Engaging Local Clinical Leadership

1. Engaging Local Clinical Leadership Clare Thomas, Senior Nurse Professional Practice Debbie Waywell, Quality & Safety Matron

2. About us • 4 site acute NHS FT • Elective orthopaedic surgery • Hot site • Day case/ outpatient/rehab • Town centre outpatients site • Population c300,000; 758 inpatient beds

3. How things were…. • Good track record of safety improvement • Limited mechanism for sharing innovation across the Trust • Professional Development Days • Quality Improvement Teams • Ward level Quality Accounts • Needed to be able to spread and share best practice across the Trust – the ward leader role is pivotal in this

4. Our aims • To achieve harm free care for at least 95% of our patients • Wanted to achieve this through the sharing of best practice via our secondary driver which is local clinical leadership • Focus on harm in its entirety rather than 4 harms individually • The promotion of cross divisional working (avoid those silos!) • Develop the role of clinical ward leaders

5. “The pessimist complains about the wind. The optimist expects it to change. The leader adjusts the sails.” (John Maxwell)

6. How did we begin? • Ward leaders were asked to self nominate to participate in a harm free care project . • 1st cohort selected to ensure members from across the Trust with a proven track record of improvement • Orthopaedic ward; medical assessment unit; surgical ward; CoE ward; ENT/ urology ward

7. And… • Launched on Nurses Day (May 12) at Professional Development event • Ward leaders of selected wards facilitated breakaway workshops for “Harm Free Care” • This photo shows our first Harm Free Collaborative meeting

8. Collaborative Working Group • Fortnightly Collaborative group meetings • Improvement model (PDSA) established • Each ward asked to identify a SMART objective • Improving patient access to nutrition • Implementing a safety huddle • Intentional Rounding pilot • Introducing an additional hot drinks round • Each objective was to be small scale and easily adopted, adapted or discarded

9. Preparatory Work • Each ward collected baseline data on harm for every patient on discharge, transfer or death • Completed for a period of two weeks • Only collecting data concerning that ward stay • Data collection tool derived from Safety Thermometer • Each Ward Leader prepared own team

10. WWL Data Set • All patients on discharge/ transfer or death • Ward stay only • LOS • Falls – harm • HAPU • HA MRSA bacteraemia • HA Cdiff • Other HAI • HA VTE • Weight loss % of patientssuffering harm

11. Improving patient access to nutrition • PLAN • Improve access to nutrition postoperatively and out of hours • DO • Patients surveyed as to preferred food pre-op • Liaising with catering enabled provision of toasters and ambient food products on the ward • Snack trolley provided in between scheduled mealtimes • STUDY • Led to easier availability of ambient snack products 24 hours a day • Improved access to and timings of snack trolleys in line with ward requirements • ACT • Other wards have now developed plans to improve availability of nutrition • Planned study days for all levels of staff to highlight nutrition

12. Implementing a Safety Huddle • PLAN • Devise a “Safety Huddle” checklist to raise awareness of risk to patients with regard to 4 harms • DO • Incidents and complaints analysed to identify greatest risks • Baseline dataset used to compile checklist • Checklist to be used daily by shift leader during handover • STUDY • Issues identified with unit caseload and suitability of checklist • Established handover format already embedded • ACT • Ongoing development of checklist via further PDSA cycles • Additional elements to be included of risk not covered by 4 harms

13. Intentional Rounding (IR) • PLAN • Devise a Tool to incorporate 4 P`s (Personal needs; Possessions; Position; Pain) to address 4 harms • DO • Tool formulated in line with current research • Guidance criteria written for staff • Trialled on two HFW – one surgery and one CoE for 24h period • STUDY • Identified issues about suitability of a universal IR tool ( not one IR fits all) . • Felt that some wards already doing IR although not in same format • Perceived to increase nursing activity from initial data • ACT • Each ward adapting local IR other wards also trialling and feed back awaited. • One ward using as a learning tool for student nurses

14. Introducing an Additional Hot Drinks Round • PLAN • to improve hydration in elderly care patients • DO • One extra drinks round per day for two patients as a small scale change. • STUDY • Patient 1 demonstrated an improvement in hydration as recorded on input output chart. • Patient 2 refused extra hot drink offered; no evidence of improved hydration. • ACT • Other areas implementing same change as additional PDSA cycle • Extra kitchen equipment required for additional drinks round • Issues identified with inadequate supplies of hot water • Time considerations for extra hot drinks round

15. Challenges faced • Time involved in implementing change • Keeping the change small scale • Gathering data and understanding measurement tools • Demonstrating evidence • Involving patient to improve experience

16. Harm Free Ward Data

18. The way forward…… • Forthcoming Quality Improvement Day and Delivering Quality Care workshop • Ongoing PDSA cycles • Harm Free Ward leaders visits to neighbouring Trusts • Display poster for “days since” harm • Second cohort of Harm Free Wards

19. …and patients were satisfied • I was in Wrightington Hospital for eight days after a hip replacement. • Meals were chicken dinner one day, steak the next with all the trimmings, and delicious puddings to follow. (letter to Wigan Observer, 30 August 2011)

20. Thankyou! • Any tools or information described in this webex is available for sharing • Clare.thomas@wwl.nhs.uk • Deborah.waywell@wwl.nhs.uk