Northern Devon Healthcare NHS Foundation Trust is an integrated trust that provides acute services from North Devon District Hospital and adult community services across a network of 17 community hospitals. Sarah James, Head of Quality and Safety, discusses her trust’s journey.
Your data shows you have had a 69% reduction in pressure ulcers. When did you first notice you were improving?
Northern Devon have been involved in a patient safety improvement collaborative in the South West for the last six years which has given us familiarity with run charts and SPC charts. We scrutinise our Safety Thermometer data on a regular basis and this knowledge of improvement and charts allowed us to see the improvement. Once we had six reduction data points and we were continuing to improve we recognised that we had sustainable change. This was about nine months into starting data collection that we knew we were improving and that the data was looking good.
What did you do to get the improvements?
It was a combination of things, we had some targeted improvement work, such as working with clinical teams on getting better at identifying pressure damage early on to prevent it getting to grade 2 or worse. We also improved our risk assessment and care plans so that staff had the appropriate tools to help them care for patients.
Another big part of the improvements was making sure that people were reporting correctly, so that when we are measuring with the Safety Thermometer we are measuring the correct thing. To ensure that we were measuring correctly the patient safety team and senior nurses follow up on any new pressure ulcers to make sure that they have been reported correctly. For example you could have grade two pressure ulcer reported that is actually a moisture lesion, it has helped massively having those checks and balances in place.
How do you use the data you collect?
The data is reported monthly and is taken to several places including sub-board level committees, our senior nurse committees and the patient safety operation meetings. It also goes onto our intranet so that staff can access the data immediately and see their wards data and compare.
How have you shared and celebrated the success that you’ve had?
We always try to keep staff aware of the good work and improvement that is happening around the trust and celebrate it. We do lots of patient safety walk rounds every month and make sure that we visit every ward in the trust at least once every six months.
On these we speak to staff to see if they are aware of how many pressure ulcers they’ve had what their improvement is. We’ve also shared our learning with colleague organisations in Devon through meetings and forums.
What have been the advantages of using the Safety Thermometer?
For us one of the major pluses has been knowing instantly what is happening on our wards. I think the way to use it is alongside other quality measures to give you an overall and rounded quality picture. When combined with measures such as incident reporting, themes from investigations, clinical outcomes and patient experience feedback, you get a complete picture.
What would be your advice to other trusts using the Safety Thermometer?
Getting your preparation and communication right at the beginning is essential, we did a few months of piloting and trialling before we went live. For the first year we used to send out a reminder a few days before data collection day, now we don’t have to do that anymore, it has become embedded in the trust. Having support and resources in place to help staff is also important, so they know what exactly they should be measuring and why.
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