BOARD OF DIRECTORS PAPER COVER SHEET Meeting date: 28 February 2007 Agenda item: 9.2 Title: In patient Survey results for 2006/07 Purpose: To inform the board of the findings of the In-Patient Survey 2006 Summary: The RD&E took part in a national in- patient survey. The purpose of the survey is to understand what patients think of the healthcare they experienced at the RD&E. The results of the survey are used as one of the national performance indicators (experience of patients). The RD&E sent a postal survey to 850 patients and received a 63% response rate. This survey essentially repeated surveys completed over the past 6 years. As in previous years the results were positive with 92% of patients rating the RD&E on a par with, or significantly better than other acute trusts. Overall the trust scored highly around patients being treated with respect and dignity, with patients recommending the hospital to family/friends. Equally, the report highlighted a number of areas where there is scope for further improvement. These include the information we provide to patients, particularly on discharge, and actively seeking feedback from patients their views on the quality of our services. The results also indicate that there is scope to involve patients more with decisions around their care whilst addressing issues around the movement of patients between wards. Directorates will now develop specific action plans, managed by the Lead Nurses, to address the issues pertinent to their areas to improve patients care and experiences. These will be monitored via the quarterly review process. Recommendation: The Board accept and note the findings of the survey Prepared by: Frances Lowery, Service Development Manager Presented by: M Orzel Director of Nursing & Service Improvement This report covers: (Please tick relevant box below) Healthcare Standards (CORE please specify which standard) Healthcare Standards (DEV T please specify which standard) Service Development Strategy Local Delivery Plan Assurance Framework Other (Please specify) C17 D8 Monitor Finance Performance Management Business Planning Complaints
Inpatient Survey 2006 Executive Summary Purpose Participation in an inpatient survey is required by The Healthcare Commission for all NHS Acute Trusts in England. All Trusts use a standard survey methodology with a core set of questions. The survey is essentially a repeat of those commissioned by the Royal Devon & Exeter NHS Foundation Trust (RD&E) from Picker over the last 6 years. The purpose of the survey is to understand what patients think of their experience of the healthcare they received whilst inpatients in the RD&E. The results of the survey contribute to the Performance Indicators - Experience of Patients and Healthcare Standard C17, Accessible and Responsive Care. Background The design of the survey questionnaire has been developed through consultation with patients, clinicians and acute trusts. The survey questions are based on aspects of care that are important from the patients perspective and analysis of the responses is undertaken by the Picker Institute on behalf of the RD&E. Postal questionnaires were sent during October & November 2006 to a random sample of 850 patients who were discharged from the RD&E during an agreed period of time. A total of 527 patients from the RD&E returned the completed questionnaire giving a response rate of 63%. The average response rate for the other Trusts surveyed by Picker (82 Trusts) was 56%. The questionnaire included 80 questions under nine categories which patients scored to identify where there are problems or room for improvement. Problem scores are then used as a summary measure, showing how the RD&E compares to the national average. The results allow the RD&E to monitor the impact of change and improvements over a period of time since 2002. The survey results for 2006 are positive in that patients views demonstrate that in 92% of the areas reviewed, the RD&E s services are equal to, or significantly better than, the rest of the country (see appendix A). These results reflect the pattern of results seen in 2005 and 96% of this year s respondents stated that they would recommend the RD&E to family and friends, whilst only 5% of the respondents rated their care as fair or poor. The areas where patient s viewed the care they received at the RD&E to be significantly better then the national comparison include: D:\Temporary Internet Files\OLK107\MNO 9 2 In-Patient Survey results 2006.doc Page 2 of 23
Privacy when being examined or treated This related both to treatment in the ED (16% of the responses for the RD&E were negative compared to 21% for the national comparison) and in the general wards (9% of the responses were negative for the RD&E compared to the national comparison of 12%). Overall 83% of patients responded positively when asked if they felt they were treated with respect and dignity (this compares to 79% nationally). Pain management Only 5% of respondents stated that they waited more than 15 minutes for pain control and 79% of patients believed that staff did everything they could to help control the pain. Cleanliness of the environment 97% of patients responded positively when asked about the cleanliness of their ward or room and 94% of the respondents felt that the toilets were clean. Hospital food 91% of patients felt they were offered an adequate choice of food (compared to 80% nationally) and 81% of these believed there was healthy food available of the menu. Communication with hospital staff Approximatly75% of patients responded positively when asked if they were given clear answers to questions by both doctors and nurses, with 80% of the respondents responding that they had trust and confidence in the nurses and doctors caring fro them. Washing of hands Approximately 85% of patients stated that they did believe that nurses and doctors washed their hands between touching patients (the national comparison was less than 80%). Whilst the above results are positive the overall results have highlighted a small number of areas where we need to review our practice in order to further improve the patient experience. Key Issues 58 of the questions used in 2006 were also used in 2005. In 92% of these areas patients views were broadly the same. However in four areas the RD&E have not scored as well as in previous years (see appendix B). These include: Waits of 4 hours or more in Emergency Department In 2005 10% of respondents gave a negative response to this question in contrast to 21% this year. It should be noted that despite this result the RD&E result is still significantly better than the national comparison. Admission process not fairly organised - In 2005 33% of respondents gave a negative response and this compares to 40% in 2006. The RD&E s results in this area are equal to the national comparison. Admission long wait to get to room/ward/bed - In 2005 20% of respondents gave a negative response in comparison to 27% in 2006. Despite this the RD&E s results are better than the national comparison. D:\Temporary Internet Files\OLK107\MNO 9 2 In-Patient Survey results 2006.doc Page 3 of 23
Care wanting to be involved in decisions - In 2005 38% of respondents gave a negative response compared to 44% 2006. The results for the RD&E are still better than the national comparison. Following the results of the in-patient survey for 2005/06 three key areas were identified as Trust-wide objectives for further improvement. These included: Patients being in two or more wards during their stay, and on occasion being in a mixed sex ward. - The results from this year s survey demonstrate that there has been improvement as the score improved from 27% to 24% since 2005. Patients being given an opportunity to give their views on the quality of care they received Whilst there has been a 1% improvement since 2005 survey this is still an area that requires further attention. The information given to patients on discharge This specifically related to not being given sufficient written or printed information and includes the need for more clearly written information about medicines. It also relates to patients not being given copies of letters sent to their GP. The results for 2006/07 demonstrate no overall change since 2005/06. Whilst the results demonstrate that work has been undertaken in the Trust resulting in a number of improvements there is still scope to review the work to date and ensure that future plans are embedded and taken forward by the individual Directorates. Directorate action plans based on the results from 2005/06 results are shown in Appendix C. Next Steps All the data collected by Picker will be analysed in more detail. The results will be broken down by directorate and reported to them by March 2007. This will allow the development of directorate specific action plans to address their areas for improvement specific to their individual results. Workshops for Lead Nurses and Senior Matrons are being developed for March/April 2007 to assist them to develop clear measurable action plans and to promote local ownership. Delivery of the action plans will be led by the Lead Nurses and progress monitored via the quarterly review process. Swift action to tackle the issues highlighted should ensure that our results for next years survey will show improved patient care and experiences. The Healthcare Commission will use the results from the in-patient survey as part of the evidence to support the achievement of the healthcare standards. They will do this by selecting a number of the 80 questions under the 5 key themes of: Access and waiting Clean safe place to be Information, communication and choice D:\Temporary Internet Files\OLK107\MNO 9 2 In-Patient Survey results 2006.doc Page 4 of 23
Building relationships Safe, high quality care There is now a need to consider the introduction of a system where patients can provide direct feedback on the quality of care they have received. A number of options are being considered, which include the use of IT systems to collate and analyse the views of patients on a regular and ongoing basis. M Orzel Director of Nursing & Service Improvement February 2007 D:\Temporary Internet Files\OLK107\MNO 9 2 In-Patient Survey results 2006.doc Page 5 of 23
APPENDIX A External Benchmarks This section shows how the RD&E compared to all Picker Trusts in this survey, (82 trusts). The range of scores are shown as a blue bar from the best trust (at the left edge of the bar), to the worst trust (at the right edge of the bar). The average score is shown as a black line towards the middle of the bar. The RD&E is shown as the yellow triangle. A. Admission to hospital Ambulance: crew not totally reassuring Ambulance: crew did not fully explain care and treatment in a clear way Ambulance: crew didn't do everything they could to control pain Ambulance: crew did not always treat with respect and dignity Emergency Department: order in which patients seen was not fair Emergency Department: not enough/too much information about condition or treatment given Emergency Department: not given enough privacy when being examined or treated Emergency Department: waited 4 hours or more for admission to bed on a ward Planned admission: not given choice of hospital and would have liked Planned admission: not given choice of admission date Planned admission: should have been admitted sooner D:\Temporary Internet Files\OLK107\MNO 9 2 In-Patient Survey results 2006.doc Page 6 of 23
Planned admission: not given enough notice of admission Planned admission: admission date changed by hospital Planned admission: not given printed information about the hospital Planned admission: not given printed information about condition or treatment Admission: process not at all / fairly organised Admission: had to wait long time to get to room/ward/bed Admission: no explanation for wait in getting to room/ward/bed UK Picker Average Royal Devon and Exeter NHS Foundation Trust B. THE HOSPITAL AND WARD B. The hospital and ward Patients sharing sleeping area with opposite sex Hospital: upset by being on a mixed sex ward Hospital: patient found it upsetting to move wards Patients in more than one ward, sharing sleeping area with opposite sex Patients using bath or shower area who shared it with opposite sex Hospital: bothered by noise at night from other patients Hospital: bothered by noise at night from staff Hospital: room or ward not very or not at all clean Hospital: toilets not very or not at all clean D:\Temporary Internet Files\OLK107\MNO 9 2 In-Patient Survey results 2006.doc Page 7 of 23
Hospital: food was fair or poor Hospital: not always healthy food on hospital menu Patients not offered a choice of food UK Picker Average Royal Devon and Exeter NHS Foundation Trust C. DOCTORS Doctors: didn't always get clear answers to questions Doctors: didn't always have confidence and trust Doctors: talk in front of you as if you're not there Doctors: didn't always get chance to talk to when needed Doctors: some/none knew enough about condition/treatment Doctors: did not always wash or clean hands between touching patients UK Picker Average Royal Devon and Exeter NHS Foundation Trust D:\Temporary Internet Files\OLK107\MNO 9 2 In-Patient Survey results 2006.doc Page 8 of 23
D. NURSES Nurses: didn't always get clear answers to questions Nurses: didn't always have confidence and trust Nurses: talk in front of you as if you're not there Nurses: sometimes, rarely or never enough on duty Nurses: didn't always get chance to talk to when needed Nurses: some/none knew enough about condition/treatment Nurses: did not always wash or clean hands between touching patients UK Picker Average Royal Devon and Exeter NHS Foundation Trust D:\Temporary Internet Files\OLK107\MNO 9 2 In-Patient Survey results 2006.doc Page 9 of 23
E. YOUR CARE AND TREATMENT Care: staff contradict each other Care: wanted to be more involved in decisions Care: not enough (or too much) information given on condition or treatment Care: not enough chance for family to talk to doctors Care: couldn't always find staff member to discuss concerns with Care: not always enough privacy when discussing condition or treatment Care: not always enough privacy when being examined or treated Care: didn't always get help in getting to the bathroom when needed Care: did not always get enough help from staff to eat meals Care: more than 5 minutes to answer call button Tests: results not explained well / not explained at all UK Picker Average Royal Devon and Exeter NHS Foundation Trust D:\Temporary Internet Files\OLK107\MNO 9 2 In-Patient Survey results 2006.doc Page 10 of 23
F. PAIN Pain: more than 15 minutes to get medicine Pain: staff didn't do everything to help control UK Picker Average Royal Devon and Exeter NHS Foundation Trust G. OPERATIONS & PROCEDURES Surgery: risks and benefits not fully explained Surgery: what would be done during operation not fully explained Surgery: questions not fully answered Surgery: not told fully how could expect to feel after operation or procedure Surgery: anaesthetist did not fully explain how would put to sleep or control pain Surgery: results not explained in clear way UK Picker Average Royal Devon and Exeter NHS Foundation Trust D:\Temporary Internet Files\OLK107\MNO 9 2 In-Patient Survey results 2006.doc Page 11 of 23
H. LEAVING HOSPITAL Discharge: too early or too late Discharge: was delayed Discharge: delayed by 1 hour or more Discharge: not enough time spent discussing recovery Discharge: not given written or printed information Discharge: not fully told purpose of medications Discharge: not fully told sideeffects of medications Discharge: not given completely clear written information about medicines Discharge: not fully told of danger signals to look for Discharge: family not given enough information to help Discharge: not told who to contact if worried Discharge: did not receive copies of letters sent between hospital doctors and GP UK Picker Average Royal Devon and Exeter NHS Foundation Trust D:\Temporary Internet Files\OLK107\MNO 9 2 In-Patient Survey results 2006.doc Page 12 of 23
J. OVERALL Overall: not treated with respect or dignity Overall: doctors and nurses working together poor or fair Overall: rating of care poor or fair Overall: would not recommend this hospital to family/friends Overall: not asked to give views on quality of care Not given information on how to complain UK Picker Average Royal Devon and Exeter NHS Foundation Trust D:\Temporary Internet Files\OLK107\MNO 9 2 In-Patient Survey results 2006.doc Page 13 of 23
APPENDIX B Historical Comparisons This section shows the Problem Scores for this year s survey and a comparison against the scores from the previous surveys. Significant differences are indicated as follows: scores significantly better than previous survey 2002 The problem score for 2002 scores significantly worse than previous survey 2004 The problem score for 2004 2005 The problem score for 2005 2006 The problem score for 2006 A. ADMISSION TO HOSPITAL Lower scores are better 2002 2004 2005 2006 A3 Ambulance: crew not totally reassuring - - 8 % 8 % A4 Ambulance: crew did not fully explain care and treatment in a - - 29 % clear way 24 % A6 Ambulance: crew did not always treat with respect and dignity - - 4 % 2 % A8 Emergency Department: order in which patients seen was not fair - - 0 % 2 % A10 Emergency Department: not given enough privacy when being - - 17 % examined or treated 16 % A11 Emergency Department: waited 4 hours or more for admission - - 10 % 21 % to bed on a ward A13 Planned admission: not given choice of admission date - 67 % 67 % 67 % A15 Planned admission: should have been admitted sooner 32 % 28 % 18 % 18 % A16 Planned admission: not given enough notice of admission 3 % 2 % 2 % 1 % A17 Planned admission: admission date changed by hospital 20 % 8 % 11 % 12 % A18 Planned admission: not given printed information about the hospital - 11 % 10 % 14 % A19 Planned admission: not given printed information about - 28 % 30 % condition or treatment 25 % A20 Admission: process not at all / fairly organised % 37 39 % 33 % 40 % A21 Admission: had to wait long time to get to room/ward/bed 31 % 25 % 20 % 27 % A22 Admission: no explanation for wait in getting to room/ward/bed 27 % 40 % 28 % 37 % B. THE HOSPITAL AND WARD 2002 2004 2005 2006 B3 Hospital: upset by being on a mixed sex ward 25 % 29 % 27 % 24 % B5 Hospital: patient found it upsetting to move wards 30 % 28 % 28 % 29 % B8 Hospital: bothered by noise at night from other patients - 39 % 40 % 41 % B9 Hospital: bothered by noise at night from staff - 18 % 15 % 20 % B10 Hospital: room or ward not very or not at all clean 2 % 4 % 3 % 3 % B13 Hospital: not always healthy food on hospital menu - - 22 % 19 % D:\Temporary Internet Files\OLK107\MNO 9 2 In-Patient Survey results 2006.doc Page 14 of 23
C. DOCTORS 2002 2004 2005 2006 C2 Doctors: didn't always have confidence and trust 14 % 17 % 13 % 17 % C3 Doctors: talk in front of you as if you're not there 23 % 26 % 23 % 26 % C5 Doctors: some/none knew enough about condition/treatment 9 % 9 % 9 % 9 % C6 Doctors: did not always wash or clean hands between touching - - 18 % patients 14 % D. NURSES 2002 2004 2005 2006 D2 Nurses: didn't always have confidence and trust 18 % 17 % 20 % 21 % D3 Nurses: talk in front of you as if you're not there 13 % 14 % 13 % 17 % D4 Nurses: sometimes, rarely or never enough on duty 38 % 41 % 40 % 44 % D6 Nurses: some/none knew enough about condition/treatment 14 % 13 % 12 % 13 % D7 Nurses: did not always wash or clean hands between touching - - 17 % patients 16 % E. YOUR CARE AND TREATMENT 2002 2004 2005 2006 E1 Care: staff contradict each other 24 % 26 % 29 % 30 % E2 Care: wanted to be more involved in decisions - 39 % 38 % 44 % E3 Care: not enough (or too much) information given on condition 15 % 18 % 18 % or treatment 16 % E6 Care: not always enough privacy when discussing condition or 26 % 27 % 23 % treatment 26 % E7 Care: not always enough privacy when being examined or 9 % 11 % 7 % treated 9 % E12 Tests: results not explained well / not explained at all 43 % 46 % 43 % 44 % F. PAIN 2002 2004 2005 2006 F3 Pain: more than 15 minutes to get medicine 9 % 8 % 7 % 5 % F4 Pain: staff didn't do everything to help control 21 % 22 % 19 % 21 % G. OPERATIONS & PROCEDURES 2002 2004 2005 2006 G2 Surgery: risks and benefits not fully explained 20 % 20 % 11 % 14 % G3 Surgery: what would be done during operation not fully explained 15 % 19 % 20 % 23 % procedure G5 Surgery: not told fully how could expect to feel after operation or - - 43 % 41 % G7 Surgery: anaesthetist did not fully explain how would put to - - 17 % sleep or control pain 12 % G8 Surgery: results not explained in clear way % 33 30 % 31 % 32 % D:\Temporary Internet Files\OLK107\MNO 9 2 In-Patient Survey results 2006.doc Page 15 of 23
H. LEAVING HOSPITAL 2002 2004 2005 2006 H1 Discharge: too early or too late 15 % 11 % 12 % 13 % H2 Discharge: was delayed - 30 % 30 % 36 % H4 Discharge: delayed by 1 hour or more - 80 % 77 % 80 % H5 Discharge: not enough time spent discussing recovery 28 % 27 % 27 % 32 % H6 Discharge: not given written or printed information 45 % 44 % 48 % 50 % H8 Discharge: not fully told side-effects of medications 42 % 40 % 44 % 44 % H9 Discharge: not given completely clear written information about - - 40 % medicines 37 % H10 Discharge: not fully told of danger signals to look for - % 40 41 % 45 % H12 Discharge: not told who to contact if worried - 16 % 21 % 23 % H13 Discharge: did not receive copies of letters sent between - - 65 % hospital doctors and GP 65 % J. OVERALL 2002 2004 2005 2006 J1 Overall: not treated with respect or dignity 16 % 16 % 14 % 17 % J2 Overall: doctors and nurses working together poor or fair 9 % 4 % 4 % 6 % J3 Overall: rating of care poor or fair 5 % 5 % 4 % 5 % J4 Overall: would not recommend this hospital to family/friends 4% 3 % 3 % 4 % J5 Overall: not asked to give views on quality of care - - 91 % 90 % D:\Temporary Internet Files\OLK107\MNO 9 2 In-Patient Survey results 2006.doc Page 16 of 23
Appendix C Directorate Action Plans Priority areas Surgery 1 Identified Target Improvement Area Page 12 A22. Did a member of staff explain why you had to wait? Page 13 B3 During your stay in hospital, did you ever share a room or bay with patients of the opposite sex? Page 42 J5 During your stay in hospital, were you ever asked to give your views on the quality of your care? Page 37 H6. Before you left hospital, were you given any written information about what you should or should not do during your recovery after leaving hospital? Page 37 H8 Did a member of staff tell you about medication side effects to watch for when you went home? Objective/Goal All patients kept fully informed of any delays at admission No mixed sex bays Patient feedback required Improve availability of discharge information All patients to be informed of medication side effects Milestones to Achieve Improvement Communication and information on admission. Nurses aware of patients waiting and regularly keep patients informed throughout this period. Written information given on admission. Exception report designed and in use Discuss within directorate and agree action plan Timescales for Delivery Person Assigned Responsibility for Necessary Action Link with other work Progress as at Q3 2007 ACCESS AND WAITING 6months Sister, Matron and nurses Bed utilisation All nurses aware of responsibilities of keeping patients informed. SAFE, HIGH QUALITY, CO-ORDINATED CARE 6 months Lead nurse to monitor Bed utilisation 1 patient at quarter 3 3 months Lead nurse to organise Lead Nurses Discussed in surgical matrons meeting All leaflets under review. 6 months Matrons with the CNS & NPs Care pathway development Discussed in surgical matrons meeting. Ward pharmacist to discuss with patient, discharging nurse to reinforces information 6 months Pharmacist, sister and matrons C16, Medicines Management Group Discussed in surgical matrons meeting
Specialist Surgery Identified Target Improvement Area Page 13 B3 During your stay in hospital, did you ever share a room or bay with patients of the opposite sex? Page 12 A22. Did a member of staff explain why you had to wait? Page 42 J5 During your stay in hospital, were you ever asked to give your views on the quality of your care? Page 37 H8 Did a member of staff tell you about medication side effects to watch for when you went home? Page 37 H6 Before you left hospital, were you given any written information about what should or should not do during your recovery after leaving hospital Objective/Goal No mixed sex bays All patients kept fully informed of any delays at admission Patient feedback required All patients to be informed of medication side effects Improve availability of discharge information Milestones to Achieve Improvement Exception report designed and in use Communication and information on admission. Nurses aware of patients waiting and regularly keep patients informed throughout this period. Written information given on admission Discuss within directorate and agree action plan Ward pharmacist to discuss with patient, discharging nurse reinforces information Timescales for Delivery Person Assigned Responsibility for Necessary Action Link with other work Progress as at Q3 2007 SAFE, HIGH QUALITY, CO-ORDINATED CARE 6 months Lead Nurse, to monitor Bed utilisation 6 patients in mixed sex bays, most only for 2-3 hours while same sex bed became available 6 months Sister, Matron and nurses Bed utilisation All nurses aware of responsibilities of keeping patients informed 3 months Lead nurse to organise Lead nurses Discussed in surgical matrons meeting, Abbey have patient feedback noticeboard 6 months Pharmacist, sister and matrons C16 Medicines Management Group Discussed in surgical matrons meeting BETTER INFORMATION, MORE CHOICE All leaflets under review 6 months Matrons with CNS & NPs Care pathway development Discussed in surgical matrons meeting D:\Temporary Internet Files\OLK107\MNO 9 2 In-Patient Survey results 2006.doc Page 18 of 23
Child and Women s health (Gynaecology) Identified Target Improvement Area Objective/Goal Milestones to Achieve Improvement Timescale s for Delivery Page 23 E1. Sometimes in a hospital, a member of staff will say one thing and another will say something quite different. Did this happen to you? Page 34 H2. On the day you left hospital, was your discharge delayed for any reason? Page 35 H3. Main reason for the delay was Meds Page 42 J5. During your hospital stay, were you ever asked to give your views on the quality of your care? Page 42 J6. If you needed to complain about the care you received, did you know how to do this? Page 36 H5. Before you left hospital, did the doctors and nurses spend enough time telling you about what would happen during your recovery at home? To ensure information given is consistent To ensure that if there is any delay this is kept to a minimum To ensure delays are kept to a minimum Staff discuss with patients how they can give views on care To ensure that all patients are aware of how to make a complaint if felt necessary. Outcomes of complaints can enhance patient care by being acted upon and aspects of care changed accordingly. To ensure all patients have enough time spent with them informing them of what will happen during the recovery period SAFE, HIGH QUALITY, CO-ORDINATED CARE 6-9 months All areas need to work according to clinical guidelines and written information Prompt delivery of TTOs to and from pharmacy. Discharges undertaken by nurses as far as possible. Nurses to ensure medical staff where required review patients as promptly as possible. Prompt delivery of TTOs to and from pharmacy. Discharges undertaken by nurses as far as possible. Nurses to ensure medical staff where required review patients as promptly as possible. Patients to be informed as part of admission process that they are able to air views All areas need to ensure that appropriate written information is available on the complaints procedures. Leaflets on complaints service need to be available. Poster on PALS Services to be displayed. Staff to be informed of the need and the importance of this factor. Preassessment and ward nurses to be made aware of this and inservice training to be provided to support this. Person Assigned Responsibility for Necessary Action Matrons for all areas plus medical staff 6 months Matrons and sisters to ensure staff aware 6 months Matrons and sisters to ensure staff aware 3 months Matrons and sisters to discuss at team meeting Within 6 months Ward/department sisters/matrons and nurse specialists in liaison with senior matron Link with other work Progress as at Q3 2007 Written information being updated Phase 4 project, to be on main site for pharmacy Phase 4 project, to be on main site for pharmacy To incorporate into preadmission process. PALS and PPI involvement and feedback Standards for better health and core standard 17. Development of PALS service and PPI forums. All patients to receive adequate information, both written and verbal Standards for Better Health C16 Written information updated, drafts with Lead Clinicians for approval Meetings held to implement use of white board in order to track TTOs. Nurse training ongoing Meetings held to implement use of white board in order to track TTOs. Nurse training ongoing Nurse specialists discuss with patients individually. Patients now giving feedback at FU visit. All depts now have leaflet on PALs. All areas have information on complaints process Written information updated and in draft awaiting approval. Issue has been rasied with pre assessment team by Lead pre assessment nurse. Pre operative visits undertaken by theatre staff. D:\Temporary Internet Files\OLK107\MNO 9 2 In-Patient Survey results 2006.doc Page 19 of 23
page 36 H6. Before you left hospital, were you given any written information about what you should or should not do during your recovery after leaving hospital? Page 37 H8. Did a member of staff tell you about medication side effects to watch for when you went home? Page 38 H9. Were you given clear written information about your medicines? Page 38 H10. Did a member of staff tell you about any danger signals you should watch for after you went home? Page 40 H13. Did you receive copies of letters sent between hospital doctors and your family doctor (GP)? Page 14 B6. Were you ever bothered by noise at night from hospital staff? To ensure that all patients have some type of written information on discharge. To improve patient knowledge of recovery and enable them to be informed in order to ask appropriate questions Patients should receive available information on any side effects All patients to receive adequate written information about their medicines.improvement in care by safe administration of medication through written information Patients to be aware of danger signs Patients are offered the choice of receiving a letter To ensure patients receive adequate rest. Ensure that staff working at night cause as little disruption to patients as possible Staff to be aware of the factors that can disturb patients. Information leaflets need to be reviewed to ensure they include relevant post discharge information. To improve patient knowledge of recovery and enable them to be informed in order to ask appropriate questions All staff, both pre-assessment, and ward, to be reminded of the need to provide written information. Staff to ensure written informaion is given to patients when available on side effects. To give verbal information on any side effects. Staff to ensure there are adequate written instructions about the medications by checking details on container. Staff to provide information leaflet as far as is possible to ensure patients have adequate information. Senior Matron to liaise with Principal Pharmacist re: provision of patient information with TTOs Staff to be able to discuss any issues with patients on discharge All staff to be aware that patients should receive correspondence if they wish Within 6 months 1 year Band 7 post holders for pre-assessment and inpatient services in conjunction with senior matron 6 months Senior matron to liaise with Chief Pharmacist to ensure any information available is sent with the drugs Within 6 month 6-9 months Matrons and Senior Matrons Ward sister and matrons 9 months Admin services Managers, Matrons and ward sisters CLEAN, COMFORTABLE, FRIENDLY ENVIRONMENT 3-6 months Inservice training/staff awareness of the possible disturbances to patients at night. Staff, including ancillary staff, to be aware of the need to create as little noise as possible when returning post-operative patients to the ward and/or admitting emergency admissions during the night. Explore the possibility of admitting emergency admissions to specific areas overnight to prevent disturbance to other patients. Ward and theatre matrons to work with individual teams All areas working towards ensuring patients having adequate written information Revision of medicines management policy March 2006 Recommendations in conjunction with medicines management policy Ward sisters and matrons to support staff and ensure they are able to offer information Medical staff letters are sent if patients request already Written information updated and in draft awaiting approval. Issue has been rasied with pre assessment team by Lead pre assessment nurse. Pre operative visits undertaken by theatre staff. Senior matron liaised with Chief Pharmacist pre packed medications already has this. Senior matron liaised with Chief Pharmacist pre packed medications already has this. Specific instructions always written in containers discharge leaflet drafted and presented at Nursing and Midwifery Governance Committee by Vicki White. Raised with Lead pre assessment nurse who has discussed it with her team. Nurses letters now sent out when requested by patients, all patients offered letters Emergency admissions admitted via a treatment area to keep noise/ disturbance down to a minimum. Discussed with general services manager for him to inform his staff of the need to keep noise to a minimum at night. Matrons discussed with their teams. D:\Temporary Internet Files\OLK107\MNO 9 2 In-Patient Survey results 2006.doc Page 20 of 23
Medicine Identified Target Improvement Area Objective/Goal Milestones to Achieve Improvement Page 12 B1. During your stay in hospital how many wards did you stay in? (2-4) B2. Did you find it upsetting to be moved from one room or ward to another? Page 13 B3. During your stay in hospital, did you ever share a room or bay with patients of the opposite sex? Page 34 H2. On the day you left hospital, was your discharge delayed for any reason? Page 42 J5. During your hospital stay, were you ever asked to give your views on the quality of your care? Page 31 & 32 G2, G3, G4. Patients not being fully informed of the risks and benefits of treatment and the questions re treatment not being fully answered and then not being fully told what would happen before the treatment page 36 H6. Before you left hospital, were you given any written information about what you should or should not do during your recovery after leaving hospital? Page 37 H8. Did a member of staff tell you about medication side effects to watch for when you went home? Minimise number of ward moves Timescales for Delivery SAFE, HIGH QUALITY, CO-ORDINATED CARE ongoing work Daily log of medical outliers, right person right ward. Predicting dates of discharge on admission for all medical pts. Taw Day Case Pilot due to start Sept 2006 to reduce number of ward moves and pull pts directly to cardiology from EMU. Person Assigned Responsibility for Necessary Action Dir of Ops and support from DMs and lead Nurses Link with other work Progress as at Q3 2007 bed utilisation Reduced med outliers up until New Year 2007 wards no mixed sex wards Exception report procduced Jun-06 Lead Nurse bed utilisation No exceptions reported Patients discharge to be planned from admission and all delays prevented Patients views re: care to be audited and acted upon Clearer, more detailed information Clearer, more detailed information All patients to be informed of side effects of medications prior to discharge TTO s to be prescribed in advance Chart to pharmacy Transport arranged on admission Discharge planned Communication book/board / suggestion boxes. Pts forums Matrons & Senior MAtrons to make informal patient rounds Patient views Liaising with PALS to review information leaflets available Produce discharge leaflet, all specialist leaflets to include discharge information TTO s prescribed 24 hour before discharge Ward Pharmacist to discuss with patient Discharging nurse to give relevant information on dispensing TTO s Nurses to receive mandatory updates 1 year Pharmacist Matrons & Senior Matrons Medical staff 1 year Matrons & Senior Matrons Jun-06 Discharge leaflet in final phase, ongoing review of current and new patient information Ward whiteboard work, roll- out of PODS to all medical wards. Discharge summary working group Esssence of Care, Matrons Charter steering group. PALS Ongoing. POD's funding agreed. Posts out to advert Ongoing. Clare Parkinson Liaising with PALS to review information leaflets available. Completed. Access team with support from clinicans and nurses 6 months Pharmacist Ward sister Matrons NMGC Medicine management Policy, Ward whiteboard PODS roll-out to Medicine Discharge leaflet in final approval POD'S technicians out to advert D:\Temporary Internet Files\OLK107\MNO 9 2 In-Patient Survey results 2006.doc Page 21 of 23
Trauma and Orthopaedics Identified Target Improvement Area Objective/Goal Milestones to Achieve Improvement Timescales for Delivery Page 12 B1. During your stay in hospital how many wards did you stay in? (2-4) B2. Did you find it upsetting to be moved from one room or ward to another? Page 34 H2. On the day you left hospital, was your discharge delayed for any reason? Page 42 J5. During your hospital stay, were you ever asked to give your views on the quality of your care? Page 11 A19. Before being admitted to hospital, were you given any printed information about your condition or treatment? Page 36 H5. Before you left hospital, did the doctors and nurses spend enough time telling you about what would happen during your recovery at home? page 36 H6. Before you left hospital, were you given any written information about what you should or should not do during your recovery after leaving hospital? Page 40 H13. Did you receive copies of letters sent between hospital doctors and your family doctor (GP)? Page 14 B6. Were you ever bothered by noise at night from hospital staff? Patients to be informed that they will be moved to a different ward following admission and they may need to vacate their bed on day of discharge Patients discharge to be planned from admission and all delays prevented Patients views re: care to be audited and acted upon Patients to receive information prior to admission Patient to receive info regarding their recovery Patient to be given any available written info re: recovery Patient to receive copies of all correspondence sent to Doctors and G.P. To ensure patients receive adequate rest. Ensure all patients aware of other patients need for rest. Ensure all patients were comfortable and pain free on settling and aware of how to call for Nurse. Information to be given on admission Communication between nurse and patients TTO s to be prescribed ASAP Chart to pharmacy Transport arranged on admission Discharge planned Communication book/board Matron and sister to make informal patient rounds Patient views Consultants to write information leaflet re:conditions and treatments which are available to patients when attending OPD and pre op assessment Patients to attend pre-op assessment clinics Nurses & Doctors to discuss recovery with patients Patient info leaflets to be given as appropriate Patient info leaflets re: relevant condition to be given Copies of District Nurse letter Doctor discharge summary Patients to be aware of other patients need for rest Call bells to be given to patients on settling Person Assigned Responsibility for Necessary Action 6 months Orthopaedic Bed Manager Admissions ward Sister Ward staff 3 months Pharmacist Ward sister Matrons Pre op nurses SHO Named nurse Link with other work Discharge protocols Medicine management Policy Progress as at Q3 2007 Informed on admission by nurses. Pharmacist monitor TTO's. Patients own drug cupboards. 1 Month Matrons Communication book. Suggestion box in OPD. 6--12 months CD Preop assessment nurses OPD matron Aftercare team Some leaflets available. Others to be written. ongoing Seen by OT & Physio ongoing Consultants Pre-op Nurses OT Physio 6 months MD, Senior matrons HR Manager, DMs 1 month ward sister night staff Patient information group Healthcare standards Physio leaflets. Info sheets available to ge given. More being written D/N letter given to patient. Patient moved if necessary to accommodate others. Night staff ensure call bells available. D:\Temporary Internet Files\OLK107\MNO 9 2 In-Patient Survey results 2006.doc Page 22 of 23
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