Great expectations: a patient safety story ….

Great expectations: a patient safety story ….

Sue SmithExecutive Director of Nursing & Patient SafetyDirector of Infection Prevention & Control

• In 2008:– HSMR 131– MRSA bacteraemia 12– C-difficile 158

• So we – Made patient safety, quality of

care and experience our No.1 priority

– Signed up to national patient safety campaigns

The story begins….

Patient Safety First

Leading Improvements in

Patient Safety

Clinical leadership

• Monday SUI panel• Monthly GTT reviews• Mortality reviews• Time-out Drs and nurses

– one healthcare record• Shared learning & action• Role modelling

What will we do? By how much? How will we measure it?

Rationale Comments

Reduce mortality Top 25% nationally by 2014

Top 10% nationally = stretch target

Dr Foster

HED data

We aim to save more lives every

year

Year 10/11 11/12 12/13 13/14

Target 95 90 85 80

Stretch 85 80 75 70

Actual 95 92

How will we reduce mortality?

Min target Stretch target By when Trajectory

Reduce HA MRSA

bacteraemia

20% reduction against 2008/09

baseline of 9

50% reduction against 2008/09

baseline of 9

2014 Year 10/11 11/12 12/13 13/14

20% 6 6 5 5

50% 5 5 4 4

Actual 4 0

Reduce HA Clostridium Difficile

20% reduction against 2008/09 baseline of 158

50% reduction against 2008/09 baseline of 158

2014 Year 10/11 11/12 12/13 13/14

40% 127 120 115 110

50% 120 100 90 80

PCT 129 59 44

Actual 53 68

Reduce cardiac arrests year on

year

5% reduction against 2010/11 baseline of 129

30% reduction against 2010/11 baseline of 129

Yearly until 2014 Year 10/11 11/12 12/13 13/14

5% 129 123 117 111

30% 129 90 63 44

Actual 129 91

What will we do? By how much? How will we measure it?

Rationale Comments

Reduce mortality Top 25% nationally by 2014

Top 10% nationally stretch target

Dr Foster

HED data

We aim to save more lives every

year

Year 10/11 11/12 12/13 13/14

Target 95 90 85 80

Stretch 85 80 75 70

Actual 95 92

How will we reduce mortality?

Min target Stretch target By when Trajectory

Reduce inpatient fractures

50% = 17 less fractures

75% = 26 less fractures

2014 Year 10/11 11/12 12/13 13/14

50% 24 22 20 18

75% 20 18 15 9

Actual 24 20

Ensure no never events occur

Zero never events Zero never events 2014 Year 10/11 11/12 12/13 13/14

Target 0 0 0 0

Actual 0 3

Physiological observations recorded:At initial assessment

Cycle Heart Rate Respiratory Rate

Systolic BP

Conscious level

Oxygen saturation

Temperature

1

(n=490)83% 73% 81% 11% 74% 78%

5 (n=447)

99% 98% 98% 97% 98% 98%

6 (n=451)

98% 97% 98% 91% 98% 97%

7 (n=440)

99% 97% 99% 91% 98% 97%

Cardiac arrests

Quarter / Year Apr- Jun 10

Jul- Sept 10

Oct-Dec 10

Jan- Mar 11

2010 – 2011 cardiac arrests

22 28

[50]

38

[88]

41

[129]

2011 – 2012 cardiac arrests

29 12

[41]

28

[69]

22

[91]

InfectionYear 2008-2009 2009-2010 2010-2011 2011-2012

(Apr-Feb)

MRSA bacteraemia 9 5 4 0

Clostridium difficile 158 136 53 68

Complaints & complimentsYear 2009 2010 2011

Complaints 358 341 371

Compliments 2,212 3,786 5,087

The latest data available from the [March 2012] North East Quality Observatory System report the 2010-2011 overall inpatient experience measure for the Trust as

77.7 against a national mean score of 74.9.

Mortality

CQC Quality Risk Profile

Outcome Number Outcome Description

Previous Risk Estimate

Current Risk Estimate

Total Number of Items

Number of Qualitative Items

Number of Quantitative Items

1 (R17) Respecting and involving people who use services Low Green High Green 106 20 86

2 (R18) Consent to care and treatment High Green High Green 5 0 5

4 (R9) Care and welfare of people who use services Low Neutral Low Green 182 20 162

5 (R14) Meeting nutritional needs Low Neutral Low Neutral 21 6 15

6 (R24) Cooperating with other providers High Green Low Green 11 1 10

7 (R11) Safeguarding people who use services from abuse

Insufficient Data

Insufficient Data 1 0 1

8 (R12) Cleanliness and infection control Low Neutral High Green 63 4 59

9 (R13) Management of medicines Low Neutral Low Neutral 14 0 14

10 (R15) Safety and suitability of premises Low Green Low Neutral 46 2 44

11 (R16) Safety, availability and suitability of equipment Low Neutral Low Neutral 13 1 12

12 (R21) Requirements relating to workers Low Green Low Green 5 0 5

13 (R22) Staffing Low Green Low Green 30 0 30

14 (R23) Supporting staff Low Green Low Green 62 0 62

16 (R10) Assessing and monitoring the quality of service provision Low Green Low Green 40 0 40

17 (R19) Complaints Low Green Low Green 8 0 8

21 (R20) Records Low Green Low Green 66 0 66

November 2011data

• National / local financial climate• £40m challenge• New hospital• Operating framework• Commissioning for Quality and Innovation

(CQUIN) - £2,741,067 plus £405,700• Regulation – CQC/Monitor/CCGs….• Quality accounts / Quality Strategy

Where next?

So far, we know that clinical leaders and good teamwork….

Saves lives – What next?