Now onto our quality priorities for 2020/21.
Every year we draw up a list of healthcare areas which we as a healthcare community would like to improve upon. We then ask you, our members, to vote on what you feel our improvement priorities should be.
As our members this is your opportunity to let us know your views and we have drawn up a shortlist of options for you under the three headings of Effectiveness, Safety and Experience.
We focus on these priorities and at the end of every year our performance in these areas is measured.
Here is the list of suggested priorities we would like you to choose from for the coming year. We would like you to select three priorities, one from each of the domains - Effectiveness, Safety and Experience.
Please respond by Friday 19 February 2021 to ensure your views are taken into consideration.
1) Reducing Non-clinical Patient Ward Transfers
Moving patients from one ward to another for non-clinical reasons is shown to have a negative outcome on patients including increasing their length of stay, increasing the risk of readmission and the development of medical complications including healthcare acquired infections and blood clots. This priority is in the interest of both hospitals and patients to ensure that we do not move patients around for any reason other than a clinical reason or as part of the clinical pathway.
Our focus for this quality priority is to develop clear processes to enable the patient flow team and ward clinical teams to monitor patient transfers effectively and to prevent non-clinical patient transfers:
- The aim is to develop clear processes and documentation to identify patient clinical transfers in EPR.
- To understand present performance against the standard (quality priority) through identifying the process for monitoring compliance.
- To understand non-compliance and the reasons for this and develop an action plan to address any barriers to compliance.
2) Recognition and timely treatment of sepsis
** Recognition of sepsis
We must keep our patients safe and appropriately treated by utilising the triggers and resources available to CHFT so we quickly recognise when someone has suspected sepsis. Our patients place their trust in us to diagnose and administer the treatment pathways based on NICE and Trust guidelines for sepsis in a timely way - that is our duty of care without exception. In order to improve our response to recognition of the suspected septic patient we should:-
- Increase our compliance of the administration of intravenous antibiotics within 60 minutes for the severely septic patient.
Sepsis is a medical emergency and a life-threatening condition and is associated with a high mortality rate. The delivery of antibiotics within 60 minutes is crucially time dependant based on a dysregulated host response to infection and the high risk of patient deterioration. We need to act quickly so our patients have every chance of recovery.
- Improve our knowledge of the signs and symptoms of sepsis through robust training for all staff including Health care assistants who provide clinical care for patients.
This is to improve staff awareness so they can confidently respond to the signs and symptoms of sepsis and support early interventions and prevent patient deterioration. The training is also intended to further promote a culture of team cohesion with treatment and prevention of sepsis.
- Introduction of the Nerve centre to the Emergency Departments.
The Nerve centre is a crucial tool to calibrate the patient’s early warning score based on their observations: the higher the score the more sick the patient is. The Nerve centre alerts the nurses, doctors and critical care. It drives the frequency of observation taking and recording which is a crucial part of patient safety.
** Timely treatment of sepsis
If sepsis is suspected the sepsis 6 screening tool must be used so that the patient receives all the necessary elements of care. This care should be clearly explained to the patient and their family: we want them to feel included and confident in our care. Discussion regarding the risks of deterioration of a patient who is severely septic should take place from the clinician.
- Compliance of all elements of the Sepsis 6 (BUFALO) to be improved to 50% using the new EPR sepsis power plan.
The sepsis power plan (part of the sepsis screening tool) makes it easier and quicker for clinicians to order tests and antibiotics. It also guides the doctor in prescribing the most suitable antibiotic treatment for different sources of sepsis. Clinicians are able to access this information to check the treatment plan during the patient’s stay in hospital. It is a source of information to assist communication at handovers and with the patient and their family.
- Change the sepsis care bundle so the clinician can clearly state the patient’s oxygen requirements including ‘not applicable at this time’.
The sepsis care bundle contains the BUFALO elements: blood cultures, urine output, fluids, antibiotics, lactate and oxygen. Severely septic patients (red flag sepsis) require all these elements ordering and recording. In less severe sepsis, oxygen may not be required initially or at all, thus a change to the options for recording oxygen needs are required to capture accurate data.
- Urine output measurement capacity to be added to the Nerve centre.
The work to add the measurement to the Nerve centre is necessary to help in the early detection of more severe sepsis. Low or no urine output can be a sign of severe sepsis or septic shock.
- Response to alert times for taking and recording the patient’s baseline observations to be monitored.
Along with the sepsis training this will help impart the importance of a quick response to the Nerve centre alert that the patient’s observations are due.
1) Reduce the number of inpatient falls
Reducing the number of inpatient falls in hospital will improve the patient experience, reduce length of stay and improve patient outcomes with the added benefit of decreasing the cost of caring for our patients – in hospital and in the community.
‘Falls among inpatients are the most frequently reported safety incident in NHS hospitals. 30-50% of falls result in some physical injury and fractures occur in 1-3% of falls. No fall is harmless with psychological sequelae leading to loss of confidence, delays in functional recovery and prolonged hospitalisation’.
The NHS has recognised the importance of falls through its national clinical quality improvement target and has placed the assessment of patients who may fall as a priority.
There are four objectives to the assessment process that we as a Trust need to embed and strengthen - these are:
- Lying and standing blood pressure for all patients over the age of 65
- Mobility assessment
- Medication reviews
- Post falls safety huddle
2) Reduce the number of Hospital Acquired Infections including COVID-19
We know that an estimated 300,000 patients a year in England acquire a healthcare associated infection (HCAI) as a result of care within the NHS.
Hospital acquired infections – also referred to as nosocomial infections – are significant both because of the effect on the health of patients and staff and the risk of transmission between patients and staff. We know that HCAIs pose a serious risk to patients, staff and visitors, can incur high costs for the NHS and can cause significant morbidity to those infected. The emergence of new infections also poses a risk to patients and staff, as highlighted by the transmission of COVID-19 in health and care settings during the pandemic.
Reducing healthcare associated infections remains high on the Trust’s safety and quality agenda and in the general public’s expectations for quality of care.
Our focus for this quality priority is to:
- Implement patient testing strategies aligned to national guidance
- Support system wide approach to vaccination programme
1) Improve communication around discharge planning
Safe and timely discharge is essential to ensure patients receive the right care, at the right time and in the right place. Early and inclusive discharge planning with good communication between all disciplines, organisations, patients, carers and relatives is central to building a culture of compassionate care based on the 6Cs – care, compassion, competence, communication, courage and commitment.
When organising for a patient to be discharged from a healthcare setting we aim to put the patient first, recognising and balancing the risks associated with discharge and with remaining in a care setting that is no longer appropriate for their level of need. We will be proactive in planning for discharge from the point at which the patient is first admitted or prior and will involve patients, their relatives and carers and work with them to prepare for discharge. We will work together across professional disciplines and agencies to prevent delays that can occur through poor communication.
Our focus for this quality priority is to ensure that a patient’s discharge does not fail due to poor communication, that there are no incidents or complaints of an unsafe discharge due to poor/lack of communication, that a full review of all communication routes/resources is established and any areas identified for improvement are taken and evidenced.
Our focus for this quality priority relates to:
- A full review of all incidents and complaints in relation to poor/lack of communication around discharge planning to identify specific themes or trends.
- Review all communication routes/resources in regard to discharge.
- Develop an improvement plan.
2) Reduce waiting times for individuals attending the Emergency Department
The current access standard of patients having a maximum wait in A&E of four hours was introduced in 2004 to drive improvement. However it is recognised that this is no longer the right measure to continue to drive improvements for patients.
Therefore, NHS England and NHS Improvement (NHSE/I) is consulting on emergency care models and how to measure standards meaningful for patients, via the publication 'Transformation of Urgent & Emergency Care: Models of care and measurement' (December 2020).
The consultation on the proposed standards for urgent and emergency care does not close until 12 February 2021, after which views will be considered and inform national guidance which will then be issued by NHSE/I. The consultation report sets out a range of policy and measurement proposals aimed at transforming the entire urgent and emergency care pathway. The changes would have a far-reaching impact across the whole system.
For acute hospitals such as at Calderdale and Huddersfield NHS Foundation Trust, there will be a set of new clinically-led standards for the urgent and emergency care pathway proposed. Examples of the proposed measures being consulted on are: ambulance handovers to Emergency Departments (ED) within 15 minutes, average time spent in ED and critical time standards. If implemented, the propsoed measures would mean a step away from the long-established four-hour A&E waiting time standard.
Once guidance is confirmed, all Trusts will be required to meet and report on agreed national standards, with other measures chosen by the Trust. Once the national guidance is issued following the completion of the consultation, the Trust will then review this guidance and decide which local measures to focus on. We cannot be sure at this point that the new measure will be agreed by the start of the new financial year in April 2021 and therefore at this point in time cannot confirm the focus for this quality priority.
Those are all the options. Please think about which of the priorities you would like us to focus on, then follow this link to vote: Quality Account 2020/21 Voting form
Don't forget, the deadline is Friday 19 February 2021.
Thank you for your time and support.