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 April 2018. 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

99.0% of patients did not experience any of the four harms whilst we were providing their care in the community

98.4% 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 6 C.difficile cases during the month of January 2018 and as a result this number may be subject to change.

 Total CasesC.difficileMRSA
This month 5 0
Improvement target (year to date) 97 0
Actual to date 75 7

 

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 20 pressure ulcers were acquired during hospital stays.
This month 26 pressure ulcers were acquired in the community.

SeverityNumber of pressure ulcers in our Acute settingNumber of pressure ulcers in our Community setting
Grade 2 17 16
Grade 3 3 9
Grade 4 0 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

 

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: 1.72

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 0 fall(s) that caused at least 'moderate' harm.

SeverityNumber of falls
Moderate 1
Severe 3
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: 0.34

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*     98.4% recommended       This is based on 906 responses.

A&E FFT Score               87.2% recommended       This is based on 2000 responses.

Community FFT Score  97.3% recommended       This is based on 350 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.

Susan Williams Patient Story can be found 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 - Partnership Working – Health and Wellbeing with ACTIVE TAMESIDE

 

The transition from a hospital ward to accessing mainstream activities within the community setting can be overwhelming. A programme has been developed with Active Tameside to support transition from acute to community services.

 

Active Tameside are taking steps to deliver in-reach support on our Stroke/ therapy wards to provide advice to patients and carers on what’s available once they leave the hospital environment to help support them to keep active and reduce repeated admissions to hospital.

The Active Tameside team are also in the process of launching a partnership arrangement, working with patients pre and post hip/knee replacement to attempt to reduce the length of stay for patients after surgery with the hope of rolling out something similar to current processes in place supporting those having cancer surgery to provide an enhanced post-operative recovery.

 

Active Tameside co-deliver on the Moving Forward after Breast Cancer course held at the Tameside Hospital Site and has been working with the Living Well after Lung Cancer Support Group to promote and deliver a taster session of Tai Chi.

 

One of the Community Workers has also been delivering Tai Chi sessions at the Saxon Unit (Mental Health) and the Anthony Seddon Centre based within our community services in Ashton under Lyne. The continuity of the instructor has been extremely beneficial for patients being discharged from the hospital environment.

 

In addition to the above, Active Tameside have also been delivering a number of courses with the GP Clinical physical activity champion at Tameside & Glossop Integrated Care NHSFT to consultants, practice nurses and trainee GP’s so they understand the importance of physical activity within the medical model and the impact this can have on reducing long term health conditions. Further training has also been undertaken around the use of motivational interviewing to inspire change in patients.

 

The establishment of a community health and social care single point of contact is a

key component of the Care Together programme and professionals from health,

adult social care and corporate services have worked closely to develop a new

community administration gateway service model.

 

This approach will generate many benefits as it will create a more streamlined and

efficient service which will improve service quality, provide a consistent response to

all referrers and reduce the need for multiple assessments across community teams.

The Community Gateway will initially work for the District Nursing neighbourhood

teams, Integrated Urgent Care Team and the Adult Social Care neighbourhood teams.

 

The Health Administrators and Adult Social Care Customer Care Officers involved in

the teams have recently been co-located into a newly refurbished Health Centre to

support integrated working and improve the services provided for local people.

The Integrated Service will ensure that new and existing users of our services have

access to urgent and non-urgent offers that enable people to remain in the

community or to return home as soon as possible from necessary hospital

admissions.

 

Over the next year plans are in place to develop the service further to provide a

single point of contact gateway to a wider range of our community health and social

care services.