Open and Honest Care in your Local Hospital The Open and Honest Care: Driving Improvement programme aims to support organisations to become more transparent and consistent in publishing safety, experience and improvement data; with the overall aim of improving care, practice and culture. Report for: Southport & Ormskirk NHS Trust March 214
Open and Honest Care at Southport & Ormskirk NHS Trust : March 214 This report is based on information from March 214. The information is presented in three key categories: safety, experience and improvement. This report will also signpost you towards additional information about the trust's performance. 1. SAFETY Safety thermometer On one day each month we check to see how many of our patients suffered certain types of harm whilst in our care. We call this the safety thermometer. The safety thermometer looks at four harms: pressure ulcers, falls, blood clots and urine infections for those patients who have a urinary catheter in place. This helps us to understand where we need to make improvements. The score below shows the percentage of patients who did not experience any new harms. 99.5% 99.1% Overall 99.3% For more information, including a breakdown by category, please visit: http://www.safetythermometer.nhs.uk/ Health care associated infections (HCAIs) of patients did not experience any of the four harms whilst an in patient in our hospital of patients did not experience any of the four harms whilst we were providing their care in the community setting of patients did not experience any of the four harms in this trust. HCAIs are infections acquired as a result of healthcare interventions. Clostridium difficile (C.difficile) and methicillinresistant staphylococcus aureus (MRSA) bacteremia are the most common. C.difficile is a type of bacterial infection that can affect the digestive system, causing diarrhoea, fever and painful abdominal cramps - and sometimes more serious complications. The bacteria does not normally affect healthy people, but because some antibiotics remove the 'good bacteria' in the gut that protect against C.difficile, people on these antibiotics are at greater risk. The MRSA bacteria is often carried on the skin and inside the nose and throat. It is a particular problem in hospitals because if it gets into a break in the skin it can cause serious infections and blood poisoning. It is also more difficult to treat than other bacterial infections as it is resistant to a number of widely-used antibiotics. We have a zero tolerance policy to infections and are working towards eradicating them; part of this process is to set improvement targets. If the number of actual cases is greater than the target then we have not improved enough. The table below shows the number of infections we have had this month, plus the improvement target and results for the year to date. Patients in hospital setting C.difficile MRSA This month 4 (year to date) 19 Actual to date 34
Pressure ulcers Pressure ulcers are localised injuries to the skin and/or underlying tissue as a result of pressure. They are sometimes known as bedsores. They can be classified into four grades, with one being the least severe and four being the most severe. Number of pressure ulcers Grade 2 Grade 3 Grade 4 Total Hospital Setting 4 4 In the hospital setting, so we know if we are improving even if the number of patients we are caring for goes up or down, we calculate an average called 'rate per 1, occupied bed days'. This allows us to compare our improvement over time, but cannot be used to compare us with other hospitals, as their staff may report pressure ulcers in different ways, and their patients may be more or less vulnerable to developing pressure ulcers than our patients. For example, other hospitals may have younger or older patient populations, who are more or less mobile, or are undergoing treatment for different illnesses. Rate per 1 bed days: Hospital Setting.24 Community Number of pressure ulcers Grade 2 Grade 3 Grade 4 Total West Lancashire 1 2 3 Southport & Formby In the community setting we also calculate an average called 'rate per 1, population'. This allows us to compare our improvement over time, but cannot be used to compare us with other community services as staff may report pressure ulcers in different ways, and patients may be more or less vulnerable to developing pressure ulcers than our patients. For example, our community may have younger or older patient populations, who are more or less mobile, or are undergoing treatment for different illnesses. Falls Rate per 1, population: West Lancashire.27 Southport & Formby. This measure includes all falls in the hospital that resulted in injury, categorised as moderate, severe or death, regardless This month we reported 6 fall(s) that caused at least 'moderate' harm. Severity Moderate Severe Death Number of falls 6 So we can know if we are improving even if the number of patients we are caring for goes up or down, we also calculate Rate per 1, bed days:.36
2. EXPERIENCE To measure patient and staff experience we use a Net Promoter Score. The idea is simple: if you like using a certain product or doing business with a particular company you like to share this experience with others. From the answers given 3 groups of people can be distinguished: Detractors - people who would probably not recommend you based on their experience, or couldn't say. Passive - people who may recommend you but not strongly. Promoters - people who have had an experience which they would definitely recommend to others. This gives a score of between -1 and +1, with +1 being the best possible result. Patient experience The Friends and Family Test The Friends and Family Test requires all patients, after discharge, to be asked: How likely are you to recommend our ward to friends and family if they needed similar care or treatment? The hospital had a score of 58 for the Friends and Family test*. This is based on 527 responses. *This result may have changed since publication, for the latest score please visit: http://www.england.nhs.uk/statistics/statistical-work-areas/friends-and-family-test/friends-and-family-test-data/ We also asked 6 patients the following questions about their care: Net Promoter Score 8% of patients felt they were involved as much as they wanted to be in decisions about their treatment or care 93% of patients felt hospital staff were available to talk about any worries or concerns they had 94% of patients felt they had enough privacy when discussing their condition or treatment 8% of patients who had been prescribed new medication had been informed of any possible medication side effects 82% of patients who were ready to be discharged said they had been informed about who to contact if they were worried about their condition after leaving hospital
A patient's story Following a recent admission Mr X wished to assure the Trust that his intention in writing was not to criticise the hospital as his experience was a positive one, however he felt that there was one issue which needed to be addressed. BACKGROUND Mr X had undergone 3 short inpatient stays within a period of 3 months. Prior to this he had mainly only had experience as a visitor and had the perception that nurses seemed to spend all their time at the nursing station chatting and doing paperwork. This he is now certain is not the case, as he has had the opportunity to observe that, for the majority of the time they are extremely busy. OBSERVATIONS Mr X observed that at visiting times the staff are restricted as to what activities they could perform. Mr X made some observation about each particular area he was a patient on: A&E A busy professional department given the throughput. Mr X felt that his initial assessment was spot on and is grateful to the doctors and nurses. EAU Only there for a very short period of time which was satisfactory, however he observed that the thoroughfare through the end of the ward by staff was not ideal, but wasn t sure if anything could be done about this. SSU Nurses excellent having to deal with all kinds of issues. Caring and courteous and Mr X could not praise them enough. 7A Mr X has been a patient on this ward twice and this is where he spent the majority of his time. Could not fault his personal attention and the hard work of the nurses, but observed too few staff per patient. Mr X suffered two sleepless nights due to the activity required to care for dementia patients, which he found detrimental to his health. His main concern is that this disturbance is not conducive to patients with heart conditions. Mr X is sorry not to beable to offer a simple solution with his observations. 7B Nurses do a wonderful job and appear to be continually under pressure. His experience of just two days was one of appreciation for their care and devotion which was clear from all the doctors and other grades and professions. CCU Mr X says that if one was to enjoy a stay in hospital this was it. The care, personal contact and dedication was brilliant. Mr X understands that this level of care is not possible throughout the hospital but says that the benefits to his health were immensely improved when he was in this department. Mr X will appreciate what was done for him here, for the rest of his life. Consultants Mr X said that both Cardiologists were absolutely fantastic and totally professional. They took time to listen to him and filled him with confidence and trust. Mr X explains that his situation was an example of care and action and he will sing their praises and that of the hospital asa result. EXPECTATIONS OF Mr X Mr X wrote to the CEO saying that his purpose for writing was to assist the Trust with its quest for improvement in what he found to be a very busy and well run hospital. SUMMARY Mr X believes that the NHS does a brilliant job and his eyes have been opened to the professionalism at Southport DGH. As Mr X believes that we as a Trust seek to continually improve in very difficult emotional and financial situations. Mr X wrote this report in an attempt to support the Trust with this aim. CONCLUSION Mr X had only one concern relating to his inpatient stays and that was the disturbance caused by dementia patients to other patients, specifically those with cardiac problems. Mr X appreciates the bed situation but feels that this needs addressing urgently, but reiterates that in no way does he wish this to be viewed as a complaint. GOOD POINTS These are well highlighted throughout the above account.
Staff experience We asked 45 staff the following questions: Net Promoter Score I would recommend this ward/unit as a place to work 22 I would recommend the standard of care on this ward/unit to a friend or relative if they needed treatment 27 I am satisfied with the quality of care I give to the patients, carers and their families 2 3. IMPROVEMENT Improvement story: we are listening to our patients and making changes CERT Patients on the Frail Elderly Support Staff Unit at Southport and Formby District General Hospital are supported by the Community Emergency Response Team (CERT) on discharge. Patients will be discussed at the daily Multi-Disciplinary Team meetings which enable staff to work with the patient prior to discharge and for their follow up care. The ward philosophy and culture is patient centred and dedicated to elderly care. With support from partner agencies, including Social Services and Mental Health who attend daily MDT meetings, the service is able to achieve timely assessments, care coordination, and care management in the patient s place of residence, including Care Homes and Residential Homes. The work has been key in supporting Winter Pressures initiatives and assisting patient flow and bed occupancy during challenging capacity and demand periods. Supporting information