After stepping outside the taxi the first thing that you see above and around the entrance of the Queens Medical Centre are large signs stating, “clean your hands” and “help us to prevent infection” (see picture above).The signs epitomizes the trusts dedication to patient safety and after speaking to the Adult and Paediatric units it is evident to see that these are not just statements but are actively being upheld.
Patient safety is one of the key objectives on the trust’s annual plan and they have a dedicated working group striving to improve patient safety. Various initiatives have been implemented e.g. the trust held their own patient safety week in Oct 2010; produced patient safety leaflets for patients, their relatives and staff and have given patient safety a prominent presence on their public and intranet websites
Queen's Medical Centre Campus (Adult Critical Care Unit)
Since joining the unit has had support from the MM team with implementing the project. There were initials feeling of bewilderment but once the interventions were broken down they realized that they were manageable and some of their practices reflected the interventions suggested. For example:
- They developed a system for data collection which included devising an appropriate data collection form. Training was provided to all medical staff including consultants, which was well received
- They produced a sticker style checklist which is inserted into the patient’s medical notes after a CVC had been inserted. The doctor will complete the check list, the observer counter signs the checklist. The observer is always a registered nurse and has the confidence and competence to challenge if the procedure is not followed accordingly
- They formed a patient safety team and held their first meeting in July 2010. The team included the Head of Service, Medical Lead, Matron (Nurse Lead) & Infection control. An action plan was put together at the meeting and all actions since have been achieved. Next Patient safety team meeting Dec 23, the MM Service Improvement Facilitator has been invited to attend.
One of the key challenges is communication. They have tried various methods e.g. emails, communication book, team meetings. However, they found it challenging due to the size and geographical location of the units. A communication plan was developed and the following are being developed and trialed. For example:
- Safety team newsletter (hard copy)
- Utilising the nurse handover for feedback and updates regarding Patient Safety initiatives A lamented sheet was initially read out at each handover. After a trial period staff found it useful but requested to receive the information less frequently i.e. once a week
- Band 7 safety walkabout was trialed. A Senior Sister walked around with the Nurse in charge to review general patient safety issues e.g. bed area, documentation, infection rate. This took 2 hours to complete which although proved useful and beneficial was time consuming. They are now revising the system to reduce the time taken to conduct the walk round i.e. randomly choosing 4 bed spaces instead of all bed areas to review.
Other safety initiatives which are being developed and implemented:
- A competency document has been developed to train and assess nursing staff to take blood cultures
- Head box – designed and produced a box for transporting emergency drugs with patients that require scan/ xrays or transfer
- Emergency theatre case review group where all patients that undergo emergency theatre procedures are reviewed to identify any clinical practice and or safety issues. An entry has been submitted for the Patient Safety awards on this initiative
- Plan to commence Root Cause Analysis for positive CVC blood stream infections
- Global trigger tool for patients in critical care to identify any potential harm. Aim is review 20 patient’s medical records a month and review data after a two month period
- Anne Illsley (Service Improvement Sister) has been invited to attend Trust safety meeting to present the initiatives that they have developed and implemented.
Queen's Medical Centre Campus (Paediatric Intensive Care Unit - PICU)
The PICU was one of the first units in the trust to fully implemented Matching Michigan. They have successfully built a culture where any member of staff can raise issues with their colleagues/ peers. Infection rate charts are displayed and visible to patients and staff. (see picture at bottom of page)
They are actively involved in promoting the project and presented at the Sharing and discussion WebEx One of their main challenges was the compliance of wearing hats and masks by medical staff when inserting a CVC line. After gaining support from the Executive team they are now fully compliant. Their next main challenge is to implement the CVC insertion pack and checklist.
Other Safety initiatives which are being developed and implemented
- Medicine Safety incident group reviews Datix data (reported incidents) once a month. Through these reviews the main issues that have been identified are communication and interruptions during the administering of medication. The number of incidents has increased due to improvement in awareness. Results are fed back to all staff every 6 months, however, the feedback process needed to be improved to include all medical staff
- Outreach team have reviewed, revised and are standardizing the observation chart for the children hospital by integrating all existing charts. The team has worked with Lincolnshire trust and the latest version will be released in Dec 2010 to both trusts.
Data from Productive Ward has shown that only 40% observations have been completed. The biggest challenge they have faced is changing staff perception on the task of performing clinical observations as they are part of the overall patient assessment. Simulated education sessions are facilitated once a month. The aim is to highlight the importance of carrying out observations, why they are performed, what they indicate and also will incorporate scenarios of clinical conditions.
Their vision is to develop a 24/ 7 paediatric critical outreach service to support the ward areas in caring for acutely unwell children.
- The Global trigger tool is being introduced to review all cardiac arrest calls in the last 12 months. In order to review, improve practice and to reduce the number of incidences
- The Retrieval team has a developed a referral tool which aides staff by ensuring that a standardized set of questions are asked and accurate information is gained at the time of referral
- In accordance with the new resuscitation guidelines PICU will be modifying their chart which is completed at the time of resuscitation.
Thanks to all the staff we met for giving us such a warm welcome.We left feeling positive and inspired by their efforts. We would like to acknowledge the trust’s hard work, commitment and enthusiasm for continually striving to improve patient safety.