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NHS North West DoNs Conference

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Includes -
Chris Jeffries
Jane Cummings
Dr Hugh Griffiths
Maxine Power
All workshops

Publié dans : Santé & Médecine
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NHS North West DoNs Conference

  1. 1. Welcome Chris Jeffries Acting Director of Workforce and Education NHS NW
  2. 2. <ul><li>Welcome </li></ul>
  3. 3. Housekeeping <ul><li>Mobiles </li></ul><ul><li>Fire Alarms </li></ul><ul><li>Toilets </li></ul><ul><li>Catering </li></ul><ul><li>Reception desk </li></ul>
  4. 4. <ul><li>Today is about </li></ul>
  5. 5. Today is about <ul><li>Celebrating nursing success </li></ul>
  6. 6. Today is about <ul><li>Harnessing energy and enthusiasm </li></ul>
  7. 7. Today is about <ul><li>Improving delivery of patient care, patient and staff experience </li></ul>
  8. 8. <ul><li>Change </li></ul>
  9. 9. <ul><li>Service Reconfigurations </li></ul>
  10. 10. <ul><li>QIPP and savings </li></ul><ul><li>3 and1/2 years to go </li></ul>
  11. 11. <ul><li>Continuously improving Quality for patients </li></ul>
  12. 12. <ul><li>Patient Safety and the public Francis Inquiry </li></ul>
  13. 13. <ul><li>Service reorganisations following Transfers of Community Services </li></ul>
  14. 14. <ul><li>Organisational Changes: clinical Commissioning Groups </li></ul>
  15. 15. <ul><li>Move to all degree Nursing </li></ul>
  16. 16. <ul><li>Changes to Health Visiting service and increase in Numbers </li></ul>
  17. 17. <ul><li>Remember what is was like when you first started as a student nurse...... </li></ul>
  18. 18. <ul><li>And then when you qualified...... </li></ul>
  19. 19. <ul><li>And now looking back from where you are now......... </li></ul>
  20. 20. <ul><li>We have plenty of success to celebrate! </li></ul>
  21. 21. SUCCESS Directors of Nursing Conference 1 September 2011
  22. 22. <ul><li>Coming together is a beginning; </li></ul><ul><li>Keeping together is progress; </li></ul><ul><li>Working together is success </li></ul><ul><li>Henry Ford </li></ul>What is Success? In order to succeed, your desire for success should be greater than your fear of failure Bill Crosby
  23. 23. The Beginning
  24. 24. Manchester
  25. 25. Bringing People Together
  26. 26. Shaping the Future of Nursing in the North West
  27. 27. 1 st Annual Director of Nursing Conference
  28. 28. 1 st Annual Director of Nursing Conference
  29. 29. North West Nursing Indicators <ul><li>General Nursing Care Indicators </li></ul><ul><ul><li>Tissue Viability </li></ul></ul><ul><ul><li>Falls Assessment </li></ul></ul><ul><ul><li>Infection Prevention & Control </li></ul></ul><ul><ul><li>Medication Assessment </li></ul></ul><ul><ul><li>Nutritional Assessment </li></ul></ul><ul><ul><li>Pain Management </li></ul></ul><ul><ul><li>Patient Observation </li></ul></ul><ul><li>Community Nursing Care Indicators </li></ul><ul><ul><li>Care of the Dying </li></ul></ul><ul><ul><li>Pressure Ulcer Care </li></ul></ul><ul><ul><li>Falls Prevention </li></ul></ul>NW CIs 2011
  30. 30. <ul><li>MRSA </li></ul><ul><li>C Difficile </li></ul><ul><li>Mixed Sex Accommodation </li></ul><ul><li>Quality Assurance </li></ul>Improvements Needed and Made
  31. 31. MRSA
  32. 32. C Difficile
  33. 33. Mixed Sex Accommodation Number of Breaches
  34. 34. Quality Assurance - Francis
  35. 35. Francis Review: Assurance
  36. 36. Francis Review: Assurance
  37. 37. Francis Review: Assurance
  38. 38. Francis Review: Assurance
  39. 39. <ul><li>AQuA has been established as a membership organisation through the active leadership of North West CEOs and Board Directors </li></ul><ul><li>It is firmly focused on supporting delivery of QIPP goals </li></ul><ul><li>Results are already being delivered: </li></ul><ul><ul><li>Stroke 90:10 driving up compliance with Sentinel Audit > 90% </li></ul></ul><ul><ul><li>AQ improving outcomes and experience for five conditions </li></ul></ul><ul><ul><li>Safety Networks – improvements in falls, pressure ulcers and VTEs </li></ul></ul><ul><ul><li>Mortality Collaborative – reducing HSMRs in 9 Trusts with highest rates </li></ul></ul>
  40. 40. AQ : A Progress Report *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 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%
  41. 41. Stroke 90:10 drove up standards in stroke care Phase 2 teams joined Phase 1 teams joined 90%
  42. 42. <ul><li>Background to Mortality Collaborative </li></ul><ul><ul><li>The Dr Foster Hospital Guide 2009 </li></ul></ul><ul><ul><li>Collaborative driven by the will of CEO community </li></ul></ul><ul><ul><li>9 participating organisations came together </li></ul></ul>Mortality Collaborative
  43. 43. 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.
  44. 44. The Collaborative Rate of Improvement – Dr Foster
  45. 45. The Collaborative Rate of Improvement - CHKS
  46. 46. <ul><li>2007 </li></ul><ul><ul><li>Primary Care Organisation of the Year – Wirral PCT </li></ul></ul><ul><ul><li>Clinical Service Redesign – Salford Royal FT and Salford PCT </li></ul></ul><ul><ul><li>Improving Patient Access – Bolton PCT </li></ul></ul><ul><ul><li>Reducing Health Inequalities – East Lancashire PCT </li></ul></ul><ul><ul><li>Improving Care with E-Technology – NHS North West </li></ul></ul><ul><li>2008 </li></ul><ul><ul><li>Workforce Development – NHS North West </li></ul></ul><ul><ul><li>Patient Centred Care – Blackburn with Darwen PCT </li></ul></ul><ul><ul><li>Patient Safety – Salford Royal FT </li></ul></ul><ul><ul><li>Improving Health with Nice Guidance – Central and Eastern Cheshire PCT </li></ul></ul><ul><li>2009 </li></ul><ul><ul><li>Primary Care Organisation of the Year – Liverpool PCT </li></ul></ul><ul><ul><li>Acute and Primary Care Innovation – Salford Royal FT </li></ul></ul><ul><ul><li>Reducing Health Inequalities – NHS Blackburn with Darwen </li></ul></ul><ul><ul><li>Using Date to Improve Care – NHS North West </li></ul></ul><ul><li>2010 </li></ul><ul><ul><li>Primary Care Organisation of the Year – NHS Western Cheshire </li></ul></ul><ul><ul><li>Improving Care with Technology – Central Manchester University Hospitals FT </li></ul></ul><ul><ul><li>Quality and Productivity – Salford Royal FT </li></ul></ul>
  47. 47. <ul><li>2009 </li></ul><ul><ul><li>Child Health – NHS Tameside and Glossop 2009 </li></ul></ul><ul><ul><li>Chief Nursing Officer Award – Salford Royal FT </li></ul></ul><ul><ul><li>Accident and Emergency – Salford Royal FT </li></ul></ul><ul><ul><li>Innovation in your Speciality – Royal Bolton FT 2009 </li></ul></ul><ul><ul><li>Mental Health – Greater Manchester West Mental Health FT </li></ul></ul><ul><li>2010 </li></ul><ul><ul><li>Patient Safety – Stockport NHS FT </li></ul></ul><ul><ul><li>Improving Maternity Services – Blackpool Fylde and Wyre FT </li></ul></ul><ul><ul><li>Patient Dignity – NHS Tameside and Glossop </li></ul></ul><ul><ul><li>Accident and Emergency Nursing – Royal Liverpool and Broadgreen University Hospital </li></ul></ul><ul><ul><li>Innovation in your Speciality – Liverpool PCT 2010 </li></ul></ul><ul><ul><li>Infection Prevention and Control – 5 Boroughs Partnership FT </li></ul></ul><ul><ul><li>Child Health – NHS Tameside and Glossop 2010 </li></ul></ul>
  48. 48. Nursing Standard – Nurse of the Year 2011 Fiona Murphy – Royal Bolton FT
  49. 49. Hazel Holmes – Director of Nursing Liverpool Heart and Chest Hospital NHS FT Travel Scholarship
  50. 50. Honours Awards 2007 - 2011 29 New Years/Birthday Honours Awarded to North West Hospital Staff since 2001
  51. 51. Leadership
  52. 52. <ul><li>The Prime Minister’s Commission on the future of Nursing and Midwifery in England – Front Line Care </li></ul><ul><li>Providing advice to the Department of Health on Nurses in Commissioning </li></ul><ul><li>Regional Energise for Excellence leadership </li></ul><ul><li>Rapid Spread </li></ul><ul><li>Best practice and improvement – peer to peer support </li></ul>Leadership
  53. 53. LEADERSHIP
  54. 54. Energise for Excellence Where did it start:
  55. 55. Energise for Excellence Safer Nursing Care Tool (AUKUH) HURST PANDA Birth Rate+ E Rostering Productive Care Safety Express High Impact Actions Essence of Care NW Care Indicators Productive Care Safety Express High Impact Actions Nurse Sensitive Outcome Measures Real-time Monitoring Experience Based Design Single Sex Accommodation Patient Stories High Impact Actions Real-time Monitoring Health and Well Being Get Staffing Right Deliver Care Measure Impact Patient Experience Staff Experience
  56. 56. Safety Express/Thermometer
  57. 57. NHS Confederation Launch 2011
  58. 58. <ul><li>Tracy Nurse – District Nurse </li></ul><ul><li>Emma Wilkes – Senior Nurse Practitioner </li></ul><ul><li>Joan O’Hanlin – Clinical Team Manager </li></ul><ul><li>Graeme Mitchell – Matron </li></ul><ul><li>Pauline McGarth – Acting Assistant Director </li></ul><ul><li>Caroline Rees- Sister </li></ul><ul><li>Sarah Sillitoe – Ward Manager </li></ul><ul><li>Joanne Mc’Donnell – Head of Nursing </li></ul>Local Nurses Leading the Way
  59. 60. <ul><li>Delivering QIPP </li></ul><ul><li>Dealing with increasing need and less resource </li></ul><ul><li>Really integrating care </li></ul><ul><li>Keeping quality, safety and experience at the heart of everything we do </li></ul>The Future
  60. 61. NHS North of England
  61. 62. How wonderful it is that nobody need wait a single moment before starting to improve the world Anne Frank
  62. 63. The New Mental Health Strategy for England Dr Hugh Griffiths National Clinical Director for Mental Health
  63. 64. Introduction <ul><li>The scale </li></ul><ul><li>The history </li></ul><ul><li>The policy context </li></ul><ul><li>The new mental health strategy </li></ul><ul><li>Mental health and QIPP </li></ul><ul><li>Some potential challenges </li></ul><ul><li>Future developments </li></ul>
  64. 65. The Scale <ul><li>1 in 4 people </li></ul><ul><li>Cost to English economy £77 billion pa. </li></ul><ul><li>More likely £105 billion pa. </li></ul><ul><li>A million people on IB </li></ul><ul><li>A third of GP consultations </li></ul><ul><li>Largest proportion of disease burden </li></ul><ul><li>Premature mortality </li></ul>
  65. 66. The History <ul><li>The National Service Framework – 1999 </li></ul><ul><li>The NHS Plan – 2000 </li></ul><ul><li>New Horizons – 2009 </li></ul><ul><ul><ul><li>All adults </li></ul></ul></ul><ul><ul><ul><li>Dual approach </li></ul></ul></ul><ul><li>The General Election – May 2010 </li></ul><ul><li>The new Mental Health Strategy </li></ul>
  66. 67. Policy Context <ul><li>Patients at the centre – shared decision-making, choice and information </li></ul><ul><li>Focus on outcomes – quality at the heart of the healthcare </li></ul><ul><li>Devolution – clarity about the “what” more than the “how” </li></ul><ul><li>Strengthening public health </li></ul><ul><li>Reform of adult social care </li></ul>
  67. 68. Policy Context <ul><li>Equity and Excellence White Paper - towards GP- led commissioning and outcomes (12 July 2010) – Health and Social Care Bill </li></ul><ul><li>The Outcomes Frameworks </li></ul><ul><li>Healthy lives, healthy people White Paper: Our strategy for public health in England (30 November 2010) </li></ul><ul><li>Healthy lives, healthy people: consultation on the funding and commissioning routes for public health (21 December 2010) </li></ul>
  68. 69. Policy Context <ul><li>A vision for adult social care: Capable communities and active citizens </li></ul><ul><li>(16 November 2010) </li></ul><ul><li>Liberating the NHS: developing the healthcare workforce (20 December 2010) </li></ul><ul><li>The Operating Framework for the NHS in England 2011/12 (15 December 2010) </li></ul><ul><li>Quality Innovation Productivity & Prevention (QIPP) agenda </li></ul>
  69. 70. 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
  70. 71. Mental Health Strategy - Themes <ul><li>Services and public mental health </li></ul><ul><li>Outcomes and quality </li></ul><ul><li>A life-course approach </li></ul><ul><li>Early intervention </li></ul><ul><li>Patient choice and control (personalisation) </li></ul><ul><li>Reducing inequality and tackling stigma </li></ul><ul><li>Improving efficiency (QIPP) in the context of a challenging financial climate </li></ul>
  71. 72. <ul><li>More people with mental health problems will recover </li></ul>Objectives <ul><li>More people will have good mental health </li></ul><ul><li>More people with mental health problems will have good physical health </li></ul><ul><li>More people will have a positive experience of care and support </li></ul><ul><li>Fewer people will suffer avoidable harm </li></ul><ul><li>Fewer people will experience stigma and discrimination </li></ul>Mental Health Strategy
  72. 73. A Cross-Government Mental Health Strategy <ul><li>Good mental health is essential for everyone </li></ul><ul><li>Improving public mental health and well-being, with prevention and early intervention, can cut the £105bn annual cost of mental ill health </li></ul><ul><li>People with mental ill-health are likely to have better outcomes if they have real, well-informed choices over their care </li></ul><ul><li>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 </li></ul><ul><li>How public service reforms will work for mental health </li></ul><ul><ul><li>A “Call to Action” with key stakeholders </li></ul></ul><ul><li>Key messages for a cross government mental health strategy </li></ul>
  73. 74. A Call to Action
  74. 75. Quality, Innovation, Productivity and Prevention (QIPP) <ul><li>Three mental health elements: </li></ul><ul><li>The acute care pathway </li></ul><ul><li>Local variations </li></ul><ul><li>Out of area treatments </li></ul><ul><li>Allocative efficiency </li></ul><ul><li>Physical and mental health </li></ul><ul><li>Medically Unexplained Symptoms, </li></ul><ul><li>co-morbidities </li></ul>
  75. 76. Potential Challenges <ul><li>General: </li></ul><ul><ul><ul><li>History </li></ul></ul></ul><ul><ul><ul><li>Lack of Payment by Results </li></ul></ul></ul><ul><ul><ul><li>Poor information </li></ul></ul></ul><ul><ul><ul><li>Stigma and culture </li></ul></ul></ul><ul><li>Social care system changes </li></ul><ul><li>Criminal justice system changes </li></ul>
  76. 77. Future Developments <ul><li>Implementation </li></ul><ul><li>The Joint Commissioning Panel </li></ul><ul><ul><ul><li>RCPsych and RCGP </li></ul></ul></ul><ul><li>The NHS Commissioning Board </li></ul><ul><ul><ul><li>Position mental health </li></ul></ul></ul><ul><li>Managed Networks </li></ul>
  77. 78. Where to find all documents <ul><li>Strategy and companion document – “Delivering better mental health outcomes for people of all ages” available at : </li></ul><ul><li>www.dh.gov.uk/mentalhealthstrategy </li></ul><ul><li>Also, “Talking Therapies: a four-year plan of action” and: </li></ul><ul><li>Impact Assessment and Analysis of Impact on Equality </li></ul>
  78. 79. Safety Express Maxine Power QIPP Safe Care National Work Stream Lead Department of Health [email_address]
  79. 80. 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
  80. 81. The NHS in 2040 Abby – student nurse paediatrics 2012 - 15 Charlotte – student nurse Adult branch 2012 - 15
  81. 82. Our challenge Equivalent to the number of patients with new stroke?
  82. 83. Can we ‘engineer’ pace and scale? Preventable cases? 29,000 8,000 49,222
  83. 84. Our research into the issues
  84. 85. Safety Express Aim <ul><li>To deliver </li></ul><ul><li>‘ harm free care’ * </li></ul><ul><li>to 95% of patients </li></ul><ul><li>by December 2012 </li></ul><ul><li>Defined as the absence of pressure ulcers, falls, urinary infection (in patients with catheters) and new VTE </li></ul>
  85. 86. What is harm free care? Pressure Ulcer Fall Catheter Infection 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%
  86. 87. Benefits
  87. 88. What have we learned? Patients affected
  88. 90. One Programme: Four Harms
  89. 91. Findings <ul><li>Strategic Fit </li></ul><ul><li>Disruptive </li></ul><ul><li>Measuring </li></ul><ul><li>Reliability </li></ul><ul><li>We didn’t help!!!!! </li></ul>
  90. 92. Frontline Teams Measuring 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
  91. 94. Provider Case Study [1] Kings College Hospital NHS FT <ul><li>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) </li></ul><ul><li>They are working in partnership with their community services and Guys and St Thomas. </li></ul><ul><li>At the outset they committed to working together to deliver: </li></ul><ul><ul><li>5% reduction in urinary catheter utilisation </li></ul></ul><ul><ul><li>20% reduction in injurious falls </li></ul></ul><ul><ul><li>Eradication of category 4 pressure ulcers </li></ul></ul><ul><ul><li>50% reduction in category 3 pressure ulcers </li></ul></ul><ul><ul><li>90% patients receiving VTE risk assessment and management </li></ul></ul><ul><li>They selected four wards to test the Safety Express programme </li></ul><ul><li>They measured progress with the NHS Safety Thermometer tool </li></ul><ul><li>They have used the Safety express programme to work across organisational boundaries </li></ul><ul><li>They have implemented systematic training </li></ul><ul><li>They have reviewed equipment stocks </li></ul><ul><li>They have ignited nurse leadership for hourly walk rounds </li></ul><ul><li>In August 2011 they are launching Safety Express with governors </li></ul><ul><li>In July they are planning to spread the changes </li></ul>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
  92. 95. Next steps 2011-12
  93. 96. Policy fit
  94. 97. Building resources
  95. 98. Measuring HARM
  96. 99. Scaling up activity
  97. 100. What will they say about us?
  98. 101. Embedding Amanda Cheesman Head of Professional Practice
  99. 102. <ul><li>Began in January 2011 </li></ul><ul><li>Aim – to roll out the Project across the Trust – all sites – all areas via Rapid Spread method </li></ul><ul><li>Quality & Safety Matron Team </li></ul>Phase 3 – Spread & Sustain E4E
  100. 103. <ul><li>Infrastructure in place </li></ul><ul><li>Bi Monthly Falls scrutiny Panel. </li></ul><ul><li>QSMs to monitor all Slips, Trips and Falls/Found on Floor. </li></ul><ul><li>Every fall investigated. </li></ul><ul><li>SBARS on serious falls ie caused harm. </li></ul><ul><li>Escalate serious falls to Trust Board for Executive review. </li></ul><ul><li>Falls Champions- Training Programme </li></ul>Phase 3 – Spread & Sustain E4E
  101. 104. <ul><li>Emphasis on: </li></ul><ul><ul><li>Environment- Clutter free ward, Lighting, Flooring, Bed Space readiness. </li></ul></ul><ul><ul><li>Communication- Handover, EPR alerts, whiteboards pt status at a glance, documentation </li></ul></ul><ul><ul><li>Intentional Rounding- Based on 4 Ps, P ersonal needs, P ain, P osition & P ossessions </li></ul></ul><ul><ul><li>Post Falls Actions </li></ul></ul><ul><ul><li>Proactive Falls Prevention Actions </li></ul></ul>Phase 3 – Spread & Sustain E4E
  102. 105. Challenges <ul><li>Financial pressures for equipment </li></ul><ul><li>Maintaining momentum </li></ul><ul><li>Root Cause Analysis (RCA) for each fall </li></ul><ul><li>Data collection </li></ul><ul><li>Changing the culture that falls are acceptable </li></ul><ul><li>NPSA Essential Care After an inpatient Fall- Serious Falls SOP, New equipment purchased, Training Programme, First Responder teams </li></ul>
  103. 106. Successes <ul><li>Electronic data collection for financial costs of falls (EPR) </li></ul><ul><li>True multi-disciplinary buy in, including Finance & IM&T </li></ul><ul><li>Shift in culture </li></ul><ul><li>Falls Scrutiny Committee </li></ul><ul><li>Trust Board’s keen and full support </li></ul><ul><li>HSJ Award </li></ul>
  104. 107. Transforming Community Services <ul><li>Fantastic Opportunity </li></ul><ul><li>Working across the whole Health Economy to prevent Falls – Acute Trust, PCT and Community Trust </li></ul><ul><li>Early days – pilot with NWAS (commencing 1 August 2011) </li></ul>.
  105. 108. Statistics – The Local Picture <ul><li>NWAS Mar 2010 to Feb 2011 </li></ul><ul><ul><li>3,599 Ambulance calls to falls patients (over 50yrs) </li></ul></ul><ul><ul><li>3,349 Patients & 206 repeat fallers (in month only) </li></ul></ul><ul><ul><li>68% (2,465) taken to A&E while 32% (1,134) non-conveyed </li></ul></ul><ul><li>A&E “falls” attendances 2009/10 </li></ul><ul><ul><li>5,859 attendances </li></ul></ul><ul><ul><li>57% over 50’s and 32% over 75’s </li></ul></ul><ul><ul><li>61% (2,059) arrived in ambulance, over third made own way to A&E </li></ul></ul><ul><li>ALW PCT Non-Elective admissions 2009/10 </li></ul><ul><ul><li>3,239 admissions </li></ul></ul><ul><ul><li>1,519 (47%) over 75’s </li></ul></ul><ul><ul><li>858 for fractures were fall coded (35%) </li></ul></ul>.
  106. 109. WWL and a HSJ Award .
  107. 110. Energising for Excellence (E4E) .
  108. 111. Fiona Murphy Clinical Lead Bereavement & Donation Nurse of the Year 2011 1 st September 2011 Bereavement and Donor Support
  109. 112. Low rates of donation in Western Europe In 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.
  110. 113. <ul><li>Nobody is denied. </li></ul><ul><li>Fulfilment of individual wishes. </li></ul><ul><li>Support regardless of donation outcome – everybody, every time. </li></ul><ul><li>Control and choice during an often uncontrolled situation. </li></ul><ul><li>Normalising donation as part of end of life care. </li></ul><ul><li>Conscientious objectors (staff) </li></ul><ul><li>True collaboration </li></ul>Why
  111. 114. How Excellent communication Bereavement Care Bundle Empowerment Support
  112. 115. Workforce Development <ul><li>Competency ’ educational module </li></ul><ul><li>Monthly training day </li></ul><ul><li>Full support from all tiers of management </li></ul><ul><li>Culture change </li></ul>
  113. 117. Culture Change Referrals to SN-OD 56 Referrals to TD- SN 540 From approx 1700 deaths. Referrals to SN-OD 56 Referrals to TD- SN 540 From app Full tissue 23 Gift Donors 6 Brain Donors 23 Eye Donors 322 Multi organ Donors 7
  114. 118. 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 .
  115. 119. Reducing Falls & Building the Case for Quality 1 September 2001 Gill Harris Director of Nursing & Performance, DIPC
  116. 120. Falls in Hospitals & Sucking Eggs <ul><li>One of the top 5 Health & Safety Risks </li></ul><ul><li>Falls & #NOF are the 2 nd most reported incidents </li></ul><ul><li>In England & Wales (2006) 200,000 falls were reported to the NPSA with 970 sustaining fractures & 26 falls related deaths </li></ul><ul><li>Financial costs on unscheduled care & follow up care for Local Authorities reported to be over 2 billion pounds Nationally </li></ul><ul><li>PREVENTION of falls is a National priority </li></ul>.
  117. 121. QIPP Agenda Workstreams <ul><li>Commissioning & Pathways: </li></ul><ul><ul><li>Safe Care; Safety Express: reduce harm from falls in 95% of patients by 2012 (measured via Safety Express) </li></ul></ul><ul><ul><li>Right Care Programme: “doing the right things” i.e. right care, right place, right time </li></ul></ul><ul><ul><li>Long Term Conditions: reducing unscheduled care hospital admissions; reduce length of stay; patient control </li></ul></ul><ul><ul><li>Urgent Care: maximise right person right place right time - 10% reduction in the number of patients attending A&E </li></ul></ul>
  118. 122. <ul><li>Provider Efficiency </li></ul><ul><li>Productive Series - RTTC Modules = knowing how we are doing, well organised ward, patient status at a glance </li></ul><ul><li>System Enablers </li></ul><ul><li>Primary Care driven workstreams, supporting implementation of Primary Care QIPP plans </li></ul><ul><li>Making Quality Happen </li></ul><ul><li>Quality Accounts </li></ul>QIPP
  119. 123. Background . <ul><li>Dr Mahmood Adil – Fellow from NHS Institute for Innovation & Improvement and now QIPP Lead </li></ul><ul><li>Supported by ‘Patient Safety First’ Campaign 2008 </li></ul><ul><li>Approached the Trust & agreed area of harm to reduce </li></ul><ul><li>Strategic & Operational teams established </li></ul><ul><li>Plan established to identify the financial cost saving (in addition to the human cost) by reducing harm from falls </li></ul>
  120. 124. Aim . <ul><li>To reduce the number of falls in the Trust by 50% in 2 years (baseline 2008-09) </li></ul><ul><li>Identify financial savings </li></ul><ul><li>Full roll out of project – January 2011 </li></ul><ul><li>Re-educate Healthcare Professionals & try and change the culture to stop normalising the abnormal! </li></ul>
  121. 125. Work plan <ul><li>Undertake detailed assessment of current situation </li></ul><ul><li>Strategy </li></ul><ul><li>Policy </li></ul><ul><li>Data collection </li></ul><ul><li>Trust’s falls figures </li></ul><ul><li>In-depth audit of inpatient falls resulting in harm </li></ul><ul><li>Review of our existing improvement interventions </li></ul>.
  122. 126. Work plan continued… <ul><li>Review existing improvement efforts </li></ul><ul><li>Implement whole system training package </li></ul><ul><li>Apply appropriate interventions </li></ul><ul><li>Develop Business Case for Quality (QIPP) </li></ul>.
  123. 127. Falls Audit – January 2010 <ul><li>Retrospective case notes audit </li></ul><ul><li>1308 falls Trust wide, focused on inpatient falls that resulted in moderate, severe harm or death </li></ul><ul><li>Timescale – all falls in hospital from December 2008 to November 2009 </li></ul><ul><li>37 patients audited in depth </li></ul>.
  124. 128. Summary of Results . <ul><li>Mainly moderate injuries </li></ul><ul><li>Most in Medicine/Rehabilitation </li></ul><ul><li>Most at bedside </li></ul><ul><li>Many patients on offending medication </li></ul><ul><li>Mainly unwitnessed falls </li></ul><ul><li>Mainly head injuries & lacerations </li></ul><ul><li>Low number of L/S BP on admission </li></ul><ul><li>Total cost (but difficult to do so) £46,312 </li></ul>
  125. 129. Project Plan – 3 Phases <ul><li>Phase 1: Diagnostic from Oct 2009 to Feb 2010 </li></ul><ul><li>Phase 2: Intervention, Pilot & Monitor from April to June 2010 </li></ul><ul><li>Phase 3: Rapid Spread, from July to Sept 2010 </li></ul><ul><li>January 2011 became the reality… </li></ul><ul><li>Sustain E4E & Monitor </li></ul>
  126. 130. Reducing the Number of Falls
  127. 131. Financial Savings - #NOF With costing ability within EPR we were able to retrospectively cost #NOF due to falls 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
  128. 132. Phase 1 <ul><li>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 </li></ul><ul><li>Identify evidence based interventions that haven’t already been implemented </li></ul><ul><li>Calculate cost of falls based on retrospective audit & develop an e-integrated system </li></ul><ul><li>Review Policy & develop new Falls Risk Assessment </li></ul>.
  129. 133. Pilot Ward Interventions <ul><li>All patients undergo new multifactoral risk reduction plan on admission </li></ul><ul><li>All patients have bedrail risk assessment undertaken on admission and intervention completed </li></ul><ul><li>Slipper exchange accessible for all patients on pilot wards </li></ul><ul><li>Incident Map updated post falls on the pilot wards </li></ul><ul><li>Post Falls – Electronic Patient Record (EPR) completed and ongoing costings assessed </li></ul><ul><li>Pharmacy input within 24 hours of admission </li></ul>.
  130. 134. Plan Prior to Launch of Phase 2 Pilot <ul><li>Ward Teams (3) trained on EPR falls form & falls reduction interventions & plan </li></ul><ul><li>Equipment available on each pilot ward (bedrails ordered & slipper exchange supported by Age UK) </li></ul><ul><li>EPR live </li></ul><ul><li>Pharmacy support in place </li></ul><ul><li>Incident Map – Productive Series </li></ul><ul><li>Trust Wide Communication Strategy </li></ul><ul><li>Data Collection agreed </li></ul>
  131. 135. Standish Ward Incident Map
  132. 136. Using Innovative Initiatives to Impact on Infection
  133. 137. Better Care Better Health Better Life Helen Crombie - Assistant Director Performance Improvement & Julie Hughes – Nurse Consultant Infection Control
  134. 138. Using Innovative Initiatives to Impact on Infection <ul><li>Introduction – a little background context… </li></ul><ul><li>Impact of Infection Initiative – Focuses on Reputation, Risk and Care Outcomes </li></ul><ul><li>Initiatives for Prevention and Protection </li></ul><ul><li>Innovative Involvement Initiative –CDI Initiative </li></ul><ul><li>Increasing Awareness Initiative – identifying IPC priorities, using a consistent information presentation, repeating the same message </li></ul><ul><li>Interactive Learning Time Initiative </li></ul>
  135. 139. Introduction <ul><li>A Little Background Context </li></ul><ul><li>The North West Experience </li></ul><ul><li>Engaging the Whole Health Economy </li></ul><ul><li>Context Facts and Figures – Acute vs Community </li></ul>
  136. 140. NHS North West - Number of MRSA Bacteraemia April 2008 – June 2011
  137. 141. NHS North West - Number of MRSA Bacteraemia April 2008 – June 2011 Trend
  138. 142. NHS North West – MRSA Bacteraemia Yearly reductions (2008-2011)
  139. 143. NHS North West – MRSA Bacteraemia Acute & Non- Acute (by Quarter)
  140. 144. MRSA – Latest position Commissioner)
  141. 145. NHS North West - Number of C- Difficile Infections April 2008 to June 2011
  142. 146. NHS North West - Number of C- difficile Infections April 2008 – June 2011 Trend
  143. 147. NHS North West – C- difficile Infections Yearly reductions (2008-2011)
  144. 148. NHS North West – C- difficile Infections Acute & Non- Acute (by Quarter)
  145. 149. C-difficile – Latest Position (Commissioner)
  146. 150. The Impact of Infection Initiative Focussing on Reputation / Risk / Outcomes <ul><li>Public Confidence </li></ul><ul><li>Media attention </li></ul><ul><li>Jobs / Recruitment </li></ul><ul><li>Risk to Patients and Residents </li></ul><ul><li>Impact on Family Life </li></ul><ul><li>Cost to Organisation/ NHS </li></ul><ul><li>Closure – Beds, Homes & Life </li></ul>
  147. 151. Impact on Reputation <ul><li>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? </li></ul><ul><li>How do your Relatives feel when your hospital, service or care homes are branded as places nobody wants to work at? </li></ul><ul><li>Do you want your place of work to be viewed as a Place of poor care standards with a history of infection? </li></ul>
  148. 152. Impact on Risks relating to Infection Prevention & Control Why Focus on this Agenda? - impacts on the whole health economy
  149. 153. Impact on Organisational Outcome <ul><li>CQC report on HPA web site - 29 September 2010 </li></ul><ul><li>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) </li></ul><ul><li>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. </li></ul><ul><li>Reasons sited: </li></ul><ul><li>Training, Cleanliness, Hygiene, Record keeping </li></ul>
  150. 154. <ul><li>Initiatives for Prevention and Protection </li></ul><ul><li>Promoting Prevention – mapping, identifying vulnerable patients – Various Trusts </li></ul><ul><li>Promoting Protection – preventing future relapse –Case Management – Initially Salford –Now the Majority </li></ul><ul><li>Promoting Patient Involvement –CDI antibiotic awareness card </li></ul>
  151. 155. Innovative Involvement Initiative CDI – The Challenge Reducing Antibiotic Prescribing Promoting Patient Involvement – Antibiotic awareness information cards – North West Wide initiative
  152. 156. CDI – The Challenge Reducing Antibiotic Prescribing Patient Information leaflet Card attached
  153. 157. CDI – The Challenge Reducing Antibiotic Prescribing Clinicians Information Sheet: Describes Purpose, Benefits Web Site www.northwest.nhs.uk/cdiff
  154. 158. CDI – The Challenge Reducing Antibiotic Prescribing Poster For: Surgery’s Dentists Pharmacies A&E Dept MAU OPD
  155. 159. Increasing Awareness Initiative <ul><li>Promoting Education </li></ul><ul><ul><li>Staff, Patients, Residents, Families </li></ul></ul><ul><ul><li>Media </li></ul></ul><ul><li>Reinforcing the Value of Audit / Monitoring Practice </li></ul><ul><ul><li>Diarrhoea Management -tools and techniques </li></ul></ul><ul><ul><li>Hand Hygiene </li></ul></ul><ul><ul><li>Cleaning </li></ul></ul><ul><ul><li>Treatment – Antibiotics </li></ul></ul><ul><ul><li>Isolation Practice </li></ul></ul>Getting the message out there……….
  156. 160. Increasing Awareness Initiative Identify Infection Prevention & Control Priorities - Focusing Resources, Promoting Guidance and Guidelines Mental Health Initiative – Julie Hughes
  157. 161. 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
  158. 162. HCAIs and IPC in mental health settings <ul><li>Prior 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 </li></ul><ul><li>HCAIs in MH overall remain low but predisposing risk factors and impact across whole health economy </li></ul><ul><li>However, little information and evidence available re extent of HCAIs in this area </li></ul><ul><li>Compliance with IPC also challenging e.g. patients compliance/ligature risks etc </li></ul>
  159. 163. Strategies for improvement <ul><li>Surveillance </li></ul><ul><ul><li>Monthly prevalence studies of HCAIs (3% HAI, 2% CAI) </li></ul></ul><ul><ul><li>Weekly surveillance </li></ul></ul><ul><ul><ul><li>wounds/infections/invasive devices/antibiotic prescribing </li></ul></ul></ul><ul><ul><li>Main infections – UTI, chest, wounds </li></ul></ul><ul><ul><li>Main organisms – MRSA, E.coli </li></ul></ul><ul><li>MRSA Screening </li></ul><ul><ul><li>98% compliance </li></ul></ul><ul><ul><li>8% of patients screened +ve </li></ul></ul><ul><ul><li>25 % > 48 hours, 75% < 48 hours </li></ul></ul><ul><ul><li>Leg/foot ulcers, self harm </li></ul></ul>
  160. 164. Strategies for improvement <ul><li>IPC audit programme </li></ul><ul><ul><li>High Impact interventions </li></ul></ul><ul><ul><li>Essential Steps </li></ul></ul><ul><ul><li>Quarterly antimicrobial prescribing – overall improvement </li></ul></ul><ul><ul><li>Essence of Care </li></ul></ul><ul><ul><li>AIMS </li></ul></ul><ul><li>Training and culture change </li></ul><ul><ul><li>increased ownership of audit results and issues by Matrons and areas </li></ul></ul><ul><li>Service user involvement </li></ul><ul><ul><li>Active engagement and empowerment </li></ul></ul>Example of monthly Matron/IPC Board and Business Stream reports Example of Service User spot-checks
  161. 166. Interactive Learning Initiative <ul><li>Promoting Engagement </li></ul><ul><ul><li>Whole Health Economy Involvement </li></ul></ul><ul><ul><li>Newsletters / Prescribing Alerts </li></ul></ul><ul><ul><li>Medicines Management Teams </li></ul></ul><ul><ul><li>Dental Services </li></ul></ul><ul><li>Supporting Education and Training initiatives </li></ul><ul><ul><li>RCN Infection Prevention Conference </li></ul></ul><ul><ul><li>North West Master class </li></ul></ul><ul><ul><li>North Lancashire Care Homes Conference </li></ul></ul>Continuing to get the message out there……….
  162. 167. Toilet Talk – Managing the Impact of Diarrhoea by Focusing on the Normal Bowel and other relevant matters <ul><li>Introduction – Pathology and Causation </li></ul><ul><li>Impact – Reputation, Risk, Care Outcomes </li></ul><ul><li>Increasing Awareness by Improving the Management of Diarrhoea </li></ul><ul><li>Identifying Infection Prevention & Control Priorities </li></ul><ul><li>Interactive Learning Time </li></ul>
  163. 168. Finally <ul><li>Remember when Preventing Infection – </li></ul><ul><li>What we have always done will not solve the problem, it gets more difficult – we have to be innovative </li></ul><ul><li>And why? </li></ul><ul><li>Because it improves the Patients Experience and their Outcomes </li></ul>
  164. 169. The New Commissioning Architecture
  165. 170. <ul><li>Cathy Maddaford - NHS Cheshire, Warrington and Wirral </li></ul><ul><li>Moira Angel - NHS Cumbria </li></ul><ul><li>Hilary Garratt - NHS Greater Manchester </li></ul><ul><li>Trish Bennett - NHS Merseyside </li></ul><ul><li>Gary Hardman - NHS Lancashire </li></ul>
  166. 173. 2011 2013 To deliver Largest change management project Cluster: Key Objectives
  167. 174. Success will be measured by the successful establishment of the new commissioning architecture Commissioning Development
  168. 175. 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
  169. 176. An Olympic Size Challenge?
  170. 177. Developing Clinical Commissioning
  171. 178. Developing Clinical Commissioning
  172. 179. <ul><li>Three key role of non medical professionals in commissioning: </li></ul><ul><li>Strategic decision making, leadership – new vision/personalisation embracing technology </li></ul><ul><li>Pathway/service redesign/contracting the best quality outcomes </li></ul><ul><li>Guardianships of the patient experience across care settings/safeguarding </li></ul>The Leadership Challenge
  173. 180. <ul><li>More than pure clinical intervention changes </li></ul><ul><li>Good clinical commissioning needs to be based on </li></ul><ul><li>the insights of many but with strong leadership </li></ul><ul><li>Release the potential for finding creative solutions </li></ul><ul><li>which already exist within system </li></ul>
  174. 181. <ul><li>Local relationships are key </li></ul><ul><li>Health Improvement and prevention is bigger than general practice </li></ul><ul><li>Patients need to be fully involved in commissioning </li></ul>
  175. 182. <ul><li>Driving leadership for outcomes </li></ul><ul><li>Supporting leadership that drives performance </li></ul><ul><li>Driving leadership for competent commissioning </li></ul><ul><li>Driving leadership for quality and safety </li></ul><ul><li>Driving leadership through Level 3 QIPP service reconfiguration </li></ul>
  176. 183. <ul><li>How do we work together as nurse leaders i.e. Cluster/acute DON’s </li></ul><ul><ul><li>What are our distinct roles? </li></ul></ul><ul><ul><li>What are our joint roles? </li></ul></ul><ul><li>Do you think the Cluster DoN’s focus of work is right? </li></ul><ul><li>What are our joint high risk priorities. How do we address them? </li></ul>