Patient Safety

Winner Royal Wolverhampton Hospitals NHS Trust

Facing the Challenge - Healthcare Acquired Infections

The dramatic improvements seen at a trust that once had some of the worst MRSA bacteraemia reduction figures in the country is ultimately the result of one overarching theme - making infection prevention rather than infection control the top priority.

The open-ended programme to strengthen infection control at Royal Wolverhampton Hospitals began in 2005, with a number of key actions including: the launch of Saving Lives Standards and A Clean Hands initiative; moving responsibility for the Infection Control team to the Director of Nursing and Midwifery; a new high profile infection prevention board chaired by the Chief Executive.

Meetings and cleanliness audits with the Patient and Public Involvement Forums profiled concerns and prompted policy changes. The Department of Health MRSA Improvement Team were also invited to suggest high impact interventions to combating HAIs.

An action plan with more than 70 key areas for improvement followed. The emphasis placed on shared responsibility with a strong leadership can be seen in the part divisional clinical directors played in developing this plan and the appointment of infection prevention champions.

Infection prevention objectives have been set for matrons as part of the drive to strengthen accountability. Prevention of infection also now appears in all job descriptions and agreed objectives for consultants form part of their appraisal.

The whole systems approach saw the trust achieve its MRSA trajectory. Cases of MRSA bacteraemia dropped from 18 in the first quarter of 2006/07 to just 1 over the corresponding period in 2007/08. Having linked infection prevention to other established processes the trust believes it has developed sustainable improvements.

The judging panel was highly impressed by the timescale of transformation and the clear metrics for demonstrating improvement. They described the programme as an outstanding achievement, one that shows just what is possible with the right focus, effort and commitment.

Cheryl Etches, Director of Nursing and Midwifery cheryl.etches@rwh-t.nhs.uk

Highly Commended Imperial College and St Mary's Hospitals Trust

The P.I.N.K Patient Safety Video

Many safety campaigns have targeted staff and system’s failures. The patient, a source of experience and expertise, has been largely ignored. Evidence shows however that developing clinical teamwork by preparing and enabling patients to take a more active role in their treatment and care can lead to better outcomes.

The P.I.N.K. Patient Safety Video embodies this principle in its ‘Participate, Inform, Notice, Know' message, delivered in a combination of animation, modern technology and flight safety briefing features.

Devised by Professor Sir Ara Darzi and colleagues fromImperialCollegeand St Mary’s trust the video follows a typical admission from the patient’s point of view, introducing events and members of the multi-disciplinary team.

A different part of the message of shared responsibility is emphasised through encounters with different members of the team - Phil the cleaner, Mr Jones the Consultant, Sister Naipaul. P.I.N.K. encourages shared information and decision-making. It also provides knowledge of key interventions such as hand-washing.

The NHS Training Hub for Operative Technologies in Healthcare has produced the animated film with the creative support of Saatchi and Saatchi. Responses to early impact evaluation show a high degree of support for the video. Trusts purchasing the animation can show it on a free-to-view Patientline channel.

Judges commended this exciting and creative project for its great potential to empower the patient and inspire further videos.

Mr. Oliver Warren Clinical Research Fellow and Surgical Registrar o.warren@imperial.ac.uk

Highly CommendedLutonandDunstableHospitalNHS Foundation Trust

Patient Safety

Patient safety has been top of the agenda at The Luton & Dunstable Hospital foundation trust for the last 5 years. In 2004 the organisation became theEnglandpilot site for the Health Foundation’s Safer Patients Initiative

Clinical governance, risk management, reporting, quality assurance and regulation – all features of a traditional approach to patient safety in the NHS – are, the trust argues, essential. They are also inadequate.

The enhanced approach to patient safety atLutonand Dunstable seeks transformational goals - no needless deaths, pain or harm for example – and also sets its ambitions high, one of a number of stated aims being to reduce Hospital Standardised Mortality Rate (HSMR) to less than 80.

Other elements of the approach include having no avoidable infections, applying improvement science and small tests of change, embedding a safety culture.Lutonand Dunstable encourage a proactive attitude to looking for adverse events and implement evidence based measures to reduce harm.

To achieve this, the trust has implemented 29 simultaneous improvement projects delivered through five workstreams, with 35 new measures to monitor progress.

Over three years the HSMR has gone from 11% worse than national average to 10% better than national average with 70% less adverse events.

The judges commended what they saw as an impressive and sustained initiative with strong evidence of clinical engagement championing from the chief executive.

Anne Thomson, Patient Safety Manager anne.thomson@ldh.nhs.uk

DevonDoctors and South Western Ambulance Service Trust

Non conveyance of patients to hospital after 999 call

A jointly organised pilot scheme between the Devon GP practices out-of-hours service – Devon Doctors – and the South Western Ambulance Service trust uses paramedics to treat patients in their own homes wherever possible.

Non-conveyance details, which support the delivery of more effective community care and elective admission planning, are passed to the GP and intermediate care teams by 08.00 the next working day. Numbers of prevented acute admissions over the last 12 months however are estimated at something in the region of 940.

Lee Grant, Service Improvement manager, Devon Doctors - lee.grant@devondoctors.nhs.uk

GatesheadHealth NHS Foundation Trust

SafeCare

SafeCareis a three-year strategic relaunch of a process of clinical governance that lacked a sense of ownership and all-round participation. Quality and safety improvement activity now takes place at a local divisional level within multi-disciplinary teams.

SafeCareis built on six key commitments: leadership and planning, promotion, accountability, analysis, openness and education and learning.

Greater patient assurance, reductions in complaints, increased staff confidence and evidence of year-on-year progress will be the measure of a developing culture and a successful strategy.

Avril Lowery Head of SafeCare avril.lowery@ghnt.nhs.uk