Open and Honest Care in your Local Hospital

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1 Open and Honest Care in your Local Hospital Report for: Bradford Teaching Hospitals NHS Foundation Trust The Open and Honest Care: Driving Improvement Programme aims to support organisations to become more transparent and consistent in publishing safety, experience and improvement data; with the overall aim of improving care, practice and culture. April, 2015

2 This report is based on information from April The information is presented in three key categories: safety, experience and improvement. This report will also signpost you towards additional information about Bradford Teaching Hospitals NHS Foundation Trust s performance. 1. SAFETY Safety Thermometer On one day each month we check to see how many of our patients suffered certain types of harm whilst in our care. We call this the NHS Safety Thermometer. The safety thermometer looks at four harms: pressure ulcers, falls, blood clots and urine infections for those patients who have a urinary catheter in place. This helps us to understand where we need to make improvements. The score below shows the percentage of patients who did not experience any harms. 91.7% of patients did not experience any of the four harms For more information, including a breakdown by category, please visit: Health care associated infections (HCAIs) HCAIs are infections acquired as a result of healthcare interventions. Clostridium difficile (C.difficile) and methicillin-resistant staphylococcus aureus (MRSA) bacteraemia are nationally monitored as we are trying to reduce the incidence of these infections. C.difficile is a type of bacterial infection that can affect the digestive system, causing diarrhoea, fever and painful abdominal cramps - and sometimes more serious complications. These bacteria do not normally affect healthy people, but because some antibiotics remove the 'good bacteria' in the gut that protect against C.difficile, people on these antibiotics are at greater risk. This means that some patients may get C.difficile despite having all appropriate care, because they need to have these antibiotics to treat their condition. Therefore for each case of C.difficile that occurs, we do a post infection review (PIR), to find out whether the case was avoidable or not, and to identify whether there aspects of care that we need to improve. The MRSA bacteria is often carried on the skin and inside the nose and throat. It is a particular problem in hospitals because if it gets into a break in the skin it can cause serious infections and blood poisoning. It is also more difficult to treat than other bacterial infections as it is resistant to a number of widely-used antibiotics. We have a zero tolerance policy to MRSA bacteraemia infections and are working towards reducing C Difficile infections; part of this process is to set improvement targets. If the number of actual cases is greater than the target then we have not improved enough. The cases that are found to be unavoidable do not count against the target. Page 2 of 14

3 The table below shows the number of infections we have had this month, plus the improvement target and results for the year to date. C.difficile MRSA This month 0 (5 cases currently under 0 post infection review) Annual Improvement target 51 0 Actual to date 0 0 For more information please visit: Bradford Teaching Hospitals NHS Foundation Trust Pressure ulcers Pressure ulcers are localised injuries to the skin and/or underlying tissue as a result of pressure. They are sometimes known as bedsores. They can be classified into four categories, with one being the least severe and four being the most severe. The pressure ulcers reported include all validated avoidable/unavoidable pressure ulcers that were obtained at any time during a hospital admission that were not present on initial assessment. This month 17 Category 2 - Category 4 pressure ulcers were acquired during hospital stays Severity Number of pressure ulcers Category 2 12 Category 3 5 Category 4 0 The pressure ulcer numbers include all pressure ulcers that occurred from 0 hours after admission to this Trust In order to know if we are improving even if the number of patients we are caring for goes up or down, we also calculate an average called 'rate per 1,000 occupied bed days'. This allows us to compare our improvement over time, but cannot be used to compare us with other hospitals, as their staff may report pressure ulcers in different ways, and their patients may be more or less vulnerable to developing pressure ulcers than our patients. For example, other hospitals may have younger or older patient populations, who are more or less mobile, or are undergoing treatment for different illnesses. Rate per 1,000 bed days Page 3 of 14

4 Falls This measure includes all falls in the hospital that resulted in injury, categorised as moderate, severe or death, regardless of cause. This includes avoidable and unavoidable falls sustained at any time during the hospital admission. This month we reported 1 fall(s) that caused at least 'moderate' harm Severity Number of falls Moderate 1 Severe 0 Death 0 In order to know if we are improving even if the number of patients we are caring for goes up or down, we also calculate an average called 'rate per 1,000 occupied bed days'. This allows us to compare our improvement over time, but cannot be used to compare us with other hospitals, as their staff may report falls in different ways, and their patients may be more or less vulnerable to falling than our patients. For example, other hospitals may have younger or older patient populations, who are more or less mobile, or are undergoing treatment for different illnesses. Rate per 1,000 bed days 0.05 Safe Staffing Guidelines recently produced by the National Institute for Health & Care Excellence (NICE) make recommendations that focus on safe nursing for adult wards in acute hospitals and maternity settings. As part of the guidance we are required to publish monthly reports showing the registered nurses/midwives and unregistered nurses we have working in each area. The information included in the report shows the monthly planned staffing hours in comparison with the monthly actual staffing hours worked on each ward and/or the percentage of shifts meeting the safe staffing guidelines. In order to view our reports please visit: Safe Staffing Data Page 4 of 14

5 2. EXPERIENCE To measure patient and staff experience we ask a number of questions. The idea is simple: if you like using a certain product or doing business with a particular company you like to share this experience with others. The answers given are used to give a score which is the percentage of patients who responded that they would recommend our service to their friends and family. Patient experience The Friends and Family Test The Friends and Family Test (FFT) requires all patients to be asked, at periodic points or following discharge, How likely are you to recommend our ward/a&e/service/organisation to friends and family if they needed similar care or treatment? In-patient FFT percentage recommended * 100 % recommended This is based on 1183 responses A&E FFT percentage recommended 80 % recommended This is based on 114 responses *This result may have changed since publication, for the latest score please visit: We also asked 588 patients the following questions about their care % Positive Responses Were you involved as much as you wanted to be in the decisions about your care and treatment? 90 If you were concerned or anxious about anything while you were in hospital, did you find a member of staff to talk 74 to? Were you given enough privacy when being examined, treated or discussing your care? 97 During your stay were you treated with compassion by hospital staff? NA Did you always have access to the call bell when you needed it? NA Did you get the care you felt you required when you needed it most? NA How likely are you to recommend our ward/unit to friends and family if they needed similar care or treatment? NA Page 5 of 14

6 A patient's story Priyanka s Story was told at the meeting of the Trust Board on Priyanka is 5 years old and a patient of the Yorkshire Auditory Implant Service and related services at the Trust her parents were shocked when she was diagnosed with profound hearing loss in both ears due to a genetic mutation. At 14 months old Priyanka had bilateral cochlear implants fitted. What stood out to them as being good about their experience? - home visits from the team - always being able to contact the team easily for timely support or advice by phone or , especially as they do not live close to the hospital & travel was difficult this meant they never felt lost or alone in what they were facing - good infrastructure, support and the flow of care getting the practical things right - the parent and child-friendly environment - the though put into recognising what could go wrong, and how to provide support when it does - good liaison between medical and education services. What did they think we could improve or change? - Developing extra information in simple language for parents to take away, to help reduce uncertainty and anxiety about the post-cochlear implant journey parents and others can feel what is it we are supposed to do? and be unsure what their expectations should be - Develop more virtual support in some way for example via phone or online - Provide more learning and support for audiologists to work with children who are similarly emotionally or behaviourally affected, or to match audiologists who have the right skills, experience and approach to work with children who need a different approach. Page 6 of 14

7 - Make the assessment process more flexible and child-friendly at the moment it feels a bit formal, and children may not respond well to this sort of approach and environment. Know and use materials that reflect children s current interest trends, and know what the specific child is interested in to connect and build a relationship. - Improve communication across services/departments/organisations so the right information is always in the right place at the right time - Don t forget to always think about what it is like from the parent or patient s point of view, and respond with kindness Today Priyanka is well established in her speech and listening abilities and her parents say it is hard to believe that she is profoundly deaf. They feel that this is only because of the right and timely support and infrastructure in place, coupled with their intense hard work as parents, following the guidance from staff in the services they use. In a letter to the Trust they said: Priyanka is lucky to have each and every one of you in her life. Your constant support, efficient service and guidance has helped to make the world a comfortable and happy place for Priyanka and as her parents it has made our parenting journey that bit easier and helped to keep the focus on keeping Priyanka happy, healthy and unconditionally loved. What one thing would they like us to remember from their story? Every time you encounter a patient, always have the attitude of I am going to make a difference to this person s life a positive difference. Page 7 of 14

8 Staff experience The Friends and Family Test The Friends and Family Test (FFT) requires staff to be asked, at periodic points: How likely are you to recommend our organisation to friends and family if they needed care or treatment? and How likely are you to recommend our organisation to friends and family as a place to work? FFT percentage recommended care* 73 % recommended This is based on 441 responses FFT percentage recommended work* 59 % recommended This is based on 441 responses *This result may have changed since publication, for the latest score please visit: We asked 310 staff the following questions % Recommended Would you recommend this ward/unit as a place to work? 62 Would you recommend the standard of care on this ward/unit to a friend or relative if they needed treatment? 68 Are you satisfied with the quality of care you give to the patients, carers and their families? 86 Page 8 of 14

9 3. IMPROVEMENT Improvement story: we are listening to our patients and making changes THINK GLUCOSE UPDATE APRIL 2015 Think Glucose is a national initiative developed between the National Institute for Innovation and Improvement, NHS Diabetes and Diabetes UK. Think Glucose aims to improve the care, outcomes and experience of people with diabetes admitted to hospital with non-diabetes related problems. Why Think Glucose was implemented Evidence from Diabetes UK (2009) shows patients with diabetes regularly report poor experience, disempowerment and dissatisfaction during hospital stays. This was evident within BTHFT; multiple instances of harm have been caused to patients, including death. The majority of these incidents can be attributed to poor knowledge amongst nursing and medical staff resulting in mismanagement of diabetes. Nationally 4% of the population has diabetes; within Bradford this is significantly higher at 5.5% due to a number of demographic reasons. People with diabetes are more likely to be admitted to hospital acutely and for elective procedures, and generally tend to stay in for longer. Nationally this is up to 2.6 days. Insulin is one of the drugs most frequently involved in medication related adverse incidents in the NHS, resulting in serious harm including death Think Glucose: the Bradford Model In order to achieve the Think Glucose goals a number of tools and initiatives were developed and implemented. An evaluation of the project pilot demonstrated improved staff knowledge, better patient experience and confidence in self-care, more appropriate timing of insulin doses, and timely referral to the Diabetes Team. It also demonstrated a small reduction in length of stay for patients with diabetes, and a reduction in prescribing errors. Page 9 of 14

10 From the roll out of the model, training rates have increased significantly within the hospital divisions and the number of referrals to the diabetes team has consistently improved from per month to per month. Improved patient satisfaction - Patients involved in care planning process. The diabetes specific care plans aim to encourage the involvement in patients in decisions regarding their care. There are two care plans (one for patients treated with insulin and one for patients who are non-insulin treated), which also act as prompts to ensure staff provide appropriate care/monitoring whilst encouraging patients to maintain control of their own diabetes. Anecdotal feedback from staff is that they find them helpful and a useful prompt. A Diabetes what care to Expect in Hospital Leaflet has been designed to provide patients with information regarding their hospital stay. These are now available copies have been provided to all inpatient ward areas and surgical pre-assessment units. The local Community Diabetes team also have a supply and have agreed to give these to patients attending their X-pert education sessions. Contact numbers of the Diabetes team are on the leaflet meaning patient can self-refer if they want to during an inpatient stay Page 10 of 14

11 Patient Satisfaction Questionnaire Responses Responses show an overall improvement in patient satisfaction, although it is recognised that there remain areas for improvement, particularly involvement in care planning and foot examination. Question Survey Undertaken Yes or most of the time: Were you satisfied with overall care of your Diabetes? Do you feel you ve been involved in your Diabetes care plan? Do staff caring for you know enough about Diabetes to meet your needs. Correct treatment of any high or low glucose levels: Patients have had their feet examined by a doctor or nurse: Initial project baseline January 2010: 75.3% April % Initial project baseline January 2010: 62.5% April % Initial project baseline January 2010: 44% April % September 2014: 92.3% April % Initial project baseline January 2010: 6% April % Page 11 of 14

12 Supporting information SAFE! Programme Overview During future months of the Bradford Teaching Hospitals NHS Foundation Trust Open and Honest Care publication we will be sharing information about the trust s on going improvement work. This month to set the scene we are sharing the work of our SAFE programme. This highlights the different areas of work within the trust that will be referred to in future publications. The SAFE! Campaign has been underway since It was initially developed in response to a serious incident which resulted in the death of a young patient. This showed unacceptable failings in the provision of basic care and highlighted that the Foundation Trust needed to act. Incident and inquest data continues to show that while significant progress has been achieved, further improvements can still be made. In 2014/2015 the programme has been reinvigorated reflecting on the evaluation of the first years of the SAFE! campaign and other quality and patient safety initiatives that the organisation has been involved in. The revised SAFE! Programme aims to build on the improvements that have already been made and continue to enhance patient care and patient experience through the use of quality improvement methodology to ensure continuous, measurable and sustainable improvements. The SAFE! Programme consists of six work streams: Management of the Deteriorating Patient; Safer Procedures Medication Safety Safety Culture Management of Long Term Conditions Mortality Review SAFE! Programme Work-streams Page 12 of 14

13 Management of the Deteriorating Patient This work-stream will cover the early and timely recognition of deteriorating patients and the management and treatment of patients, whose condition is deteriorating, with the aim of improving patient outcomes and reducing the incidence of avoidable deterioration. For 2015, the Foundation Trust is committed to participating in the NHS QUEST Breakthrough Series Collaborative on the management of the deteriorating patient, focusing on sepsis (blood borne infection) and cardiac arrests. In addition the Foundation Trust will be focusing on getting the basics right in a work-stream on the early detection and management of the deteriorating patient. Safer Procedures This work-stream will cover all elements of a patient s journey through a surgical procedure including pre-assessment; the procedure itself and post-operative care. The aim of this work-stream is to reduce the avoidable harm associated with surgical procedures and to ensure we comply with best practice guidance to improve quality and care for patients undergoing procedures, whilst also improving communication and teamwork. For 2015, this work-stream will be focusing on sustaining the implementation of the WHO Surgical Checklist (which is a safety checklist to ensure all aspects of safety are undertaken before and operation or procedure), across all surgical procedures and ensuring that the process of obtaining consent from patients about to undergo a surgical procedure is undertaken according to best practice. Medication Safety This work-stream will cover all areas related to medicine safety including the measuring of high risk medicines through the Medication Safety Thermometer. The aim of this work-stream is to reduce harm associated with medication and to monitor those medications that could cause substantial harm if used inappropriately. For 2015, this work-stream will focus on the use of intravenous fluids (IV drip) across the organisation and will streamline the current process of managing those fluids to patients requiring both quick administration (resuscitation) and continuous use (maintenance). Page 13 of 14

14 Safety Culture This work-stream will use the information that has been learned from the Mid Staffordshire Inquiry into poor care (Francis, 2012); to inform a change in culture with the aim of moving towards a more positive culture that supports its staff, patients and patient representatives. In 2015, this work-stream will focus on Executive level engagement with frontline staff through a leadership walk-round programme; learn from the experiences of patients perceptions about hospital safety through the Patient Reporting and Action for a Safer Environment (PRASE) project; identify more supportive ways to deal with staff after medication errors have been identified to develop learning through the management of medication errors project and promote the positive culture that already exists in this organisation through the Above & Beyond project. Management of Long Term Conditions This work-stream will cover topics related to long term conditions. It will look at individual conditions as well as the patient pathway between primary and secondary care with the aim of improving the quality of care received by patients who are managing their long term condition and smoothing the process at admission and discharge from hospital. In 2015, this work-stream will focus on the existing work undertaken in the Think Glucose project which looks at improving the management of diabetic patients; it will also focus on venous thromboembolism (VTE) (formation of blood clots) assessment and management to improve the quality of treatment patients receive within the organisation. Mortality Review This work-stream focuses on the review of patients medical notes after their death with the aim of learning from the patients journey, identifying areas for improvement and making changes to current processes to improve the quality and safety of patients care. In 2015, this work stream will look at different ways of reviewing patients medical records to establish a system whereby the patient s journey can be recorded to obtain learning that will help us make improvements in care for others. Page 14 of 14