Introducing the NHS Safety Thermometer

Yeovil District Hospital NHS Foundation Trust

Author: Jackie Henderson, General Manager, Clinical Governance

The senior nursing and therapy teams within the Trust have enthusiastically supported the implementation of the NHS Safety Thermometer. It is a real chance to engage with patients and identify good practice.

Leadership and Teamwork

The approach to testing and implementing the NHS Safety Thermometer at Yeovil District Hospital was considered by the senior nursing staff in the Trust. The Nursing, Midwifery and Therapy Leadership Group agreed that a "small steps of change" approach was preferable to a "big bang" introduction. The Director of Nursing and Clinical Governance, Sue Jones informed the Board of Directors of the plan, in conjunction with the Associate Directors of Nursing (Jo Ryan, Maddie Groves and Neil Tomlin) and the General Manager for Clinical Governance (Jackie Henderson) and a roll-out plan was agreed.

Strategic team Ward-led team
Director of Nursing and Clinical Governance
Associate Directors of Nursing
General Manager Clinical Governance
Ward Managers
Heads of Therapy services

Creating and Integrating a Plan

The data capture tool from the NHS Information Centre was used to develop an in-house recording sheet for use on each ward. This was tested on one ward during March 2012 and the feedback from the Ward Manager was that this was easy to use and the process took approximately 10 minutes for each patient. The same test was repeated on another ward during April 2012, with similar results. Consideration was given to the use of iPADS to collect the data on each ward, but the Ward Managers were clear that a paper tool was preferable. Data input to the electronic tool was completed by a Clinical Governance Assistant directly from the paper data capture sheets. A pre-audit briefing session was arranged where all the Matrons, Ward Managers and Associate Directors of Nursing meet at 8.30 am to agree the audit teams, confirm that parameters of the reviews and answer any queries. As a result of the first two pre-audit briefing sessions an information sheet/quick reference guide was developed. A feedback meeting takes place at 12 noon where the results are provided to the Ward Managers and any specific safety trends are considered.

Planning SMART objectives
Communication with senior clinical staff
Ensure time to complete the audits
Engage all grades of staff in the process
Ensure a simple system
Administrative support
Specific: Roll-out of the NHS Safety Thermometer ensuring that the process provides feedback of the results to the ward managers and sisters within four hours of the start of the audit
Measurable: NHS Safety Thermometer surveys completed and timeliness audit
Achievable: Using a systematic approach
Relevant: To all appropriate clinical areas
Timebound: By 31st December 2012

Implementing the Plan

The use of an adapted paper version of the Department of Health data entry tool has been well received by the ward staff. Using a Clinical Governance Assistant to input data has been beneficial and has allowed the clinical staff to concentrate on the assessment and review of the patients. The pre-briefing session and post audit feedback sessions have been well received and provide an oppoprtunity for clinical debate and support for staff.

Implementation - Assessment and Diagnosis Implementing and Planning
Why are you doing this audit?
What happens if I don't want to participate?
Where should we start?
How can we facilitate time for staff?
What would a user guide look like?
How do we give the feedback in a positive and safe environment?

Measuring and Results

Data capture has been relatively straight forward and there has been great buy-in from clinical staff across the wards. The pre-audit briefing has given a chance for staff from areas not involved to work with colleagues in other departments and attendance at the feedback sessions has been excellent. In the majority of areas the "harmfree care" scores are improving each month. Staff who manage wards at the end of the roll-out plan have asked if they can be brought forward as they are so keen to start using the NHS Safety Thermometer.

Spreading the Message

Information about the NHS Safety Thermometer was shared at the internal Nursing and Midwifery Leadership group and the Board of Directors ahead of the testing phase. Results are now included in the monthly clinical governance report to the Board, and each Ward Manager takes their results back to share with their teams on the day of the audit. Discussion with the commissioning Primary Care Trust about progress with the roll-out takes place at the quality monitoring meetings. Information about the NHS Safety Thermometer survey process will be included in the patients' bed-side folders, and consideration is being given to a press release later in the year.