Continually Improving Patient Safety

Jane MacdonaldDirector of Nursing and Improvement

@GM_AHSN

AHSN – National ContextInnovation Health and Wealth

AHSN LicenceFocus on the needs of patients and local populations

Speed up adoption of innovation intopractice to improve clinical outcomes and patient experience

Build a culture of partnership andcollaboration

Create wealth throughco-development, testing, evaluationand early adoption and spread of newproducts and services.

Greater Manchester AHSN – Local context

GM AHSN footprint

4Universities

1 Ambulance Service

Executive team

Mike Burrows Managing Director• Martin Gibson• Gary Leeming• Sarah Thew

Research and Informatics

• Linda Magee• Keith Chantler

Industry and Wealth

• Donal O’Donoghue• Jane Macdonald

Health and Implementation

Improving Patient Safety…..as easy as ABC?

A. Sign up to Safety

B. Take your Patient Safety Collaborative (PSC) forward

C. See yourself as part of the Q initiative

Q

A. The 5 Sign up to Safety pledges are

• Putting safety first. Commit to reduce avoidable harm in the NHS by half and make public our locally developed goals and plans

• Continually learn. Make organisation more resilient to risks, by acting on the feedback from patients and staff and by constantly measuring and monitoring how safe our services are

• Being honest. Be transparent with people about our progress to tackle patient safety issues and support staff to be candid with patients and their families if something goes wrong

• Collaborating. Take a lead role in supporting local collaborative learning, so that improvements are made across all of the local services that patients use

• Being supportive. Help people understand why things go wrong and how to put them right. Give staff the time and support to improve and celebrate progress.

Sign up to SafetyMembers that have currently signed up:• Salford Royal NHS Foundation Trust• The Christies NHS Foundation Trust• Bolton NHS Foundation Trust• Tameside NHS Foundation Trust• Central Manchester NHS Foundation Trust• East Lancashire NHS Foundation Trust• North West Ambulance Service NHS Trust• AQuA• Greater Manchester Academic Health Science Network• Manchester Mental Health and Social care trust• Pennine Care NHS FT• Pennine Acute NHS Trust• University Hospital of South Manchester NHS FT• Stockport NHS FT• Bolton Clinical Commissioning Group

:

B. PSC Topics - Safety Wall

NICE CG 180 - 2014Current prescribing of anticoagulants for AF in England

NICE Costing report: AF (2014) IMS Disease Analyser 2012/13 and GRASP-AF database download April 2014

Treatment Percentage of AF Population

Number of people

No treatment 28.99% 258, 000

Aspirin 22.49% 200,000

Warfarin 34.32% 305,000

NOACS 14.20% 126,000

Why is this not safe…

1 in 6 strokes occurs in people with AFOf the next 10 patients with AF who have a

stroke:– 8 would have been known to be high risk of stroke– 6 should have been on warfarin / NOAC– 3 will go home– 5 will end up in supported care– 2 will die....

THE NUMBER AND COST OF STROKE

*Publically available data

Hospital Episode Statistics* (HES)

C. The Q Initiative• Began life as ‘5000 Safety

Fellows’ following the Berwick report

• Initial Founding Cohort 150 - 250, 10 places for each AHSN

• Consider the structure the long term design

• 5,000 in this initiative by 2020

• Funding in 2015, 2million

Q initiative – the Founding Cohort in GM

Vanessa Gardener May Moonan Michael Spence Abigail Harrison Alison Dwyer Caroline Poole

Chelliah Selvasekar Lesley Lappin Maria Ahmed Katie Pieroni Andrea McGuinness Jane Macdonald

IN SUMMARY

• So the future is bright!!! • And safer…..

Q• Productivity Challenge / Spending Review• Structure and format for delivery

A. Sign up to SafetyB. Patients Safety Collaborative (PSC)C. Q Initiative

PATIENT SAFETY REMAINS THE CENTRAL TENANT