Download Open and Honest May 2015 - Royal Liverpool University Hospital

Open and Honest Care at Royal Liverpool and Broadgreen
Hospitals Trust : May 2015.
This report is based on information from May 2015. The information is presented in three key categories:
safety, experience and improvement. These reports will also signpost you towards additional information
about the trust's 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 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 new harm.
93.2% 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 bacterium 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 are 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; 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
MRSA
C.difficile
This month
1
0
Improvement target
44
0
(year to date)
Actual to date
1
1
For more information please visit:
www.rlbuht.nhs
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.
This month 1 Grade 2 - Grade 4 pressure ulcers were acquired during hospital stays.
Severity
Grade 2
Grade 3
Grade 4
Number of pressure ulcers
5
2
0
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 1,000 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 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. On the whole the trust has very low numbers of
grade 2, 3 and grade 4 pressure ulcers. In May we saw a further reduction in the numbers reported and a
reduction in the overall rate. We know from experience and our success in reducing hospital acquired pressure
ulcers that undertaking a full root cause analysis [where a group of nurses discuss with the senior nursing team
the factors that may have contributed to the development of pressure ulcers], has a real impact on helping
staff to understand the issues and therefore learn from this and prevent it from happening again. We have
from March commenced full root cause analysis for all hospital acquired pressure ulcers, previously only doing
this for grade 3 and 4 we are now focusing on grade 2 to really look at the preventability early on.
Rate per 1000 bed days:
0.29
Falls
This measure includes all falls in the hospital that resulted in injury, categorized as moderate, severe or
death, regardless of cause.
This month we reported falls that caused at least 'moderate' harm.
Severity
Moderate
Severe
Death
Number of falls
1
0
0
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 1,000 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. Of the 1 fall resulting in moderate harm this has been reviewed through root
cause analyses (RCA). With the patient who has been reviewed through the RCA she nursed with close
observation from staff and family, at time of fall to monitor with close observations due to change over in staff
this patient fell fracturing their right arm. The lessons learnt from this RCA are better communication, we have
been reviewing this and how staffs communicate at patients who are at high risk of falls. Ensuring that patients
who need close observation are able to get the correct staffing levels, to help keep the patient safe at all times.
Rate per 1,000 bed days: 5.4
Patient Experience
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, or couldn't say .
Passive - people who may recommend you but not
strongly.
Promoters - people who have had an experience which
they would definitely recommend to others.
This gives a score of between -100 and +100, with +100 being the best possible result.
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 53 in May 2015, or the Friends and Family test*.
*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/
In May we also asked 184 patients the following questions about their
care:
The % score represents patients who provided positive responses.
Were you involved as much as you wanted to be in the decisions about your care and treatment?
Did you find someone to talk to about your worries or fears?
Were you given enough privacy when discussing your condition or treatment?
Have your medications and potential side effects been discussed with you?
How many patients rated their experience good, very good or excellent?
Was your pain managed effectively? % who said yes.
% positive rating.
70%
70%
85%
73%
%
88%
Staff experience: 2014 staff survey. Focus on staff pledge 2 of the NHS
constitution.
To provide staff with personal development, Access to appropriate education and
training for their jobs, and line management support to enable them to fulfill their
potential.
2012
2013
Percentage of staff having job relevant training or development in the past 12 months. 78%
Support from immediate managers rating on a scale of 1-5
3.6
Percentage of staff having a well-structured appraisal in the last 12 months.
32%
81%
3.67
33.0%
There has been a slight dip in the percentage of staff reporting that they have accessed job
relevant training and this is consistent with the increase in operational pressures which has
impacted on the release of staff to undertake training. Training for managers continues to be
implemented and a leadership behaviors questionnaire has been incorporated into the
appraisal process for 2015/16 to invite direct reports to give anonymous feedback to their line
managers about their leadership skills – this will help the Trust to develop the skills of
managers in a tailored way. The appraisal system will also have a review process incorporated
to allow staff to feedback on both the appraisal process and the appraiser.
3. IMPROVEMENT
Improving how we share lessons learned from clinical incidents.
The Trust has reviewed its risk management system and processes and a big part of this is to
improve how we share lessons learned. From the beginning of May the Trust commenced a
weekly staff bulletin called the 'Patient Safety and Experience Bulletin'. This is circulated via
Email and is available on our Staff intranet. It has been really helpful in sharing information to
other staff with the aim of reducing risk to our patients; we have had some really positive
feedback. We have also seen an increase in the number of staff who wants to share
information through this bulletin.
We have seen an improvement in staff reporting incidents, with 90% of staff indicating in the
staff survey that they report incidents which was one of the most significant increases in the
2014 staff survey results, the trust has seen an increase in datix incident reporting by 21% from
the previous financial year. Mock CQC inspections take place to give assurance to our board
that national standard are considered and adhered to.
IMPROVEMENT STORY: Are we listening to our patients and
making changes
The Trust holds “Listening weeks” throughout the year. These events are to support gathering
feedback from patients and members of the public on key issues and developments at the
hospitals. Subjects have ranged from:
 No smoking at the hospital resulting in a campaign to support patients to “Stop before
their Operation”
 Promotion of the work done to support patients admitted to our hospitals with dementia
 Seeking views of patients and the public about the new hospital build regarding the single
rooms, visiting times and the layout of the new hospital
 Promotion of the Specialist Nurses in post to support the reduction of harm to patients
2014
79%
3.68
33.0%

Implementation of the Intentional rounding to ensure that patients are assessed regularly
and that their needs are met.
 Food tasting sessions to show case the wide variety of food and drinks available for our
patients
These events are very popular and provide a rich source for the Trust about what our patients
think about the services we provide in order for improvement to take place.
Learning from Complaints:
A patient with learning disabilities was admitted to the Emergency Department and the Trust did
not have the correct equipment (spreader bar) to transfer the patient via the hoist. This caused
a negative experience for the patient and his family.
The Trust met with the patient and his family and immediate remedial action was taken. The
Trust also met with the Learning Disability Community Nurse in order to improve the experience
for patients with a learning disability within our hospital.
The patient recently attended another clinic at the hospital. All of the equipment was available
and was a much more positive experience for the patient and his family.
Supporting information