NHS North West DoNs Conference

Healthier Horizons

WelcomeChris Jeffries Acting Director of Workforce and Education NHS NW

Better Care Better Health Better Life

Welcome


Housekeeping

• Mobiles

• Fire Alarms

• Toilets

• Catering

• Reception desk


Today is about


Today is about

Celebrating nursing success


Today is about

Harnessing energy and enthusiasm


Today is about

Improving delivery of patient care, patient and staff experience


Change


Service Reconfigurations


QIPP and savings

3 and1/2 years to go


Continuously improving Quality for patients


Patient Safety and the public Francis

Inquiry


Service reorganisations following Transfers of Community Services


Organisational Changes: clinical Commissioning

Groups


Move to all degree Nursing


Changes to Health Visiting service and

increase in Numbers


Remember what is was like when you first started as a student nurse......


And then when you qualified......


And now looking back from where you are now.........


We have plenty of success to celebrate!

SUCCESS

Directors of Nursing Conference 1 September 2011

Coming together is a beginning;

Keeping together is progress;

Working together is success

Henry Ford

What is Success?

In order to succeed, your desire for success should be greater than your fear of failure

Bill Crosby

The Beginning

Manchester

Bringing People Together

Shaping the Future of Nursing in the North West

1st Annual Director of Nursing Conference

1st Annual Director of Nursing Conference

North West Nursing Indicators

General Nursing Care Indicators• Tissue Viability• Falls Assessment• Infection Prevention & Control• Medication Assessment• Nutritional Assessment • Pain Management• Patient Observation

Community Nursing Care Indicators • Care of the Dying• Pressure Ulcer Care• Falls Prevention

NW CIs 2011

• MRSA

• C Difficile

• Mixed Sex Accommodation

• Quality Assurance

Improvements Needed and Made

229201

302

415

668

0

250

500

750

2007/08 2008/09 2009/10 2010/11 PCT Objective2011/12Financial Year

24% reduction

NHS North WestReduction in MRSA Bacteraemia cases 2007 - 2011

38% reduction

27% reduction

12% reduction

MRSA

NHS North West Reduction in C difficile infections 2007 - 2011

9579

6726

4911

2912

3859

0

2000

4000

6000

8000

10000

2007/08 2008/09 2009/10 2010/11 PCT Objective2011/12

Financial Year

30% reduction

21% reduction

27% reduction

25% reduction

C Difficile

MSA Performance January - July 2011 Northwest

822 823923

176 183 201 158

0

100

200

300

400

500

600

700

800

900

Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11

Month

Nu

mb

er

of

Bre

ach

es

Mixed Sex AccommodationNumber of Breaches

Quality Assurance - Francis

Francis Review: Assurance




• AQuA has been established as a membership organisation through the active leadership of North West CEOs and Board Directors

• It is firmly focused on supporting delivery of QIPP goals• Results are already being delivered:

• Stroke 90:10 driving up compliance with Sentinel Audit > 90%

• AQ improving outcomes and experience for five conditions

• Safety Networks – improvements in falls, pressure ulcers and VTEs

• Mortality Collaborative – reducing HSMRs in 9 Trusts with highest rates

AQ : A Progress Report

Clinical Area UK Year One Position* UK Year Two Position

**

US Year One Position

***

AMI 92.55% 96.89% 89.31%

CABG 96.76% 96.94% 87.34%

HF 62.11% 69.95% 69.60%

HK 88.97% 92.73% 87.52%

PN 76.32% 81.55% 73.72%

*UK Year One Position reflects the AQ programme’s overall Composite Quality Score per clinical area for October 2008 – September 2009.

** UK Year Two Position reflects the AQ programme’s overall Composite Quality Score per clinical area for October 2009 – March 2010

***US Year One Position reflects the HQID overall Composite Quality Score per clinical area for October 2003 – September 2004.

Note: while similar, the measures analysed within each clinical group for the year one HQID project are not identical to those used in year one of the AQ project. For a full list of the HQID initial measure set go to www.qualitydemo.com

Phase 2 teams joinedPhase 1 teams joined

90%

Stroke 90:10 drove up standards in stroke care

• Background to Mortality Collaborative

• The Dr Foster Hospital Guide 2009

• Collaborative driven by the will of CEO community

• 9 participating organisations came together

Mortality Collaborative

Collaborative Improvement Aim

By April 2011 participating organisations will have improved adjusted mortality by at least 10 points during 2010 – 2011 as measured by CHKS or Dr. Foster.

The Collaborative Rate of Improvement – Dr Foster

The Collaborative Rate of Improvement - CHKS

• 2007• Primary Care Organisation of the Year – Wirral PCT• Clinical Service Redesign – Salford Royal FT and Salford PCT• Improving Patient Access – Bolton PCT• Reducing Health Inequalities – East Lancashire PCT• Improving Care with E-Technology – NHS North West

• 2008• Workforce Development – NHS North West• Patient Centred Care – Blackburn with Darwen PCT• Patient Safety – Salford Royal FT• Improving Health with Nice Guidance – Central and Eastern Cheshire PCT

• 2009• Primary Care Organisation of the Year – Liverpool PCT• Acute and Primary Care Innovation – Salford Royal FT• Reducing Health Inequalities – NHS Blackburn with Darwen• Using Date to Improve Care – NHS North West

• 2010• Primary Care Organisation of the Year – NHS Western Cheshire• Improving Care with Technology – Central Manchester University Hospitals FT• Quality and Productivity – Salford Royal FT

• 2009• Child Health – NHS Tameside and Glossop 2009

• Chief Nursing Officer Award – Salford Royal FT

• Accident and Emergency – Salford Royal FT

• Innovation in your Speciality – Royal Bolton FT 2009

• Mental Health – Greater Manchester West Mental Health FT

• 2010• Patient Safety – Stockport NHS FT

• Improving Maternity Services – Blackpool Fylde and Wyre FT

• Patient Dignity – NHS Tameside and Glossop

• Accident and Emergency Nursing – Royal Liverpool and Broadgreen University Hospital

• Innovation in your Speciality – Liverpool PCT 2010

• Infection Prevention and Control – 5 Boroughs Partnership FT

• Child Health – NHS Tameside and Glossop 2010

Nursing Standard – Nurse of the Year 2011Fiona Murphy – Royal Bolton FT

Hazel Holmes – Director of NursingLiverpool Heart and Chest Hospital NHS FT

Travel Scholarship

Honours Awards 2007 - 2011

29 New Years/Birthday HonoursAwarded to North West Hospital Staff since 2001

Leadership

• The Prime Minister’s Commission on the future of Nursing and Midwifery in England – Front Line Care

• Providing advice to the Department of Health on Nurses in Commissioning

• Regional Energise for Excellence leadership

• Rapid Spread

• Best practice and improvement – peer to peer support

Leadership

LEADERSHIP

Energise for Excellence

Where did it start:

Energise for Excellence

Safer Nursing Care Tool (AUKUH)HURSTPANDA

Birth Rate+E Rostering

Safer Nursing Care Tool (AUKUH)HURSTPANDA

Birth Rate+E Rostering

Productive CareSafety Express

High Impact Actions

Essence of CareNW Care Indicators


High Impact Actions

Essence of CareNW Care Indicators


High Impact Actions

Nurse Sensitive Outcome Measures


High Impact Actions

Nurse Sensitive Outcome Measures

Real-time Monitoring

Experience Based Design

Single Sex AccommodationPatient Stories

Real-time Monitoring

Experience Based Design

Single Sex AccommodationPatient Stories

High Impact Actions

Real-time MonitoringHealth and Well Being

High Impact Actions

Real-time MonitoringHealth and Well Being

Get Staffing Right

Get Staffing Right Deliver CareDeliver Care Measure

ImpactMeasure Impact

Patient Experience

Patient Experience

Staff Experience

Staff Experience

Safety Express/Thermometer

NHS Confederation Launch 2011

• Tracy Nurse – District Nurse

• Emma Wilkes – Senior Nurse Practitioner

• Joan O’Hanlin – Clinical Team Manager

• Graeme Mitchell – Matron

• Pauline McGarth – Acting Assistant Director

• Caroline Rees- Sister

• Sarah Sillitoe – Ward Manager

• Joanne Mc’Donnell – Head of Nursing

Local Nurses Leading the Way

• Delivering QIPP

• Dealing with increasing need and less resource

• Really integrating care

• Keeping quality, safety and experience at the heart of everything we do

The Future

NHS North of England

How wonderful it is that nobody need wait a single moment before

starting to improve the world

Anne Frank

The New Mental Health Strategy for England

Dr Hugh GriffithsNational Clinical Director for Mental Health

Introduction

• The scale

• The history

• The policy context

• The new mental health strategy

• Mental health and QIPP

• Some potential challenges

• Future developments

The Scale

• 1 in 4 people

• Cost to English economy £77 billion pa.

• More likely £105 billion pa.

• A million people on IB

• A third of GP consultations

• Largest proportion of disease burden

• Premature mortality

The History

• The National Service Framework – 1999

• The NHS Plan – 2000

• New Horizons – 2009

• All adults

• Dual approach

• The General Election – May 2010

• The new Mental Health Strategy

Policy Context

• Patients at the centre – shared decision-making, choice and information

• Focus on outcomes – quality at the heart of the healthcare

• Devolution – clarity about the “what” more than the “how”

• Strengthening public health

• Reform of adult social care

Policy Context

• Equity and Excellence White Paper - towards GP- led commissioning and outcomes (12 July 2010) – Health and Social Care Bill

• The Outcomes Frameworks• Healthy lives, healthy people White Paper: Our

strategy for public health in England (30 November 2010)

• Healthy lives, healthy people: consultation on the funding and commissioning routes for public health (21 December 2010)

Policy Context

• A vision for adult social care: Capable communities and active citizens

(16 November 2010)• Liberating the NHS: developing the

healthcare workforce (20 December 2010)• The Operating Framework for the NHS in

England 2011/12 (15 December 2010)• Quality Innovation Productivity & Prevention

(QIPP) agenda

Mental Health Strategy

A strategy to transform the mental health and well-being of the nation

An ambition to mainstream mental health and achieve ‘parity of esteem’ with physical health

The aim for mental health to be ‘everyone’s business’ – all of Government, employers, education, third sector

Mental Health Strategy - Themes

• Services and public mental health• Outcomes and quality• A life-course approach• Early intervention• Patient choice and control

(personalisation)• Reducing inequality and tackling

stigma• Improving efficiency (QIPP) in the

context of a challenging financial climate

2. More people with mental health problems will recover

Objectives

1. More people will have good mental health

3. More people with mental health problems will have good physical health

4. More people will have a positive experience of care and support

5. Fewer people will suffer avoidable harm

6. Fewer people will experience stigma and discrimination

Mental Health Strategy

A Cross-Government Mental Health Strategy

• Key messages for a cross government mental health strategy

• Good mental health is essential for everyone

• Improving public mental health and well-being, with prevention and early intervention, can cut the £105bn annual cost of mental ill health

• People with mental ill-health are likely to have better outcomes if they have real, well-informed choices over their care

• A twin-track approach will improve outcomes for people with mental ill-health and build resilience and well-being to prevent mental ill-health in the whole community

• How public service reforms will work for mental health

A “Call to Action” with key stakeholders

http://www.communitycare.co.uk/Home/

http://www.communitycare.co.uk/Home/

A Call to Action

Quality, Innovation, Productivity and Prevention (QIPP)

Three mental health elements:• The acute care pathway

Local variations• Out of area treatments

Allocative efficiency • Physical and mental health

Medically Unexplained Symptoms,

co-morbidities

Potential Challenges

• General:• History• Lack of Payment by Results• Poor information• Stigma and culture

• Social care system changes• Criminal justice system changes

Future Developments

• Implementation• The Joint Commissioning Panel

• RCPsych and RCGP• The NHS Commissioning Board

• Position mental health• Managed Networks

Where to find all documents

• Strategy and companion document – “Delivering better mental health outcomes for people of all ages” available at :

• www.dh.gov.uk/mentalhealthstrategy• Also, “Talking Therapies: a four-year plan of

action” and:• Impact Assessment and Analysis of Impact

on Equality

http://www.dh.gov.uk/mentalhealthstrategy

Safety Express

Maxine PowerQIPP Safe Care National Work Stream LeadDepartment of Health

[email protected]

The only thing that exceeds my admiration for the NHS is my hope for the NHS. I hope that you will never, never give up on what you have begun. I hope that you realize and reaffirm how badly you need, how badly the world needs, an example at scale of a health system that is universal, accessible, excellent, and free at the point of care – a health system that is, at its core, like the world that we wish we had: generous, hopeful, confident, joyous, and just.

Donald Berwick, July 1, 2008

The NHS in 2040

Abby – student nursepaediatrics 2012 - 15

Charlotte – student nurseAdult branch 2012 - 15

Our challenge

Equivalent to the number of patients with new stroke?

Can we ‘engineer’ pace and scale?

Preventable cases?

29,000

8,000

49,222

Our research into the issues

Safety Express Aim

To deliver ‘harm free care’ *to 95% of patients by December 2012

Defined as the absence of pressure ulcers, falls, urinary infection (in patients with catheters) and new VTE

What is harm free care?

Pressure Ulcer

Fall CatheterInfection

VTE HFC

Patient 1 √ x x x x

Patient 2 x x x x √

Patient 3 x √ x x x

Patient 4 x x x √ x

Total 75% 75% 100% 75% 25%

Benefits

What have we learned?

Patients affected

One Programme: Four Harms

Findings

• Strategic Fit

• Disruptive

• Measuring

• Reliability

• We didn’t help!!!!!

Frontline TeamsMeasuring 4 Harms at the point of care

NHS Safety Thermometer

Pressure Ulcers Harm from falls Urinary catheters

VTE Risk assessment &

treatment

New VTE Harm Free Care

Kings College hospital joined Safety Express in January 2011, they are also implementing the Energising for Excellence programme. This work is lead by Liam Edwards (Corporate Nurse)

They are working in partnership with their community services and Guys and St Thomas. At the outset they committed to working together to deliver:

5% reduction in urinary catheter utilisation 20% reduction in injurious fallsEradication of category 4 pressure ulcers50% reduction in category 3 pressure ulcers90% patients receiving VTE risk assessment and management

They selected four wards to test the Safety Express programme They measured progress with the NHS Safety Thermometer tool They have used the Safety express programme to work across organisational boundaries They have implemented systematic training They have reviewed equipment stocks They have ignited nurse leadership for hourly walk rounds In August 2011 they are launching Safety Express with governors In July they are planning to spread the changes

KING'S COLLEGE HOSPITAL NHS FOUNDATION TRUSTLONDON SHA

Total falls with harm

Show national benchmark

New

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

10%

Sep-10

Oct-10

Nov-10

Dec-10

Jan-11

Feb-11

Mar-11

Apr-11

May-11

Jun-11

Pressure ulcers

0%

1%

2%

3%

4%

5%

6%

7%

8%

Sep-10

Oct-10

Nov-10

Dec-10

Jan-11

Feb-11

Mar-11

Apr-11

May-11

Jun-11

Falls

0%

5%

10%

15%

20%

25%

Sep-10

Oct-10

Nov-10

Dec-10

Jan-11

Feb-11

Mar-11

Apr-11

May-11

Jun-11

% patients with catheter % patients with catheter AND UTI

Catheters

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Sep-10

Oct-10

Nov-10

Dec-10

Jan-11

Feb-11

Mar-11

Apr-11

May-11

Jun-11

% patients assessed % patients given prophylaxis

VTE

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Sep-10

Oct-10

Nov-10

Dec-10

Jan-11

Feb-11

Mar-11

Apr-11

May-11

Jun-11

No Harms 1 Harm 2 Harms

Harm free care

Total number of patients at selected organisation surveyed to date: 337Safety Thermometer Results

DashboardStep 1: select SHA Step 2: select organisation

New Total falls with harm

Patients with a new VTE

0%

1%

1%

2%

2%

3%

3%

4%

4%

5%

Sep-10

Oct-10

Nov-10

Dec-10

Jan-11

Feb-11

Mar-11

Apr-11

May-11

Jun-11

Provider Case Study [1]Kings College Hospital NHS FT

Impact of Safety Express and E4E on the pilot wards

New Pressure Ulcers Falls with Harm Catheters

VTE Risk assessment & prophylaxis New VTE Harm Free Care

Next steps 2011-12

Policy fit

Building resources

Measuring HARM

Scaling up activity

What will they say about us?

your hospitals, your health, our priority

Embedding

Amanda Cheesman

Head of Professional Practice


• Began in January 2011

• Aim – to roll out the Project across the Trust – all sites – all areas via Rapid Spread method

• Quality & Safety Matron Team

Phase 3 – Spread & Sustain E4E


• Infrastructure in place

• Bi Monthly Falls scrutiny Panel.

• QSMs to monitor all Slips, Trips and Falls/Found on Floor.

• Every fall investigated.

• SBARS on serious falls ie caused harm.

• Escalate serious falls to Trust Board for Executive review.

• Falls Champions- Training Programme



• Emphasis on:

Environment- Clutter free ward, Lighting, Flooring, Bed Space readiness.

Communication- Handover, EPR alerts, whiteboards pt status at a glance, documentation

Intentional Rounding-Based on 4 Ps, Personal needs, Pain, Position & Possessions

Post Falls Actions

Proactive Falls Prevention Actions



Challenges

• Financial pressures for equipment

• Maintaining momentum

• Root Cause Analysis (RCA) for each fall

• Data collection

• Changing the culture that falls are acceptable

• NPSA Essential Care After an inpatient Fall-Serious Falls SOP, New equipment purchased, Training Programme, First Responder teams


Successes

• Electronic data collection for financial costs of falls (EPR)

• True multi-disciplinary buy in, including Finance & IM&T

• Shift in culture

• Falls Scrutiny Committee

• Trust Board’s keen and full support

• HSJ Award


Transforming Community Services

.

• Fantastic Opportunity

• Working across the whole Health Economy to prevent Falls – Acute Trust, PCT and Community Trust

• Early days – pilot with NWAS (commencing 1 August 2011)


Statistics – The Local Picture

.

• NWAS Mar 2010 to Feb 2011– 3,599 Ambulance calls to falls patients (over 50yrs)

– 3,349 Patients & 206 repeat fallers (in month only)

– 68% (2,465) taken to A&E while 32% (1,134) non-conveyed

• A&E “falls” attendances 2009/10– 5,859 attendances

– 57% over 50’s and 32% over 75’s

– 61% (2,059) arrived in ambulance, over third made own way to A&E

• ALW PCT Non-Elective admissions 2009/10– 3,239 admissions

– 1,519 (47%) over 75’s

– 858 for fractures were fall coded (35%)


WWL and a HSJ Award

.


Energising for Excellence (E4E).

Fiona Murphy Clinical Lead Bereavement & Donation

Nurse of the Year 2011

1st September 2011

Bereavement and Donor Support

Low rates of donation in Western EuropeIn 2002 Bolton NHS trust began to make service changes with the aim of increasing donor rates

Education can enhance knowledge & confidence in end of life care and ultimately improve the quality of bereavement and donor support

In 2004 Bereavement & Donation became a ‘usual not unusual’ part of our care.

Nobody is denied.Fulfilment of individual wishes.

Support regardless of donation outcome – everybody, every time.

Control and choice during an often uncontrolled situation.

Normalising donation as part of end of life care.Conscientious objectors (staff)

True collaboration

Why

How

Excellent communication

Bereavement Care Bundle

Empowerment

Support

Workforce Development

Competency’ educational module

Monthly training day

Full support from all tiers of management

Culture change

Culture Change

Actual donors trust wideApril 2010-April 2011

A4 B3 B4 C1 C2 C3 C4

CCU D1 D2 D3 D4 E3 E4

F3 F5 TSU G4 BCU H3 N4

A&E ICU HDU REC'Y

Referrals to SN-OD56Referrals to TD- SN540From approx 1700 deaths.

Referrals to SN-OD56Referrals to TD- SN540From app

Full tissue 23 Gift Donors 6 Brain Donors 23 Eye Donors 322 Multi organ Donors 7

Insanity

Death is the only certainty in life – there is no excuse for all professionals

to be less than fully prepared

The responsibility for providing quality end of life care now rests with each

and every clinical member of staff

Collaborative working sets out a clear

and established policy providing guidance and support to all those

looking after the dead; thus ensuring true choice .


Reducing Falls & Building the Case for

Quality1 September 2001

Gill Harris Director of Nursing & Performance, DIPC


Falls in Hospitals & Sucking Eggs

.

• One of the top 5 Health & Safety Risks

• Falls & #NOF are the 2nd most reported incidents

• In England & Wales (2006) 200,000 falls were reported to the NPSA with 970 sustaining fractures & 26 falls related deaths

• Financial costs on unscheduled care & follow up care for Local Authorities reported to be over 2 billion pounds Nationally

• PREVENTION of falls is a National priority


QIPP Agenda Workstreams

• Commissioning & Pathways:

Safe Care; Safety Express: reduce harm from falls in 95% of patients by 2012 (measured via Safety Express)

Right Care Programme: “doing the right things” i.e. right care, right place, right time

Long Term Conditions: reducing unscheduled care hospital admissions; reduce length of stay; patient control

Urgent Care: maximise right person right place right time - 10% reduction in the number of patients attending A&E


• Provider EfficiencyProductive Series - RTTC Modules = knowing how we are doing, well organised ward, patient status at a glance

• System EnablersPrimary Care driven workstreams, supporting implementation of Primary Care QIPP plans

• Making Quality HappenQuality Accounts

QIPP


Background

.

• Dr Mahmood Adil – Fellow from NHS Institute for Innovation & Improvement and now QIPP Lead

• Supported by ‘Patient Safety First’ Campaign 2008

• Approached the Trust & agreed area of harm to reduce

• Strategic & Operational teams established

• Plan established to identify the financial cost saving (in addition to the human cost) by reducing harm from falls


Aim

.

• To reduce the number of falls in the Trust by 50% in 2 years (baseline 2008-09)

• Identify financial savings

• Full roll out of project – January 2011

• Re-educate Healthcare Professionals & try and change the culture to stop normalising the abnormal!


Work plan

.

• Undertake detailed assessment of current situation

• Strategy

• Policy

• Data collection

• Trust’s falls figures

• In-depth audit of inpatient falls resulting in harm

• Review of our existing improvement interventions


Work plan continued…

.

• Review existing improvement efforts

• Implement whole system training package

• Apply appropriate interventions

• Develop Business Case for Quality (QIPP)


Falls Audit – January 2010

.

• Retrospective case notes audit

• 1308 falls Trust wide, focused on inpatient falls that resulted in moderate, severe harm or death

• Timescale – all falls in hospital from December 2008 to November 2009

• 37 patients audited in depth


Summary of Results

.

• Mainly moderate injuries

• Most in Medicine/Rehabilitation

• Most at bedside

• Many patients on offending medication

• Mainly unwitnessed falls

• Mainly head injuries & lacerations

• Low number of L/S BP on admission

• Total cost (but difficult to do so) £46,312


Project Plan – 3 Phases

• Phase 1: Diagnostic from Oct 2009 to Feb 2010

• Phase 2: Intervention, Pilot & Monitor from April to June 2010

• Phase 3: Rapid Spread, from July to Sept 2010

January 2011 became the reality…

Sustain E4E & Monitor


Reducing the Number of Falls


Financial Savings - #NOFFinancial Cost # Femur

£0.00

£50,000.00

£100,000.00

£150,000.00

£200,000.00

£250,000.00

2007/08 2008/09 2009/10 2010/11 2011/12

Financial Cost # Femur

Financial Year 2007/08 2008/09 2009/10 2010/11 2011/12

Financial Cost # Femur £200,807.36 £67,752.10 £50,201.84 £50,201.84 £12,550.46

TYPE OF COST COST £

Radiology Costs £ 33.00

Pathology Costs £ 10.00

Procedure Costs £ 9,231.00

Physio Costs £ 69.00

Nursing Costs £ 18.13

Clinician Costs £ 37.98

Increased LOS Costs £ 3,151.26

Total Costs £ 12,550.37

With costing ability within EPR we were able to retrospectively cost #NOF due to falls


Phase 1

.

• Data quality, collections & analysis of falls figures; data trials; design of new electronic data form to capture financial impact & preparation for moving to electronic data collection in phase 2

• Identify evidence based interventions that haven’t already been implemented

• Calculate cost of falls based on retrospective audit & develop an e-integrated system

• Review Policy & develop new Falls Risk Assessment


Pilot Ward Interventions

.

• All patients undergo new multifactoral risk reduction plan on admission

• All patients have bedrail risk assessment undertaken on admission and intervention completed

• Slipper exchange accessible for all patients on pilot wards

• Incident Map updated post falls on the pilot wards

• Post Falls – Electronic Patient Record (EPR) completed and ongoing costings assessed

• Pharmacy input within 24 hours of admission


Plan Prior to Launch of Phase 2 Pilot• Ward Teams (3) trained on EPR falls form & falls

reduction interventions & plan

• Equipment available on each pilot ward (bedrails ordered & slipper exchange supported by Age UK)

• EPR live

• Pharmacy support in place

• Incident Map – Productive Series

• Trust Wide Communication Strategy

• Data Collection agreed


Standish Ward Incident Map

Healthier Horizons

Using Innovative Initiatives to Impact on Infection


Helen Crombie - Assistant Director Performance Improvement&Julie Hughes – Nurse Consultant Infection Control


Using Innovative Initiatives to Impact on Infection

• Introduction – a little background context…

• Impact of Infection Initiative – Focuses on Reputation, Risk and Care Outcomes

• Initiatives for Prevention and Protection

• Innovative Involvement Initiative –CDI Initiative

• Increasing Awareness Initiative – identifying IPC priorities, using a consistent information presentation, repeating the same message

• Interactive Learning Time Initiative


Introduction

• A Little Background Context

• The North West Experience

• Engaging the Whole Health Economy

• Context Facts and Figures – Acute vs Community


NHS North West - Number of MRSA Bacteraemia April 2008 – June 2011

NHS North West - Number of MRSA Bacteraemia April 2008 - June 2011

0

10

20

30

40

50

60

2008/09 2009/10 2010/11


NHS North West - Number of MRSA Bacteraemia April 2008 – June 2011 Trend

NHS North West - MRSA Bacteraemia April 2008 - June 2011

0

10

20

30

40

50

60


NHS North West – MRSA Bacteraemia Yearly reductions (2008-2011)

NHS North WestMRSA Bacteraemia - Yearly % reductions

229

302

415

0

100

200

300

400

500

2008/09 2009/10 2010/11

FinancialYear

27% reduction

24% reduction


NHS North West – MRSA Bacteraemia Acute & Non- Acute (by Quarter)

NHS North West - MRSA Apportionments April 2008 - June 2011

Acute

Non Acute

Acute 79 58 70 54 48 35 34 55 30 34 22 21 21

Non Acute 49 33 34 38 41 29 27 33 33 32 24 33 24

Apr-J un

J ul-Sep

Oct-Dec

J an-Mar 09

Apr-J un

J ul-Sept

Oct-Dec

J an-Mar 10

Apr-J un

J ul-Sept

Oct-Dec

J an-Mar 11

Apr-J un


MRSA – Latest position Commissioner)

80.8

41.1

25 24.418.2 16.3

10.7 4.5 2.9

-18.2

-20

-10

0

10

20

30

40

50

60

70

80

90

North East NorthWest

East ofEngland

SouthWest

South EastCoast

Yorkshire& the

Humber

EastMidlands

SouthCentral

WestMidlands

London

MRSA Bacteraemia - All SHAs% Ahead of Plan (April 2011 - June 2011)


NHS North West - Number of C-Difficile Infections

April 2008 to June 2011

NHS North West - C difficile Infections April 2008 - June 2011

0

100

200

300

400

500

600

700

800

900

2008/09 2009/10 2010/11


NHS North West - Number of C-difficile Infections April 2008 – June 2011 Trend

NHS North West - Number of C difficile Infections April 2008 - June 2011

0

100

200

300

400

500

600

700

800

900


NHS North West – C-difficile Infections Yearly reductions (2008-2011)

NHS North WestC difficile - Annual (3 year)

6726

4911

3859

0

2000

4000

6000

8000

2008/09 2009/10 2010/11

FinancialYear

27.0% reduction

21.4% reduction


NHS North West – C-difficile InfectionsAcute & Non- Acute (by Quarter)

NHS North West - C difficile Apportionments April 2008 - June 2011

Acute

Non Acute

Acute 1198 906 805 1035 737 602 641 673 609 505 445 410 366

Non Acute 852 722 595 613 584 632 538 504 522 544 420 404 424

Apr-J un 08

J ul-Sept

Oct-Dec

J an-Mar

Apr-J un 09

J ul-Sept

Oct-Dec

J an-Mar

Apr-J un 10

J ul-Sept

Oct-Dec

J an-Mar

Apr-J un 11


C-difficile – Latest Position (Commissioner)

9.1

5.1

-2.8-6.2 -7.5 -7.5

-19.8

-26.5-28.8

-30.9

-35

-30

-25

-20

-15

-10

-5

0

5

10

South EastCoast

East ofEngland

NorthWest

EastMidlands

North East SouthCentral

WestMidlands

SouthWest

London Yorkshire& the

Humber

C Difficile Infections - All SHAs% Ahead of Plan (April 2011 - June 2011)


The Impact of Infection InitiativeFocussing on Reputation / Risk / Outcomes

• Public Confidence

• Media attention

• Jobs / Recruitment

• Risk to Patients and Residents

• Impact on Family Life

• Cost to Organisation/ NHS

• Closure – Beds, Homes & Life


Impact on Reputation

• How do you recruit high caliber staff if people are reluctant to work in organisations due to poor reputation and history of problems with diarrhoea outbreaks and high levels of infections?

• How do your Relatives feel when your hospital, service or care homes are branded as places nobody wants to work at?

• Do you want your place of work to be viewed as a Place of poor care standards with a history of infection?


Impact on Risks relating to Infection Prevention & Control

Why Focus on this Agenda?- impacts on the whole health

economy


Impact on Organisational Outcome

CQC report on HPA web site - 29 September 2010

• Thirty-four care homes and eight agencies providing care in people’s homes closed in the past 12 months following regulatory action and the Care Quality Commission (CQC)

• In six cases, CQC issued legal notices to close the service. In the remaining, owners closed or sold the service after CQC took enforcement action. CQC said that risks to people’s health and welfare were too great and the only option was closure.

Reasons sited:• Training, Cleanliness, Hygiene, Record keeping


Initiatives for Prevention and Protection

Promoting Prevention – mapping, identifying vulnerable patients – Various Trusts

Promoting Protection – preventing future relapse –Case Management – Initially Salford –Now the Majority

Promoting Patient Involvement –CDI antibiotic awareness card


Innovative Involvement Initiative

CDI – The ChallengeReducing Antibiotic Prescribing

Promoting Patient Involvement – Antibiotic awareness information cards – North West Wide initiative



Patient Information leaflet

Card attached



Clinicians Information Sheet:

Describes Purpose, Benefits

Web Sitewww.northwest.nhs.uk/cdiff



Poster For:

Surgery’sDentistsPharmaciesA&E DeptMAUOPD


Increasing Awareness Initiative

• Promoting Education• Staff, Patients, Residents, Families• Media

• Reinforcing the Value of Audit / Monitoring Practice• Diarrhoea Management -tools and techniques• Hand Hygiene• Cleaning• Treatment – Antibiotics• Isolation Practice

Getting the message out there……….


Increasing Awareness Initiative

Identify Infection Prevention & Control Priorities - Focusing Resources, Promoting Guidance and Guidelines

Mental Health Initiative – Julie Hughes


HCAIs and IPC in mental health settings

– different bugs or different approaches?1 J Hughes, 2 L Owens

1 Nurse Consultant Infection Control/Lecturer, 5 Boroughs Partnership NHS Trust, Warrington, University of Chester, Cheshire, UK

2 Infection Prevention and Control Practitioner, 5 Boroughs Partnership NHS Trust, Warrington, Cheshire, UK


HCAIs and IPC in mental health settingsPrior to Health and Social Care Act (2006) and the Care

Quality Commission (CQC) Mental Health not under such scrutiny in relation to IPC but now under increasing focus

HCAIs in MH overall remain low but predisposing risk factors and impact across whole health economy

However, little information and evidence available re extent of HCAIs in this area

Compliance with IPC also challenging e.g. patients compliance/ligature risks etc


Strategies for improvement

MRSA SCREENING CRITERIA

All patients who fit into the following criteria MUST be screened at the time of their admission, the ‘admitting nurse’ has responsibility to ensure this is undertaken

Has the patient:

Previous history of MRSA?

Been transferred from another

hospital?

Been transferred from a

residential or nursing home?

Used intravenous drugs and

has wounds/lesions?

Any self harm

wounds/lesions?

Any indwelling devices or

chronic wounds?

Screen: 1 swab dipped in sterile

saline solution for both nostrils,

1 swab dipped in sterile saline for both sides of groin

Any other areas of concern to be swabbed as normal

Fax any positive laboratory form results to 01925 664817

Inform Infection Prevention & Control Team of any MRSA Positive patients on 01925 664055

DON’T FORGET TO INCLUDE YOUR RESULTS IN MONTHLY MRSA RETURNS

Surveillance – Monthly prevalence studies of

HCAIs (3% HAI, 2% CAI)– Weekly surveillance

• wounds/infections/invasive devices/antibiotic prescribing

– Main infections – UTI, chest, wounds

– Main organisms – MRSA, E.coli

MRSA Screening – 98% compliance– 8% of patients screened +ve – 25 % > 48 hours, 75% < 48

hours– Leg/foot ulcers, self harm

April 2011 HAI

67%

25%

8%

Urine

Wound

Eyes

April 2011 CAI

23%

22%

11%

22%

22%Urine

Wound

Chest

Skin

ear


Strategies for improvementIPC audit programme

– High Impact interventions

– Essential Steps

– Quarterly antimicrobial prescribing – overall improvement

– Essence of Care

– AIMS

Training and culture change– increased ownership of audit

results and issues by Matrons and areas

Service user involvement– Active engagement and

empowerment

Example of monthly Matron/IPC Board and Business Stream reports

Example of Service User spot-checks



Interactive Learning Initiative

• Promoting Engagement• Whole Health Economy Involvement• Newsletters / Prescribing Alerts• Medicines Management Teams• Dental Services

• Supporting Education and Training initiatives • RCN Infection Prevention Conference• North West Master class • North Lancashire Care Homes Conference

Continuing to get the message out there……….


Toilet Talk – Managing the Impact of Diarrhoea by Focusing on the Normal Bowel and other

relevant matters• Introduction – Pathology and Causation

• Impact – Reputation, Risk, Care Outcomes

• Increasing Awareness by Improving the Management of Diarrhoea

• Identifying Infection Prevention & Control Priorities

• Interactive Learning Time


FinallyRemember when Preventing Infection –

What we have always done will not solve the problem, it gets more

difficult – we have to be innovative

And why?

Because it improves the Patients Experience and their Outcomes

The New Commissioning Architecture

• Cathy Maddaford - NHS Cheshire, Warrington and Wirral

• Moira Angel - NHS Cumbria

• Hilary Garratt - NHS Greater Manchester

• Trish Bennett - NHS Merseyside

• Gary Hardman - NHS Lancashire

2011

2013To deliverLargest change management project

Cluster: Key Objectives

Success will be measured by the successful establishment of the new commissioning architecture

Commissioning Development

1. Integrated Finance, Operations and Delivery

3. Emergency Planning and Resilience

4. Commissioning development

5. The New Public Health System

2. Ensuring Safety & Quality

6. QIPP Delivery & Provider Development

Day to Day

Delivery

The New Commissioning

Architecture

Service Transformation

Cluster: Key Objectives

An Olympic Size Challenge?

Developing Clinical Commissioning

Developing Clinical Commissioning

Three key role of non medical professionals in commissioning:

• Strategic decision making, leadership – new vision/personalisation embracing technology

• Pathway/service redesign/contracting the best quality outcomes

• Guardianships of the patient experience across care settings/safeguarding

The Leadership Challenge

More than pure clinical intervention changes

Good clinical commissioning needs to be based on the insights of many but with strong leadership

Release the potential for finding creative solutions which already exist within system

Local relationships are key

Health Improvement and prevention is bigger than general practice

Patients need to be fully involved in commissioning

• Driving leadership for outcomes

• Supporting leadership that drives performance

• Driving leadership for competent commissioning

• Driving leadership for quality and safety

• Driving leadership through Level 3 QIPP service reconfiguration

• How do we work together as nurse leaders i.e. Cluster/acute DON’s- What are our distinct roles?- What are our joint roles?

• Do you think the Cluster DoN’s focus of work is right?

• What are our joint high risk priorities. How do we address them?

Date post:	15-Nov-2014
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