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7/28/2019 Nuh Qa2012 Summary v4 Rgb

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Welcome 1

Patient involvement & consultation 3

Looking back to 2011/12 4

How we did against our priorities for 2011/12 5

Quality & safety: 2011/12 highlights 10

Looking ahead: 2012/13 priorities 15

Contents

This document is available in other languages and formats upon requestfrom the Communications Team at Nottingham University Hospitals NHS

Trust on 0115 924 9924 ext. 63562or by e-mail at [email protected]


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1Nottingham University HospitalsQuality Account Summary Version 2011/12

Welcome to a summarised version ofNottingham University Hospitals NHSTrusts 2011/12 Quality Account

Our Quality Account supplements our Annual Report & FinancialAccounts. Quality Accounts provide detailed information on thequality of care and services at our hospitals, and our improvement.Quality covers safety, patient experience and effectiveness.

We are one of the largest

employers in the region, witharound 13,500 staff working acrossour three sites Queens MedicalCentre, Nottingham City Hospitaland Ropewalk House.

Our full portfolio of specialistservices includes heart, cancer,stroke, renal, neurosurgery and

trauma.We are at the forefront ofmany world-leading researchprogrammes and new surgicalprocedures. In partnership withthe University of Nottingham, weoperate two National Institutefor Health Research BiomedicalResearch Units - in hearing anddigestive diseases. NUH is inthe top ve trusts nationallyin providing opportunities forpatients to take part in clinicalresearch studies.


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Why we are here: our values

We are here for you is ourpromise to patients. We havemade a commitment to patientsthat we will do all we can toensure they feel cared for, safeand condent in their treatment.

Who we serve

We strive to continually improveclinical outcomes and patientexperience to meet the needs ofthe local, regional and nationalpopulation that we serve. NUHprovides secondary care services to

a population of over one millionpeople in the Nottinghamshirearea and specialist tertiary care topatients across the East Midlands.A proportion of the Trusts activityis provided to patients who arereferred to our hospitals fromoutside the region.


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Patient involvement & consultationfor our Quality Account

Our priorities for improvement are informed by:

Patients and carers told us thatthe most important issues forthem were ensuring that:

1 Thehospitalenvironmentis

cleanandsafe

2 Individualpatients(andtheircarers)arelistenedtoandkeptinvolvedin(andinformedabout)theircare

3 Theyreceivehighqualitywritteninformation

Over 80% of online respondentsdescribed that they wanted thefollowing information in the fullversion of our Quality Account:

Waiting times

Infection rates

Learning from our mistakes

Complaints

Cancelled operations

Privacy and dignity

Environmental cleanliness

Feedback from patients

National and regionalhealthcare priorities

Our extensive patient safetyprogramme

Better for You, our Trust-widecontinuous improvementprogramme

Our performance against ourquality priorities is monitoredby the Trust Board and Quality

Assurance Committee (a Boardsub-committee), and externally bythe local Clinical Quality ScrutinyPanel (hosted by NottinghamshireCluster Primary Care Trust).

This year we have built on theQuality Account consultationwe undertook during 2010/11by holding a number of events

for our patients and members,a members focus group andquestionnaire, two listening eventsfor patients, carers and staff andan online survey for patients,public and staff. 67 people tookpart in the focus group events and241 questionnaires were received.


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Looking back to 2011/12 a summary of our performance

against the priorities we setWe have achieved many of last years goals, and are on track tomeet many others.

Some of our key achievementsinclude:

Improving our HospitalStandardised Mortality Ratio(HSMR). We aimed to reducethis to 93.4 or less. We achieved93.5. Our latest StandardisedHospital Index (SHMI) of 0.95(year to September 2011) iswithin the expected range(there is not an excess of

deaths) 8 MRSA bloodstream infections

(target fewer than 10)

Fewer Clostridium difcile casesthan previous years (better thantarget)

We reduced the numberof pressure ulcers by 21%

(exceeding our target) We continue to embed our

values and behaviours, knowncollectively as we are here foryou

Over 2,500 staff are nowdirectly involved in Better forYou, providing energy and

ideas, and in excess of 230projects are now active


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How we did against our priorities for2011/12

Priority 1. To reduce NUH-associated avoidable harm

1 Ensurethatmorethan90%ofoureligiblepatientshaveaVTE(bloodclot)riskassessmentwithin24hoursofadmission

andprescribeappropriateprophylaxis

We exceeded this target fromsummer 2011.

We increased compliance in 2011,and have consistently exceededthe 90% target since June. Wedeveloped an electronic risk

assessment system which allowsjunior doctors to complete therisk assessment quickly and safely(it links to the patients bloodtest results). The system showsa prompt until assessment iscompleted, and produces detailedspecialty reports.

2 Reducethenumberofpatientfallsby15%

We reduced the number ofpatients who fell more than

once from 1.56 per 1,000bed days to 1.33 (i.e. ourmanagement of patients whofell improved). However, thenumber of rst-falls increasedby 6% (3,669 vs 3466 theprevious year).

We have strengthened our Trust

wide preventative programme,and introduced a monthly FallsOperational Group (chaired byour Chief Executive), to driveimprovements. We have alsolaunched a Trust-wide fallsprevention campaign.


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3 ImprovethemanagementofourpatientswithdiabetesbyimprovingtheirmedicationcomplianceviatheThinkGlucosecampaign.ThisisanNHSInstituteforImprovement

andInnovationprogrammedesignedtoimprovethemanagementofpeoplewithdiabeteswhentheyareadmittedtohospital

We achieved this target.

Through Think Glucose we have:

Improved staff knowledge

about insulin safety by aprogramme of diabeteseducation across the Trust

Raised awareness of themanagement of patientswith diabetes via a Trust-widecampaign supported by theNHS Institute for Improvement

and Innovation Revised Trust policy on self-

administration of medicationto improve patient experienceby the promotion of self-administration of insulin

Improved the earlyidentication and referral

of patients to the diabetesspecialist team to 95%

4 Reducethenumberofpressureulcersacquiredinourhospitalsby5%

We have exceeded this targetachieving a 21% reduction ingrade 3-4 pressure ulcers.

Each hospital-acquired pressureulcer is considered in detail byour clinical teams. Performanceis monitored by a Pressure UlcerOperational Group (chaired by ourChief Executive).

We have developed andimplemented an electronic

reporting system, and a packageof care for at risk patients.

We launched our Take thePressure Off campaign to raiseawareness of pressure ulcerprevention.


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Priority 2. To reduce NUH-associated infections

1 Havefewerthan10patientswhoacquireMRSAbloodstreaminfectionscausedbyourcare

We bettered this target.

2 Havefewerthan158casesofClostridiumdifcilecausedbyourcare

We bettered this target.

3 Reducethenumberofpatientswithcatheter-relatedinfectionsbyatleast10%

We have achieved this target.

From April 2011 we undertookquarterly prevalence surveys. Arelatively low rate of catheter-associated infection (vs publishedexperience) was a consistentnding.


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Priority 3. To improve staff training

We will focus on:

1 Raisingstaffawarenessofspecicpatientneeds,includingculturally-determinedneeds,andthoseinlong-standingconditions(suchasvisualimpairment)

2 Valuesandbehaviourstrainingforallstaff(over5,000staffcompletedthetrainingin2010/11)

3 Improvedwrittencommunicationforpatients

4 Ensuringthatatleast50%ofstaffhavecompleteddementiaawarenesstraining(partofarollingprogrammeofwork)

We met this target.

1 Inearly2011,weorganiseda

seriesofstaffworkshopsonAsianCulturalAwareness.TheTrusthosteditsannualstaffequalityconferenceinOctober2011featuringpresentationsonlearningdisabilities(fromtheLearningDisabilityTeam),sexualorientationandwhyitmattersinhealthcare,and

BritishSignLanguage.InDecember2011,theTrustlaunchedane-learningDisabilityAwarenessTrainingCourse,developedbyDisabledGo.

2 AttheendofMarch2012,9,500

staffhadcompletedvaluesandbehaviourstraining(weaimforallstafftocompletethetrainingbySummer2012)

3 Wehaveimprovedthequalityofpatientinformationleaets(weachievedtheInformationStandardaccreditationthenewqualitymarkforpatientinformationattheendof2011)

4 Over3,300staffhaddementiatrainingin2011/12.Allnurserecruitshavespecictrainingindementiacareaspartoftheirinduction.


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Priority 4. To improve application of NUH research in clinicalpractice

Weaimedtoincreasethenumberofpatientsrecruitedtoclinicalresearchtrialsto10,000

byMarch2012.

We achieved this target,recruiting 10,000 patients toclinical research projects.

Our achievements last yearincluded:

Increasing recruitment toNational Institute for HealthResearch (NIHR) portfolio

clinical trials by 46%, rankingamongst the top ve NHS trustsin the country. NUH is now thethird most active NHS trust inthe country in terms of numberof active research studies

Increasing research incomefrom the NIHR and NIHR

partners by 50%

Increased commercial researchactivity by almost 100%

Launching the NottinghamHealth Science Biobank andintegrated patient informatics

strategy

Developing an integratedstrategy for building researchcapacity in the nursing,midwifery and allied healthprofessionals professions.

853 publications as a result ofinvolvement in clinical research


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Quality & safety: 2011/12 highlights

Caring around the clock

This is NUHs enhanced versionof hourly rounding which willenable us to ensure the basiccare needs of our patients aremet consistently, every day

3 months scholarship researchhas been undertaken in theUSA by one of our experiencednurses, Marie Hutchings. Marievisited 14 US hospitals andattended 5 nursing conferencesin 11 weeks at the end of 2011

This learning is now being

applied at NUH and is guidingour roll-out of Caring aroundthe clock on our wards

A values-based video has beenmade to call staff to action,and gain commitment for theproject

Between 8am and 11pm, nurseswill check on the basic care needsof patients every hour (everytwo hours between 12 midnightand 8am). This includes checking

what we call the Ps and Qs pain, position, personal care,prevention, plan of care, questionsand supplies.

We are rolling out Caring aroundthe clock on 10 pilot wardsbetween February and April 2012and ensuring staff receive the

appropriate teaching and learningto equip them with the skills andtools needed. It will be rolled outto over 80 wards across QMC andCity Hospital by October 2012.


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Improving nutrition through Mealtimes Matter

As a high impact action fornursing and midwifery, improvingnutritional care for patientsis a key objective at NUH. Our

Trust-wide Essence of Carebenchmarking programmeidentied the inconsistentimplementation of protectedmealtimes as a challenge facingnursing teams. The food and drinkbenchmark is scored annuallyand the nursing dashboard alsomeasures nutritional qualitymeasures each month.

A Trust-wide approach toprotecting mealtimes throughengaging all staff was identiedas essential, to ensure consistentimplementation across all wards.Mealtimes Matter is our nutritioncampaign, launched early 2012

across NUH, and is a period of timeover mealtimes when all non-essential activities on our wardsstop. This prevents unnecessaryinterruptions to mealtimes.Our nurses, catering staff andvolunteers are available on wardsto help serve the food and giveencouragement and assistance topatients who need extra support.

This applies:

8 am 9am

12pm 1pm

5 pm 6pm

Key improvements:

People on the wards are kept toa minimum at these times andnursing staff, and volunteersmonitor the patients foodintake during their mealtimeand aim to make it anenjoyable experience

Relatives supporting their lovedones are encouraged and verywelcome on our wards duringmealtimes

Continued improvement inpractices will be monitoredthrough the scoring of the foodand drink benchmark


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Safety Thermometer

The Department of Health hasset targets to reduce harm fromfalls, VTE (blood clots), pressureulcers and urinary tract infections

in patients with urinary catheters.This is something called theSafety Express programme. Allhospitals have to carry out a snapshot audit once a month called aSafety Thermometer audit whichchecks every adult patient to seeif they have experienced any ofthe 4 harms. The audit enableshospitals to measure how manypatients are having harm-free care free of falls resulting in harm,

pressure ulcers, VTE and urinarytract infections where the patienthas a catheter. NUH started touse the Safety Thermometer in

February 2012. In March 2012, 88%of patients in the audit had harm-free care.


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Cancelled operations

We know that cancellingoperations causes a great dealof distress to our patients andtheir families. We have received

a number of complaints aboutcancellations. Patients and ourcommunity wanted to know moreabout the numbers and why thishappens. Between January 1 and31 April the Trust cancelled 563operations on the day of plannedsurgery. We undertook over42,400 operations and surgicalprocedures over that four monthperiod.

During the winter period wesaw an increase of 2.4% patientsattending our EmergencyDepartment - 949 more patientsthan the same period last year,with slightly more admitted. The

admitted patients were sicker,older and with more complexmedical problems. During this timewe opened 30 additional inpatientbeds, and a new ambulatorycare unit. We recruited morenursing and medical staff. Wechanged the way our geriatriciansworked ensuring they covered ouradmission wards. We improvedour theatre scheduling for routinesurgery to better reect thecapacity available particularlyduring bank holiday periods.

Actions that are already underwayand which will be monitored bythe Trust Board are:

Further separating emergencyand elective work and thereforeas many elective procedures willbe moved to City Hospital withorthopaedic transfer scheduledfor September 2012

An in-depth review of theatrescheduling of elective surgery

Opening a new clinicalobservation unit at QMC inSeptember 2012


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Emergency Department four hour waits

During 2011/12, we did not achievethe 95% target for patientswaiting four hours or less in ourEmergency Department. While

we saw an increased demand forour emergency services duringthe winter months we also saw anincrease in the length of time ourpatients admitted as emergenciesstayed as inpatients. Althoughwe had planned for the winterwe were not able to maintain ourperformance in the face of theunanticipated increase in severityof illness and length of stay.

To ensure we meet the target for2012/13, as well as the actionshighlighted on page 13 some ofthe actions we are implementingare:

A larger discharge lounge,which will facilitate dischargeearlier in the day for morepatients (it opened in March2012)

Extending the presence of theacute physician of the day

Increased transport capacity toallow transfer of patients to theCity Hospital

GP out-of-hours service willoperate a satellite unit overbank holiday weekends


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Looking ahead: 2012/13 priorities

Priority 1. Improve outcomes of treatment for patients

Reduction in avoidable deathsfrom severe sepsis

Fewer than 5 MRSAbacteraemias

Fewer than 133 cases ofClostridium difcile

10% reduction in number ofpatient falls

Eliminate avoidable stage 2, 3and 4 pressure ulcers

Fewer avoidable readmissionscaused by our care or discharge

Priority 2. Improve our patients experience

Signicantly reduce thelikelihood that a patientsplanned operation will be

cancelled Signicantly reduce

unnecessary waits in a patientsjourney, notably for dischargearrangements (includingmedications) to be completed

Improve the quality ofcommunication with patients

and their families Increase the proportion of

patients who feel listened toand involved in their care

Measure a 10 percentagepoint increase in proportionof patients who wouldrecommend our services to their

friends and family

From 1 April 2012 our patients arebeing asked: how likely is it thatyou would recommend this service

to a friend or family? using ascale from extremely likely tonot at all likely. The question,known as the net promoterquestion or score, will be askedin all NHS acute hospitals. We willbe able to benchmark ourselvesagainst other hospitals, andlearn from those who better

meet or exceed their patientsexpectations.


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Priority 3. Align research and clinical service priorities and buildcapacity for future research

Increase research income by10% compared to 2011/12

Enrol 20% more patients inclinical trials compared to2011/12

20% increase in samples in theBiobank

Monthly progress andachievement against each ofour priorities will be monitoredvia our quality and integratedperformance report dashboardswhich are overseen by Trust-wideor Board-level committees.

We welcome feedback on ourQuality Account so that we cancontinue to make improvements

to our publications year-on-year.You can feed back by email at:[email protected],by phone: 0115 9249924 ext 63562or via our website at:www.nuh.nhs.uk.

Copies of our full, summary andeasy read versions of our 2011/12Account are available on ourwebsite at:www.nuh.nhs.uk.

Hard copies of each of theseversions, including large print andBraille copies, are available upon

request by contacting:0115 9249924 ext 63262 or byemailing:[email protected].

If you would like our QualityAccount in a different language orformat please contact:0115 9249924 ext 63262 and wewill arrange this.


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