Quality & Safety Committee Date: 14 th August Princess of Wales Hospital Update Report. Paul Stauber, Director Princess of Wales Hospital

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1 SUMMARY REPORT ABM University Health Board Quality & Safety Committee Date: 14 th August 2014 Agenda item: 2.1 Subject Princess of Wales Hospital Update Report Prepared & Approved by Paul Stauber, Director Princess of Wales Hospital 1. Purpose The purpose of this report is to provide members with an update on the work being undertaken at the Princess of Wales Hospital. 2. Trusted to Care Within the Princess of Wales Hospital continued focus continues to be given to improve standards, which include the recommendations within Trusted to Care (May 2014). The Welsh Government announced visits came to the Princess of Wales Hospital on the 4 th July 2014 when they visited Wards 5, 6, 19 and the Acute Medical Unit and a summary of their findings is attached as Appendix A. A summary of the issues are as follows:- Medication Nurses were re-issued with copies of NMC Standards for Medicines Management, Self Administration Guidelines, Anti-psychotic Guidelines, Administration of Medicines in Acute Settings Policy and the Covert Drugs Administration Policy. Medicines management was discussed at ward meetings and Professional Nurse Forum and Lead Nurses undertake regular spot checks. The Chief Nurse has been working closely with the Head of Pharmacy to ensure rigorous monitoring of medicines management and Pharmacists have been involved in ward based teaching. Omissions in practice are immediately dealt with via Health Board Policy and we are currently working with the Head of Pharmacy to ensure a consistent approach to this Continence Mr. Keith Ridler, Continence Advisor has been undertaken regular teaching sessions across hospital wards and there has been a significant improvement in continence assessment and management. How has this been measured? A Continence CNS took up post in early July and is focussing on strengthening the Link Nurse Network for management of continence, staff education and training. Spot checks continue to be undertaken by Lead Nurses on all wards and there has been NO evidence of patients being told to urinate where they lay across ANY wards in Princess of Wales Hospital, or any complaints from relatives that this is in fact happening.

2 Hydration Nurses were re-educated in fluid balance and the importance of hydration across a number of wards prior to the publication of Andrews and there have been NO observed issues with hydration since the publication of Trusted to Care. Spot Checks Since the publication of Trusted to Care, there has been a regime of Spot checks within the Princess of Wales Hospital undertaken by Heads of Nursing and the Corporate Nursing Team since May Feedback from the Spot checks has been extremely positive with no issues with medication, hydration, continence or dignity observed. The Welsh Government Spot Check took place on 4 th July 2014 and Wards 5, 6, 19 and AMU were visited. Areas of exemplary practice were noted, which were:- Leadership on Wards 19 and AMU Developments for frail elderly on Ward 19, including day room facilities and provision of ward wheelchairs to take patients outside Pharmacy Project Medicines Management Ward 19 Screensavers highlighting care of the elderly There were no observed issues with hydration or continence management across the four wards. Unfortunately, there were a number of issues identified on Ward 6. These were in relation to storage of medicines, missed doses of drugs on four occasions, failure to support a patient with nutrition on one occasion and standards of hygiene in relation to a patient s finger nails on one occasion. The medicines management issues were investigated and two were found to be explained without further action necessary. The two nurses associated with the remaining incidents were dealt with via the Disciplinary Policy. Across the three wards visited, reviewers found examples of the inappropriate storage of medicines, for example at the bottom of the drugs trolley or in boxes not designed for drug use. They also discovered an unlocked cupboard on Ward 6. All of these issues were dealt with immediately. The Welsh Government Unannounced Team have now undertaken Spot Checks at the 4 acute hospitals and the Trusted for Care Steering Group are working through how there is consistency of implementing the change in practice to resolve any issues. Assurance Framework for Frail Elderly Staff within the Princess of Wales Hospital has been fully engaged with the development of an Assurance Framework for the Frail Elderly in partnership with the RCN and Nicky Hayes, Consultant Nurse for Older People. The Framework was piloted on a number of wards using a multi-disciplinary team approach and work is ongoing to develop standards of care for the frail elderly. It is anticipated that work will complete by the end of August 2014.

3 In addition to this, the ANP for Older People in Princess of Wales Hospital has developed an educational package using the Silver Standards for older people that is being delivered to Nurses on a weekly basis. This compliments existing dementia training and clinical skills based learning. The RCN and Nicky Hayes held a workshop on Care of the Older Person in June 2014, which was well attended and evaluated. 3. Workforce Nurse staffing levels on all wards in the Princess of Wales Hospital meet the CNO Guiding Principles. Recruitment of Registered Nurses continues to be challenging due to a high attrition rate following interview. In May 2014, 32 Nurses were offered positions and of these only 19 have started work or will start following registration in September A further 21.8 wte were appointed in July 2014 and Lead Nurses are keeping in regular contact with them in an attempt to avoid further drop out. A percentage of these new recruits will start as a Band 2 HCSW until their registration is processed. A further advertisement is out to recruit the outstanding 8.49 wte Band 5 vacancies and interviews will take place in August Interviews will take place in August to fill the unqualified nursing vacancies. In addition to the budgeted establishment, consideration is being given to appoint an additional 16 wte Band 2 HCSW s who will provide a pool of Nurses to deliver one to one care. This initiative is replicating one that is successful in King s College, London and ensures that patients who require one to one care for cognitive impairment will be cared for by skilled nurses who will be trained in interventions such as distraction therapy. The additional unqualified nurses would generally undertake one to one duties which are presently being covered by agency staff. A Modernisation Project is looking at changing the skill mix on the rehabilitation wards and the introduction of a Band 3 Team Leader role. It is anticipated that this model can be rolled out to Ward 19 and possibly Ward 20 in the future and will provide a more sustainable workforce going forward, as well as career development for our excellent Non- Registered workforce. A two week skill based education package is being developed for all new non-registered recruits and will start in September/October. Once recruitment is complete, it is anticipated that not only will nursing be up to its full establishment by the end of the year, but the workforce is more sustainable moving forward. The workforce challenges that remain for the site are sickness levels being amongst the highest in the Health Board, at an average of 6.5% and morale amongst nursing staff. The Chief Nurse holds regular Band 5 and Band 2 Focus Groups as well as organisational wide In your Shoes feedback sessions. In addition to this a monthly Open Staff Forum and New Registration Group has started. Feedback from these is that nursing staff are fearful of external scrutiny and public criticism. As a consequence, sickness rates are high with stress and anxiety being a common factor.

4 The final workforce challenge has been increased sickness in Band 7 s and 6 s across the site. A number of new appointments have been made and an advertisement is currently out to increase the numbers of Junior Sisters who will support our succession planning programme. As far as medical staffing is concerned: Interviews for community geriatrician will be held on 8 th August Interviews for the two consultant cardiologists will be held on the 4 th September It is hoped that these posts will be appointed to. 4. Education and Development A defining factor of change in Princess of Wales Hospital has been an increased focus on education and development. As well as mandatory clinical skills training, Specialist and Advanced Nurses have been working alongside new registrants to deliver on-the-job education. Examples of this have been around NEWS scoring delivered by the Outreach Team in response to incidents, IV and medicines management delivered by the Medical Device Trainers, diabetes management delivered by the Diabetic CNS s and C.Difficile on the spot training delivered by Consultants and the Infection Control Nurses at ward level to the multi-disciplinary team. A new set of competences have been developed for Band 5 Nurses and Band 6 are in development. The Chief Nurse is involving partners in our education programme with Senior Nurses from RCN Wales contributing to Band 5 development and Mrs Chantel Patel from Swansea University is delivering number of professional seminars to the Senior Nursing Team in the autumn. The vision of the Princess of Wales Hospital being a learning environment and one that values work-based education is clearly being embedded for all staff groups. Two Nurses, Louise Ebenezer, Parkinson CNS and Andrea Croft, Anticoagulation ANP have been nominated for RCN Nurse of the Year and Louise Ebenezer has won a Bridge FM Local Hero Award, nominated by her patients. 5. Complaints, Incidents and Patient Experience a. Complaints All Princess of Wales Hospital complaints, concerns and enquiries are sent directly to the Hospital Director and Head of Patient Experience who link and discuss with the relevant senior managers or clinicians. The POW team are continuing to contact the person raising the concern as soon as possible, within 24 to 38 hours. Meetings may be offered at the outset, to ensure that any work to resolve the concern is effective and timely. Between 1 st March.2014 and 31 st July 2014 there have been 83 letters of thanks and 391 complaints, enquiries and concerns coded on DATIX, 285 (72.8%) have been resolved and progress is being made towards ensuring 90% are resolved within 30 days by the end of October This has been achieved while work has been delivered to clear a backlog of

5 inherited complaints from 214 in February to 48 in July. Throughout the month of July the Princess of Wales Hospital has received on average 21 complaints per week. The top themes for complaints are: Implementation of care or ongoing monitoring, Appointments and waiting times Communication. Moving forward with the Patient Experience agenda, three Patient Advisory Liaison Officers (PALS) have been appointed and will take up their posts at the beginning of September. A further update will be provided on the development of this service for the next meeting. Ward 7 & Maternity Ward has been identified as pilot wards to roll out the new Friends & Family Feedback, Snap 11 project as start date is yet to be agreed but the project will be supported by the newly appointed PALS officers. Lessons Learned A case study has been presented to the medical clinical audit group covering issues of clinical interpretation and communication. Significant input has been given to Ward 20, which has led to a reduction of concerns being received for this area. The Emergency Department have introduced a leaflet to be provided to patients, where it has not been possible to make a diagnosis, patients will now be given After leaving the Emergency Department information that explains the position and what the patient should do next, e.g, see GP, or return to Department. b. Incidents There continue to be high levels of incidents reported ( a month) and the system is helping to highlight areas where work is needed to improve patient safety and service delivery. The main issues being reports are falls, staffing levels and pressure areas. To improve responsiveness and effective action being taken as a result of incidents, service area reports are being prepared that will be sent out monthly so that clinical teams can ensure that incidents are responded to and managed, with evidence of action taken, improvements and / or lessons learnt. This activity can then be brought back to this committee. c. Patient Experience Three Patient Advisory Liaison Officers (PALS) have been appointed and will take up their posts at the beginning of September. A further update will be provided on the development of this service for the next meeting. Ward 7 & Maternity Ward has been identified as pilot wards to roll out the new Friends & Family Feedback, Snap 11 project. The start date is yet to be agreed but the project will be

6 supported by the newly appointed PALS officers. Closer links have been made with voluntary sector organisations, including the carers association which provides the Princess of Wales Teams with a community perspective on the work of the hospital. 6. Mortality Reviews The reported position for June is as follows: Stage 1 100% compliance Stage 2 16 new reviews (2 general surgery, 3 orthopaedic, 9 medicine and 2 medicine for the elderly) Of the 90 outstanding stage 2 reviews, 67 have been completed with the remainder either having being reassigned to consultants not involved with the patient care or awaiting patient records. 7. Recommendation The Quality & Safety Committee are requested to note the contents of the report and to receive an update at the next meeting.