Priority One: Improving Frailty and Dementia Care within the hospital Executive Lead: Director of Nursing Key Objective Suggested Outcome measures Comments / Next Steps Where will the data be collected Milestones/ Trajectory To implement and deliver a front door frailty service. Produce a model of care framework. Develop the workforce to support frailty at the front door. Reducing the number of frail patients that have to be admitted Reducing their length of stay. Advanced Clinical Practice (ACP) framework will assist with workforce development. Electronic Staff Record. Admissions from Cerner available via IT analyst. Length of stay data from IT analyst. ACP programme in place by March 2019. To develop and support Dementia care initiatives across the Trust through delivery of a Dementia strategy within WAHT. Production of a Dementia strategy by 2019, developed and supported by Ward and Department staff Embed the principles of ‘John’s Campaign‘ and enable flexible visiting times for Carers. Commencement of a Dementia Nurse to lead strategy. Ward sisters to embrace and implement the concept and benefits of John’s campaign principles e.g flexible visiting times. Carer’s evaluation review at patient experience review group. Dementia Steering Group. Patient Experience Review Group. Develop strategy by March 2019. Test the principles of flexible visiting on 1 ward by end of July 2018 plan to roll out Trustwide by March 2019. Improve access of activities for those with Dementia whilst in hospital. Availability of therapeutic activities for patients within hospital in key wards. Improved recognition of Dementia on admission through screening of 90% of patients. Reduced length of stay for patients with Dementia and Improve discharge outcomes .ie reduction in readmission rates of patients. Ensure frailty plan/strategy and services are in alignment with North Somerset and Somerset. Collection of activities available on wards. Increase % of Dementia screening on IPR Data analysis of readmission Assess baseline and increase by 20% of activities by March 2019. By March 90% of patients screened for dementia.
Priority Two: Reducing Harm from Pressure Damage Executive Lead: Director of Nursing Key Objective Suggested Outcome measures Comments / Next Steps Where will the data be collected Milestones/ Trajectory To reduce the number of Grade 2- 4 hospital acquired pressure injury. Reduction by 25% of Grade 2 hospital acquired pressure injury Grade 3 – 50% reduction Grade 4 – 100% reduction. Days since last pressure injury per ward (Grade 2,3,4 ). Further education of staff in the prevention and identification of pressure injury. Work across BNSSG community on improvement in identification and care in order to prevent further deterioration of injury when admitted to hospital. Safety thermometer data. Datix validated pressure injury. Monthly reporting by ward. By March 2019 a reduction of 25% Grade 2, 50% Grade 3 and 100% Grade 4 from 2017/2018. Increase staff knowledge and responsiveness to pressure injury. Directorate Level SWARM (a rapid review of an incident immediately post identification) for all Grade 2. Executive Level SWARM completed – every Grade 3 or 4. Improvement in accuracy of reporting and a Reduction in number of pressure ulcers occurring. Sharing of root cause analysis and action plans. Multi professional involvement, increased visibility at the bedside by Senior Nurses and Tissue Viability Nurse. Increase in resource for Tissue Viability Service required. Completion of SWARM stickers in patient notes Completed 72 hour reports confirming SWARM Grade 3/ 4. Audit through Perfect ward. Action Points discussed at Ward Sisters meeting named Ward Wednesday. By December 2018 improvement in accuracy of validated pressure damage. All wards completing monthly audits by March 2019.
Priority Four: Learning from deaths in hospital and improving end of life care Executive Lead: Medical Director Key Objective Suggested Outcome measures Comments / Next Steps Where will the data be Milestones/ Trajectory Embed the structured judgement review within the organisation. Monitor the percentage of deaths undergoing mortality review on the Mortality Database. Establish regular directorate mortality reviews. Deliver teaching to MAU, Sandford and Surgical teams with help from consultants at internal directorate meeting named - Cabinet meeting Generated from a mortality database report. Minutes of the meetings. Aim 50% reviews by end of quarter 1, 2018 To establish meetings by end of July 2018 Improve our relative’s experiences when a patient has died. Gather feedback from bereaved families to understand their experience of care in the Trust and incorporate learning within the work plan. Improved staff confidence, skills and knowledge through education. Audit. Deliver teaching to all staff groups within the organisation. Data collection reported to patient experience group and clinical effectiveness group By the end of 2018 have collected information from bereaved families/carers about improved communication and experience at the time of death. By April 2019 have implemented changes based on feedback to demonstrate improved communication and satisfaction. Develop and implement an end of life strategy following national guidance. The identified outcomes from the National Audit for End of Life. Develop an implementation workplan for the next 5 year. Improved outcomes from the annual national audit of End of Life Care. Increase the numbers of patients whose life ends in a place of their choosing and whose family/carers report satisfaction with the care they receive at the time of their death.
Priority Five: Reducing delays in hospital to improve patient safety Executive Lead: Director of Operations Key Objective Suggested Outcome measures Comments / Next Steps Where will the data be collected Milestones/ Trajectory NHS Improvement SAFER patient flow bundle - will be embedded within all areas of the Trust. Daily report on SAFER in all areas 75% attendance by consultant on board round. Work with University Hospitals Bristol to improve Cardiology pathway. Ensure consistent Multidisciplinary team (MDT) attendance at board rounds every day. Audit. Monthly Performance Management Review (PMR). 50% consultant attendance by September 75% by March 2019. Embed the national campaign for End Pyjama (PJ) Paralysis (#endpjparalysis) within the Trust to reduce length of stay of patients. End PJ paralysis information on all wards and bays via poster. Information on all admission letters and discharge information Recommence Assessment Fit training. Launch of #endpjparalysis in April 2018. Education attendance lists. National Audit on app for #endpjparalysis. Posters in all ward areas on end PJ Paralysis by Sept 2018. Admission booklets updated by December 2018. Utilise Red and Green days to increase discharge. Informing all staff what a red day is Work with NHS Improvement Emergency Care Improvement Programme (ECIP) to increase staff awareness. Increase morning discharges. Increase use of discharge lounge Reduce Length of Stay to national average as indicated by Healthcare intelligence and quality improvement services - CHKS. Trial ‘Ticket Home’ initiative on Cheddar Ward then implement across organisation. Board rounds. Monthly PMR. Ticket home in place by Sept 2018. Reduce bed occupancy. Right patient in right place including speciality bed. Increase used of Cerner Millenium computer system to include speciality of patients so flow team can Cerner Millenium (PAS). Twice daily updated information – Sept 2018
repatriate to correct ward. Priority Six: Enhancing the way we use communication to influence care and service development Executive Lead: Director of Human Resources Key Objective Suggested Outcome measures Comments / Next Steps Where will the data be collected Milestones/ Trajectory Develop an internal organisational communication plan that : Improves staff engagement. Ensures staff are more aligned with the organisations values, vision, objectives and priorities. Improvement in Staff Attitude Survey scores for: KF6 – Staff reporting good communication between senior management and staff. KF7 - Able to contribute towards improvement at work. % of positive ‘Happy App’ (staff engagement and feedback app indicating what went well) comments to have increased at first 6 month review. Consult and engage with key groups to seek feedback/ideas against an agreed plan. To undertake a lessons learned from Radiology where the ‘Happy App’ is currently operational. To develop a plan to roll this out within the organisation ensuring necessary resources are available. Staff Attitude Survey Results 2018 Plan to be developed by 31st July 2018 Implementation from 1st September 2018. Initial evaluation March 2018 of ‘Happy App’ to be operational throughout Trust by 31st December 2018. Assess the process for producing, and the quality of information for patients that is produced by the communications team to ensure that the process is effective and the information is of a high quality. Contribution towards improvements in metrics that measure communication with patients. Review the Trust’s patient information service, its process and performance. Engagement with divisions to ensure visibility of performance and issues and improved joint working in the future. Pull together proposals for improvement and agree these with internal stakeholders. Implement changes. Complaints, PALs service, patient experience scores. Assessment of process, performance and quality by 31 May. Engagement with divisions in June. Launch of changed process by mid-July.
Priority Seven: Reducing harm from medicines Executive Lead: Medical Director Key Objective Suggested Outcome measures Comments / Next Steps Where will the data be collected Milestones/ Trajectory Reducing the harm to patients from medication errors. Reduced % of medication incidents with harm. Reduced omitted doses of critical medications. Reduced delayed administration of critical medication. Develop multidisciplinary quality improvement projects to understand, measure and improve performance at ward level. Datix. Medication audits. Quality improvement project reporting. Reduce overall incidents due to medication errors by 10% during 2018/19. Ensuring patients receive the correct medication both in hospital and when discharged and that GPs receive the correct information about all discharge medications. Increased number of patient receiving medicines reconciliation within 48 hours of admission. Improved accuracy of discharge prescriptions. Reduced % medication incidents raised by primary care. Train and deploy pharmacy staff described in trusts pharmacy transformation plan to improve medicines reconciliation in key areas. Increase use of connecting for care to ensure accuracy of medications on admission. Improve timeliness and accuracy of discharge summaries. Pharmacy reporting. Medication audits. Medicines Reconciliation reports. Discharge summary accuracy audits. GP, north Somerset partnership and CCG datix. Deliver trust improvement trajectory to attain required medicines reconciliation by December 2018. Improve discharge summary prescription accuracy by 50%. Ensuring patients understand their medications. Provide detailed discharge information cards for patients and their relatives/carers. Develop methodology to ensure key medicines are explained prior to discharge in a consistent and easy to understand way. Complaints. GP, north Somerset partnership and CCG datix. A reduction in complaints and incidents around poor medication understanding. Reducing delays to timely patient discharge due to medication issues. Reduction in numbers of patients not discharged before 10am due to pharmacy reasons. Ensure pharmacy resources are distributed optimally to support early discharge. Performance team repots on reasons for discharge delays. Increase numbers of patients discharged before 10 am.