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: The Newcastle upon Tyne Hospitals NHS Foundation Trust May 217
Open and Honest Care at The Newcastle upon Tyne Hospitals NHS Foundation Trust : May 217 This report is based on information from May 217. The information is presented in three key categories: safety, experience and improvement. This report will also signpost you towards additional information about The Newcastle upon Tyne Hospitals NHS Foundation Trust's performance. 1. SAFETY NHS 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 harms. 94.2% of patients did not experience any of the four harms whilst an in patient in our hospital 97.1% of patients did not experience any of the four harms whilst we were providing their care in the community setting Overall 95.1% of patients did not experience any of the four harms in this Trust. For more information, including a breakdown by category, please visit: http://www.safetythermometer.nhs.uk/ Health care associated infections (HCAIs) HCAIs are infections acquired as a result of healthcare interventions. Clostridium difficile (C.difficile) and methicillin-resistant 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 and have already made great progress; 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 2 1 Annual Improvement 13 Target to date Actual to date 5* 1 *1 successful appeals for C.Diff ^ MRSA third party assignment agreed with CCG For more information please visit: http://www.newcastle-hospitals.org.uk/patient-guides/keeping-hospitals-clean.aspx Further information about HCAIs and C.difficile appeals is on pages 5 and 6.
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 categories, with one being the least severe and four being the most severe. The pressure ulcers reported include all avoidable/unavoidable pressure ulcers that occured at any time during a hospital admission that were not present on initial assessment. This month 69 Category 2 - Category 4 validated pressure ulcers were acquired during Acute hospital stay and in the community. Number of Pressure Ulcers in our Severity Number of Pressure Ulcers in our Acute Hospital setting Newcastle Community setting Category 2 63 Category 3 6 Category 4 The pressure ulcers reported include all pressure ulcers that occurred from zero hours after admission 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: 1.82 Hospital Setting In the community setting we also calculate an average called 'rate per 1, Clinical Commisioning Group 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. Rate per 1, Population:. Newcastle Further information about our work to reduce harms is on pages 4 and 5. Falls This measure includes all falls in the hospital that resulted in injury, categorised as moderate, severe or death, regardless of cause. This includes avoidable and unavoidable falls sustained at any time during the hospital admission. Falls within the community setting are not included in this report. This month we reported 9 fall(s) that caused at least 'moderate' harm. Severity Moderate Severe Death Number of falls 3 4 2 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 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 falls in different ways, and their patients may be more or less vulnerable to falling 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:.24 Further information about our work to reduce harms is on pages 4 and 5.
2. EXPERIENCE To measure patient and staff experience we ask a number of questions.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. The answers given are used to give a score which is the percentage of patients who responded that they would recommend our service to their friends and family. Patient experience The Friends and Family Test The Friends and Family Test requires all patients, after discharge from hospital, to be asked: How likely are you to recommend our ward to friends and family if they needed similar care or treatment? We ask this question to patients who have been an in-patient and/or attended Acccident & Emergency (A&E) and has most recently been rolled out to Community Services. All scores (if applicable) are below: In-patient FFT score 97 % recommended This is based on 244 responses A&E FFT score 9 % recommended This is based on 768 responses Community FFT score 95 % recommended This is based on 2 responses In addition to asking FFT questions we asked 97 patients in May 217 the following questions about their care in the hospital: Yes Always/Most of Time or Excellent/Good Do you feel able to ask any questions about your treatment or condition? 98% Are you involved as much as you want to be in decisions about your care and treatment? 99% If you have needed to use your nurse call button, has this been responded to in a timely manner? 98% Overall do you feel safe, secure and supported in this hospital? 1% How likely are you to recommend this ward to your family/friend if they needed similar care or Treatment? 1% A patient's story Sepsis affects everyone. More people die each year from sepsis than breast cancer, bowel cancer and prostate cancer combined. Everyone needs to be aware of the signs and symptoms of sepsis and how important it is to respond quickly. Katie was a happy, healthy 18 year old when she suddenly started to feel unwell with a sore throat. Her GP diagnosed her with tonsillitis and advised that this should improve over time. Sadly the next day Katie started to feel worse with breathlessness and vomiting, her Dad was convinced that there was something seriously wrong with her and when Katie started to deteriorate further he rang NHS 111, who listened and asked questions. They arranged for an ambulance to pick Katie up and bring her to the RVI. He was shocked at the speed of her deterioration and terrified that he might lose her. Katie s sore throat had developed into Sepsis due to a severe infection of her lung and chest cavity. She spent 4-5 days critically unwell on intensive care before thankfully improving and she is now happily living her life having just started University and has made a full recovery. This story highlights the importance of rapid recognition and treatment of this devastating disease both in the community and hospital setting, it also shows that sepsis can affect anyone. The improvement story in Section 3 shows the work we have done to improve awareness and treatment. Staff experience In the fourth quarter of 216/17 we carried out a survey on a sample of our employees, we received 191 responses to the following questions: Extremely Likely/Likely How likely are you to recommend the Trust to friends and family if they needed care or treatment? 94% How likely are you to recommend the Trust to friends and family as a place to work? 73% See supporting information for more detail on the Staff Survey
3. IMPROVEMENT Improvement story: we are listening to our patients and making changes Improving the recognition and treatment of patients with sepsis is a key Trust safety priority and is one of five key areas of work linked to the national Sign up To Safety campaign. By Signing up to Safety and focusing on sepsis we aimed to: *Improve early detection and initial management of the severely septic/septic shocked patients by 5% by 218 (Adult) *Reduce the numbers of children treated inappropriately for sepsis by 5% by 218 (Paediatrics). In the last year, significant improvements have been made in the monitoring, recognition and treatment of sepsis. At the start of 216 an audit undertaken across the Trust showed room for improvement; rates of sepsis screening in A&E were 56% and for all inpatient wards 62%. These figures have improved significantly during 216-17 with 1% of patients in A&E and 94% of inpatients being screened in March 217. Significant progress has also been made with patients receiving antibiotics within 6 minutes. These changes have been made possible following: *the introduction of an online prescribing package helping staff to prescribe antibiotics and other elements of the Sepsis 6 quickly and efficiently *a comprehensive training package has delivered to staff *4 prompt cards given to staff that can be stored on ID badge holders to remind staff of the signs, symptoms and treatment options for sepsis *A paediatric sepsis toolkit developed which includes an updated antibiotic policy, prompt cards, posters and simulation training. *a video of Katie telling her story has been made and shared with staff as part of the awerness raising and ongoing educational activites. The Trust will continue to educate staff and the public to be sepsis aware. Supporting information The Trust regularly reports a low rate of harm from the Safety Thermometer. This is demonstrated on the graph below which shows that the Trust (blue line) has reported a low rate of harm maintaining 95.5% or above harm free care and a 12 month average of 96.71%, both of which are above the national average of 94.22%. In order to achieve and maintain this position the Trust has done significant work to minimise Falls, Infections and Pressure Ulcers. This report is an opportunity for us to share with you some of our learning and what we have done to reduce harm.
Falls Prevention Prevention of patient falls, particularly those which may cause patients harm, is a key priority for the Trust. There has been a lot of work done to make sure all staff working in our hospitals take responsibility for preventing falls. This has included: *The Trust recently led a regional collaborative project working with two other Trusts to embed an evidence based "Falls Care Bundle". This project ended in July 216 but further funding was secured by The Newcastle Hospitals to expand this work from the original 6 wards to 12 other wards within the Medicine/Care of the Elderly directorate over the next 6 months. The Falls Prevention Coordinator is continuing to measure compliance through a monthly audit and results to date have been positive. *The Trust falls assessment has been updated as part of the collaborative project discussed above and this is currently being rolled out across the organisation for all adult inpatients (some hospitals only do a falls assessment on patients who are aged 65 and over. *A falls prevention campaign called No Falls On My Patch. This includes posters being displayed in all wards and departments to highlight falls prevention. * Call Don t Fall posters are displayed at patient bed spaces and in toilets and bathrooms to prompt patients to press their call bell when they need assistance. *We have over 1 beds that lower to the floor for the highest risk patients who may fall out of a standard bed. These beds reduce the risk of injury for our patients. *For patients who do not bring in footwear or don t have appropriate footwear for their stay in hospital, we can provide well-fitting slippers and also non-slip slipper socks so that all patients have access to safe footwear. *All patients who are assessed as being at risk of falling whilst in hospital have regular comfort and safety checks using the FOCUS Chart. These checks include making sure the patient has everything they need close by, including a drink and the call bell. Also, staff can offer assistance with activities such as going to the toilet for those patients who are not safe enough to do this on their own. *We have a specialist Falls Prevention Coordinator who reviews all falls incidents and carries out an investigation if a patient suffers serious injury following a fall e.g. a broken hip. *A Post Fall Assessment Checklist is now in use across all adult in-patient wards following a successful trial on the Care of the Elderly wards at Freeman Hospital. This document is a multidisciplinary checklist to ensure the Trust Post Fall Protocol is adhered to and that patients a receive the best quality care after a fall. *The teams for Falls Prevention and Tissue Viability continue to work closely together to reinforce Harm Free Care for all patients. Lessons learnt from looking at data about when and why falls have occurred and Root Cause Analysis, are shared with clinical staff through briefings at professional forums, link nurse meetings and formal falls prevention education. We are committed to reducing harm and review the circumstances when patients have fallen to identify learning. We also review the clinical evidence and network with other care providers to see what we can learn, all of which has resulted in a further 5% reduction since last year. Safety Thermometer - Funnel plot for Falls with Harm (Newcastle is the selected trust) and demonstrates the Trust's positive position when compared with others. Pressure Ulcers The Trust is committed to reducing the incidence of Trust acquired pressure damage to an absolute minimum. At times, pressure ulcers develop and this is inevitable, for example when patients have to be nursed flat on a mattress and cannot be turned because they are too medically unstable to do this; or when they spend long times in theatre (some patients can be on a theatre table for 12-14 hours for very long life-saving operations). Nevertheless, the majority of pressure damage can be prevented with frequent and regular repositioning regime.
Pressure Damage Numbers by Category, Category II and Moisture Lesions being our highest numbers of damage The line graph demonstrates a variable incidence, in fact when we have an increase in emergency admissions, these tend to be very sick patients and incidence increases, despite staff working very hard to meet the needs of these very vulnerable patients. This pattern of increased emergency activity, which decreases as pressure reduces demonstrates the link between number of sick frail patients where damage can occur very quickly. When pressure ulcers develop, an open and honest investigation takes place to ascertain the origin of the skin damage. Any lessons to be learnt are shared with all staff through our Trust-wide monthly Safety Briefings. Experience is telling us that to reduce the incidence of pressure ulcers, a three pronged approach is necessary: strengthening leadership, building team work and ensuring clinical practices are up-to-date. We have been working very closely with all our wards to embed turning regimes in every ward routine; we have invested in a selection of excellent mattresses that redistribute pressure to minimise risks and improve comfort; we have invested in renewing all the pillows so that patients can be repositioned from side to back to side with comfort and efficacy; we have invested in a Time2Turn campaign where care plans, documentation and turning discs assist nurses and all other health professionals to turn patients. Finally we have designed a patient leaflet to remind patients and carers that we are partners in the fight against pressure damage and that they can help and support us achieve our very ambitious target. We are now in the phase of ensuring that all these interventions are embedded in clinical practice with regular auditing taking place. We are aiming to achieve a 2% reduction in Trust-acquired pressure ulcers and after six months, 18 wards are on course to achieve this. Infection Prevention and Control Preventing healthcare-acquired infection (HCAI) is a top priority for the Trust and the infection prevention and control team work very closely with clinical staff to help them reduce risks and deliver safe care. These are some of the ways we try and achieve this: We talk and listen to each other If there is a case of C. difficile, MRSA bacteraemia blood infection and/or other infections, we take this very seriously. We want to know what has happened and why, so we meet with senior nursing and medical staff, the doctors and nurses caring for the patient to review the care given. We look at what went well; identifying areas of good practice but also talk about what we could have been done better. We share this with all other departments in the Trust so that everyone learns. We regularly meet with the infection prevention and control experts from other local Trusts to share ideas and experiences. We also review practices with other similar and comparable Trusts to share best practice and learning. We remind staff what is best practice Hand hygiene is the most effective action staff can take to prevent the spread of infection. We have eye-catching posters, designed specifically for the Trust, to remind staff, patients and visitors how and when to clean their hands. We also use soaps, hand gels and moisturisers which are kind to the skin. As part of the Year of Harm Free Care initiative, there is a programme of campaigns to promote best practice and raise awareness on how to reduce HCAI. Some examples of these include awareness campaigns on Clostridium difficile, which was targeted at all groups of clinical staff in both the hospital and the community, flu prevention and safe use of antibiotics. We deliver care in a safe, clean environment We work with Hotel Services and Estates to ensure our wards and departments are clean and well-maintained. In addition to our routine cleaning staff, we have Rapid Response Cleaning Teams who are not based on one ward or department, but are ready and available to go to any area that requires additional cleaning. We have also increased the frequency of routine of cleaning that occurs throughout the wards. How do we know what we think happens, does happen? We undertake a whole range of observations of practice and audits so that we can be assured we are delivering safe care and reducing harm. Examples of these include assessment of staff knowledge, practice and cleanliness. C.difficile Appeals There is an appeal process in place in relation to C. difficile cases, as it is recognised that not all cases are avoidable. The Trust is required to provide a comprehensive case history to a panel of local experts external to the Trust for review. Up to date progress on this year s appeals can be seen in Section 1 of this report. MRSA Third Party Assignment Third Party assignment of an MRSA bacteraemia provides an acknowledgement of the complex nature of MRSA bloodstream infections and is designed to capture instances where an MRSA case cannot legitimately be assigned to either the Trust or the CCG. Following the Post Infection Review (PIR), cases considered to be Third Party are reviewed via an arbitration process which is led by the Regional Director of Nursing or the Regional Medical Director, this panel is responsible for the final case assignment (See Section 1). Staff Family & Friends Test (FFT) Staff Family & Friends Test (FFT) is completed by staff across the year via an online survey. It is a chance for our employees to anonymously feedback views on our organisation, with each Directorate getting invited to take part in one of the quarters. Within the region we are the best performing Trust for recommending us as a place for care and in 2 nd place for being recommended as a place to work. When compared to a National Benchmarking Group we are again the best performing Trust for recommending us as a place for care and within the top 3 Trusts recommended as a place to work.