How To Improve The Trust

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1 Bringing you the latest news about quality and improvement from across the Trust Issue 19: April 2014 Providing high quality, safe services The Trust s Maternity service has just received national recognition for the high standard of its quality and safety. The service is one of only 35 in the country to achieve Level 3 in the Clinical Negligence Scheme for Trusts (CNST) Maternity Clinical Risk Management Standards which is the highest level of compliance in the scheme. The Trust achieved a score of 48 out of 50 in the scheme, which shows mums using the service that Maternity and Neonatal staff are following guidelines for best practice and provision of care, ensuring they are receiving a high quality of safe care. The achievement is the latest for the service in recent months. The CQC s 2013 Maternity Survey highlighted a number of positive findings for our Maternity Service and showed that the overall experiences of women who took part was very good. And earlier this year the Trust achieved Stage 2 accreditation of the UNICEF Baby Friendly Initiative. This means that pregnant women and new mums are receiving more help and advice then ever before about feeding their newborn babies. The NHS Litigation Authority (NHSLA) provides an 'insurance scheme' to NHS Trusts. Through a robust assessment; guidelines, education and risk management are reviewed as these often feature in claims for clinical negligence. Trusts have to meet standards of care that show they are promoting and using effective risk management in order to minimise the risk of harm. Because of the nature of claims in NHS maternity services, a separate set of maternity CNST standards have been devised. The CNST Level 3 achievement has been a long journey with steady progress with key milestones of achievements: The Trust achieved Level 1 in 2010 and Level 2 in February 2012 and received confirmation of Level 3 attainment on 26 March Overall, the CNST Level 3 achievement was accomplished through a team approach and all contributions were invaluable. It was recognised by the NHSLA Assessor that this was a highly deserved Level 3 achievement. Read more about what our staff thought about the news, and what the report said about our Maternity service on Page 2 Quality and Safety Providing the best clinical outcomes, patient safety and patient experience Healthcare Standards Delivering consistently high performance healthcare standards People and Innovation Striving for excellence through people and innovation Community and Partnership Improving the health and wellbeing of our community through partnership Financial Strength Building a sustainable future

2 Top marks for the Trust s Maternity services Achieving Level 3 in the Clinical Negligence Scheme for Trusts (CNST) Maternity Clinical Risk Management Standards reflects the professionalism and commitment of our staff. On this page we will take a closer look at what our staff thought about the news, as well as a bit about what the report said about the Trust s services. You can see some of the team involved in helping the Trust attain Level 3 accreditation in the picture below. From left to right: Rachel Lloyd (Audit & Monitoring Facilitator), Angela Hughes (CNST Midwife), Paula Williams (Guidelines Midwife), Nathalie Watson (CNST Administrator), Jacqui Bolton (Guidelines Midwife), and Mel Eccles (Guidelines Administrator). The CNST report highlighted that audit reports and action plans were of a high quality in general, and that the audit proforma were well structured. It was apparent that they had served the maternity service well in terms of the identification of weakness and blockages in the system. The report added: Particularly impressive was the spread of actions that had been implemented as a result of the audit findings. There is a temptation within the NHS to set a simple solution against a complex problem, which in the long run does not tackle the causative factors and ultimately perpetuates the issues identified. It was clear to the assessors that each deficit identified had been carefully considered and time and effort had been put into drilling down to the root causes and applying meaningful measures to rectify the issues. Another area of good practice is the individual feedback to clinicians where their documentation and/or practice had fallen short; this is done in a supportive way, encouraging learning and reflection. 2 We are delighted to have achieved Level 3, which is a real achievement for all involved who worked hard to demonstrate that we are providing the highest quality and safety of care possible, for mums using our service. This is formal recognition of the quality and safety of our Maternity service. The result demonstrates a high quality of care and also reflects the professionalism and commitment of the clinical and managerial team. We scored 96% well above the 80% pass rate required to achieve the status. Most importantly this means mums using the service can be reassured that they are accessing a high quality and safe Maternity service within Shropshire. The assessment normally takes place over two days but ours was completed in less than five hours, which is testament to the excellent organisation and quality of the evidence we presented. I would like to thank all staff involved Doctors, Midwives, Administrative staff and colleagues in my team for all of their efforts to help ensure high standards of quality and safety. Angela Hughes, CNST Midwife at the Trust

3 April Falls Ward 22 S/R at RSH has developed a back to basics approach to quality and safety on their ward which involves the whole team taking ownership. Carol Aldridge, Ward Manager, said The whole team have risen to the challenge of tackling the quality and safety agenda within the environment of the ward. Carol is keen to link the new initiative into both the challenge of the 6 C s and also ensuring the Trust s values are maintained. A common theme highlighted during a number of Root Cause Analysis which Carol shares at each team meeting, was that nursing risk assessments were not always being completed in a timely manner. It was then agreed that the team would focus each month on a quality/safety issue with the hope that this would improve and enhance practices. A small group each month will focus on a key quality or safety theme. A variety of different approaches to disseminate the information are used to keep the subject fresh and interest high. The team then come up with a title to match their subject. Last month s subject, titled Keep Moving March focused on pressure area management and pressure ulcer prevention. This month s subject April Falls was developed by Sister Claire Newby. It has involved a teaching board on the ward, a resource room which includes up to date literature, journals, and NICE guidelines. The ward team also plan to commence the Fall Safe Training within the next few weeks. It is envisaged that future months will see staff at all levels becoming involved with this initiative. This approach has been welcomed warmly by all staff within the MDT. Forthcoming Months are going to include: Dementia Awareness Fluid & Nutrition Providing the most supportive environments for our patients Helen Coleman, the Trust s Dementia Project Lead Nurse, talks a bit more about what was involved in designing the new Ward 17. Earlier this month the Trust opened the new short stay medical ward (Ward 17) at PRH in the area where the old Management Suite used to be. This was to allow the Gynaecology Ward to be located next to the current Ward 12 area as part of the new Women and Children s Centre. A big part of this new development involved making sure the ward was a dementia friendly environment. This included incorporating a range of design features, such as: shinny speckled floors can create illusions and confusion for patients with dementia, therefore the flooring is matte with a clear boarder to promote independence and safety. to help patients navigate more easily, doors to patient areas have a distinctive colour whilst doors to non patient areas are neutral colours. The signage in the ward is consistent with clear written and pictorial signs on the shower rooms and toilets. The contrasting navy blue toilet seat covers and grab rails in all the shower rooms make it easy for patients to distinguish the sanitary wear, reducing the risk of falls. There are clear faced clocks in all bays and side rooms so that patients can be orientated to time and place. All of the above help support an environment for patients with dementia that can ease some of their anxiety, confusion and disorientation. A big thank you needs to be given to everyone who made the move from Ward 12 to the new Ward 17 such a success. This involved members of the ward team, the Future Configuration Of Hospital Services Project Team, the Estates Department, IT, Domestic Services, and many other volunteers who helped with preparing the ward and with the actual move. 3

4 With a little helps from our Friends... The Trust has been able to buy new equipment thanks to generous donations from the Friends groups at both PRH and RSH. Donations totalling 14, have paid for electronic Patient Status at a Glance (PSAG) touch screens on Day Surgery Wards together at both hospitals, with VitalPAC (Electronic Vital Sign Observations) at RSH. PSAG screens provide the hospital with real time, at a glance, key patient information and have been installed in all adult inpatient wards (excluding Maternity) since In the picture above you can see Dr Edwin Borman, Medical Director, with Staff Nurse Agnieska Dudek demonstrating the latest functionality to be added to the screens. These include the: Doctor Review Medical Criteria for Discharge These functions help to improve the safety of clinical handover by using the screens to input and display key information and tasks relating to patient care and safe discharge. These have been developed in collaboration with two of our consultants, Dr Koottalai Srinivasan and Dr Kevin Eardley. A small gesture can make a very large change Dr Adrian Marsh, Emergency Medicine Consultant, reflects on the success of the recent NHS Change Day events at the Trust. There was a fantastic enthusiasm and support on NHS Change Day. There were over 140 pledges made at the events held on both hospital sites over the two days in March. These pledges have been placed on the intranet, which you can find a link to through the NHS Change Day news article in the news menu. Most of the pledges made focused on how individuals were going to change their behaviour to improve patient care and patient safety. Some of the pledges involved changing practices or introducing new processes to improve patient care. The Trust has already begun to work through these pledges in order to make them happen. One of my favourite pledges made by multiple people was to smile more at work. This is an easily achievable pledge with far reaching benefits. Studies suggest that when people smile the other person finds that person more kind, pleasant, friendly, trustworthy, sincere, and honest and that person is happy. All of these factors are important 4 with daily consultations and care of our patients. This in turn should lead to improved consultations, improved patient care and patient satisfaction. This proves that a small gesture can make a very large change. In six months time we hope to be able to Trust staff supporting the NHS Change Day event at PRH update everyone where we have reached and what were we hope to be in 12 months time. I hope that this will become a yearly event where we can build on our success of this year. You can find out more about NHS Change Day at

5 Safe Care Shropshire The region s health and social care sector came together to reaffirm its commitment at a major conference in the county to provide safe and harm free care to all patients. Sharing best practice was a key focus of Safe Care Shropshire, held on 2 April at Telford Hotel and Golf Resort. The event brought together health professionals, patients and patient representatives from a wide range of organisations across the county and surrounding areas. The conference marked the progress of Safe Care: Harm Free, a county wide partnership charged with tackling the four main harms to patient safety falls, pressure ulcers, catheter associated urinary tract infections (CAUTI) and Venous Thromboembolism (blood clots). Safe Care: Harm Free came about as part of the national Harm Free Care programme that challenged NHS trusts to deliver harm free care to all patients, but with a target of at least 95%. The event featured a keynote address from Elaine Inglesby Burke, Executive Nurse Director at Salford Royal NHS Foundation Trust, and a series of expert speakers, who spoke about the main harms to patient safety and the importance of nutrition and hydration to patients. The event also promoted the role of Care Makers. These are healthcare staff who underlined the importance of compassion in practice at the event. Care Makers are selected for their ability to demonstrate and advocate the 6Cs of nursing in their practice and in their own personal beliefs. The 6Cs are: Care Compassion Competence Communication Courage Commitment Safe Care: Harm Free is a partnership of health commissioners (Shropshire CCG and Telford & Wrekin CCG); providers (Shropshire Community Health NHS Trust, The Shrewsbury and Telford Hospital NHS Trust and The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust); other local organisations (Shropshire Partners in Care, Healthwatch Shropshire, Healthwatch Telford and Wrekin, Shropshire Council, Telford & Wrekin Council); and patient representatives. Updates from across the Trust New Director appointed: Sarah Bloomfield has been appointed as the Trust s Director of Nursing and Quality. Sarah has been conducting the role on an Acting basis for some months and has now been successfully appointed to the role on a substantive basis. Are you planning for your retirement? The Trust, together with Oak Tree Financial Training, has organised a course to help guide you through the financial complexities of retirement in a clear and jargon free way. The course will take place on 14 May in the Education Centre at PRH, and on 19 May in the SECC at RSH. Both sessions will run between 9.30am and 1.30pm. The course will cover the financial implications of retirement including: State pensions and allowances Company pensions Investments and savings Insurance and other benefits Wealth preservation, wills and succession planning Long term care and inheritance tax Numbers are limited for each session of the course. Places can be booked via the Training Diary on the intranet. For more information please call Sue Pugh on ext Improvements work at RSH: Works to the stairs immediately in front of Elizabeth House, the doors to Elizabeth House and the door at the top of the staircase are taking place over the next few weeks to improve disabled access. Access will still be possible around these areas over this period but please be particularly aware of the following works: Electrical works to the doors into Elizabeth House and top of the staircase week commencing 22 April 2014 between 8am and 5pm. Concrete base for lift 26 April 2014 between 8am and 5pm, barriers will be placed around the concrete. Access to the above area will still be possible and the contractors will maintain safe access for all users. Doors will remain in operation as they currently are and will be unaffected. 5