Download - NHS North West DoNs Conference
Healthier Horizons
WelcomeChris Jeffries Acting Director of Workforce and Education NHS NW
Better Care Better Health Better Life
Welcome
Better Care Better Health Better Life
Housekeeping
• Mobiles
• Fire Alarms
• Toilets
• Catering
• Reception desk
Better Care Better Health Better Life
Today is about
Better Care Better Health Better Life
Today is about
Celebrating nursing success
Better Care Better Health Better Life
Today is about
Harnessing energy and enthusiasm
Better Care Better Health Better Life
Today is about
Improving delivery of patient care, patient and staff experience
Better Care Better Health Better Life
Change
Better Care Better Health Better Life
Service Reconfigurations
Better Care Better Health Better Life
QIPP and savings
3 and1/2 years to go
Better Care Better Health Better Life
Continuously improving Quality for patients
Better Care Better Health Better Life
Patient Safety and the public Francis
Inquiry
Better Care Better Health Better Life
Service reorganisations following Transfers of Community Services
Better Care Better Health Better Life
Organisational Changes: clinical Commissioning
Groups
Better Care Better Health Better Life
Move to all degree Nursing
Better Care Better Health Better Life
Changes to Health Visiting service and
increase in Numbers
Better Care Better Health Better Life
Remember what is was like when you first started as a student nurse......
Better Care Better Health Better Life
And then when you qualified......
Better Care Better Health Better Life
And now looking back from where you are now.........
Better Care Better Health Better Life
We have plenty of success to celebrate!
SUCCESS
Directors of Nursing Conference 1 September 2011
Coming together is a beginning;
Keeping together is progress;
Working together is success
Henry Ford
What is Success?
In order to succeed, your desire for success should be greater than your fear of failure
Bill Crosby
The Beginning
Manchester
Bringing People Together
Shaping the Future of Nursing in the North West
1st Annual Director of Nursing Conference
1st Annual Director of Nursing Conference
North West Nursing Indicators
General Nursing Care Indicators• Tissue Viability• Falls Assessment• Infection Prevention & Control• Medication Assessment• Nutritional Assessment • Pain Management• Patient Observation
Community Nursing Care Indicators • Care of the Dying• Pressure Ulcer Care• Falls Prevention
NW CIs 2011
• MRSA
• C Difficile
• Mixed Sex Accommodation
• Quality Assurance
Improvements Needed and Made
229201
302
415
668
0
250
500
750
2007/08 2008/09 2009/10 2010/11 PCT Objective2011/12Financial Year
24% reduction
NHS North WestReduction in MRSA Bacteraemia cases 2007 - 2011
38% reduction
27% reduction
12% reduction
MRSA
NHS North West Reduction in C difficile infections 2007 - 2011
9579
6726
4911
2912
3859
0
2000
4000
6000
8000
10000
2007/08 2008/09 2009/10 2010/11 PCT Objective2011/12
Financial Year
30% reduction
21% reduction
27% reduction
25% reduction
C Difficile
MSA Performance January - July 2011 Northwest
822 823923
176 183 201 158
0
100
200
300
400
500
600
700
800
900
Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11
Month
Nu
mb
er
of
Bre
ach
es
Mixed Sex AccommodationNumber of Breaches
Quality Assurance - Francis
Francis Review: Assurance
Francis Review: Assurance
Francis Review: Assurance
Francis Review: Assurance
• AQuA has been established as a membership organisation through the active leadership of North West CEOs and Board Directors
• It is firmly focused on supporting delivery of QIPP goals• Results are already being delivered:
• Stroke 90:10 driving up compliance with Sentinel Audit > 90%
• AQ improving outcomes and experience for five conditions
• Safety Networks – improvements in falls, pressure ulcers and VTEs
• Mortality Collaborative – reducing HSMRs in 9 Trusts with highest rates
AQ : A Progress Report
Clinical Area UK Year One Position* UK Year Two Position
**
US Year One Position
***
AMI 92.55% 96.89% 89.31%
CABG 96.76% 96.94% 87.34%
HF 62.11% 69.95% 69.60%
HK 88.97% 92.73% 87.52%
PN 76.32% 81.55% 73.72%
*UK Year One Position reflects the AQ programme’s overall Composite Quality Score per clinical area for October 2008 – September 2009.
** UK Year Two Position reflects the AQ programme’s overall Composite Quality Score per clinical area for October 2009 – March 2010
***US Year One Position reflects the HQID overall Composite Quality Score per clinical area for October 2003 – September 2004.
Note: while similar, the measures analysed within each clinical group for the year one HQID project are not identical to those used in year one of the AQ project. For a full list of the HQID initial measure set go to www.qualitydemo.com
Phase 2 teams joinedPhase 1 teams joined
90%
Stroke 90:10 drove up standards in stroke care
• Background to Mortality Collaborative
• The Dr Foster Hospital Guide 2009
• Collaborative driven by the will of CEO community
• 9 participating organisations came together
Mortality Collaborative
Collaborative Improvement Aim
By April 2011 participating organisations will have improved adjusted mortality by at least 10 points during 2010 – 2011 as measured by CHKS or Dr. Foster.
The Collaborative Rate of Improvement – Dr Foster
The Collaborative Rate of Improvement - CHKS
• 2007• Primary Care Organisation of the Year – Wirral PCT• Clinical Service Redesign – Salford Royal FT and Salford PCT• Improving Patient Access – Bolton PCT• Reducing Health Inequalities – East Lancashire PCT• Improving Care with E-Technology – NHS North West
• 2008• Workforce Development – NHS North West• Patient Centred Care – Blackburn with Darwen PCT• Patient Safety – Salford Royal FT• Improving Health with Nice Guidance – Central and Eastern Cheshire PCT
• 2009• Primary Care Organisation of the Year – Liverpool PCT• Acute and Primary Care Innovation – Salford Royal FT• Reducing Health Inequalities – NHS Blackburn with Darwen• Using Date to Improve Care – NHS North West
• 2010• Primary Care Organisation of the Year – NHS Western Cheshire• Improving Care with Technology – Central Manchester University Hospitals FT• Quality and Productivity – Salford Royal FT
• 2009• Child Health – NHS Tameside and Glossop 2009
• Chief Nursing Officer Award – Salford Royal FT
• Accident and Emergency – Salford Royal FT
• Innovation in your Speciality – Royal Bolton FT 2009
• Mental Health – Greater Manchester West Mental Health FT
• 2010• Patient Safety – Stockport NHS FT
• Improving Maternity Services – Blackpool Fylde and Wyre FT
• Patient Dignity – NHS Tameside and Glossop
• Accident and Emergency Nursing – Royal Liverpool and Broadgreen University Hospital
• Innovation in your Speciality – Liverpool PCT 2010
• Infection Prevention and Control – 5 Boroughs Partnership FT
• Child Health – NHS Tameside and Glossop 2010
Nursing Standard – Nurse of the Year 2011Fiona Murphy – Royal Bolton FT
Hazel Holmes – Director of NursingLiverpool Heart and Chest Hospital NHS FT
Travel Scholarship
Honours Awards 2007 - 2011
29 New Years/Birthday HonoursAwarded to North West Hospital Staff since 2001
Leadership
• The Prime Minister’s Commission on the future of Nursing and Midwifery in England – Front Line Care
• Providing advice to the Department of Health on Nurses in Commissioning
• Regional Energise for Excellence leadership
• Rapid Spread
• Best practice and improvement – peer to peer support
Leadership
LEADERSHIP
Energise for Excellence
Where did it start:
Energise for Excellence
Safer Nursing Care Tool (AUKUH)HURSTPANDA
Birth Rate+E Rostering
Safer Nursing Care Tool (AUKUH)HURSTPANDA
Birth Rate+E Rostering
Productive CareSafety Express
High Impact Actions
Essence of CareNW Care Indicators
Productive CareSafety Express
High Impact Actions
Essence of CareNW Care Indicators
Productive CareSafety Express
High Impact Actions
Nurse Sensitive Outcome Measures
Productive CareSafety Express
High Impact Actions
Nurse Sensitive Outcome Measures
Real-time Monitoring
Experience Based Design
Single Sex AccommodationPatient Stories
Real-time Monitoring
Experience Based Design
Single Sex AccommodationPatient Stories
High Impact Actions
Real-time MonitoringHealth and Well Being
High Impact Actions
Real-time MonitoringHealth and Well Being
Get Staffing Right
Get Staffing Right Deliver CareDeliver Care Measure
ImpactMeasure Impact
Patient Experience
Patient Experience
Staff Experience
Staff Experience
Safety Express/Thermometer
NHS Confederation Launch 2011
• Tracy Nurse – District Nurse
• Emma Wilkes – Senior Nurse Practitioner
• Joan O’Hanlin – Clinical Team Manager
• Graeme Mitchell – Matron
• Pauline McGarth – Acting Assistant Director
• Caroline Rees- Sister
• Sarah Sillitoe – Ward Manager
• Joanne Mc’Donnell – Head of Nursing
Local Nurses Leading the Way
• Delivering QIPP
• Dealing with increasing need and less resource
• Really integrating care
• Keeping quality, safety and experience at the heart of everything we do
The Future
NHS North of England
How wonderful it is that nobody need wait a single moment before
starting to improve the world
Anne Frank
The New Mental Health Strategy for England
Dr Hugh GriffithsNational Clinical Director for Mental Health
Introduction
• The scale
• The history
• The policy context
• The new mental health strategy
• Mental health and QIPP
• Some potential challenges
• Future developments
The Scale
• 1 in 4 people
• Cost to English economy £77 billion pa.
• More likely £105 billion pa.
• A million people on IB
• A third of GP consultations
• Largest proportion of disease burden
• Premature mortality
The History
• The National Service Framework – 1999
• The NHS Plan – 2000
• New Horizons – 2009
• All adults
• Dual approach
• The General Election – May 2010
• The new Mental Health Strategy
Policy Context
• Patients at the centre – shared decision-making, choice and information
• Focus on outcomes – quality at the heart of the healthcare
• Devolution – clarity about the “what” more than the “how”
• Strengthening public health
• Reform of adult social care
Policy Context
• Equity and Excellence White Paper - towards GP- led commissioning and outcomes (12 July 2010) – Health and Social Care Bill
• The Outcomes Frameworks• Healthy lives, healthy people White Paper: Our
strategy for public health in England (30 November 2010)
• Healthy lives, healthy people: consultation on the funding and commissioning routes for public health (21 December 2010)
Policy Context
• A vision for adult social care: Capable communities and active citizens
(16 November 2010)• Liberating the NHS: developing the
healthcare workforce (20 December 2010)• The Operating Framework for the NHS in
England 2011/12 (15 December 2010)• Quality Innovation Productivity & Prevention
(QIPP) agenda
Mental Health Strategy
A strategy to transform the mental health and well-being of the nation
An ambition to mainstream mental health and achieve ‘parity of esteem’ with physical health
The aim for mental health to be ‘everyone’s business’ – all of Government, employers, education, third sector
Mental Health Strategy - Themes
• Services and public mental health• Outcomes and quality• A life-course approach• Early intervention• Patient choice and control
(personalisation)• Reducing inequality and tackling
stigma• Improving efficiency (QIPP) in the
context of a challenging financial climate
2. More people with mental health problems will recover
Objectives
1. More people will have good mental health
3. More people with mental health problems will have good physical health
4. More people will have a positive experience of care and support
5. Fewer people will suffer avoidable harm
6. Fewer people will experience stigma and discrimination
Mental Health Strategy
A Cross-Government Mental Health Strategy
• Key messages for a cross government mental health strategy
• Good mental health is essential for everyone
• Improving public mental health and well-being, with prevention and early intervention, can cut the £105bn annual cost of mental ill health
• People with mental ill-health are likely to have better outcomes if they have real, well-informed choices over their care
• A twin-track approach will improve outcomes for people with mental ill-health and build resilience and well-being to prevent mental ill-health in the whole community
• How public service reforms will work for mental health
A “Call to Action” with key stakeholders
A Call to Action
Quality, Innovation, Productivity and Prevention (QIPP)
Three mental health elements:• The acute care pathway
Local variations• Out of area treatments
Allocative efficiency • Physical and mental health
Medically Unexplained Symptoms,
co-morbidities
Potential Challenges
• General:• History• Lack of Payment by Results• Poor information• Stigma and culture
• Social care system changes• Criminal justice system changes
Future Developments
• Implementation• The Joint Commissioning Panel
• RCPsych and RCGP• The NHS Commissioning Board
• Position mental health• Managed Networks
Where to find all documents
• Strategy and companion document – “Delivering better mental health outcomes for people of all ages” available at :
• www.dh.gov.uk/mentalhealthstrategy• Also, “Talking Therapies: a four-year plan of
action” and:• Impact Assessment and Analysis of Impact
on Equality
Safety Express
Maxine PowerQIPP Safe Care National Work Stream LeadDepartment of Health
The only thing that exceeds my admiration for the NHS is my hope for the NHS. I hope that you will never, never give up on what you have begun. I hope that you realize and reaffirm how badly you need, how badly the world needs, an example at scale of a health system that is universal, accessible, excellent, and free at the point of care – a health system that is, at its core, like the world that we wish we had: generous, hopeful, confident, joyous, and just.
Donald Berwick, July 1, 2008
The NHS in 2040
Abby – student nursepaediatrics 2012 - 15
Charlotte – student nurseAdult branch 2012 - 15
Our challenge
Equivalent to the number of patients with new stroke?
Can we ‘engineer’ pace and scale?
Preventable cases?
29,000
8,000
49,222
Our research into the issues
Safety Express Aim
To deliver ‘harm free care’ *to 95% of patients by December 2012
Defined as the absence of pressure ulcers, falls, urinary infection (in patients with catheters) and new VTE
What is harm free care?
Pressure Ulcer
Fall CatheterInfection
VTE HFC
Patient 1 √ x x x x
Patient 2 x x x x √
Patient 3 x √ x x x
Patient 4 x x x √ x
Total 75% 75% 100% 75% 25%
Benefits
What have we learned?
Patients affected
One Programme: Four Harms
Findings
• Strategic Fit
• Disruptive
• Measuring
• Reliability
• We didn’t help!!!!!
Frontline TeamsMeasuring 4 Harms at the point of care
NHS Safety Thermometer
Pressure Ulcers Harm from falls Urinary catheters
VTE Risk assessment &
treatment
New VTE Harm Free Care
Kings College hospital joined Safety Express in January 2011, they are also implementing the Energising for Excellence programme. This work is lead by Liam Edwards (Corporate Nurse)
They are working in partnership with their community services and Guys and St Thomas. At the outset they committed to working together to deliver:
5% reduction in urinary catheter utilisation 20% reduction in injurious fallsEradication of category 4 pressure ulcers50% reduction in category 3 pressure ulcers90% patients receiving VTE risk assessment and management
They selected four wards to test the Safety Express programme They measured progress with the NHS Safety Thermometer tool They have used the Safety express programme to work across organisational boundaries They have implemented systematic training They have reviewed equipment stocks They have ignited nurse leadership for hourly walk rounds In August 2011 they are launching Safety Express with governors In July they are planning to spread the changes
KING'S COLLEGE HOSPITAL NHS FOUNDATION TRUSTLONDON SHA
Total falls with harm
Show national benchmark
New
0%
1%
2%
3%
4%
5%
6%
7%
8%
9%
10%
Sep-10
Oct-10
Nov-10
Dec-10
Jan-11
Feb-11
Mar-11
Apr-11
May-11
Jun-11
Pressure ulcers
0%
1%
2%
3%
4%
5%
6%
7%
8%
Sep-10
Oct-10
Nov-10
Dec-10
Jan-11
Feb-11
Mar-11
Apr-11
May-11
Jun-11
Falls
0%
5%
10%
15%
20%
25%
Sep-10
Oct-10
Nov-10
Dec-10
Jan-11
Feb-11
Mar-11
Apr-11
May-11
Jun-11
% patients with catheter % patients with catheter AND UTI
Catheters
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Sep-10
Oct-10
Nov-10
Dec-10
Jan-11
Feb-11
Mar-11
Apr-11
May-11
Jun-11
% patients assessed % patients given prophylaxis
VTE
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Sep-10
Oct-10
Nov-10
Dec-10
Jan-11
Feb-11
Mar-11
Apr-11
May-11
Jun-11
No Harms 1 Harm 2 Harms
Harm free care
Total number of patients at selected organisation surveyed to date: 337Safety Thermometer Results
DashboardStep 1: select SHA Step 2: select organisation
New Total falls with harm
Patients with a new VTE
0%
1%
1%
2%
2%
3%
3%
4%
4%
5%
Sep-10
Oct-10
Nov-10
Dec-10
Jan-11
Feb-11
Mar-11
Apr-11
May-11
Jun-11
Provider Case Study [1]Kings College Hospital NHS FT
Impact of Safety Express and E4E on the pilot wards
New Pressure Ulcers Falls with Harm Catheters
VTE Risk assessment & prophylaxis New VTE Harm Free Care
Next steps 2011-12
Policy fit
Building resources
Measuring HARM
Scaling up activity
What will they say about us?
your hospitals, your health, our priority
Embedding
Amanda Cheesman
Head of Professional Practice
your hospitals, your health, our priority
• Began in January 2011
• Aim – to roll out the Project across the Trust – all sites – all areas via Rapid Spread method
• Quality & Safety Matron Team
Phase 3 – Spread & Sustain E4E
your hospitals, your health, our priority
• Infrastructure in place
• Bi Monthly Falls scrutiny Panel.
• QSMs to monitor all Slips, Trips and Falls/Found on Floor.
• Every fall investigated.
• SBARS on serious falls ie caused harm.
• Escalate serious falls to Trust Board for Executive review.
• Falls Champions- Training Programme
Phase 3 – Spread & Sustain E4E
your hospitals, your health, our priority
• Emphasis on:
Environment- Clutter free ward, Lighting, Flooring, Bed Space readiness.
Communication- Handover, EPR alerts, whiteboards pt status at a glance, documentation
Intentional Rounding-Based on 4 Ps, Personal needs, Pain, Position & Possessions
Post Falls Actions
Proactive Falls Prevention Actions
Phase 3 – Spread & Sustain E4E
your hospitals, your health, our priority
Challenges
• Financial pressures for equipment
• Maintaining momentum
• Root Cause Analysis (RCA) for each fall
• Data collection
• Changing the culture that falls are acceptable
• NPSA Essential Care After an inpatient Fall-Serious Falls SOP, New equipment purchased, Training Programme, First Responder teams
your hospitals, your health, our priority
Successes
• Electronic data collection for financial costs of falls (EPR)
• True multi-disciplinary buy in, including Finance & IM&T
• Shift in culture
• Falls Scrutiny Committee
• Trust Board’s keen and full support
• HSJ Award
your hospitals, your health, our priority
Transforming Community Services
.
• Fantastic Opportunity
• Working across the whole Health Economy to prevent Falls – Acute Trust, PCT and Community Trust
• Early days – pilot with NWAS (commencing 1 August 2011)
your hospitals, your health, our priority
Statistics – The Local Picture
.
• NWAS Mar 2010 to Feb 2011– 3,599 Ambulance calls to falls patients (over 50yrs)
– 3,349 Patients & 206 repeat fallers (in month only)
– 68% (2,465) taken to A&E while 32% (1,134) non-conveyed
• A&E “falls” attendances 2009/10– 5,859 attendances
– 57% over 50’s and 32% over 75’s
– 61% (2,059) arrived in ambulance, over third made own way to A&E
• ALW PCT Non-Elective admissions 2009/10– 3,239 admissions
– 1,519 (47%) over 75’s
– 858 for fractures were fall coded (35%)
your hospitals, your health, our priority
WWL and a HSJ Award
.
your hospitals, your health, our priority
Energising for Excellence (E4E).
Fiona Murphy Clinical Lead Bereavement & Donation
Nurse of the Year 2011
1st September 2011
Bereavement and Donor Support
Low rates of donation in Western EuropeIn 2002 Bolton NHS trust began to make service changes with the aim of increasing donor rates
Education can enhance knowledge & confidence in end of life care and ultimately improve the quality of bereavement and donor support
In 2004 Bereavement & Donation became a ‘usual not unusual’ part of our care.
Nobody is denied.Fulfilment of individual wishes.
Support regardless of donation outcome – everybody, every time.
Control and choice during an often uncontrolled situation.
Normalising donation as part of end of life care.Conscientious objectors (staff)
True collaboration
Why
How
Excellent communication
Bereavement Care Bundle
Empowerment
Support
Workforce Development
Competency’ educational module
Monthly training day
Full support from all tiers of management
Culture change
Culture Change
Actual donors trust wideApril 2010-April 2011
A4 B3 B4 C1 C2 C3 C4
CCU D1 D2 D3 D4 E3 E4
F3 F5 TSU G4 BCU H3 N4
A&E ICU HDU REC'Y
Referrals to SN-OD56Referrals to TD- SN540From approx 1700 deaths.
Referrals to SN-OD56Referrals to TD- SN540From app
Full tissue 23 Gift Donors 6 Brain Donors 23 Eye Donors 322 Multi organ Donors 7
Insanity
Death is the only certainty in life – there is no excuse for all professionals
to be less than fully prepared
The responsibility for providing quality end of life care now rests with each
and every clinical member of staff
Collaborative working sets out a clear
and established policy providing guidance and support to all those
looking after the dead; thus ensuring true choice .
your hospitals, your health, our priority
Reducing Falls & Building the Case for
Quality1 September 2001
Gill Harris Director of Nursing & Performance, DIPC
your hospitals, your health, our priority
Falls in Hospitals & Sucking Eggs
.
• One of the top 5 Health & Safety Risks
• Falls & #NOF are the 2nd most reported incidents
• In England & Wales (2006) 200,000 falls were reported to the NPSA with 970 sustaining fractures & 26 falls related deaths
• Financial costs on unscheduled care & follow up care for Local Authorities reported to be over 2 billion pounds Nationally
• PREVENTION of falls is a National priority
your hospitals, your health, our priority
QIPP Agenda Workstreams
• Commissioning & Pathways:
Safe Care; Safety Express: reduce harm from falls in 95% of patients by 2012 (measured via Safety Express)
Right Care Programme: “doing the right things” i.e. right care, right place, right time
Long Term Conditions: reducing unscheduled care hospital admissions; reduce length of stay; patient control
Urgent Care: maximise right person right place right time - 10% reduction in the number of patients attending A&E
your hospitals, your health, our priority
• Provider EfficiencyProductive Series - RTTC Modules = knowing how we are doing, well organised ward, patient status at a glance
• System EnablersPrimary Care driven workstreams, supporting implementation of Primary Care QIPP plans
• Making Quality HappenQuality Accounts
QIPP
your hospitals, your health, our priority
Background
.
• Dr Mahmood Adil – Fellow from NHS Institute for Innovation & Improvement and now QIPP Lead
• Supported by ‘Patient Safety First’ Campaign 2008
• Approached the Trust & agreed area of harm to reduce
• Strategic & Operational teams established
• Plan established to identify the financial cost saving (in addition to the human cost) by reducing harm from falls
your hospitals, your health, our priority
Aim
.
• To reduce the number of falls in the Trust by 50% in 2 years (baseline 2008-09)
• Identify financial savings
• Full roll out of project – January 2011
• Re-educate Healthcare Professionals & try and change the culture to stop normalising the abnormal!
your hospitals, your health, our priority
Work plan
.
• Undertake detailed assessment of current situation
• Strategy
• Policy
• Data collection
• Trust’s falls figures
• In-depth audit of inpatient falls resulting in harm
• Review of our existing improvement interventions
your hospitals, your health, our priority
Work plan continued…
.
• Review existing improvement efforts
• Implement whole system training package
• Apply appropriate interventions
• Develop Business Case for Quality (QIPP)
your hospitals, your health, our priority
Falls Audit – January 2010
.
• Retrospective case notes audit
• 1308 falls Trust wide, focused on inpatient falls that resulted in moderate, severe harm or death
• Timescale – all falls in hospital from December 2008 to November 2009
• 37 patients audited in depth
your hospitals, your health, our priority
Summary of Results
.
• Mainly moderate injuries
• Most in Medicine/Rehabilitation
• Most at bedside
• Many patients on offending medication
• Mainly unwitnessed falls
• Mainly head injuries & lacerations
• Low number of L/S BP on admission
• Total cost (but difficult to do so) £46,312
your hospitals, your health, our priority
Project Plan – 3 Phases
• Phase 1: Diagnostic from Oct 2009 to Feb 2010
• Phase 2: Intervention, Pilot & Monitor from April to June 2010
• Phase 3: Rapid Spread, from July to Sept 2010
January 2011 became the reality…
Sustain E4E & Monitor
your hospitals, your health, our priority
Reducing the Number of Falls
your hospitals, your health, our priority
Financial Savings - #NOFFinancial Cost # Femur
£0.00
£50,000.00
£100,000.00
£150,000.00
£200,000.00
£250,000.00
2007/08 2008/09 2009/10 2010/11 2011/12
Financial Cost # Femur
Financial Year 2007/08 2008/09 2009/10 2010/11 2011/12
Financial Cost # Femur £200,807.36 £67,752.10 £50,201.84 £50,201.84 £12,550.46
TYPE OF COST COST £
Radiology Costs £ 33.00
Pathology Costs £ 10.00
Procedure Costs £ 9,231.00
Physio Costs £ 69.00
Nursing Costs £ 18.13
Clinician Costs £ 37.98
Increased LOS Costs £ 3,151.26
Total Costs £ 12,550.37
With costing ability within EPR we were able to retrospectively cost #NOF due to falls
your hospitals, your health, our priority
Phase 1
.
• Data quality, collections & analysis of falls figures; data trials; design of new electronic data form to capture financial impact & preparation for moving to electronic data collection in phase 2
• Identify evidence based interventions that haven’t already been implemented
• Calculate cost of falls based on retrospective audit & develop an e-integrated system
• Review Policy & develop new Falls Risk Assessment
your hospitals, your health, our priority
Pilot Ward Interventions
.
• All patients undergo new multifactoral risk reduction plan on admission
• All patients have bedrail risk assessment undertaken on admission and intervention completed
• Slipper exchange accessible for all patients on pilot wards
• Incident Map updated post falls on the pilot wards
• Post Falls – Electronic Patient Record (EPR) completed and ongoing costings assessed
• Pharmacy input within 24 hours of admission
your hospitals, your health, our priority
Plan Prior to Launch of Phase 2 Pilot• Ward Teams (3) trained on EPR falls form & falls
reduction interventions & plan
• Equipment available on each pilot ward (bedrails ordered & slipper exchange supported by Age UK)
• EPR live
• Pharmacy support in place
• Incident Map – Productive Series
• Trust Wide Communication Strategy
• Data Collection agreed
your hospitals, your health, our priority
Standish Ward Incident Map
Healthier Horizons
Using Innovative Initiatives to Impact on Infection
Better Care Better Health Better Life
Helen Crombie - Assistant Director Performance Improvement&Julie Hughes – Nurse Consultant Infection Control
Better Care Better Health Better Life
Using Innovative Initiatives to Impact on Infection
• Introduction – a little background context…
• Impact of Infection Initiative – Focuses on Reputation, Risk and Care Outcomes
• Initiatives for Prevention and Protection
• Innovative Involvement Initiative –CDI Initiative
• Increasing Awareness Initiative – identifying IPC priorities, using a consistent information presentation, repeating the same message
• Interactive Learning Time Initiative
Better Care Better Health Better Life
Introduction
• A Little Background Context
• The North West Experience
• Engaging the Whole Health Economy
• Context Facts and Figures – Acute vs Community
Better Care Better Health Better Life
NHS North West - Number of MRSA Bacteraemia April 2008 – June 2011
NHS North West - Number of MRSA Bacteraemia April 2008 - June 2011
0
10
20
30
40
50
60
2008/09 2009/10 2010/11
Better Care Better Health Better Life
NHS North West - Number of MRSA Bacteraemia April 2008 – June 2011 Trend
NHS North West - MRSA Bacteraemia April 2008 - June 2011
0
10
20
30
40
50
60
Better Care Better Health Better Life
NHS North West – MRSA Bacteraemia Yearly reductions (2008-2011)
NHS North WestMRSA Bacteraemia - Yearly % reductions
229
302
415
0
100
200
300
400
500
2008/09 2009/10 2010/11
FinancialYear
27% reduction
24% reduction
Better Care Better Health Better Life
NHS North West – MRSA Bacteraemia Acute & Non- Acute (by Quarter)
NHS North West - MRSA Apportionments April 2008 - June 2011
Acute
Non Acute
Acute 79 58 70 54 48 35 34 55 30 34 22 21 21
Non Acute 49 33 34 38 41 29 27 33 33 32 24 33 24
Apr-J un
J ul-Sep
Oct-Dec
J an-Mar 09
Apr-J un
J ul-Sept
Oct-Dec
J an-Mar 10
Apr-J un
J ul-Sept
Oct-Dec
J an-Mar 11
Apr-J un
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MRSA – Latest position Commissioner)
80.8
41.1
25 24.418.2 16.3
10.7 4.5 2.9
-18.2
-20
-10
0
10
20
30
40
50
60
70
80
90
North East NorthWest
East ofEngland
SouthWest
South EastCoast
Yorkshire& the
Humber
EastMidlands
SouthCentral
WestMidlands
London
MRSA Bacteraemia - All SHAs% Ahead of Plan (April 2011 - June 2011)
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NHS North West - Number of C-Difficile Infections
April 2008 to June 2011
NHS North West - C difficile Infections April 2008 - June 2011
0
100
200
300
400
500
600
700
800
900
2008/09 2009/10 2010/11
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NHS North West - Number of C-difficile Infections April 2008 – June 2011 Trend
NHS North West - Number of C difficile Infections April 2008 - June 2011
0
100
200
300
400
500
600
700
800
900
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NHS North West – C-difficile Infections Yearly reductions (2008-2011)
NHS North WestC difficile - Annual (3 year)
6726
4911
3859
0
2000
4000
6000
8000
2008/09 2009/10 2010/11
FinancialYear
27.0% reduction
21.4% reduction
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NHS North West – C-difficile InfectionsAcute & Non- Acute (by Quarter)
NHS North West - C difficile Apportionments April 2008 - June 2011
Acute
Non Acute
Acute 1198 906 805 1035 737 602 641 673 609 505 445 410 366
Non Acute 852 722 595 613 584 632 538 504 522 544 420 404 424
Apr-J un 08
J ul-Sept
Oct-Dec
J an-Mar
Apr-J un 09
J ul-Sept
Oct-Dec
J an-Mar
Apr-J un 10
J ul-Sept
Oct-Dec
J an-Mar
Apr-J un 11
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C-difficile – Latest Position (Commissioner)
9.1
5.1
-2.8-6.2 -7.5 -7.5
-19.8
-26.5-28.8
-30.9
-35
-30
-25
-20
-15
-10
-5
0
5
10
South EastCoast
East ofEngland
NorthWest
EastMidlands
North East SouthCentral
WestMidlands
SouthWest
London Yorkshire& the
Humber
C Difficile Infections - All SHAs% Ahead of Plan (April 2011 - June 2011)
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The Impact of Infection InitiativeFocussing on Reputation / Risk / Outcomes
• Public Confidence
• Media attention
• Jobs / Recruitment
• Risk to Patients and Residents
• Impact on Family Life
• Cost to Organisation/ NHS
• Closure – Beds, Homes & Life
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Impact on Reputation
• How do you recruit high caliber staff if people are reluctant to work in organisations due to poor reputation and history of problems with diarrhoea outbreaks and high levels of infections?
• How do your Relatives feel when your hospital, service or care homes are branded as places nobody wants to work at?
• Do you want your place of work to be viewed as a Place of poor care standards with a history of infection?
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Impact on Risks relating to Infection Prevention & Control
Why Focus on this Agenda?- impacts on the whole health
economy
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Impact on Organisational Outcome
CQC report on HPA web site - 29 September 2010
• Thirty-four care homes and eight agencies providing care in people’s homes closed in the past 12 months following regulatory action and the Care Quality Commission (CQC)
• In six cases, CQC issued legal notices to close the service. In the remaining, owners closed or sold the service after CQC took enforcement action. CQC said that risks to people’s health and welfare were too great and the only option was closure.
Reasons sited:• Training, Cleanliness, Hygiene, Record keeping
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Initiatives for Prevention and Protection
Promoting Prevention – mapping, identifying vulnerable patients – Various Trusts
Promoting Protection – preventing future relapse –Case Management – Initially Salford –Now the Majority
Promoting Patient Involvement –CDI antibiotic awareness card
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Innovative Involvement Initiative
CDI – The ChallengeReducing Antibiotic Prescribing
Promoting Patient Involvement – Antibiotic awareness information cards – North West Wide initiative
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CDI – The ChallengeReducing Antibiotic Prescribing
Patient Information leaflet
Card attached
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CDI – The ChallengeReducing Antibiotic Prescribing
Clinicians Information Sheet:
Describes Purpose, Benefits
Web Sitewww.northwest.nhs.uk/cdiff
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CDI – The ChallengeReducing Antibiotic Prescribing
Poster For:
Surgery’sDentistsPharmaciesA&E DeptMAUOPD
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Increasing Awareness Initiative
• Promoting Education• Staff, Patients, Residents, Families• Media
• Reinforcing the Value of Audit / Monitoring Practice• Diarrhoea Management -tools and techniques• Hand Hygiene• Cleaning• Treatment – Antibiotics• Isolation Practice
Getting the message out there……….
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Increasing Awareness Initiative
Identify Infection Prevention & Control Priorities - Focusing Resources, Promoting Guidance and Guidelines
Mental Health Initiative – Julie Hughes
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HCAIs and IPC in mental health settings
– different bugs or different approaches?1 J Hughes, 2 L Owens
1 Nurse Consultant Infection Control/Lecturer, 5 Boroughs Partnership NHS Trust, Warrington, University of Chester, Cheshire, UK
2 Infection Prevention and Control Practitioner, 5 Boroughs Partnership NHS Trust, Warrington, Cheshire, UK
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HCAIs and IPC in mental health settingsPrior to Health and Social Care Act (2006) and the Care
Quality Commission (CQC) Mental Health not under such scrutiny in relation to IPC but now under increasing focus
HCAIs in MH overall remain low but predisposing risk factors and impact across whole health economy
However, little information and evidence available re extent of HCAIs in this area
Compliance with IPC also challenging e.g. patients compliance/ligature risks etc
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Strategies for improvement
MRSA SCREENING CRITERIA
All patients who fit into the following criteria MUST be screened at the time of their admission, the ‘admitting nurse’ has responsibility to ensure this is undertaken
Has the patient:
Previous history of MRSA?
Been transferred from another
hospital?
Been transferred from a
residential or nursing home?
Used intravenous drugs and
has wounds/lesions?
Any self harm
wounds/lesions?
Any indwelling devices or
chronic wounds?
Screen: 1 swab dipped in sterile
saline solution for both nostrils,
1 swab dipped in sterile saline for both sides of groin
Any other areas of concern to be swabbed as normal
Fax any positive laboratory form results to 01925 664817
Inform Infection Prevention & Control Team of any MRSA Positive patients on 01925 664055
DON’T FORGET TO INCLUDE YOUR RESULTS IN MONTHLY MRSA RETURNS
Surveillance – Monthly prevalence studies of
HCAIs (3% HAI, 2% CAI)– Weekly surveillance
• wounds/infections/invasive devices/antibiotic prescribing
– Main infections – UTI, chest, wounds
– Main organisms – MRSA, E.coli
MRSA Screening – 98% compliance– 8% of patients screened +ve – 25 % > 48 hours, 75% < 48
hours– Leg/foot ulcers, self harm
April 2011 HAI
67%
25%
8%
Urine
Wound
Eyes
April 2011 CAI
23%
22%
11%
22%
22%Urine
Wound
Chest
Skin
ear
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Strategies for improvementIPC audit programme
– High Impact interventions
– Essential Steps
– Quarterly antimicrobial prescribing – overall improvement
– Essence of Care
– AIMS
Training and culture change– increased ownership of audit
results and issues by Matrons and areas
Service user involvement– Active engagement and
empowerment
Example of monthly Matron/IPC Board and Business Stream reports
Example of Service User spot-checks
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Interactive Learning Initiative
• Promoting Engagement• Whole Health Economy Involvement• Newsletters / Prescribing Alerts• Medicines Management Teams• Dental Services
• Supporting Education and Training initiatives • RCN Infection Prevention Conference• North West Master class • North Lancashire Care Homes Conference
Continuing to get the message out there……….
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Toilet Talk – Managing the Impact of Diarrhoea by Focusing on the Normal Bowel and other
relevant matters• Introduction – Pathology and Causation
• Impact – Reputation, Risk, Care Outcomes
• Increasing Awareness by Improving the Management of Diarrhoea
• Identifying Infection Prevention & Control Priorities
• Interactive Learning Time
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FinallyRemember when Preventing Infection –
What we have always done will not solve the problem, it gets more
difficult – we have to be innovative
And why?
Because it improves the Patients Experience and their Outcomes
The New Commissioning Architecture
• Cathy Maddaford - NHS Cheshire, Warrington and Wirral
• Moira Angel - NHS Cumbria
• Hilary Garratt - NHS Greater Manchester
• Trish Bennett - NHS Merseyside
• Gary Hardman - NHS Lancashire
2011
2013To deliverLargest change management project
Cluster: Key Objectives
Success will be measured by the successful establishment of the new commissioning architecture
Commissioning Development
1. Integrated Finance, Operations and Delivery
3. Emergency Planning and Resilience
4. Commissioning development
5. The New Public Health System
2. Ensuring Safety & Quality
6. QIPP Delivery & Provider Development
Day to Day
Delivery
The New Commissioning
Architecture
Service Transformation
Cluster: Key Objectives
An Olympic Size Challenge?
Developing Clinical Commissioning
Developing Clinical Commissioning
Three key role of non medical professionals in commissioning:
• Strategic decision making, leadership – new vision/personalisation embracing technology
• Pathway/service redesign/contracting the best quality outcomes
• Guardianships of the patient experience across care settings/safeguarding
The Leadership Challenge
More than pure clinical intervention changes
Good clinical commissioning needs to be based on the insights of many but with strong leadership
Release the potential for finding creative solutions which already exist within system
Local relationships are key
Health Improvement and prevention is bigger than general practice
Patients need to be fully involved in commissioning
• Driving leadership for outcomes
• Supporting leadership that drives performance
• Driving leadership for competent commissioning
• Driving leadership for quality and safety
• Driving leadership through Level 3 QIPP service reconfiguration
• How do we work together as nurse leaders i.e. Cluster/acute DON’s- What are our distinct roles?- What are our joint roles?
• Do you think the Cluster DoN’s focus of work is right?
• What are our joint high risk priorities. How do we address them?