KF18* Percentage of staff experiencing harassment, bullying or abuse from patients, relatives or the public in the last 12 months 34% 29% Highest (worst) 20% *The lower the score the better Whilst the Trust is encouraged to see that more staff have responded to the survey, there have been no significant changes in 28 of the 29 key findings since 2013. During 2015/16 it is therefore proposed to focus efforts where Trust results are in the ‘worst 20%’ performing category. Staff Engagement Scores Despite the improvements made against Key Finding 24 since 2012, the overall staff engagement score has not shown a significant statistical change since the 2013 survey. In 2013 the overall staff engagement score was 3.70 and in 2014 this dipped slightly to 3.64 and remains in the lowest (worst) 20% category. The overall engagement score is calculated by using the questions that make up Key Findings 22, 24 and 25. Key Finding 2013 Score 2014 Score Ranking Significant Change since 2013? KF22 Staff ability to contribute towards improvements at work 72% 69% Average No KF24 Staff recommendation of the Trust as a place to work or receive treatment (scored out of 5 with 5 being highest) 3.46 3.42 Lowest (worst) 20% No KF25 Staff motivation at work (scored out of 5 with 5 being highest) 3.88 3.78 Below (worse than) average No It is disappointing that the overall engagement score has declined and staff engagement and motivation will remain a key focus during the forthcoming year. Our initial analysis of the survey results was described in a paper to our Board in March 2015. . A detailed action plan will be made available on the Trust’s website once approved. Supporting apprenticeships The Trust is keen to support the development of its Band 1-4 workforce and in early 2015 has enrolled a further 19 existing staff of all ages on an Apprenticeship programme run through Weston College, joining the 40 staff already enrolled. Staff can select from a range of Apprenticeship opportunities dependent on their job role. These include Customer Services, Team
4.1 Patient Safety This table sets out our 5 key goals for Patient Safety last year and how we have done on each. Our Patient Safety Quality Priorities and why we chose them What we aimed to achieve How did we do? In 2014/15 we said our No. 1 goal was: Pressure sore reduction. Pressure ulcers are debilitating for patients and so have been one of our highest-ranked Quality Priorities (along with infection control) ever since our first set of Quality Accounts. Although this has improved we have not made the progress we would wish and will continue to have a high focus on this area. 10% less patients will acquire a pressure ulcer April to October 2014 and 15% less patients October 2014 to March 2015 We will have undergone a peer review process and implemented actions recommended from this. We will have partnered with community colleagues to undertake a public facing prevention campaign We have achieved this target. Incident reports of pressure ulcers reduced by 25% during the first six months of the year and by 35% during the last six months. Peer review did occur in July 2014 – led by Somerset Clinical Commissioning Group. The panel found many areas of good practice and made recommendations for improvement in our nursing documentation and incidents management. We partnered with North Somerset Community partnership, our colleagues in Social Care and product suppliers, to undertake a public pressure ulcer awareness campaign in support of world Stop Pressure Ulcer Day 2014. Our Wound care Expert and her colleagues ran a stand for the public in Weston’s Sovereign Shopping Centre and spoke to many staff who work in social care settings.
In 2014/15 we said our No. 4 goal was: Venous Thromboembolism (VTE) VTE (a blood clot) is a major contributor to severe illness or death in the UK. We have improved our performance and embedded this change in our clinical practice. We will achieve the 95% national target for quality standards relating to VTE. We will develop a database and mechanism to work in “real time” so that we know which, if any, patients have not been assessed. The Trust has achieved the 95% national target consistently each month since May 2014. A database and dedicated VTE clerk are in place to monitor assessments of patients. In 2014/15 we said our No. 5 goal was: Medication safety. Medications safety is a crucial element of an overall patient safety programme. High risk medications such as blood thinning agents pose a greater risk of serious harm to patients if they are incorrectly prescribed or administered. Missed doses of medication can lead to significant harm for patients. We will reduce our number of drug errors that cause moderate harm or worse. Ongoing education will occur for all staff involved in medication errors. All reports from incidents with harm graded moderate or above will be sent to all staff concerned following Quality Improvement Team sign off. We achieved this target. During 2013/14 2% of our drug errors caused moderate harm or worse. In 2014/15 none of our drug errors caused moderate harm or worse. Feedback to relevant staff and the sharing of lessons learned has occurred via our Medicines Optimisation Group. Where errors have caused low harm, individual staff training needs have been assessed following each incident as part of root cause analysis. We have also introduced calculation training for nurses.
In 2014/15 we said our No. 6 goal was: Leadership development. We have invested significantly in developing leadership potential in our staff. We will have developed the Clinical Advisory Group and Nursing and Midwifery Committee into advisory groups. We will utilise the Quality Improvement Hub to develop leadership for patient safety improvement for clinical staff We will develop the Care Maker programme to facilitate nursing front line leadership skills. We will maintain the number of staff on national NHS leadership programmes. We will reserve time each month for Executive Directors and senior managers to leave their offices and spend time with patients and staff throughout the Hospital. We have developed the Clinical Advisory Group and Nursing and Midwifery Committee into advisory groups. Our Quality Improvement Hub has extended its improvement work with clinical staff – providing regular reports on progress to our Quality & Governance Committee. 15 staff members have signed up to the national Care Maker programme. This has helped to raise awareness of the Chief Nursing Officer’s campaign to champion compassion in health care. We have increased the number of staff on national leadership programmes from 23 (2013/14) to 27 (2014/15). Each month our Executive Directors carry out an ‘Executive walk –round’. All of our service areas have been visited in this way during the year.
In 2014/15 we said our No. 2 goal was: Fully implement the Friends and Family test and improve the number of people who would recommend the Trust. This is a national requirement and the measure helps us to understand the patient experience It is also one of the “learning milestones” we have set in our ‘Patient Experience Strategy’. We will have met the national requirements for rolling out the Friends and Family programme. We will have met the national requirement for improving the response rate We will have improved on the proportion of staff who would recommend the hospital to family and friends in the national staff survey. We have achieved the Friends and Family Test national targets for patients – which have been rolled out this year to incorporate all outpatient departments and children’s services. The Trust is also achieving the national requirement for improving the response rate, with 40% of inpatients and 20% of Urgent Care patients now completing the Friends and Family Test. However the proportion of staff who would recommend the hospital to friends and family has remained unchanged. In 2014/15 we said our No. 3 goal was: Improving the complaints process 80% patients will receive a response within target All staff involved in the complaint will receive a copy of resulting actions. Clinical issues identified by complaints will initiate quality improvement in the Hub. We will increase the number of patients contacted by telephone and offered a meeting as a means of resolving a complaint. The Trust has not achieved a consistent 80% response rate with the average recorded at 71.8%. All staff involved have received a copy of the resulting actions. We achieved this target on one occasion following complaints around treatment escalation. All patients have been telephoned and offered a meeting where contact details have been available.
4.3 Clinical Effectiveness The table below sets out our 3 key priorities for Clinical Effectiveness last year and outlines how we performed. Our Clinical Effectiveness quality priorities and why we chose them What we aimed to achieve How did we do? In 2014/15 we said our No. 1 goal was: Embedding the Keogh review of mortality. 50% of deceased patients’ care will be reviewed using the Global Trigger Tool. Pressures on our medical workforce caused by increased demand and staff vacancies affected our ability to audit patient records using this tool. Approximately a third of deceased patients’ care was reviewed using the Global Trigger Tool – so we did not achieve this in year. In 2014/15 we said our No. 2 goal was: Best practice in managing patients with sepsis 100% of eligible patients will receive Sepsis 6 tests in line with best practice Patients with Urinary Tract Infection as a primary diagnosis will stay in hospital less time. Patients with a primary diagnosis of pneumonia will stay in hospital less time whilst maintaining levels of readmissions. 33% patients had Lactate test within an hour of arrival in A&E. This reflects the increase in Emergency Department attendances and ongoing difficulties in leadership and recruitment in the Emergency Departments locally and nationally. We did not achieve this target. Our average length of stay slightly increased. In 2013/14 it was 8.1 nights and in 2014/15 it was 8.3. Our average length of stay did decrease – but only slightly. In 2013/14 it was 8.4 nights and in 2014/15 it was 8.2.
In 2014/15 we said our No. 3 goal was: Best practice in managing patients with a fractured neck of femur Patients with a fractured neck of femur will have their care managed in adherence to best practice guidance. We achieved this in part. Measuring ourselves against national best practice standards we improved our performance from 22% to 57% overall. In 2014/15 we said our No. 4 goal was: Best practice in managing patients with pneumonia Patients with pneumonia will have their care managed in adherence to best practice guidance. Our audit of our care discovered that although hospital acquired pneumonia was well identified and antibiotics rapidly commenced, a quality improvement project is underway to raise awareness, appropriately prescribe antibiotics and improve documentation.
Pressure sore reduction: Pressure sores are debilitating for patients and largely avoidable injuries which cost the NHS millions of pounds every year. By working together with key community and Primary Care providers across North Somerset we want to considerably reduce avoidable pressure sores for our patients. 10% less patients will acquire a pressure ulcer during2015/16 We will continue to partner with community colleagues to improve our documentation so that is more aligned and our care is improved. We will report on the numbers and types of pressure ulcers, and the corrective action being taken, in our monthly Safety Thermometer and our ‘Performance Assurance Framework’ (reviewed by senior patient-facing staff). Our Trust Board will also receive a full report at three public meetings. Reducing Falls: Although the Trust has done a lot of work on reducing the incidence of falls, we want to continue to improve performance in collaboration with the community and primary care services. No more than eight patients will have a fall resulting in moderate harm or worse whilst in our care. No more than five patients will have had a fall whilst in our or our community partners care in each months prevalence snap shot survey as measured by the NHS Safety Thermometer by March 2016 We will report on the numbers and severity of falls, in our monthly Safety Thermometer and our ‘Performance Assurance Framework’ (reviewed by senior staff). Our Trust Board will also receive a full report at three public meetings. Infection control: Our aim is that no patient will be harmed by a preventable infection whilst in our care. We will continue to focus our efforts on achieving this. No patient will have an MRSA bacteraemia. No more than three patients will have an MSSA bacteraemia in year No more than 18 patients will acquire Clostridium difficile infection in year We will monitor progress through monthly infection prevention and control meetings. The Director of Infection Prevention and Control will produce a quarterly report for the Quality and Governance Committee. Our Trust Board will also receive a full report at each bimonthly public meeting.
Medication safety: Getting medication prescribing and administration right for patients is essential to a speedy recovery. We will decrease the percentage of incidents documented as causing harm by a further 2 percentage points to 3.5%. We will decrease the number of reports of omitted / delayed doses from 26% to under 15% We will improve our prescribing practice by involving doctors in root cause analysis of the incidents they are involved in. We will continue to measure our compliance with prescribing standards. We will improve our education and training on safe and effective use of medicines – achieved by training analysis and strategy development, monitored via progress with strategy action plan We will report on the numbers and types of medication errors, and the corrective action being taken, in our monthly ‘Performance Assurance Framework’ (reviewed by senior staff). Our Trust Board will also receive a full report of ‘serious incidents’ at each meeting. We will increase our mechanisms to hear expert staff and user views on the safety of the care that we provide. Using a variety of methods to do so will strengthen our confidence in the quality of care we provide. We will introduce Schwartz rounds to ensure that staff concerns about the quality of care are listened to. We will introduce first hand patient stories to Board meetings We will continue to monitor what our staff say via our Staff Experience & Engagement Committee. We will monitor what patients tell us via our Patient Experience Review Group. Both of these committees then report to our Quality & Governance Committee.
Best practice in managing patients with sepsis It has been proven that by following six best practice steps patients recover sooner. By the end of March 2016 85% of patients admitted with sepsis will have the Sepsis 6 standards administered within one hour. Progress will be monitored by quarterly reports from the Quality Improvement Hub to the Quality and Governance Committee. Best practice in managing patients with a fractured neck of femur It has been proven that by following certain best practice steps patients are more likely to return to previous levels of mobility and be able to stay in their own home following this fracture. We will embed the improvements we have made and attain best practice standards for 60% of patients. We will do this by; completing pre and post operative assessment of mental state improving time to surgery (i.e. within the 36 hours target) ensuring geriatrician assessment occurs within 72 hours of admission Progress will be monitored by quarterly reports from the Quality Improvement Hub to the Clinical Advisory Group and Quality and Governance Committee. Best practice in managing patients with pneumonia Assessment of the severity of hospital acquired pneumonia will occur and be documented for 95% of patients. Antibiotics will be prescribed according to guidelines (or discussed with a microbiologist) in 95% of cases. 95% of patients with hospital acquired pneumonia will commence antibiotic therapy within 4 hours. Progress will be monitored by quarterly reports from the Quality Improvement Hub to the Clinical Advisory Group and Quality and Governance Committee.