Quality summary report: Rehabilitation

Transcription

1 Quality summary report: Rehabilitation CLCH Quality Report Jan Dec 2011 Service exact name Address line 1 Address line 2 Town/city County Postcode No. beds Website Community Rehabilitation including Early Supported Discharge for Stroke, Community Rehabilitation, Choices Vocational Rehabilitation, Early Supported Rehabilitation, Neurological Rehabilitation. London London N/A Main telephone Completed by Approval Louise Turpin-Clifford Professional Lead for Occupational therapy Service Manager Ann Duncan and Marina Tempia Associate Directors for Adults Portfolio 1

2 CLCH Quality Report 2011 Summary report for Community Rehabilitation Services Directorate Adults 1 Service area Community Rehabilitation and Neuro Rehabilitation. In two of the three boroughs there are separate Neuro rehab teams and in one borough there is no separation. Therefore this report includes all services. This may need to be readjusted for next year as neuro rehab is quiet a separate patient group diagnosis and follow different treatment programmes. Early supported Discharge for stroke and Early supported Rehabilitation is provided in Westminster only. Choices for Vocational Rehab is provide in Hammersmith and Fulham only. Boroughs Barnet Kensington & Chelsea Hammersmith & Fulham Westminster CQC statement of purpose for this service Overall summary of quality performance and next steps The services are for 16/18 years+, live in the borough and able to participate in rehabilitation. Be medically stable, Have a home that is safe and conductive for rehabilitation treatment to be provided and meet the criteria of the service specification. Progress: All services using GAS as the PROM of choice across CLCH Development of Stroke reviews post 6 months of discharge Identifying NICE champions in the service Single point of entry Developing rotations across all the boroughs Improving patient feedback Completing patient stories

3 Safety Overview We aim to make our service as safe as possible at all times. Key achievements this year We identified the following safety improvement actions in our 2010 Quality Report. This section outlines the progress we have made on each of them: Improve discharge processes from hospitals to the community Actions 2011: Explore option of being able to feedback as an organisation rather than individual services for incidents which are external to CLCH i.e. discharge pathways - This work is on going Establish clear pathways for incidents related to poor discharges. Against this work is going and being strengthened by the work of the pathway leads working in acute care closer to home Action 2012: Staff will know and have robust consistent approach to reporting unsafe hospital discharges as well as getting feedback on their reporting Key results Total incidents Jan-Dec 2011 by category Total Number of Incidents: 227 Total number of Near Misses: 57 (25%)

4 of incidents Jan-Dec 2011 by severity Tot al nu mb er Low Minor Medium High Catastrophic Level of reporting In this service, incidents and near misses are recorded ain the majority of cases. The most number of incidents across community rehab relate do to falls which does not always directly relate to falls during a treatment programme sometimes rather than a reported fall or coming across someone who has fallen on a home visit. Safe Guarding for adults risks being highlighted through Datix is becoming

5 more common which could mean the safe guarding adults agenda is being highlighted appropriately. More work about the process of alerting safe guarding concerns needs to be completed with staff so confidence about the process can improve but also so two way feedback is received when a referral is made. The patients that are referred to the community following discharge from hospital are also highlighted as a significant issue for staff. More work with the pathway leads on this will be completed throughout the year. It is interesting to note that the two patient stories completed for the Early Supported Rehab team (ESRT) also highlighted this as an issue. Of particular concern is the lack of equipment and follow up /onward referral. Safety Action Expected Named lead Improvement completion Actions for date 2012 Staff will know and have robust consistent Dec 2012 Service approach to reporting unsafe hospital discharges Managers as well as getting feedback on their reporting. All staff will have PDPR with a year. A variety of Dec 2012 Service training sessions will be offered in house for staff managers/ and include profession specific and MDT training Professional for appropriately identified training needs. leads Datix reports will continue to increase and Dec 2012 Professional feedback and learning be an integral part of Team Leadership Leads Clinical Audit across rehab service s to be Dec 2012 Professional identified possible within each specialty e.g. Community Rehab, Neuro etc Leads

6 Effectiveness Overview Key achievements this year We aim to achieve the best possible outcomes for patients. To do this, we regularly check to see that we are delivering care and treatment according to best practice standards, and we increasingly look to measure and improve clinical and patient reported outcomes. We identified the following clinical effectiveness improvement actions in our 2010 Quality Report. This section outlines the progress we have made on each of them: 1) Strengthen results of clinical and patient reported outcomes Actions 2011: Development of a consistent approaches to data collection in particular in relation to patient and clinical reported outcomes. All staff now use GAS as their PROM Actions 2012: Audit across services about patient involvement in goal setting Actions 2011: Engage with IT to identify and implement a consistent system for recording/data processing of clinical and patient reported outcomes. GAS is now the PROM of choice for all bedded services. Actions for 2012 Consistent approach across all rehab services to GAS goals and recording on a data base to be included in business plans and monitored ¼. Action 2011: Hone a basket of outcomes measures to specific service areas to ensure measures are used consistently across CLCH This is work in progress Currently different teams use different outcome measured specific to their profession or team which need to come together to be co-ordinated and used and reporting system needs to be put in place for this to be gathered Key results Patient Reported Outcome Measures (PROMs) Community Rehabilitation services are now regularly using the Goal Attainment Score (GAS) as their PROM. However there remains inconsistent reporting of the PROM on a central

7 database, which limits the conclusions which can be drawn. From the information we had a sample of the information from a community rehab team can be found below 509 clients had a total of 764 goals agreed. 83% of these goals achieved a score of 10 or more which is a meaningful change. Actions 2012: Ensure robust reporting of GAS on a central database to ensure we are capturing all the data. Actions 2012: Improve engagement with patients about their treatment plans and therapy Actions 2012: Improve the number of GAS Goals that patients have completed with them to 85% Clinical Outcomes From the data available approximately 37% of patients have further outcome measure as well as or as instead of the GAS goals. These included the TUAG (timed up and go), the Bartle, AMPS(assessment of Motor and process skills - specific to Occupational Therapy Clinical Audit Participation in Trust-wide audits during 2011 The Community Rehabilitation Service took part in the health Records audit. The results are as follows: Service Community Rehabilitation Community Rehab Neuro Number of Health Mean compliance rate Records audited 75 72% 15 73% This year our clinical audit plan has focused on the following audits: 1) NICE Guidelines Implementation Audit for Dementia 2011

8 2) NICE Guidelines Implementation Audit for Multiple Sclerosis ) NICE Guidelines Implementation Audit for Parkinson s Disease 2011 Conclusions from the three above audits The CRS has achieved 100% compliance in more areas than shown in previous audits and continues to show a significant improvement in many comparable areas. This is largely due to better documentation of care and full use of the MDT assessment form. Many areas of compliance would be further improved if the CRS assessment form was fully completed by every therapist. A thorough induction for all new/rotational staff on the importance of the MDT assessment & its link with increasing compliance with NICE guidelines may assist with further improvement of results and better care for patients. Discipline specific assessment and treatment tools to use with clients with Multiple Sclerosis (and if appropriate Dementia and Parkinson s Disease) may further improve our compliance with the care pathways for each condition. This would need to be looked at in more detail and implemented on a trial basis throughout NICE compliance The following NICE guidance is either fully or partially relevant to this service: NICE Guidance and reporting are inconsistent across the community rehab teams and patch. With the identity of NICE champions since January 2012 this should now not only have a more consistent approach to measuring the compliance across teams but also allow for implementation of best practise in areas that are not meeting relevant guidance. Code Title Borough H&F K&C West CG1 and Schizophrenia G CG82 CG2 Infection Control G G G CG8 Multiple sclerosis G G G CG21 Falls: NICE guideline A G CG35 Parkinson's disease G G G CG42 Dementia G

9 CG59 Osteoarthritis: NICE guideline G CG66 & Type 2 diabetes: the G G CG87 management of type 2 diabetes (update) CG68 Stroke G G G CG90 Depression in adults (update) G CG91 Depression with a chronic G physical health problem CG96 Neuropathic pain - G G pharmacological management CG101 Chronic obstructive G G pulmonary disease (update) CG109 Transient loss of G consciousness in adults and young people PH1 Brief interventions and G G G referral for smoking cessation PH10 Smoking cessation services G G G PH16 Mental wellbeing and older people G Research and innovation We had one Occupational Therapist and one Physiotherapist finish an MSC this year and another who is completing a PHD. Several staff have been on MSC course or are completing paper relevant to their areas of work and we are looking at supporting more in the future. What the patients say about the outcomes of their care and treatment Thanks to the help of the rehab team members I am learning to get back on with life... Nxx is a brilliant father figure who has advised and taught me how to survive with day to fay living, whether cooking or personal care. They see so many like me but manage their time so well, they have impeccable manners, they never lapse and always seem to have high standards. I have become very attached to them as they are angels and I thought you should know... Wonderful service from Rehab Assistant,...giving me the confidence to walk to

10 the shops to buy some bananas. I would like to compliment her on her natural supportive and encouraging teaching ability that ensured I had the confidence and skill to carry out the tasks we were working on. Customer wants to pass on his Mother's appreciation and thanks for the department s efforts in getting her mobile again. Clinical Effectiveness improvement actions Actions Recording of PROMS in a central database Expected Named completion lead date End of 2012 Louise Turpin Audit across services about patient involvement in goal setting End of 2012 Louise Turpin Improve engagement with patients about their treatment plans and therapy End of 2012 Louise Turpin Improve the number of GAS Goals that patients have completed with them to 85% End of 2012 Louise Turpin Experience Overview Key achievemen ts this year We care about treating everybody with kindness, dignity and respect at all times. We identified the following patient experience improvement actions in our 2010 Quality Report. This section outlines the progress we have made on each of them: Involve patients more in designing and managing their own care No decisions about me without me

11 Actions 2011: Ensure all compliments are sent to on a regular basis for collation by PALS. Feedback from staff is that this is being completed need to ensure staff are reminded to do this and have system to ensure this happens Patient survey results Patient surveys (known as Patient Reported Experience Measures PREMs) Summary of results for core patient experience measures (Aug-Dec 2011) Question Result for this service Trust-wide average % patients/carers rating overall experience good or excellent % patients saying they were definitely involved in planning their treatment % patients saying they were always treated with dignity & respect % patients saying they definitely understood explanation 63% 93% 64% 56% 95% 92% 91% 88% % patients satisfied with waiting time 83% 74% Interpretation of PREM results Staff report involving patients in the majority of their decision. It is evident from the PROMs that a third of patients still do not believe they have been involved in their process of decision making about their treatment. More work will be completed on this throughout the year including an audit of notes and paper work to ascertain how much involvement is really done. This will be completed on the back of some work completed in a smaller team last year. It may mean that some training needs are identified which our training department can assist with involve some training. There has been a drop in the amount of people who rate the service overall as good or excellent. This is disappointing we need to ensure we that we keep our

12 standards up and as much as possible and more availability to support staff will be made. PREM methodology Anyone who is discharged from the service is handed a PREM for completion with a self-addressed stamped envelope. Discussion with the team about how to ensure as many are handed over as possible as well as to encourage clients to fill them out have been had throughout the year. All staff now carry PREMS with them in case of unexpected discharges and are encouraged to discuss the PREM and its importance with clients when they give them out. Complimen ts and Complaints Compliments and Complaints There were 4 formal complaints received about her rehab service over the last year all. All were resolved with the clients and resulted in one staff member receiving some extra support and training. The service received numerous compliments: After not seeing anyone about my condition and getting a bit low at times I now know that I can get help which is good k.. And I.. And their team were professional, highly competent and extremely helpful, kind and considerate. A wonderful example and credit to NHS' very helpful service and very friendly physio Dear J B (physio)...the equipment you provided is very satisfactory and I am grateful for all the time you gave to us. Dear NC I should like to put on record how grateful I am for the help given me by MP (Physiotherapist).She is an asset to the service. Other qualitative feedback This is something the community rehab teams will need to focus on in the coming year and will include patient stories.

13 What the patients say I am writing to thank you and your team so much for the most excellent help in enabling my movement and well-being. Both the Physio, CD, and Occupational Therapist, S G, were extremely helpful and diligent in their attention.... Thank-you so much for arranging the hydro-therapy, the brace helps. Can't ask for more care and attention than you have given me. Many, many, many thanks. A and L - just a thank you note to let you know how much we appreciate your care... R is so happy, looks like he's got a new leg. He can walk so much better... You re doing a great job. Patient Actions Expected Name experience completion d lead Improveme date nt Actions Audit Patient involvement in treatment and action plan after Dec 2012 Team further findings Leads Ensure other ways of collecting patient feedback are Dec 2012 All completed e.g. patient stories Team memb ers