Avril Lowery explains how Gateshead Health Foundation Trust has taken the guiding principle of Patient Safety First, to make patient safety the trust’s number one priority, and applied it to their own environment, creating an internal campaign that works for them.
SafeCare is Gateshead’s internal branding created to communicate the trust’s overarching patient safety ethos. Integral to this is the vision that no patient should suffer unnecessary harm, pain or suffering as a result of an error or planned medical intervention.
The trust was this year’s best performing medium-sized trust of the year. The Dr Foster Intelligence Hospital Guide reported that the trust has been driving patient safety and has redesigned its entire clinical governance under SafeCare.
Leadership is a critical element in safety and quality becoming “business as usual”. Gateshead believes the patient is the most important member of the healthcare team and to ensure safe and high quality care, we have sent a clear and unambiguous message to patients and staff that SafeCare is the trust’s number one priority. Sign-up and commitment to Patient Safety First, as part of this drive, has been communicated at all levels by our chief executive.
Executive leaders are key to establishing the value system, setting goals and aligning efforts to succeed. The leaders in the organisation are visible in a number of ways and are supporting the strategy through the development of executive walkabouts.
In April 2007 the trust established a SafeCare council jointly chaired by the director of nursing and midwifery and medical director to harness the skills and expertise of staff.
Clear lines of responsibility have been laid down and communicated throughout the trust so that every member of staff knows their role (called the SafeCare accountability framework).
Changes and results
The clinical emphasis has been on reducing harm from deterioration. To date, measurement of observations complete and appropriate response has been rolled out to all surgical wards and is being spread across medical wards.
Positive outcomes include improvement in the quality and frequency of ward based physiological observations – aggregated trust score is being maintained at over 80 per cent and improvement in the recognition and response of patients who have triggered. The aim is to achieve 95 per cent by the end of 2009.
- EWS charts have been redesigned with colour coding and additional areas, to include actions taken and accountability. The Sepsis Six framework has been incorporated to improve compliance with implementation of the bundle.
- A modified early obstetric warning score chart has been designed and is being piloted within maternity services. A perinatal model of SBAR is also in development.
- The critical care outreach team service has been extended from 8am-10pm to 24 hours a day on weekdays.
- Education and training for qualified staff and healthcare assistants has been further developed to include bite-size sessions delivered in clinical areas.
- The SBAR framework has been introduced not only for use when communicating about acutely ill patients but also for ward handovers and patient transfers. It is being piloted for use within the ward round.
- Marketing tools have been developed to encourage the use of the SBAR framework such as posters and prompt cards. A training DVD has been produced demonstrating the use of SBAR within a variety of clinical scenarios.
The trust is working with stakeholders to develop and implement local initiatives to promote greater openness with patients and their families, and is committed to providing required support.
Patients want to have confidence that staff will be open and honest and deal with the consequences of a mistake. This can be difficult for frontline staff and the trust is committed to doing more to help staff in these situations.
We aim to reduce our HSMR to 90 in 2009-2010 and have identified other priority areas of work that include:
- Reducing the number of MRSA cases from 16 to 12 in 2009-10
- Reducing the number of C difficile cases from 107 to 100 in 2009-10
- Reducing avoidable harm from VTE
- Reducing harm from medication errors
- Increasing the percentage of patients reporting a positive experience
For more information on Patient Safety First, visit www.patientsafetyfirst.nhs.uk
Avril Lowery is head of SafeCare at Gateshead Health Foundation Trust.