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Open and Honest Care at Royal Liverpool and Broadgreen
Hospitals Trust: June 2015.
This report is based on information from June 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.
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.
96.12% of patients did not experience any of the four harms in this trust.
For more information, including a breakdown by category, please visit:
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
This month
Improvement target
(year to date)
Actual to date
For more information please visit:
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, 10 Grade 2 - Grade 4 pressure ulcers were acquired during hospital stays.
Grade 2
Grade 3
Grade 4
Number of pressure ulcers
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 June we saw an increase in the numbers reported and 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:
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.
Number of falls
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 3 falls resulting in moderate/severe harm these have 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 is that there needed to be an improvement in the completion of the
patient Risk Assessments and initiate the appropriate plan of nursing management.
Rate per 1,000 bed days: 6.2
Patient 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
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 65 in June 2015, or the Friends and Family test*.
*This result may have changed since publication, for the latest score please visit:
In June we also asked 218 patients the following questions about their
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?
Was your pain managed effectively? % who said yes.
% positive rating.
Staff experience: 2014 staff survey. Focus on staff pledge 2 of the NHS
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
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
Percentage of staff having a well-structured appraisal in the last 12 months.
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.
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
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
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.
Patient Story:
A patient referred himself to the Abdominal Aortic Aneurysm screening programme on the
October 2013, having heard about the service on the local radio. Two weeks later he attend for
his screening in the community where an operable size aneurysm was found. The day after, he
was referred to Vascular outpatients where he had his appointment early November
2013. Detailed scans in the Vascular lab took place in December 2013 in order to plan his
surgery. The patient requested an operation date after Christmas which he agreed to being
February 2014. Following a successful operation he was discharged one week later in the same
The patient noted he was extremely grateful to have heard the radio advert and to have been
seen so quickly and with such kindness and professionalism. Without which he may have
ruptured and not survived which would have meant he would not have been around to meet his
Supporting information