Patient Safety Priorities 2016/17 Surgical Division

Acute Kidney Injury

(AKI), NEWS, Sepsis, Clostridium difficile (inc

AMR), Movement of patients location,

Improving Insulin safety,

Medicine Safer nurse staffing

Stroke (SSNAP) Ambulatory Care

Patients with a LOS >20 days

Women & Children’s Glucose Tolerance Testing

Stillbirth Jaundice Management

Paediatric “safe” programme Learning from incidents

Patient Safety Priorities 2016-17

NatSSips, Falls, Venous Thromboembolism (VTE), Pressure Ulcers, Emergency

Laparotomy, Missed Doses, anticoagulation, SSIS, Frailty, Harm and MFFD patients

Surgery # NOF surgery

OOH ITU transfers Pre-op Fasting IRA completion

Frailty

Acute Kidney Injury

(AKI), NEWS, Sepsis, Clostridium difficile (inc

AMR), Movement of patients location,

Improving Insulin safety,

Medicine Safer nurse staffing

Stroke (SSNAP) Ambulatory Care

Patients with a LOS >20 days

Women & Children’s Glucose Tolerance Testing

Stillbirth Jaundice Management

Paediatric “safe” programme Learning from incidents

Patient Safety Priorities 2016-17

Fractured neck of femur Hip fracture carries a mortality of 30-35% Early surgery (within 48hrs)

Reduces pain, duration of immobility, pressure ulcers

Reduces morbidity and mortality Reduces LOS Increased return to independent living

BPT introduced 2011 Surgery within 36hr Joint care ortho/geriatrician. MDT input. Prevention (falls/bone health)

Fractured neck of femur Objective Improve #NOF pathway

KPIs

80% of patients to receive surgery for hip fracture within 36 hours.

Receive BPT for 75% of hip # patients.

Quarter 1

Design and trial an electronic trauma database. Baseline audit for hip # patients.

Quarter 2

Standardise and improve coding for hip # patients. Complete baseline audit.

Quarter 3

Monitor against baseline audit

Quarter 4

Monitor against baseline audit

Fractured neck of femur Database designed, implementation delayed

(FirstNet). Paper based system in place Audit completed

No further delays for NOAC Capacity issues

Ongoing monthly review of patients not achieving 36hr target to identify further learning

Coding reviewed. Recording of osteoporotic fractures agreed with NHSE. Ongoing review of coding

Baseline

OOH ITU discharges OOH ITU discharge is any transfer between

2200 and 0700 ICNARC data shows OOH transfers significantly

increase both morbidity and mortality

OOH ITU discharges

Objective Eliminate overnight transfer out of ITU

KPIs Eliminate OOH ITU transfers

Quarter 1 Baseline audit of current practice Identify themes and devise an action plan

Quarter 2 Formation of a task & finish group with key stakeholders

Quarter 3 Improvements from baseline

Quarter 4 Improvements from baseline

OOH ITU discharges Part of larger project CQUIN group chaired by Claire Damen

Increased staff awareness Work with site team to achieve daytime transfers Datix all OOH discharges Analysis of all OOH discharges Monthly monitoring and reporting

Apr May Jun Jul Aug Sept OOH discharges 10 3 6 3 5 (4) 6 (3) Datix reports 3 3 5 1 3 3

ITU delayed discharges

Pre-operative fasting Fasting is utilised to prevent pulmonary

aspiration of stomach contents during induction of anaesthesia

Incidence is 1:10000, predominantly emergency cases, causing serious morbidity and death

Prolonged fasting causes harm Dehydration Hypovolaemia Hypoglycaemia Delayed recovery from anaesthesia → Poor clinical outcomes

Pre-operative fasting

Objective Minimise pre-op fasting (non-elective)

KPIs Reduction in pre-op fasting time

Quarter 1 Maximise theatre 1 efficiency Baseline audit of unnecessary fasting

Quarter 2 Launch 12 hour stop

Quarter 3 Action planning

Quarter 4 Monitor fasting times

Theatre 1 scheduling 8am SAU MDT

meeting Triage of cases Traffic light system,

12 hour stop

4pm meeting

Wait times for theatre 1

Category A (within 1 hour) Category D (elective)

Wait times for theatre 1

Category B (within 6 hours)

Category C (within 48 hours)

IRA completion Up to 10% inpatients experience a safety-related

incident Approx 50% of these are preventable Risk assessment on admission identifies

vulnerable patients allowing steps to be taken to reduce risk

IRA completion

Objective Timely IRA completion

KPIs 95% completion of initial risk assessments (IRA) on all surgical wards

Quarter 1 Baseline Audit of current practice.

Identify barriers preventing timely completion and devise action plan

Quarter 2 Re-launch IRA standard

Quarter 3 Demonstrate improvement from Q2

Quarter 4 Demonstrate improvement from Q3

IRA completion Baseline audit complete Barriers/problems identified Relaunch planned for November

Meeting with Surg Sisters/wards Inclusion in handover Monitoring tools Review pre-assessment pathway

Frailty recognition Frail patients have little physiological reserve

and decompensate rapidly in hospital Increased complications Delayed recovery Prolonged LOS Limited recovery of pre-morbid state

Early recognition and specialist MDT input mitigates this

Frailty

Objective Early identification of frailty in Surgical patients

KPIs 95% completion of the frailtiy assessment on admission

Quarter 1 Agree criteria and devise frailty assessment tool for surgical patients

Quarter 2 Launch new assessment tool and baseline measures

Quarter 3 Demonstrate improvement from Q2

Quarter 4 Demonstrate improvement from Q3

Frailty assessment

Frailty in laparotomy patients “Orthogeriatrics” success story Pilot of similar approach in elderly Gen Surgery

patients undergoing laparotomy QI project started May 2016, running to end

November 3 sessions/wk geriatician time Patients >70 yr eligible for NELA Data input behind schedule (no research nurse) Results early 2017