Agenda item

Due to the tight schedule in putting this report together, it has not been possible to complete the report within the normal timescales and therefore the report will be circulated in due course.

Helen Kershaw, Associate Director of Nursing and Patient Care Standards, introduced the East Cheshire Hospital Trust’s Quality Account. 

 

She explained that the Trust had a number of quality and safety improvement initiatives underway including requirements from the PCT, standards from the Care Quality Commission and from the Trust’s own Quality Strategy that had been introduced in 2008.  The Quality Strategy had focused on 10 areas of patient safety and 5 on improving patient experience and improvement in 8 out of the 10 areas had been demonstrated.  Two of the areas had been included as priority areas for 2010/11 – reduction of falls and reducing serious medication errors.  In relation to reducing falls, various measures had already been introduced through a strategy and action plan but reducing falls had proved challenging.  Further work was to be carried out including the introduction of functional electrical stimulation as recommended by the National Institute for Health and Clinical Excellence.  In relation to reducing medication errors it was noted that most medication errors were minor and could be classed as prescribing, dispensing or administrative errors.  Progress in reducing errors had not been as expected and a study had been undertaken to improve understanding of the issues.  This had now resulted in some specific areas of work to try to reduce medication errors.

 

The Trust Board had agreed the following statements as underpinning principles for continuing to improve care given to patients:

 

      Do me no harm (safety)

      Make me better (clinical effectiveness)

      Be nice to me (patient experience)

 

            The following areas were identified as priorities for 2010/11:

 

            Do me no harm

 

      Reduce the number of falls sustained by patients;

      Protect patients from hospital acquired infection;

      Reduce the impact of medication errors on patients.

 

            Make me better

 

      Reduce avoidable death, disability and chronic ill health from venous thromboembolism;

      Deliver evidence based interventions to patients with a diagnosis of acute myocardial infarction, heart failure, pneumonia, stroke or undergoing hip or knee surgery;

      Support the timely and effective discharge of patients to the most appropriate setting and provide timely information to GPs.

 

 

            Be nice to me

 

      Ensure patients within the hospital’s care were treated in privacy with dignity and respect which would include the provision of same sex accommodation unless it was clinically justified.  All toilet areas and bays were same sex.  In the critical care unit curtains were available around individual beds to enable greater privacy and one-to-one nursing took place;

      Ensure patients concerns and complaints were listened to, investigated appropriately and acted upon and lessons were learnt.  The Committee was advised that all complainants were contacted within 48 hours;

      Develop all staff to ensure they acted as a role model, took personal responsibility, had courage to speak up and make voices heard;

      Improve incident reporting and be in the highest 25% of reporters.

 

            The report included a list of audits both national and local that had been conducted in relation to the hospital Trust or in which the Trust

            had participated.   An unannounced visit by the Care Quality Commission (CQC) had found the Trust was compliant with the Hygiene Code and the Trust had registered with the CQC without conditions.

 

            The Trust had also improved on the Hospital Standardised Mortality Ratio (HSMR), which was a calculation that provided hospitals with a benchmark in relation to death in hospitals with a rate below 100 showing performance better than the benchmark.  The Trust had shown a continuous reduction in HSMR with the latest risk (based on January – December 2009) of 88.0.

 

            The National Inpatient Survey had placed the Trust in the lowest performing 20% for hand washing by doctors and hand washing by nurses and Ms Kershaw explained that this could in part be due to perception and staff had been advised to make patients aware that they had washed their hands by either specifically telling the patient this or through the use of hand gel at the bedside. 

 

            During the discussion the following issues/questions were raised:

 

      Role of visitors and visiting times - the Committee was advised that a Visitors’ Charter was about to be launched with a list of expectations on visitors.  Visiting times were generally fixed to ensure there was sufficient time to enable patients to rest but flexibility would be allowed if necessary, numbers of visitors per patient would usually be limited;

      How were medicines issued on wards?  The Committee was advised that the qualified Registered Nurse who was looking after each patient would issue any required medicine;

      What stroke care was available?  There was an acute stroke unit at the hospital and a CT scanner;

      What specific measures to ensure dignity and respect were in place?  Patients were asked how they wished to be addressed and there was staff training to reinforce the importance of this action, a number of new volunteers had been appointed to assist at lunchtimes and a sticker system for high calorie drinks had been introduced to help with ensuring patients were drinking the required amount at the right intervals;

      Whether it was unhygienic for nursing staff to wear their uniforms on the way to work?  A recent Department of Health document suggested that there were no risks to hygiene but to ensure a professional image and good perception staff were advised to cover their uniform when travelling to and from work;

      How was disruption from dementia patients dealt with?  In response the Committee was advised that a side room would be used if available but side rooms would be prioritised for any patients with the MRSA infection;

      Did the Hospital Trust work with the Cheshire and Wirral Partnership NHS Foundation Trust (CWP) regarding patients with learning difficulties or mental health issues?  The Committee was advised that there were close links with CWP and other organisations including the Dementia Society and Admiral Nurses;

      Staff turnover was not high;

      Whether future Quality Accounts could include an overview of performance perhaps in the form of a “traffic light” approach at the front to assist the Committee.

 

            RESOLVED:  That

 

            1) the draft Quality Account for 2009/10 be received, and the     information provided on the quality of care and services be welcomed;

 

            2) the Trust’s priorities for improvement and performance measures for          2010/11 be endorsed, and progress be reviewed if necessary in year     and as part of the Quality Account for next year;

 

            3)  attention be drawn to the following issues:

 

            a) the continuing reduction in the number of health care acquired          infections be welcomed, noting in particular the demanding target of          less than four MRSA cases for 2010/11;

 

            b) that the hospital has succeeded in reducing hospital acquired          pressure sores by 22% over the last year and that a further 5%         reduction is sought for 2010/11 which is a challenging target;

 

            c)  reducing inpatient falls remains a priority area for the Trust as          despite a number of initiatives the incidence has not been lowered.   It     is important to check whether the patients have a history of falls and      carers should be included in this process.  The focus on avoiding         serious falls and minimising harm caused is welcome;

 

            d) it is a matter of concern that the Trust is in the bottom 20% nationally           for handwashing by medical staff according to the National Inpatient   Survey but it is recognised that this may be due to lack of patient            awareness and that the hospital is working to address these issues;

 

            e)  despite issues raised previously in the “Dr Foster” report the           hospital has achieved a progressive reduction in the Hospital         Standardised Mortality Ratio, moving from a rate higher than average          in 2008 to being well below the national average in the period to           December 2009 which means East Cheshire is a safe hospital;

 

            f) that the Committee reviewed and commended a number of aspects             of patient safety and experience and the steps taken by the hospital to            improve, including

 

      Same sex accommodation is provided everywhere except in critical care areas;

      Detailed attention is given to hygiene including rigorous bed cleaning and disinfection given high bed turnover;

      Advice against bringing flowers onto wards and encouragement of visitor handwashing to reduce the risk of hospital acquired infection;

      Visiting times and the control of visitors from ward to ward including prohibition on sitting on beds.

 

            g) that the hospital performs well in responding to complaints, generally           achieving 100% of response targets.  The Trust has also introduced             new initiatives learning from complaints with the “Patients Passport” for         people with learning difficulties as an example which has been well      received;

 

            h) that the format of the Quality Account, although prescribed, does not            make it easy to focus attention on any areas of particular concern and   it would be better if a “traffic lights” approach or similar could be         adopted to highlight specific performance issues.  Although the Trust   was working to provide in future a “discretionary” summary to help, the     issue should be drawn to the attention of the Department of Health, to        consider altering the format of the Quality Account reports;

 

            i) the importance of ensuring that reports such as these are written in   plain English to enable them to be readily understood by a wide     audience;

 

4)  these comments be forwarded to the East Cheshire NHS Hospital Trust for inclusion in their Quality Account and to the Central and Eastern Cheshire Primary Care Trust and East Cheshire Local Involvement Network for information.