SAFE

1. SAFE NHS Fife HealthCheck November-December 2013 Presented to NHS Fife Board on 25th February 2014 EFFECTIVE Activity was 81,361 patient episodes which included 8,386 overnight stays Higher is better Higher is better NO DATA Higher is better Lower is better Lower is better by Dec 15 by Dec 15 Lower is better Lower is better Lower is better *Data from July-December 2013 is for GNEF CHP only. From January 2014 onwards this will also include Acute Services Division data.

2. PERSON-CENTRED • Activity • Activity for the period November 2013 to December 2013 was 81361 patient episodes. This included 8386 overnight stays and 4445 day cases. There were 25510 new and 43002 review Outpatient attendances. • Hospital Standardised Mortality Rate (HSMR) • The last quarterly data to June 2013 was published in November 2013. This shows NHS Fife with a HSMR of 0.89 and an improvement in mortality of 15% since the Scottish Patient Safety programme (SPSP) started. This is the lowest HSMR that has been recorded in Fife. • 95% Harm Free Care • One of the aims of the SPSP is that 95% of people in acute adult health care are free from the four harms of the Scottish Patient Safety Indicator (SPSI). The four harms are Cardiac Arrests; Catheter Associated Urinary Tract Infection (CAUTI); Pressure Ulcers and Falls. • Falls – mean rates are provided but comparison between the NPSA rate and NHS Fife rate may not be particularly helpful for falls prevention. Organisations are encouraged to focus more on improvement over time within their own organisation than on whether their fall rates are higher or lower than in similar organisations. Low fall rates may indicate a poor culture of reporting falls rather than robust prevention of falls. Falls rates are expected to vary between organisations due to differences in local population; differences in specialist services; and reporting culture. The target is the required 25% reduction for all falls by SPSP. • Pressure Ulcers – mean rates are provided but variation may reflect different patient groups and reporting cultures and processes, as well as variation in the actual incidence of pressure ulcers. • Significant Adverse Events (SAE) Review • There was an increase in the total number of incidents reported for 2013. This increase is thought to be due both to the introduction of an electronic incident reporting system which staff appear to find easier to use and sustained encouragement of staff to report incidents. It is important to note that a rise in incident reporting should not be interpreted as indicating a decreasing standard of care. • There were a total of 2116 incidents reported from November 2013 to December 2013. Of these 0.7% (15/2116) reported were graded as major/extreme and 7% (1/15) have been commissioned for an internal SAE Review. This was categorised as patient fall but the review focused on the management of the response to the fall, adherence to policies, staffing and resources at the time of the incident. • Complaints • There were 48 formal complaints (with multiple issues) reported in November 2013 and December 2013. The 3 key themes from these formal complaints were: clinical treatment 39% (70/179); communication (oral) 22% (39/179); and attitude and behaviour 15% (22/179). • Patient/Staff Experience • During February 2014 a further three areas will test the “Your Care Experience” questionnaire with patients in the first instance. • Scottish Public Services Ombudsman (SPSO) • Two SPSO decisions were reached during the reporting period. • In the first case the complaint was that there was an avoidable delay by staff at the Victoria Hospital in establishing the cause of Mr H’s symptoms due to lung cancer. The complaint was upheld and the Board were asked to make a formal apology and ensure that where cancer is suspected there is a robust cancer pathway in place in accordance with the Scottish Referral Guidelines for suspected cancer. • In case 2 the patient sustained a spinal injury following a fall at home. The complaints made were as follows: there was an unreasonable failure to immobilise the patient until such times as the injuries had been determined, there was a failure to carry out appropriate tests to establish the extent of his injuries and a failure to transfer the patient directly to the spinal injuries unit at the Southern General Hospital in Glasgow. The initial complaint was upheld and the Board were asked to apologise for removing a hard collar before the patient was confirmed as neurologically intact.  The Board was also asked to take appropriate steps to satisfy themselves that, with regard to evaluation, ATLS guidelines are fully complied with. • It is the responsibility of the Clinical Governance Committee to assure the Board that all actions are followed up on. • Theme for Person Stories at today’s Board • A key theme arising from our work in Mortality, Adverse Events, Serious Adverse Events Reviews and Complaints is around the recognition and response to the deteriorating patient. This is a complex and multi-factorial issue. At its most extreme it may manifest as Cardiac Arrest, hence it features as one of the 4 key Harms included in the Scottish Patient Safety Indicator, whereby the aspiration is that at least 95% of patients will leave the Acute hospital setting without Cardiac Arrest, Falls, Pressure Ulcers (grade 2-4) or Catheter Acquired Urinary Tract Infection. • Like Acute hospitals nationally NHS Fife has room for improvement in this area. Today’s person stories will focus attention on the contemporary patient and staff experience around recognition and response to the deteriorating patient, describe ongoing and evolving work in this area, and identify areas where even more work is required. • Data • The source of data contained within this document varies and can be derived from validated published sources, official government returns and databases, and local activity data and management information from a variety of internal sources. • The frequency of data updating also varies, with some data being updated monthly and others quarterly. • Data correct as at 11/02/2014 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jul-13 Lower is better NO DATA NO DATA