Open and Honest Care in your Local Hospital Report for: Royal Wolverhampton NHS Trust January 2016 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.
This report is based on information from 2015. The information is presented in three key categories: safety, experience and improvement. This report will also signpost you towards additional information about New Cross Hospital 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 NHS 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. Improvement target: % harm-free care Monthly - % harm-free care 2015/2016 95% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar % of patients did not experience any of the four harms in this trust 93.79% 93.67% 93.92% 94.36% 94.29% 95.59% 92.60% 94.32% 94.65% 93.50% For more information, including a breakdown by category, please visit: http://www.safetythermometer.nhs.uk/ Health care associated infections (HCAI s) HCAI s are infections acquired as a result of healthcare interventions. Clostridium difficile (C. difficile) and methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia are nationally monitored as we are trying reduce the incidence of these infections. 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. Page 2 of 12
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 MRSA bacteraemia infections and are working towards reducing C. difficile infections; 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. Annual improvement target MRSA bacteraemia C. difficile No more than 35 infections Number of infections Patients in Hospital Setting 2015/2016 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Total year to date 0 infections 0 0 0 0 0 0 0 0 0 0 0 5 11 5 3 10 6 9 7 6 3 65 For more information please visit: http://www.royalwolverhamptonhospitals.nhs.uk/patients public/infection_prevention.aspx 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 validated avoidable/unavoidable pressure ulcers that were obtained at any time during a hospital admission that were not present on initial assessment. In order to 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 1,000 occupied bed days'. This allows us to compare our improvement over time, but cannot be used to compare us with other hospitals, as Page 3 of 12
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. Hospital acquired Unavoidable Number/rate of Pressure Ulcers 2015/2016 Severity Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Total year to date Category 2 22 35 33 23 16 22 19 25 30 27 253 Category 3 4 7 3 0 2 5 5 6 4 3 39 Category 4 0 0 1 1 0 1 0 1 3 0 7 Rate per 1000 bed days 0.98 1.61 1.35 0.87 0.74 1.06 0.90 1.22 1.46 1.12 1.13 Hospital Acquired Avoidable Number/rate of Pressure Ulcers 2015/2016 Severity Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Total year to date Category 2 10 8 4 7 5 4 11 6 7 5 67 Category 3 2 5 8 3 4 8 3 5 3 7 53 Category 4 1 0 1 0 0 0 1 0 2 0 5 Rate per 1000 bed days 0.49 0.50 0.48 0.36 0.37 0.46 0.56 0.42 0.47 0.46 0.46 Page 4 of 12
In the community setting we also calculate an average called 'rate per 10,000 CCG 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. Community Acquired Unavoidable Number/rate of Pressure Ulcers 2015/2016 Severity Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Total year to date Category 2 2 12 3 11 7 3 4 3 6 4 51 Category 3 4 6 5 4 7 4 5 9 5 3 49 Category 4 0 0 2 0 3 2 0 2 1 2 10 Rate per 10,000 population 0.24 0.71 0.40 0.59 0.67 0.36 0.36 0.55 0.47 0.36 0.47 Community Acquired Avoidable Number/rate of Pressure Ulcers 2015/2016 Severity Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Total year to date Category 2 2 3 3 4 1 0 2 1 3 0 19 Category 3 3 3 3 1 2 2 6 4 1 3 25 Category 4 1 0 1 0 0 0 0 1 1 0 4 Rate per 10,000 population 0.24 0.24 0.28 0.20 0.12 0.08 0.32 0.24 0.20 0.12 0.21 Page 5 of 12
Falls Number/rate of Falls 2015/2016 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Total Severity year to date Moderate 5 3 5 1 3 1 3 3 3 2 27 Severe 0 0 1 0 0 0 0 0 0 0 1 Death 0 0 0 0 0 0 0 0 0 1 0 Rate per 1000 bed 0.19 0.12 0.22 0.04 0.12 0.04 0.11 0.11 0.12 0.12 0.12 days 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. In order to 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 1,000 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. Page 6 of 12
Safe Staffing Guidelines recently produced by the National Institute for Health & Care Excellence (NICE) make recommendations that focus on safe nursing for adult wards in acute hospitals and maternity settings. As part of the guidance we are required to publish monthly reports showing the registered nurses/midwives and unregistered nurses we have working in each area. The information included in the report shows the monthly planned staffing hours in comparison with the monthly actual staffing hours worked on each ward and/or the percentage of shifts meeting the safe staffing guidelines. In order to view our reports please visit: http://www.nhs.uk/services/hospitals/overview/defaultview.aspx?id=1082 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 Monthly - % recommended 2015/16 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar In-patient FFT score* 91% 91% 92% 92% 91% 90% 90% 90% 91% 89% Total number of in-patient responses on which % is based 1422 1584 1524 1538 1235 1358 1368 1263 1299 929 The Friends and Family Test Page 7 of 12
The Friends and Family Test (FFT) requires all patients to be asked, at periodic points or following discharge, How likely are you to recommend our ward/a&e/service/organisation to friends and family if they needed similar care or treatment? Monthly - % recommended 2015/16 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Community FFT score* 90% 90% 90% 86% 81% 87% 84% 88% 86% 86% Total number of in-patient responses on which % is based 292 281 286 1251 945 994 1081 1409 1207 704 *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 patients in the hospital setting the following questions about their care: Catering Please indicate your overall satisfaction with the services you received from catering during your stay Quarterly Quarter 2 (July/August /September ) Quarter 3 (October, November, December ) Excellent Good Acceptable Poor Excellent Good Acceptable poor 40% 33% 24% 3% 47% 42% 10% 1% Page 8 of 12
A Patient/Family/Staff story The purpose of the story is to see care through the eyes of the patient or family member or to capture and share the experience of the staff member, therefore the stories are best told in the words of the patient, family or staff member. The narrative should be clear, concise and jargon free. Try to avoid long, dense paragraphs of text Paste your story over this text. Expand the text box by increasing the line depth or adding new lines The patient experienced a positive journey during his treatment from Emergency Department to AMU however he was transferred to B14 and over the festive period he was offered a meal which contained beef which offended his religious and cultural beliefs. He was then offered a high carb alternative of jacket potato. The family decided that there was a requirement to bring food from home which met his needs to supplement what was offered. They did not raise this issue directly with the ward at that time. Page 9 of 12
The Friends and Family Test The Friends and Family Test (FFT) requires staff to be asked, at periodic points: How likely are you to recommend our organisation to friends and family if they needed care or treatment? and How likely are you to recommend our organisation to friends and family as a place to work Quarterly reporting 2015/2016 Quarter 1(April,May June ) Quarter 2 (July,August,September) Quarter 3 (October, November, December) FFT recommended care* 78.5% 79.9% Do not collect this quarter FFT recommended work* 69.6% 69.6% Do not collect this quarter *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/ Page 10 of 12
3. IMPROVEMENT Improvement story: we are listening to our patients and making changes The Swan Project This is a project to improve patient and carer experience at the end of life The highlights below also concentrate on customer care and communication to patients and families and are the actions that have been put into place to support the project Trust ethos and philosophy agreed in preparation for launch day, teaching programme and for inclusion into new intranet page SWAN champions identified and 92 trained to date. Care in the Last Few Days of Life documentation Patient and relative information leaflet on care of the dying Education programme SWAN boxes and contents are available on wards Mortuary refurbishment completed Page 11 of 12
Supporting information Page 12 of 12