Reducing Harm and Mortality in Hywel Dda Health Board

1. Reducing Harm and Mortality inHywel Dda Health Board May 11th 2010 Reducing Harm and Mortality in Hywel Dda Health Board

2. Reducing Harm & Mortality in Hywel Dda - Our Main Aims • Reduce RAMI to below 100 in 2 years • Reduce episodes of harm by 25% in 2 years Reducing Harm and Mortality in Hywel Dda Health Board

3. Executive Leads • Janet Wilkinson:- • Leadership • Dr Simon Mahon Medical Director:- • Critical Care& Rapid Response to Acute Illness • Bernadine Rees:- • Medicines Management • Tony Chambers:- • Healthcare Associated Infections Reducing Harm and Mortality in Hywel Dda Health Board

4. Executive Leads Caroline Oakley Director of Nursing:- Hospital Acquired Pressure Ulcers Chris Wright:- Surgical Complications Kathryn Davies:- Hospital Acquired Thrombosis Dr Sue Fish Medical Director:- Acute Stroke Reducing Harm and Mortality in Hywel Dda Health Board

5. RAMI 2010 Our aim is to reduce the RAMI to below 100 and also to reduce the variation in our monthly RAMI scores Reducing Harm and Mortality in Hywel Dda Health Board

6. How We are going To Achieve Our Aims • By Using Continuous Quality Improvement Methodology Reducing Harm and Mortality in Hywel Dda Health Board

7. How We are going To Achieve Our Aims Reducing Harm and Mortality in Hywel Dda Health Board

8. How We are going To Achieve Our Aims • Each ward/department required to sign up to at least one quality Improvement project inline with the requirements of the Health Board Quality Improvement strategy and 1000 Lives+ content areas Reducing Harm and Mortality in Hywel Dda Health Board

9. How We are going To Achieve Our Aims Page 1 of form • Each ward/department has to complete quality improvement project notification and approval form Reducing Harm and Mortality in Hywel Dda Health Board

10. How We are going To Achieve Our Aims • These forms will be used to track the quality improvement projects and ensures that each project has a sponsor and has been agreed • They will also set out the reporting arrangements for the project Reducing Harm and Mortality in Hywel Dda Health Board

11. Quality Improvement Project Feedback/Communication form Each ward/department will be required to provide updates on progress on to the 1000 Lives+ teams monthly Reducing Harm and Mortality in Hywel Dda Health Board

12. Driver Diagram Reducing Harm and Mortality in Hywel Dda Health Board

13. Reduction of RAMI and Harm Primary Drivers • Reduce Mortality Levels • Weekly Review of all Deaths in Secondary Care • First review meeting held (Execs & AMD’s in attendance). • 39 Deaths reviewed • Implementation of Quality Improvement and Patient Safety Strategy • How to Guide for Health Board staff being written • Reduce episodes of harm to our patients • This will be achieved by ensuring all elements of the 1000 Lives+ are implemented along with achieving the aims of the Quality Improvement Strategy Reducing Harm and Mortality in Hywel Dda Health Board

14. Reduction of RAMI and Harm Secondary Drivers • Analysis of CHKS data to identify areas of potential concern • This work has already started • Address data quality issues • Reduce backlog of un-coded notes • 6000 sets of un-coded notes coded in 6 weeks • Improve systems for coding of patients notes • Discharge summaries/letters being revised Reducing Harm and Mortality in Hywel Dda Health Board

15. Reduction of RAMI and Harm Secondary Drivers • Improve systems for undertaking GTT audits in 4 main hospitals • 10 sets every two weeks • Train more staff to undertake GTT audits • Improve system for obtaining patients details and retrieval of notes Reducing Harm and Mortality in Hywel Dda Health Board

16. Reduction of RAMI and Harm Secondary Drivers • Executive lead for each content area tasked with driving forward the initiatives helping to ensure that harm and mortality reduction targets are met • Quality and Safety teams to be set up in each county Reducing Harm and Mortality in Hywel Dda Health Board

17. Clinician Engagement • Mortality and Morbidity meetings to be rolled out across the Health Board • Standard Agenda to include • Mortality Review • CHKS validation • Unexpected admissions to ITU • Cardiac Arrest Qualitative audits • Adverse Incident • Infection control issues • GTT Reducing Harm and Mortality in Hywel Dda Health Board

18. Key Quality Issues Currently Being Addressed • Standardised Handover (SBAR) • Clerking Performa • Track and Trigger • Improved discharge/death documentation • Clinicians engagement with clinical coding • DNAR Reducing Harm and Mortality in Hywel Dda Health Board

19. Driver Diagram Reducing Harm and Mortality in Hywel Dda Health Board

20. General Ward Primary Drivers • Develop an infrastructure that promotes quality care (Transformational Leadership) • Provide an environment that has efficient and organised systems in place (Releasing Time to Care) • Provide appropriate, reliable and safe care to patients using evidence-based therapies (Safety & Reliability) • Create a highly effective and collaborative multidisciplinary team and safety culture (Teamwork & Vitality) • Ensure patient and family centred care Reducing Harm and Mortality in Hywel Dda Health Board

21. General Ward Secondary Drivers (Transformational Leadership) • Continue to implement the ‘Empowering Ward Sisters’ principles for leadership & development in all areas • Establish integrated multi-disciplinary teams supported by the ward/ department Leader • Ensure patient care & ward objectives are measurable & aligned to the Health Board priorities Reducing Harm and Mortality in Hywel Dda Health Board

22. General Ward Secondary Drivers (Releasing Time to Care) Establish open and accessible processes to report outcome measures ‘Knowing How We Are Doing Boards’ are creating opportunities for staff, patients & public to understand the information and it’s implications for practice. Create efficient sustainable working environments and systems of work 5’s principles are one example being used to achieve sustainable changes with staff commitment Develop visual information/ communication systems to convey patient information ‘Patent Status At A Glance’ Boards are being developed to support this, with some areas investing in white board technology Reducing Harm and Mortality in Hywel Dda Health Board

23. General Ward Secondary Drivers (Safety & Reliability) • Reduce Pressure Ulcers by 50%(See separate driver diagram) • Reduce Patient Falls by 50%(See separate driver diagram) • Reduce HAI infections by targets within the Quality strategy and AOF Reducing Harm and Mortality in Hywel Dda Health Board

24. General Ward Secondary Drivers (Safety & Reliability) • Modified early warning system (MEWS) to identify patient deterioration • Currently 3 different systems in use • Scoring systems being aligned to ensure consistency • Health Board wide system being developed Reducing Harm and Mortality in Hywel Dda Health Board

25. General Ward Secondary Drivers (Teamwork & Vitality) • Establish accurate & accountable MDT care planning • Ensure all MDT communication / handover processes apply the principles of SBAR some areas have linked the handover to the Patient Status At A Glance board, improving accuracy of information, patient safety and effective use of staff time Reducing Harm and Mortality in Hywel Dda Health Board

26. General Ward Secondary Drivers (Patient & Family Care) • Ensure patients physical comfort • Involve patients & family with care planning goal setting and discharge planning National Fundamentals of Care Audit provides information regarding the patients’ perception annually to all wards, additional short stay areas to be included . • Communicate openly and effectively amongst the MDT, Patient & Family • Ensure Patients wishes are respected within end of life care planning • End of life care pathway provides auditable information Reducing Harm and Mortality in Hywel Dda Health Board

27. Driver Diagram Reducing Harm and Mortality in Hywel Dda Health Board

28. Falls Primary Drivers • Identification of Risks • Multifactorial risk assessment • Multifactorial interventions • Communication of falls risk status • Education of staff, patient and family carer Reducing Harm and Mortality in Hywel Dda Health Board

29. Falls Secondary Drivers • Each area to assess their local falls risk- • analysis of falls on units by: time of day, patient’s age range, type of patients, condition. • Utilisation of warning cards (above patients head) for patient with a history of falls Reducing Harm and Mortality in Hywel Dda Health Board

30. Falls Secondary Drivers • Each ward/Department to work with allied health colleagues to assess • Falls History/ Medication review • Gait Balance, mobility, muscle weakness • Osteoporosis risk • Functional ability • Visual & Cognitive impairment • Urinary incontinence • Cardiovascular assessment - Hazards Reducing Harm and Mortality in Hywel Dda Health Board

31. Falls Secondary Drivers • Involvement of patient & family • Include falls status in ward handovers and safety briefings • Develop a Falls prevention information pack for patients, families and caregivers • Develop a Falls education pack and Falls preventions program for staff Reducing Harm and Mortality in Hywel Dda Health Board

32. Driver Diagram Reducing Harm and Mortality in Hywel Dda Health Board

33. Pressure Sores • Baseline data for pressure sores within the Health Board Data is from CHKS Reducing Harm and Mortality in Hywel Dda Health Board

34. Pressure Sores Primary Drivers • Risk Identification • Risk Assessment • Implementation of the SKIN bundle • Identification, grading of pressure ulcers existing on admission/transfer & appropriate intervention • Education Reducing Harm and Mortality in Hywel Dda Health Board

35. Pressure Sores Secondary Drivers • All staff to be able to understand the risk factors for acquiring pressure ulcers • Understand the local context & analyse local data to assess patients on ward/unit most at risk • Utilisation of patient ‘At risk’ cards to quickly identify those at increased risk Reducing Harm and Mortality in Hywel Dda Health Board

36. Pressure Sores Secondary Drivers • All patients to have their pressure ulcer risk assessed on admission • Re-assess skin every 8 hours • Initiate and maintain correct and suitable preventative measures when needed Reducing Harm and Mortality in Hywel Dda Health Board

37. Pressure Sores Secondary Drivers • All wards/Departments to implement the SKIN bundle which aaddresses these areas: • Surface • Keep Turning • Incontinence • Nutrition Reducing Harm and Mortality in Hywel Dda Health Board

38. Time Scales • May 11th 2010 Health Board Executives and others attend 1000 Lives+ launch • May 12th 2010 Aims of 1000 lives+ conveyed to all Health Board Staff • End of May/Beginning of June ward/department sign up to at least one intervention • The Transforming Care initiative to be implemented into all ward/in-patient areas by the end of 2012 Reducing Harm and Mortality in Hywel Dda Health Board

39. Thank You Reducing Harm and Mortality in Hywel Dda Health Board

40. Reducing Harm and Mortality inHywel Dda Health Board May 11th 2010 Presenter: Dr Simon Mahon Medical Director Reducing Harm and Mortality in Hywel Dda Health Board

41. Reducing Harm & Mortality in Hywel Dda - Our Main Aims • Reduce RAMI to below 100 in 2 years • Reduce episodes of harm by 25% in 2 years Reducing Harm and Mortality in Hywel Dda Health Board

42. Executive Leads Janet Wilkinson:- Leadership Dr Simon Mahon:- Critical care& Rapid Response to acute illness Bernadine Rees:- Medicines management Tony Chambers:- Healthcare Associated Infections Caroline Oakley:- Hospital Acquired Pressure Ulcers Chris Wright:- Surgical Complications Kathryn Davies:- Hospital Acquired Thrombosis Dr Sue Fish Acute Stroke Reducing Harm and Mortality in Hywel Dda Health Board

43. RAMI 2010 Our aim is to reduce the amount of variation in our monthly RAMI (2010) scores and make it more consistent Reducing Harm and Mortality in Hywel Dda Health Board

44. By reducing the amount of variation in the RAMI will improve the predictability of patient outcomes and will help to reduce the frequency of poor results. Reducing Harm and Mortality in Hywel Dda Health Board