Patient Experience Report Tissue Viability

Patient Experience Report Tissue Viability August 2015 Making a difference. Demonstrating Effectiveness of care. Nine patient s experience:- staff fantastic could not have been treated any better, thank you all the 7 ladies who treated me seemed to know what they were about I think you need more nurses. Sometimes it is a long wait overall an excellent service, just sometimes have to wait a bit Myself and otgers (CIRC) are brought to the clinic by hospital transport it s the return home waiting for transport is often a long wait not complaining about the (CIRC) only wishing for some means of refreshments up to today s date every Thursday, the way they give treatment is excellent. Well job done and saving so many people like me and make up pain free. Thanks a lot. Mr S. *** ps this is my second experience find excellent. Thanks again from the start of entering the clinic I was treated with kindness and help in all departments. With special thanks for all which was done with my legs by the team of nurses treating me, for ever thankful. Kath *** the service provided by the complex wound treatment centre is excellent it does not need any improvement. Thanks you very helpful Background / Rationale Annual patient satisfaction audit. This patient satisfaction audit has been undertaken by the Tissue Viability Team (TVT) to determine the experiences of all new patients attending between April 2014 March 2015. The audit is linked to CQC Outcomes 1,2,4,6,8,10, 11, 12, 16 Aims & Objectives Aims To determine the views and opinions of all new patients who attended the complex wound treatment centre between 1.4.14 31.3.15 Objectives 1. Determine any shortfalls in delivery of tissue viability service for patients attending the complex wound clinic 2. Determine the impact that the CWC has on patients in the management of their chronic wounds and the benefits / experiences as a result of attending the clinic. 3. Determine any adaptations that would be necessary to ensure patient centred care is at the centre of service delivery. 1 Page

Criteria & Standards Privacy and Dignity Challenges 2009 NHS Improvement Plan 2004 NMC Code of Professional conduct: standards for conduct performance and ethics (2014) Our Care Pledge To You (2009) Quality Care Indicators (2009) Methodology A simple questionnaire, adapted from previous audit tools used by the team, with a tick column, rating each facility/service as excellent, very good, good, satisfactory or poor was used to enable the older client ease of use. The questionnaire, which was anonymous, was either posted or given to the patient when they attended the clinic. All new patients who attended the clinic between 1.4.14 31.3.15, except those patients who had moved out of area or died were given the questionnaire. 87 questionnaires were given out. An explanatory letter and a freepost envelope addressed to clinical governance were included and a six week deadline date was given for the return of the forms. Quality Governance undertook the analysis. The report was written by Tissue Viability. The report, written by TVT, has linked the findings to the Dignity challenges (UK DOH 2009a) and Quality Care indicators (UK DOH 2009b) Abstract/Summary of key findings. Key Results 33 (38%) of the questionnaires were returned and analysed. 91% (n=30) patients rated excellent v.good or good for being offered an appointment that suited them. These results are very positive and provide evidence that people are treated as individuals and assisting people to maintain confidence and a positive self-esteem. 84% (n=28) patients rated excellent v.good or good for being involved in decision making for their treatment. Health Care Professionals need to ensure patients are involved in decision making which improves concordance to treatment and improved clinical outcomes which has been demonstrated in previous outcomes audits and by the many comments made in this audit. 94% (n=31) patients rated excellent/very good/good of which 58% (n=19) rated excellent and a further 27% (n=9) rated v. good for care needs meeting expectation. 94% (n= 31) rated excellent/very good/good of which 58% (n=19) patients rated excellent for their privacy and dignity being respected. 1 patient rated poor. Extremely excellent results providing evidence for all the Dignity challenges and PEAT 3 - dignity and respect and PEXIS 8 dignity and respect. 94% (n=31) patients rated excellent/very good/good for being given the opportunity to ask questions etc regarding their care. Patients working in partnership with Health Care Professional take control for their health and research has shown better concordance to treatment (Wanless 2002). 94% (n=31) patients rated excellent/very good/good of which 73 %( n=24) patients rated excellent for how they were treated by staff eg courteous respectful and friendly manner. There was 1 poor response 2 Page

52% (n= 17) patients stated they experienced improvement in their lives. 91% (n=30) patients stated they were extremely likely or likely to recommend this service to friends and family if they needed this service, 73% (n=24) of whom stated they were extremely likely. 36% (n=12) patients made other comments. 1 comment related to the District Service. 1 comment related to long waits with the transport service. 2 comments mentioned having a long wait for their appointment and suggested needing more nurses. 67% (n=8) comments were extremely positive and are outlined as above. Key recommendations of the audit:- Inform stakeholders of results to ensure community based services are commissioned close to peoples homes for patients with complex wounds in Hillingdon. Ensure staffing levels meet demands to reduce waiting list times for patients. Consider developing business case for development of a Well leg service for healed patients. The results of this audit are extremely positive demonstrating that the team are providing high quality care to patients with chronic complex wounds to achieve better outcomes, reducing pain and restoring normal function to improve quality of life. Limitations There are no limitations in this audit. The audit tool was developed by the TVT with some slight adaptions over the years and appears to be user friendly for the patients. Results 87 audit tools were sent to new patients who attended between April 2014 March 2015. 33 (38%) of questionnaires were returned. The following findings were collated by clinical governance and the report written by the Tissue Viability Team. All percentages have been rounded up. Where appropriate results have been linked to the Dignity challenges and the Quality Care indicators as referenced above in order to provide the evidence that the challenges/indicators are being achieved. The patients were asked Q1 Age range Age Range Frequency Not answered 0 Under 18 0 18-35 1 36-50 1 51-65 7 66-80 10 Over 80 14 Total 32 3 Page

Q2 Ethnic Origin Ethnic origin Frequency Not answered 1 White (British, Irish and other white backgrounds 26 Black ( Caribbean, African, any other black background 0 Asian ( Indian, Pakistan, Bangladeshi) 4 Other ethnic groups 2 Total 33 Q3 Gender Gender Frequency Male 14 Female 18 Not answered 1 Total 33 How would you rate the following:- Q4 Waiting time for initial appointment (n=33) 78% (n=26) patients rated excellent/very good/good. The complex wound clinic had long periods of breach in waiting times for first appointments during the audit period for nonurgent appointments, and hence obtaining 2 poor results for this question. Evidence for PEXIS 1 - patient experience for access and waiting. Q4. Waiting time for initial appointment: 11 9 6 4 2 1 34% 27% 18% 12% 6% 3% Q5 Being offered an appointment time that suited you. (n=33) 91% (n=30) patients rated excellent/very good/good. No patients rated poor. These results are very positive and provide evidence that people are treated as individuals and assisting people to maintain confidence and a positive self-esteem (Dignity Challenge 3 & 9). PEXIS 1 patient experience for access and waiting. This is also one of the aims of the DOH 2010 to ensure services meet individual patient s needs and aspirations. Q5.being offered an appointment time that suited you 19 8 3 3 0 0 58% 24% 9% 9% 0% 0% 4 Page

Q6 Waiting time at the clinic (n=33). 84% (n=28) rated excellent/very good. /good No patients rated poor. Evidence for PEXIS 1 - patient experience for access and waiting. Considering the heavy workload of the team and provision of holistic individual care which is very time consuming in this group of patients, this is an excellent result. The team have also carried a high level of long term sickness in the last financial year. Q6. Waiting time at the clinic: Excellent V.Good Good Satisfactory Poor No ans 10 8 10 5 0 0 30% 24% 30% 15% 0% 0% Q7 Being involved/included in the decision making for your treatment (n=33). 84% (n= 28) patients rated excellent/very good/good 1 patient rated poor. Results are very positive and provide evidence that people are given the opportunity to participate fully in decisions about their life, health and services (Dignity Challenge 2). Pexis 3 Patient experience for better information, more choice. The team are ensuring that patients are involved in their treatment options which encourage concordance to treatment and better outcomes (Wanless 2002) as previously demonstrated in many outcomes audit and in the biannual PROMS audits undertaken by the team. Q7. Being involved in decision making Excellent V.Good Good Satisfactory Poor No ans 16 7 5 3 1 1 48% 21% 15% 9% 3% 3% Q8 All your care needs being met at the initial assessment (n=33). 64% (n=21) rated excellent and a further 33% (n=11) rated very good/good. 1 patient rated poor. Excellent results providing evidence for PEXIS 2 patient experience for high quality co-ordinated care and PEXIS 6 focusing on the person. Q8. All you care needs being met at the initial assessment: 21 5 6 0 1 0 64% 15% 18% 0% 3% 0% 5 Page

Q9 Care provided meeting your expectation (n=33). 58% (n=19) rated excellent and a further 36% (n=12) rated v. good/good. 1 patient rated poor. The TVT also undertake a rolling bi-annual audit to determine the patient s expectations of their outcomes and service delivery to be assessed at first appointment and 4 weeks later. This is in line with the NHS outcomes framework in the white paper (UK 2010) which suggests patient-reported outcomes. Q9. Care meeting expectation 19 9 3 1 1 0 58% 27% 9% 3% 3% 0% Q10 Information, support and advice being given during your treatment in the clinic (n=33). 85% (n=28) rated excellent/ v. good. And 12% rated Good. 1 patient rated poor. Excellent results providing evidence for PEXIS 3 - Patient experience for better information, more choice, PEXIS 6 focusing on the person. Q10 Information, support and advice given during treatment 20 8 4 0 1 0 61% 24% 12% 0% 3% 0% Q11 Being given information leaflets explaining elements of your care (n=33). 75% (n=25) rated excellent/very good/good. 2 patients rated poor. Information leaflets are always given to patients with leg ulcers and pressure ulcers. However we do not give leaflets regarding other wound types eg post - operative wounds or malignant wounds. This result demonstrates that the service provides evidence for Dignity Challenge 5 (Listen and support people to express their needs and wants, Dignity Challenge 8 (engage with family and carers) and PEXIS 3 - Patient experience for better information, more choice, PEXIS 6 focusing on the person. The team will endeavour to develop information leaflets regarding the other types of wounds. Q11. Being given information leaflets explaining elements of your care. 9 8 8 3 2 3 27% 24% 24% 9% 6% 9% 6 Page

Q12 How was your privacy and dignity respected (n=33). 58 % (n=19) patients rated excellent and a further 36% (n=12) rated very good/good. 1 patient rated poor. Extremely excellent results providing evidence for all the Dignity challenges and PEAT 3 - dignity and respect and PEXIS 8 dignity and respect. Q12 How was your privacy and Dignity? 19 8 4 0 1 1 58% 24% 12% 0% 3% 3% Q13 Opportunity to ask questions etc about your care (n=33). 94% (n=31) patients rated excellent/very good/good. 1 patient rated poor. Extremely positive results providing evidence for Dignity challenge 8 and PEXIS 2 patient experience for high quality co-ordinated care, PEXIS 4 patient experience for building closer relationships. This result is extremely relevant in putting patients and public first. The white paper (UK 2010) outlines the principle of shared decision making becoming the norm - to allow patients to have greater choice and control no decision about me without me. Patients working in partnership with Health Care Professional take control for their health and research has shown better concordance to treatment (Wanless 2002) Q13 Opportunities to ask questions about your care. 19 6 6 0 1 1 58% 18% 18% 0% 3% 3% Q14 Treatment by staff (i.e. courteous, friendly manner) (n=33). 73 %( n=24) patients rated excellent and a further 21% (n=7) rated very good/good. 1 patient reported poor. Excellent results providing evidence for Dignity Challenge 2 and PEXIS 4 - patient experience for building closer relationships and PEXIS 6 - patient experience for focusing on the person. The White paper (UK 2010) places emphasis on personalised care and providing a better experience of the NHS for patients. This excellent result demonstrates that the TVT is delivering high quality, personalised care in a professional courteous manner. Q14 Treatment by staff 24 7 0 0 1 1 73% 21% 0% 0% 3% 3% Q15 Do you have difficulties with distance in getting to the clinic? Yes 10 30% No 23 70% Not answered 0 0% 7 Page

Q16 Did you need any help with interpreting? Yes 0 0% No 33 100% Not answered 1 1% Q16a If yes, was this provided? NA Yes NA No Not answered NA Q16b If no did this affect the treatment you received? Yes 1 3% No 18 55% Not answered 14 42% Q17. Has there been any improvement in your life since attending the clinic eg pain, walking, general activities 52% (n= 17) patients stated they had experienced improvements in their life, 39% (n=13) stated no and 9 % (n=3) did not answer. Yes 17 52 % No 13 39% Not answered 3 9% Question 18. How likely would you recommend this service to friends and family if needed. 91% (n=30) patients stated they were extremely likely or likely to recommend the service to friends and family. 8 Page

Friends and Family recommendation (n=33) Frequency Extremely likely 24 73% Likely 6 18% Neither likely or unlikely Unlikely 2 6% Very unlikely Not answered 1 3% percentage The following are comments written by patients. If yes please give details 36% (n=12) patients made comments regarding the service. 1 comment related to the District Service. 1 comment related to long waits with the transport service. 2 comments mentioned having a long wait for their appointment and suggested needing more nurses. 8 comments were extremely positive. A given time would be helpful when the district nurse attends Staff fantastic could not have been treated any better, thank you all No The 7 ladies who treated me seemed to know what they were about I think you need more nurses. Sometimes it is a long wait Overall an excellent service, just sometimes have to wait a bit Myself and otgers (CIRC) are brought to the clinic by hospital transport it s the return home waiting for transport is often a long wait not complaining about the (CIRC) only wishing for some means of refreshments up to today s date every Thursday, the way they give treatment is excellent. Well job done and saving so many people like me and make up pain free. Thanks a lot. Mr S. *** PS this is my second experience find excellent. Thanks again 9 Page

From the start of entering the clinic I was treated with kindness and help in all departments. With special thanks for all which was done with my legs by the team of nurses treating me, for ever thankful. Kath *** None The service provided by the complex wound treatment centre is excellent it does not need any improvement. Thanks you Very helpful. Conclusions The results of this audit are extremely positive demonstrating that the team are providing high quality care to patients with chronic complex wounds to achieve better outcomes for patients, reducing pain and restoring normal function to improve quality of life. The audit results are very similar to previous audits undertaken where excellent feedback was also given. Recommendations 6. Recommendations: (Please detail any recommendations made and complete Action plan overleaf) Continue to provide high quality service for patients with complex wounds in Hillingdon. ACTION Tissue Viability Team (TV) Ensure all stakeholders are given results of this audit to ensure community based services are commissioned closer to people s homes for all patients in Hillingdon. ACTION TV, Quality Governance (QG), Performance team Ensure that staffing levels meet demand to ensure that there is a reduced waiting list for first assessments ACTION TV 4. Re-audit in one year ACTION TV, QG 5. Patient Reported Outcomes (PROMS) Audit to capture data regarding the objectives and expectations of patients attending first assessment eg reduction in pain, improved walking, to be evaluated following treatment. ACTION TV and QG Presentation The audit will be circulated to: - Tissue Viability Team, Professor Das, Performance team, Quality Governance, Head Adults Services and the key results will be uploaded onto the public web site. 10 Page

References United Kingdom Department of Health (2007) World Class Commissioning Vision Summary HMSO United Kingdom Department of Health (2008) Next Stage Review, High Quality Care for all HMSO United Kingdom Department of Health (2009a) Dignity Challenge HMSO United Kingdom Department of Health (2009b) Quality Care Indicators HMSO United Kingdom Department of Health (2010) Equity and Excellence: Liberating the NHS HMSO 11 Page

Appendix 1 Patient Satisfaction Audit tool 12 Page

Quality Improvement Action Plan Project Title: Patient Satisfaction Audit Tissue Viability September 2015 Service/Ward/Team Action Action Required Person(s) Due Date Action Status Outcome/Changes in Date Responsible practice Tissue Viability February Develop business TV Clinical Service Summer 2016 2015 case for service Lead and Business design to incorporate Development team Well leg service for healed leg ulcers. Actions should be Specific, Measurable, Achievable, Realistic and Timely. 1 Page