Twelve months have passed since the June 2008 launch of the Patient Safety First Campaign. Promoting a vision of an NHS with no avoidable death or harm, the campaign is helping to make patient safety the highest priority for everyone from chief executive to ward cleaner, surgeon to visiting carer.

NHS clinicians and managers taking the campaign forward focus on five evidence-based interventions from both the clinical and leadership domains. They are:

  • leadership for safety;
  • reducing harm from deterioration;
  • reducing harm in critical care;
  • reducing harm in perioperative care;
  • reducing harm from high-risk medication.

To date, the core team behind this non-governmental and voluntary initiative - borne out of chief medical officer Sir Liam Donaldson’s Safety First report of 2006 - has attracted support from 267 (89 per cent) of all acute trusts and over 50 per cent of the non-acute (primary care, mental health, ambulance) trusts.

“The emphasis throughout the first year was on what we call ‘building the will’, getting corporate leaders to sign up and create the right environment in their organisations to enable teams wanting to engage to start working on the interventions,” says Stephen Ramsden, core team chair and chief executive of Luton and Dunstable Hospital foundation trust.

Tangible evidence

“Now over the next 12 months it will be much more about demonstrating that will exists, converting statements that make safety a priority into tangible evidence,” he continues. “To make the transition we are advocating that trust boards make a public declaration of their intent that holds them to account, to commit themselves to ambitious goals such as saving a set number of lives over a fixed time span.”

Several trusts fast out of the blocks have implemented some campaign interventions and are already showing lifesaving improvements (see case studies).

Mr Ramsden says: “As well as providing ‘how to’ guides on the website, the campaign team is already actively developing networks that can support these and other organisations in implementing and sustaining those interventions and stop associating measurements of improvement with anxieties about performance culture and hitting targets.”

Leadership for safety at Liverpool Heart and Chest Hospital trust

Over the last financial year Liverpool Heart and Chest Hospital trust recorded no cases of MRSA bacteraemia. The Patient Safety First interventions have, as far as chief executive Rajesh Jain is concerned, helped highlight safety as the number one issue and brought the organisation to the point where it was poised to deliver such an impressive level of improvement (see graphs). Leadership was a key factor.

“We are setting ourselves ambitious and explicit goals and at the top of the list we have put reducing avoidable harm down to zero over our three-year planning period,” he says. “We make sure that care compliance is in our performance metrics and reports and the executives are held accountable to those quality indicators. We do programmed executive safety walkabouts on a weekly basis, we have pulled together a syllabus of improvement science courses and, while there might not be anything outstanding about how we monitor our progress, we know that if we stop paying attention, improvement could drop off - so we stick at it religiously.

Reducing harm from deterioration at Royal United Hospital Bath

Following sign-up to Patient Safety First, monthly harm event monitoring at Royal United Hospital Bath trust highlighted a shortfall in recorded early warning scores.

Over recent months, work under the “reducing harm from deterioration” intervention has seen a marked improvement not just for the appropriate recording of scores - now at a frequency of

96 per cent - but also with instructions for the frequency of observations (see graphs).

“The organisation learned a lot from the ward where these changes and closer monitoring were first implemented,” says assistant director of nursing in patient safety and clinical effectiveness Jo Miller.

“We worked with the staff team to develop a standard for observing vital signs and recording early warnings based on national guidelines. Baseline monitoring and measurements for progress have been done using a Productive Ward audit tool.

“Metrics from this and seven other work streams are reported back to the steering group. The objective is to have 100 per cent of wards with an observations and early warnings standard and 100 per cent compliance against that by October of this year.”