Transcript Slide 1

Leadership in Clinical Practice
Quality of Care Rounds
Improving Quality Programme and Ward
Accreditations
Deborah Carter
Deputy Director of Nursing (Quality)
What did we want to achieve?
• Improve our patients experience
• Empower ward leaders to gather their own
data about the environment of care
• Ward teams able to directly influence the
quality of care and the environment
• Patients and staff giving direct feedback
• Board level assurance on the quality of patient
care
Where Did We Start?
• In 2008 ~ no Trust wide approach to data
collection on the environment of care or
patients view of this
• Review of results from 5 years inpatient
survey
• Analysis of complaints feedback
• Understanding the national picture
• Choosing which aspects to measure
Understanding What Matters
•
•
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•
•
•
Environment of Care
Privacy and Dignity
Clean
Infection control
Communication
Food
Pain
Quality Care Dashboard
Presenting the
Quality of Care
For
Ward
Part of the
PatientExperienceMetrics
QualityCampaign.co.uk
December 2011
Reported Distributed on 16/01/2011
Ensuring Infections are Controlled
Achieving a Clean Environment
100%
90%
80%
Ensuring Patient Safety
Achieving Good Communication
100%
100%
100%
90%
90%
90%
80%
80%
80%
70%
70%
70%
60%
60%
60%
50%
50%
50%
40%
40%
40%
70%
60%
Scored by…
Blue - Patients via Tracker
Turquoise - Ward Managers via MWR/QCR (New QCR started April 2011)
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Overall Quality
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KEY:
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Meeting Personal Hygiene & Care Needs
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Ensuring Patient Satisfaction
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Meeting Equality & Diversity Needs
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Respecting Privacy & Dignity
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Involving Patients & Carers
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Ensuring Pain is Managed
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Providing Good Nutrition
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40%
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85% Lower Threshold - 95% Upper Threshold
Quality Care Dashboard
Average Length of Stay
Reducing Complaints
Monitoring Infection Rates
4
10.0
Safeguarding Patients
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9.0
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8.0
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6.0
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12
5.0
2
2
10
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3.0
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2.0
4
Monitoring Patient Falls
Monitoring Medication Errors
40
20
90
35
35
18
30
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16
25
14
Yellow - Moderate/Grade 3 Orange - Major/Grade 4 Red - Catastrophic (L5)
Central Manchester University Hospitals NHS Foundation Trust.
Delivering the Best Patient Experience in the NHS
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2
*Grades refer to Pressure Sores only
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KEY: By Severity…Teal - Low/Grade 1 Green - Minor/Grade 2
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Monitoring Pressure Sores
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Brown - Safeguarding Incidents
Green - PALS Compliments, Blue - PALS Complaints and Red - Complaints
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80
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Purple - CDIFF
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Total Reported Incidents
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Black - MRSA
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Green - Median Length of Stay
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Monthly Snap Shot
IP Quality Care Round Dashboard
For
All Categories
Trust
Part of the
PatientExperienceMetrics
Showing data for
December 2011
0%
5%
How Clean is your Environment
96.0%
Are we doing our best to Control Infections
97.8%
How Safe do you feel in this Environment
96.6%
How Effective is our Communication
98.0%
Are we Offering Good Nutrition & Hydration
93.8%
Are we Managing your Pain Levels
93.3%
Do we give you Privacy & Dignity
95.5%
Are you Satisfied with our Service
91.0%
Did we Involve You and/or your Carer
96.1%
Have we met your Equality & Diversity requirements
85.5%
Are we meeting your Personal Hygiene needs
94.8%
Overall Quality Score
95.4%
10% 15% 20% 25% 30% 35% 40% 45% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95%
Patient Experience Tracker Dashboard
All Categories
For
Trust
Lower Threshold
UpperThreshold
Part of the
PatientExperienceMetrics
Central Manchester University Hospitals NHS Foundation Trust.
Delivering the Best Patient Experience in the NHS
Showing data for
Number of Audit taken place:
940
December 2011
0%
5%
How Clean is your Environment
75.0%
Are we doing our best to Control Infections
89.4%
How Safe do you feel in this Environment
82.8%
How Effective is our Communication
82.2%
Are we Offering Good Nutrition
73.7%
Are we Managing your Pain Levels
75.5%
Do we give you Privacy & Dignity
81.5%
How Aware of Equality & Diversity
80.9%
Did we Involve You and/or your Carer
78.4%
How Satisfied are you
74.0%
National NHS CQUIN Measures
79.7%
Overall Patient Experience Score
80.3%
10% 15% 20% 25% 30% 35% 40% 45% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95%
Lower Threshold
Report Produced by
Colin Hunter
Information Analyst
Quality Campaign Team (Analysis)
Central Manchester University Hospitals NHS Foundation Trust.
Delivering the Best Patient Experience in the NHS
UpperThreshold
Continuous improvement
• Review of process with matrons and ward
managers
• Understand what adds value to the
patient experience
• Improve report functions
• Spread to non-ward areas
• Developed the tool further
• Board Assurance
Improving Quality Programme
• NHSi Productive Ward
– whole hospital roll out pilot site 2007-2010
• Recognised some good ideas started but not spread
– Lacked standardisation
• Not embedded as a culture
– Seen as a project
• Had become another performance measure
– Rated red, amber or green
• Reviewed sustainability
– What did we want to sustain?
Key Elements
• Well organised environment (WOW)
• Improving Quality data board
• Patient Status at a Glance (PSAG)
• Shift Handover
Key Elements
Shift Handover
Verbal Prompt for Shift Handover
Shift Handover - Core Huddle
Ward Area
Date
Time of Handover
No.
Alert
Specific requirements
1
Patients with similar
names
List all patients names and
Hospital Numbers
S ituation
To include patient details e.g. location, name, age, gender and
to provide summary of current admission e.g. current diagnosis and
management plan / interventions.
Deteriorating patients with
2
EWS above 3
Safeguarding / Vulnerable
Day to Night - Shift Handover Monthly Audit 3- August
patient issues
Report Details
List all patients names and
Hospital Numbers
List all patients names and
Hospital Numbers
Was S.B.A.R. used for all patient handovers?
A ssessment
To include an overview of patient care during your shift, e.g.
relevent observations /monitoring, EWS etc., any 'risks', MDT
7
involvement
13
19
R ecommendation
5
Infection Control Issues
check screening, pathways, VIP
charts, any barrier nursing
Absent Patients
include names of patients not on
ward, current location if known
and last time seen
7
Patients on Liverpool Care
Pathway
List all patients names and
Hospital Numbers
8
Patients with DNR order
List all patients names and
Hospital Numbers
9
Confused / Wandering
Patients
List all patients names and
Hospital Numbers
Was a core huddle completed?
8
7
To include relevent past medical history and social circumstances.
13
19
Falls risks
12
18
6
24
B ackground
14
20
8
14
20
1
2
3
4
6
5
9
10
11
15 16
17
21 22
23
25 26
27 28
29 30 31
12 Relatives / Carers resident
1812
on ward
24
Give details
No Date this
month
10
Incidents or Complaints
Yes
No
12
Details of significant clinical
incidents or complaints
Staffing Issues
Off duty checked and NHSP
booking made / outstanding
Cleaning Matters
discuss with H.S.A any issues
affecting cleaning schedule
ONCE DATA COLLECTION COMPLETED OPEN A3 REPORT IN SHIFT HANDOVER AND CLICK ON THE 11
PALE BLUE TAB TO FIND
CORRECT PAGE TO INPUT DATA
To include requests for next shift related to patient care needs,
management plan or any outstanding tasks.
Confirm completed assessments,
actions, traffic lights
4
1
2
3
4
6
5
9
10
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15 16
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21 22
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25 26
27 28
29 30 31
Handover from……………………………………
Handover to………………………………
Improving Quality Programme
Set minimum standards with flexibility to apply in all areas
Developed agreed Trust wide ‘gold standards’
Provide teaching in methods:
Provided a 14 week programme of master classes and
facilitation to all wards
Provide resources:
Provided handbooks, data collection tools and electronic
resource files
Establish 30 day project mentality:
Feedback sessions after 30 days with expectation of
further learning and improvements
Create motivation:
Assessments to achieve Bronze, Silver or Gold
Layered Approach
Standardisation
Align to normal
business
Embed knowledge
Layered Assessments
Wards are assessed and rated as:
•
•
•
•
White
Bronze
Silver or
Gold
Standardisation: At end of 14 weeks
assessing successful implementation of standards (with
facilitation)
Embedding knowledge: 12 weeks later
assess ability to apply methods to issues identified in data
(without facilitation)
Align to normal business: 12 weeks later
comprehensive ward accreditation process
Clinical Leadership
In wards that were successful in achieving and
maintaining silver or gold:
• Leaders with clear vision and good
communication
• High level of staff involvement and engagement
in IQP work
• Good understanding of data and methodology
Ward Accreditation Process
• Data review
• Observation
• Culture of continuous improvement
• Environment of care
• Communication about and with patients
• Nursing processes
• Discuss findings of observation and review in
context of data
• Score standards as White, Bronze, Silver or
Gold
• Overall score validated at panel review
Aims to…
Support ward leaders and their staff in….
• achieving the best patient experience
on their ward through continuous
improvement work
• thus provide a level of assurance to the
board about the quality of care on wards
and departments
As measured by…
• Number of wards assessed and rated
• Improvements in Quality Care
Dashboard data
• Findings of external assessors including
CQC
• Staff and Patient survey results
How are we doing?
Number of wards achieving overall results as
Gold, Silver, Bronze or White
30
25
20
15
10
5
0
GOLD
SILVER
BRONZE
WHITE
number to
complete
Achieving Good Standards
% of wards acheiving silver or gold for each category
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90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Culture of
continuous
improvement
Environment of care Communication about Medicines - process
and w ith patients
Meals - process
Communication About Patients
Using Standardised Communication Tools
100.0%
95.0%
Core
Huddle
90.0%
85.0%
80.0%
Status at
a Glance
Boards
75.0%
70.0%
90%
target line
65.0%
60.0%
Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11
Improving Risk Assessments
Documentation - Risk Assesments Completed Within Timescale
100.0%
95.0%
Falls
90.0%
Bed rails
85.0%
Pressure
ulcers
Nutrition
(adult)
Continence
80.0%
75.0%
70.0%
90% target
line
65.0%
60.0%
Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11
Medications - Ensure Drugs Fridge Locked
100.0%
95.0%
90.0%
85.0%
80.0%
75.0%
70.0%
65.0%
60.0%
Apr-11 May-11 Jun-11
Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11
Focus on Process
Meals - Offering Hand Wipes With Meals
100.0%
95.0%
90.0%
85.0%
80.0%
75.0%
70.0%
65.0%
60.0%
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Supporting White Wards
• Understanding that areas are safe
• Diagnostic assessment
• Individual support for ward manager
• Blended approach to providing support
to ward team to achieve improvement
Celebrating Gold
“Never tell people how to do things.
Tell them what to do and they will
surprise you with their ingenuity”
George S Patton