What is risk management?

‘Active Risk Management at Rotherham’

Rotherham NHS FTQUEST presentation

24th June 2011

Dr Trisha Bain

What is risk management?

‘Risk management is the identification, assessment, and prioritisation of risks followed by coordinated and economical application of resources to minimise, monitor, and control the probability and/or impact of negative events or to maximize the realisation of opportunities’

QUEST topicsVTE

Falls, Pressure Ulcers, UTIs• Falls care pathway

assessments• Pressure ulcer

assessment , including MUST

• UTIs – blood sampling method to accurately identify catheter related UTIs

Identification of risks • Web Datix Incident • Web Risk registers • Serious Incident process• Mortality reviews (Trust and CSU MDT)• Global Trigger• NICE/NCEPOD, National Audits • CHKS :national and peer benchmarking

Monitoring and prioritisation of risks

Assessment and management of risk across pathways: Falls • A&E: Falls and Fracture pathway (50-75yrs)• Referral Osteoporosis and Bone Health Clinic• Referral to community: home safety

assessment, falls management• FNOF pathway were appropriate• Ward Falls assessment and MDT Action Plan• Discharge forms to the community team

Community to BoardMonitoring and ImprovementProgrammes

• SNAP electronic data collection tool• All wards, community sampling• Automated ‘real-time’ feedback reports• Linked to quality accounts programmes

% Patient assessment completion

Hospital Acquired Pressure Ulcers by Month and Grade

PATIENT SAFETY & EXPERIENCE% Patient assessment completion

PATIENT SAFETY & EXPERIENCENumber of incidents per month by type

0

10

20

30

40

50

60

70

80

90

100

110Bed railsassessmentcompleted

Bed railassessmentactioned

Falls assessmentcompleted

Falls assessmentactioned

0

10

20

30

40

50

60

70

80

90

100

Falls

Medicationerrors

All Incidents

0

1

2

3

4

5

6

7

8

9

10

Grade 1 Grade 2 Grade 3 Grade 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

0

10

20

30

40

50

60

70

80

90

100

110

Nutritionalassessmentcompleted onadmission

Smoking statusdocumented

Smoking cessationrecorded in nursingnotes

% Patient assessment completion

Hospital Acquired Pressure Ulcers by Month and Grade

PATIENT SAFETY & EXPERIENCE% Patient assessment completion

PATIENT SAFETY & EXPERIENCENumber of incidents per month by type

0

10

20

30

40

50

60

70

80

90

100

110Bed railsassessmentcompleted

Bed railassessmentactioned

Falls assessmentcompleted

Falls assessmentactioned

0

10

20

30

40

50

60

70

80

90

100

Falls

Medicationerrors

All Incidents

0

1

2

3

4

5

6

7

8

9

10

Grade 1 Grade 2 Grade 3 Grade 4

Qtr 1

Qtr 2

Qtr 3

Qtr 4

0

10

20

30

40

50

60

70

80

90

100

110Nutritionalassessmentcompleted onadmission

Smoking statusdocumented

Smoking cessationrecorded in nursingnotes

B3 Ward Quality Indicators

B2 Ward Quality Indicators

Local level monitoring

Falls from height: April 2009 – March 2011

Falls same level April 2009 – March 2011

Trust wide monitoring

National benchmarks of reported slips, trips and falls in acute (NPSA 2010)

hospitals

VTE90% target metevidence ofactions

Proxy measures

Linked to improvement programmes: Quality Accounts

•Linked to Improvement programmes

•On-going : Mortality. Fluid balance and MUST tool

• CQUINs, National Priorities

• Reducing 30day re-admission rates for Falls, Diabetes,

COPD•Continue to achieve month on month 90% VTE risk assessment

•Ensure 90% of VTE prophylaxis prescribed as per national guidance

• Increasing responsiveness to our patients needs on composite indicator (PET)

• Increasing compliance to 95% of key measures of End of Life care pathway

• 95% high risk prescriptions, opiates, anticoagulants, antibiotics prescribed as per protocol

• Reduce number of communication incidents : handover/hand-off

• Continue to have zero Never Events

Patient Safety

Patient Experience

KPIsClinically Effective

Continuous improvementand management of risks

1 Quality Account indicators at a glance

Baseline type

Baseline period

Baseline Value Target QTR 1 QTR 2 QTR 3 QTR 4 Year to

DateQTR

ChangeYTD

RatingData

Rating

Employee sickness rates (unplanned) Quarter Qtr 4 2009/10 4.8% 3% 4.0% 3.9% 4.3% 4.4% 4.2%

National Inpatient Survey - % of questions where the trust's performance is in the top 20% of trusts nationally Year 2009/10 16.9% Increase 23.4% 23.4% -Staff satisfaction survey - number of key findings in the top 20 percent of 40 domains Year 2009/10 11 Increase 13 13 -Increased IR1 reporting (Datix) Year 2009/10 6555 Increase 1799 2065 1968 1920 7752

All applicable staff to have in year PDR Snapshot Qtr 4 2009/10 69% 100% 61.9% 57.8% 44.1% 56.2% n/a -All staff receive mandatory and statutory training (data quality issues are significant)

Reduction in hospital acquired UTIs (related to catheterisation) per 1,000 occupied bed days 2 Qtrs Qtrs 3/4 2009/10 0.12 50% baseline 0.14 -

Reduction in intrapartum stillbirth rates Year 2009/10 0.0% Reduce 0.0% 0.1% 0.0% 0.0% 0.0%

Reduction in unexpected neonatal admissions (babies over 2.5Kg) Year 2009/10 8.7% Reduce 9.9% 10.1% 4.9% 6.6% 7.9%

Reduction in Caesarian Section rates Year 2009/10 22.0% Reduce 18.4% 21.3% 16.3% 20.7% 19.2%

Number of patients with hospital acquired MRSA Year 2009/10 5 3 0 0 0 0 0

Patients with hospital acquired Claustridium Difficile Year 2009/10 43 Reduce 22 5 7 16 50

Inpatient falls (from height) per 1,000 inpatient admissions Year 2009/10 4.4 Reduce 4.6 4.0 4.7 5.9 4.8

Inpatient falls (same level - SLIP) per 1,000 inpatient admissions Year 2009/10 5.7 Reduce 5.6 6.3 6.6 5.8 6.1

Patient medication errors per 1,000 dispensed item episodes Year 2009/10 1.1 Reduce 1.6 1.7 1.6 1.6 1.6

'Never' events that occur within the hospital Year 2009/10 0 0 0 0 0 0 0

Reduction in the number of complaints from baseline Quarter 4 Qtr 4 2009/10 171 Reduce 168 140 162 181 651

Increase in the number of patients on the end of life care pathway Year 2009/10 28.7% Increase 33.6% 43.9% 42.9% 45.7% 41.6%

Increase in the number of patients assessed using the MUST nutritional tool on admission (SNAP) Quarter 1 2010/11 89.2% 100% 89.2% 93.0% 89.0% 92.6% 91.1%

Reduction in hospital acquired pressure ulcers grade 2 and above (Datix) Year 2009/10 267 Reduce 66 43 58 51 218

Increase in the number of patients undergoing VTE assessments from baseline Month Jun-10 53.2% 90% 53.2% 57.7% 66.8% 88.5% 64.9%

Increase in patients on Hip & Knee replacement bundle (calculated on combined raw data from 3 indicators) Quarter 1 2010/11 96.3% Increase 96.3% 96.4% 96.9% 94.3% 95.9%

Appropriate reduction in LoS for patients following (EL & NEL) surgical intervention (CHKS) Quarter 4 2009/10 1.4 Reduce 1.5 1.3 1.2 1.2 1.3

Reduction in 'Risk Adjusted Mortality Indicator' (RAMI 2010 by CHKS) Year 2009/10 93.6 80.0 76.7 73.9 88.8 79.3 79.7

Reduction in unplanned readmission rates within 28 days (CHKS) Year 2009/10 7.5% Reduce 8.4% 8.3% 7.9% 6.4% 7.7%

Reduction in unplanned readmission rates within 14 days (CHKS) Year 2009/10 5.4% Reduce 6.1% 6.0% 5.8% 5.0% 5.7%

Increase in depth of coding - Average diagnosis per coded episode (CHKS) Year 2009/10 2.6 Increase 2.9 3.0 3.1 3.1 3.0

Clinical Quality

Data Quality

Culture

Annual survey

Annual snapshot audit

Annual survey

Insufficient data quality to report

Patient safety

Patient Experience

Any Questions