidents and Harm Free Care
Chart 2 opposite indicates to a positive reporting and safety culture at UHNS.
The rate of Patient Safety Incidents per 100 admissions is continuing to decrease. The severity of the incidents is reducing and Serious Harm (as defined by and reported to the National Patient Safety Agency) is decreasing
Chart 3 shows that the trend in patients receiving harm free care, as measured by the monthly Safety Express surveys, is increasing and in March 2012 97% of the patients surveyed were recorded as receiving harm free care.
The Trust has reported 11 new Serious Incidents.
Safety Express
Within the Safety Express programme, Harm Free care is measured against 4 harms: Falls / Catheter
associated UTI / PE or DVT / Pressure Ulcer. UHNS have implemented Safety Express across every ward, surveying every patient on the ward on one specific day within every month. Summaries of these 4 harms can be seen below.
Blood Clots (VTE)
National best practice guidance states that on admission patients should be risk assessed to prevent the development of blood clots (VTE) and where necessary commenced on anti blood clot medication. The Trust’s VTE Risk assessment completion
performance continues to exceed the national (90%) and local (95%) targets with over 98% during April 2013.
VTE Prophylaxis compliance has also continued to improve with over 99% in April.
Chart 2: Patient Safety Incidents
Chart 3: Harm Free Care
Chart 4: VTE Risk Assessments and Prophylaxis
Chart 5: Hospital Acquired PE/DVT
827 869 871 934 903 761 832 796 702 653 626 795 747 0.00 1.00 2.00 3.00 4.00 5.00 6.00 7.00 8.00 0 100 200 300 400 500 600 700 800 900 1000 A pr -1 2 M ay -1 2 Ju n-12 Ju l-1 2 A ug -1 2 Se p-12 O ct -1 2 N ov -1 2 D ec -1 2 Ja n -1 3 Feb -1 3 M ar -1 3 A pr -1 3 M ay -1 3 Ju n-13 Ju l-1 3 A ug -1 3 Se p-13 O ct -1 3 N ov -1 3 D ec -1 3 Ja n -1 4 Fe b-14 M ar -1 4
Patient Safety Incidents (PSI's) PSI per 10 0 admissions Trend (PSI's)
9 6 .6 3 % 9 6 .3 9 % 9 6 .1 8 % 9 7 .3 8 % 9 5 .9 0 % 9 6 .6 6 % 9 7 .7 7 % 9 7 .4 0 % 9 7 .3 4 % 9 7 .2 2 % 9 7 .5 3 % 9 7 .0 5 % 9 7 .4 8 % 93.00% 94.00% 95.00% 96.00% 97.00% 98.00% 99.00% 100.00% A p r-1 2 M a y-1 2 Ju n -1 2 Ju l-12 A u g -1 2 S e p -1 2 O c t-12 N o v -1 2 D e c-1 2 Ja n -1 3 F eb -1 3 M a r-1 3 A p r-1 3 M a y-1 3 Ju n -1 3 Ju l-13 A u g -1 3 S e p -1 3 O c t-13 N o v -1 3 D e c-1 3 Ja n -1 4 F eb -1 4 M a r-1 4
% Harm Free Care (Safety Express) Trend (Harm Free Care)
50.00% 55.00% 60.00% 65.00% 70.00% 75.00% 80.00% 85.00% 90.00% 95.00% 100.00% A pr -1 2 M ay -1 2 Ju n-12 Ju l-1 2 A ug -12 Se p-12 O ct -1 2 N ov -1 2 D ec -1 2 Ja n -1 3 Feb -1 3 M ar -1 3 A pr -1 3 M ay -1 3 Ju n-13 Ju l-1 3 A ug -13 Se p-13 O ct -1 3 N ov -1 3 D ec -1 3 Ja n -1 4 Feb -1 4 M ar -1 4
Quality and Safety Indicators
Patient Falls
Chart 6 shows that the reporting of patient falls have increased recently, however, there has been a reduction in the severity of these falls as a consequence of improved assessment and actions taken (i.e. use of ultra low beds, improved patient footwear and en-hanced hourly observations). UHNS Rate of Patient Falls per 1000 bed days is 6.53 for April 2013.
Chart 7 shows that the number of patients being risk assessed for falls is consistently above 99%, however, compliance with the Falls Bundle still needs to be improved. These are key to reduce harm as a consequence of falls.
Pressure Ulcers
Chart 8 shows a reduction in hospital acquired pressure ulcers during April. Of the 7 ulcers reported during the month 3 were unavoidable.
UHNS has not had a Grade 4 Hospital Acquired Pressure Ulcer for 728 days (as at 22.05.13). The ambition for 2013/14 is to reduce further all avoidable hospital acquired pressure ulcers. Chart 9 Shows that within the safety express the number of new pressure ulcers identified increased to 16 in April while 97.4% of admitted patients had a Pressure Risk Assessment completed within 6 hours of admission during April 2013.
The Trust is re-enforcing the “Stop the Pressure”
improvement programme, which includes:
A Pocket Prompt which guides staff on the
ap-propriate assessment of pressure ulcers
An information manual regarding best practice
relating
to
nutrition/continence/pressure
relieving products/ assessment tools/dressings.
An integrated skin care plan and comfort round
tool.
A Yellow wrist band to identify patients at high
risk of pressure damage.
A yellow star on blue background magnet at the
bedhead to further identify high risk patients.
Chart 6: Falls Trend
Chart 7: Falls Risk Assessments
Chart 8: Hospital Acquired Pressure Ulcers
Chart 9:Pressure Ulcer Risk Assessment
167 142 151 178 118 143 127 131 157 185 181 185 199 0 1 2 3 4 5 6 7 0 50 100 150 200 250 A pr -1 2 M ay -1 2 Ju n-1 2 Ju l-1 2 A ug -1 2 Se p -1 2 O ct -1 2 N o v-12 D ec -1 2 Ja n -1 3 Fe b -1 3 M ar -1 3 A pr -1 3 M ay -1 3 Ju n-1 3 Ju l-1 3 A ug -1 3 Se p -1 3 O ct -1 3 N o v-13 D ec -1 3 Ja n -1 4 Fe b -1 4 M ar -1 4 Patien t F a lls p er 1 0 0 0 b ed d a y s T o ta l P a ti en t F a ll s
Falls Rate per 1,0 00 Bed Days Linear (Falls )
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% A pr -1 2 M ay -1 2 Ju n-12 Ju l-1 2 A ug -1 2 Sep -1 2 O ct -1 2 N ov -1 2 D ec -1 2 Ja n -1 3 Fe b-13 M ar -1 3 A pr -1 3 M ay -1 3 Ju n-13 Ju l-1 3 A ug -1 3 Se p-13 O ct -1 3 N ov -1 3 D ec -1 3 Ja n -1 4 Feb -1 4 M ar -1 4 % S co re s
Falls Bu ndle Score Falls Risk As sessmen ts Co mpleted
0 5 10 15 20 25 30 35 A p r-1 2 M a y-1 2 Ju n -1 2 Ju l-1 2 A u g -1 2 S e p -1 2 O c t-1 2 N o v -1 2 D ec -1 2 Ja n -1 3 F e b -1 3 M a r-1 3 A p r-1 3 M a y-1 3 Ju n -1 3 Ju l-1 3 A u g -1 3 S e p -1 3 O c t-1 3 N o v -1 3 D ec -1 3 Ja n -1 4 F eb -1 4 M a r-1 4
Reported HA Grade 4 Pressure Ulcers Reported HA Grade 3 Pressure Ulcers Reported HA Grade 2 Pressure Ulcers Safety Expres s N ew Pressure Ulcers
94% 95% 96% 97% 98% 99% 100% A p r-1 2 M a y-12 Ju n -1 2 Ju l-12 A u g -1 2 S e p -12 O c t-12 N o v -1 2 D e c-12 Ja n -1 3 F e b -13 M a r-1 3 A p r-1 3 M a y-13 Ju n -1 3 Ju l-13 A u g -1 3 S e p -13 O c t-13 N o v -1 3 D e c-13 Ja n -1 4 F e b -14 M a r-1 4
Quality and Safety Indicators
Continence and Nutrition
The Trust continued to achieve 99% performance for carrying out nutritional assessments
Feedback received as part of our Proud to Care standards shows positive performance regarding helping patients to eat, however, there has been a decrease in replacement meals being provided if the main meal is missed. The Trust has also introduced snack boxes available to patients between set meal times. Work continues with Matrons and Ward Managers to ensure that this is addressed in future months as part of the Proud to Care (P2C) programme. This will be monitored through Dietician Mealtime Audits
Chart 12 shows a long term reduction in Catheter Associated Urinary Tract Infections as monitored through our monthly Safety Express audits with only 1 reported in April 2013.
Privacy and Dignity
Chart 13 demonstrates that there have been no single sex breaches since April 2012.
Chart 14 demonstrates that the Trust has received improved patient feedback regarding sharing mixed sex rooms/bays on admission.
However Chart 15 shows decreasing results for mixed sex room/bays when being moved. This is being discussed with Matrons who are addressing this with their individual wards.
Chart 10: Nutrition Risk Assessments
Chart 11: Meal Assistance and Replacement
Chart 12: Catheter Associated UTIs
Chart 13: Single Sex Breaches
Chart 14: Share room/bay on Admission
Chart 15:Share room/bay when moved
55.00% 65.00% 75.00% 85.00% 95.00% A pr -1 2 M ay -12 Ju n-12 Ju l-12 A ug -12 Se p-12 O ct -12 N ov -1 2 D ec -12 Ja n -13 Fe b-13 M ar -13 A pr -1 3 M ay -13 Ju n-13 Ju l-13 A ug -13 Se p-13 O ct -13 N ov -1 3 D ec -13 Ja n -14 Fe b-14 M ar -14Nutrition Risks Completed Patients Weighed
80% 85% 90% 95% 100% A p r-1 2 M a y-12 Ju n -1 2 Ju l-1 2 A u g -12 S e p -12 O c t-12 N o v -1 2 D e c-12 Ja n -13 F e b -13 M a r-13 A p r-1 3 M a y-13 Ju n -1 3 Ju l-1 3 A u g -13 S e p -13 O c t-13 N o v -1 3 D e c-13 Ja n -14 F e b -14 M a r-14
P2C Feedback - Helped to eat if required P2C Feedback - Replacement meal given if missed
0 2 4 6 8 10 A p r-12 M a y-12 Ju n -12 Ju l-12 A u g -12 Se p-12 O ct -1 2 N ov -1 2 D ec -1 2 Ja n -13 Feb -1 3 M ar -1 3 A p r-13 M a y-13 Ju n -13 Ju l-13 A u g -13 Se p-13 O ct -1 3 N ov -1 3 D ec -1 3 Ja n -14 Feb -1 4 M ar -1 4
CAUTI's (Safety Expres s) Trend
0 5 10 A p r-11 M a y-11 Ju n -11 Ju l-11 A u g -11 S e p -1 1 O c t-1 1 N o v -1 1 D e c-11 Ja n -12 F e b -1 2 M a r-12 A p r-12 M a y-12 Ju n -12 Ju l-12 A u g -12 S e p -12 O c t-1 2 N o v -1 2 D e c-12 Ja n -13 F e b -1 3 M a r-13 A p r-13
Single Sex Breaches Trend (Single Sex Breaches)
0% 100% A p r-12 M a y-12 Ju n -12 Ju l-12 A u g -12 S e p -12 O c t-12 N o v -1 2 D e c-12 Ja n -13 F e b -13 M a r-1 3 A p r-13 M a y-13 Ju n -13 Ju l-13 A u g -13 S e p -13 O c t-13 N o v -1 3 D e c-1 3 Ja n -14 F e b -14 M a r-1 4
P2C Feedback - Not shared a bay/room with patients of opposite sex when admitted Trend 0% 50% 100% A p r-12 M a y-12 Ju n -12 Ju l-12 A u g -12 Se p-12 O ct -1 2 N ov -1 2 D ec -1 2 Ja n -13 Fe b-13 M ar -1 3 A p r-13 M a y-13 Ju n -13 Ju l-13 A u g -13 Se p-13 O ct -1 3 N ov -1 3 D ec -1 3 Ja n -14 Fe b-14 M ar -1 4
P2C Feedback - Not shared a bay/room with patients of opposite sex when moved Trend
Quality and Safety Indicators
Administration of Medicines
Chart 17 shows that Medication incidents are increasing overall but the rate per 10,000 bed days is remaining relatively constant. The Safe Medications Groups, at a corporate and divisional level, monitor and review the individual incidents and where necessary issue alerts to share learning.
Chart 18 shows that overall (96.4%) when asked patients stated that their pain had been kept under control during their stay in hospital. Although it is noted that there has been a reduction in positive responses during the last 12 months.
Chart 19 shows an overall improvement in the number of patients receiving written information about their medications, with 96% in April 2013. This is the highest return during the last 12 months.
Mortality
Chart 20 shows that current mortality rates are decreasing The current figure for January 2013 is 92.7 for Dr Foster and 100 for Healthcare Evaluation Data (HED) Tool.
Both indicators have year to date HSMR as below 100 benchmark. The latest SHMI has been published and this is 1.03 (Band 2 = expected range). The Trust are undertaking further reviews regarding Deaths after Surgery Indicator which identified UHNS as a negative outlier.
Chart 17:Medication Related Adverse Incidents
Chart 18: Patients Pain Under Control
Chart 19: Patients received Written Information
Chart 20: Hospital Standardised Mortality Rate
79 84 77 106 106 85 81 96 78 79 114 101 113 0 20 40 60 80 100 120 140 A pr -1 2 M ay -12 Ju n-12 Ju l-1 2 A ug -1 2 Se p -12 O ct -12 N ov -1 2 D ec -12 Ja n -1 3 Fe b -13 M ar -1 3 A pr -1 3 M ay -13 Ju n-13 Ju l-1 3 A ug -1 3 Se p -13 O ct -13 N ov -1 3 D ec -13 Ja n -1 4 Fe b -14 M ar -1 4
Medication Incidents Reported Rate per 10 ,000 Bed Days
Trend (Medication Incidents)
88% 90% 92% 94% 96% 98% 100% A p r-12 M a y-1 2 Ju n -12 Ju l-12 A u g -12 S e p -1 2 O c t-1 2 N o v -1 2 D ec -1 2 Ja n -13 F e b -1 3 M a r-13 A p r-13 M a y-1 3 Ju n -13 Ju l-13 A u g -13 S e p -1 3 O c t-1 3 N o v -1 3 D e c-1 3 Ja n -14 F e b -1 4 M a r-14
P2C Feedback - Comfortable & pain kept under control Trend
75% 80% 85% 90% 95% 100% A p r-12 M a y-1 2 Ju n -12 Ju l-12 A u g -12 S e p -1 2 O c t-1 2 N o v -1 2 D ec -1 2 Ja n -13 F e b -1 3 M a r-13 A p r-13 M a y-1 3 Ju n -13 Ju l-13 A u g -13 S e p -1 3 O c t-1 3 N o v -1 3 D e c-1 3 Ja n -14 F e b -1 4 M a r-14
P2C Feedback - Explanation/written info about medication Trend
0 20 40 60 80 100 120 140 A p r-11 M a y-1 1 Ju n -1 1 Ju l-1 1 A u g -1 1 S e p -1 1 O c t-1 1 N o v -1 1 D ec -1 1 Ja n -1 2 F eb -1 2 M a r-1 2 A p r-12 M a y-1 2 Ju n -1 2 Ju l-1 2 A u g -1 2 S e p -1 2 O c t-1 2 N o v -1 2 D e c-1 2 Ja n -1 3 F e b -1 3 M a r-1 3 A p r-13
Quality and Safety Indicators
Infection Prevention and Control
Chart 21 shows improving positive feedback from patients in relation to the cleanliness of the wards during Quarter 3.
Whilst it is noted that there was a reduction in July and August 2012 from patients stating that they were encouraged to wash their hands there has been an improvement during the remainder of 2012/13.
Chart 21: Patient Feedback on Cleanliness
Improved compliance with infection prevention and control polices and enhanced practices has resulted in a reduction in hospital acquired MRSA, Clostridium Difficile and E. Coli
There was 1 case of MRSA during April 2013. Occurrences of C-Difficile have continued to reduce and the Trust is within its agreed trajectory.
E-Coli infections continue to remain at low levels, however, MSSA infections have increased for the past 2months.
Chart 22: MRSA Trend
Chart 23: Clostridium Difficile Trend
Chart 24: MSSA Trend
Chart 25: E Coli Trend
0 1 2 3 A pr -1 2 M ay -1 2 Ju n-12 Ju l-1 2 A ug -1 2 Se p-12 O ct -1 2 N ov -1 2 D ec -1 2 Ja n -1 3 Fe b-13 M ar -13 A pr -1 3 M ay -1 3 Ju n-13 Ju l-1 3 A ug -1 3 Se p-13 O ct -1 3 N ov -1 3 D ec -1 3 Ja n -1 4 Fe b-14 M ar -14
MRSA MRSA Rate per 10,000 Bed Days
0.00 0.50 1.00 1.50 2.00 2.50 3.00 3.50 4.00 0 2 4 6 8 10 12 A p r-12 M a y-1 2 Ju n -1 2 Ju l-1 2 A u g -1 2 S ep -1 2 O c t-1 2 N o v -1 2 D ec -1 2 Ja n -1 3 F e b -1 3 M a r-1 3 A p r-13 M a y-1 3 Ju n -1 3 Ju l-1 3 A u g -1 3 S e p -1 3 O c t-1 3 N o v -1 3 D e c-1 3 Ja n -1 4 F eb -1 4 M a r-1 4
MSSA MSSA Rate per 10,000 Bed Days
0 2 4 6 8 10 12 A pr -1 2 M ay -1 2 Ju n-12 Ju l-12 A ug -1 2 Se p-12 O ct -1 2 N ov -1 2 D ec -1 2 Ja n -1 3 Fe b-13 M ar -1 3 A pr -1 3 M ay -1 3 Ju n-13 Ju l-13 A ug -1 3 Se p-13 O ct -1 3 N ov -1 3 D ec -1 3 Ja n -1 4 Fe b-14 M ar -1 4
C.Diff C.Diff Rate p er 10,000 Bed Days
0 2 4 6 8 10 12 14 16 18 A p r-1 2 M a y-1 2 Ju n -1 2 Ju l-1 2 A u g -1 2 S e p -12 O c t-1 2 N o v -1 2 D ec -1 2 Ja n -1 3 F e b -13 M a r-1 3 A p r-1 3 M a y-1 3 Ju n -1 3 Ju l-1 3 A u g -1 3 S e p -13 O c t-1 3 N o v -1 3 D e c-1 3 Ja n -1 4 F e b -14 M a r-1 4
E.Coli E.Coli Rate per 10,00 0 Bed Days
85% 90% 95% 100% A pr -1 2 Ju n-12 A ug -1 2 O ct -1 2 D ec -12 Feb -1 3 A pr -1 3 Ju n-13 A ug -1 3 O ct -1 3 D ec -13 Fe b-14
P2C Feedback - Wards/Clinics were clean P2C Feedback - Staff washed their hands
The University Hospital of North Staffordshire has a programme of Quality Walkabouts, which provide members of the Board and Shadow Governors the opportunity to meet with staff and patients and talk about the service being provided. During April and May wards 102, 108 and 109 received a quality visit.
General Comments
The wards were extremely busy.
The visiting teams were immediately greeted and
assisted at the nurse station.
The staff were very helpful demonstrating a very
positive attitude.
The bays were clean, tidy and free from clutter,
however the main ward thoroughfares were cluttered.
Areas of good practice:
When possible, the sister and junior sister work
supernumerary, which enables them to speak to all patients, checking that they are receiving the care they require and know who to speak to if they have any concerns.
One patient was particularly complimentary about
the way that staff had communicated with him, which ensured that he was involved in his treatment rather being told what would be done to him.
All sluice areas were particularly well organised, with
clearly labelled containers to ensure items are easy to locate
Patients commented that they felt well informed
about their condition and plan of care on all 3 wards visited
The team received very good feedback from patients
about nursing care.
A “Knowing Who We Are” banner was placed at the
main entrance to wards.
100% of staff had received an appraisal.
The following areas for improvement were identified:
Statutory and mandatory training uptake needs to be
improved, the staff agreed to look into the rota arrangements and to see whether time to undertake training can be factored in around handover time.
Organisation of the environment is to be completed
following the recent refurbishment, to de-clutter wherever possible and to ensure that information about the ward is easy to locate.
Staffing levels may need to be reviewed. It was noted
that there have been some leavers recently due to promotions or other.
Quality Notice Boards to be purchased, informing staff
and patients of the wards performance against key quality measures.
Information about the ward routine should be
developed and made available to patients and their relatives.
Quality Walkabouts
Learning from Adverse Incidents
One of the key results from adverse incident reporting is
for the Trust to learn lessons and make
changes to enhance the quality of the care and services provided to prevent similar incidents reoccurring. The section below summarises some of the key actions reported at the Trust’s Risk Management Panel.
While many of the changes may appear minor, it is often the ‘little things’ which can make the difference between a good and a poor experience for our patients along with a shift in culture to one where the
attention to detail does matter.
Following a patient being discharged with a cannula in situ the Trust is to implement a discharge checklist for Children’s Assessment Unit and the use of visual aid magnets to identify that the patient has a cannula. Following an incident re: the monitoring of patients it has been agreed to provide additional refresher Training for Junior Medical Staff and Nursing Staff with regard to the correct use of the Trust’s Modified Early Warning Score (MEWS) chart and MEWS escalation plan
The Trust’s WHO Safer Surgery checklist is to be amended in section 3 to include specific details about the need for blood:
Does the procedure require blood, is it available and
what is its location.
Following the Trust’s MRSA Bacteraemia in April 2013 the following action has been taken. A Palliative care review is to be undertaken by the Clinical Lead for the patient and the specialist Palliative care team to ensure appropriate and timely transfer of patients back to community settings when identified as ‘fast track’.
Mystery Shopper Feedback
This section updates the Board on feedback from Mystery Shops during January. Eighteen Mystery shops were completed in total, fifteen were completed as patients and three from a carer perspective. Feedback was provided on the following experiences :
8 Outpatient Appointments
5 Telephone Contacts
1 Letter
4 In patient stays.
Out Patient Appointments
Reception
8 Mystery Shoppers experienced an outpatient appointment.
Where relevant, all patients stated that:
They were greeted by the receptionist as soon as they approached the desk
They were given a ward and friendly welcome
The receptionist was polite
The receptionist spoke clearly in a way they could understand.
The receptionist had a professional appearance. Where relevant 6 patients stated that:
The receptionist used their preferred name. Where relevant 3 patient stated that:
There was a delay between the time of their appointment and the time they were seen
They all stated that they were not notified of the delay, that no reason for the delay was given and no apology was offered.
About Out Patient Reception, our Mystery Shoppers said : “The automated check in system was used and referred to by the receptionist avoiding duplication.” “Lots of help available at check in, if needed. Good”. “My name wasn’t used at all”.
“We waited 90 minutes over my appointment time. We went to ask why but no reason was given”.
Short delay, although unexplained was acceptable with
call numbers displayed clearly on a large
monitor”.
“Staff appeared helpful at reception desk. Did smile at me. Very busy at job”.
About their Consultant, our Mystery Shoppers said:
“The Dr appeared to be in a rush and although courteous I did not feel I had his full attention”
“The Dr was very polite and well spoken. Gave me results of my recent test, however, hurried from the room before I could ask questions”.
“The Dr was very thorough and explained everything to me”.
“All medical staff must wash their hands before touching a patient. Again this did not happen during my visit or did not see them doing it prior to seeing me”
Telephone Experience
5 Mystery Shoppers had telephone conversations. All patients stated that:
Their telephone call was answered.
They were treated with courtesy and the caller stated their name.
The person calling was polite was avoided jargon.
They were given time to express how they felt and questions answered.
They were redirected if the person answering the call were unable to help
3 patients stated that the caller understood what they needed and provided the information
Consultation
All patients stated that the Consultant:
Gave a warm and friendly welcome, they were polite and they spoke clearly and in away that could be understood.
Had a professional appearance and wore a name badge.
6 patients stated that were referred to by their preferred name.
7 patients stated they were given time to express how they feel and to have their questions answered .
About telephone calls, our Mystery Shoppers said: “The caller was extremely helpful , concerned and polite. She expressed real concern...a leaf should be taken from this ladies book”.
“I was left without the pertinent information over a weekend”
Experience of Letter
Only 1 patient shared their experience about their letter. The Mystery Shopper stated that:
“The letter was clear but there was no explanation of why my appointment has been further deferred or any apology for any inconvenience”
Inpatient Stay
4 Mystery Shoppers had an inpatient experience. All stated that:
They were given a warm and friendly welcome
Were referred to by their preferred name
Staff had a professional appearance and wore name badges.
1 shopper stated that:
The staff were not polite and did not speak clearly and in a way that could be understood.
The staff did not understand what was being asked of them
They were not treated with dignity and respect.
“The overall experience was reasonable as my mother was admitted quickly and efficiently”
“The atmosphere was generally calm so I did not feel in danger”
“Lots of care form the staff. All my medication was given on time so my pain level was good”.
“The one staff nurse was very informative and friendly, the other seemed very disinterested in having any type of conversation with me about anything”
Conclusion
In conclusion , the report shows the focus the Trust has on improving the quality of patient care. The wide range of quality indicators summarised within this report are used on a weekly basis by clinical managers to demonstrate and drive improvements in practice. The regular Quality Walkabouts demonstrates our continued focus on improving the patient experience, and our continued to improving patient safety.
