Open and Honest Care in your Local Hospital

Transcription

1 Open and Honest Care in your Local Hospital 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. Report for: Northern Lincolnshire and Goole NHS Foundation Trust April 215

2 Open and Honest Care at Northern Lincolnshire and Goole NHS Foundation Trust : April 215 This report is based on information from April 215. The information is presented in three key categories: safety, experience and improvement. This report will also signpost you towards additional information about Northern Lincolnshire and Goole 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. 87.9% 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) bacteremia are the most common. 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. The bacteria does 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. 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 infections and are working towards eradicating them; 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 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 3 Annual Improvement target 21 Actual to date 3 For more information please visit:

3 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 24 Category 2 - Category 4 pressure ulcers were acquired during hospital stays. Severity Category 2 Category 3 Category 4 Number of pressure ulcers 2 4 The pressure ulcer numbers include all pressure ulcers that occured from hours after admission to this Trust. So we can 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, 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 bed days: 1.13 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 fall(s) that caused at least 'moderate' harm. Severity Moderate Severe Death Number of falls So we can 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, 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, bed days:.

4 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, after discharge, to be asked: How likely are you to recommend our ward to friends and family if they needed similar care or treatment? We ask this question to patients who have been an in-patient or attended A&E (if applicable) in our Trust. In-patient FFT score* 95.% % recommended This is based on 1287 responses. A&E FFT Score 79.6% % recommended This is based on 1245 responses *This result may have changed since publication, for the latest score please visit: We also asked 317 patients the following questions about their care: % Recommended Were you involved as much as you wanted to be in the decisions about your care and treatment? 96 If you were concerned or anxious about anything while you were in hospital, did you find a member of staff to talk to? 93 Were you given enough privacy when discussing your condition or treatment? 97 During your stay were you treated with compassion by hospital staff? 96 Did you always have access to the call bell when you needed it? 92 Did you get the care you felt you required when you needed it most? 98 How likely are you to recommend our ward/unit to friends and family if they needed similar care or treatment? 99

5 A patient's story This is Tom s experience of his stroke journey to date. He is waiting to go home, pending some final tests. He is amazed at the huge set of notes I am carrying, he cannot believe people could visit hospital so much and begins to tell me how he has not been unwell in his life and what it was like for him. I am normally a fit chap, I still work and in fact I can show those younger lads a thing or two when it comes to grafting. I was out in town to be honest and I got back to the car and felt a bit funny. My right hand was tingling and then it started moving up my arm and into my face. I sat for a b it and it went off. I decided to get back out the car and carry on but it started as soon as I got out. I got back in and drove to the hospital. By the time I got to the car park I couldn t feel my right arm or my face. I parked the car and walked to AE mind you I got some funny looks. I couldn t even walk properly by then, I was limping and staggering. The girl on AE reception gave me a look when I went in as if to say great, another drunk. She quickly realised I was ill though when I told her. She sent me through to a room and a nurse and doctor came immediately. The Doctor got me to do a few things, like grip his ha nds. He told me it sounded like a TIA or a stroke and I needed to go to Scunthorpe. I asked Tom how he felt about that. Well you do think why can t they do it here but it was ok. The only thing is all the TV ads say the first hour is vital and I had already took 15 mins to get to AE, and then the journey to Scunthorpe is 4 minutes. I suppose you would nt normally drive to AE though, the ambulance would take y ou straight to Scunthorpe.I discharged myself once I got to Scunthorpe, the CT scan was normal and I felt back to my old self the wife came and got me. Unfortunately the next morning it happened again and the ambulance took me back to Scunthorpe. I went in the acute bit that is very busy. People moving in and out all the time. That was the Friday; I had another scan an MRI. Now that is a terrible experience really scary, they give you a little emergency thing to get you out of there. The man said keep your eyes shut it s the best way. It s so noisy even with the earphones in squeaks and bangs; it s like being trapped in a sea of dolphins. I thought I would be able to go home if the scan was normal, my wife came at visiting and they said if it still showed nothin g she could take me home. I had aspirin and other than some tingling I felt ok. In the hyper acute bit they came in and said right we need a bed, I put my hand up but at that stage the scan was not back so I couldn t move. The poor lady they did try to move though went right off blood pressure was 75/25, I was watching it on the screen. She went all slumped over- so it was me that moved after all, just round the corner into the ward. Then the nurse came and said my scan wasn t normal and I was staying. They showed me the scan and the doctor explained everyt hing no bigger than a pea the stroke area and hopefully it will revasculise. The girls told me I would go back to Grimsby at 4 pm, well at 7 I was still wa iting, and then they came at 7.3 to say the ambulance was on its way. I went at 11.3 at night, with another chap on a stretcher. Then I have sat all weekend doing absol utely nothing, all day Monday and now I am just waiting for my neck scan and a scan of my heart if they are normal I can go. Staff come to tell him that they cannot tell him the times for his scans today Tom is keen to go. If I could ve had these at the weekend couldn t I have gone home? Instead I have sat, costing the NHS goodness knows how muc h, in a bed probably needed by someone else. But I can t fault the care everyone has been great. I thank Tom for his story and start to walk away. Tom laughs and after shouts after me Can you do something about the porridge though - it s a shocker! Staff experience We asked 29 staff the following questions: % Recommended I would recommend this ward/unit as a place to work 1 I would recommend the standard of care on this ward/unit to a friend or relative if they needed treatment 1 I am satisfied with the quality of care I give to the patients, carers and their families IMPROVEMENT Improvement story: we are listening to our patients and making changes Tom's story gives the Trust significant feedback about a number of things including the quality of our stroke service, the care received, the attitude of the staff caring for him and even the food. We have centralised the stroke service within our locality at the Scunthorpe General Hospital site where stroke patients have access to hyperacute care 24 hours a day, 7 days a week. Prior to this, hyperacute care was inconsistent across the hospital sites and not always accessible. Centralising the service to 1 site has meant that we can focus our specialist resources, equipment, medical and nursing staff to deliver care in the right place and at the right time. The outcome of this change is that the clinical outcomes for patients is much improved. Our team of rapid responders based on the stroke unit are alerted to when an ambulance is bringing a patient to the Emergency Department so that with the advance warning, the responder is available in the department from the point of arrival and can undertake a thorough and speedy assessment. This means that investigations including blood tests and scans can be organised in a timely fashion which aids diagnosis and leads to efficient and effective courses of action including the administration of life-saving thrombolysis treatment where this is indicated. Care and treatment is given within national guidance and support is offered from a stroke consultant either face-to-face or by using video-technology. This means that consistent care and treatment is given, irrespective of the time a patient arrives in the hospital.

6 If a patient is diagnosed with a stroke they are then transferred to the hyperacute area on the stroke ward where a team of specially trained nurses deliver a high standard of care for up to 72 hours. Later, the patients are transferred to another bay in the same ward or transferred to their local hospital for further recovery and rehabilitation. The stroke team is made up of dedicated nurses, doctors, health care assistants and a team of therapists including physiotherapy, occupational therapy, dieticians, pyschologists and speech and language therapists. It is this fantastic team that, working together with patients and carers, helps people to achieve their goals in rehabilitation and ensure the patient is supported until they are discharged from hospital. There is further work being undertaken at present to ensure a more effective process is in place to transfer patients in a timely manner back to their local hospital so they are closer to their family and friends and a more familiar environment to aid their recovery. Supporting information