Royal Brompton & Harefield NHS Foundation Trust’s first organisational value is: “We believe our patients deserve the best possible specialist treatment for their heart and lung condition in a clean, safe place.” To promote this idea of safety as a priority, the trust signed up to Patient Safety First in July 2008.
Director of Operations, Robert Craig says: “Clinical governance issues have always been very important to us and we have done a lot of work on improving patient safety in the past. When we heard of Patient Safety First we saw it as a good way of raising awareness of patient safety within the trust – amongst staff and patients – while at the same time helping to build the public’s faith in the health service.
“Patient Safety First makes it easy for trusts to have a hook on which to hang their changes – while most organisations do focus on patient safety in some form already, to have a national campaign with which we can align ourselves is a bonus and makes us feel part of a national initiative.”
Over the last 18 months, more than 40 executive safety walkrounds have been undertaken in clinical areas across the trust to bring senior management and frontline staff together to discuss patient safety.
Robert says of the walkrounds: “They’ve been really successful so far as it gives executives like me a welcome opportunity to talk to frontline staff about any problems that could arise – these might be really low-level things that, if not dealt with, could become a problem in the long run and potentially lead to an incident.”
As well as the leadership intervention the trust has put into practice the care of deteriorating patients in acute care intervention to promote earlier recognition and treatment of the deteriorating patient and thereby reduce in-hospital cardiac arrest and morbidity/mortality rates. The patient at risk (PAR) score has been introduced, aiming to ensure that any deterioration in a patient’s condition is detected as early as possible and acted upon. Robert says: “We have done quite a lot of work with this and have a critical care outreach team that is always ready to go out to a patient who is deteriorating, rather than them having to wait for a bed to become available in another ward.”
The trust has also been active in starting to implement the World Health Organisation’s Safer Surgery Checklist, as part of the reducing harm in perioperative care intervention. Safety Briefings have proved successful so far and a version of the checklist will be introduced for all patients undergoing treatment in theatres, catheter laboratories and the bronchoscopy suite.
In paediatric intensive care, care bundles for the prevention of catheter-related bloodstream infections and ventilator-associated pneumonia are in place with regular monitoring of compliance and numbers of infections. This is all a part of the reducing harm in critical care intervention and similar work is in progress in adult intensive care units across the trust.
Robert says that the most notable change since signing-up to Patient Safety First is a reduction in rates of cancelled operations. He says: “We were running at rates of almost 1.5% cancellations in the middle of last year, and with some changes and focused attention, we’re now seeing a reduction in rates to below 1%.”
However, Robert insists that there is still a lot more work that all trusts can do to enhance patient safety: “Our plans to increase patient safety are ongoing. For example, we have recently had two Darzi fellows join our trust for the year who will lead on improvements in patient safety; and we have started the NHS Institute’s Productive Ward Programme to help clinicians eradicate waste and devote more time to patient care.
“I would definitely recommend other trusts sign up to Patient Safety First – the campaign has great resources that will help you provide a framework for any patient safety work you are doing. The best thing about Patient Safety First is its adaptability – trusts can adapt it locally to suit them and sign up to each intervention they feel appropriate. ”
This first appeared in HSJ Online on 24 July 2009