A national patient safety tool targeted at nurses has sparked a rise in harm-free care, with improvements across all of the areas that it measures, shows latest data shared with Nursing Times.
There have been marked reductions in fall rates, pressure ulcers, urinary infections from a catheter and new venous thromboembolisms since nurses in England began using the NHS Safety Thermometer nearly four and a half years ago.
“There have been some significant improvements in some of these key indicators”
According to the latest national data shared with Nursing Times, there has been an increase in the proportion of patients who experience “harm-free” care from 91.3% in July 2012 to 94.2% in October 2016 – although this is still short of the 95% goal for the project.
Meanwhile, the proportion of patients with a new pressure ulcer has reduced by 30.8% from 1.3% to 0.9%, while the proportion experiencing a fall with harm has reduced by 40% from 1% to 0.6%.
In addition, the proportion of patients with a catheter and any type of urinary infection has dropped by 41.7% from 1.2% to 0.7%. The proportion of patients with a new venous thromboembolism has also reduced by 50%, from 0.8% to 0.4%.
This represents the first time the data revealing the “success story” to date has been drawn together and published, with academic papers explaining the improvement for each area still in the pipeline.
However, the healthcare advisor who spearheaded the launch of the NHS Safety Thermometer admitted the scheme had a “very bumpy landing” and was a mixed success to start with.
“Just because something is working in one area, you can’t just then roll it out everywhere”
Professor Maxine Power, who led the Safety Express pilot to develop and test the eventual thermometer tool, said the original vision of the scheme had become “hugely lost”. It was only now – four years after it was rolled out nationally – that “we are starting to see people understand the data and make changes”, she told Nursing Times.
Her comments also followed the separate publication of an evaluation of the early phases of the NHS Safety Thermometer scheme, which was rolled out across England from April 2012. The paper in the journal BMJ Open collated the experiences of those involved in launching the scheme with findings from external evaluators from the University of Leicester.
Mainly focusing on the pilot stage, it laid bare the “arduous” process of developing the measurement tool and attempting to launch it against a background of “extreme policy turbulence”. It also highlighted challenges, including patchy data collection, and concluded that it was hard to say whether the initiative did indeed help improve clinical outcomes at first.
Exclusive: Nurse patient safety tool has reduced harm
Professor Power, chief executive of the Haelo innovation and improvement science centre at Salford Royal NHS Foundation Trust, was upfront about the challenges involved in implementing the programme across the whole NHS and said there were “huge lessons” for other quality improvement schemes.
She said one aim of the scheme was to try and “bring the measurement and care process together” but this had been “a very hard sell”.
“The safety thermometer asks you to go round all your patients on one day and check for those four harms – to look at your patients, talk to them and examine their skin and so on,” she said.
“Some people did that, but many more were sitting at the nursing station going through the paper notes to figure out whether someone had documented a pressure ulcer,” she said. “That is missing the point.”
Professor Power said it had taken time for the national drive to result in “local action”. However, the data shared with Nursing Times suggested the programme was having an impact, she said.
“While this paper shows mixed results and a very bumpy landing, since then there have been some significant improvements in some of these key indicators which is a good news story for England,” she said.
Despite its teething problems, Professor Power said the project had resulted in an enviable safety tracking system and most organisations currently used safety thermometer data in their quality accounts.
Meanwhile, clinicians in areas like mental health, maternity, medicine safety and paediatrics had gone on to develop the “next generation of safety thermometers”. People were using them “not because they have been told to but because they want to”, she noted.
“The safety thermometer is one of a number of ways to get intelligence about whether or not your system is safe,” she said.
“It has given us new insights into harm and supported improvement work”
Elaine Maxwell, associate professor in leadership at London South Bank University and former executive nurse, said the project showed “it was a lot more difficult to do things at scale than people imagine”.
“I think a lot of nurses feel this was designed as a project for staff, particularly nurses, to do some quality improvement – a tool to help them,” she said. “But the measure quickly became a performance management tool and nurses are now assessed on their safety thermometer score.”
Another issue – also flagged up by Professor Power – was a lack of knowledge and skills among nurses when it came to data analysis and running quality improvement programmes.
“People think anybody can go off and do a quality improvement programme tomorrow, but there is a definite set of skills and knowledge you need,” said Dr Maxwell.
“There has to be a greater capacity among nurses to run quality improvement projects and that means they are going to need a lot more education and understanding.”
Dr Maxwell said she hoped policy-makers would learn from the safety thermometer experience.
“Just because something is working in one area, you can’t just then roll it out everywhere – it needs a bit more thought – and that applies to a whole range of things nurses are involved in,” she said.
“I would hope that people setting up national programmes – including NHS Improvement – would look at this and really learn from it,” she added.
A spokeswoman for NHS Improvement said: “The NHS Safety Thermometer was developed by the NHS for the NHS and has been and positive step for patient safety in England.
“It has given us new insights into harm and supported improvement work across the NHS focussing attention on reducing specific types of harm,” she said.
However, she added: “We are aware that data collection varies between organisations – this is one of the reasons we are clear that safety thermometer data should never be used to compare organisations’ performance or to make external judgments about their safety.
“The safety thermometer is best used by clinical teams to provide a quick and simple method for surveying patients and analysing results to help them continue making local improvements to care over time,” she said.