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: St Helens & Knowsley Teaching Hospitals Trust October 213
Open and Honest Care at St Helens & Knowsley Teaching Hospitals NHS Trust : October 213 This report is based on information from October 213. The information is presented in three key categories; safety, experience and improvement. This report will also signpost you towards additional information about St Helens & Knowsley Teaching Hospitals NHS Trust's performance. 1. SAFETY Safety thermometer On one day each month we check to see how many of our patients suffered harm whilst in our care. We call this the safety thermometer. The safety thermometer looks at four harms in particular; 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. 97% of patients received harm free care in the hospital. 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) bacteraemia 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 the inside of 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. C.difficile MRSA This month 1 Improvement target (year to date) 16 Actual to date 13 3 For more information please visit: http://www.sthk.nhs.uk/
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. We also record whether the pressure ulcer developed within 72 hours of being admitted into the hospital, or anytime after 72 hours in hospital. This month 2 of our patients suffered Grade 2 - Grade 4 pressure ulcers. Pre 72 hours Post 72 hours Total Grade 2 2 2 Grade 3 Grade 4 So we 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 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 Falls This measure includes all falls in the hospital that resulted in injury, categorised as moderate, severe or death, regardless of cause. This month, 1 of our patients suffered a fall that caused at least moderate harm. Severity Moderate Severe Death Number of falls 1 So we 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:.5
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 Passive - people who couldn't really say one way or another 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 We asked 274 patients the following questions about their care: Score Were you involved as much as you wanted to be in the decisions about your care and trea 35 If you were concerned or anxious about anything while you were in hospital, did you find a 38 to talk to? Were you given enough privacy when discussing your condition or treatment? 52 During your stay were you treated with compassion by hospital staff? 61 Did you always have access to the call bell when you needed it? 55 Did you get the care you felt you required when you needed it most? 63 How likely are you to recommend our ward/unit to friends and family if they needed similar care or treatment? 66 Patient A - " I would like to say a big thank-you to the whole team on the ward for their care and attention in preparing us to cope in our own homes when we leave Duffy. Patient B- "I have been treated with care and compassion of the highest order. I am extremely grateful for all the care and attention shown to me by all staff". 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 79 for the Friends and Family test. This is based on 1236 responses *This result may have changed since publication, for the latest score please visit: http://www.sthk.nhs.uk/
A patient's story Patient One Chris a father and main carer for his 45 year old daughter since the death of his wife some years back, describes his recent experience at St. Helens and Knowsley Teaching Hospitals NHS Trust. Chris explained how his daughter had been experiencing a massive amount of pain and due to her learning disability this pain does not always present itself in a " text book fashion". Despite using private local health services, Chris felt unable to get doctors, consultants or any health care professionals to take his concerns regarding his daughters pain seriously, until his appointment with one of the Gastroenterology consultants at Whiston Hospital. The consultant ordered a series of tests including several complex x-rays and an endoscopic procedure. Chris explained his fear about trying to support his daughter through such necessary tests. Chris was well aware that this would cause great distress to his daughter meaning her behaviour could become difficult to manage. The radiology manager and the surgical care group matron listened to Chris's concern with great regard and pulled together a co-ordinated way of conducting these investigations to limit any distress for Chris and his daughter. Chris explained nothing was too much of a problem. Originally we were listed for an afternoon time slot, when Chris explained this could be difficult, immediately a morning slot was offered. On the day of being admitted Chris explained ; "everything ran like clockwork the care was so personalised. There was no doubt in my mind that I had been listened to and that we were in very safe hands. All of the investigations were co-ordinated and conducted under general anaesthetic. The matron, who I am very grateful to, walked us to theatre and really put me at ease. The doctor walked with us to the ward and kept a close eye on my daughter. On this occasion Whiston Hospital did everything they could, the care and co-ordination was outstanding. I can't thank the teams involved enough. They even gave me a buttie and a brew. Whiston Hospital delivered a brilliant service much better than the so called private provider. It's the first time I haven't had to fight for my daughters rights. Thank you " Staff experience We asked staff the following questions: Score I would recommend this ward/unit as a place to work 68 I would recommend the standard of care on this ward/unit to a friend or relative if they nee 81 I am satisfied with the quality of care I give to the patients, carers and their families 76
3. IMPROVEMENT Improvement story: we are listening to our patients and making changes The Trust now has a Nursing and Midwifery Strategy - based on the national 6 Cs document. The 6 Cs are: communication, compassion, care, courage, commitment and competence. For each of the 6 Cs there are dedicated senior nursing leads who are working towards delivering the short and longer term goals outlined in the delivery plan. Over the last four weeks there has been much activity sourcing membership for the groups - these are very diverse groups consisting of a mixture of spiritual care, nursing staff, reception staff and patient representatives /carers. The groups will decide what are the priorities to be delivered and will drive the implementation of these changes. This is a very exciting journey that has only just started but has huge support and enthusiasm to make a difference across a wide range of services within the organsiation that will make further improvements to the patient experience. Supporting information The Department of Tissue Viability held a STOP PRESSURE ULCER DAY on Thursday 21st November 213. There was a display outside the Main Reception,,Whiston Hospital. Our aim was to make Trust staff and visitors aware of the importance of reducing pressure ulcers and of the work we do within the hospital setting to reduce the incidence of pressure ulcers and what they can do to prevent pressure ulcers occurring within the community.