Transcript Main Header - The Rotherham NHS Foundation Trust

Quality Accounts 2011/12
Looking back, looking forward
Dr Patricia Bain
Director of Quality and Standards
12th September 2012
Quality Accounts 2011/12
• Legal requirement to produce quality account
• Statement of assurance, Monitor, DH
• Audited: KPMG – without conditions, green for all selected
indicators
• Chief Executive commentary: context
• Looking back: Achievements, External Assurance
• Looking forward: Improvement programmes, new
indicators, supporting programmes
Section 2: Looking Back
• Between 2010 and 2011, for the National surveys,
• more positive feedback from patients in 2 of the 5 questions
• the same for one question
•
less positive feedback for 2 of the 5 questions
Staff Survey
Top 4 ranking scores 2011 (2011-12 vs 2010-11)
2011-12
TRFT
Effective team working (KF6)
Staff witnessing potentially harmful errors, near misses or incidents in the last month (KF20)
Staff using flexible working options (KF9)
Support from immediate managers (KF15)
Bottom 4 ranking scores 2011 (2011-12 vs 2010-11)
3.84
29%
69%
3.78
Staff experiencing physical violence from staff in the last 12 months (KF24)
Staff feeling valued by their work colleagues (KF3)
Impact of health and well-being on ability to perform work or other daily actvities (KF28)
Staff receiving job-relevant training, learning or development in the last 12 months (KF11)
• In 2011-12 national survey, reduction in staff reporting
good communication between senior management and
staff, (33% to 24% )
• Staff satisfaction for 2011-12 is 3.55, above the national
average for acute Trusts (3.47 in 2011-12)
• Reduction in the number of harmful errors witnessed (5%)
• Local survey highlighted training, job satisfaction as areas
of concern , feeling valued higher
National
National
TRFT
average
average
3.72
3.76
3.69
34%
34%
37%
61%
67%
63%
3.61
3.75
3.61
2011-12
TRFT
2%
74%
1.59
76%
2010-11
2010-11
National
National
TRFT
average
average
1%
2%
1%
76%
72%
76%
1.56
1.6
1.57
78%
80%
78%
Local survey Subject area
Feeling valued
Learning and Development
Performance
Health and Wellbeing
Communication from managers
Job satisfaction
Conflict resolution
Overall score
Trust
improvement/
deterioration
2.1%
-14.7%
3.0%
0.8%
Trust
improvement/
deterioration
0.0%
2.8%
-0.6%
-5.0%
Average Score
7.2
6.0
6.1
7.3
6.6
5.7
7.0
6.5
Looking Back:
Improvement programmes 2011-12
Liverpool
Care
Pathway
Acute &
Community
Patient
Experience
Tracker
High risk
medication
compliance
Looking back: 2011/12
Quality Review
Communication
IR1s & RCA
30 day
readmission
rates
Improvement Programme1i: High risk drugs - compliance
Medication
Opiate
(Morphine
PRN)
Anti-coagulant
(Tinzaparin subcutaneous)
Anti-coagulant
(Warfarin oral)
Antibiotics
(various)
Category
Prescription
Administration
Monitoring
Prescription
Administration
Monitoring
Prescription
Administration
Monitoring (<5 INR)
Prescription
Administration
Monitoring
Total for all medications/categories
Target Qtr 1
Qtr 2 Qtr 2 Total
95%
-
88.9%
95%
-
96.8%
95%
-
25.8%
95%
-
98.1%
95%
-
81.7%
95%
-
73.6%
95%
-
36.1%
95%
-
36.4%
95%
-
87.9%
95%
-
54.0%
95%
-
92.0%
95%
-
92.0%
95%
-
76.9%
(n=42)
Qtr 3 Qtr 3 Total
Qtr 4
91.2%
94.6%
100.0%
77.6%
(n=57) 100.0%
15.4%
100.0%
85.4%
(n=107)
91.3%
88.9%
(n=116)
75.0%
(n=39)
50.0%
(n=42)
73.0%
83.0%
64.4%
(n=47)
16.1%
98.8%
99.0%
90.2%
89.1%
(n=94)
41.9%
83.6%
88.0%
75.4%
35.9%
46.0%
(n=93)
43.0%
79.4%
47.9%
73.6%
(n=31)
96.4%
74.0%
99.0%
4.3%
57.3%
91.5%
74.0%
(n=48)
78.6%
41.5%
YTD
91.7%
81.8%
34.3%
48.7%
72.2%
(n=50)
Qtr
change
77.8%
37.2%
48.6%
Q4 Total
87.6%
91.8%
75.9%
74.6%
•
Improvements in the prescribing, administration and monitoring of opiates, antibiotics and
the anticoagulation medicine Tinzaparin; prescription and administration of Warfarin are
the key areas for on-going focus
•
Current actions: reviewing of anticoagulation service, training on anti-coagulants
routinely included in junior doctor study day
•
Focus remains , expanded to all aspects of medicines management- Trust wide medicine
management task finish group currently taking a comprehensive work programme forward
Improvement Programme 1ii:
Communications Incident reporting & Root Cause Analyses
(RCA)
Formal RCA of communications related incidents ensures that learning is
captured, and proactive steps taken to minimise communication issues
which may affect their care.
• Incidents relating to ‘Communications between staff and teams ‘ showed
5% increase in reporting and 33% increase in completed RCAs
• Incidents relating to communication with the patient showed a 3%
increase in reporting and 31% increase in completed RCAs
• Investigations into issue relating to patient case notes increased by 20%
• A key theme incidents related to handover; progress noted by deanery,
to be further progressed in 2012-13, linking to EPR
Improvement Programme 2i:
Reducing 30 day readmissions arising from elective admissions
2010-11
Elective
Admissions
Discharged in
year
Cardiology
2011-12
% of Discharges
of which
in period that
returned as a
returned as a
non elective
non-elective
admission within
admission within
30 days
30 days
Elective
Admissions
Discharged in
year
% of Discharges
of which
in period that
returned as a
returned as a
non elective
non-elective
admission within
admission within
30 days
30 days
586
35
5.97%
521
33
6.33%
-
-
-
1
0
0.00%
Dermatology
689
12
1.74%
680
9
1.32%
ENT
764
7
0.92%
712
4
0.56%
Gastroenterology
2318
59
2.55%
2080
59
2.84%
General Medicine
1782
105
5.89%
1742
82
4.71%
General Surgery
5897
255
4.32%
6259
282
4.51%
39
4
10.26%
28
2
7.14%
Gynaecology
4482
138
3.08%
4324
128
2.96%
Haematology (Clinical)
1560
125
8.01%
2341
133
5.68%
171
3
1.75%
217
9
4.15%
Ophthalmology
4132
70
1.69%
4174
71
1.70%
Oral Surgery
3390
37
1.09%
3351
30
0.90%
85
2
2.35%
45
2
4.44%
Photopheresis
559
10
1.79%
485
5
1.03%
Rehabilitation
15
3
20.00%
9
2
22.22%
Rheumatology
418
13
3.11%
486
11
2.26%
Trauma & Orthopaedics
4343
143
3.29%
4126
132
3.20%
Urology
4200
179
4.26%
4192
180
4.29%
35430
1200
3.39%
35773
1174
3.28%
Clinical Oncology
Geriatric Medicine
Obstetrics*
Paediatrics
T otal:
*for patients using a hospital bed or Delivery Facilities
2011-12 Vs
2010-11
-
30 day re-admissions: on-going actions
Work continues to try and impact on the rate of readmission for all types of
admission across the Trust, including:
•
Implementation of ‘open access’ to follow up appointments for selected
specialties
•
A review of discharge information provided to patients
•
Scoping of the ‘virtual ward’ concept
•
Exploration of ‘telemedicine’ and a Single Point of Access call/contact centre to
signpost patients appropriately to the care they need
•
Development of the Early Pregnancy Advisory Unit (EPAU) telephone triage
service, introduction of urgent outpatient appointments
•
Accident and Emergency, piloting of a GP triage service, a Community Matron
pilot, audit of admissions with a length of stay less than 48 hours and Multi
Disciplinary Team meetings to review issues related to frequent attenders
Improvement Programme 3i:
Increasing our responsiveness to patient needs: volume
Significant improvement in the volume of community surveys by Quarter 4,
No improvement for Acute services.
Both Adult and Universal Services Community Health achieved year end results
in excess of their quarter 2 baseline.
Increasing our responsiveness to patient needs: responses
Acute inpatients (PET CQUIN template)
Baseline period & value
Qtr 1
Qtr 2
Qtr 3
Qtr 4
YTD
Did a member of staff tell you about medication side effects to watch for when you went home?
Did hospital staff tell you who to contact if you were worried about your condition or treatment after you left hospital?
April 2011
April 2011
84.7
87.5
88.6
91.6
83.0
81.2
78.2
75.1
78.7
76.9
81.5
80.2
Did you find someone on the hospital staff to talk to about your worries and fears?
Were you given enough privacy when discussing your condition and treatment?
Were you involved as much as you wanted to be in decisions about your care and treatment?
April 2011
April 2011
April 2011
87.5
93.8
87.5
90.1
94.1
89.7
88.0
86.5
82.4
81.7
80.7
76.9
83.8
80.3
79.9
85.5
84.0
81.8
Average score
April 2011
88.5
91.0
84.1
78.4
79.8
82.6
Number of surveys completed
April 2011
144
286
292
197
770
1545
Community Health - Adult (PET template data)
Baseline period & value
Qtr 1
Qtr 2
Qtr 3
Qtr 4
YTD
Have you been involved as much as you wanted to be in decisions about your care and treatment?
Were you given enough time to discuss your condition with healthcare professionals?
Qtr2 2011-12
Qtr2 2011-12
89.3
87.3
-
89.3
87.3
87.7
89.8
90.7
89.8
89.2
88.8
Do you know what number/who to contact if you need support out of hours (after 5pm)?
Overall, have staff treated you with dignity and respect?
Overall, are you satisfied with the personal care and treatment you have received from community services?
Average score
Qtr2 2011-12
Qtr2 2011-12
Qtr2 2011-12
Qtr2 2011-12
90.8
96.0
94.2
91.5
-
90.8
96.0
94.2
91.5
92.3
96.8
97.1
92.7
95.8
95.6
93.4
93.0
92.6
96.2
94.9
92.3
Number of surveys completed
Qtr2 2011-12
454
Community Health - Universal Services (PET template data)
Baseline period & value
-
454
353
313
1120
Qtr 1
Qtr 2
Qtr 3
Qtr 4
YTD
Were you given enough time to discuss your child’s health with the healthcare professionals?
Did staff clearly explain the purpose of their contact with you in a way that you could understand?
Do you know what number/who to contact if you need support out of hours (after 5pm)?
Qtr2 2011-12
Qtr2 2011-12
Qtr2 2011-12
92.2
93.9
86.1
-
92.2
93.9
86.1
96.6
98.0
85.4
91.3
94.4
87.1
93.7
95.7
86.2
Overall, have staff treated you and your family with dignity and respect?*
Overall, are you satisfied with the service you have received from community services?
Average score
Qtr2 2011-12
Qtr2 2011-12
Qtr2 2011-12
0.0
94.8
73.1
-
0.0
94.8
73.1
57.3
97.6
87.0
97.9
96.3
93.5
54.0
96.4
85.2
Number of surveys completed
Qtr2 2011-12
160
-
160
236
179
396
Qtr Change
YTD
Qtr Change
YTD
Qtr Change
YTD
-
Focus on improving patient’s rating of their experience will be continued
throughout 2012-13 in the acute setting.
-
Improvement Programme 3ii:
Compliance with 5 key Liverpool Care Pathway measures
Number of deceased (mortality Database)
Proportion of those on LCP
LCP question
Qtr 1
Qtr 2
Qtr 3
Qtr 4
YTD
Qtr Change
258
247
264
286
1,055
<1084
50.0%
45.7%
42.8%
49.3%
47.0%
>41.3%
Qtr 1
Qtr 2
Qtr 3
Qtr 4
YTD
Qtr Change
Target
Target
Q5
Has the patient had the opportunity to discuss what is important to them & their wishes
38.0%
47.8%
45.1%
41.1%
42.7%
95.0%
Q6
Has the relative / carer had the opportunity to discuss what is important to them & their wishes
38.0%
48.7%
44.2%
41.1%
42.7%
95.0%
The patient has medication prescribed on a PRN basis for the following:
29.3%
40.4%
36.8%
36.7%
35.6%
95.0%
Pain
36.4%
46.0%
42.5%
39.7%
40.9%
95.0%
Agitation
31.0%
44.2%
41.6%
39.0%
38.7%
95.0%
Respiratory Tract Secretions
29.5%
38.9%
37.2%
39.0%
36.1%
95.0%
Nausea / vomiting
24.0%
38.1%
33.6%
32.6%
31.9%
95.0%
Dyspnoea
Q7
25.6%
34.5%
29.2%
33.3%
29.6%
95.0%
Q13
Is a full explanation of the current plan of care given to the relative / carer?
36.4%
46.9%
44.2%
41.1%
41.9%
95.0%
Q14
Has the LCP Coping with death leaflet or equivalent been given to the relative / carer?
34.1%
46.0%
40.7%
38.3%
39.5%
95.0%
32.6% 43.5% 39.8% 38.4% 38.4%
•
Proportion of deceased on LCP increased from 41% to 47%, national
average is 26%
•
95% target for 5 elements was not achieved , although increase shown
across all questions, continued target for 2012-13
•
Governors indicator for this years quality accounts and extended to the
community setting
95.0%
YTD
Target
status
‘Quality at a glance’ Indicators: 2011-12

Zero local targets set for MRSA (with 23 months of zero MRSA infections) One
occurrence impacted on zero achievement for the whole year; still achieves DoH
targets

C. Difficile performance achieved and improved by 30% against last year’s
performance, falling from 50 (March 2011) to 35 for the year ending March 2012.

Performance against National Peers incredibly strong – with the average rate for
MRSA = 4.1 , C.Diff 82.7

Medication error rate, reduced year on year – from 1.6 to 1.5 (per 1,000 dispensed
items). Attributed in part to focus on high risk medication protocol adherence

Fluid Balance and Patient At Risk (PAR) scoring on wards have improved vastly –
from 64.5% and 50% (2010-11) to 83.8% and 82.7% respectively- major
contribution towards optimising conditions for patient recovery.

First Never Event in 3 years – retained swab, zero target re-set for 2012/13
‘Quality at a glance’ 2011-12 contd..
•
Grade 2+ pressure ulcer occurrences for acute inpatients have reduced by 8%
against performance in 2010-11.
•
Risk Adjusted Mortality Index (RAMI – CHKS Live) has decreased from 95
(2010-11) to 84 (2011-12).
•
Our Summary level Hospital Mortality Indicator also reflects some improvement,
decreasing from 76.1 (2010-11) to 74.2 (2011-12), for in hospital deaths .
•
Falls from height increasing by 1.8/1000 bed days to 2.3/1000 bed days,
however improvements already seen in Q1 this year.
•
National comparisons NHS Safety Thermometer lowest number of ‘harms’ from
falls (1.2% national , 0.2% TRFT)
Section 2b: Statement of Assurance
• Service reviews: External reviews , NHSLA,CQC risk profile
• CQUIN : For 2011-12 the baseline value of CQUIN was £2.5m,
total estimated value payable to the Trust for CQUIN for 2011-12 is
£2.32m
• Clinical Audit activity, broadened and expanded include NICE
Quality Standards (currently 15)
• Research programmes, number of patients increased by 300
• Data Quality >98% on selected indicators
•
Information Governance: 5 of 6 categories satisfactory, IG training
increased 30% to 80% , not satisfactory rating overall
• National Priorities indicators 23 out of 28 targets met
Quality Accounts 2012/13
Our overarching strategic objectives for the next 3 years as set out in our
Quality Strategy and linked to the Quality Accounts programme, are:
SAFE

Reduce mortality: achieve a position in top 10% of organisations with
lowest risk adjusted mortality

Reduce Harm: 95% of patients are harm-free
CARING

Improve the patient/staff experience: achieve top 20% for patient
and staff experience surveys
RELIABLE

Provide reliable care: ensuring that evidence based practice is
followed by meeting 90% compliance with all NICE Quality Standards
Specific Improvement Programmes 2012-13
• Never events (cont’d)
• Medicines management
(cont’d and expanded)
• NHS Safety Thermometer
(Falls, UTI,VTE,PU)
• Health assessments for
looked after children
* NICE Quality Standards ongoing
Reliable
Safe
Caring
• End of Life Care Pathway,
extended to community setting
• Fast track discharges to CHC
for Dementia patients
• Dementia investigations
Quality indicators for 2012-13
Domain
Culture
ID
C_1
C_2
C_3
C_4
Patient
Safety
SAFE
Rationale for monitoring
Links to ‘caring’ objectives
Reflects ‘no blame’ culture
Links to supporting staff objectives
Reflects morale of staff
To ensure that we are meeting 90% compliance
PS_1 against all of the standards set out in relation to
safe and secure storage of medications
High risk medications review to be reported as part of the Ward Nursing
Accreditation Scheme (WNAS), which includes all wards – due to limited success
attained in the four areas reviewed last year.
The selected indicator for this year is a more comprehensive review of all
medicines management processes
PS_2a Have zero ‘Never Events’
Zero target not achieved for 2011/12-continue
PS_2b Rate of patient safety incidents/1000 admissions
New DoH/Trust indicator
PS_2c
Patient
Experience
CARING
Indicator name
All applicable staff to have in year PDR
Increase in IRI reporting
All staff to maintain compliance against MAST
training
Employee sickness rates
Percentage of patient safety incidents resulting in
severe harm or death
New DoH/Trust indicator
PS_3 Number of patients with CDiff/Rate of CDiff
New DoH/Trust indicator
PS_4 Number of patients with MRSA
On-going Trust requirement
PS_5 Increase in number of complaints
On-going Patient Experience indicator
Increasing our responsiveness to our patients
PE_1 needs using a composite indicator of care, from
April 2011 baseline
Increasing compliance to 95% of 5 key measures
PE_2 on the Liverpool Care of the Dying Pathway (LCP)
by April 2012
Increase the proportion of community OT visits for
PE_3 assessment within 28 days from April 2012/13
baseline to 95% by April 2013/14
Improvement on 2011/12 required, metric continues to be a CQUINs indicator for
12012-13
This is the Governor selected indicator for 2012-13, also continues to be a CQUINs
indicator
New programme - community focus
Quality indicators for 2012-13 contd.
Domain
ID
PE_4
Patient
Experience
PE_5
PE_6
CE_1
CE_2
Clinical
CE_3
Effectiveness
CE_4
RELIABLE
CE_5
CE_6
Indicator name
Increase the number of Health Visitor first visit within
10-14 days of birth from 90% to 97%
Increase in the number of patients assessed using
the MUST nutritional tool and completed fluid
balance charts
PROMS data
Reducing the number of hospital re-admissions from
care homes within 30 days from April 2012 baseline
Reducing emergency re-admissions to hospital
within 28 days of discharge
Rationale for monitoring
Reduction in Mortality: SHMI value and banding
New DoH indicator
% patients admitted treatment inc palliative care
New DoH indicator
% patients whose death inc in SHMI treatment
palliative care
Reducing weekend mortality rates as at April
baseline 2012
New DoH indicator
DQ_1 Data Quality index CHKS live (HRG4 based)
Data Quality
Blank or invalid or unacceptable primary diagnosis
rates CHK live HRG4 based
Depth of coding average diagnosis per coded
DQ_3
episode CHKS live exclude Breathing Space
DQ_2
New programme - community focus
On-going Trust requirement
New DoH indicator
New programme - community focus
New DoH indicator
New Trust indicator mortality targets
On-going Trust requirement
On-going Trust requirement
On-going Trust requirement
Developments for 2012-13
• SDS3 and Quality Strategy implementation, monitored PMO
• Strengthening of the Quality Governance Framework
• Revised Patient Safety, Patient Experience and Clinical Effectiveness
Strategies
• Initiatives aligned with the Trust’s Business Intelligence strategy –
currently being implemented
Datix/CHKS/ Quality Dashboards: Service to Board
– Supports end user ‘self service’
• Dashboards configured to suit end user requirements
• Capability to ‘drill down’ to data detail as necessary
• Data available for review as soon as it is entered
Will provide ‘real time’ information to the Board and weekly Harm
meetings
Any Questions?