Improving Together
Improving Together Issue #9 - December 2019
CHIEF EXECUTIVE, PAULA CLARK FOLLOWS UP ON CQC REPORT
IMPROVING CARE FOR PATIENTS WITH MENTAL HEALTH CONDITIONS
FIRST COHORT OF INDIAN NURSES ARRIVE AT OUR HOSPITALS
Our Quality Improvement journey to delivering great care Caring | Well-Led | Responsive | Effective | Safer
T AS A RESULRVE Y OF S TAFF SUACK FEEDB
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MATERNITY SERVICES
By Paula Clark Chief Executive
Earlier this month the CQC published the findings of the focused inspections they carried out on our Maternity services in April 2019. This inspection is not to be confused with the inspection that took place in November, and does not grade the departments. Pleasingly though, the inspection team in April found improvements in our Maternity services. This includes improved staffing levels, morale and governance.
Key improvements highlighted in the report include: • CTG centralised monitoring was in place on labour ward for full oversight and fresh eyes. • Incident reporting had increased to demonstrate openness to improve from lessons learnt. • Midwives spoke positively about the changes made to provide a safer service. • Equipment was in good working order and a new track and trace electronic system had been introduced. • Medical handover now occurred twice daily on the labour ward. • Midwives told us the increased visibility and approachability of the senior managers, matrons and deputy head of midwifery has raised morale and the culture felt more engaged and open. • They explained how the preceptorship model was well supported, encouraging retention of new staff. >
• Appraisals were completed effectively to discuss individual feedback. Great respect was shown from managers and currently appraisal completion was 82%. Staff told us they were encouraged to speak with the co-ordinator at all times. • The daily management huddle ensured that each area had an oversight of risk and activity, enabling support and advice to be given. • Improvements to the service had been signed off by senior leaders. Improvements included; handovers being completed twice daily on labour ward, high risk women in labour were reviewed by medical staff and reduced fetal movements policy had been reviewed with a defined pathway developed. • Weekly and monthly reviews of the CQC submission and quality improvement plan had focused the service to embed the changes and ensure timely progress.
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Matron Jill Whitaker with the new pregnancy information booklets that is given to mums-to-be. During the CQC visit midwives spoke positively about the changes made to provide a safer service.
Driving improvements in Maternity has been a key focus for us, and it will continue to be a priority for this organisation. We still have further to go but it is pleasing that our improvements are being recognised. The majority of negative feedback from the inspection in April focused on the number of staff vacancies – this was because back in March 2019 there was a vacancy deficit of 11%, which rose to 26% when the identified Birthrate Plus requirements were included. However, I am pleased to say these problems no longer exist and the initial written feedback from the most recent November inspection (full report to be published next year) states: “Staffing levels met patients’ needs at the time of the inspection.”
Other positive feedback from the November inspection includes:
Medical handovers occur twice daily on the labour ward.
• Governance processes were effective and had driven improvements • The environment was visibly clean and well maintained. • Patients told the inspectors they were treated by staff who were kind and compassionate.
These are really positive early indicators of change. Thank you all for your hard work, and I know you will continue to help us keep driving improvements.
Consultant Guy Calcott using the CTG centralised monitoring system that is now in place on the labour ward.
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Pictured below: Weekly spot checks are to be conducted in both Emergency Departments by a clinician external to the departments
Emergency Departments During their most recent inspection, the CQC inspectors unfortunately highlighted serious concerns in our Emergency Departments and Medical Wards. We have taken this feedback very seriously and are acting immediately. The enforcement notice we received covers three elements—managing patients with sepsis or a deteriorating condition; the streaming of minors and the treatment of patients with mental health issues. We will work closely with you right across the pathways from ED and into the medical wards first as these are the most pressing areas. We will also work continue to work closely with the CQC and update them on a weekly basis on the work we are doing to improve. This includes:
Pictured right: Angela Windsor is the Trust’s specialist Sepsis Nurse and is working closely with the teams in ED
A lot more still needs to be done to get our Emergency Departments where we want them to be. We have a Quality Improvement Plan in place and we will be working closely with everyone in the team to help deliver improvements.
I would also like to take this opportunity to thank our teams • The Trust is bringing in external Mental Health experts to in ED for their continued efforts. The number of people attending our departments is increasing every year, for review the services. We are also working with a patient representative, Linda Jones, who spent the week with us example over one weekend in December (Saturday 7 and Sunday 8) we had an extra 166 patients coming through the recently as part of a Rapid Process Improvement Week doors compared to the same weekend in 2018. With that (read more about this on the next page) came an extra 25 ambulances. • Mental Health training is being provided to doctors and nurses working in the Emergency Departments and Medical Wards.
And it didn’t stop there. The Monday after saw and extra 74 patients and 22 ambulances compared to the same day in 2018.
• Weekly spot checks are to be conducted in both Emergency Departments by a clinician external to the departments. Spots checks are also being conducted to ensure mental health patients are being triaged and escalated appropriately.
These are not excuses. We have to get better, but we do all recognise the pressures you are under. Reconfiguration of our hospitals will help significantly, and improvements across the whole local health system are needed to ensure care packages are in place for those ready to go home, but • A specialist Sepsis Nurse, Angela Windsor, was employed in the meantime we all need to ensure our departments are the very best they can be. in the summer. She is working closely with the teams in both Emergency Departments to deliver training to The feedback we receive about our ensure patients are managed appropriately. Specialist performance gives us the opportunity to Sepsis Trollies and Sepsis Boxes have also been make improvements. From my short time introduced within each department. at the Trust I’m really positive about our organisation because, despite our • Specialist paediatric training is being delivered to all setbacks, there’s an energy to make it nursing staff, while the Trust continues to proactively better and a growing band of staff who advertise for specialist paediatric nurses. are driving this. By Paula Clark Chief Executive
The Trust is exploring ways to improve the care of patients presenting with mental health conditions in its Emergency Departments (EDs). Throughout the second week of December, doctors, nurses and other healthcare professionals at SaTH used the Trust’s Transforming Care Production System - which is now fully embedded at SaTH following the five-year partnership with the USA’s Virginia Mason Institute – to improve the care and treatment for patients with mental health conditions. These newly-designed processes are now being trialled to help: • All staff in the Trust’s two EDs, as well as the on-call teams, know the correct process for the admission of 16 and 17-year-olds presenting in the EDs with a mental health condition • All patients in the EDs are triaged using a much-improved Mental Health Triage Tool • The number of patients triaged within 15 minutes of arrival in the EDs is increased During the week the team were also joined by Lynda Jones, an independent mental health activist, who has been inputting and guiding the team from a patient perspective.Adrian Vreede, Operations Manager at SaTH, said: “This has been an incredibly valuable week for everyone involved.
“We know we have to make improvements in this area and by coming together and taking a week away from the day-to-day business, we have been able to come up with a number of solutions that should improve outcomes for patients. “We are not going to find a magic fix in a week, but through the introduction of a number of new tools, and then regularly testing and tweaking, I am confident we have taken the first steps towards positive change.”
Improving care of patients with Mental Health conditions
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Improvements made during the week include: • The creation of a Mental Health Triage Tool – all patients presenting in ED are currently assessed using a Physical Health Tool. A much-improved Mental Health Triage Tool is to be introduced alongside this which will help decide the next course of action for the patient • The creation of a flowchart for all staff in the Emergency Departments - a step-by-step guide has been created to ensure all staff are fully aware of the correct pathway for 16 to17-year-olds presenting in ED with a mental health condition • Improved education and awareness - information folders are to be created containing important information, including the flowchart and the Mental Health Triage Tool, and contact details of external organisations that may be able to assist in the delivery of great patient care of those presenting with a mental health condition Lynda Jones said: “The Trust is most definitely heading in the right direction. Over the past few months there has been a much greater focus on mental health and the way patients, and staff, are cared for. “My job is to challenge the staff and always provide the patient voice. It is the best way of working and I am really pleased to be asked to work with the team this week and going forwards.“The Trust has lot more planned for 2020 – which is really exciting – building on the good work that has already been done, including the creation of Mental Health First Aiders and Peer to Peer Listeners, and the introduction of suicide prevention training. “We still have work to do but I am confident that mental health is now a key priority for SaTH. In the meantime I will keep delivering the patient voice.” The results of this week’s work will be presented to all staff tomorrow (Friday 13 December) and then trialled within the EDs with a view to it being rolled out permanently.
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News in Brief The first cohort of nurses recruited from India arrived at SaTH in December. The 176 nurses have been recruited to help improve the quality of care for patients. The Trust has looked to overseas recruitment, through Health Education England’s (HEE) Global Learners programme, to help fill gaps in its substantive nursing and midwifery workforce. Rhia Boyode, Acting Workforce Director at SaTH, said: “Our teams are working incredibly hard to boost our substantive nursing workforce and reduce the reliance on agency staff.
“The HEE programme was implemented to meet the shortfall of over 270 Band 5 nursing and midwifery vacancies in the Trust and these appointments will help to improve the care we give to our patients. “HEE’s Global Health Exchange is working with healthcare providers globally to improve the quality and volume of the NHS workforce through global education and workplace exchanges. Barbara Beal, Director of Nursing and Midwifery at SaTH, who led on the recruitment campaign with Workforce colleagues, welcomed the news. Barbara said: “This is extremely good news for our patients and our staff, so it very important that our nurses feel welcome and we are doing everything we can to ensure they feel at home.”
Groundbreaking 3D software introduced at SaTH The service has already been used to plan surgery for a patient with cancer of the upper jaw, a patient with a large cyst close to the eye and a patient who has suffered serious facial injuries in a cycling accident.
Groundbreaking 3D software which will help to virtually plan surgery and reconstruction for cancer and trauma patients has been introduced at SaTH. It has been made possible thanks to a generous donation totalling nearly £50,000 from a former patient and the League of Friends of the Royal Shrewsbury Hospital (RSH). The donation has enabled a new 3D Printing and Surgical Planning service to be introduced in the Maxillofacial and Orthodontic Laboratory, based at RSH – meaning quicker and more advanced treatment for patients.
Mr Sunil Bhatia, Consultant, said: “With this being in-house we are now able to perform virtual surgery to remove cancer from a very difficult area of the body, and we are also now able to very accurately predict the defect and also fabricate a framework from patient bone or a titanium.”
Extra support to reduce length of stay Doctors and Nurses are to get support in the evenings, at weekends and during Bank Holidays in order to improve patient flow and reduce hospital length of stay. SaTH is introducing its first cohort of Medical Assistants (MAs), who will work with Medical and Surgical staff. The MAs will be paid to work fixed hours during evenings, weekends and Bank Holidays to support on-call and ward-cover Junior Doctors and ward nurses with specific tasks including siting cannulas, taking blood samples and blood cultures and performing ECGs (electrocardiograms). The role will allow MAs to carry out the relatively simple tasks, helping to free up the time of senior members of staff. MAs are senior medical students who have been signed off as competent in these specific tasks by senior nursing skills educators. They will work under the supervision of the on-call Doctors. Dr Koottalai Srinivasan, Hospital Dean, said: “This initiative should help improve patient flow and safety by supporting our very busy medical and nursing teams on the wards.”
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The wishes of patients are being prioritised The wishes of patients are being prioritised in a new way for doctors to record how someone wants to be cared for at the end of their life. SaTH has recently introduced the national ReSPECT process, along with health and care partners across Shropshire and Telford & Wrekin.
Nearly 100 members of staff were celebrated recently for a host of learning achievements. Over the past 12 months, staff at SaTH have completed qualifications including: Masters Degrees, Bachelors Degrees, Post Graduate Diplomas in Advanced Clinical Practice, Lean for Leadership, End of Life Care and Pharmacy Service. An afternoon tea celebratory event was held at The Whitehouse Hotel in Wellington, and was hosted by Interim Chief Executive, Paula Clark, and Trust Chair, Ben Reid. Paula said: “I would like to congratulate everyone on their achievements. I’m proud to work alongside these incredible teams and individuals who have worked incredibly hard to improve themselves for the benefit of our patients. It’s so important to take the time to celebrate their work.”
Vanguard Unit now in use at the Princess Royal Hospital A mobile recovery unit is now in place at the Princess Royal Hospital (PRH) in Telford. The Vanguard Unit, situated towards the rear of the hospital, has been brought in to help alleviate the impact that winter pressures has on day surgery – same day surgery that does not require an overnight stay. The capacity offered by the mobile facility will allow SaTH, to ensure continuity of access to a number of surgical specialities, including Ear, Nose and throat. Kath Preece, Head of Nursing for Scheduled Care at SaTH, said: “We have used Vanguard Units
ReSPECT - Recommended Summary Plan for Emergency Treatment and Care - is a patient-held form which enables all healthcare professionals to have a structured conversation with a patient and their family about what to do in an emergency.The purple ReSPECT form captures each patient’s wishes formally, in a way which seeks to balance a patient’s care and comfort against clinical interventions. It replaces the previous ‘Do Not Attempt Resuscitation’ (DNAR) protocols, which were only available at SaTH and which experts said were more focused on clinical considerations than patients’ priorities. Dr Elin Roddy, Clinical Lead for End of Life Care at SaTH, said: “The ReSPECT form stays with the patient wherever they are – acute hospital, home, community hospital, hospice or nursing home – and is an important communication and handover tool for healthcare professionals, as well as an added reassurance to our patients, and their families, that their wishes will be taken into account. “This is a great step forward for shared decision making with our patients, and we are grateful to everyone for their input and enthusiasm.” suitable patients, without the risk of their treatment being cancelled due to winter pressures.”
successfully in the past – most recently at RSH earlier this year. “This mobile unit allows us to plan for patients to receive their day surgery procedures over the winter months. This is good news for our patients as it means that we will be able to treat a cohort of
Neil Rogers, Assistant Chief Operating Officer for Scheduled Care at SaTH, said: “The deployment of the unit is crucial at this time of year when the volume of people using our services increases; and it is likely to remain in use until April.” The mobile unit offers space for up to seven day surgery patients at a time.
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Mobile App More than 2,600 people have downloaded our staff app – MySaTH – in the first five months of launch and now further improvements are being made to it to make it even more beneficial to you. The app was launched in July with the aim of improving staff engagement, which was identified as an issue in the 2018 NHS Staff Survey. Following your feedback, you can now use the app to access ESR, your work email and a new clinical information portal. The content included in the Clinical Information portal is still very limited, but teams are encouraged to contact sath.communications@nhs.net to discuss how they feed into the section in the same way as the Sepsis team have done. The app also allows staff to read the latest news and updates and access rotas, while also providing important links to staff development opportunities and the latest benefits and discounts available. It also has a section entitled ‘Help for Staff’ which has links to Freedom To Speak up Guardians, Health and Wellbeing offers and the Guardian for Safe Working. Julia Clarke, Director of Corporate Governance at SaTH, said: “My SaTH is about investing in and engaging with you. “Listening to and engaging with our staff is fundamental to embedding our culture of quality improvement and the My SaTH app is a simple and extremely effective way for us to do just that. “As use in the app grows over time, you can make suggestions for change and local improvement. These will be fed back to our Communications Team to implement so our teams can see their own ideas being the basis for local change.”
Total downloads: 2,634 Page views: More than 10,000 every month Most popular: e-Roster, News, NHS Mail and Jobs
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Time in app: 36% of people spending more than 5 minutes at a time Visits per day: Anywhere between 250 and 1,500