Quality summary report: Tuberculosis Nursing Service CLCH Quality Report Jan Dec 2011 Service exact name Tuberculosis Nursing Service Address line 1 Address line 2 Town/city County Postcode No. beds Website 5 th Floor Hammersmith House Hammersmith Hospital Du Cane Road London W12 0HS N/A www.clch.nhs.uk Main telephone 020 8 383 3074 Completed by Gloria-Anne Cox Service Manager for Tuberculosis Nursing Service Approval Joanne Jones Associate Director of Adults Services Portfolio 2
CLCH Quality Report 2011 Summary report for Tuberculosis Nursing Service Directorate Adults 2 Service area TB Nursing Service Boroughs Barnet Kensington & Chelsea Hammersmith & Fulham Westminster CQC statement of purpose for this service The Tuberculosis (TB) Nursing Service is a specialist service that provides care and support to all patients who have suspected or a confirmed diagnosed of TB. The service offers a range of interventions in both an in-patient and out-patient setting. Patients are offered on-going support during the clinical investigations and throughout their treatment. This is through both face to face contact and telephone advice. The TB Nursing service also provides counselling support for patients to help cope with the diagnosis of TB. The TB nursing Service also advocates health promotion and for example takes a preventative approach to TB by undertaking routine BCG vaccinations for children from high risks groups. The service is provided as both in-patient and out-patient and is based at Hammersmith Hospital & Charing Cross Hospital. The service aims to provide the highest level of care to patients and support for their families. Key areas of the service include; 1) Any patient considered to be infectious will be seen within 24 hours of referral 2) Each patient has a care plan detailing the care pathway for the duration of treatment 3) Each patient has a named nurse 4) GP services are kept informed of current treatment plans Overall summary of Safety As part of improving safety for both patients and the public the service has
quality performance and next steps developed information leaflets and counselling letters in the most commonly spoken languages, so that patients understand all aspects of their treatment, for example the medication dosages and side effects. This ensures that patients with TB have access to a service which will provide clinical and practical support, alongside appropriate medication, to prevent the spread of infection to the public. Effectiveness In order to achieve the most effective service, treatment and outcomes as possible the service always follows local guidelines and best practice policy when managing our patients The service has also made various quality improvement actions targeting the effectiveness of the service, these include developing formal paediatric nurse led support clinics, implementing adult prescriptions and improving patient correspondences. Experience The service aims for patients to experience a high level of satisfaction in the service, which helps engage patients in their treatment and ensures good compliance and completion rates. This can be demonstrated by the results of the Patient Reported Experience Measures (PREMs), which shows that 97% of respondents rated their experience of the service either good or excellent. The service has also implemented various actions to improve the experience that patients have of the service, these include developing nurse led support clinics and providing patient information in 7 commonly used languages. Safety Overview We aim to make our service as safe and accessible as possible at all times. By providing an accessible service we ensure that patients with TB have access to a service which will provide clinical and practical support alongside appropriate
medication to prevent the spread of infection to the public. Therefore as part of improving safety for both patients and the public we have developed information leaflets and counselling letters in several most commonly spoken languages. This is to ensure that patients understand all aspects of their treatment, for example the medication dosages and side effects. We encourage the importance of reporting incidents and near misses through the online reporting system (Datix) and we follow the Incident Reporting and Management Policy. We also have a professional responsibility for continual professional development and ensure we keep up to date with local and national guidance on the management of TB as well as attending training sessions such as Infection Prevention updates. Key achieveme nts this year The service did not complete a quality report last year but has implemented various quality improvement actions with the aim of increasing the safety of the service, these actions include: Developed nurse led clinics for paediatric patients: The nurse led clinics for paediatric patients were set up as result of discussion with the paediatric team and following best practice. It has been found that, as a result of having the nurses supporting and seeing patients monthly, the compliance of medication has improved. Parents are able to seek advice while their families are screened and treated, contact tracing has improved and we are also able to give BCG to children who are at risk and have missed their vaccination. New adult prescription for: The new prescription was set up as a result of previous medication dosage errors. The new prescription was trialled in Charing Cross hospital and shows more clearly the previously prescribed medication. Next steps involve introducing a similar prescription template for the paediatric department at Hammersmith Hospital. Weekly multi-disciplinary meetings (MDT): The service has established weekly MDT meetings with the Infectious Diseases teams, this give us an understanding of the inpatients being treated for tuberculosis we are able to support and advise nursing staff and relatives before the patients is discharged, giving us a better chance of achieving good compliance and a good healthy patient at the end of their treatment.
Key results Total incidents Jan-Dec 2011 by category Category Number Percentage IT 1 100% Total incidents Jan-Dec 2011 by severity Severity Low Minor Moderate High Catastrophic 1 0 0 0 0 Level of reporting: In this service, incidents are recorded in only rarely. Near misses are recorded only rarely. Themes arising The only category of incident that was reported in 2011 was involving IT failure. Safety Improveme nt Actions for 2012 Actions Expected completion Named lead date To audit the prescription documentation End of 2012 Gloria- Anne Cox To encourage the reporting of incidents. End of 2012 Gloria- Anne Cox
Effectiveness Overview We aim to achieve the best possible outcomes for patients. In order to achieve the most effective service, treatment and outcomes as possible the service always follows local guidelines and best practice policy when managing our patients, such as the following best practice: 1) Between the start and completion of treatment all patients are seen either weekly or monthly, depending where they are in their treatment. 2) Our documentation includes a risk assessment tool which allows the nurse to undertake a risk assessment of her patient so that they can be identified as soon as possible, and we ensure patients who are deemed to be at risk of not complying with the medication are given as much support as possible from the start of their treatment. This is set out in the NICE guidelines, which also may include the service giving the patient their medication directly. 3) People with or at risk of developing TB are given every opportunity to make informed decisions around the care they are to receive in partnership with the health care worker. Families and carers are also welcomed and given an opportunity to be part of the decision process around treatment and care. 4) All information given to the individual patient and or their relative are given in a format that meets their requirement. 5) We discuss our nurse led patients with the medical team at regular MDT meetings. 6) We are able to access extra funds (incentives) for patients who find it difficult to travel to the clinic or are in financial difficulty to buy extra food stuff. In addition to following best practice the service has also made various quality improvement actions targeting the effectiveness of the service, these include developing formal paediatric nurse led support clinics, implementing adult prescriptions and improving patient correspondences. Key achievements this year The service did not complete a quality report last year but has implemented various quality improvement actions with the aim of increasing the safety of the service, these actions include: 1) Formal Paediatric Nurse Led support clinics: The service has
implemented formal paediatric nurse led support clinics on the Hammersmith Hospital site. The service also supports the Consultant clinic seeing children who are diagnosed with tuberculosis or about to start treatment. We offer support to their parents. NICE CP117 R 28 2) Adult prescriptions: The service has introduced adult, and shortly the paediatric, prescription of patients on treatment. 3) Improved patient correspondence: The service has implemented a system to ensure that patient correspondences are sent directly to our service in real time following clinic electronically. Key results Patient Reported Outcome Measures (PROMs) The service does not currently carry out a PROM; however, the service will review the different formats of PROMs available and implement a PROM within 2012. Clinical Audit Participation in Trust-wide audits during 2011 The TB service contributed to the CLCH trust-wide health records. The service audited 20 records and achieved a mean compliance rating of 79.44%. Local audits during 2011 TB Nursing Service carries out the following local audits: 1) Clinical indicator: this is carried out monthly by the service it gives an outline of clinical data in round numbers such as how many patients seen 2) Clinical incidents: it is useful for seeing how much activity is undertaken by the service 3) Screening outcomes: This audit breaks down the number of tests the nurses request when seeing their patients information required for local team meetings 4) New Entrant screening: This audit was stopped on 1/7/2011. 5) HIV up take for all Index patients over 16 years of age (CP 117 and London Metric): this is very important test as it influences the management
of the patient. 6) Cohort review (sector review quarterly presentation): This is a formal meeting where each team discusses all their patients and the strategy used to follow up their contacts of Index patients and see if we improve are screening outcomes so opportunistically hoping to treat possible cases of latent TB infections. This strengthens the skill of the staff that are able to discuss with piers how to deal with problematic case and learn for others practice and share good practice. 7) Completion data via London TB Register: This data is held by the Health Protection Agency (HPA); it allows each service to see how they are managing their services by showing how many patients they treated overall. It gives service manages an overview of how to fund and predict rates of TB in their catchment areas, so they can develop and support services for the future year. This is an on-going audit and us used by the HPA to inform Government on the control of TB in London. It shows the clinical staff how they are performing day to day in relation to their patients and gives the service managers an overview of what demands are being made on the service and how they can fund/run the service. It is an on-going audit which allow for failings or improvement are picked up quickly, and acted on. NICE compliance The following NICE guidance is either fully or partially relevant to this service: Tuberculosis Number CG 117 Type Clinical Guidelines To ensure that we are complying with these best practice guidance, we have carried out the following actions in 2011: NICE guidance baseline assessment conducted and guidance implemented -Tuberculosis CG 117 including R19, R28, R33, R34, R66, R68 and R69. All Care Plans developed for specific guidance to reach full compliance care plans ensure that patients are seen monthly by a Specialist Nurse to ensure risk assessment and compliance to medication and general wellbeing are monitored and review frequently.
What the patients say about the outcomes of their care and treatment Clinical Effectiveness improvement actions This was a nightmare and it would be have been worse if you had not been so lovely looking after me It s good to see good old fashion nursing This nurse has gone beyond the call of duty to help me it was much appreciated Action Expected Named completion lead date Launch PROM April 2012 Gloria- Anne Cox Experience Overview We care about treating everybody with kindness, dignity and respect at all times. The service aims to a good experience by: 1) Being welcoming and accessible to all patients. 2) Endeavour to accommodate the patient where possible and develop a good rapport with the patient/their family or carer, while they are in treatment. 3) Encourage the partnership approach in the developing of care programmes. This brings with it a good response from the patient and thus we are able to keep our patients engaged in their treatment and ensure good compliance and completion rates for our patient. This can be demonstrated by the results of the Patient Reported Experience Measures (PREMs), which shows that 97% of respondents rated their experience of the service either good or excellent. The service has implemented various actions to improve the experience that patients have of the service, these include developing nurse led support clinics and providing patient information in 7 commonly used languages.
Key achievements this year The service did not complete a quality report last year but has implemented various quality improvement actions with the aim of increasing the experience of the service, these actions include: 1) Developed Nurse led support clinics: the service has developed nurse led support clinics which ensure that GPs receive correspondence from our service following consultation with the nurse about their progress. 2) Patient information literature in additional languages: The service has introduced the patient treatment counselling document in the 7 languages that the service s patients most commonly use. 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 97% 93% % patients saying they were definitely involved in planning their treatment 74% 56% % patients saying they were always treated with dignity & respect 97% 92% % patients saying they definitely understood explanation 93% 88% % patients satisfied with waiting time 82% 74% Interpretation of PREM results The patients of the service reported very good PREM results regarding their overall experience of the service, being treated with dignity & respect and
reporting that they understood the treatment. The service received its worst result from patients reporting that they were definitely involved in planning their treatment. The service will examine ways it can improve upon this result and involve patients more in planning their treatment. PREM methodology The following table summarises the number of patients that responded to a PREM this year, and shows this as a percentage of all referrals during the survey period (August December 2011). Our aim was to achieve a representative view of patient feedback, so we set out to survey each patient that was prepared to return a PREM. PREM volume targets Total (Aug-Dec 2011) Number of patients who responded to a PREM 29 Total new referrals 270 % of new referrals who responded to a PREM 10% Target % of respondents 30% Target achieved? No Compliments and Complaints Patient user groups and focus groups Compliments and Complaints Number of compliments Jan 2011 Dec 2011: 0 Number of complaints Jan 2011 Dec 2011: 0 Peer Support: This year the service trailed the use of using a volunteer, a mother of a child who had had treatment previously, to help support a new mother whose children were going to start treatment. This proved very useful as this new mother was very worried about the prospect of giving her 6 children daily medication at different doses. But the volunteer s experience was inspirational and did much more than the service could have done to convince this mother about what to expect.
Other qualitative feedback What the patients say The following quote is from a patient: This was a nightmare and it would be have been worse if you had not been so lovely looking after me The following quote is from a patient s response to a PREM : I would like to mention special thanks to M, I feel very touched by the care and concern provided by her. She went out of her way to ensure that my scanned biopsy letters were received by personally handing it to me. Thanks very much. Patient experience Improvement Actions Actions Develop an action plan for setting up more formalised Peer support groups for paediatric service Expected Named completion lead date 2012 Gloria- Anne Cox