Safety Thermometer in Oldham Care Homes with Nursing Beds

NHS Greater Manchester NHS Oldham

Author: Grace Wall, Clinical Lead, Unscheduled Care, NHS Greater Manchester

Partnership working between all organisations and stakeholders has been the key to success. Sharing a vision and a common purpose has enabled the NHS Safety Thermometer to be embedded into our culture.

Leadership and Teamwork

Grace Wall, Lead

Michelle Mellor, Manager of Continuing Health Care Team and Clinical Lead for Personalised Care

Deborah Hardie, Complex Case Manager offered Project Support.

To implement the NHS Safety Thermometer in the Care Homes with nursing beds it was identified within our organisation that the Continuing Health Care Team was best placed to undertake this work due to the already established  relationships through commissioning services. Looking specifically at the three harms measured in care homes we indentified who our key stakeholders were to support service improvement. These were Pennine Care Foundation Trust; Falls Co-Ordinator Helen Ashton; Clinical Lead Specialist Nursing Helen Wrench; Specialist TVN Adele Scimone; Maggie Hurley, Age UK.

The NHS Safety Thermometer stakeholders meet on a monthly basis to discuss data and service improvements. There are 14 care homes with nursing beds in the Oldham locality; this equates to 800+ beds. The number of patients being surveyed varies each month dependant on numbers being cared for in NHS funded beds. (This includes FNC and CHC funded care). All these care homes were signed up and engaged with Harm Free Care within 6 weeks of first contact. Other pivotal stakeholders for success have been members of the Quality and Safety Team, Local Authority and Clinical Commissioning Group. 

Strategic team Ward-led team
The work that has been undertaken within the Oldham independent sector care homes with nursing beds reports directly to the NHS Greater Manchester Harm Free Care Team led by Margaret Williams, Associate Director of Nursing and Quality, and Anita Rolfe, Deputy Director for Nursing and Quality.

Creating and Integrating a Plan

The NHS Safety Thermometer has been piloted in each of the care homes with nursing beds. An early adopter was Chadderton Total Care where the Matron Mary Green piloted the tool to determine if it could be used within the independent sector. The implementation of the NHS Safety Thermometer (not including thrombosis) in the care homes with nursing beds in Oldham has strengthened the partnership working between all organisations to provide Harm Free Care. The aim of this work is to continue to build upon and strengthen this partnership to share experience with the aim of improving outcomes for patients. Now that each of the care homes are submitting data and are able to use the tool, we can submit our data via our designated e-mail address in August to the NHS Information Centre and start to make better use of our data. Our key message is that the NHS Safety Thermometer is a quality improvement tool that allows health care professionals to note the inclusive impact of all harm on patients that they care for. It is not purely an audit tool, it facilitates intelligent questions to be asked, and immediate improvement action to be taken. One of the homes has strengthened their business case for additional care staff on night duty, using their evidence to demonstrate risk in provision of safe care. To sustain improvement NHS Oldham is facilitating a series of clinical learning and sharing events around the three harms with the support of key stakeholders including Age UK.

Planning SMART objectives
Clinical leadership
Partnership working
Safety Thermometer quality improvement tool
Harm Free Care is everyones' responsibility
Keeping the momentum
Building on the change
Think clinical care not contracts
Think quality not quantity #data
Think fewer not newer #harm
What will this look like in 5 years?
Specific: 14 Care homes with nursing beds to be actively submitting data
Measurable: Aim 100% of care homes submiiting consistently through out the year
Achievable: Improvements within data submission
Relevant: Improving experience; improving delivery; improving Outcomes
Timebound: 1st October 2012

Implementing the Plan

We used the NHS Safety Thermometer to measure the prevalence of the three harms (minus VTE) in the care homes with nursing beds. To deliver the NHS Safety Thermometer tool, Deborah Hardie, Complex Case Manager and myself visited each of the homes and explained the Harm Free care agenda, installed the tool onto their computer, showed the Managers how to use it, and asked each home if they would be able to commit to a pilot. There was an overwhelming sense of support from the homes for Harm Free Care, with each committed to reducing harm wherever possible and using the NHS Safety Thermometer tool as a key way to demonstrate their commitment. A standing operating procedure is in place outlining the steps to be taken from initial engagement to data feedback.

Implementation - Assessment and Diagnosis Implementing and Planning
Is what we are doing impacting positively on patient care?
What are the specific issues for care home with nursing beds?
What does best practice look like?
How do we share best practice?
What does harm mean from a patient perspective?
How can we make the Safety Thermometer work within the independent sector?
The Safety Thermometer was designed for large acute trusts, will this translate well for smaller data sets?

Measuring and Results

A key result achieved is that every care home with nursing beds within the locality is signed up to the Harm Free Care agenda and is using the NHS Safety Thermometer tool to submit data to NHS Oldham. The first results from the data were extremely positive and will be used as a benchmark for future analysis.

Falls: As a result of the NHS Safety Thermometer, NHS Oldham Clinical Commissioning Group in partnership with Age UK have funded a 'Slipper Exchange' event where old ill-fitting slippers will be exchanged for new. This event forms part of our falls prevention work with the care homes.

Pressure Ulcers: We also plan to implement the 'Your Turn' campaign in each of the Trusts to raise awareness of the importance of regular turning to prevent pressure damage.

Urinary Tract Infections in Patients with Indwelling Catheters: NHS Oldham's infection control team are facilitating a shared learning event for continence. This will be a collaborative event.

Spreading the Message

There is a bi-monthly newsletter produced by NHS Oldham of which the homes can provide content as they wish. The content includes: best practice, updates and experiences of using the tool. A copy of the newsletter's front page is loaded on the Harm Free Care website. We are also considering social media options for strengthening communication across our community. We are now entering phase two of our Harm Free Care strategy and will explore the concept of care rounding tools for use in the care homes. We are working with local media to spread the Harm Free Care message and promotional improvement campaigns like the Sloppy Slipper campaign.