Open and Honest Tameside

'Open and Honest Care' at Tameside and Glossop Integrated Care NHS Foundation Trust

NHS England

This report is based on information from August 2017. The information is presented in three key categories: safety, experience and improvement. This report will also signpost you towards additional information about Tameside and Glossop Integrated Care NHS Foundation Trust's performance..

1. SAFETY

Safety thermometer

On one day each month we check to see how many of our patients suffered certain types of harm whilst in our care. We call this the Safety Thermometer. The Safety Thermometer looks at four harms: pressure ulcers, falls, blood clots and urine infections for those patients who have a urinary catheter in place. This helps us to understand where we need to make improvements. The score below shows the percentage of patients who did not experience any harms.

98.1% of patients did not experience any of the four harms whilst an inpatient in our hospital

98.8% of patients did not experience any of the four harms whilst we were providing their care in the community

98.3% of patients did not experience any of the four harms in the Trust

 

For more information, including a breakdown by category, please visit:
http://www.safetythermometer.nhs.uk/

Health care associated infections (HCAIs)

HCAIs are infections acquired as a result of healthcare interventions. Clostridium difficile (C.difficile) and methicillin-resistant staphylococcus aureus (MRSA) bacteremia are the most common. C.difficile is a type of bacterial infection that can affect the digestive system, causing diarrhoea, fever and painful abdominal cramps - and sometimes more serious complications. The bacteria does not normally affect healthy people, but because some antibiotics remove the 'good bacteria' in the gut that protect against C.difficile, people on these antibiotics are at greater risk.

The MRSA bacteria is often carried on the skin and inside the nose and throat. It is a particular problem in hospitals because if it gets into a break in the skin it can cause serious infections and blood poisoning. It is also more difficult to treat than other bacterial infections as it is resistant to a number of widely-used antibiotics.

We have a zero tolerance policy to infections and are working towards eradicating them. If the number of actual cases is greater than the target then we have not improved enough. The table below shows the number of infections we have had this month and results for the year to date.

The rigorous Root Cause Analysis is in place to determine whether a ‘lapse in care’ occurred for the 7 C.difficile cases during the month of July 2017 and as a result this number may be subject to change.

 Total CasesC.difficileMRSA
This month 4 0
Improvement target (year to date) 97 0
Actual to date 29 3

 

Avoidable CasesC.difficileMRSA
This month 0 0

 

For more information please visit: https://www.england.nhs.uk/patientsafety/associated-infections/

 

Pressure ulcers

Pressure ulcers are localised injuries to the skin and/or underlying tissue as a result of pressure. They are sometimes known as bedsores. They can be classified into four grades, with one being the least severe and four being the most severe. The pressure ulcers reported include all validated avoidable/unavoidable pressure ulcers that were obtained at any time during a hospital admission that were not present on initial assessment.

 

This month 9 pressure ulcers were acquired during hospital stays.
This month 11 pressure ulcers were acquired in the community.

SeverityNumber of pressure ulcers in our Acute settingNumber of pressure ulcers in our Community setting
Grade 2 6 4
Grade 3 0 2
Grade 4 1 1

 

The pressure ulcer numbers include all pressure ulcers that occurred from 72 hours after admission to this Trust.

In the hospital setting, in order to know if we are improving even if the number of patients we are caring for goes up or down, we also calculate an average called 'rate per 1,000 occupied bed days'. This allows us to compare our improvement over time, but cannot be used to compare us with other hospitals, as their staff may report pressure ulcers in different ways, and their patients may be more or less vulnerable to developing pressure ulcers than our patients. For example, other hospitals may have younger or older patient populations, who are more or less mobile, or are undergoing treatment for different illnesses.

 Rate per 1000 bed days: 0.60

 

In the community setting we also calculate an average called 'rate per 10,000 CCG population'. This allows us to compare our improvements over time, but cannot be used to compare us with other community services as staff may report pressure ulcers in different ways, and patients may be more or less vulnerable to developing pressure ulcers than our patients. For example, our community may have younger or older patient populations, who are more or less mobile, or are undergoing treatment for different illnesses.

Rate per 10,000 population: 0.28

Falls

This measure includes all falls in the hospital that resulted in injury, categorised as moderate, severe or death, regardless of cause. This includes avoidable and unavoidable falls sustained at any time during the hospital admission.

This month we reported 2 fall(s) that caused at least 'moderate' harm.

SeverityNumber of falls
Moderate 5
Severe 0
Death 0

 

So we can know if we are improving even if the number of patients we are caring for goes up or down, we also calculate an average called 'rate per 1,000 occupied bed days'. This allows us to compare our improvement over time, but cannot be used to compare us with other hospitals, as their staff may report falls in different ways, and their patients may be more or less vulnerable to falling than our patients. For example, other hospitals may have younger or older patient populations, who are more or less mobile, or are undergoing treatment for different illnesses.

Rate per 1,000 bed days: 0.43

2. EXPERIENCE

To measure patient and staff experience we ask a number of questions.The idea is simple: if you like using a certain product or doing business with a particular company you like to share this experience with others.

The answers given are used to give a score which is the percentage of patients who responded that they would recommend our service to their friends and family.

Patient experience

The Friends and Family Test

The Friends and Family Test (FFT) requires all patients, after discharge, to be asked: How likely are you to recommend our ward to friends and family if they needed similar care or treatment? We ask this question to patients who have been an in-patient or attended A&E (if applicable) in our Trust.

In-patient FFT score*     97.5% recommended       This is based on 856 responses.

A&E FFT Score               82.9% recommended       This is based on 600 responses.

Community FFT Score  90.1% recommended       This is based on 60 responses.

*This result may have changed since publication, for the latest score please visit:

http://www.england.nhs.uk/statistics/statistical-work-areas/friends-and-family-test/friends-and-family-test-data/

 

 

A patient's story

Our patient stories are important to us and we believe that feedback - both positive and negative - is essential to improving the care received by the patients and their families.

Watch the Family Nurse Partnership here

 

Staff experience

Guidelines produced by the National Institute for Health & Care Excellence (NICE) make recommendations to ensure safe staffing levels on adult wards in acute hospitals and maternity settings. In-line with this guidance we are required to publish monthly reports showing the number of Registered Nurses/Midwives and Health Care Assistants (Care Staff) working on our in- patient wards.

Each month the data compares the number of staff hours ‘Planned’ against the number of staff hours used ‘Actual’. This is collected by ward, by shift, and is reported by calendar month as a % fill rate by day and by night.

An overview of Tameside hospitals current position is given below:

 

To view our detailed reports, which provide a breakdown by ward and to access the monthly Trust Board Reports relating to Safer Staffing information at Tameside, please use the link below:

Safer Staffing

3. IMPROVEMENT

Improvement story: We are listening to our patients and making changes

 

IV Therapy Service

 

The Community IV Therapy Service aims to facilitate hospital discharge for those patients requiring IV treatments that can be safely managed in the community. It also aims to work closely with GPs and patients in order to avoid admissions for those patients who can be safely managed with IV therapy within their own home/clinic environment.

 

Delivering community based intravenous treatments will not only help reduce length of stay in hospital, but also promote admissions avoidance by direct referral from GPs or other community services for those patients who would otherwise be admitted to hospital for IV therapy

 

 

Delivering care closer to home such as this helps

 

  simplify the patient journey

 

  reduce the number of hospital acquired infections

 

  improve antimicrobial stewardship

 

  improve patient choice

 

  promote independence and self-management

 

  reduce family separation

 

  deliver better use of available resources.

 

 

The service expanded in August to operate 13 hours per day, 7 days per week and 365 days per year. Increased availability will better meet the needs of all patients from the locality requiring IV therapy.

 

 

The health outcomes possible by delivering care such as this closer to home makes better use of available resources. It also supports standardisation of practice across the Health Economy, reducing variation and ensuring that the patients receive the right care by the right people in the right environment.

 

 

The service is fundamental for moving care out of the acute setting and into the individuals homes and communities thereby increasing independence within the local population.

 

 

The IV therapy service vision is also aligned to our Care Together vision to move quickly to a fully person-centred and integrated model of care, with a much heavier emphasis on prevention, self-care and care closer to home.