Additional cubicle facilities open to support Emergency Department at PRH

Transcription

1 Putting Patients First Focusing on clinical quality and improvement in The Shrewsbury and Telford Hospital NHS Trust January 2016 The creation of additional facilities to support the Emergency Department at PRH was a team effort. Additional cubicle facilities open to support Emergency Department at PRH Additional facilities to support the Accident and Emergency Department at the Princess Royal Hospital (PRH) in Telford opened earlier this month Eight additional cubicle facilities have been introduced to the department to provide high level care, improve privacy and dignity to patients and increase controlled patient flow. Over the last five or so years we have seen an increase in Emergency Department admissions by two to five per cent year on year, therefore this expansion is vitally important to deal with the increased demands. The whole development has been 100 per cent patientfocused as our aim is for patients to have the best journey they possibly can through the hospital. This will make a real difference to patient experiences. Adrian Vreede Emergency Centre Manager thank Adam Huxley, the Operations Manager, for all his hard work. I would also like to thank the Friends of PRH for donating 95,000 towards the project, enabling each cubicle to be installed with patient monitors I would like to thank all the staff and a central surveillance and in the Emergency Department alarming system. for their patience during the The building of the new cubicles works and I d like to particularly has been an excellent team had inadequate cubicle facilities for the demand. The investment will benefit patients in the future, regardless of any decision on the location of 1 Accident and Emergency The Accident and Emergency facilities as part of the NHS Department at PRH previously Future Fit programme. effort and I would also like to congratulate our Estates Department and everyone involved, including our main contractors SJ Roberts and the electrical contractor Dimension Data, who delivered the project while maintaining operation clinical functionality.

2 Tackling infections at our hospitals Sarah Bloomfield Director of Nursing and Quality The Trust s two acute hospitals have not seen a case of MRSA bacteraemia and the most serious hospital-acquired pressure ulcers for more than eight months. The last recorded case of MRSA bacteraemia at the Trust was 282 days ago and the last avoidable Grade 3 or Grade 4 pressure ulcer was 257 days ago. While this is good news for patients, there is still work to be done to reduce all hospital infections. For example, the Trust has exceeded its target of 25 for the number of cases of Clostridium difficile (C.diff) in 2015/16. There have been 27 cases of C.diff during 2015/16. We take our performance to reduce infections very seriously and aim to provide a safe and infection free experience for our patients. We re working hard to reduce the number of cases. We re continuing to monitor compliance with guidelines in antibiotic prescribing, raising awareness of the need for rapid isolation of patients with symptoms in statutory training and compliance with hand hygiene and environmental cleanliness and have found that most cases caused by antibiotic usage are in line with the antibiotic policy. Likewise, we re part of a local health economy approach to reduce incidences of C.diff, that includes colleagues from the Clinical Commissioning Groups, GPs and lead pharmacists in all health sectors. I m particularly pleased that our efforts to eliminate cases of MRSA bacteraemia and avoidable Grade 3 and 4 pressure have been working. We re not complacent though and will continue to do our best to ensure we don t see any such cases. People planning to visit hospitals and other healthcare facilities in Shropshire are being asked to stay away if they have experienced any symptoms of Norovirus. Norovirus, sometimes known as the winter vomiting bug, is the most common stomach bug in the UK. It is highly contagious and can affect people of all ages. The number of cases of diarrhoea and vomiting recorded in the community normally increases at this time of year and it is particularly important that people help to prevent the spread of these illnesses, especially to vulnerable patients. One way to do this is by not visiting acute or community hospitals if you or any members of your family have had diarrhoea, vomiting or flu-like symptoms in the last 48 hours. These stomach bugs can spread rapidly anywhere that people are gathered, such as schools or offices. Hospitals are public buildings with hundreds (or thousands) of visitors every day. That is why the NHS asks people to think carefully before visiting hospitals if they or anyone in their family has even mild symptoms of stomach upset. Dr Patricia O Neill, Consultant Microbiologist and Director for Infection Prevention and Control at The Shrewsbury and Telford Hospital NHS Trust (SaTH), which runs the Royal Shrewsbury Hospital and the Princess Royal Hospital in Telford, said: This is a good time to remind people of our normal seasonal message for all hospital visitors - please follow the 48 hour rule: do not visit hospitals or care homes if you, or the people you live with, have had diarrhoea, vomiting or flu-like symptoms in the last 48 hours. If you are unsure whether to visit, please feel free to contact the ward nurse before you come into hospital. Sue Sayles, Infection Prevention and Control Nurse at The Robert Jones and Agnes Hunt Orthopaedic Hospital in Oswestry, said: We would ask that all our patients and visitors help us to keep Norovirus at bay. If you, or anyone in your household, has experienced diarrhoea, vomiting or any flu-like symptoms in the last 48 hours, then please stay away from the hospital. Diarrhoea and vomiting outbreaks can result in ward closure. If you are not sure whether you would be safe to visit, then 2 please do feel Putting Patients First Advice on Norovirus this winter free to ring up and speak to the ward staff, who would be happy to give you advice. Rachael Allen, Shropshire Community Health NHS Trust s Head of Infection Prevention and Control, said: Protecting vulnerable patients and hospital staff is really important, whether this is in the county s main hospitals or in the four community hospitals in Ludlow, Whitchurch, Bridgnorth or Bishop s Castle. We are asking anyone who is considering visiting or attending any of our hospitals to think very carefully about doing this if they have experienced diarrhoea, vomiting, flulike symptoms, or have been generally unwell in the last 48 hours. If you do feel that your visit is necessary then please telephone the ward or department for advice beforehand. Good hand hygiene can help to limit the spread of the infection and there are some simple steps that the public can take to help stop Norovirus spreading: Wash your hands frequently and thoroughly with soap and warm water, particularly after using the toilet, and before preparing food or eating. If you re in an NHS facility, pay attention to hand hygiene notices such as using hand gel upon entering and leaving a ward. Disinfect any surfaces or objects that could be contaminated with Norovirus. It is best to use a bleach-based household cleaner. Always follow the instructions on the cleaning product. Flush away any faeces or vomit in the toilet. You should also keep the surrounding toilet area clean and hygienic. Wash any clothing, or linens, which could have become contaminated with Norovirus. Washing with hot, soapy water will help to ensure that the virus is killed. Although people usually recover without treatment in hours, it is important to stay away from work, school, college or any social gatherings until you have been free of symptoms for at least 48 hours. You can also find additional information about Norovirus at Page 2

3 Putting Patients First Take steps this winter to ensure we stay well Jo Banks Associate Director of Nursing (Patient Safety) Debbie Kadum Chief Operating Officer Plans put in place for winter have meant Shropshire s two acute hospitals have so far coped better than last year. The Royal Shrewsbury Hospital (RSH) and the Princess Royal Hospital (PRH) in Telford saw a reduction in breaches of the national four-hour Accident and Emergency Department (A&E) waiting time target in the two week Christmas to New Year period. The Trust implemented its internal Winter Plan at the end of November As part of that plan 44 surgical beds were temporarily reassigned as medical beds across both sites, with elective orthopaedic work As winter continues there are steps that all of us can take to stay well, and to ease the burden on NHS staff. The main focus for all health and care organisations this year is to support those people who are most vulnerable to winter ailments, and most likely to need hospital admission, to stay well. The simple advice for all of us and our loved ones is: Get a flu vaccination (these are free for people who are most at risk). Heat your home to at least 18oC (65oF), if you can. Overall A&E attendances remained broadly the same as 2014/15. Breaches of the national four-hour A&E standard at RSH decreased by 17.7% against a rise in attendances of 6%. The number of patients aged 75 and over attending ED is about the same as last year, however the number of those admitted from A&E has risen by 5%. There has been a 15.9% fall in the number of deaths compared to the same period of time last year. In the first week of January 2016, despite high demand, only 13 patients had their elective procedure cancelled in comparison to 31 the previous year. being provided through a mobile day surgery unit at PRH. The Trust had to implement its Hospital Full Protocol on four consecutive days from 3-7 January. However, thanks to the hard work of staff, the escalation level - which reflects the current status of the hospitals in terms of bed availability and level of emergency demand was reduced from Level 4, on 4 January, to Level 2 on 7 January. Last year the Trust was on Level 3 throughout the winter period. We know the peak winter period is a busy one for hospitals up and down the country, and we are no exception. We took steps following last winter to ensure that lessons were learned and many of those worked well over the Christmas and New Year period. The plan runs until mid-march so it is too early to assess its full impact at this stage, and we will make sure we do not get complacent. We will take the learning from this plan forward as we prepare for the Easter Bank Holiday. During December, more than eight out of every 10 patients seen by the Trust s A&Es was admitted, transferred or 3 discharged within four hours. Seek immediate advice and help from a pharmacist as soon as they feel unwell, before it gets too serious. Keep an eye on elderly or frail friends, neighbours and relatives. Take your prescribed medicines as directed. You can find more information about how to Stay Well This Winter at Plans in place for winter has resulted in our hospitals so far coping better than last year During that time, emergency attendances were up 3.17% compared with December Overall there has been an increase of 6,645 attendances between April and December a rise of 6.77% on the year-todate. Although the Trust did not meet the national 95% standard, plans are in place to reduce the number of people waiting for a long time in A&E. In the run-up to winter, the NHS Emergency Care Improvement Programme (ECIP) was invited to carry out a review of the whole local health economy to help identify areas to improve patient flow. The team acknowledged that SaTH was struggling with the resilience of the Emergency Departments due to a significant number of consultant vacancies, but said they were encouraged to see the Departments using Emergency Nurse Practitioners (ENPs) and Advanced Nurse Practitioners (ANPs) following recent investment. The Trust is currently undertaking a business continuity plan to ensure the continued safe, effective and dignified running of Emergency Services. Page 3

4 Putting Patients First First Sponsor Development Day in Trust s partnership with Virginia Mason Institute Cathy Smith KPO Leader Our partnership with Virginia Mason will help us to become one of the safest hospitals in the country. It will do this by supporting all of us in the Trust to use lean improvement to make lasting changes that benefit our patients. We do this by focusing on Value Streams effectively the journey through our services by which we add value for our patients. This week saw the first major piece of work on our journey the commencement of our first Value Stream which is looking at discharge for respiratory patients. Every Value Stream has a Sponsor Team made up of clinicians, managers and an executive sponsor. The Sponsor Team for our first Value Stream comprises Debbie Kadum (Executive Sponsor), Alison Trumper (Team Leader), Vicky Jefferson, Jill Dale, Nonny Stockdale, Dr Saskia Jones- Perrott, Dr Koottalai Srinivasan and Sarah Kirk along with the Kaizen Promotion Office Team. An important stage in any Value Stream is the Sponsor Development Day. Our first one took place on Monday (25 January). The purpose of this Sponsor Development Day was to define the Future State. In other words, what do we want the experience of discharge for our respiratory patients to be like in future? During the day we reflected on the current state and a lot of work has already taken place to understand the current experience of our patients and our staff. Much of this has taken place through direct observations of each step in the patient journey. We are really grateful for the time that clinicians and managers have already given to help with these observations, and to review what we ve found out so far. The Sponsor Development Day allowed us to focus on those areas where we can make great improvements for patients and for working lives. It helped us to define the activities that will take place over the next 24 weeks on our journey of improvement. This will include a Rapid Process Improvement Week (RPIW), likely to be in March, which will engage colleagues right across the Trust whose role contributes to the process for our respiratory patients. Following the initial RPIW, a series of subsequent weeks will Group discussions taking place during the Sponsor Development Day. be arranged where we continue to test out the improvement ideas and measure the impact. This week also saw the launch of our second Value Stream. Following the Trust Guiding Team Meeting last week, the group identified the clinical pathway for patients with signs of Sepsis as our next piece of work. The Sponsor Team for this Value Stream is currently being put together and an Executive Sponsor is Dr Edwin Broman (Medical Director). This Value Stream journey will follow exactly the same methodology. We will gain a deep understanding of the current state and identify what we want the future state to look like. We will then work on a series of small improvement projects over the next 12 months to achieve our goal. Supporting our partnership with Virginia Mason and the teams who will drive this forward, is the Kaizen Promotion Office (KPO): 4 The Virginia Mason Guiding Team in Seattle, USA. Cathy Smith, KPO Leader Nick Holding, Senior KPO Specialist Louise Brennan, KPO Specialist Carla Webster, KPO Facilitator Richard Stephens, KPO Facilitator Rachel Hanmer, PA to KPO Team Tony Fox, KPO Medical Advisor The KPO Team are supported by Laura Kavanagh, HR Business Partner, and Tricia Penney, Corporate Finance Manager. The word Kaizen means a change for the better but Kaizen is often used in business terms to describe the continuous improvement work that is required in any successful organisation. This team provides expert help and guidance to the Value Stream teams, logistical support and training on methodologies. The team is now complete with appointments being made over the last month, and they are already embedded with the two current value streams to guide the processes in these early stages of our learning journey. Page 4

5 Putting Patients First New hotline launched for pregnant women Claire Murgatroyd Antenatal Ward Manager Senior Fertility Sister Clare Soltysiak, Pre-Registrant Embryologists Annemieke Mitchell and Clare Giraud, and Andrew Sizer, Consultant Obstetrician and Gynaecologist, in the new Scanning Suite. Major investment ensures safety of human embryos Improvements to fertility services means the Trust s unit is among the safest in the country. JASON KASRAIE, Consultant Embryologist, explains the importance of this to thousands of future families Major improvements have been made to fertility services following a 250,000 investment, meaning the Trust s unit is now among the safest in the country. The safe storage of human embryos is one of the greatest responsibilities we ve got. The embryos we have in storage could result in the birth of 1,000 children in the future. For many couples, the embryos they have in storage represent their only hope of starting a family. The improvements, which follow national changes to inspection legislation, include a Liquid Nitrogen Generator, a cutting-edge piece of equipment which means the unit can generate its own liquid nitrogen to store embryos in. Previously, liquid nitrogen was delivered to the Fertility Unit once a week, but the new generator means a supply is always available. We should never run out of liquid nitrogen, which further ensures the safety of the embryos. We also have an uninterruptable power supply to every single alarm for each tank the embryos are in, to ensure that if anything should go wrong, we will know about it and can fix it. A new state of the art Cryogenics Room has also been created where embryos, eggs and sperm can be stored in safety. The investment means we now have one of the safest Cryogenic storage facilities in the country. A new Scanning Suite, which is more spacious and of a higher specification than the previous scanning room, has also been completed as part of the work. The air-flow systems have been upgraded to ensure the air in the room is replaced every 50 seconds, bringing additional safety benefits to staff. The team at the Centre are delighted that the Trust invested to ensure the future safety of the embryos and staff 5 in the department. Improvements have been made to the way women who suffer complications during their pregnancy can access care and support in Shropshire. Women are now able to call a new hotline number if they suffer complications or have concerns during their pregnancy for which they want advice. The hotline is staffed by a Midwife who is able to provide advice and reassurance. If the complications are such that a woman needs to be checked further, the Midwife will refer them to the Antenatal Ward in the Shropshire Women and Children s Centre at the Princess Royal Hospital in Telford where a new Obstetrics Triage Area is running 24-hours-a-day, seven days-a-week. Pregnancy is generally safe for mothers and babies, but sometimes events can occur that cause concern. Our new triage system means that if a woman has concerns during her pregnancy she can call a dedicated number to seek advice, and if she needs to be seen by one of our staff, she will be asked to attend our Antenatal Ward. Women are being seen quickly, depending on the urgency of their complication, and they are given a confidential consultation with a midwife. Urgent problems, for example heavy bleeding, will require prompt attention, while other situations may need investigating less urgently. These improvements mean that any woman who is due to give birth either at the Shropshire Women and Children s Centre or at our Midwife-Led Units (MLUs) in Bridgnorth, Ludlow, Oswestry, Shrewsbury and Telford, have a central number to call if they have concerns. Page 5

6 Putting Patients First Treating patients with dignity The Shrewsbury and Telford Hospital NHS Trust (SaTH) will hold a celebrating Dignity Action Day at the Royal Shrewsbury Hospital (RSH) and Princess Royal Hospital (PRH) in Telford on Monday 1 February, led by the National Dignity Council. Picture perfect: Detecting a sight-threatening disease Optometrist DAVID PARKINSON explains the importance of three new retinal cameras to the Shropshire Diabetic Eye Screening Programme s aim of detecting early signs of Retinopathy Graeme Mitchell, Associate Director of Nursing (Quality and Patient Experience), said: Providing our patients with dignified and compassionate care is of paramount importance. Our staff take great pride in the care they deliver, and we feel it is very important to support the national Dignity Action Day as this helps to raise awareness around some very important issues. To mark the day we are holding our own Dignity Awareness Week which will feature a chance for people to pick up useful information and take part in light-hearted activities which have an important message at their heart. Each year Dignity Action Day is used to highlight the importance of dignity and respect in providing high quality caring services both in hospitals, in the community or in people's own homes. The Trust will use this opportunity to raise awareness of its own Dignity Champions Programme by displaying materials outside the Mytton Oak Restaurant at RSH and the Apley Restaurant at PRH, on Monday 1 February between 12noon and 2pm. Some of the Trust s 350 Dignity Champions will be distributing leaflets about the programme and displaying posters containing the Dignity Do s. Dignity Action Day is an opportunity for the Trust to affirm its commitment to ensuring that all patients and members of the public accessing services are treated with dignity and respect. The Shrewsbury and Telford Hospital NHS Trust has been providing Diabetic Eye Screening in Shropshire for over 10 years. During that time, the number of people in the county with diabetes has risen from approximately 15,000 to over 25,000. Presently this number has a net growth of about 80 to 100 patients per month, an annual increase of around 4.5 per cent. We screen all patients from 12-years-old to death, which is unique in National Screening Programmes, as others have an upper age limit. This highlights the importance of good vision in modern society. This is why our numbers constantly increase and is the reason for the introduction of three new retinal cameras to the programme - two to replace obsolete models and one to increase our capacity by 25 per cent. We now have five retinal cameras, two fixed at PRH and RSH and three which we take to 19 outreach venues throughout Shropshire. Our key aim is to detect potentially sight threatening disease in our diabetic patients. This is known as Retinopathy. In simple terms, when a person has raised blood glucose (i.e. above a nationally agreed level) there is a risk of damage to the small blood vessels (capillaries) all over the body. The retina, which is a unique structure, is capable of changing light energy into electrical impulses that go to the brain where they are processed to create vision. The retina has the highest blood supply requirement per cubic mm of any structure in the body. It has an extensive vasculature which is susceptible to changes from diabetes, which leads to leakage of blood and reduced oxygenation. This creates oedema and ischemia, both of which damage the retinal structure, thus threatening sight. Optometrist David Parkinson looking through one of the new retinal cameras Digital Retinal Photography can be used to spot these changes at a very early stage, prior to any damage being caused, so appropriate action can be taken, mainly through better systemic control of the diabetes. It is a classic stich in time scenario, which is in place to protect the sight of our diabetic patients. An example of an image captured by the new cameras. 6 Page 6

7 Putting Patients First Trust goes above and beyond to improve end of life and bereavement care As promised in the last edition of PPF, we take a look at the new 1.89 million bereavement facilities at RSH with RUSSELL HADDOCK, Chief Anatomical Pathology Technologist, at the Trust. When coming up with ideas for new facilities for bereaved families at the Royal Shrewsbury Hospital, we wanted to make sure we did more than just provide facilities for the here and now. We wanted to look to the future and I am delighted to confirm we have gone above and beyond what the Care Quality Commission (CQC) identified the Trust needed to improve in their most recent report. The 1.89 million investment has transformed the mortuary facilities, which had remained largely unchanged since the 1970s, and greatly improved dignity for friends and relatives, as well as the working environment for staff. Improvements include two new Swan rooms for families to say goodbye to loved ones, as well as a Cygnet room for children. The new facilities incorporate the Swan Scheme, which is being implemented across the Trust to improve End of Life and Bereavement Care. The rooms include comfortable furniture and specially chosen The area has been designed to be much more comfortable and easier for relatives. We want to make it as easy for families as we can. We have also made improvements in the areas that members of the public don t see, so that we are better equipped to deal with high risk cases, such as infectious diseases, and bariatric patients. Pictures show inside the At the opening of the new 1.89 million Mortuary facilities, new-look bereavement facilities at the Royal Shrewsbury Hospital from left, Sarah Bloomfield (Director of Nursing and Quality), Jules Lewis (End of Life Care Facilitator) and Russell Haddock (Chief Anatomical Pathology Technologist). artwork to create a calming environment Other improvements include a Bereavement Garden, where people can take time to reflect in peaceful surroundings, as well as improved car parking and washroom facilities. area itself, which will make the area fit for purpose for many years to come. We have been aware for a long time that improvements were needed in this area and we are delighted with what has been achieved. It is so much better than what we had before the There have also been whole area is much more improvements for the Mortuary 7 welcoming. Page 7

8 Twiddlemuffs: A life-changing idea that is helping patients who have dementia I have always loved knitting, it relaxes me - so I nearly always have some on the go. However, one of the most niggling things about knitting is the leftover stash of wool. When my daughter saw a piece in her local paper in Yorkshire calling for knitters for her local hospital she sent it to me. I went on the internet to find out more about these Twiddlemuffs I was reading about and discovered that a few other hospitals were using them with great success for calming anxious and unsettled patients. Twiddlemuffs are cosy, knitted tubes of wool into which patients can put their hands as they rest them on their laps. Attached to the inside and outside of the muff are buttons, ribbons, beads, keys etc, designed to encourage patients to keep their hands busy, and to help stimulate their mind. I knitted a couple and found them very addictive and a brilliant way of using up all those odds and ends of wool. They are quick to make, and the variety of colour combinations and decisions about what Twiddles to attach to help patients is very satisfying. Around a quarter of the patients SaTH cares for live with dementia and Twiddlemuffs in other hospitals are proven in helping calm them, so it was agreed that we could introduce them here. My colleagues on the Patient Experience and Health officials are working together to improve access to Wi- Fi for patients and staff at Shropshire s two acute hospitals. Officials from Telford and Wrekin Clinical Commissioning Group (CCG) offered to provide 200,000 match funding to support the project which is being led by The Shrewsbury and Telford Hospital NHS Trust (SaTH), which runs the Princess Royal Hospital in Telford and the Royal Shrewsbury Hospital. It means that SaTH can move forward with plans to have free Wi- Involvement Panel (PEIP) had mentioned several patients who were in need of something to occupy and comfort them. To alleviate concern over crossinfection we came up with the idea of labelling each one so it could be presented to a patient as a gift and taken with them when they left our hospitals. This also means that we need a never-ending supply! Since we promoted the idea in the local media and on social media, we have received muffs from across the region. Local groups of knitters, Craft Guilds and Women s Institutes, as well as many individual knitters, have supported us and I am so pleased. It s wonderful how it has taken off. One knitter said: It s really nice to know that these Twiddlemuffs are going to go to people who will be able to keep them. Twiddlemuffs can be knitted or crotched and include ribbons, zips, buttons, beads and even keys both inside and out, that can be twiddled. You can find the knitting or crochet pattern for the muffs on our dedicated web page at Fi across both hospital sites. We are constantly looking at ways to improve the experience of our patients, visitors and staff. Any length of stay in hospital, whether you are the one receiving treatment or supporting a loved one, can be, at times, frustrating or boring. Whilst we already provide free patient Wi-Fi in a number of areas where we know patients are likely to have a lengthy stay such as our Chemotherapy Day Centre and the Shropshire Women and Children s 8 Centre we have been twiddlemuffs Decorating a Twiddle Muff - a few things to consider: Putting Patients First Choose a good variety of decorations and try to include at least six twiddles on the outside and at least four on the inside - more if you can. Make sure everything is sewn on tight so they cannot be pulled off and there are no loose threads. Muffs with colourful stripes and different textures are very popular. Twiddles should not be sharp or dangerous. If you don t knit but, would like to contribute, you can by providing balls of wool, buttons, keys, ribbons and textured fabrics which can be incorporated into Twiddlemuffs. This project is part of a wide range of activities PEIPs do to assist patients. Details of how to donate Twiddlemuffs, wool or twiddles is available at or call Lou Allmark on Plans to improve Wi-Fi access to patients and staff Simon Wright Chief Executive Judith Rice Member of the Patient Experience and Involvement (PEIP) panel keen for some time to expand this to cover all of our hospital sites. We are delighted our CCG partners have offered to match our funding for this important scheme. This will not just benefit our patients and visitors. Technology is playing an increasing role in almost everything we do and being able to access Wi- Fi across our sites will help all of our staff manage the increasing demand on their time as well as improving the accuracy of record keeping and improving patient safety. Page 8