Open and Honest Care in your Local Hospital

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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: Aintree University Hospital NHS Foundation Trust November 216

2 Open and Honest Care at Aintree University Hospital NHS Foundation Trust : November 216 This report is based on information from November 216. The information is presented in three key categories: safety, experience and improvement. This report will also signpost you towards additional information about Aintree University Hospital 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. 98.% 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 4 Annual Improvement target 31 Actual to date 2 * To date 12 C.difficile infections have been successfully appealed with no lapses in care being identified 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 4 Category 2 - Category 4 pressure ulcers were acquired during hospital stays. Severity Category 2 Category 3 Category 4 Number of pressure ulcers 4 The pressure ulcer numbers include all pressure ulcers that occured from hours after admission to this Trust. Due to the nature of Category 3 and Category 4 pressure ulcer formation, the numbers include all pressure ulcers in these categories from 72 hours after admission to this Trust. The Trust has had three Category 3 or 4 pressure ulcers this month. 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:.2 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 1 fall(s) that caused at least 'moderate' harm. Severity Moderate Severe Death Number of falls 1 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:.5

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* 99% % recommended This is based on 828 responses. A&E FFT Score 85% % recommended This is based on 679 responses *This result may have changed since publication, for the latest score please visit: We also asked 3 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? 87 If you were concerned or anxious about anything while you were in hospital, did you find a member of staff to talk to? 9 Were you given enough privacy when discussing your condition or treatment? 73 During your stay were you treated with compassion by hospital staff? 97 Did you always have access to the call bell when you needed it? 97 Did you get the care you felt you required when you needed it most? 7 How likely are you to recommend our ward/unit to friends and family if they needed similar care or treatment? 87

5 A patient's story Focus on Mental health This months patients story highlights the difficulty some patients face in hospital when they are suffering from mental health issues. A patient with a mental health problem was recently treated on the Acute Medical Unit (AMU) and wanted to share her experience. The patient had some problems related to alcohol and suffered with chronic anxiety, and she had been recently diagnosed with a borderline personality disorder. After medical assessment on the AMU, a decision was taken to discharge the lady home. She was then transferred to the Ambulatory Care Area of the AMU department to await her prescription to take home. Unfortunately one of the take home drugs had been missed off the prescription and this led to a significant delay in the discharge arrangements. This delay ultimately led to the patient becoming increasingly anxious due her ongoing mental health issues and the patient describes pacing the floor and other patients showing concern for her. The lady approached the nursing staff on several occasions to ask for her medication and felt she was spoken to in a disrespectful manner each time. The patient described a deep feeling of guilt and shame because of her alcohol dependence and low self-esteem, and was aware that she didn t look her best as she was mid-way through a detoxification from alcohol programme. She felt that her appearance impacted on the way she was spoken to. The communication with the staff gave the impression that other people deserved more attention than she did. The patient explained that just because mental illness cannot be seen it does not mean it does not exist, and she wants people to understand that addiction is an illness. The patient explains that she wasn t just waiting for medication, she was psychologically unwell. The aim for this patient in sharing her story is the hope that staff will have a better understanding of the problems faced by people who have mental health issues, and those who are battling addictions. This lady described spending twenty years as a teacher but due to her problems, losing her status in life and how she now lives alone in a one bedroom flat. The patient also hopes that by highlighting her issues the misconception that addiction is a lifestyle choice will be corrected and that there will be understanding of the isolation people with addictions and mental health issues feel. In her words just because you can t see an illness doesn t mean it isn t there. Staff experience We asked 15 staff the following questions: % Recommended I would recommend this ward/unit as a place to work 87 I would recommend the standard of care on this ward/unit to a friend or relative if they needed treatment 67 I am satisfied with the quality of care I give to the patients, carers and their families 8

6 3. IMPROVEMENT Improvement story: we are listening to our patients and making changes The Aintree Experience The individual s healthcare experience shared collectively in patient stories can help us build a picture of what it is like as a service-user and how we can improve the service we provide. Our patients' stories bring experiences to life and make them accessible to other people. They encourage a focus on the patient as a whole person rather than just a clinical condition or as an outcome. We then have the opportunity to shift the traditional view of the patient as a passive recipient of our services, to the view of patients as integral to the improvement and innovation process. Patient Stories and Quality Improvement Quality improvement depends on frontline staff generating fast improvement cycles in the setting where the work is delivered. Because of the fast and localised nature of quality improvement work, it suits a variety of different tools to identify and monitor projects. Patient stories have unique features which make them appropriate in quality improvement projects. We always aim to deliver a positive experience to all of our patients but unfortunately on occasion, we may get things wrong. It is important that we are aware of when we have not provided a good service and that we learn from those experiences and always strive to achieve better. Aintree has a dedicated Patient Advice and Complaints Team (PACT) which deals with comments, concerns and complaints. The team is located near the main reception in a dedicated PACT centre with its own reception area (open 9am - 4pm). Patients and visitors are encouraged to speak to the appropriate Ward Manager or Matron in the first instance if they have any concerns or complaints as this means they may be able to resolve issues whilst in hospital. Supporting information Clinical Health Psychology at Aintree We all have times when we lack confidence and don t feel good about ourselves. But when low self-esteem becomes a long-term problem, it can have a harmful effect on our mental health and our lives. Self-esteem is the opinion we have of ourselves. When we have healthy self-esteem, we tend to feel positive about ourselves and about life in general. It makes us able to deal with life s ups and downs. When our self-esteem is low, we tend to see ourselves and our life in a more negative and critical light. We also feel less able to take on the challenges life throws at us. The Clinical Health Psychology Team is made up of psychological practitioners who specialize in the assessment and treatment of psychological difficulties (e.g. coping difficulties, emotional difficulties, and difficulties coming to terms with the situation faced), that can all often be experienced when living with physical health problems. The team of qualified clinical psychologists are all registered with the Health and Care Professionals Council and as a clinical department of the Trust they currently provide specialist clinical services across a variety of areas within the hospital or at Community Clinics. The aim of the team is to help patients to achieve the best possible medical outcome in living with and managing their illness or medical condition. They provide a range of support to help achieve this goal and offer a variety of support and treatment options, aimed at helping patients to cope, adjust and manage the many difficulties (both physical and emotional) that can arise when facing serious illness, long term health problems or physical trauma. Living with physical health problems and chronic health conditions can not only impact on general well-being but can also commonly affect how people feel and cope with many aspects of life. The team can help people move forward in the face of such problems by offering telephone support, one-toone treatments, family sessions or group treatments.

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