Agenda item A5(vi) THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST NHS SAFETY THERMOMETER EXECUTIVE SUMMARY The NHS Safety Thermometer is a point of care survey, which is a local improvement tool for measuring, monitoring and analysing patient harms and harm free care. It was mandated by the Department of Health as a new CQUIN goal in 2012/13. It relates to four specific patient harms, i.e. Falls Catheter associated urinary tract infections Pressure ulcers Venous thrombo-embolism. Since July 2012, data collected using the NHS Safety Thermometer have been part of the Commissioning for Quality and Innovation (CQUIN) payment programme. Data relating to each of the harms must be collected for every inpatient in the Acute Trust and for every patient on the District Nurses caseload on a specific day, each month, and this is then required to be uploaded to a national database, managed by the NHS Information Centre. Analysis of data from the Trust shows that the vast majority of the Trust s patients consistently receive harm free care (mean 96% harm free for the period December 2012 December 2013). Whilst the tool is promoted as a local improvement tool there is, inevitably, a degree of benchmarking and the Trust performs well in this respect. To date the Trust is performing well in relation to the associated CQUIN target, which has a financial value to the Trust of 723,000. Nationally, work is underway to expand the scope of the NHS Safety Thermometer. Proposals currently include medication errors and Maternity Services. The Trust is not currently involved in any pilots in respect to these. RECOMMENDATION To receive and note the content of this report. Helen Lamont Nursing and Patient Services Director Suzanne Medows Senior Nurse Practice Development 17 th February 2014
THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST NHS SAFETY THERMOMETER 1. BACKGROUND The Department of Health published guidance to support the NHS in implementing the NHS Safety Thermometer Delivering the NHS Safety Thermometer CQUIN 2012/13 and Delivering the NHS Safety Thermometer CQUIN 2013/14. The NHS Safety Thermometer provides nurses with a template to check fundamental levels of care, identify where things are going wrong and take action. This tool measures four high volume patient safety issues. It is used by frontline healthcare staff to measure and track proportions of patients in their care with pressure ulcers, catheter associated urinary tract infections, venous thromboembolisms and falls. The NHS Safety Thermometer CQUIN was initially designed to incentivise the collection of data on patient harm, using the tool to survey all relevant patients in all relevant NHS providers in England on one day each month. The data submitted over the course of 2012/13 were then used to incentivise organisations to develop a better understanding of the outcomes they were measuring using the NHS Safety Thermometer and move towards delivering and measuring improvement in these outcomes. Specifically, the focus was on the reduction of harm from Pressure Ulcers within locally agreed parameters. In the Newcastle Hospitals this was agreed as a 25% reduction in new category II - IV Pressure Ulcers. A CQUIN has also been proposed in relation to the year 2014/15 and this is likely to build on that for the current year. The Government s aim is to increase transparency of the public sector and drive improvements in standards across all areas and achieve greater value for money, by achieving reductions in these four harms across acute services and community care. Absolute transparency is seen as the key to driving improvements in standards of care. 2. IMPLEMENTATION OF THE SAFETY THERMOMETER WITHIN THE TRUST The Trust introduced the NHS Safety Thermometer systemically into all inpatient wards in May 2012 and the Community in June 2012. A steering group was established, which now meets bi-monthly to monitor any issues. Good engagement from staff across all areas has resulted in the Safety Thermometer now being seen as business as usual by both acute and community staff. It is noted that this is a further, and time-consuming responsibility, for front line nursing staff. A system is in place for pressure ulcers, venous thrombo-embolisms and falls, where the lead clinicians liaise with staff responsible for completion of the Safety Thermometer on the day of data collection, in order to ensure that information is valid and robust. 1
Leads for all four harms use the data from the Safety Thermometer to highlight areas for improvement and raise awareness of the harms. Recently, close scrutiny of the data related to catheter associated urinary tract infections has identified areas which appear to be outliers in terms of duration for indwelling urinary catheters and this has enabled specific and targeted education to be planned and delivered. The information collected may be used with other existing clinical information to continue to focus on, and improve, clinical outcomes and experience for individuals using our services. 3. BENCHMARKING DATA Analysis charting functions are built in to the NHS Safety Thermometer, so individual areas can view their results straight away. A chart provides an overview for the previous 12 months for each area and this can also be obtained for the Trust as a whole and for Acute areas and Community areas separately. Although the NHS Safety Thermometer is not promoted as a tool with which to benchmark against other organisations, it is possible to do so and one advantage of this is to identify other organisations that appear to be doing well and to learn from these organisations. i. NHS Quality Observatory This site, http://www.safetythermometer.nhs.uk/ has been designed to be a single repository of the NHS Safety Thermometer data and contains data from January 2012 onwards. It is possible to use this site to compare single organisations against all other organisations and also to monitor individual Trusts performance over time. The funnel plots at Appendix 1 show all acute organisations. The Trust is identified by a diamond and demonstrates performance which is better than average. ii. North East Quality Observatory System The North East Quality Observatory System (NEQOS) provides a quality measurement service to NHS trusts (both providers and commissioners) across the North East region. Analysis in relation to each individual harm shows: New Pressure Ulcers - The funnel plots at appendix 1 illustrate that the Trust is significantly better than most other organisations in relation to pressure ulcer prevalence. Falls with Harm - The funnel plots at appendix 1 illustrate that the Trust is significantly better than most other organisations in relation to falls with harm. Catheters with UTI - The funnel plots at appendix 1 illustrate that the Trust is significantly better than many other organisations in relation to Catheters with UTI 2
VTE - The funnel plots at appendix 1 illustrate that the Trust is better than average in relation to VTE. 4. TRANSPARENCY OF DATA Information from the Safety Thermometer is publicly available on the NHS Information Centre website; this is attributable by individual Trust. Individual areas within the Newcastle upon Tyne Hospitals display their Harm Free Care data for a rolling 12 month period on their public facing How are we doing boards. 5. PROPOSED DEVELOPMENTS IN THE NHS SAFETY THERMOMETER Current proposals at a national level are to expand the Safety Thermometer to incorporate a wider range of harms include medication and maternity care. These tools are currently being piloted in a small number of Trusts across the country. i. Medication The Medication Safety Thermometer is a national tool that is currently being piloted. It is designed to focus on the issues of medication error and harm caused from medication error, in line with Domain 5 of the NHS Outcomes framework. As a measurement tool for improvement, the Medication Safety Thermometer focuses on Medication Reconciliation Medication Omission, and Identifying triggers of harm from critical and high risk medicines. ii. Maternity The NHS Maternity Safety Thermometer allows maternity teams to check on harm and records the proportion of mothers who have experienced harm free care and also records the number of harm(s) associated with maternity care. The Maternity Safety Thermometer measures harm from Perineal and/or Abdominal Trauma Post-Partum Haemorrhage Infection Separation from Baby Psychological Safety Babies with an Apgar of less than Seven at Five Minutes and/or Those who are admitted to a Neonatal Unit 3
6. NEXT STEPS The Trust places patient safety at the heart of its agenda, and has a long track record for the provision and delivery of high quality patient care. However, it is recognised that there is always room for improvement. The NHS Safety Thermometer does provide a measure of reducing harm and placing patients in the centre of everything we do. The NHS Safety Thermometer Steering Group currently meets monthly. However, as data collection continues to be embedded as usual practice, the meetings will cease and the Senior Nurse - Practice Development will continue to monitor any issues or developments. The CQUIN currently associated with the NHS Safety Thermometer relates to reduction in harm from new Pressure Ulcers and is monitored through the Pressure Ulcer Task Force, led by the Head of Nursing, Freeman Hospital and the Nurse Consultant, Tissue Viability. The Trust has other systems in place to promote patient safety such as falls, bladder, bowel and continence care Task Groups. The NHS Safety Thermometer continues to strengthen intelligence in patient safety by using all the current systems 8. SUMMARY Efforts continue to use the Safety Thermometer in a positive way to bring about service improvements and work towards harm free care which is a continuous journey and an ongoing commitment to our patients. The Trust consistently achieves better than 95% harm free care and efforts continue to improve this. 9. RECOMMENDATION To receive and note the content of this report. Helen Lamont Nursing and Patient Services Director Suzanne Medows Senior Nurse Practice Development 17 th February 2014 4
Overall performance compared to all other acute organisations Appendix 1 Pressure Ulcer Prevalence Falls Harm Free Care (All Harms) Catheters and UTI VTE Incidence Source: http//www.safetythermometer.nhs.uk/ 5