2017/2018 - Hospiscare · 2017-09-15 · 2017/2018. Hospiscare Quality Account 2017 3 ... their...

1Hospiscare Quality Account 2016

Because every day matterswww.hospiscare.co.ukRegistered charity no. 297798

Annual Quality Account2017/2018


Chief Executive’s statement

I am delighted to present our Quality Account for 2017. I do hope you will enjoy reading about how we have consolidated and developed our services following last year’s overall ‘Outstanding’ rating from the Care Quality Commission, and the ways in which we are continuing to expand our offering.

In July 2016, our Director of Nursing Mrs Liz Gibbons retired, having steered us with flying colours through our first Care Quality Commission (CQC) inspection under their new approach. Mrs Tina Naldrett has now joined us as our Director of Care and is leading our clinical teams. Tina brings to Hospiscare a wealth of experience from senior roles within the NHS as well as wide expertise in dementia care.

We have continued to develop our Hospiscare@Home service with support and funding from our partner Hospiscare charities in East Devon. The evidence from trialling this service in Seaton has been overwhelmingly positive. It is highly valued by patients, their families and local health and social care professionals, not least because it helps more people to be cared for in their own homes. We want everyone on our ‘patch’ to benefit from this service and will continue to expand it as our finances allow.

We are delighted to be employing the first specialist palliative care Admiral Nurse in the South West. Admiral Nurses are experts in dementia care and ours will work alongside our clinical teams to provide specialist knowledge and advice. Increasingly, Hospiscare is supporting patients who are living with a diagnosis of dementia, as well as another life-limiting illness.

We have redesigned our day hospice services to take a rehabilitative approach and, thanks to a grant from St. James’s Place Foundation, have been able to employ an occupational therapist to take this forward. We continue to reach out into our local community from our day hospices in Exeter, Honiton and Tiverton. The number of highly trained volunteer care navigators in our team now stands at 48, and they do an amazing job of supporting patients and families and helping them to find their way through the health and social care system.

Hospiscare Quality Account 20174 7

Lastly, we have valued the opportunity to support the Devon Sustainability and Transformation Plan in collaboration with the other adult hospices in Devon. We hope that this will strengthen and improve access to, and the quality of, end-of-life care in Devon in the coming years.

None of this would have been possible without the dedication and commitment of our amazing clinical teams and the support they receive from our fundraisers, support staff and volunteers. Thank you for your passion and determination to improve end-of-life care in Devon.

Glynis Atherton

Chief Executive

“My husband passed away two days ago. He got his dearest wish – to remain at home. Without the Hospiscare@Home nurses I am sure I would not have coped. To have their help at the end of a phone, day or night, was exceptional. The nurses became our friends and my husband and I spoke together about how lucky we were to have such wonderful support. Thank you so much for the wonderful service you provide.”


Northern Eastern and Western Devon Clinical Commissioning Group Statement September 2017

Northern, Eastern and Western Devon Clinical Commissioning Group (NEW Devon CCG) are pleased to have the opportunity to comment on the 2017/2018 Quality Account from Hospiscare, to look back on successes and look forward to in-year progress.

This Account is a clear and concise way for commissioners to be assured of how well services deliver care for the general public in Devon. The CCG recognises the need for good quality end-of-life care and the collaborative approach taken by Hospiscare. This is particularly important with the introduction of the new Sustainability and Transformation Plan (STP) and the alignment and joint working with all areas of health and social care across NEW Devon CCG.

The Quality Account shows a continued willingness to work on improvements in service delivery with an emphasis on quality for patients and carers, building on the strong foundation established by Hospiscare in their previous years as a provider. Being able to deliver quality care at the most difficult time for patients and their families is challenging, and the compassion and support offered by Hospiscare is clearly captured in this report.

There is an emphasis, displayed here, on a service that understands the importance of the choices and wishes of a person and a family as they approach end of life. Hospiscare offers that necessary and essential support, for the most part in people’s homes. This report clearly reflects this choice and the willingness of Hospiscare to provide an excellent level of care around this national and local agenda.

Hospiscare Quality Account 20176

Hospiscare forms part of the newly appointed Sustainability and Transformation Planning, End of Life Steering Group. This group collaborates on shaping palliative care services for the whole of Devon, offering a strong voice, leading on issues and projects that offer long-lasting benefit to services and the public of Devon and the South West.

We would also like to welcome Mrs Tina Naldrett in the role of Hospiscare’s Director of Care. Tina brings a wealth of experience in community services and was previously a Trustee. This experience, along with considerable knowledge gained from her work in community hospitals across Devon, will enhance the future shape of services for end-of-life care.

Priorities for 2016-17

Priority 1: Develop Hospiscare@Home service: The NEW Devon CCG would like to acknowledge the work of the community team in Seaton, supported by Seaton Hospital League of Friends, in the delivery of a successful trial.

Priority 2: Develop a rehabilitative model in day hospice services: The range of rehabilitative services available through the pilot are comprehensive, and we look forward to seeing how the service is rolled out across other settings.

Priority 3: End-of-life care for people with dementia: We acknowledge the grant for the clinical nurse specialist who was employed for 18 months and the contribution to inform the service improvement agenda for this vulnerable group of patients.

Priority 4: Working to develop better access to end-of-life care: Better access to care is also a priority of the NEW Devon CCG, and collaborative working on this agenda will benefit the whole health care community.

The NEW Devon CCG looks forward to continuing to work closely with Hospiscare and all palliative and end-of-life care providers in 2017-18. The priorities for 2017-18 are appropriate and will improve existing arrangements and establish new services offering care for patients and families.

Hospiscare continues to prioritise moving care close to home and looking after people in the most appropriate care setting. They intend to increase their day hospice offering through 2017-18 and are looking to improve access to care for the varied population that makes up Devon.

The NEW Devon CCG will also be placing an emphasis on the availability and quality of training across Devon in 2017-18 and would hope to link closely with Hospicare and all palliative-care providers in order to improve the training offer this year.


The assurance offered by the safeguarding and quality aspects of this report tells us about the high-quality care that is being delivered by Hospiscare and reflects the work that is going on with regard to the priorities for both 2016-17 and the current work taking place in 2017-18.

The NEW Devon CCG is assured that complaints and serious incidents are dealt with in a robust way and that CQC inspections have resulted in an outstanding review.

Hospiscare is looking at a range of rehabilitative services for their day hospice offer and the range and scope in improving people’s lives, with the focus on anxiety, depression and pain management. The NEW Devon CCG looks forward to seeing the positive impact that this will have over the next 18 months.

The previous year has been another successful one for Hospiscare, and the NEW Devon CCG looks forward to a continued collaborative approach to advancing the service improvement agenda for end-of-life provision. Hospiscare is to be commended on their positive and active contribution to this agenda.

Lorna Collingwood-Burke

Chief Nursing Officer

NEW Devon Clinical Commissioning Group

What we believe Hospiscare’s values

Because we value dying as an important part of living and believe that every day matters to people approaching the end of their lives, we;

✓ Put the needs of patients, and those close to them, at the centre of what we do

✓ Provide timely and accessible services

✓ Make the best use of our resources

✓ Act fairly according to the needs of patients and our staff, both paid and voluntary

✓ Are sensitive, honest and clear in all our communications

✓ Respect everyone’s contribution to our service, and work co-operatively in teams.

8 Hospiscare Quality Account 2017

What we do Hospiscare is a local charity that delivers adult end-of-life care to people across Exeter, Mid and East Devon.

Our specialist teams at Searle House in Exeter, the Royal Devon and Exeter Foundation Trust (RDEFT), at our day hospices and in the community deliver expert treatment, care and support to patients and their families. All our services are supported by the extraordinary efforts of our team of volunteers and are free at the point of delivery.

Hospiscare Community Nursing Teams

Hospiscare has a caseload at any one time of between 650-700 adults living with a life-limiting illness. Most of these people wish to remain in their own home, or within a familiar community setting, supported by the expertise of our community palliative care teams.

The teams are organised in five clusters based at GP surgeries, community hospitals as well as Hospiscare’s facilities. They work closely with NHS and social care teams to meet the needs of individual patients and their families. The person with the illness is central to our care and the specialist nurses, registered nurses and assistant practitioners work together to provide the best possible personalised care, irrespective of diagnosis or circumstance.

Our community nurses have immediate access to Hospiscare’s multi-disciplinary team based at Searle House. The team, in partnership with hospice ward staff, provides a seven-day service and an overnight advice line for patients, carers and our health and social care colleagues. This means that people can access our expert knowledge and advice whenever they need it.

The community nursing team includes a Hospiscare@Home service in Seaton which is funded by the Seaton Hospital League of Friends.

Medical Support for Hospital Patients

The RDEFT funds sessions from our team of doctors who work alongside colleagues at the hospital. Our doctors visit patients and their families on the wards and recommend treatment and options for their future care.

The doctors work closely with other services provided by Hospiscare, as well as with NHS and social care teams.


They do their best to ensure that, with the patient’s permission, appropriate information is shared with colleagues to achieve the best possible outcome for them and their family.

The Ward at Searle House

The ward provides 12 beds for patients whose symptoms are complex and difficult to manage or who require round-the-clock nursing care at the end of life. Hospiscare employs consultants and doctors in palliative medicine who are available to assess and respond to patients’ medical needs 24 hours a day.

Searle House provides treatment and care in a pleasant, comfortable environment with maximum emphasis placed on comfort and dignity. Overnight accommodation is available for visitors, and our staff will do everything in their power to meet the needs and wishes of patients and their families. Our chefs prepare and freshly cook all meals on the premises.

Hospiscare Day and Supportive Care Services

Hospiscare provides day hospice services at three centres: Pine Lodge in Tiverton, Searle House in Exeter and Kings House in Honiton. Our day hospices are staffed by trained nursing staff and volunteers and together they provide an individualised patient needs assessment and regular clinical review, as well as a programme of activities. The range on offer includes creative arts, complementary therapies, bathing, exercise and relaxation groups as well as social activities. Where needed, transport to and from each day hospice is offered by volunteers.

Day hospices offer significant benefits to patients and their families when a life-limiting illness makes it hard to get out, curbs normal physical activities or causes social isolation and loneliness. Carers and families can enjoy time to themselves without worrying about their friend or loved one. Our Mid Devon day hospice, Pine Lodge, also offers a dedicated service for patients who have dementia as well as a life-limiting illness. This provides quality care for patients and a vital period of respite for their families and carers.

We also provide a range of supportive care services from allied professionals who make up our multi-professional team. This includes care management and onward care planning, referral to other agencies, religious and spiritual care and complementary therapy, as well as bereavement care for patients and family if required. These services are based at Searle House in Exeter, but also available via our day hospices to any patient who is referred to us.


What we do (continued)

Care Navigators

We have recruited and trained a team of 48 volunteer care navigators. These volunteers support individual patients and their families for the duration of their illness. They provide emotional and practical support, helping patients to navigate the health and social care system and linking them to useful agencies and networks.

Learning and Development

Our Learning and Development team works with local and regional colleagues to share good practice through education events on topics relating to end-of-life care. Hospiscare is committed to supporting our staff, volunteers and others in their professional and personal development. We offer a range of education events, placements and learning opportunities to help inform and educate

“Thank you for all the care you showed my Dad during his short stay with you. You made his last few days painless and comfortable, especially his bath he had - he really loved that, and his foot massage. A special thanks to Neil who connected with Dad and became a friend to him. We will never forget what you did.”A patient’s daughter


Activity for period April 2016 to March 2017Community team

People who are supported by Hospiscare’s community nursing team are more likely to achieve their wish to reach the end of their lives at home than people who die without this type of expert support.

2,524 patients supported

25,012 telephone calls

14,473 home visits

43% Patients Home

15% Acute Hospital

10% Community Hospitals

17% Hospice

Patients in the care of Hospiscare’s community teams

15% Care Home


Hospital Support Team

Day Care Services

The Ward at Searle House

576 patients supported

5,295 day care places

331 admissions

46% of admissions to the hospice were from the RDEFT

1,994 face to face visits

‘Throughput’ (number of admissions per bed, per annum) was 28, which reflects the acute nature of admissions

Pine Lodge, our Mid Devon day hospice offers one day specifically for patients with co-morbidities including dementia

28

8Average length of stay 8 days


Review of Quality Performance in 2016

Priority 1

Develop Hospiscare@Home service

We said we would build on our successful trial in Seaton of Hospiscare@Home, a scheme that has been funded in partnership with Seaton Hospital League of Friends. The model reduces unnecessary admissions to acute care and enables speedier discharge for people who choose to be cared for and die at home.

During the team’s first full year of operation (September 2015 to August 2016) they cared for 152 people, of whom 82 died. Some 77% of patients expressed a preference about their preferred place of death and 95% of them achieved that aim, while 77% of patients died in their usual place of residence. The team recorded that

they avoided admission to acute care on 60 occasions.

In June 2017 this scheme was extended to Exmouth, Lympstone, Budleigh Salterton and Woodbury. These are areas with a disproportionately elderly population and we estimate that the new service will reach approximately 90 patients a year.

This development has been made possible by funding from Hospiscare’s partner charities, Exmouth & Lympstone Hospiscare and Budleigh Salterton & District Hospiscare. Exeter Hospiscare is the registered provider of this new service and has employed eight more nurses to deliver it.

“The service this charity provides is very special, to feel so supported and cared for at such a difficult time is just invaluable. I was able to carry out my best friend’s wishes, and feel very comforted that she died at home peacefully, just as she had wanted to.”


Patient experience of day hospice care

A young patient of ours who has motor neurone disease has told us about his experience of day hospice care.

He lives at home with his family and agreed with his Hospiscare community nurse that coming to the Searle House day hospice once a week would mean that he could enjoy the mutual support and company of other patients, as well as find out more about the hospice and enable his carer to have a break.

When at the day hospice he has also been able to access specialist advice about wheelchair adaptations and has enjoyed bringing his family to our Every Day Matters Café as well.

Following a review of our day services we said we would introduce a rehabilitative approach to day hospice care, which includes regular review, goal setting and access to a range of therapies.

Thanks to grant funding from St. James’s Place Foundation we have employed an occupational therapist who is implementing this approach and we have established a steering group, so that learning from this rehabilitative pilot project can be shared across Hospiscare settings.

We have started this work by looking at a range of tools that help patients and their carers identify their main concerns and their goals, and are now working with patients to establish how we can maximise their independence and encourage self-management.

By September we will have a suite of activities to support people to achieve their goals, including:

• Relaxation for pain and symptom relief, using yoga techniques

• Seated exercise classes

• Managing fatigue, anxiety and breathlessness (FAB) course.

To support this new model of working there is a planned education programme for staff and volunteer care navigators which will enable them to help patients and carers achieve the goals they have identified and review them regularly.

Priority 2

Develop a rehabilitative model in our day hospices

“Coming here makes a lovely change - to be able to meet other people. The opportunity to open up and say how I really feel without upsetting my family.”


We said we would improve end-of-life care for people with dementia. We developed a dementia strategy, recognising that people with dementia are at a high risk of receiving poor end-of-life care. Thanks to a grant from St. James’s Place Foundation we were able to employ a clinical nurse specialist for 18 months to provide support and education for our clinical teams. The two overarching aims of the project were to:

• Empower nurses and other health professionals with skills and confidence in working with people living with dementia, and their families

• Involve older people living with dementia and their families in every aspect of transforming services and developing staff, new roles and pathways.

Priority 3

End-of-life care for people with dementia

This project ended in March 2017 and was very successful in improving the capability of our staff and volunteers to support people with dementia. It involved individual casework, learning and an education programme, in which 177 people took part. It was found that our workforce’s knowledge of dementia had improved by 33%.

Following the successful completion of this project, we agreed to fund, jointly with Dementia UK, an Admiral Nurse with a specific end-of-life care brief, and we have now appointed Chrissy Hussey, who is the first hospice-based Admiral Nurse in the South West.

Admiral Nurses provide the specialist dementia support that families need. When things become challenging or difficult, the nurses work alongside people with dementia, their families and carers. They give them one-to-one support, expert guidance and practical solutions.

“Patients living with dementia and their carers will now have access to the appropriate level of support to enhance their quality of life and a greater understanding of the challenges and losses experienced throughout the trajectory of their dementia.”

Chrissy Hussey, Admiral Nurse


Priority 4

Working to develop better access to end-of-life careFollowing the publication of the Government’s commitment to end-of-life care in July 2016, we said we would continue to advocate for improvements in end-of-life care locally, specifically working collaboratively with the other Devon adult hospices to achieve this.

This year, the Devon hospices, NEW Devon CCG and South Devon and Torbay CCG have worked together to ensure that end-of-life care is incorporated into the Sustainability and Transformation Plan (STP). The Devon hospices held a workshop in March 2017 to develop an STP offer for end-of-life care in Devon, which has been agreed and a work plan is being implemented.

An important element in improving access to end-of-life care involves working with colleagues throughout health care to enable them to offer hospice-quality care.

Hospiscare provides education and advice for local health and social care professionals. Our commitment is not only to ensure our own workforce is fit for purpose, now and in the future, but that we empower others locally to provide a sensitive and skilled end-of-life care workforce.

The number of people attending our external courses remains consistent and we continue to work in partnership with a number of local health and social care organisations.

New initiatives in the year included increasing awareness and training on dementia through four, 90-minute workshops. To engage delegates, we developed a learning passport in which learners collected a stamp for each session attended. A total of 177 training places were filled by Hospiscare staff and health and social care colleagues. We have also produced videos about dementia to support professionals and carers in caring for someone with dementia. They have been posted on the Hospiscare website, where they have had a total of 300 views.

External delegates continue to attend our nurse masterclass, communication workshops, bereavement training and our suite of personal effectiveness courses. In total, we provided 1,231 classroom-based training places, up from 1,061 the previous year.

“I want to send the rest of my team! It was excellent.” Delegate to the Introduction to Communication course 2017


We plan to continue to expand our very successful Hospiscare@Home model. This has proved that it helps more people to die in their usual place of residence and is extremely well evaluated by patients, carers and local professionals.

Within a year, with the support of our partner Hospiscare charities, we intend that these services will extend throughout the coastal towns in East Devon, where there are disproportionately high numbers of elderly people in need of our care. We believe that Hospiscare@Home will become increasingly important as plans to reduce the number of community hospital beds in East Devon are implemented.

We have also identified a need for this model in Mid Devon where, in our experience, people’s desire to be cared for and die at home is often hampered by care services that cannot be relied upon because they are scarce in rural areas.

We plan to hold a public appeal for funding to enable us to introduce a Hospiscare@Home service in Mid Devon. For this service, we will develop a new hybrid nursing role that will be capable of offering both nursing and personal care.

We also plan to support this service with volunteer care navigators, the specially trained volunteers who provide additional support to patients and their families.

We will also continue to upskill our clinical nurse specialists, so that they can prescribe medication. This will reduce delays in patients at home having access to medication for symptom control.

Priorities for Service Improvement 2017- 2018

Priority 1

More care closer to home


Priority 2

Enhance our day hospice services in the community

We are in the process of implementing a plan to broaden these services and introduce a rehabilitative approach in our three day hospices.

We plan to deliver services under three main headings:

Being Social and Involved: so every day matters

Many Hospiscare patients and bereaved people are challenged by social isolation and loneliness. Our plan is to deliver a programme that prioritises social engagement, reduces isolation, provides fun activities and creates memories, and this year we will begin by running a creative arts programme and a film club. The programme will be delivered in our day hospice and be open to everyone within Hospiscare’s ‘extended family’.

We launched our Every Day Matters Pop-up Café in June 2017. It is open to all, and we have created it to become a place of welcome and support.

Being Active and Able: so I can make the most of every day

We intend to continue to embed a rehabilitation model in day hospice services, setting goals with patients to empower them to maximise their activity and independence. In order to support them we will introduce a variety of self-management courses and groups.

We plan to introduce more nursing and medical outpatient clinics, including working with RDEFT to offer chemotherapy across our sites and closer to people’s homes. Discussions regarding joint clinics and self-management courses are currently underway.

Being Informed - so I can decide and plan

During the coming year we intend to facilitate legal and financial advice clinics for patients, carers and bereaved people, as well as trialling different types of carers’ information courses and support provision.


Priority 3

Expand our service to people with illnesses other than cancer

We are aware that people approaching the end of life who have an illness other than cancer are less likely to benefit from specialist palliative care. The reasons for this are complex but we are committed to increasing access to good palliative care either directly, through new services, or indirectly, by supporting other providers to offer hospice-quality care.

Dementia Admiral Nurse

We have extended our support for people with dementia by collaborating with Dementia UK to employ an Admiral Nurse. Our aim is to enhance the quality of care at the end of life for people with dementia and their families.

In the coming year the Admiral Nurse will provide support to family carers and people living with dementia throughout the progression of their illness, primarily during complex periods of transition. In particular, this work will revolve around grief and loss in order to enhance adjustment and enable carers to cope with their caring role.

The Admiral Nurse specialist role will also provide education, leadership, development and support to colleagues within Hospiscare and other service providers. Working collaboratively across the board is a key element of this role and has helped to establish a creative dialogue between Hospiscare and Dementia UK.

Heart2Heart heart failure clinic

We plan to work more closely with the heart failure team at RDEFT. Some 30-40% of people diagnosed with heart failure die within a year but are referred infrequently for palliative care. Recent clinical trials have demonstrated the value of patients with a diagnosis of heart failure receiving multi-professional specialist palliative care. Benefits were seen in quality of life, advance care planning, symptom control and fewer hospital admissions.

RDEFT Enhanced Supportive Care programme

We plan to work more closely with the Enhanced Supportive Care programme at RDEFT. This programme blends palliative care options with active treatment, aiming to introduce palliative care at an earlier point in a patient’s illness.


Priority 4

Increasing access to end-of-life care throughout Devon

We plan to continue to work collaboratively with other Devon hospices, the CCG and STP to improve end-of-life care in Devon. We will support the STP end-of-life care work plan and task groups as they begin to develop the offer designed at the workshop in March 2017.

We are committed to continuing to educate and empower other health professionals by sharing knowledge, expertise and passion. To achieve this goal we are in the process of appointing a Clinical Nurse Learning and Development Lead. They will lead on work with providers developing bespoke packages to their individual needs. We will also provide a range of symptom management courses delivered at the hospice. New additions to the 2017-18 programme include: the use of defibrillation equipment, improving communication at handovers, verification of death, managing conflict and a workshop exploring spirituality. We continue to provide workshops on improving clinical skills, communication, bereavement and a suite of personal productivity courses.

We are aware of the need to ensure that hard-to-reach groups can access good quality end-of-life care. We plan to improve our monitoring of access to our services to identify any gaps, and we anticipate the need to address these gaps through direct service provision and education.


The CQC’s new approach to inspecting hospice services came into effect in October 2014 and includes gathering information from the hospice provider, the staff, other organisations they work with and patients and families before and during the inspection.

The inspectors consider six key areas in detail when examining the service under review:

Hospiscare was inspected using this approach in spring 2016. The service was rated ‘outstanding’ in four domains: effective, caring, well-led, and responsive to people’s needs, and it was rated ‘good’ in relation to safety.

You can view the full report on our website: www.hospiscare.co.uk

Since the inspection Hospiscare continues to improve its role of safeguarding vulnerable people and during the last year, since our CQC inspection, we have worked with both clinical and non-clinical teams to improve the safety of others

Quality Assurance and ImprovementThe Care Quality Commission (CQC) Inspection and Report

✓ Is it safe?

✓ Is it effective?

✓ Is it caring?

✓ Is it responsive to people’s needs?

✓ Is it sensitive, honest and clear in all our communications?

✓ Is it well-led?


Relevant for all staff and volunteers to have an awareness of what actions they should take during any safeguarding incident.

Hospiscare is a small but complex local organisation, whose employees and volunteers come into contact with a wide range of people, many of whom will be vulnerable adults or children.

Within our framework of safeguarding vulnerable adults, Hospiscare staff provide a safe environment for all those who use our service and have a responsibility, and therefore awareness, appropriate to their job role.

“At Hospiscare, we recognise that safeguarding is everyone’s responsibility, whether this relates to patients, carers, relatives, staff or volunteers. We have a duty to ensure that any child or young person under 18, and any vulnerable adult, is protected whether they are receiving a service from us or working for us as an employee or volunteer.”

Within Hospiscare there are three levels of safeguarding training which will give all staff the requisite skills and knowledge to work within this policy and keep our patients, families and colleagues as safe as possible. Our training includes:

LEVEL

Equips our managers and team leaders to act appropriately and assess the need for escalations or further support that may be required.

LEVELLEVEL

Equips senior staff with skills to discuss and escalate concerns. Hospiscare’s lead for safeguarding is Tina Naldrett, Director of Care. Our lead for mental capacity and deprivation of liberty is Dr Becky Baines, Medical Director. Both will have deputies, and will be accessible to staff who may need to discuss any complex areas of concern within their own safeguarding role.

Quality Assurance and Improvement

Hospiscare has a Quality Improvement Group and members are from all departments within the clinical teams: ward staff, day hospices, community palliative care team, supportive care team, infection prevention and control lead nurse and the medical team. This group meets quarterly and reports to the Hospiscare Quality Assurance and Improvement Committee.

LEVEL


The purpose of this group is to:• Monitor continuous improvement of the quality of care provided by Hospiscare • Reduce unwarranted variations within the service• Deliver the best outcome for every patient/service user• Improve patient experience

The group will review any initiatives that are occurring within Hospiscare. This could include:• Audit• Patient surveys/questionnaires, including IWantGreatCare• Feedback and complaints• Research• Significant incidents and debriefs• Service review• Create or update Hospiscare clinical policies or standard operating procedures• Service review• Education• Review local, regional or national guidelines that will affect the service, e.g. NICE

Guidelines, Hospice UK guidance, NHS initiatives

Audit: An audit programme over the year included 22 scheduled audits and three that were completed as a result of the need for service improvement.

Some significant audits have included:

AduitDocumentation of Equality and Diversity

To focus on documentation of Equality and Diversity

Documentation of age and martial status good but an improvement in collation of ethnicity, religion and sexual orientation is required

- Review of Equality and Diversity training

- worn items such as glove holder and lampshade. - A bath was left wet in places after use and some fluff matter in an air vent

Purpose Outcome Action

- Staff awareness sessions to share the completed audit- Prompts for staff to use within their communication skills to engage patients in these conversations

To review the weekly Hospiscare community team meeting with a Hospiscare Consultant (MDT)

To ensure all new, complex and deteriorating patients are assessed, presented and discussed by the team in line with the specialist Palliative Care National Guidelines

Advantage of advanced preparation of a list of patients to discuss to capture those patients to be reviewed and to have accurate information about them at hand

Meeting redesigned and results show an increase in number of patients being presented at the MDT meeting

Patient Led Assessment of Care Enviroment (PLACE) Audit on the Inpatient Unit Hospiscare

To assess how the environment supports patient’s privacy and dignity, food, cleanliness and general building maintenance

Minor areas of concern noted Issues passed on to relevant managers and acted upon.


We have introduced a service improvement initiative called Outcomes and Complexity Collaborative (OACC). This is intended to help hospices and other palliative care teams learn more about outcome measures, and start to introduce a shared set of outcome measures into clinical practice.

OACC looks at complexity of care, which includes caseload, resources and planning services, and measures outcomes, demonstrating that we have made a difference at individual patient and organisation level, and provides evidence for funding.

The measures are:

• Australian-modified Karnofsky Performance Status

• Phase of Illness

• Integrated Palliative-care Outcome Scale (IPOS)

• Views on care

• Barthel Index

• Zarit Carer Burden Interview

At present we have begun to use the Phase of Illness measure and the Karnofsky Performance Status measure and we are evaluating how teams are using them to influence and embed into their practice. We have a working group to refresh and update training for staff, to ensure that we are using the OACC tool effectively. In the next few months we plan to introduce the IPOS measure.

Outcomes and Complexity Collaborative


Sign up to Safety

During June 2017 Hospiscare pledged to improve patient safety by registering for Sign up to Safety. This national patient safety campaign helps healthcare environments in England build a safe place to be and address the problem of unsafe care and avoidable harm.

By joining Sign up to Safety we are demonstrating our commitment to focusing on patient safety so that all patients and the staff who care for them are free from avoidable harm.

Over the next three to five years, Hospiscare plans to focus on specific areas where local data shows that improvements can be made, and will be working collaboratively with our hospice colleagues in the South West to do so.


What patients and families say about our serviceIWantGreatCare

We examine and review all feedback, both good and bad, to learn from it and make changes where needed.

IWantGreatCare is a tool that collects feedback from patients and families and it helps us to identify good practice and opportunities for improvement.

Hospiscare is one of seven hospices in the south west which have commissioned this service, designing the questions and working together to improve outcomes for patients. IWantGreatCare reports are produced monthly and reviewed by our Quality Assurance and Improvement Committee and circulated to staff.

Our user experience key performance question is:

Are our patients and families receiving good care?

Our user experience key performance indicator is:

An IWantGreatCare minimum monthly score of 4.85 out of 5.00.

Hospiscare received 422 IWantGreatCare posts during the period under review.

In December 2016 we noted that our performance had fallen below the benchmark of 4.85 out of a possible score of 5. This was investigated and reported to the Quality Assurance and Improvement Committee. It was because during this month we had one patient out of three in one of our day hospices who replied that it would be “extremely unlikely” that they would recommend our service to family or friends. The survey is completed anonymously and so we are unable to discover why they

April 20164.96

May 20164.83

June 20164.71

July 20164.96

August 20164.96

September 20164.99

October 20164.97

November 20164.81

December 20164.74

January 20174.93

February 20174.86

March 20174.91


expressed this view; however, we noted that all three patients gave a score of 4 out of 5 or above, and all the narrative replies given were positive.

Significant event analysis Significant event analysis is conducted into an event or incident which could or did lead to an undesirable outcome for patients, staff or volunteers. The analysis is conducted in a manner of open enquiry to maximise learning and improve treatment and care.

Events are categorised as either external: mainly involving other agencies but reported by Hospiscare staff; or internal: occurring on Hospiscare premises and involving Hospiscare staff or volunteers.

Significant event Outcome Learning/changes

1. Miscommunication within Hospiscare teams about an admission of a patient to the ward

Internal

Unprepared, unorganised admission to ward

Teams to review their means of communication within their own team and with external colleagues

2. Miscommunication regarding medication to take home on discharge

Internal

Patient took wrong dose of Oramorph

Discharge medication to be added to GP letter and emailed directly to him/her.Patient’s own medication to be reviewed prior to more stock being ordered

3. Miscommunication with Hospiscare and external team about an admission of a patient to the ward.

Internal

Unprepared, unorganised admission to ward. Caused distress to the family

Teams to review their means of communication within their own team and with external colleagues

4. Incomplete and mislaid incident form regarding a pre-existing pressure ulcer

Internal

Delay in documentation and communication with external colleagues providing care prior to admission

Clear process for incident form reporting now completed

5. Verbal aggression to staff from visitors

Internal

Staff and family distressed Route of miscommunication identified. Staff and family debriefed.


Complaint Outcome Learning/changes

1. Concern raised by a relative of a patient about the support they received from Hospiscare and some miscommunication around provision of medication

Partially upheld

Resolution meeting held between the relative and Hospiscare Director of Nursing

Discussion had about the expectation and role of Hospiscare when working with other multiple agencies in providing care for a patient and family. Information about Hospiscare’s service given to patients and families reviewed.

2. Feedback from a relative about their experience whilst husband was a patient on the ward

Partially upheld

Letter of apology following her experience and face-to-face meeting held between the relative, Inpatient Services Manager and Hospiscare Clinical Nurse Specialist

Awareness of the importance of clear communication with patients and families and to have joint expectations

3. Concern raised by the daughter of a patient about her experience of communication with Hospiscare Community Palliative Care team and Northern Devon Healthcare NHS Trust community nursing teamPartially upheld

Joint resolution meeting held which Hospiscare attended.Full investigation completed, formal written feedback given

Apology given for any distress caused to the family.Team reviewed care provision and possible gaps in the service

Complaints about our service We welcome complaints, because they help us to review services, learn from experience and make changes where needed. We follow a documented complaints policy and offer the complainants an opportunity to meet with us to discuss their concerns. Complaints can be found to be: upheld (and found in favour of the complainant); partly upheld; or not upheld. We received six formal complaints in the period under review and the following table describes the key emerging themes.



4. Feedback from a relative, following a bereavement visit, about the negative experience received on the ward when returning after her family member’s death

Upheld

Letter and telephone call giving an apology completed

Investigation concluded that a change in staff meant that the relative was not known to those on duty.Readdressed staff communication skills when greeting someone they do not recognise

5. A relative raised a concern about a) communication she had with a Hospiscare nurse and b) management of medication to control symptomsUpheld

Full investigation completed, formal written feedback given, and face-to-face meeting offered but declined

Staff reviewed the communication between themselves and family members

6. Concern raised by the relative of a deceased patient about communication she had with a staff member

Upheld

Full investigation completed and formal written feedback given

Staff member awareness and reflection upon the communication had with the family member

We are pleased to share such a positive Quality Account with you. If you have any enquiries or would like more copies, please contact Tina Naldrett, Director of Care, email: [email protected].

Notes



Hospiscare, Searle House, Dryden Road, Exeter, EX2 5JJTelephone: 01392 688000 Fax: 01392 495981www.hospiscare.co.uk

Registered charity no. 297798

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