Transcript Turning national guidance into local reality AGM

Turning national guidance into local reality
Julie Windsor
Patient Safety Clinical Lead – Medical Specialties/ Older People
13th October 2016
What I’m going to cover.
Links between national audit data and other
drivers to enhance improvement work
Engaging with patients to ensure data
improves services important to them
Linking data with CQC inspection
NHS Improvement Falls Collaborative
In-patient falls audit
• Most commonly reported patient
safety event in hospital
• Over 600 reported per day in
England and Wales (>200,000 a
year)
• Not all result in injury but affects
confidence and increases anxiety
• >2500 hip fractures occur in
hospital (4.2%)
• £15 million per year
How do we prevent falls in hospital?
• No easy answer
• Multiple interventions performed by MDT
reduces falls by 20-30%
• Patients with dementia and delirium at particular
risk
• NICE CG161 and NPSA guidance
• Audited all hospitals in England and Wales (and
Northern Ireland)
Audit Design
Organisational Audit
• Section 1- organisational
details including data for
falls/1000 OBD
• Section 2- policies and
protocols
• Section 3- leadership and
service provision
Participation 96% trusts and
LHB’s
Clinical Audit
• Section 1- evidence of
assessment and
intervention by case note
review
• Section 2- bedside
assessment
Participation 90% trusts and
LHB’s
Organisational results
• Everyone has a Falls Prevention Policy- no relation
between this and what actually happens
• 85.3% have a falls steering group, multi-disciplinary
working group or sub group
• 73.1% use a falls risk prediction tool- NOT advised!
• 50.7% audit their bedrail use
Key recommendations for Trusts and
LHB’s
1 Falls steering group –board-level falls steering
group that has representation from and reports to
the board. Review trends in falls/1000 OBD’s
2 Falls multidisciplinary working group –that meets
regularly, and that they reviews the activities of the
falls service. This group should monitor
interventions to improve prevention of falls in
hospital and use proven methods to embed these
changes.
Key recommendations for Trusts and
LHB’s
3 Do NOT use a fall risk prediction tool –
This is a tool identifying high/low risk
None are predictive of falls
Assess:
a ALL patients aged 65 years or older
b patients aged 50–64 years who are judged by a
clinician to be at higher risk of falling because of an
underlying condition.
Key recommendations for Trusts and
LHB’s
4 Audit bed rail use –regularly audit the use of bed rails
against their policy and embed changes to ensure
appropriate use.
5 Review multifactorial falls risk assessments (MFRAs) –
review their MFRA and associated interventions to include all
the domains in this audit.
Key clinical data national results
Or put another way…
•
•
•
•
•
•
•
6/7 patients didn’t have a l and s BP
Half didn’t have a clear medication review
2/3 didn’t have a delirium assessment
Half didn’t have a vision assessment
1/3 couldn’t reach their mobility aid
1/5 couldn’t reach their call bell
So there is a lot of room for improvement!
Key indicator recommendations
6 Dementia and delirium –review their dementia and
delirium policies to embed the use of standardised
tools and documented relevant care plans.
Falls teams should work closely with dementia and
delirium teams (if present) to ensure team working
for these high-risk patients.
Key indicator recommendations
7 Blood pressure –all
patients aged over 65 years
should have a lying and
standing blood pressure
performed as soon as
practicable, and that actions
are taken if there is a
substantial drop in blood
pressure on standing.
Key indicator recommendations
8 Medication review –
We recommend that all
patients aged over 65
years have a medication
review, looking particularly
for medications that are
likely to increase risks of
falling.
Key indicator recommendations
9 Visual impairment – all
patients aged over 65
years are assessed for
visual impairment and, if
present, that their care
plan takes this into
account.
Key indicator recommendations
10 Walking aids –
A- all trusts have a system in
place to ensure patients get the
appropriate walking aid on
admission
B- Regular audits should be
undertaken to assess whether
the policy is working and
whether mobility aids are within
the patient’s reach, if they are
needed.
Key indicator recommendations
11 Continence care plan –all
patients aged over 65 years
have a continence care plan
developed if there are
continence issues, and that the
care plan takes into account
and mitigates against the risks
of falling.
Key indicator recommendations
12 Call bells – We recommend
that all trusts and health
boards regularly audit whether
the call bell is within reach of
the patient and embed change
in practice if needed.
CQC Inspection – a driver for improvement
20
Anywhere Hospital
National Audit of Inpatient Falls
Metric
53
cases
Case Ascertainment
All patients
CQC Key
Question
2015²
Report
National
Aggregate
(England)
National
Aspirational
Standard
Not reported for this audit
Well led
Audit’s rating
n/a
Does the trust have a multidisciplinary working group
specifically for falls prevention
where data on falls and falls
resulting in harm, severe harm
and death per 1,000 OBDS is
discussed at most or all the
meetings.?
Effective
Yes
n/a
yes
n/a
Proportion of patients who had a
vision assessment
Safe
53.3%
48.3%
100%
Between 50 and 79%
Proportion of patients who had a
lying and standing blood
pressure assessment
Safe
22.4%
16.1%
100%
Less than 50%
Proportion of patients assessed
for the presence or absence of
delirium
Safe
85.6%
35.6%
100%*
More than 80%
Proportion of patients with
appropriate mobility aid in reach
Responsive
83.7%
68%
100%
More than 80%
1 Xxx 1x- Xxx 1x
2 May 15
* NICE Clinical Guideline
Anticipated date of next
update is mm/yy
21
NHS Improvement – support for improvement
22
Who are NHS Improvement?
Patient Safety function from
NHS England
(including National Learning &
Reporting System)
Strong regional presence to support 238
NHS and Foundation Trusts.
Support improvement (national and
local)
Work alongside providers
Support local systems in agreeing
longer term solutions and delivering
them
Provide balance between support
and regulation
Work closely and collaboratively with
other national bodies, especially NHS
England and CQC
Provide leadership support,
24
Key role to share best practice and
reduce variation
 Develop a national approach to improvement that supports local
capability, aspiration and energy.
 Ensure focus is on the quality of patient care.
 Create a culture of continuous improvement.
 Current nurse led improvement programmes include:
o
o
o
o
25
Pressure Ulcers
1:1 Nurse care
Infection, Prevention & Control Collaborative
Falls Collaborative launches on 19th October.
NHSI Falls Collaborative
Based on national audit indicators
Main purpose to:
 Reduce incidence of falls and
harm
 Encourage increase in quality
of reporting to support learning
 Increase quality of interventions
 Reduce variance in adherence
to evidence based approaches
26
Other influencing opportunities
27
Summing up
 National audit extremely well taken up
 Provided high quality data
 Focussed provider and national body attention
 Provided a ‘road map’ for improvement
Thanks for listening …Any questions?
[email protected]
28