ARGYLL & BUTE CHP COMMITTEE MEETING - NHS Highland · 16. Partnership Working 16.1 Argyll & Bute...

of 209/209
Wednesday 19 December 2012 Queens Hall, Dunoon 12.30pm to 1pm Lunch 1pm - Meeting AGENDA 1. Chairman’s Welcome Robin Creelman 2. Apologies Robin Creelman 3. Conflicts of Interests Robin Creelman 4. Minutes from Previous Meeting 4.1 Minute of Previous Meeting – 31 October 2012 (attached) Robin Creelman 5. Matters Arising 6. NHS Highland Organisational Issues 6.1 Draft Minute of Highland NHS Board – 4 December 2012 (to be tabled) Robin Creelman 6.2 NHSH Annual Review 2012 – Scottish Government Summary (attached) Derek Leslie 7. Clinical Governance 7.1 Clinical Governance & Risk Management Report (attached) Pat Tyrrell 7.2 Infection Control Report (attached) Pat Tyrrell ARGYLL & BUTE CHP COMMITTEE MEETING 10.30am - 12.30pm – Committee Members Development Session Charter of Patient Rights & Responsibilities – Jane Davies, NES Argyll & Bute Adult Protection Committee Biennial Report April 2012 - March 2012 - Bill Brackenridge, Chair, A&B APC, Rebecca Barr, Area Manager – Adult Protection, A&B Council Public Health - Director of Public Health Annual Report 2012 – Elaine Garman, Public Health Specialist, Hugh McLean, Chair, Healthy Options
  • date post

    28-May-2020
  • Category

    Documents

  • view

    2
  • download

    0

Embed Size (px)

Transcript of ARGYLL & BUTE CHP COMMITTEE MEETING - NHS Highland · 16. Partnership Working 16.1 Argyll & Bute...

  • Wednesday 19 December 2012

    Queens Hall, Dunoon

    12.30pm to 1pm Lunch

    1pm - Meeting

    AGENDA

    1. Chairman’s Welcome Robin Creelman

    2. Apologies Robin Creelman 3. Conflicts of Interests Robin Creelman 4. Minutes from Previous Meeting 4.1 Minute of Previous Meeting – 31 October 2012 (attached) Robin Creelman 5. Matters Arising 6. NHS Highland Organisational Issues

    6.1 Draft Minute of Highland NHS Board – 4 December 2012 (to be tabled) Robin Creelman 6.2 NHSH Annual Review 2012 – Scottish Government Summary (attached) Derek Leslie

    7. Clinical Governance 7.1 Clinical Governance & Risk Management Report (attached) Pat Tyrrell 7.2 Infection Control Report (attached) Pat Tyrrell

    ARGYLL & BUTE CHP COMMITTEE MEETING

    10.30am - 12.30pm – Committee Members Development Session

    � Charter of Patient Rights & Responsibilities – Jane Davies, NES � Argyll & Bute Adult Protection Committee Biennial R eport April 2012 - March 2012

    - Bill Brackenridge, Chair, A&B APC, Rebecca Barr, Area Manager – Adult Protection, A&B Council

    � Public Health - Director of Public Health Annual Report 201 2 – Elaine Garman, Public Health Specialist, Hugh McLean, Chair, Healthy Options

  • 3.30pm – 4pm - Public Meeting

    8. Financial Governance 8.1 Finance Report (attached) George Morrison 9. Staff Governance

    9.1 Argyll & Bute CHP Partnership Forum – Draft Minutes of 15-11-12 (attached) David Logue/ Dawn Gilles/Liz McMillan

    9.2 PDP/R and eKSF Implementation (attached) David Logue

    10. Director of Public Health Annual Report 2012 (attached) Elaine Garman

    11. Director of Operations Report (verbal) Derek Leslie 12. Review of Management Structure – Cowal & Bute/Helensburgh & Lomond (attached) Viv Smith 13. Renal Dialysis (attached) Stephen Whiston 14. Cowal 24/7 Report (attached) Stephen Whiston 15. Mental Health Modernisation Update (attached) Derek Leslie 16. Partnership Working

    16.1 Argyll & Bute Public Partnership Forum Draft Notes – 27-11-12 (attached) Duncan Martin

    17. Performance Management 17.1 Delayed Discharge (attached) Derek Leslie

    18. Papers for Noting: 18.1 Argyll & Bute CHP eHealth Steering Group Draft Minute – 07-11-12 (attached)

    19. AOCB*

    20. Date, Time & Venue for Next Meeting

    Wednesday 20 February 2013 at 10.30am in Rooms J03- J07, Mid Argyll Community Hospital & Integrated Care Cen tre, Lochgilphead

    * to be notified to Chairman in advance of meeting

    The Committee meeting will be followed by:

  • Argyll & Bute CHP Committee Date of Meeting : 19 December 2012

    Agenda item : 4.1

    MINUTE OF MEETING OF THE ARGYLL & BUTE CHP COMMITTEE

    Argyll & Bute Community Health Partnership Aros Lochgilphead Argyll PA31 8LB www.nhshighland.scot.nhs.uk/

    Mid Argyll Community Hospital & Integrated Care Centre

    Lochgilphead

    31 October 2012

    Present Mr Robin Creelman, Chairman, Argyll & Bute CHP

    Mr Derek Leslie, Director of Operations, Argyll & Bute CHP Dr Michael Hall, Clinical Director, Argyll & Bute CHP Ms Pat Tyrrell, Lead Nurse, Argyll & Bute CHP Ms Elaine Garman, Public Health Representative, Argyll & Bute CHP Ms Mary Wilson, AHP Representative, Argyll & Bute CHP Mr David Ritchie, Communications Manager, Argyll & Bute CHP Ms Tricia Morrison, CVO Representative, Argyll & Bute CHP Ms Elizabeth Reilly, Area Dental Committee Representative Mr Duncan Martin, Chairman, Public Partnership Forum Mr Michael Roberts, Vice Chair, Public Partnership Forum Ms Glenn Heritage, CVO Representative Ms Liz McMillan, Staffside Representative Councillor Elaine Robertson, Argyll & Bute Council Representative (by VC)

    In Attendance Apologies

    Mr George Morrison, Head of Finance, Argyll & Bute CHP Mr David Logue, Head of HR, Argyll & Bute CHP Mr Stephen Whiston, Head of Planning Contracting & Performance, Argyll & Bute CHP Ms Sara Wedgwood, Chair of Clinical Governance Committee & Spiritual Care Committee, NHS Highland Mr John Dreghorn, Project Director, Mental Health Modernisation - (agenda item 14.1) Mrs Sheena Clark, PA to Director of Operations - Minute Secretary Councillor George Freeman, Argyll & Bute Council Representative Mr Cleland Sneddon, Argyll & Bute Council Representative Ms Dawn Gillies, Staffside Representative Mr Donald Barr, Area Optical Committee Representative Mr Neil Robinson, Area Pharmaceutical Committee Representative Ms Ann Gent, Director of HR, NHS Highland

    1. CHAIRMAN’S WELCOME The Chairman opened the meeting by welcoming everyone to the Mid Argyll Community Hospital & Integrated Care Centre, Lochgilphead. 2. APOLOGIES Apologies for absence were noted as above.

  • 2

    3. CONFLICTS OF INTEREST No conflicts of interest were declared. 4. MINUTE FROM PREVIOUS MEETING 4.1 Minute of Meeting held on 29 August 2012 Mr Michael Roberts asked that his apologies be recorded. With the above amendment the Minute of the meeting on 29 August 2012 was accepted as a complete and accurate record of the meeting. The Committee: • Approved the content of the Minute of the meeting on 29 August 2012. 4.2 Minute of Public Session – 29 August 2012 The Minute of the public session on 29 August 2012 was accepted as a complete and accurate record of the meeting. The Committee: • Approved the content of the Minute of the public session on 29 August 2012. 5. MATTERS ARISING FROM PREVIOUS MEETING HELD ON 29 August 2012 Page 4 – Helensburgh & Lomond Planning Group Ms Wedgwood requested clarification on the position regarding public engagement with Helensburgh & Lomond patients. Mr Leslie reaffirmed that the public should engage with the CHP through local Public Partnership Fora. There continued to be some challenges in establishing such a forum to cover the Helensburgh and Lomond locality however. Page 4 – Pressure Ulcer Prevention Ms Wedgwood commented on the reference to photographic data. Ms Tyrrell provided assurance that a clear policy is followed when obtaining this photographic evidence, which, Mr Creelman advised, verifies the grading of the ulcer and enables monitoring of healing. Mull PCC Mr Leslie reported on the public meeting in Mull on 16 October, attended by representatives of the CHP, Argyll & Bute Council and West Highland Housing, with an attendance of approximately 100 members of the public. The meeting addressed a number of predetermined questions relating to various areas of public concern, including outreach clinics, physiotherapy, transport, kitchen facilities. The Mull PCC Frequently Asked Questions information sheet will be updated to capture the detail of the questions and responses.

  • 3

    Open Days within the new unit have been arranged for 6 and 7 November 2012. A further public session has been arranged on Mull for 4 December 2012, when the model of care for older peoples’ services will be presented again and discussed and the public given the opportunity to seek clarity around all aspects of service provision. Ms Heritage advised that a meeting of the Transport Network Partnership Initiative is scheduled to take place on Saturday 3 November 2012 at the Loch Fyne Hotel, Inveraray, attended by the representatives of the Scottish Ambulance Service, the Red Cross and the Voluntary Sector. Ms Heritage suggested that representatives from the Mull Community Council may wish to link in to this meeting which would provide an opportunity to discuss transport concerns on Mull. Ms Tyrrell stated that she would contact Councillor Mary-Jean Devon to ensure that she was aware of the above event. 6. NHS Highland Organisational Issues 6.1 Meeting of Highland NHS Board Meeting – 2 Octob er 2012 The draft Minute was circulated for information. Mr Creelman highlighted details in the Minute particularly relevant to the CHP. 110 Audit Committee – Mr Creelman requested an update regarding the Service Level Agreement with NHS Greater Glasgow & Clyde. 121 Patients Rights (Scotland) Act 2011 – Mr Creelman advised that the presentation referred to in the Minute was still to be given to the CHP. Jane Davies from NES will be attending the CHP Committee Development Session in December to discuss the work currently being undertaken from the perspective of preparing the NHS Scotland workforce for the Patient Rights Act and the forthcoming Charter of Patient Rights and Responsibilities. 122 Inequalities Action Plan - Ms Wedgwood reported on the initiatives and targeted work to reduce inequalities in poverty areas. The importance of early interventions is recognised throughout the Board area, i.e. Healthy Living Initiatives. Ms Garman reported that the Director of Public Health's Annual Report details the extensive work of the Keep Well project and on health inequalities within remote and rural settings. The report will be taken to the CHP Committee meeting in December. 123 NHS Highland Engagement with School Pupils - Mr Creelman reinforced the need for NHS Highland to continue the programme of engagement with school children and young people who are considering a career within the NHS. He acknowledged the quality of the pupils who had recently participated in the NHS Highland engagement process and the need to maximise this engagement. Ms Garman advised that within the CHP the engagement process is conducted through Curriculum for Excellence, in conjunction with Argyll & Bute Council. This approach will be refreshed, with the focus to ensure re-engagement by young people. It was suggested that pupil representation may be appropriate within the local network, i.e. Public Partnership Forum (PPF) and the Community Planning Partnership (CPP). Mr Leslie will discuss this further at the next meeting of the CPP and with the Chair of the PPF. Ms Tyrrell highlighted the Child Protection poster on display at today's meeting and advised that the details and drawings were produced with the involvement of children and young people.

  • 4

    130 Chief Executive's and Directors' Report - Mr Creelman asked for clarity around the public and patient engagement process by NHS Greater Glasgow & Clyde during their current clinical review. Mr Whiston advised that the recent paper produced for the West of Scotland Planning Group is a summary of activity and confirmed the engagement process is ongoing, with Scottish Health Council involvement and continuing discussions with the NHS GG&C Lead Planner in relation to impact of the review on CHP patients. Mr Roberts advised that he is aware of information regarding the NHS GG&C clinical review and process being presented at 3 Public Partnership Forum meetings but not currently presented to the wider public. The Committee: • Noted the Minute of the meeting on 2 October 2012 6.2 Director of Operations Report Mr Leslie stated that the circulated report resulted from recommendations of the recent Internal Audit report on CHP governance and management arrangements, and featured highlights of the business of the CHP Core Team and CHP Management Team. Mr Leslie requested members of the Committee forward to him any comments/suggestions on this initial report. Mr Creelman thanked Mr Leslie for his report and recorded his support of Mr Leslie in the ongoing discussions between the CHP, Islay GPs and representatives of the community to ensure the continuation of a safe and sustainable health service on the island. Ms Wedgwood acknowledged the conciseness, brevity and succinctness of the report, together with the operational content but advised the need for a corporate view from the NHS Highland Board to clarify issues/topics which are for governance decision and those which require operational consideration and input. Mr Leslie advised that he and Mr Creelman will further consider the content of future reports and will await a corporate view from the Board. 6.3 NHS Highland Internal Audit Report – A&B CHP Govern ance and Management

    Arrangements Mr Leslie provided a brief summary of the outcome of internal audit carried out by Scott-Moncrieff, to review the governance and management arrangements in place within Argyll & Bute CHP, and to consider the interaction with the Board of NHS Highland and its standing committees, as well as plans to integrate services with Argyll & Bute Council. The outcome of the report was generally positive, with management action points identified being considered and actioned by the Chairman and Director of Operations. Ms Robertson enquired about the timescale for the proposed integration of services. Mr Leslie replied that the timescale is set by the outcome of the national consultation. Broader discussions are due to take place between NHS Highland and Argyll & Bute Council and further information will be given at the next Committee meeting. Ms Wedgwood congratulated the CHP on a positive audit report.

  • 5

    7. Hospital Dialysis Service Mr Whiston referred to the conclusion of the previous report in May 2012, as detailed, and advised that the purpose of this report is to update the Committee on additional actions agreed with regard to planning for the future provision of hospital renal dialysis services for a proportion of the CHP’s population in the Oban, Lorn & Isles catchment area. On 1 October 2012 CHP management representatives attended a community council meeting in Taynuilt, which was hosted to enable the public and local councillors, including the MP Alan Reid, to explore the CHP’s conclusion and to request the CHP to reconsider the possibility of an enhanced local access to renal dialysis. Particular points made at the meeting included:

    � the current very high cost of transporting patients to the Belford, � the significant impact the current travel arrangements using taxis has on patients

    travelling to the Belford for hospital dialysis � option of the qualified renal nursing staff from Belford (who run the unit - Mon, Wed &

    Fri) coming down to provide the service at LIH unit Tues, Thurs, Sat. � indication that the community would look to fund raise to pay for the facility and buy

    the equipment etc for a local unit, � the opportunity to gain income from holiday dialysis.

    The CHP agreed to undertake a high level piece of work to assess whether there is a case for establishing a viable Hospital dialysis service at LIH. Mr Whiston advised that a high level macro analysis, based on current available information, supplemented by user and stakeholder feedback on current service provision, will be carried out to assess the viability of a local service. Ms Garman advised that equality and diversity regarding the number of population, the area covered and transport concerns required to be considered in relation to any proposed service. Mr Leslie commented that current discussions had attracted significant political and public interest and the review will be undertaken set against the facts and public health predictions to consider and address the concerns of those involved. Mr Roberts enquired regarding the viability of anticipating the number of renal patients and the subsequent provision of a renal nurse specialist, in comparison to the chemotherapy provision at Mid Argyll Hospital. Mr Morrison replied that a renal dialysis service requires a more complex infrastructure and therefore enhanced capital investment. Ms Garman stated that projected figures for the future development of a dialysis service should be modelling dependent, not predicted. It is not intended to present an outline business case but a written report outlining the findings and criteria to establish a viable unit will be taken to the CHP Management Team and CHP Committee in December 2012. The Committee: • Noted the findings in regarding the currently and future profile of service delivery. • Considered the criteria identified to inform the assessment of what would make a viable

    “local” hospital dialysis service in Lorn & Isle Hospital. • Approved the approach outlined and the level of detail to be presented in the report.

  • 6

    Mr Creelman agreed to take Mental Health Services M odernisation Project as the next agenda item. 14. MENTAL HEALTH SERVICES MODERNISATION PROJECT 14.1 Update Report Mr Dreghorn spoke to the previously circulated report. Project governance arrangements have been reviewed for the capital element of the project, resulting in the establishment of a new Capital Project Board. The first meeting of this group took place on 19 October 2012 and will meet monthly to oversee the new inpatient services mental health hospital capital project. Capital Project – the hub stage 1 submission was received on 5 October 2012 and was presented to the Project Board on 19 October. Key points within the report included: • Estimated capital cost is within the £9.45 million cap set at the start of the project. • The Facility Management (FM) and Life Cycle Costs (LCC) are currently projected to be

    above the £43 per m2 set at the start of the project. These costs are currently being reviewed by external advisors (Technical, Financial & Legal) and a final report is awaited, which will to a large extent dictate whether the stage 1 submission is accepted. This process should be completed by 4 December 2012

    • The design development work is progressing well with a full set of drawings likely to be available by the end of November.

    Ms Wedgwood enquired about the remit of the external advisors. Mr Dreghorn assured the Committee regarding their financial and legal expertise in relation to Hub projects. The development of the Outline Business Case continues to progress, with the approvals timetable revised to : CHP Committee on 19 December 2012; NHS Board on 5 February 2013; Asset Management Group on 15 February 2013; and the Scottish Government - Capital Investment Group on 26 February 2013. Mr Dreghorn summarised the detail of the report relating to: • Inpatient services • Staff redeployment • New posts • Budget • Projected Operational Funding Gap • Resettlement Group • New hospital • Community Mental Health Service (CMHS) • Community Mental Health Service Team Base • Crisis Response Mr Dreghorn advised that the lead Architect has met with staff and service users to discuss the design of the new hospital building and the plans have subsequently been amended following those discussions. Identifying suitable premises as a base for the CMHS teams in Campbeltown and Dunoon continue to be problematic. The benefits of having all members of a CMHS team in one location has been acknowledged, therefore in both areas it is planned to develop underutilised areas of the hospital as a CMHS base, incorporating NHS and council staff. Discussions are ongoing regarding the financial implications of this proposal.

  • 7

    Mr Creelman raised the issue of crisis response in Dunoon. Mr Dreghorn acknowledged the concerns and advised discussions have taken place regarding the sufficiency of the designated place of safety in the hospital. Community mental health teams are very responsive but concerns around provision during out of hours are being addressed. Mr Dreghorn reported that he is currently visiting all places of safety within the CHP and meeting with staff, management and service users and the discussions and any recommendations will be reviewed. The Committee: • Noted content of the Modernisation of Mental Health Services Update Report 8. Workforce Planning Mr Logue referred to the circulated paper summarising the detail of the monthly NHS Highland Workforce Information report. This provides a range of information on staff throughout NHS Highland and a comparison can be made on some items between Argyll & Bute CHP and other areas in NHS Highland. The paper provides a snapshot of the situation at August 2012, with some charts providing trends and historical data over the previous 12 months. Points highlighted:

    • Replacement Whole Time Equivalent – use of Bank staff is reducing. • Job Families – comparable figures – NHS Highland 64.44% staff in immediate front

    line patient care, 34.81% - support and administrative services staff. CHP 64.26% of staff in immediate front line patient care, 35.07% - support and administrative services staff. Senior managers – 0.74% in Highland, 0.68% in the CHP.

    • Turnover and Stability – figure is currently falling, indicating a trend towards higher

    turnover and possibly a more active employment market, which is also indicated by an increase in vacancies over the last 12 months.

    • Occupational Health (OH) Service KPIs - KPI 2 shows the average referral to

    treatment time (RTT) for seeing an OH nurse. Although improving recently this remains low. It should be noted that the target RTT for Inverness is lower than other areas. The OH is working to overcome the challenges presented by the wide geographic area and have recently appointed to a vacancy covering Argyll and Bute. Also, increased use of telephone appointments has been introduced providing a more flexible and quicker response to staff out with Inverness.

    • Sickness Trends - the Argyll and Bute figure remains above that of NHS Highland

    overall. There is continuing work between HR, managers and OH to address frequent or long term absences. The annual trend for Argyll and Bute follows the NHS Highland trend line for reduction and the gap has closed over the year from 0.6% to 0.2%.

    • Employee relations - charts provide information on the numbers and lengths of the

    various procedures being undertaken under NHS Highland Employee Relations Policies (PIN Policies). A summary for the CHP is taken to the Core Management team for discussion. Managers and HR, in partnership with the Staffside, are

  • 8

    committed to reducing the time taken to complete these procedures, with regular case reviews undertaken to improve the timeline. Mr Logue advised that the CHP % of cases and lengths of completion times are similar to NHS Highland.

    • NHS Highland Re-deployment Register - there are considerably more staff on this

    register in the CHP than in other areas of Highland and this is indicative of the scale of service changes being enacted. The large majority of staff are on the register due to their posts being subject to change. They remain at work and undertaking their normal duties but are given priority status for any vacancies which arise. This greatly assists in the process of revising service establishments and supporting staff to move into suitable alternative posts.

    • Employee Friendly Leave – the range of leave available to staff to assist them at

    times of emergency, family crisis or similar events provide them with the opportunity to overcome or deal with the difficulty. NHS Highland initiatives are valued by staff and are a small aspect of staff attendance. In August 2012 total leave of this type in NHS Highland was 30.96 wte equating to 0.46% of the workforce.

    Ms Wedgwood asked for clarification of the figure of 161 fixed term contracts. Mr Logue replied that this is possibly due to cultural issues around recruitment but will ensure a specific examination of this figure.

    Ms Tyrrell highlighted the age profile of staff and the challenges for the CHP in forthcoming years to address any resulting issues. Ms Tyrrell asked about the appropriateness of discussing retirement plans with individual staff. Mr Logue advised that this would be appropriate in the circumstances of addressing any capability issues but the preparation for such discussions was critical to the need of the individual in relation to discussions with Managers and could also be incorporated within the individual’s eKSF/PDP procedure. 9. Clinical Governance 9.1 Clinical Governance & Risk Management Report Ms Tyrrell spoke to the previously circulated paper and highlighted a number of areas from the report. Risk Management Incidents A total of 442 incidents were reported during quarter 2 of 2012/13 which is a reduction on the previous reporting period. Slips, trips and falls remain the highest reported category of incidents in Cowal & Bute, Mid Argyll & Kintyre and Lorn & Isles. Medication and sharp incidents were the highest reported category in Helensburgh & Lomond. During the reported period the reported incidents were reported as low -242 (54.74%) and medium – 165 (37.33%), with the remaining 35 incidents still to be graded. Pressure Ulcer Prevention The CHP is continuing to implement the NHS Highland zero tolerance approach to preventable pressure ulcers. There is heightened awareness of early identification and increased reporting and a range of measures to improve the identification and management of those patients at risk of developing pressure ulcers in all hospital and community settings.

  • 9

    Ms Tyrrell advised that Argyll & Bute CHP is at the lower end of reported cases but actions continue to drive down any incidences. Details are recorded on Datix and learning is shared through the Tissue Viability Leadership Group and also reported to the Board Clinical Governance Group. Ms Garman enquired about the level of CQI training for staff. Ms Tyrrell advised that actions are being taken to address identified gaps and needs in staff training and skills. Senior Charge Nurses have identified the need for ownership by teams. Ms Wedgwood asked about the plan for the care of tissue viability patients on discharge from hospital to the community. Ms Tyrrell advised that details are recorded in the patient discharge plan, with the transfer of care managed by the Community Nursing Team. Discussions have been held with and assurance given by NHS Greater Glasgow & Clyde to assure that accurate details are included in the care plan for tissue viability patients on discharge from NHS GG&C back to Argyll & Bute. Mr Roberts requested clarification on the July and August figures reported for Islay. Ms Tyrrell confirmed that the reported figures are by occupied bed day numbers and she will circulate information to provide clarification on the numbers reported. Falls Prevention Ms Tyrrell reported that a significant amount of work is being undertaken to reduce the risk and number of falls in healthcare settings; to improve the reporting information available and to highlight areas requiring support. Complaints Ms Tyrrell commented on the challenges in adhering to the 20 day response time due to the complexity of some complaints and the need to provide a concise response. Ms Wedgwood advised that this is a concern expressed in other areas and is due for discussion at the NHS Highland Clinical Governance and Risk Management meeting. Health & Safety and Fire Safety An Argyll & Bute Hospital Risk Assessment group has been established to carry out a review of environmental and statutory requirements to ensure safe practice and a safe environment for staff and patients. An action plan has been drawn up for review at the fortnightly meetings, chaired by Mr Leslie. Quality Scottish Patient Safety Focus on Medicines Management and Medicines Reconciliation continues, to address areas requiring improvement. Further detail will be provided in the next report to the Committee. External Reviews Forensic Network Review A Forensic Network Review of the Intensive Psychiatric Care Unit at Argyll & Bute hospital was carried out in September 2012 as part of a peer review to measure performance against the Low Secure Forensic Standards. A draft report has been received indicating that most standards were assessed as being at the developing stage.

  • 10

    Care Inspectorate Follow Through Inspection of Services to Protect Children & Young People Ms Tyrrell advised that a follow up inspection by the Care Inspectorate is scheduled to take place in January 2013. Healthcare Environment Inspectorate Notification has been received that the HEI will undertake a minimum of 30 annual, unannounced inspections of acute and community hospitals. All hospitals within the CHP are required to reassess their compliance with the standards and further walk rounds are planned to support this process by a number of senior staff. The Committee: • Noted the content of the Clinical Governance and Risk Management Report 9.2 Infection Control Report Ms Tyrrell spoke to the previously circulated paper. Staphylococcus Aureus Bacteraemia (SAB) NHS Highland rate April–August 2012 is 20.0 per 100,000 bed days, (0.20 per 1,000 bed days). The MRSA programme has been implemented and there have been no further cases of SAB in the Lorn & Isles hospital since the last report. Clostridium Difficile NHS Highland rate April – August 2012 is 21.7 per 100,000 total occupied bed days, (0.217 per 1,000 occupied bed days) (20 cases) in patients age 65 and over using the Clostridium Difficile toxin test. Hand Hygiene NHS Highland Compliance with hand hygiene 98% in July and August 2012. Mr Roberts challenged the reported figures, particularly with regard to clinicians. During discussion it was suggested that it may be appropriate for a public representative to participate in infection control walk rounds. Ms Tyrrell acknowledged the need for locality ownership and external scrutiny to maintain compliance by all staff. Mr Creelman supported the CHP process and commented that there is scope for members of the public to receive training to enable them to participate in the carrying out of audits. Ms Tyrrell acknowledged the need for locality ownership and external scrutiny to maintain compliance by all staff, and welcomed the suggestion of a public representative. Health & Safety Executive Visit to Care Homes in North Highland

    NHS Highland is working with the Health and Safety Executive on two strands of infection control work at present; one relates to improving the arrangements for managing infection control in NHS Care Homes, the other relates to community nursing staff.

  • 11

    Within Argyll and Bute CHP we will ensure that actions within the plan for training and education for staff working in community settings are complied with across all sites. In addition we will work with partners in the Argyll and Bute Council and Independent Sector to share the learning and policy changes developed through the NHS Highland Health Protection Team. The Committee • Noted the content of the Infection Control Report. 9.3 Health Improvement Report Mental Health & Wellbeing Framework Ms Garman reported that the Argyll and Bute Community Planning Partnership document Strategic Framework for Mental Health and Wellbeing in Argyll and Bute 2012–2014 was launched in March 2012. This framework arose from the mental health modernisation programme and was developed from a partnership of Argyll and Bute Council, the Third Sector and Argyll and Bute Community Health Partnership. The purpose of the framework is to ensure investment in evidence informed approaches to improving mental health. A CHP action plan is currently being developed which will be governed by the Mental Health Modernisation Programme Board and the Community Planning Partnership Management Committee. Young People in Alcohol In March 2011 the Argyll & Bute Alcohol & Drug Partnership released the needs analysis report “Young People, Alcohol and Drug Misuse Across Argyll and Bute” by Barnard, Griffin and Milton which identified a number of key points in relation to young people’s alcohol use in Argyll & Bute. The Scottish Schools Adolescent Lifestyle and Substance Use Survey 2010 (SALSUS) report for Argyll & Bute indicated that:

    • Compared with 2006, there has been a decrease in the proportion of 13 year old pupils who had ever had an alcoholic drink (from 63% in 2006 to 51% in 2010)

    � There has been no statistically significant change in the proportion of 15 year olds who have ever had an alcoholic drink (86% in 2006 and 84% in 2010)

    • In both age groups, the proportion of pupils in Argyll & Bute who have ever had a proper alcoholic drink is higher than the national average (51% of 13 year olds compared with 44% nationally, and 84% of 15 year olds compared with 77% nationally)

    The CHP Senior Health Promotion Specialist: Alcohol and Drugs has undertaken research work looking at the alcohol use by 5th year pupils in three schools in Argyll & Bute and the results were detailed in the circulated report. Alcohol brief intervention work was recently delivered through a series of training events to staff working with young people within the public sector and third sector organisations. The Argyll & Bute Alcohol & Drug Partnership Children & Families group are in the process of finalising an action plan, connected to five key practice areas:

    • Education, information and prevention • Diversion and prevention • Identification and response to children at risk

  • 12

    • Training and Development • CAPSUM (Children Affected by Parental Substance Misuse)

    Mr Leslie emphasised the value and benefits of health improvement work. There is a need to address the stigma in mental health and to advocate the importance of mental health wellbeing. It was acknowledged that the work being carried out to address concerns regarding young people and alcohol requires the sign-up of the young people and a cultural change to achieve self management. The Committee: • Noted the content of the Health Improvement Report. 10. FINANCIAL GOVERNANCE 10.1 Finance Report Financial Position At end September 2012 Argyll & Bute CHP recorded an overspend of £57,000, a significant improvement on the previous month as it represents a decrease of £128,000 on the overspend of £185,000 recorded at the end of August.

    Mr Morrison summarised the budgetary performance across Argyll & Bute CHP to end September 2012 and advised on the overspending budgets caused by either unachieved savings or cost pressures. The main cost pressures being experienced are;

    • Medical locum cover for vacancies and a suspension in Cowal. • An overspend on commissioned services relating mainly to increased patient referrals

    to Raigmore & Belford Hospitals which are internally cross-charged on a cost per case basis.

    • Locum cover for GP vacancies in Bowmore, Jura and Inveraray. • An overspend on hospital and community nursing pay costs on Bute.

    In addition to the cost pressures noted above, there is also the ongoing risk relating to settlement of the patients services SLA with NHS Greater Glasgow & Clyde. No value has been agreed for this financial year and GG&C are continuing to claim that a substantial increase to the SLA value is required to reflect increased activity and case complexity.

    Specific attention is drawn to the entry of “Planned Management Action”. This entry is necessary to support a forecast year-end break-even position for the CHP. However it indicates that without action to address savings target shortfalls, it is likely that the CHP will overspend by £300k. Cost Improvement Programme 2012/13 The CHP approved budget for 2012/13 contained a requirement to achieve savings of £5m. Several of these savings will arise naturally e.g. prescribing drugs coming off-patent, restricted uplift to SLA values, etc.

  • 13

    Initially a balance of £2.24m required to be delivered through management action, however this has recently been reduced to £1.56m, mainly as a result of increased savings being achieved from off-patent prescribed drugs. This has enabled locality savings targets to be reduced from 3% to 2%.

    Recurring targets by budget manager, sums declared achieved to date, forecast achievements based on current information, and likely shortfalls are as detailed in the report. Based on current information, there is likely to be a shortfall of £0.5m against savings targets. Mr Morrison emphasised the need for managers to take action to deliver on savings targets where a shortfall is currently predicted. Forecast Outturn for 2012/13 Overall, notwithstanding the risk relating to the GG&C SLA, Argyll & Bute CHP is forecasting a year-end break-even position. This is, of course, dependent on managers delivering on their savings targets and continuing to exercise control over emerging cost pressures. The Committee: • Noted the contents of the Finance Report 10.2 Service Level Agreement (SLA) Update Report Mr Whiston advised that the detail of the paper sets out the governance arrangements and provides a broad scope of contracts for services provided to the Argyll and Bute population for 2012/13. NHS Greater Glasgow & Clyde – Main Patient SLA The CHP participates in regular liaison meetings with senior management of NHS GG&C with regard to its’ SLA to consider and address operational and financial issues pertaining to the services it commissions. There are 2 sets of meetings, financial and operational: The SLA Finance Group oversees overall financial arrangements, including agreeing costs, variations and exclusions, managing financial risks between both organisations, taking account of West of Scotland Regional Planning arrangements as well as monitoring financial and activity performance. The SLA Operational Review Group reviews and monitors the operational delivery of services against the SLA as well as issues and progress against action achieved. There is also an emphasis on ensuring equitable access for Argyll and Bute patients to NHS GG&C services by having these formal arrangements. Service redesign are managed and lead through the CHP planning managers with consultant outreach services (specialist clinics delivered in Argyll and Bute) being the most frequent issue. Discussions are taking place with NHS Highland regarding the implementation of the Patient Management System (PMS) and the specific issues for the CHP in relation to patient flows predominantly being to NHS Greater Glasgow & Clyde. There are ongoing discussions to clarify laboratory governance following changes to the NHS GG&C laboratory management structures.

  • 14

    11. STAFF GOVERNANCE 11.1 Argyll & Bute CHP Partnership Forum Draft Minute - 23 August 2012 The draft minute was previously circulated for information. The Committee: • Noted the contents of the Argyll & Bute CHP Partnership Forum Draft Minute of

    23 August 2012 11.2 PDP/R and eKSF Implementation Mr Logue reported that at end September 2012 the CHP recorded 10.86% of reviews completed for all AfC staff (14.82% excluding Bank staff). Concerted efforts are being made in all areas to achieve the target of an 80% completion rate by end March 2013. Derek advised that he has received assurances from Managers that review dates for staff have been set which will result in an improved completion rate to ensure the target is met. 12. PARTNERSHIP WORKING 12.1 Argyll & Bute CHP Public Partnership Forum Dra ft Notes – 28 August 2012 The draft note was previously circulated for information. The Committee: • Noted the contents of the Argyll & Bute CHP Public Partnership Forum Draft Notes of

    28 August 2012 13. PERFORMANCE MANAGEMENT 13.1 Delayed Discharge/Joint Performance Report Mr Leslie reported on the monthly census which indicated 1 case >6 weeks, with an exemption code due to the complexity of the case. Delayed discharge performance is a key priority in partnership working which is positively reflected in the reporting of only 2 delayed discharges breaching targets over a considerable number of months. It was agreed that the Joint Performance Report will be included in future Committee papers. The Committee: • Noted the contents of the Delayed Discharge Report.

    The Committee: Noted the content of the PDP/R and eKSF Implementation 2012/13 Report

  • 15

    15. Papers for Noting 15.1 CEL 27 (2012) - AHPs as Agents of Change in He alth & Social Care – The National Delivery Plan for the Allied Health Profe ssions in Scotland, 2012–2015 15.2 Proposed CHP Committee Dates 2013 The Committee: • Noted content of the above papers. 16 AOCB There was no other competent business highlighted. 17 DATE, TIME & VENUE FOR NEXT MEETING: Wednesday 19 December 2012 at 10.30am in Queens Hal l, Dunoon

  • Argyll & Bute CHP CommitteeDate of Meeting : 19 December 2012

    Agenda item : 6.2

  • Argyll & Bute CHP CommitteeDate of Meeting : 19 December 2012

    Agenda item : 6.2

  • Argyll & Bute CHP CommitteeDate of Meeting : 19 December 2012

    Agenda item : 6.2

  • Argyll & Bute CHP CommitteeDate of Meeting : 19 December 2012

    Agenda item : 6.2

  • Argyll & Bute CHP CommitteeDate of Meeting : 19 December 2012

    Agenda item : 6.2

  • Argyll & Bute CHP CommitteeDate of Meeting : 19 December 2012

    Agenda item : 6.2

  • Argyll & Bute CHP CommitteeDate of Meeting : 19 December 2012

    Agenda item : 6.2

  • Argyll & Bute CHP Committee Date of Meeting : 19 December 2012

    Agenda item : 7.1

    Argyll and Bute CHP Clinical Governance and Risk Ma nagement Report Report by Pat Tyrrell, Lead Nurse and Fiona Campbel l, Clinical Governance Manager

    The CHP Committee is asked to:

    • Note the contents of the Clinical Governance and Risk Management Report.

    1. CONTRIBUTION TO THE BOARD’S CORPORATE OBJECTIVES NHS Highland’s mission is to provide patient-centred services tailored to people’s needs in a systematic and consistent way – to provide quality care to every person every day. The Board approach embraces the Healthcare Quality Strategy for Scotland and also takes account of the priorities within the NHSScotland Efficiency and Productivity Framework for SR10. NHS Highland vision is to:

    • Provide quality care at all times; • Support people and communities to maximise their own health; • Develop precisions driven services so that when people need our care they

    experience timely, focussed, effective services that minimise the duration and frequency of contact;

    • Ensure that every health pound spent delivers maximum health gain.

    2. RISK MANAGEMENT 2.1 Incidents The following information relates to incidents reported in Quarter 2, the period from July to September 2012

  • 2

    FIGURE 1 Argyll and Bute Incidents Last 13 months

    A total of 442 incidents were reported during Quarter 2 of 2012/12.

    • Cowal & Bute 100 (22.62%) • Helensburgh 13 (2.94%) • Mid Argyll & Kintyre 219 (49.54%) • Oban Lorn & Isles 99 (22.40%) • Outwith NHS Highland 11 (2.49%) (patients transferred in)

    FIGURE 2 Category by Locality

    In the last financial quarter slips trips and falls remained the highest reported category of incidents for Argyll & Bute – this was the case across Cowal & Bute, Mid Argyll & Kintyre and Oban, Lorn & Isles. For Helensburgh medication (2) and sharps (2) incidents were the highest category of incidents.

  • 3

    FIGURE 3 Grade of Incidents by Locality

    During Quarter 2 of 2012/13 the incidents reported in Argyll & Bute were graded as follows:

    • Low – 242 (54.75%) • Medium – 165 (37.33%)

    The remaining incidents were still to be graded. FIGURE 4 Incidents with a Major or Extreme Consequ ence

    There were no major or extreme incidents reported in July, August or September 2012. Note: this figure could change as some incidents are still being reviewed.

  • 4

    FIGURE 5: INCIDENTS BY LOCALITY WITH OUTCOME

    Overall outcome for Argyll & Bute in Quarter 2:

    • No injury / harm – 248 (56.1%) • Near miss – 44 (9.95%) • Injury / harm – 138 (31.22%) • Death – 0 • Property damage – 12 (2.71%)

    2.1.2 Pressure Ulcer Prevention

    Implementation of NHS Highland Zero Tolerance approach to preventable pressure ulcers continues with a range of measures being taken to improve the identification and management of those patients at risk of developing pressure ulcers in all settings. The following graphs highlight trends from April 2011 until October 2012. FIGURE 6 Rate of Pressure Ulcers developed in hospi tal per 1000 Occupied Bed

    Days for Argyll and Bute

  • 5

    Figure 7: Numbers and Rates of Hospital Acquired Pr essure Ulcers Grade 1 – NHS Highland

    Figure 8: Numbers and Rates of Hospital Acquired Pr essure Ulcers Grade 2– NHS Highland

    Figure 9: Numbers and Rates of Hospital Acquired Pr essure Ulcers Grade 3– NHS Highland

    Numbers of Grade 1 Hospital Acquired Pressure Ulcers August 11 0.41

    September 14 0.53

    October 12 0.44

    Numbers of Grade 2 Hospital Acquired Pressure Ulcers August 23 0.85

    September 32 1.20

    October 21 0.77

    Numbers of Grade 3 Hospital Acquired Pressure Ulcers August 2 0.07

    September 0 0.00

    October 2 0.07

  • 6

    Figure 10: Numbers and Rates of Hospital Acquired P ressure Ulcers Grade 4– NHS Highland

    While the overall number of pressure ulcers being reported across NHS Highland remains reasonably static, there is a much higher number of Grades 1 and 2 being reported. This can be attributed to increased awareness and improved risk assessment which is leading to earlier identification of tissue damage. Early identification enables preventative actions to be taken to avoid further damage which can lead to more serious Grade 3 and 4 ulcers developing. The overall number of Grade 3 and 4 pressure ulcers developing within hospitals is very low across NHS Highland. Each of the Grade 3 and 4 pressure ulcers identified is subjected to increased scrutiny to ensure that all actions are taken to a) heal the ulcer and b) learn lessons to prevent future similar occurrences where at all possible. TABLE 1 Rate of Pressure Ulcers per 1000 Occupied B ed Days and Pressure

    Ulcer CQI Compliance Scores for each in patient wa rd from MAY 2012.

    MAY JUNE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER Rate

    per 1000 OBDs

    CQI % Rate per 1000 OBDs

    CQI %

    Rate per 1000 OBDs

    CQI Rate

    Rate per 1000 OBDs

    CQI Rate

    Rate per 1000 OBDs

    CQI %

    Rate per 1000 OBDs

    CQI %

    Rate per 1000 OBDs

    CQI %

    COWAL AND BUTE Victoria Hospital

    0 95 0 100 0 95 6 97 0 100 0 95 0 100

    CCH Ward 1 0 100 0 0 0 0 0 100 6 96 CCH Ward 2 6 100 0

    100 0

    97.5 0

    97 0

    98 0 0

    MID ARGYLL, KINTYRE AND ISLAY Glenaray 4 95 0 100 4 95 5 63 0 95 0 100 0 95 Glassary 0 100 0 0 0 0 0 100 0 100 Cara 0 100 0 0 0 0 0 0 Knapdale 0 100 0

    100

    0

    100

    0

    100

    0

    100

    0 0 Campbeltown 5 97.5 2 95 0 100 2 97 0 NR 0 97 4 95 Islay 0 100 0 90 0 85 20 95 0 90 0 90 0 90 OBAN, LORN AND ISLES Ward A 0 100 0 90 0 100 4 95 0 95 0 100 0 100 Ward B 3 95 0 95 0 97 5 97 0 100 0 100 8 98 Ward I 0 100 2 100 0 100 0 100 0 100 0 100 0 100 Dunaros 0 93 0 100 0 nr 0 96 0 95 0 N/R 0 N/R

    Numbers of Grade 4 Hospital Acquired Pressure Ulcers August 0 0.00

    September 1 0.04

    October 0 0.00

  • 7

    2.1.3 Falls Prevention The graph below illustrates trends across NHS Highland. FIGURE 11 Monthly Rate of Falls per 1000 OBDs in NH S Highland since January

    2011

    FIGURE 12: Reported Falls WITH Harm per 1000 Occupi ed Bed Days, September 2012 across Highland Hospitals

  • 8

    TABLE 2 Rate of Falls with Harm per 1000 Occupied B ed Days and Falls Prevention CQI Compliance Scores for each in patien t ward from MAY 2012.

    MAY JUNE JULY AUGUST SPETEMBER OCTOBER NOVEMBER Rate

    per 1000 OBDs

    CQI %

    Rate per 1000 OBDs

    CQI % Rate per 1000 OBDs

    CQI Rate

    Rate per 1000 OBDs

    CQI Rate

    Rate per 1000 OBDs

    CQI Rate

    Rate per 1000 OBDs

    CQI %

    Rate per 1000 OBDs

    CQI %

    COWAL AND BUTE Victoria Hospital

    0 93 2.97 100 3 98 3 97 6 100 7 100 0 100

    CCH Ward 1 0 95 0 0 6 0 0 96 6 98 CCH Ward 2 0 95 3.22

    100 3

    100 0

    100 0

    100 0 0

    MID ARGYLL, KINTYRE AND ISLAY Glenaray 0 97 4.10 100 4 100 5 100 0 100 0 100 15 100 Glassary 6 100 6.67 34 0 0 0 100 10 100 Cara 0 100 0 0 0 8 8 0 Knapdale 8 100 0

    100

    4

    100

    4

    100

    0

    100

    0 4 Campbeltown 3 97 2.80 nr 0 96 3 NR 0 NR 0 100 0 94 Islay 0 95 0 95 0 83 0 52 13 NR 14 87 7 90 OBAN, LORN AND ISLES Ward A 0 100 6.67 96 0 100 0 97 4 96 5 96 4 97 Ward B 0 100 0 97 0 100 0 100 0 NR 0 100 0 98 Ward I 4 100 2.43 100 5 100 6 100 17 100 16 100 4 100 Dunaros 14 100 0 96 6 96 0 100 0 100 0 N/R 0 N/R

    Wards with higher percentage of frail, older people, especially with cognitive impairment generally have higher rates of falls. In Argyll and Bute this can include all of the Community Hospitals as well as Ward I in Lorn and Islands Hospital, Oban. The work that is underway to implement the standards for Older People in Acute Care (OPAC), which also includes Dementia Standards, includes assessments of the environment within hospitals to make areas more accessible and easy to navigate for people with cognitive impairment. FIGURE 13 RIDDOR Reportable Incidents

  • 9

    There were 2 RIDDOR reportable incidents for Argyll & Bute:

    • 1 staff accident – hit by a moving object. • 1 fall by a member of the public, sprained wrist

    2.2 Serious Untoward Incidents A serious untoward incident is a situation in which staff, or one or more patients are involved in an event which is likely to produce significant clinical, legal, media or other interest. If not managed effectively it may result in the loss of life or the loss of organisation's assets or reputation. There have been three such events in Argyll and Bute since September 2012, each of which has been investigated under the NHS Highland Serious Untoward Events policy. Immediate actions were taken where necessary to address issues of concern; full reports into these incidents with all key learning will be addressed through the CHP Clinical Governance and Risk Management Group, as well as through NHS Highland Clinical Governance Committee. 2.3 Risk Register Development Development work is being undertaken to make the management of Risk Registers within the CHP more robust. Guidance is being developed to refresh existing approaches; to make processes more dynamic and to strengthen processes for transfer of risks to the appropriate level within the CHP. Development proposals will be presented at the next CHP CGRM Group to be held in January 2013. 3 COMPLAINTS TABLE 3 Argyll and Bute Complaint Performance repo rt

    Target Amber Red Aug-12 Sep-12 Oct-12 Number of complaints

    received 4 5 ~ 6 7 and over 7 3 4 Achievement against 20 day 80% 70 - 79% Under 69% 0% 0% 0% Number of complaints over 40 working days old * 0 ~ 1 or more 0 1 2 Number of further correspondence over 20 working days old * 0 ~ 1 or more 0 0 0 Number of complaints categorised as high risk 1 2 3 and over 2 1 2 Two complaints related to services in Argyll and Bute have been referred by the complainants to the Ombudsman. One relates to palliative care in Cowal Community Hospital and the other to A&E services in Victoria Hospital, Rothesay. Information in relation to both cases has been provided to the Ombudsman and the outcomes of the reviews are awaited.

  • 10

    4. EXTERNAL REVIEWS 4.1 Inspection of Children’s Services in Argyll and Bute Notification has been received from the Care Inspectorate of the proposed inspection of Children’s Services in Argyll and Bute, due to commence in March 2013. Argyll and Bute is one of four partnerships in Scotland in which the new inspection regime will be piloted. Rather than focussing specifically on Child Protection the inspection will review outcomes for all children and young people to provide assurances of the quality of services, particularly for vulnerable children and young people. This new scrutiny model will be Partnership-orientated and will focus on outcomes for those who use our services. The inspection is intended to be transparent, intelligence-led and risk-based, integrated and coordinated and supporting improvement. The multi disciplinary and multi agency inspection team will review the self evaluation and evidence as well as sample case records; in addition they will spend 13 days on site during March and April 2013. The inspection will focus on well we are working together to provide services to improve the lives of children and young people against 22 quality indicators. The public report will be published within four weeks of the inspection and will record findings in relation to:

    o How well are the lives of children, young people and their families improving? o How well do services work together to improve the lives of children and

    families? o How well do services lead and improve the quality of work and achieve better

    outcomes for children and families? 5. Quality 5.1 Person Centred Care Led by the Scottish Government the national launch of the Scottish Person Centred Care Programme took place over two days at the SECC in Glasgow at the end of November. This programme, covering health and social care, will focus on the following key elements which include:

    - care experience - staff experience - co-production

    All Boards in Scotland are expected to implement the requirements of this programme to ensure that progress is made across health and social care to deliver person centred services and care. Heidi May, Board Nurse Director, is the NHS Highland Executive Lead for this work.

  • 11

    5.2 Standards for Older People in Acute Care (OPAC) All hospitals in Argyll and Bute are working to implement these standards, many of which also support the delivery of person centred care. Inspection of progress by the HEI will focus on Raigmore Hospital in the first instance. However it is critical that we ensure that all patients receiving care in hospital are assured of the same standards and quality of services. 5.3 Scottish Patient Safety Programme (SPSP) Progress in Lorn and Islands Hospital in relation to SPSP is highlighted in the dashboard included in Appendix One. Most actions are now embedded in practice and the improvements sustained; these are measured through ongoing audit programmes within the hospital. The most challenging area continues to be medicines management and work is ongoing to identify and develop the actions that will deliver the required improvements. Since the programme began five years ago Lorn and Islands Hospital has seen a 24% reduction in Hospital Standardised Mortality Rates; this improvement has exceeded the national target of 15%. Some of the appropriate care bundles have already been spread to the Community Hospitals. These include best practice is use of Peripheral and Central Venous Catheters, use of the SBAR communication tool and Safety Briefings. Plans are now being developed to support use of improvement methodology and measurement tools to ensure that improvements are being measured and more consistent approaches are taken to sustaining improvement. Two of the Practice Development Nurses, Alison Guest and Liz Higgins, have commenced training in Improvement Science in Action with the national programme; in addition, Veronica Kennedy, Acting Locality Manager in Oban, Lorn and Isles has been accredited as an Improvement Advisor with Institute for Healthcare Improvement. This will provide us with improved leadership and capacity within Argyll and Bute to support the development of the skills and knowledge of clinical staff in application of the evidence based tools to improve quality and safety of care. 6. HEALTH AND SAFETY 6.1 Monitoring Implementation of the Managing Skin at Work Procedure Following an investigation by the HSE into a number of dermatitis cases an improvement notice was issued to the Board. As a result, amendments to the skin health surveillance programme for staff involved in wet work were made. NHSH Health and Safety Committee has set an implementation date of the end of February 2013. Health and Safety Managers have undertaken a review which indicates that some areas have fully implemented the new procedures and all areas are making progress towards implementation. Implementation will continue to be supported and monitored to ensure full implementation in advance of the target date set.

  • 12

    6.2 Stress in the Workplace All areas have undertaken a staff stress survey. To consider the results and develop an action plan Focus Groups will take place in each area. All areas have nominated and trained a focus group facilitator and some areas have held their focus groups and developed action plans. The target date for all areas to have action plans in place to address stress in the workplace is the end of March 2013. Health and Safety Managers will continue to monitor progress. 7. FIRE SAFETY 7.1 Fire Risk Assessments Fire risk assessments using the 3i system continue to progress. Garelochhead; Kilcreggan; Campbeltown and Islay are complete. Lorn and Islands Hospital risk assessment has been carried out, the process of uploading information to 3i data base is underway and will be issued to managers in January 2013. 7.2 Compartmentation Survey Funding has been allocated and compartmentation work to be undertaken is being prioritised. Sub-compartmentation of wards is a key priority. Funding has also been allocated to update fire alarm systems to L1 standard in Dunoon and Oban and this work has been scheduled. 7.3 Unwanted Fire Alarm Signals The requirement for a full investigation screen to be completed within Datix for all alarm activations means the cause of the unwanted fire alarm signal is identified and actions identified to prevent recurrence. Analysing incidents and identifying preventative actions continues to have a positive effect on reducing unwanted fire alarm signals 7.4 Fire Extinguisher Training for Kitchen Staff Risk assessment has highlighted the need for additional fire extinguisher training for kitchen staff. Training has been developed and is now in the process of being delivered to all kitchen staff.

  • - 13 -

    Appendix One LIH SPSP Dashboard October 2012

  • Argyll & Bute CHP Committee Date of Meeting: 19 December 2012

    Item No: 7.2

    INFECTION CONTROL REPORT Report by Pat Tyrrell, Lead Nurse The CHP Committee is asked to: • Note the contents of the report.

    1 Aim The purpose of this paper is to update CHP Committee members of the current status of Healthcare Associated Infections (HAI) and infection control measures in Argyll and Bute CHP and NHS Highland.

    2 Background In line with the NHS Scotland HAI Action Plan 2008, there is a requirement for a HAI report to be presented to the Board on a two monthly basis. 3 Scaling factor used in reporting incidence rates To ensure consistency with wider UK and ECDC reporting, and in light of decreases in the observed rates, Health Protection Scotland have changed the scaling factor used in reporting incidence rates to ‘per 100 000 bed days’ instead of the previously used ‘per 1000 bed days’. It should be noted that NHS Highland figures for Staphylococcus aureus bacteraemia (SAB) and Clostridium difficile are provisional until validated by HPS on a quarte rly basis. 4 Summary

    This report provides an overview for the Board of Infection Prevention and Control with particular reference to the incidence of Healthcare Associated Infections (HAI) against Scottish Government HEAT targets, together with results from cleanliness monitoring, hand hygiene audit results and surgical site infections.

    Group Target NHS Scotland

    NHS Highland

    Clostridium difficile

    Age 65 and over

    39.0 (100,000 OBDs)

    30.8 For period April – June 12

    32.8 For period April – June 12

    Green

    Staphylococcus aureus bacteraemia

    Age 15 and over

    26.0 (100,000) OBDs

    30.2 For period April – June 12

    30.2 For period April – June 12. Annual rate is 23.39 which means that the Board is still on track to meet the

    Amber

  • 2

    HEAT Target

    Hand Hygiene 95% %

    98% Green

    Cleaning 90%

    %

    96% Green

    Antibacterial prescribing

    Hospital-based Empiric prescribing

    Compliant Yes Green

    Surgical antibiotic prophylaxis

    Compliant Yes Green

    Primary Care empirical prescribing

    Compliant Yes Green

    Source: - Health Protection Scotland/ISD/Local data.

    5 Contribution to Board Objectives Our key objective is “to reduce to an absolute minimum the chance of acquiring an infection whilst receiving healthcare and to ensure our hospitals are clean”. This report presents a comprehensive view of HAI data and activities for scrutiny and feedback from the CHP Committee. 5 Governance Implications 6.1 Staff Governance

    As additional information is distributed more widely it should ensure staff are better informed in respect of current issues relating to Infection Prevention & Control and the management of HAI in our healthcare premises - “Infection Prevention is Everybody’s Business”.

    6.2 Patient and Public Involvement

    The distribution of regular information to the patient/public sector should increase awareness and facilitate increased participation of patient/public representatives in the Infection Prevention & Control agenda.

    6.3 Clinical Governance

    By improving infection prevention & control practices, we will endeavour to provide a healthcare environment for patients that minimises the risk of HAI.

    6.4 Financial Impact

    By reducing the incidence of HAI in our healthcare premises, financial savings can be achieved through lower rates of infection.

    6.5 Better Health, Better Care, Better Value

    By improving infection prevention & control practices, we will endeavour to provide a healthcare environment for patients that minimises the risk of HAI.

  • 3

    7 Risk Assessment By risk assessing infection prevention & control practices, we will endeavour to minimise the risk of HAI. 8 Planning for Fairness As Infection Control policies are updated they are impact-assessed for equality and diversity. 9 Communications and Engagement Work is ongoing around raising awareness with staff to make sure they consistently apply the principles of Standard Infection Control Precautions. Hand hygiene is the single most important procedure for preventing cross infection, as hands are of special significance in the transmission of infections. All Health Boards are required to demonstrate, every two months, a minimum of 95% compliance with the five moments and technique for hand hygiene. A Hand hygiene module is now available online. The module is mandatory for all staff. There are two public representatives on Argyll and Bute CHP Infection Control Group. In addition regular Infection Control reports are presented to the PPF at CHP and locality levels.

  • 4

    Argyll and Bute CHP Healthcare Associated Infection Report –

    December 2012

    Section 1 – NHS Highland Board Wide and Argyll and Bute Issues

    Staphylococcus aureus (including MRSA)

    National Context

    With effect from April 2011, all Boards are expected to achieve a rate of 26 Staphylococcus aureus bacteraemia (SAB) cases per 100,00 bed days (0.26 per 1000 acute occupied bed days) or lower by year ending March 2013. For NHS Highland that means no more than 73 cases. National data published by Health Protection Scotland identifies that NHS Scotland Staphylococcus aureus bacteraemia rate April - June 2012 was 30.2 per 100,000 acute occupied bed days (AOBDs). NHS Highland’s rate was also 30.2 per 100,000 AOBDs (19 SABs), 3 MRSA and 16 MSSA, (5 True Community, 3 Contaminated blood cultures and 11 acquired in the community or hospital, mainly due to invasive devices). This is an increase on the previous quarters, (January – March 2012 there were 15 SABs, October – December 16 SABs). Each SAB is reviewed in Microbiology and if it is felt that the SAB could have been avoided or prevented, then a clinical review meeting is held with the relevant clinical team which is responsible for ensuring that learning outcomes are disseminated to staff and that processes are in place to monitor practice. July - September 2012 (unvalidated data) there were 8 SABs, all MSSA, (1 True Community and 7 acquired in community or hospital) The annual rate (invalidated) for NHS Highland, October 2011 – September 2012 is 23.39 per 100, 000 AOBDs ( National target March 2013, 26 per 100,000 AOBDs)

    Staphylococcus aureus is an organism which is responsible for a large number of healthcare associated infections, although it can also cause infections in people who have not had any recent contact with the healthcare system. The most common form of this is Meticillin Sensitive Staphylococcus Aureus (MSSA), but the more well known is MRSA (Meticillin Resistant Staphylococcus Aureus), which is a specific type of the organism which is resistant to certain antibiotics and is therefore more difficult to treat. More information on these organisms can be found at:

    Staphylococcus aureus :

    http://www.nhs24.com/content/default.asp?page=s5_4&articleID=346

    MRSA: http://www.nhs24.com/content/default.asp?page=s5_4&articleID=252

    NHS Boards carry out surveillance of Staphylococcus aureus blood stream infections, known as bacteraemias. These are a serious form of infection and there is a national target to reduce them. The number of patients with MSSA and MRSA bacteraemias for the Board can be found at the end of Section 1 and for each hospital in Section 2. Information on the national surveillance programme for Staphylococcus aureus bacteraemias can be found at:

    http://www.hps.scot.nhs.uk/haiic/sshaip/publicationsdetail.aspx?id=30248

  • 5

    MRSA Screening NHS Boards are required to ensure MRSA screening becomes part of their local integrated approach to improving the quality of person centred, safe and effective patient care. All Boards have received the final tranche of non recurring funding. Work is ongoing to minimise the financial risk when this funding ends. NHS Highland is one of 7 Boards taking part in a pilot to test the audit tool which will measure compliance with MRSA screening. A report will be submitted to the Board in six months time. Figure 1 shows year on year Cumulative SAB numbers in NHS Highland

    TABLE 1 shows the cumulative totals for SAB within Argyll and Bute CHP for the years since 2009-2010: Hospitals 09/10 10/11 11/12 12/13 Lorn and Islands, Oban 8 3 0 5 Victoria Hospital, Rothesay 1 1 0 0 Mid Argyll Hospital, Lochgilphead 0 1 0 0 Argyll & Bute Hospital, Lochgilphead 0 0 0 0 Campbeltown Hospital 0 0 0 0 Dunaros, Mull 0 0 0 0 Islay Hospital, Bowmore 0 0 0 0 Cowal Community Hospital, Dunoon 0 0 0 0 There has been one further community acquired SAB case attributed to LIH, Oban since the last CHP Committee report in Argyll and Bute. This case has been subjected to enhanced surveillance and was not HAI related. This total of five cases for LIH in 2012-2013 all appear to have been community acquired, two of which may have been healthcare associated. Each case has been subject to microbiology review; there does not appear to have been anything to have prevented these cases.

  • 6

    Clostridium difficile

    Clostridium difficile Infection (CDI)

    With effect from April 2011, all Boards are expected to achieve a rate of 39 cases of Clostridium difficile per 100,000 total occupied bed days (OCBDs), (0.39 cases per 1000 total occupied bed days) or lower among patients aged 65 and over by year ending March 2013. For NHS Highland that means no more than 86 cases.

    National data published by Health Protection Scotland (HPS) identifies that the overall Clostridium difficile infection (CDI) rate for NHS Scotland during the period April – June 2012 in patients aged 65 and over was 30.8 cases per 100,000 total occupied bed days (OBDs). NHS Highland’s rate for the same period was 32.8 cases per 100,000 OCBDs. The annual rate (unvalidated) for NHS Highland, October 2011 – September 2012 is 32.15 cases per 100,000 bed days (National target March 2013, 39 cases per 100,000 OCBDs) which means the Board is on track to meet the National HEAT Target.

    Figure 2 Cumulative Clostridium difficile positive episodes in NHS Highland Patients aged 65 and over

    Clostridium difficile is an organism which is responsible for a large number of healthcare associated infections, although it can also cause infections in people who have not had any recent contact with the healthcare system. More information can be found at:

    http://www.nhs.uk/conditions/Clostridium-difficile/Pages/Introduction.aspx

    NHS Boards carry out surveillance of Clostridium difficile infections (CDI), and there is a national target to reduce these. The number of patients with CDI for the Board can be found at the end of Section 1 and for each hospital within the CHP in Section 2. Information on the national surveillance programme for Clostridium difficile infections can be found at:

    http://www.hps.scot.nhs.uk/haiic/sshaip/ssdetail.aspx?id=277

  • 7

    Initiatives to reduce CDI Cases

    • Continued promotion of good hand hygiene across all staff groups and general public including the introduction of mandatory, on line training module for multidisciplinary staff.

    • An action plan is being worked through to improve the use of proton pump inhibitors • A review of the Antimicrobial Prescribing Guidance in the management of infection • Briefing sessions, facilitated by Microbiology Consultants from NHS GGC are being

    held at locality level for medical staff • Ensuring plans are in place to maintain the fabric of the clinical areas.

    Enhanced surveillance is carried out on every CDI case with immediate feedback to staff concerned. Surveillance includes 30-day follow up from diagnosis TABLE 2 shows the cumulative CD Toxin Positive Case s in each CHP Hospital for the years since 2009-2012

    Hospitals 09/10 10/11 11/12 12/13

    Lorn and Islands Hospital, Oban 0 1 2 1

    Cowal Community Hospital, Dunoon 3 1 2 2

    Victoria Hospital, Rothesay 3 0 1 0

    Dunaros, Mull 0 1 0 0

    Argyll & Bute Hospital, Lochgilphead 0 0 0 0

    Mid Argyll Hospital, Lochgilphead 0 0 1 0

    Campbeltown Hospital 0 0 1 1

    Islay Hospital, Bowmore 0 0 0 0 TABLE 3 shows the cumulative CD Toxin Positive Case s in community for the years since 2009-2012

    09/10 10/11 11/12 12/13

    North CHP 10 1 5 1

    Mid CHP 16 14 6 5

    South East CHP 19 11 12 4

    Argyll & Bute CHP 2 4 2 2

    6

  • 8

    Anti Microbial Prescribing National Report on Primary Care Antibiotic Prescribing Indicators Primary care prescribers across Highland continue to have low rates of antibiotic prescribing. Preferred antibiotics now account for more than 80% of prescriptions with the 4C’s antibiotic use falling from 19.9% in 2007/8 to 10.4% in 2011/12. NHS Highland is one of only two Boards in Scotland to achieve the prescribing indicator for reduced seasonal variation in prescribing of quinolone antibiotics. Prescribers in primary care have acted upon the best practice messages regularly provided by the Antimicrobial Management Team in conjunction with the GP sub-committee and the primary care prescribing advisors. Table 4 shows NHS Highland progress against the 3 national indicators. Antimicrobial Indicator NHS Highland progress

    Hospital-based empirical prescribing In acute admission areas, antibiotic prescriptions are compliant with the local antimicrobial policy and the rationale for treatment is recorded in the clinical case note in above 95% of sampled cases.

    Compliant Two areas are monitored, as required, in Raigmore Hospital. Acute Medical Admissions Unit and Surgical Admissions Ward (4A), data for August and September shows compliance with guidelines above the target of 95%.

    Surgical antibiotic prophylaxis Duration of surgical antibiotic prophylaxis is less than 24 hours and compliant with local antimicrobial prescribing policy in above 95% of sampled elective colorectal surgical cases.

    Compliant. Data to the end of July 2012 shows continuing compliance above 95% with antibiotic choice and duration of prophylaxis. Further data collection is currently being undertaken. Data collection for urological surgery commenced in November 2012.

    Primary care empirical prescribing Seasonal variation in Quinolone use (summer months vs. winter months) is less than 5%.

    Compliant. Data to the end of March 2012 indicates continuing compliance with this measure. NHS Highland is one of only two Boards in Scotland to demonstrate compliance with this quality indicator for every year since it was first measured in 2008/09.

  • 9

    Hand Hygiene

    NHS Highland Hand Hygiene Rolling Monthly Audit Programme continues across all clinical areas sustaining an average of 98% compliance for September and October 2012. Non compliance with hand hygiene requirements is unacceptable and all staff must comply with the NHS Highland Hand Hygiene Policy. Hand hygiene audits are undertaken monthly by all clinical areas and the results are displayed. Hand hygiene training is provided across NHS Highland and is also available via E-learning on LearnPro NHS, the uptake of which has been steadily increasing since its launch. All areas in Argyll and Bute continue to demonstrate compliance with the standards- the results for each hospital are included within the charts in section 2 of the report. Cleaning and the Healthcare Environment

    Domestic Service teams continue to carry out monthly cleaning and estates audits as per NHS Scotland National Cleaning Services Specification. Compliance with cleaning and estates across NHS Highland was 96% in September and October 2012.

    The new National Electronic Domestic Monitoring tool is currently being rolled out across Scotland. This tool is based on the National Monitoring Specification which determines the frequency of monitoring according to the national codes and applies dates for completion against the various areas to be monitored. There are still some anomalies in the system which are being worked on to ensure that it is fit for purpose in Highland where areas in all hospitals are monitored each month to ensure that deviations from compliance can be rectified and standards maintained.

    Good hand hygiene by staff, patients and visitors is a key way to prevent the spread of infections. More information on the importance of good hand hygiene can be found at:

    http://www.washyourhandsofthem.com/

    NHS Boards monitor hand hygiene and ensure a zero tolerance approach to non compliance. The hand hygiene compliance score for the Board can be found at the end of section 1 and for each hospital and community hospitals within each CHP in section 2. Information on national hand hygiene monitoring can be found at:

    http://www.hps.scot.nhs.uk/haiic/ic/nationalhandhygienecampaign.aspx

    Keeping the healthcare environment clean is essential to prevent the spread of infections. NHS Boards monitor the cleanliness of hospitals and there is a national target to maintain compliance with standards above 90%. The cleaning compliance score for the Board can be found at the end of Section 1 and for each hospital and community hospitals within each CHP in Section 2. Information on national cleanliness compliance monitoring can be found at:

    http://www.hfs.scot.nhs.uk/online-services/publications/hai/

    Healthcare environment standards are also independently inspected by the Healthcare Environment Inspectorate. More details can be found at:

    http://www.nhshealthquality.org/nhsqis/6710.140.1366.html

  • 10

    Hand Hygiene results for Argyll and Bute Hospitals are highlighted in the charts in Section 2 of this report.

    Outbreaks/Incidents Norovirus Norovirus is prevalent in the community throughout Scotland. The outbreaks across Highland were recognised and brought under control quickly and effectively with all staff from ward to Board working in partnership. Staff in Lorn and Islands Hospital, Oban were commended on the prompt recognition and effective management of the outbreak. Key learning points have been shared with other areas. Strict infection control precautions are put in place which include restricting visiting to affected wards and asking people not to visit if they have had any vomiting or diarrhoea within the previous 48hrs. Staff movement into the affected wards is also restricted. These measures help to reduce the risk of infection spreading.

    Table 5 Norovirus outbreaks in NHS Highland

    October 2012, MacKinnon Memorial Hospital 5 Patients & 21 Staff

    October 2012, Ward 2A Raigmore Hospital 15 Patients & 13 Staff

    November 2012, Ward B Lorn & Islands

    Hospital

    4 Patients & 8 Staff

    Decontamination The Central Decontamination Unit is CE Certificated with the Medicines and Healthcare products Regulatory Agency (MHRA) which is subject to the successful application of ISO 13485:2003, Quality Management System – Medical Devices and satisfactory surveillance auditing. Following a successful bid at the Asset Management Group the washer disinfectors will be replaced in early 2013. An option appraisal paper on delivering compliant endoscope decontamination facilities for NHS Highland was submitted to the Senior Management Team for consideration and was approved. A plan has been developed to enable a compliant endoscope decontamination facility to open on the Raigmore site initially with a staged approach throughout 2013 for the peripheral sites. The Head of Decontamination is now responsible for the training, assessment and audit of staff undertaking endoscope decontamination as well as the de-cluttering and improvements in housekeeping and record keeping in all existing endoscope decontamination units. Compliance within the Independent Dental Practitioner setting will be monitored as per the recent Chief Dental Officer (CDO) letter. The CDO has written to all independent GDP with the offer of providing compliant washer disinfectors. A recent audit of GDPs was undertaken and over 80% of units were compliant.

  • 11

    A working group has been established to look at what needs to be done to enable all local decontamination in theatres to be halted by the end of 2014.

    Inspection

    HEI Inspections

    An unannounced HEI visit was undertaken in Caithness General Hospital on 3rd & 4th September 2012. They found the hospital clean and well maintained, with evidence of good compliance with sharps and linen management and the use of personal protective equipment (PPE), up-to-date audit and surveillance data was displayed on the wards and they saw staff washing their hands and using the hand gel available. The final report contained 3 requirements and 6 recommendations. Further unannounced inspection took place in Raigmore Hospital on November 21st 2012. Initial feedback from the inspection indicates that actions since the last visit are being taken forward and there have been notable improvements. Final report will be published in January 2013. Work across Argyll and Bute CHP continues to ensure that all HAI standards are implemented and sustained in all settings. Programme of visits to all hospitals by the Executive Lead for Infection Control in NHS Highland, Heidi May, is underway. Visit to Cowal Community Hospital in November was very positive; further visits to MACHICC, Lochgilphead and Campbeltown Hospital will take place on December 17th and 18th. Task force, chaired by Director of Operations, established to address key issues within Argyll and Bute Hospital. Action plan is in place and fortnightly monitoring meetings organised to ensure that timescales are being met. Infection Control nurses are delivering sessions for staff to prepare them for the inspection process and to share good practice across the CHP.

  • 12

    Healthcare Associated Infection Reporting Template (HAIRT) Section 2 – Healthcare Associated Infection Report Cards

    The following section is a series of ‘Report Cards’ which provide information on the number of cases of Staphylococcus aureus blood stream infections (also broken down into MSSA and MRSA) and Clostridium difficile infections. Hand hygiene and cleaning compliance completes the report card. This includes information for pan Highland, Lorn and Islands Hospital, Oban, Community Hospitals collectively for Argyll and Bute and NHS Highland out of hospital infections. The information in the report cards is provisional local data, and may differ from the national surveillance reports carried out by Health Protection Scotland and Health Facilities Scotland. The national reports are official statistics which undergo rigorous validation, which means final national figures may differ from those reported here. However, these reports aim to provide more detailed and up-to-date information on HAI activities at local level than is possible to provide through the national statistics. Understanding the Report Cards – Infection Case Num bers Clostridium difficile infections (CDI) and Staphylococcus aureus bacteraemia (SAB) cases are presented for each hospital, broken down by month and the community hospitals within each CHP. Staphylococcus aureus bacteraemia (SAB) cases are further broken down into Meticillin Sensitive Staphylococcus aureus (MSSA) and Meticillin Resistant Staphylococcus aureus (MRSA). Data is presented as both a graph and a table giving case numbers. More information on these organisms can be found on the NHS24 website: Clostridium difficile : http://www.nhs24.com/content/default.asp?page=s5_4& articleID=2139&sectionID=1 Staphylococcus aureus : http://www.nhs24.com/content/default.asp?page=s5_4&articleID=346 MRSA: http://www.nhs24.com/content/default.asp?page=s5_4&articleID=252&sectionID=1 For each acute hospital and community hospitals in the CHP, the total cases for each month are those which have been reported as positive from a laboratory report on samples taken more than 48 hours after admission. For the purposes of these reports, positive samples taken from patients within 48 hours of admission will be considered to be confirmation that the infection was contracted prior to hospital admission and will be shown in the “out-of-hospital” report card. Understanding the Report Cards – Hand Hygiene Compl iance Good hand hygiene is crucial for infection prevention and control. More information can be found from the Health Protection Scotland’s national hand hygiene campaign website: http://www.washyourhandsofthem.com/ Hospitals carry out regular audits of how well their staff are complying with hand hygiene. The first page of each hospital/CHP report card presents the percentage of hand hygiene compliance for all staff in both graph and table form.

  • 13

    Understanding the Report Cards – Cleaning Complianc e Hospitals strive to keep the care environment as clean as possible. This is monitored through cleaning compliance audits. More information on how hospitals carry out these audits can be found on the Health Facilities Scotland website: http://www.hfs.scot.nhs.uk/online-services/publications/hai/ The Report Cards show the hospitals’ cleaning compliance percentage in both graph and table form.

  • 14

  • 15

  • 16

  • 17

  • 18

  • 19

  • 20

  • 21

  • 22

  • 23

  • 24

    Abbreviations

    AMT Antimicrobial Prescribing Team

    AMAU Acute Medical Admissions Unit

    CHP Community Health Partnership

    CDI Clostridium difficile Infection

    CNO Chief Nursing Officer

    CVC Central Venous Catheter

    CSM Clinical Services Manager

    ECDC European Centre for Disease Prevention & Control

    GDP General Dental Practitioner

    HAI Healthcare Associated Infection

    HAIRT Healthcare Associated Infection Reporting Template

    HEAT Health Improvement, Efficiency, Access, Treatment

    HEI Healthcare Environment Inspectorate

    Hemi arthroplasty An operation used to treat fractured hip similar to a total hip replacement, but involves only half of the hip.

    ICU Intensive Care Unit

    JAG Joint Advisory Group

    MSSA Meticillin Sensitive Staphylococcus Aureus

    MRSA Meticillin Resistant Staphylococcus Aureus

    PICC Peripherally Inserted Central Catheter

    PPI Proton Pump Inhibitor

    PVC Peripheral Venous Catheter

    QUAD Quality Assurance Document

    RIDDOR Reporting of Injuries, Diseases and Dangerous Occupational Regulations 1995

    SAB Staphylococcus aureus Bacteraemia

    SCN Senior Charge Nurse

    SHPN Scottish Health Planning note

    SHTM 64 Scottish Health Technical Memoranda – Sanitary assemblies.

    SPC Statistical Process Chart

    SAPG Scottish Antimicrobial Prescribing Group

  • 25

    SICPs Standard Infection Control Precautions

    SPSP Scottish Patient Safety Programme

    VAP Ventilator Associated Pneumonia

    Staphylococcus Aureus Bacteraemia (SAB) criteria

    Contaminated blood culture

    • Staphylococcus aureus isolated from blood, and • SAB diagnosis incompatible with clinical picture, i.e. no or minimal

    clinical signs and symptoms indicating SAB.

    Hospital acquired infection

    • Staphylococcus aureus isolated from blood cultures taken 48 hours after admission or within 48 hours of discharge, and,

    • The presence of clinical signs and symptoms indicating SAB

    Community onset-healthcare associated infection

    • Staphylococcus aureus isolated from blood cultures taken

  • Argyll & Bute CHP Committee Date of meeting: 19 December 2012

    Item No : 8.1

    FINANCE REPORT REPORT BY GEORGE MORRISON The Committee is asked to: • Note the financial position at month 8 1. Argyll & Bute CHP - Financial Position at M