Audit where you are now
The ‘harm free’ care plan is not about throwing away all of the great improvement work you have done up to this point. It’s about building on what you already have in place.
By working through each of the secondary drivers and making changes in process, you will deliver the aim of a 95% reduction in the 4 harms by 2012. To help your improvement team work out which of the secondary drivers will have the biggest impact for change, we have created a Baseline Audit Tool.
Upon completion, the Baseline Audit Tool will highlight the areas your improvement should focus on first within the secondary drivers.
If you are having difficulty accessing the online tool, please click here to download a hard copy version which can be printed out for distribution and completion.
Leadership and Safety Culture
(a) How would you rate your local clinical leadership?
(b) Can you provide evidence that this is true?
(c) Are you confident that the clinical leadership in your poorest performing ward/area is of an acceptable standard?
Leadership and Safety Culture
(a) Do your Senior Executive leaders undertake regular (at least monthly) safety walk rounds?
(b) Does every senior leader know what their personal contribution is to patient safety?
(c) Do you have 'ward to board' reporting for patient safety/'harm free' care?
Leadership and Safety Culture
Have you implemented hourly nursing rounds (a structured way of getting round your patients on a regular basis, usually every hour in hospital)?
Systems to deliver clinical care with high levels of reliability
(a) Do you have a single risk assesment for the four harms?
(b) Have you agreed critical review points where management will need to change e.g. post surgery, after a change in medication, following deterioration of vital signs?
Systems to deliver clinical care with high levels of reliability
Do you have reliable processes in place to manage skin, moisture and continence (including only placing catheters that are absolutely necessary and a system to ensure removal of catheters as soon as possible)?
Systems to deliver clinical care with high levels of reliability
(a) Do you screen at least 95% of your patients for malnutrition / risk of malnutrition using a validated screening tool such as 'MUST'?
(b) Do malnourished patients and those at risk of malnutrition have an appropriate care plan that is implemented and monitored?
(c) Have all of your frontline staff involved in delivering nutritional care received appropriate training?
(d) Do you have management structures in place to ensure best nutritional practice (including a nutrition steering committee, nutrition support team, nutritional pathways of care that span across the health economy)?
(e) Do you have reliable processes to manage your patients' hydration safely?
Systems to deliver clinical care with high levels of reliability
Have you implemented a system to review patients' medication within 6 hours of being admitted to your care?
Systems to deliver clinical care with high levels of reliability
Do you have equipment waiting for your patients or are your patients waiting for the equipment they need?
Systems to deliver clinical care with high levels of reliability
Are your frontline teams receiving the education and training needed to deliver 'harm free' care?
Implement a single risk assessment for the four harms and agree critical review points where management will need to change e.g. post surgery, after a change in medication, following deterioration of vital signs
Use the NHS Safety Thermometer as your 'point in care' improvement measurement tool
Implement and test a system for delivering continence, skin and moisture care in a highly reliable way (95% reliability)
Implement a system to deliver nutritional screening with reliability using tests of change and measurement to reach 95% reliability
Implement a system to develop nutritional care plans using tests of change and measurement to reach 95% reliability
Ensure all frontline staff undertake the e-learning module for nutrition and test their learning by asking key questions at handover
Work across the different teams involved in delivering nutritional care (doctors, nutrition nurses, dieticians, pharmacists, catering and facilities) to design a nutritional care pathway at the patient level that mirrors the patient journey
Implement and test a system to achieve good fluid management. Ensure frontline teams complete the hydration e-learning module and adopt best practice from other Safety Express teams
Implement a system to ensure that at least 95% of patients in your care have their medications reviewed within 6 hours of being admitted. Shamelessly steal the best ideas of others who have implemented systems to achieve this. Listen to the medication reconciliation webex before planning your improvement work
Work with your team to redesign the ordering and supply of equipment. You should aim to design a system that allows you to ensure that the equipment needed is waiting for your patients
Ensure your staff complete the harm free care e-learning modules. Build two-minute teaching sessions into each handover and ask staff to take turns to share their key learning