Sign up to Safety Drivers and Measurement

Size: px
Start display at page:

Download "Sign up to Safety Drivers and Measurement"

Transcription

1 Sign up to Safety Drivers and Measurement Expert Partner Nicola Davey

2

3 Topics for today Driver diagrams Linking improvement aims to strategic objectives Generating simple improvement measures Measures Process, outcome measures from clinical, managerial and patient perspectives Balancing measures

4 Food intake Energy in Alcohol intake Aim: 2 kg lighter Fizzy drinks Everyday exercise Energy out Mobility aids e.g. lifts, cars Aerobic exercise PRIMARY DRIVER SECONDARY DRIVER

5 Have I achieved my goal? MEASUREMENT

6 Have I achieved my goal? Calories Units Calories No of drinks Weight Calories Steps/Miles Times used Exercise sessions

7 Where to start? Priorities and dependencies

8 Start out time Get to work on time every time Journey time

9 Ready to leave for work Start out time Time of leaving Get to work on time every time Mode of transport Journey time Route Known delays

10 Ready to leave for work Start out time Time of leaving Get to work on time every time Mode of transport Journey time Route Known delays

11 Ready to leave for work Start out time Time of leaving Get to work on time every time Mode of transport Journey time Route Known delays

12 Any questions

13 How do change ideas connect to strategic aims? BIG DOT little dot DRIVER Aligning organisational strategic aims to change ideas at the front line &.. Connecting you to your sponsor!

14

15

16 Your improvement project aim Improvement focus Change interventions Leadership Nominate a leader for each transfer of care Valuing transfer of care as an essential part of care Structured transfer of care right each time Participants Involve the appropriate people at all times Place/space/phone A specific place or setting in which handover can occur Standardised protocol Correctly use the right process and include right information every time Standard information template Structured communication tool & training, eg SBAR Documented transfer of care process

17 Your improvement project aim Improvement focus Change interventions Standard information template Structured transfer of care right each time Standardised protocol Correctly use the right process and include right information every time Structured communication tool & training, eg SBAR Documented transfer of care process

18 Your improvement project aim Improvement focus Change interventions Standard information template Usability test Structured transfer of care right each time Weekly sample of transfers Standardised protocol Correctly use the right process and include right information every time No. of staff trained Structured communication tool & training, eg SBAR Weekly observation Documented transfer of care process Daily sample of transfer notes

19 No. of delayed discharges Weekly sample of transfers No of complaints citing communication failure during transfer Patient harms as a result of communication failures during transfer (Datix/RCA)

20 Any questions

21 Model for Improvement What are we trying to achieve? How will we know the change is an improvement? What change can we make that will result in the improvement we seek? How do I test my idea? The Model for Improvement. Langley, Nolan, Nolan, Norman & Provost. The Improvement Guide, Josse Bass, 1996

22 Developing a SMART improvement aim Specific Measureable Achievable Results focused Time-bound

23

24 Example v v v v v v v

25 Sepsis 6 implemented on admission and in-patient Routine use of Sepsis Score cards Sepsis Reduce mortality from sepsis by 50% by 2017 UTI Prevention Improvement Plan implemented HAP and aspiration pneumonia improvement plan implemented Surgical site infection reduced Emergency laparatomy pathway implemented Antibiotic prescribing stewardship routinely implemented to prevent CDT

26 Measurement for improvement checklist Easy quick to do on regular basis Reliable same if someone else did the measurement Reproducible can measure same on many occasions Meaningful Understand what I can learn from this measurement Informing It will help me decide what to do next

27 Sepsis 6 implemented on admission and in-patients Sepsis Reduce mortality from sepsis by 50% by 2017 Routine use of Sepsis Score cards UTI Prevention Improvement Plan implemented HAP and aspiration pneumonia improvement plan implemented Surgical site infection reduced Emergency laparatomy pathway implemented Antibiotic prescribing stewardship routinely implemented to prevent CDT Sample 5 patients per ward per week Score 6 = Implemented Score < 6 = Not implemented Weekly sample % of completed cards No. of red boxes Weekly sample No communicated during handover Weekly sample No of meds prescribed without/contrary to microbiology report

28 System alignment..for measures too! Clinical Managerial AND Patient Focused!

29 Clinical Examples Clinical Process measures Surgical checklist completed Clinical outcome measures Successful operations VTE checklist completed VTE prophylaxis given where indicated Pre-op antibiotics given Number of post operative infections

30 Patient outcomes Return to good health No bad after effects e.g. when planned

31 Managerial Examples Managerial Process measures Enough beds to meet demand Managerial outcome measures Reduced length of stay Number of VTE assessments being completed Number of MRSA infections CQUIN payments received National MRSA target met Number of complaints satisfactorily resolved Friends and family score

32 Patient outcomes Return to good health No bad after effects e.g. DVT or infections Confidence in local service

33 A perfect synergy clinical & managerial AND patient process & outcome measures No bad after effects From surgery e.g. deep vein thrombosis

34 Balancing measures Unanticipated and/or unwanted impact of planned improvement Process/outcome measures Reduced Length of Stay Balancing measures Increase in readmissions Reduction in medicines toxicity/overdose Increase in instances of sub therapeutic dose Adherence to sepsis bundle Increased admissions for infections suitable for non-acute management Increased access to diagnostics Number of non essential interventions

35 Any questions

36 Resources driver diagrams Driver diagrams, Bob Lloyd, IHI Open School OR Youtube Driver Diagrams Handbook of Quality and Service Improvement Tools, NHS Institute for innovation and Improvement ice_improvement_tools/driver_diagrams.html

37 Resources - Measurement Run Charts, Bob Lloyd, IHI Open School OR Youtube Seven steps to measurement, Mike Davidge on Measurement for Improvement Measurement for improvement, QI Bitesize03 - Emma Donaldson and Tickle PDSA, Handbook of Quality and Service Improvement Tools, NHS Institute for Innovation and Improvement Measuring for Improvement, Improvement Leaders Guide, NHS Institute for Innovation and Improvement (NHS staff LOGIN, Others via Quality Improvement Clinic) =document_product_info&cpath=65&products_id=301

38 NikkiDQIC

39

40 THE MEASUREMENT AND MONITORING OF SAFETY, The Health Foundation, Spotlight 2013 Past harm: this encompasses both psychological and physical measures Reliability: this encompasses measures of behaviour and systems Sensitivity to operations: the information and capacity to monitor safety on an hour or daily basis Anticipation and preparedness: the ability to anticipate, and be prepared for, problems Integration and learning: the ability to respond to, and improve from, safety information

41

Step by step measurement guide

Step by step measurement guide Step by step measurement guide The guide has been produced under a creative commons license please use the symbols shown for guidance if you wish to use or adapt the material This edited presentation has

More information

Online library of Quality, Service Improvement and Redesign tools. Reliable design. collaboration trust respect innovation courage compassion

Online library of Quality, Service Improvement and Redesign tools. Reliable design. collaboration trust respect innovation courage compassion Online library of Quality, Service Improvement and Redesign tools Reliable design collaboration trust respect innovation courage compassion Reliable design What is it? Patients receiving the right care,

More information

Using QI tools: Action Effect Diagrams

Using QI tools: Action Effect Diagrams Using QI tools: Action Effect Diagrams Tom Woodcock Supported by and delivering for: London s NHS organisations include all of London s CCGs, NHS England and Health Education England 1 Learning Objectives

More information

Implementing PEWS. With Peter Lachman, Nikki Davey and The NHS

Implementing PEWS. With Peter Lachman, Nikki Davey and The NHS Implementing PEWS Sebastian Yuen Sebastian.yuen@gmail.com Consultant Paediatrician, George Eliot Hospital, Nuneaton Fellow, NHS Institute for Innovation and Improvement (2008-10) With Peter Lachman, Nikki

More information

This is a high level overview report to update the Board on the Acute Adult Safety Programme consisting of the following sections:

This is a high level overview report to update the Board on the Acute Adult Safety Programme consisting of the following sections: Greater Glasgow and Clyde NHS Board Board Meeting June 2014 Board Paper No. 14/34 Board Medical Director Scottish Patient Safety Programme Update 1. Background The Scottish Patient Safety Programme (SPSP)

More information

Safety in Mental Health Collaborative

Safety in Mental Health Collaborative NHS Tayside Safety in Mental Health Collaborative Improving Safety in Mental Health Programme Aims supported by an Improvement Advisor: Dr Noeleen Devaney Support 4 UK organisations to: reduce harm improving

More information

The 6C s: A Vision for Nursing

The 6C s: A Vision for Nursing The 6C s: A Vision for Nursing Teresa Fenech Deputy Director of Quality Assurance The 6Cs : Ward Managers Manchester November 2013 The NHS Mandate 2 NHS Presentation Nov 2013 The vision for nurses, midwives

More information

Risk Assessment & Safety Planning Driver Diagram Phase Two. The Scottish Patient Safety Programme is co-ordinated by Healthcare Improvement Scotland

Risk Assessment & Safety Planning Driver Diagram Phase Two. The Scottish Patient Safety Programme is co-ordinated by Healthcare Improvement Scotland Risk Assessment & Safety Planning Driver Diagram Phase Two The Scottish Patient Safety Programme is co-ordinated by Healthcare Improvement Scotland Risk assessment and safety plans are implemented for

More information

Introduction. Singapore. Singapore and its Quality and Patient Safety Position 11/9/2012. National Healthcare Group, SIN

Introduction. Singapore. Singapore and its Quality and Patient Safety Position 11/9/2012. National Healthcare Group, SIN Introduction Singapore and its Quality and Patient Safety Position Singapore 1 Singapore 2004: Top 5 Key Risk Factors High Body Mass (11.1%; 45,000) Physical Inactivity (3.8%; 15,000) Cigarette Smoking

More information

Commissioning for Quality & Innovation (CQUIN)

Commissioning for Quality & Innovation (CQUIN) Commissioning for Quality & Innovation () The following suite of s are goals relating to improvements in the quality of patient care which the Trust has agreed with commissioners (with the exception of

More information

Making it safe for acutely ill patients - a whistlestop tour of medical error & patient harm

Making it safe for acutely ill patients - a whistlestop tour of medical error & patient harm Making it safe for acutely ill patients - a whistlestop tour of medical error & patient harm Sara Barton Acute Physician Salford Royal NHS Foundation Trust What is medical error? Medical errors can be

More information

A3/B3: Improvement in the Intensive Care Unit

A3/B3: Improvement in the Intensive Care Unit A3/B3: Improvement in the Intensive Care Unit Carol Peden, MD, MPH, FRCA, FFICM, Associate Medical Director for Quality Improvement, Consultant in Anesthesia and Intensive Care Session Objectives Structure

More information

This paper provides an update on the the recent national SPSP conference the programme of work for Tissue Viability Acute Adult Care SPSP

This paper provides an update on the the recent national SPSP conference the programme of work for Tissue Viability Acute Adult Care SPSP Greater Glasgow and Clyde NHS Board Board Meeting December 2016 Board Paper No. 16/81 Scottish Patient Safety Programme Update 1. Background The Scottish Patient Safety Programme (SPSP) is one of the family

More information

Quality Improvement Strategy

Quality Improvement Strategy / Colchester Hospital University NHS Foundation Trust Quality Improvement Strategy 2015-2018 Including our four Quality goals Strategy Author Angela Tillett, Medical Director Version 1 Date of Issue -

More information

Improving Patient Outcomes Strategy

Improving Patient Outcomes Strategy Improving Patient Outcomes Strategy 2015-2018 Hertford County I Lister I Mount Vernon Cancer Centre I QEII Improving Patient Outcomes Strategy 2015-2018 Page 1. Executive Summary 1 2. Introduction 2 3.

More information

Status: Information Discussion Assurance Approval. Claire Gorzanski, Head of Clinical Effectiveness

Status: Information Discussion Assurance Approval. Claire Gorzanski, Head of Clinical Effectiveness Report to: Trust Board Agenda item: Date of Meeting: 2 October 2017 SFT3934 Report Title: Annual quality governance report 2016-2017 Status: Information Discussion Assurance Approval X Prepared by: Executive

More information

Surgical Safety Checklist:

Surgical Safety Checklist: Implementing the Surgical Safety Checklist: the journey so far... Introduction This document summarises the experience and reflections of NHS Trusts about their progress in implementing the World Health

More information

Inpatient Experience Survey 2016 Results for Royal Infirmary of Edinburgh

Inpatient Experience Survey 2016 Results for Royal Infirmary of Edinburgh Results for August, Official Statistics Contents Page Introduction 3 Notes of interpretation 4 Chapter 1: Rated results 6 Chapter 2: Comparison with previous surveys 28 Chapter 3: Variation in hospital

More information

Inpatient Experience Survey 2016 Results for Western General Hospital, Edinburgh

Inpatient Experience Survey 2016 Results for Western General Hospital, Edinburgh Results for, Edinburgh August, Official Statistics Contents Page Introduction 3 Notes of interpretation 4 Chapter 1: Rated results 6 Chapter 2: Comparison with previous surveys 28 Chapter 3: Variation

More information

Inpatient Experience Survey 2016 Results for Dr Gray's Hospital, Elgin

Inpatient Experience Survey 2016 Results for Dr Gray's Hospital, Elgin Results for, Elgin August, Official Statistics Contents Page Introduction 3 Notes of interpretation 4 Chapter 1: Rated results 6 Chapter 2: Comparison with previous surveys 28 Chapter 3: Variation in hospital

More information

Prevention and control of healthcare-associated infections

Prevention and control of healthcare-associated infections Prevention and control of healthcare-associated infections Quality improvement guide Issued: November 2011 NICE public health guidance 36 guidance.nice.org.uk/ph36 NHS Evidence has accredited the process

More information

Antimicrobial stewardship in Scotland: quality improvement agenda

Antimicrobial stewardship in Scotland: quality improvement agenda Antimicrobial stewardship in Scotland: quality improvement agenda Dr Jacqueline Sneddon Project Lead Scottish Antimicrobial Prescribing Group Background Scottish Antimicrobial Prescribing Group (SAPG)

More information

Understanding Patient Choice Insights Patient Choice Insights Network

Understanding Patient Choice Insights Patient Choice Insights Network Quality health plans & benefits Healthier living Financial well-being Intelligent solutions Understanding Patient Choice Insights Patient Choice Insights Network SM www.aetna.com Helping consumers gain

More information

How Digital Systems Can Impact on Antimicrobial Stewardship (AMS) Stephen Hughes (Antimicrobial Pharmacist) Chelsea & Westminster Hospital

How Digital Systems Can Impact on Antimicrobial Stewardship (AMS) Stephen Hughes (Antimicrobial Pharmacist) Chelsea & Westminster Hospital How Digital Systems Can Impact on Antimicrobial Stewardship (AMS) Stephen Hughes (Antimicrobial Pharmacist) Chelsea & Westminster Hospital Importance of AMS Antimicrobial Resistance: Any selective pressure

More information

Healthcare quality lessons from the best small country in the world

Healthcare quality lessons from the best small country in the world Healthcare quality lessons from the best small country in the world Scotland and Canada Scotland 5.5 Million people Scottish Politics Scottish Politics Devolution - 1997 Scottish National Party minority

More information

FOREWORD Introduction from the Chief Executive 2 BACKGROUND 3 OUR TRUST VALUES 4 OUR AIMS FOR QUALITY 5 HOW WE MEASURE QUALITY 16

FOREWORD Introduction from the Chief Executive 2 BACKGROUND 3 OUR TRUST VALUES 4 OUR AIMS FOR QUALITY 5 HOW WE MEASURE QUALITY 16 Contents FOREWORD Introduction from the Chief Executive 2 BACKGROUND 3 OUR TRUST VALUES 4 OUR AIMS FOR QUALITY 5 - Our achievements so far - Our aims for quality 2017 2020 AIM 1: AIM 2: AIM 3: AIM 4: Reducing

More information

EMBEDDING A PATIENT SAFETY CULTURE

EMBEDDING A PATIENT SAFETY CULTURE EMBEDDING A PATIENT SAFETY CULTURE October 2011 Robert J. Bell The NHS (2005) DEPARTMENT OF HEALTH STRATEGIC HEALTH AUTHORITIES PRIMARY CARE TRUSTS ACUTE CARE TRUSTS Manage and integrate primary care for

More information

Acute kidney injury Keeping kidneys healthy: The AKI programme board. Dr Richard Fluck, National Clinical Director (Renal) NHS England

Acute kidney injury Keeping kidneys healthy: The AKI programme board. Dr Richard Fluck, National Clinical Director (Renal) NHS England Acute kidney injury Keeping kidneys healthy: The AKI programme board Dr Richard Fluck, National Clinical Director (Renal) NHS England NHS Outcomes Framework NHS Five Year Forward View A vision for the

More information

IQC/2013/48 Improvement and Quality Committee October 2013

IQC/2013/48 Improvement and Quality Committee October 2013 Item 9.4 IQC/2013/48 Improvement and Quality Committee October 2013 Pressure Ulcer Prevalence Improvement Plan 1. SITUATION AND BACKGROUND This paper is to update the Improvement and Quality Committee

More information

The Core Elements of Antibiotic Stewardship with CMS and QAPI Updates

The Core Elements of Antibiotic Stewardship with CMS and QAPI Updates The Core Elements of Antibiotic Stewardship with CMS and QAPI Updates Emily Lutterloh, MD, MPH Director, Bureau of Healthcare Associated Infections New York State Department of Health February 8, 2017

More information

CQC INSPECTION. Ann Marr Chief Executive July 2016

CQC INSPECTION. Ann Marr Chief Executive July 2016 CQC INSPECTION Ann Marr Chief Executive July 2016 Introduction to the Trust Acute District General Hospital, with obstetrics and paediatrics, major provider of non-elective services, regional burns and

More information

Commissioning for Quality and Innovation (CQUIN) Guidance for 2016/17 Published March 2016

Commissioning for Quality and Innovation (CQUIN) Guidance for 2016/17 Published March 2016 Commissioning for Quality and Innovation (CQUIN) Guidance for 2016/17 Published March 2016 Commissioning for Quality and Innovation (CQUIN) Introduction1 The CQUIN scheme is intended to deliver clinical

More information

NHS TAYSIDE MORTALITY REVIEW PROGRAMME

NHS TAYSIDE MORTALITY REVIEW PROGRAMME NHS TAYSIDE MORTALITY REVIEW PROGRAMME Aim Primary Drivers Processes, Rules of Conduct, Structure MEASUREMENT Secondary Drivers Components, Activities Understand how mortality rates/ratios are measured

More information

Inpatient Patient Experience Survey 2014 Results for NHS Grampian

Inpatient Patient Experience Survey 2014 Results for NHS Grampian Results for August, Official Statistics Contents Page Introduction 3 Chapter 1: Rated Results 4 Chapter 2: Comparison with Previous Surveys 19 Chapter 3: Variation in NHS Board Results across 28 Chapter

More information

National COPD Audit Programme

National COPD Audit Programme National COPD Audit Programme COPD: Working together Clinical audit of COPD exacerbations admitted to acute hospitals in England and Wales 2017 Findings and quality improvement The audit programme partnership

More information

Quality Improvement (QI)

Quality Improvement (QI) Quality Improvement (QI) HOW DOES IT WORK? Dr S Narayanan Neonatal Consultant Watford General Hospital Outline of the talk Background Definitions QI What? Why? When? Where? How? Case study Discussion

More information

OPAT & Paediatric OPAT Standards and Practical Implications for the Hospital and Community. Dr Sanjay Patel & Dr Ann Chapman

OPAT & Paediatric OPAT Standards and Practical Implications for the Hospital and Community. Dr Sanjay Patel & Dr Ann Chapman OPAT & Paediatric OPAT Standards and Practical Implications for the Hospital and Community Dr Sanjay Patel & Dr Ann Chapman UK OPAT Good Practice Recommendations - Practical considerations and challenges

More information

Thinking Differently Acting Differently. Higher staff satisfaction = better patient outcomes & better patient experience

Thinking Differently Acting Differently. Higher staff satisfaction = better patient outcomes & better patient experience Thinking Differently Acting Differently Higher staff satisfaction = better patient outcomes & better patient experience Staff Satisfaction is the best indicator of a High Quality Culture Nursing contribution

More information

Advanced Measurement for Improvement Prework

Advanced Measurement for Improvement Prework Advanced Measurement for Improvement Prework IHI Training Seminar Boston, MA March 20-21, 2017 Faculty: Richard Scoville PhD; Gareth Parry PhD Thank you for enrolling in IHI s upcoming seminar on designing

More information

Putting It All Together: Strategies to Achieve System-Wide Results

Putting It All Together: Strategies to Achieve System-Wide Results 1 Putting It All Together: Strategies to Achieve System-Wide Results Katharine Luther, Lloyd Provost, Pat Rutherford Hospital Flow Professional Development Program April 4-7, 2016 Cambridge, MA Session

More information

PHARMACIST INDEPENDENT PRESCRIBING MEDICAL PRACTITIONER S HANDBOOK

PHARMACIST INDEPENDENT PRESCRIBING MEDICAL PRACTITIONER S HANDBOOK PHARMACIST INDEPENDENT PRESCRIBING MEDICAL PRACTITIONER S HANDBOOK 0 CONTENTS Course Description Period of Learning in Practice Summary of Competencies Guide to Assessing Competencies Page 2 3 10 14 Course

More information

Public health guideline Published: 11 November 2011 nice.org.uk/guidance/ph36

Public health guideline Published: 11 November 2011 nice.org.uk/guidance/ph36 Healthcare-associated infections: prevention ention and control Public health guideline Published: 11 November 2011 nice.org.uk/guidance/ph36 NICE 2017. All rights reserved. Subject to Notice of rights

More information

Generic Job Description Consultant Pharmacist. Job Purpose

Generic Job Description Consultant Pharmacist. Job Purpose Generic Job Description Consultant Pharmacist Grade: Based at: 8b-d Operating sites as required Accountable to: Head of Pharmacy/Clinical Director of Pharmacy/ Divisional director or equivalent Managed

More information

Targets, flow, exit block, stranded patients, red2green. What s any of this got to do with good patient care?

Targets, flow, exit block, stranded patients, red2green. What s any of this got to do with good patient care? Targets, flow, exit block, stranded patients, red2green. What s any of this got to do with good patient care? Lee Dowson Divisional Director of Medicine Royal Wolverhampton NHS Trust Clinical Associate

More information

Reducing Harm Improving Healthcare Protecting Canadians MEDICATION RECONCILIATION IN THE ICU. Change Package.

Reducing Harm Improving Healthcare Protecting Canadians MEDICATION RECONCILIATION IN THE ICU. Change Package. Reducing Harm Improving Healthcare Protecting Canadians MEDICATION RECONCILIATION IN THE ICU Change Package January 2012 Background The ultimate goal of medication reconciliation is to prevent adverse

More information

Ambulatory emergency care Reimbursement under the national tariff

Ambulatory emergency care Reimbursement under the national tariff HFMA briefing Ambulatory emergency care Reimbursement under the national tariff Introduction Ambulatory emergency care is defined as a service that allows a patient to be seen, diagnosed and treated and

More information

Are you at risk of blood clots?

Are you at risk of blood clots? Are you at risk of blood clots? DVT (deep vein thrombosis) & PE (pulmonary embolism) Information for patients in hospital or going home from hospital Are you at risk of blood clots? (DVT & PE) This leaflet

More information

Leroy Edozien. Consultants - Obstetrics & Gynaecology St Mary s Hospital, Manchester, UK

Leroy Edozien. Consultants - Obstetrics & Gynaecology St Mary s Hospital, Manchester, UK Leroy Edozien Consultants - Obstetrics & Gynaecology St Mary s Hospital, Manchester, UK Introduction Clinicians fundamental principle: first do no harm 1 in every 10 patients suffers a medical accident

More information

PATIENT ASSESSMENT POLICY Page 1 of 7

PATIENT ASSESSMENT POLICY Page 1 of 7 Page 1 of 7 Policy applies to: All staff and allied health professionals involved in patient care delivery at Mercy Hospital including Manaaki. Related Standards: Health & Disability Services (core) Standards

More information

Developing a Patient Safety Culture within the NHS Setting the Scene. Peter Davey

Developing a Patient Safety Culture within the NHS Setting the Scene. Peter Davey University of Dundee School of Medicine Developing a Patient Safety Culture within the NHS Setting the Scene Peter Davey How Do We See Ourselves? content courtesy of Martin Marshall, Director of Clinical

More information

National Patient Safety Goals & Quality Measures CY 2017

National Patient Safety Goals & Quality Measures CY 2017 National Patient Safety Goals & Quality Measures CY 2017 General Clinical Orientation 2017 January National Patient Safety Goals 1. Identify Patients Correctly 2. Improve Staff Communication 3. Use Medications

More information

Online library of Quality, Service Improvement and Redesign tools. Discharge planning. collaboration trust respect innovation courage compassion

Online library of Quality, Service Improvement and Redesign tools. Discharge planning. collaboration trust respect innovation courage compassion Online library of Quality, Service Improvement and Redesign tools Discharge planning collaboration trust respect innovation courage compassion Discharge planning What is it? A specific targeted discharge

More information

Medical Technology Innovation: Driving efficiencies of healthcare systems

Medical Technology Innovation: Driving efficiencies of healthcare systems Medical Technology Innovation: Driving efficiencies of healthcare systems John Wilkinson, CEO Eucomed Session: A multifaceted approach to responsible innovation in healthcare European Commission Conference

More information

CASE STUDY The Safer Patients Initiative

CASE STUDY The Safer Patients Initiative CSE STUDY The Safer Patients Initiative Critical care in practice: Royal ree Hospital and the University Hospital of Wales 1. INTRODUCTION In late 4, the Health oundation funded the Institute for Healthcare

More information

We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards.

We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Spire Wellesley Hospital Eastern Avenue, Southend-on-Sea, SS2

More information

Carol J. Peden BSC, MB ChB, MD, FRCA, FFICM, MPH Royal United Hospital, Bath

Carol J. Peden BSC, MB ChB, MD, FRCA, FFICM, MPH Royal United Hospital, Bath Carol J. Peden BSC, MB ChB, MD, FRCA, FFICM, MPH Royal United Hospital, Bath Up to 25,000 surgical deaths per year 5-10% of surgical cases are high risk 79% of deaths occur in the high risk group Overall

More information

Integrating quality improvement into pre-registration education

Integrating quality improvement into pre-registration education Integrating quality improvement into pre-registration education Jones A et al (2013) Integrating quality improvement into pre-registration education. Nursing Standard. 27, 29, 44-48. Date of submission:

More information

National Programme to Prevent Central-Line Associated Bacteraemia. Project Charter October 2011 to April 2013

National Programme to Prevent Central-Line Associated Bacteraemia. Project Charter October 2011 to April 2013 National Programme to Prevent Central-Line Associated Bacteraemia Project Charter October 2011 to April 2013 1. Overview Central-Line Associated Bacteraemia (CLAB) prevention is one of the most important

More information

Gathering and Using Evidence & Data to Demonstrate Improvements Within Your Care Home

Gathering and Using Evidence & Data to Demonstrate Improvements Within Your Care Home Gathering and Using Evidence & Data to Demonstrate Improvements Within Your Care Home Carolyn Leslie Programme Support Manager Healthcare Associated Infections Copyright 2007 Improvement Foundation Objectives

More information

OHA HEN 2.0 Partnership for Patients Letter of Commitment

OHA HEN 2.0 Partnership for Patients Letter of Commitment OHA HEN 2.0 Partnership for Patients Letter of Commitment To: Re: Request to Participate in the Ohio Hospital Association Hospital Engagement Contract Date: September 24, 2015 We have reviewed the information

More information

Healthcare Improvement Scotland. NHS Tayside

Healthcare Improvement Scotland. NHS Tayside Faculty Site Visit Report Healthcare Improvement Scotland NHS Tayside 8 th June 2011 FINAL VERSION 19 July 2011 CONTENTS 1. Key Contacts... 2 NHS Tayside... 2 Site Visit Team... 2 2. SPSP Programme Key

More information

NHS Wales Delivery Framework 2011/12 1

NHS Wales Delivery Framework 2011/12 1 1. Introduction NHS Wales Delivery Framework for 2011/12 NHS Wales has made significant improvements in targeted performance areas over recent years. This must continue and be associated with a greater

More information

Meeting the NEW RCN Standards for Infusion Therapy in practice

Meeting the NEW RCN Standards for Infusion Therapy in practice Meeting the NEW RCN Standards for Infusion Therapy in practice sumanshrestha@nhs.net Suman Shrestha MSc BSc RN Advanced Nurse Practitioner Intensive Care Frimley Park Hospital suman_sr FRIMLEY PARK HOSPITAL

More information

Patient Safety. If you have any questions, contact: Sheila Henssler Performance Improvement/Patient Safety Coordinator Updated:

Patient Safety. If you have any questions, contact: Sheila Henssler Performance Improvement/Patient Safety Coordinator Updated: Patient Safety If you have any questions, contact: Sheila Henssler Performance Improvement/Patient Safety Coordinator 615-7018 Updated: 2013-05-03 Learning Objectives In this presentation, you will learn:

More information

A Resident-led PICU Morbidity and Mortality Conference

A Resident-led PICU Morbidity and Mortality Conference A Resident-led PICU Morbidity and Mortality Conference James Moses, MD, MPH Associate Program Director Boston Combined Residency Program Director of Patient Safety and Quality Department of Pediatrics

More information

Kentucky Sepsis Summit. August 2016

Kentucky Sepsis Summit. August 2016 1 Kentucky Sepsis Summit August 2016 St. Elizabeth Healthcare About Us: - 7 facilities & over 1200 licensed beds - Serving the NKY/Cincinnati Region in: - Orthopedic Care - Heart and Vascular Institute

More information

UI Health Hospital Dashboard September 7, 2017

UI Health Hospital Dashboard September 7, 2017 UI Health Hospital Dashboard September 20 September 7, 20 UI Health Metrics FY Q4 Actual FY Q4 Target FY Q4 Actual 4th Quarter % change FY vs FY Discharges 4,558 4,680 4,720 Combined Observation Cases

More information

EQuIPNational Survey Planning Tool NSQHSS and EQuIP Actions 4.

EQuIPNational Survey Planning Tool NSQHSS and EQuIP Actions 4. Standard 1: Governance for safety and Quality and Standard 2: Partnering with Consumers Section 1 Governance, Policies, Business decision making, Organisational / Strategic planning, Consumer involvement

More information

Andrea Croft RGN Lead Advanced Nurse Practitioner Anticoagulation. Welsh Nurse Director Thrombosis UK

Andrea Croft RGN Lead Advanced Nurse Practitioner Anticoagulation. Welsh Nurse Director Thrombosis UK Andrea Croft RGN Lead Advanced Nurse Practitioner Anticoagulation Welsh Nurse Director Thrombosis UK Background Venous Thromboembolism (VTE), the collective term for deep vein thrombosis (DVT) and pulmonary

More information

Standardised handover protocol: increasing safety awareness

Standardised handover protocol: increasing safety awareness Standardised handover protocol: increasing safety awareness This Future Hospital Programme case study details how Dr Shirine Boardman from Grantham and District Hospital, United Lincolnshire Hospitals

More information

Developing a care bundle for stroke. Hazel Fraser Stroke Co-ordinator NHS Fife September 2011

Developing a care bundle for stroke. Hazel Fraser Stroke Co-ordinator NHS Fife September 2011 Developing a care bundle for stroke Hazel Fraser Stroke Co-ordinator NHS Fife September 2011 Aim to cover Background Scottish Patient Safety Programme Care bundles PDSA Challenges faced Is it working?

More information

NHS LANARKSHIRE QUALITY DASHBOARD Board Report June 2011 (Data available as at end April 2011)

NHS LANARKSHIRE QUALITY DASHBOARD Board Report June 2011 (Data available as at end April 2011) NHS LANARKSHIRE QUALITY DASHBOARD Board Report June 2011 (Data available as at end April 2011) INTRODUCTION This paper provides a monthly quality dashboard for NHS Lanarkshire. This is in line with the

More information

HOSPITAL SOCIAL WORKER

HOSPITAL SOCIAL WORKER Position Title: Classification: Reports To: Department: Award / Enterprise Agreement: Hospital Social Work Qualified Social Worker in accordance with experience Manager Community Support Community Support

More information

Final Topline The Management and Control of Hospital Acquired Infection Part 3 Orthopaedic Surgery

Final Topline The Management and Control of Hospital Acquired Infection Part 3 Orthopaedic Surgery Final Topline - 26.9.2003 The Management and Control of Hospital Acquired Infection Part 3 Orthopaedic Surgery 96 postal questionnaires returned from 176 Acute NHS Trusts Fieldwork carried out between

More information

Quality Improvement Scorecard March 2018

Quality Improvement Scorecard March 2018 Mortality: HSMR Nat NB: Each month is a 12 month rolling value. I.e. Mar-16 reports the monthly average of Apr-15 to Mar-16. Performance further improved in October. November data not yet available. Mortality:

More information

HEI self-assessment. Completing the self-assessment - Guidance to NHS boards

HEI self-assessment. Completing the self-assessment - Guidance to NHS boards HEI self-assessment Completing the self-assessment - Guidance to NHS boards INTRODUCTION This document should be read in conjunction Healthcare Improvement Scotland healthcare associated infection (HAI)

More information

Pre Assessment Policy. Trust Policy Forum March 2004

Pre Assessment Policy. Trust Policy Forum March 2004 Policy No: OP19 Version 1.0 Name of Policy: Pre Assessment Policy Effective From: March 2004 Approved by: Trust Policy Forum March 2004 Next Review Date: March 2005 Reviewed by: This policy supercedes

More information

Documentation 101: CDI JULY 19, 2017

Documentation 101: CDI JULY 19, 2017 Documentation 101: CDI THE FIFTH NATIONAL PHYSICIAN ADVISOR AND UTILIZATION REVIEW BOOT CAMP JULY 19, 2017 Infirmary Health: About Us Infirmary Health is the largest non-governmental healthcare system

More information

EXPERIENCE OF THE ERADICATION OF PRESSURE ULCERS IN PRIMARY CARE

EXPERIENCE OF THE ERADICATION OF PRESSURE ULCERS IN PRIMARY CARE EXPERIENCE OF THE ERADICATION OF PRESSURE ULCERS IN PRIMARY CARE HAMISH LAING Consultant plastic and reconstructive surgeon ABM University Health Board, Wales UK Terminology 2 Pressure sores Bed sores

More information

The Productive Operating Theatre Building teams for safer care TM

The Productive Operating Theatre Building teams for safer care TM The Productive Operating Theatre Building teams for safer care TM Patient Preparation Version 1 This document is for theatre managers, theatre matrons, theatre coordinators, theatre staff, preoperative

More information

Pressure Ulcers to Zero Collaborative Guide

Pressure Ulcers to Zero Collaborative Guide Pressure Ulcers to Zero Collaborative Guide Table of Contents Page Number Purpose of the guide 2 Why get involved? 3 Pressure Ulcer Definition 5 What is the Pressure Ulcers to Zero Collaborative 6 Getting

More information

Who s s on What? Latest Experience with the Framework Challenges and Successes. November 29, Margaret Colquhoun Project Leader ISMP Canada

Who s s on What? Latest Experience with the Framework Challenges and Successes. November 29, Margaret Colquhoun Project Leader ISMP Canada Who s s on What? Latest Experience with the Framework Challenges and Successes November 29, 2005 Margaret Colquhoun Project Leader ISMP Canada 1 Outline ISMP Canada Partnership with SHN The Canadian Getting

More information

Additional Considerations for SQRMS 2018 Measure Recommendations

Additional Considerations for SQRMS 2018 Measure Recommendations Additional Considerations for SQRMS 2018 Measure Recommendations HCAHPS The Hospital Consumer Assessments of Healthcare Providers and Systems (HCAHPS) is a requirement of MBQIP for CAHs and therefore a

More information

Building Capability and Capacity for Improvement in Qatar

Building Capability and Capacity for Improvement in Qatar Building Capability and Capacity for Improvement in Qatar Wednesday, 11 December - Workshop D6/E6 Mike Richmond Chief of Medical, Academic and Research Affairs State of Qatar The State of Qatar is a sovereign

More information

Improving patient safety and infection. Patient Safety Forum Dr J Coleman 1 ELECTRONIC PRESCRIBING AND CLINICAL DECISION SUPPORT (CDS)

Improving patient safety and infection. Patient Safety Forum Dr J Coleman 1 ELECTRONIC PRESCRIBING AND CLINICAL DECISION SUPPORT (CDS) Improving Patient Safety and Infection Control Through Electronic Prescribing Dr Jamie Coleman Senior Lecturer in Clinical Pharmacology / Honorary Consultant Physician The brief Clinical computing technologies

More information

DON T GIVE UNIT TWO WITHOUT REVIEW!

DON T GIVE UNIT TWO WITHOUT REVIEW! DON T GIVE UNIT TWO WITHOUT REVIEW! Single Unit Blood Transfusion QIP Dr Aqeem Azam CT1 Dr Sarah Clegg FY1 Nobles Hospital, Isle of Man SMART Aim To increase the percentage of RBC transfusions given as

More information

Improving Outcomes for High Risk and Critically Ill Patients

Improving Outcomes for High Risk and Critically Ill Patients Improving Outcomes for High Risk and Critically Ill Patients KP Woodland Hills Medical Center Presented by: Sharon M. Kent RN BSN, CCRN Lynne M. Agocs-Scott RN MN, CCRN CCNS Introduction of the IHI The

More information

Enhanced recovery after laparoscopic surgery (ERALS) programme. Patient information and advice

Enhanced recovery after laparoscopic surgery (ERALS) programme. Patient information and advice Enhanced recovery after laparoscopic surgery (ERALS) programme Patient information and advice Welcome to the enhanced recovery programme. The aim of the programme is to enable you to be well enough to

More information

Best Care Clinical Strategy Principles for the next 10 years of Best Care. Dr Caroline Allum, Executive Medical Director

Best Care Clinical Strategy Principles for the next 10 years of Best Care. Dr Caroline Allum, Executive Medical Director Best Care Clinical Strategy 2017 2027 Principles for the next 10 years of Best Care Produced By: Produced For: Dr Caroline Allum, Executive Medical Director NELFT Board Date Produced: 17 th July 2017 Version:

More information

The PCT Guide to Applying the 10 High Impact Changes

The PCT Guide to Applying the 10 High Impact Changes The PCT Guide to Applying the 10 High Impact Changes This Guide has been produced by the NHS Modernisation Agency. For further information on the Agency or the 10 High Impact Changes please visit www.modern.nhs.uk

More information

Advancing Quality & Improving Care: Getting to the Results that Matter. Shantanu Agrawal, MD, MPhil October 9, 2018

Advancing Quality & Improving Care: Getting to the Results that Matter. Shantanu Agrawal, MD, MPhil October 9, 2018 Advancing Quality & Improving Care: Getting to the Results that Matter Shantanu Agrawal, MD, MPhil October 9, 2018 Results with National Impact Lives saved Drop in early elective delivery rates 2010-2016

More information

Quality Accounts: Corroborative Statements from Commissioning Groups. Nottingham NHS Treatment Centre - Corroborative Statement

Quality Accounts: Corroborative Statements from Commissioning Groups. Nottingham NHS Treatment Centre - Corroborative Statement Quality Accounts: Corroborative Statements from Commissioning Groups Quality Accounts are annual reports to the public from providers of NHS healthcare about the quality of services they deliver. The primary

More information

Enhanced Recovery Implementing Meaningful Change

Enhanced Recovery Implementing Meaningful Change Enhanced Recovery Implementing Meaningful Change Jeff Simmons MD Associate Professor UAB Department of Anesthesiology and Perioperative Medicine I have no relevant financial relationships to disclose.

More information

Integrated Quality Report

Integrated Quality Report Integrated Quality Report Data provided by Patient Services and the Clinical Governance and Risk Department June 2018 Included this month: Health-care Associated Infections Patient Falls Pressure Ulcers

More information

Identifying and Defining Improvement Measures

Identifying and Defining Improvement Measures Identifying and Defining Improvement Measures M1 December 8, 2014 Following the CAUTI Case P2 1. Baselines, Gaps, Aims, Outcomes Where are we now, and what are we trying to accomplish? 2. Building a Theory

More information

SCIP. Surgical Care Improvement Project. Making Surgeries Safer. By: Roshini Mathew, RN

SCIP. Surgical Care Improvement Project. Making Surgeries Safer. By: Roshini Mathew, RN SCIP Surgical Care Improvement Project Making Surgeries Safer By: Roshini Mathew, RN Importance Hospitals could prevent 13,000 patient deaths and 271,000 surgical complications each year 4 measures are

More information

Statement 2: Patients/carers are offered verbal and written information on VTE prevention as part of the admission process.

Statement 2: Patients/carers are offered verbal and written information on VTE prevention as part of the admission process. THROMBOSIS GROUP Venous thromboembolism (VTE) is a collective term referring to deep vein thrombosis (DVT) and pulmonary embolism (PE). VTE is defined by the following ICD-10 codes: I80.0-I80.3, I80.8-I80.9,

More information

Nursing skill mix and staffing levels for safe patient care

Nursing skill mix and staffing levels for safe patient care EVIDENCE SERVICE Providing the best available knowledge about effective care Nursing skill mix and staffing levels for safe patient care RAPID APPRAISAL OF EVIDENCE, 19 March 2015 (Style 2, v1.0) Contents

More information

OPAT CELLULITIS PATHWAY

OPAT CELLULITIS PATHWAY OPAT CELLULITIS PATHWAY ANY exclusion criteria for OPAT Sepsis syndrome Active drug/alcohol abuse Active underlying orthopaedic condition Craniofacial cellulitis Failure to improve with > 48hrs IV Rx YES

More information

Medicine Reconciliation FREQUENTLY ASKED QUESTIONS NATIONAL MEDICATION SAFETY PROGRAMME

Medicine Reconciliation FREQUENTLY ASKED QUESTIONS NATIONAL MEDICATION SAFETY PROGRAMME Medicine Reconciliation FREQUENTLY ASKED QUESTIONS NATIONAL MEDICATION SAFETY PROGRAMME The Process What is medicine reconciliation? Medicine reconciliation is an evidence-based process, which has been

More information