One trust changed the way in which it used data to show how interventions improved patient safety and to maintain the campaign’s momentum
Keywords Patient Safety, Staff motivation, Leadership
As patient safey had already been identified as the first core goal of Salisbury Foundation Trust’s organisational development strategy, signing up to the Patient Safety First campaign felt like a natural progression.
The trust had already participated in the Leading Improvement in Patient Safety (LIPS) course (see tinyurl.com/lips-safer-care for more information). As a result, we had already been collating data to identify a baseline on safety as well as areas for future focus. Although we were developing a culture and awareness of safety, Patient Safety First gave us a framework within which we could implement safety work streams.
The trust chose to put the following four Patient Safety First interventions into practice:
- Leadership for safety;
- Reducing harm in critical care;
- Reducing harm in perioperative care;
- Reducing harm from deterioration.
Under the leadership intervention, the Institute for Healthcare Improvement’s Global Trigger Tool was applied to hospital notes to enhance the information that the trust had on each patient. This provided staff with more information about patients’ health so they would be able to tell if they were deteriorating.
As of April 2008, 20 sets of discharged patients’ notes are reviewed by a nurse consultant and intensive care consultant every month. A consultant anaesthetist and a consultant histopathologist review all hospital deaths using the GTT on an ongoing basis.
Following a review of the results at the trust’s safety steering group, we found that pneumonia was affecting a consistently high number of patients. As a result, the trust started implementing the ventilator acquired pneumonia (VAP) bundle, part of Patient Safety First’s reducing harm in critical care intervention, in the intensive care unit. It is now focusing on nutritional assessment and its links with pneumonia in high risk patients across the trust.
Under the reducing harm in perioperative care intervention, the trust also introduced the World Health Organization’s (2009) surgical safety checklist, which aims to improve perioperative care and teamwork in theatres. The checklist is now used for more than 90% of patients.
We are interested in the thoroughness and quality of the WHO processes. On measuring compliance with the checklist, we found that compliance with “sign out” (that is, ensuring the last section is carried out before the patient leaves the operating room) was very low. Our weekly compliance audit allowed us to identify this as an area for improvement and we are undergoing further small scale cycles of change to improve this.
The improvement methodology “measurement for improvement” (see tinyurl.com/measure-improve) has helped the trust to understand levels of engagement and change, as well as helping staff to understand the impact of changes and determine future areas for action. Patient Safety First’s measurement “how to” guide (see tinyurl.com/how-to-measure-improve) has been particularly useful for learning the best ways to measure accurately.
Measuring the impact of our changes has given focus to our work streams as well as visibility to the campaign. It has inspired staff, as they see the measurements displayed in their departments; for example, the VAP bundle graphs are on the walls in the ICU and the WHO surgical safety checklist compliance graph is displayed in theatres. These results are used in clinical meetings such as the theatre risk meeting and the surgical specialties meeting to prompt debate.
The results have helped to shape the way the campaign moves forward. They are raised each month at the safety steering group meeting, which better enables staff to systematically plan the next steps.
While the campaign has been a success in many ways, it was not totally straightforward. Initial difficulties lay in staff confidence, as many did not know where to start when making changes. There were problems in engaging some sections of the clinical workforce. We overcame these difficulties by establishing the safety steering group, which had strong representation from clinical champions, including the medical director, as well as other executive board members, such as the director of operations and the director of finance. Leadership has been paramount in getting others involved.
The trust ensured that staff who were involved were able to attend the Open Insight events hosted by trusts on behalf of Patient Safety First in late 2008 and early 2009. Staff could also join in the online WebEx sessions that Patient Safety First holds regularly; these enable representatives to log on and dial in to meetings between others from trusts and experts from Patient Safety First. The feedback from these has been positive.
The national campaign provides a wealth of information and material. The online user guides make the interventions feel clearly focused, proactive and positive, and promote local ownership while giving us the tools to continue measuring for improvement.
Lorna Wilkinson, BSc, RN, is head of risk management; Tracey Nutter, IMHL, MSc, BSC, RN, is director of nursing and executive lead for risk; both at Salisbury Foundation Trust.
For more information on Patient Safety First click here.
World Health Organization (2009) Safe Surgery Saves Lives. Geneva: WHO.