Betsi Cadwaladr University Health Board - Patient Safety Goals for BCUHB

1. Betsi Cadwaladr University Health Board Betsi Cadwaladr University Health Board - Patient Safety Goals for BCUHB

2. Betsi Cadwaladr University Health Board Betsi Cadwaladr University Health Board

3. Betsi Cadwaladr University Health Board Aim To reduce the Betsi Cadwaladr University Health Board Global Trigger Tool adverse event rate and to also reduce the mortality rate.

5. Betsi Cadwaladr University Health Board Top Priorities Rapid response to the deteriorating patient Safe provision of acute medical care CG50 NICE Infection prevention & Control Hospital Acquired thrombosis Outcome measure Compliance

6. Betsi Cadwaladr University Health Board

7. Betsi Cadwaladr University Health Board 1000 Lives Plus and Intelligent Targets Existing interventions that will continue as mini-collaboratives: Preventing stroke through timely management of Transient Ischaemic Attack (TIA) Rehabilitation following Stroke Reducing Chronic Heart Failure Transforming care – including Reducing Hospital Acquired Pressure Ulcers and falls in hospital Preventing Hospital Acquired Thrombosis Rapid Response to Acute Illness (RRAILLS) Improving Medicines Management Reducing Healthcare Associated Infections

8. Betsi Cadwaladr University Health Board 1000 Lives Plus and Intelligent Targets New mini-collaboratives to be introduced from May 2010 onwards: Depression Dementia Preventing Acute Coronary Syndrome Patient Identifiers Enhanced Recovery after Surgery Reducing Falls in Intermediate Care Maternity Services

9. Betsi Cadwaladr University Health Board 1000 Lives Plus and Intelligent Targets Reducing avoidable harm and mortality WHO / NPSA Surgical Checklist SBAR Communications Trigger Tools Leadership Patient Stories Model for Improvement Normothermia Critical Care Bundles Acute Stroke

10. Betsi Cadwaladr University Health Board Adverse event rate

11. Betsi Cadwaladr University Health Board BCUHB CHKS Diagnosis Codes

12. Betsi Cadwaladr University Health Board Leadership Patient Safety Steering Group set up Making patient safety a priority at high level meetings –dashboard developed Patient stories polices agreed for use across BCUHB – agreed programme of use of Patient Stories Previously established Executive WalkRoundsTM – process and programme for BCUHB under development

13. Betsi Cadwaladr University Health Board Executive WalkRoundsTM

14. Betsi Cadwaladr University Health Board Global Trigger Tool Alignment of processes across BCUHB Inclusion and exclusion criteria Number of reviewers To apply to notes of patients discharged from April 2010

15. Betsi Cadwaladr University Health Board Primary Care Trigger Tool “The Annual Operating Framework includes the use of the Primary Care Trigger Tool in one in twenty practices. Currently, there are no practices in North Wales consistently using this tool. Consideration needs to be given on how BCU HB encourage and support this work in GP Practices.” 1000 Lives BCUHB organisational briefing, April 2010 For further information please contact:- Andrea.hobbs@wales.nhs.uk

16. Betsi Cadwaladr University Health Board Communication Do you have a good news/success story to share? A template for sharing your story across BCUHB and possibly in the local media is available from Sylvia.hughes@wales.nhs.uk Please help to Spread the learning and celebrate the successes

17. Betsi Cadwaladr University Health Board Leadership

18. Betsi Cadwaladr University Health Board Leadership

19. Betsi Cadwaladr University Health Board Critical Care

20. Betsi Cadwaladr University Health Board Critical Care

21. Betsi Cadwaladr University Health Board Rapid Response to Acute Illness “The campaign team are aware from attendance at the learning sets that the BCU HB teams are involved in this content area but there is paucity of reliable process data on the extranet to comment on progress. There was excellent work on investigating the cardiac arrest data (east) after a signal within the data identified an increased rate. It is important that any findings from the investigative case note reviews that result in the planning of improvement work is implemented using the methodology advocated by the campaign – the Model for Improvement.” 1000 Lives BCUHB organisational briefing, April 2010

22. Betsi Cadwaladr University Health Board Rapid Response to Acute Illness

23. Betsi Cadwaladr University Health Board Medicines Management “Localised work ongoing but very little pace associated with the improvement of warfarin management processes, especially across the interface between primary and secondary care – process mapping event held before the end of 2009 does not appeared to have progressed.” 1000 Lives BCUHB organisational briefing, April 2010

24. Betsi Cadwaladr University Health Board Healthcare Associated Infections “Hand hygiene in secondary care, alongside antibiotic stewardship in both primary and secondary care, remain the key process measures in relation to driving down the incidence of Clostridium Difficile and MRSA. Hand hygiene compliance is not sustained above 95% across the organisation (for medical, surgical and critical care areas) although critical care has demonstrated an improvement in the east – but this is against a background of reduced observation sample size. Antibiotic stewardship demonstrates reliability in both primary and secondary care areas but again this appears to be illustrated in test/pilot areas only.” 1000 Lives BCUHB organisational briefing, April 2010

25. Betsi Cadwaladr University Health Board Healthcare Associated Infections

26. Betsi Cadwaladr University Health Board Hospital Acquired Pressure Ulcers

27. Betsi Cadwaladr University Health Board Surgical Complications “Well established, reliable process measures are sustained for this work stream across all acute sites. Initial engagement with community care (i.e. the use of the WHO checklist and appropriate hair removal) has commenced to support the roll out of these interventions.” 1000 Lives BCUHB organisational briefing, April 2010

28. Betsi Cadwaladr University Health Board Surgical Complications

29. Betsi Cadwaladr University Health Board Hospital Acquired Thrombosis “There is very little engagement with this mini-collaborative at present. The only measurement submitted to support the process of risk assessment, appropriate prescribing and administration of thrombo-prophylaxis currently includes only elective surgical patients, and not medical patients; therefore it is recommended that the leadership team at BCU HB nominate a lead to support participation in this content area.” 1000 Lives BCUHB organisational briefing, April 2010

30. Betsi Cadwaladr University Health Board Intelligent Targets – how much by when

31. Betsi Cadwaladr University Health Board Organisational Briefing  Key Recommendations The Campaign would endorse the following to ‘stack the cards’ in the favour of Health Boards achieving their goals and aspirations. Take a strategic approach to quality improvement: Building the will to make measurable systemic improvement as quickly as possible. This will needs to be generated at all levels, and needs to include the will of senior leaders to make new ways of working more attractive and engage staff commitment and enthusiasm. Encouraging and spreading ideas about alternatives to the status quo which are robust enough to form the basis of new working systems; and also ideas about how to introduce them. Attending relentlessly to the execution of an aligned range of improvement initiatives into the daily work of the organisation.

32. Betsi Cadwaladr University Health Board Organisational Briefing  Key Recommendations Ensure a data-driven approach to measuring progress is maintained in the Health Board. Have the ability to understand the variation in your system and turn data into intelligent and useful information. Boards need to recognise that organisation level measures can mask variation between services. The capability to drill down to examine service level mortality and harm is therefore essential. Reliable processes are the key to shifting outcomes. It is essential for leaders to set expectations and use process improvement measures to hold teams to account for local progress. Identify executive leads for each work stream and , working with each content team, devise spread plans to enable the good work tested within the pilot areas to be rolled out in a structured and coordinated manner. 1000 Lives BCUHB organisational briefing, April 2010

33. Betsi Cadwaladr University Health Board Organisation Briefing Overview “BCU HB has demonstrated throughout the life of the campaign its ability to take on new interventions and successfully test and implement changes through the use of PDSA’s and supported by continuous measurement. What is evident, via the extranet progress reporting is that the ability to spread outside the pilot areas has proved challenging and this limits the effect that process reliability will have on organisational outcomes. Spread is not organic and can only be affected by the continued structured application of the methodology and strong executive and clinical leadership.” 1000 Lives BCUHB organisational briefing, April 2010

34. Betsi Cadwaladr University Health Board Organisation Briefing Overview “Participation and commitment of individuals and teams from BCU HB have been highly visible in the majority of work streams. The campaign team have identified that there are significant ‘enablers’ across the organisation, but as their capacity is often limited to their own area of expertise, their ability to drive spread is restricted. Increased capability and capacity must be a priority for BCU HB, if the existing campaign interventions are to be reliably sustained and spread and new interventions are to be taken on and successfully tested and implemented by the organisation.” 1000 Lives BCUHB organisational briefing, April 2010