How West Suffolk Made A Real Difference To Patient Safety

by Lisa Nobes, Head of Nursing Development
West Suffolk Hospital NHS Trust

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Leadership and teamwork

“Safety Express was actually handed to my colleague in Governance and Safety, but I caught sight of it and said ‘I want to do this’. I saw it as a really exciting opportunity to put into practice some of the things I wanted to work on. It identified the key drivers for safe care whilst providing a framework for implementation”.

“The first activity was forming a strategic team, led by a champion with a real passion for delivering safe care. After that, a ward-led team was created to work through the operational process and implement intentional rounding.”

“I formed a strategic team to support the overall programme and we identified our pilot sites to be our poorest performing wards. I was adamant about that – they needed the greatest input and a boost to moral.”

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Creating and integrating a plan

“In developing the programme’s plan, a number of key themes emerged. The drivers were central to discussions, as an intensive, multi-driver approach was required. The poorest performing wards were identified as pilots because they had minimal recent attention. The pilots were phased one ward at a time and clear objectives were set.”

“I was focusing on reducing the harms as my overall aim, but using the drivers as a means to achieve that. I certainly didn’t have a clear idea of how that was going to work at the outset, but the drivers have always been the framework that I’ve used. I have always found the drivers to be the most helpful parts because they are the components I really do believe make a difference. For me, they have real impact.”

 

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“A key aspect of the planning stage was to determine measurement process and a baseline data set of the four harms. We also measured the impact on patient experience. The measurement objectives were based on the national aim – with realistic staged reductions over the 15 months.”

 

Implementing the plan

“We all learnt together and it was quite an intensive process. Throughout the implementation period the Executives also increased their ward walk arounds and we also worked closely with the ward managers. This was important as each had different ways of doing things and priorities. And some of the rounding tools had to be different. For example, the stroke unit has patients with different needs to those on the rehab unit therefore we adapted the tools for each area as required.”

At the heart of the plan was the implementation of intentional rounding, encompassing the secondary drivers and measurement processes. During three half-day sessions the ward teams were asked to discuss the current structure of their ward and a typical day. From this shared analysis, a plan for putting in place intentional rounding was agreed. The new day structure and intentional rounding was then shared amongst the wider ward team over a number of sessions.”

 

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Measurement and results

“If I’m completely honest, I wasn’t expecting the reduction that we have seen. The first impact shown was the increased morale in staff on the wards – the interest shown in their work and improved processes have created a happier ward workforce.”

“The drivers impacted across a whole range of quality indicators including incidence reporting and quality management systems. Initially, NHS Safety Thermometer data was based on a 50% sample and collected by the clinical project lead. Standard data collection continued by ward staff.”

“The harms have reduced across all pilot wards, especially to higher risk patients, but this was due to our intentional rounding tool being high risk triggered. The medium/low risk patients are now the ones that are falling most frequently– we’ve identified this from our measurement and we are testing an adapted  rounding tool to address this.”

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“The harms have reduced across all pilot wards, especially to higher risk patients, but this was due to our intentional rounding tool being high risk triggered. The medium/low risk patients are now the ones that are falling most frequently– we’ve identified this from our measurement and we are testing an adapted  rounding tool to address this.”

Spreading the message

“The cycle of ‘harm free’ care is becoming self-fulfilling and sustainable. It is discussed at Matron’s meetings and there’s an element of internal and peer ‘competition’ – whose ward is at the top of the league? Ward staff are now escalating potential risks to matrons and ward managers, ensuring risk management is proactive and daily, assessing increased risk before an incident occurs. The Trust wants to improve – teams have seen and heard the benefits and positive outcomes on pilot wards.

A rollout across all units is planned and a low-medium risk intentional rounding tool is being developed, in addition to the high risk / vulnerable tool undergoing continuous improvement.”

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To read Lisa’s top tips, download practical tools, read key elements of our implementation plan, watch videos and hear success stories from the wider West Suffolk team, click here.