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St Wilfrid’s Hospice is a charity founded in 1982; its purpose is to provide palliative and end of life care to the population of Eastbourne and the surrounding area, a total of 235,000 people. The charity’s mission is ‘reaching out to transform end of life care’. Over 1,100 patients with life limiting illness and their families were supported by St Wilfrid’s in the past year. Patients are referred by their GP or healthcare practitioner with problems that may include uncontrolled pain, vomiting, breathlessness, fatigue, anxiety or low mood. They may also have practical or family concerns. The hospice seeks to offer a holistic service to meet clinical, psychosocial and spiritual need, using a multi-disciplinary team comprising consultants and specialty doctors in palliative medicine, specialist nurses, physiotherapists, occupational therapists, social workers and spiritual support workers. The staff team is enhanced by almost 600 volunteers who bring a wide range of practical and life skills. Services provided in the hospice and in the community include an inpatient unit, currently offering 15 short-stay beds; a 7-day a week Hospice at Home service; a team of clinical nurse specialists; a night sitting service; a 24/7 nurse-led advice and support helpline; a rehabilitative Wellbeing Centre; and a counselling and bereavement support service. Services were inspected by the Care Quality Commission in 2014 and were rated as outstanding. A brand new development is the establishment of St Wilfrid’s Care at Home, providing personal care in the home to patients in the last 12 weeks of life. These Quality Accounts were prepared by senior clinicians leading the patient safety, patient experience and clinical effectiveness work streams that make up the hospice’s clinical governance framework. They have been approved by the Clinical Governance Committee, a sub-committee of the St Wilfrid’s Board of Trustees. To the best of my knowledge, the information presented in this set of Quality Accounts is a fair and accurate representation of the care provided by St Wilfrid’s Eastbourne. David Scott-Ralphs Chief Executive

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St Wilfrid’s Hospice has declared itself compliant as part of the registration process with the Care Quality Commission (CQC) to comply with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In February 2015 the hospice was awarded a rating of outstanding by the Care Quality Commission following an unannounced inspection in August 2014.

Why a. We saw an increase in falls activity in 2016/17 compared to previous years b. We want to reduce harm caused by falls c. We want to demonstrate continuous quality improvement on safety

Implementation and measurement

d. Ensure our falls activity remains below the average number of falls documented for category C in the Hospice UK benchmarking for 2016/17

e. Review falls policy and procedure f. Form a falls working group g. Undertake as a minimum one audit against agreed standards to demonstrate our practice in

falls management

Why a. It is nationally recognised that there is under-representation for some hard to reach

communities in hospice care (eg homeless, LGBT) b. We do not confidently understand the impact of our service to these groups locally

Implementation and measurement

c. Develop a better understanding of who is accessing our service and relate it to what we know about the community of our part of East Sussex

d. Deliver education on equality and diversity to our workforce e. Seek opportunity to obtain feedback from harder to reach groups in our community f. Improve our recording of ethnicity on admission to our hospice services

Whya. To build on our developments over the past two years of the national Outcome Assessment

and Complexity Collaborative measures b. To consistently collect and report on high quality data on the patients we care for and start to

use it to guide future service development and augment services appropriately Implementation and measurement

a. Embed Views on Care in all clinical settings b. Review the process of collecting performance score (AKPS), phase of illness and integrated

palliative outcome score (IPOS) to ensure its effective use in day-to-day clinical practice c. Streamline reporting processes of outcome and complexity scores to ensure they remain

meaningful d. We will monitor activity of IPOS as a clinical key performance indicator (KPI)

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Why a. Our previous chaplain left at the end of September 2016 which created an opportunity for

review b. Stakeholder engagement has highlighted broad commitment to the provision of religious and

spiritual support but also that there is considerable scope for further development and improvement

Implementation and measurement

c. Recruitment to a new post holder with a revised job description whose task it will be to drive change forward, in collaboration with the wider team

d. We will agree a spiritual support philosophy and statement e. We will agree a plan for rollout of spiritual support f. We will increase the number of spiritual support assessments g. We will seek to demonstrate increase in patient and carer satisfaction with spiritual support

Why a. In 2016 the hospice saw significant changes in its structure largely due to the transfer in of the

community Clinical Nurse Specialist service from NHS employment b. Work was undertaken in 2016/17 as part of the organisation’s strategic objectives reviewing

clinical capacity and it was agreed that this work would inform further activity c. The hospice has a mission to reach more people at the end of life and needs to improve

access to its services

Implementation and measurement a. Undertake a review of the multidisciplinary team meetings in the hospice to ensure optimum

effectiveness b. Create a multidisciplinary forum to review the process of acceptance and triage of referrals

for hospice services c. Ensure as a minimum one audit against an agreed standard to demonstrate practice within

our referral process

We established a safer discharge working group led by the Inpatient Unit (IPU) Nurse Manager, comprising a multi-disciplinary membership. Each month this group identifies all patients who have stayed on the IPU for more than 22 days and further analyses the factors which may have contributed to this, and where learning and quality improvement may be realised.

The length of stay was scrutinised monthly. The end of year average length of stay was below the target set as a KPI for the year

There were no incidents relating to discharge reported through the hospice’s accident, incident and near miss procedure

We monitored the length of stay for Hospice at Home and the IPU throughout the year, as part of the clinical KPIs. These were discussed monthly at the Clinical Leaders Forum

The policy and procedure related to discharge was reviewed and revised during the reporting year

The IPU Nurse Manager and Nursing Director attended regular regional hospice meetings where discharge was discussed to compare and contrast St Wilfrid’s performance with other providers

Through networking different initiatives have been identified, piloted and changes to practice implemented to ensure a safer discharge from the IPU setting including: the introduction of a medication on discharge document; the introduction of a discharge information leaflet; a multi-disciplinary approach to patient goal setting with the introduction of white boards

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within patients’ rooms; changes to the discharge planning window and discharge letter on patients’ electronic records.

We successfully set up St Wilfrid’s Hospice as an organisation with its own domain for NHS mail

All clinical staff in roles that require it have an NHS mail account 86% of all staff for whose role it is necessary completed the Information Governance Toolkit

annual refresher, exceeding our target of 80%. We did not achieve read-only access of the local NHS community provider’s electronic patient

records. The provider was unable to progress this request due to competing priorities. We are currently working towards access to the local summary care record

We did not achieve access for the local NHS trust to the hospice’s electronic patient record. The partner NHS trust did not further request to view the hospice’s electronic patient record.

All managers had, as part of their Performance Development Review, one objective to

implement a People with Personal Experience (PPE) initiative We agreed a new definition of PPE beyond the traditional focus on patients and families, to

also include our customers, our public and our staff and volunteers. Clinical and non-clinical staff and volunteers ran twenty PPE initiatives across clinical and

non-clinical areas of service delivery, gaining broad stakeholder feedback. Examples include feedback regarding the delivery of spiritual care, the design of a new leaflet, a community volunteer project and our café. This informed service development in the respective areas.

Initiatives were informed by and mapped against strategic business priorities, our quality improvement priorities, Care Quality Commission lines of enquiry and themes emerging from complaints.

Staff were supported individually in their initiatives by the PPE governance lead, and through lunch time learning events.

Two ‘PPE celebration’ events, attended by staff and volunteers, were held to present work undertaken.

The implementation of the Integrated Palliative Care Outcome Scale (IPOS) was a KPI discussed monthly within the hospice’s Clinical Leaders Forum

In addition, the completion of IPOS was reported to the Board of Trustees bi-monthly We reported monthly on the percentage of all patients in receipt of care who had an initial

and follow up IPOS. The percentage remained low through the reporting year. Establishing improved practice will be led this reporting year with a new quality improvement priority

Activity for outcome measures was represented in a poster format shared with managers and their teams on a quarterly basis

A poster on an aspect of outcome measurement which looked at Views on Care was exhibited at the Hospice UK annual national conference in Liverpool

The following is a series of statements that all providers must include in their Quality Accounts. Not all of these statements are directly applicable to specialist palliative care, including hospice providers.

During 2016/17 St Wilfrid’s Hospice provided the following services:

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Inpatient care within our Inpatient Unit (IPU) with 308 total admissions, including 249 first-time admissions and 59 repeat admissions. Average length of stay was 14 days Day care services within Wellbeing supported 204 patients (135 new) Care to patients within their own home and usual place of residence, including care homes, through our Hospice at Home team supported 509 patients (404 new) The hospice Nurse Line service, providing 24/7 telephone advice and support to patients, their relatives and carers, and health professionals handled 10,765 contacts in 2016/17.

In addition the new Hospice Community Nurse Specialist service commenced in January 2017, supporting 274 patients (539 telephone calls (patients/carers), 280 visits and 45 outpatient appointments.

a. National audits and confidential enquiries b. Local clinical audits Over the past year the audit timetable and process was refined and audits have been undertaken by both clinical and non clinical members of staff. We have had two successful audit presentations and staff are working on action plans generated by discussion from these sessions. We will continue to encourage staff to take part in the audit cycle as part of their performance development review.

Discharge planning vs admission date and length of time starting the process

This audit was carried out by members of the Discharge Planning Working Group. It looked at the length of time it took to start thinking about discharge planning from admission. This is now planned for re-audit to gauge the effect of further awareness raising with the clinical team.

Integrated palliative care outcome score (IPOS): high scores and generation of a management plan

This audit was carried out in both clinical areas (Inpatient and Hospice at Home) and looked at IPOS problems which had a score of 3/4 and the correlation of a management plan being generated. The results showed that in all areas management plans were completed for the physical symptoms scoring 3/4 but not those for problems such as peace, family and friends’ anxiety, and information needs. Ongoing actions identified education for all staff to devise management plans for the topics identified. This will be led by a work project in the Registered Nurses undertaking their tenure level project. The IPOS will also be more in the forefront in the Multidisciplinary team discussions to help staff to identify patient needs.

Prevention, management and reporting of pressure ulcers within the IPU

This was based on a Hospice UK Audit tool, and has been part of the work done by the Pressure Ulcer Group. The ongoing work generated by this audit includes: development of a patient information leaflet, development of the Pressure Ulcer Policy and Procedure, to implement new pressure ulcer documentation in the clinical areas and to provide staff training in this area.

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TTA (to take away, ie discharge) prescribing, cost implication and wastage

This audit was generated as it was identified that TTA medication was being ordered several times for patients prior to discharge. It was identified that in 75% of discharges there was over ordering of medication. Ongoing work includes: the formation of a Task and Finish Group to look at making the ordering process smarter, the production of an ordering template for the TTAs and the provision of staff training on the use of the discharge planning window.

Care in the dying phase documentation Documentation changes required on Crosscare (electronic patient record), to produce a unified process for identifying how patients are commenced on the dying phase, to be linked to the forthcoming phase of illness work (part of the outcome and complexity measures).

Proprietary vs generic prescribing on medication charts Ongoing work in this area.

Medication times in relation to administration (ongoing audit cycle)

There has been a steady increase in our effectiveness of meeting the standard of medication being given within the hour of the prescribed time. The audit cycle is to continue.

Correct documentation of allergies and recording of patient details on medication charts (ongoing audit cycle)

This is a repeat audit to look at the documentation of allergies and NHS number on the medication chart. Ongoing work; admission process to be made smarter.

Controlled drugs audit Demonstrated compliance with storage and disposal of controlled drugs.

Audit of the patient environment Improved procedures for storage of food and patient aids.

Handling and disposal of linen 100% compliance has been maintained.

Safe waste management Improvements to storage and infection control measures.

Hand washing Improved awareness demonstrating above 95% compliance.

Infection control practice with medical devices There have been changes made to the cleaning process.

Information governance: consent obtained from relatives

Smarter process in recording on Crosscare.

Information governance: consent is obtained when recording clinical activity

Smarter process in recording on Crosscare.

Follow-up phone calls to patients who did not attend gym classes (re-audit cycle)

Training to be given to staff in this area, to ensure that patients who do not attend sessions are contacted.

During the reporting year the Accountable Officer (AO) role was transferred to the Nursing Director, and a deputy AO identified. Both individuals have undertaken formal training on the AO role. The AO has undertaken or commissioned regular audits of stock and patient named controlled drugs to ensure they are correct and used in accordance with national protocols. All deceased patient records are checked to ensure appropriate use of the drugs. Contact has continued with the Controlled Drug Liaison Officer for Sussex Police who destroys all controlled drugs which are no longer required and advises on environmental aspects of controlled drug storage. There has been an increase in controlled drug incidents with 19 reported 2016/17 compared to 12 the previous year.

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No patients receiving NHS services provided or sub-contracted by St Wilfrid’s Hospice in 2016/17 were recruited during that period to participate in research approved by a research ethics committee. St Wilfrid’s Hospice is committed to evidence based care and during the reporting period has reviewed and strengthened its approach to ensuring evidenced based care is embedded within the hospice, through the clinical governance structure.

St Wilfrid’s Hospice has not recruited patients to any National Portfolio Research studies between April 2016 and March 2017.

St Wilfrid’s Hospice endeavoured to further its interest in engagement with palliative care research during the time period.

St Wilfrid’s Hospice has been involved in the following research studies:

a. HOLISTIC study: Hospice UK has been commissioned by NHS England to undertake a study to examine the effect of hospice-led interventions on the use of acute resources and outcomes for people at the end of life. St Wilfrid’s Hospice is taking part to demonstrate the impact of the Nurse Line service

b. Team resilience: an action research study. The objective is to explore what teams (can) do to become more resilient. In particular to explore a range of questions, including:

Is a resilient team more than a group of resilient individuals? What factors or processes contribute to team resilience? What are some of the practical steps involved? How does team resilience affect team performance? How does team resilience affect the well being of team members?

The study is led by external researchers from the Ashridge Centre and has recruited six members of clinical staff from the hospice. .

Individual Research Olivia Beeney-Bennett (Registered Nurse) is undertaking a study as part of her dissertation for her Masters in Nursing degree at Kings College, London. The aim of her study is to explore the understanding and views of healthcare professionals working within specialist palliative care settings towards the concept of rehabilitative palliative care. Lara Cowley (Advanced Practitioner- Physiotherapy)

Barriers to exercise therapy in individuals already attending a gym (completed) Exploration of the effects that participation in a hospice-based exercise programme

has on future exercise habits (in process)

Conferences attended/ Research abstracts presented: Hospice UK national conference ‘People, partnerships and potential’ – November 2016 Liverpool, UK Four posters were presented as follows: Harrison, C., Barclay, D. and Clarke, S. How do users find Views on Care? Engaging people with personal experience. Poster presentation

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Clarke, K. Engaging people to empower patients. Poster presentation Speight, B. Building confident and resilient communities: a foundation for our vision. Poster presentation. Schrikker, T. En suite drugs: quality improvements in medicines management. Poster presentation.

van Vliet LM, Gao W, DiFrancesco D, Crosby V, Wilcock A, Byrne A, Al-Chalabi A, Chaudhuri KR, Evans C Silber E1, Young C, Malik F, Quibell R, Higginson IJ; OPTCARE Neuro. How integrated are neurology and palliative care services? Results of a multicentre mapping exercise. BMC Neurol. 2016 May 10. This paper describes the evidence from the initial mapping exercise that St Wilfrid’s Hospice participated in for the Opt-Care Neuro Study.

No staff members were involved in external teaching on research degrees this year.

Dr Farida Malik has been appointed external examiner to the MSc in Palliative Care at Kings College London (2016/17).

St Wilfrid’s Hospice is required to register with the Care Quality Commission and its current status is as registered to provide treatment of disease, disorder or injury and diagnostic and screening procedures. The CQC has not taken enforcement action against St Wilfrid’s Hospice during 2016/17. St Wilfrid’s Hospice was inspected by the CQC in August 2014 under the new model of inspection and awarded an outstanding rating. This is broken down to the five key areas as follows: safe – good; caring – good; effective – good; responsive – outstanding; well- led – outstanding.

No formal registered provider visits have been undertaken in the reporting year. The Chair of the Trustees is active in the hospice’s Schwartz Rounds which are held on a monthly basis, and is also a member of the Clinical Governance Committee. There are three Trustees in the membership of the hospice’s Audit Committee and one Trustee in the Health and Safety Committee.

Good data quality underpins the effective delivery of patient care and is essential if improvements in quality of care are to be made. St Wilfrid’s is committed to ensuring high standard data as a key business objective. During 2016/17 we have continued to monitor and scrutinise data quality through our Clinical Leaders Forum and clinical governance structure. The hospice submitted a satisfactory Information Governance toolkit assessment in March 2017.

St Wilfrid’s Hospice, in accordance with agreement with the Department of Health, submits a National Minimum Data Set (MDS) to the National Council for Palliative Care. The hospice has been accredited to access and has maintained an N3 community of interest network (COIN) connection which required the satisfaction of 20 requirements as specified in the NHS Information Governance toolkit for voluntary services.

St Wilfrid’s Hospice has a well-established clinical governance structure. This comprises a Clinical Governance Committee with three sub-groups: Patient Safety, People with Personal Experience and Clinical Effectiveness. During the reporting year the hospice had a change of Chief Executive. During 2016/17 the Chair of the Clinical Governance Committee was transferred to the Deputy Chief Executive. A new external scrutiniser and the Chair of the

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Board of Trustees joined the committee. Each sub-group is chaired by a Clinical Director and comprises multi-disciplinary membership from across all departments of the hospice. In addition to the sub-groups, there are several working groups who feed in to the structure: medicines management, information governance, infection control, nutrition and safe discharge. The hospice has further demonstrated its strong commitment to clinical governance by implementing the new role of Quality Improvement Lead in the reporting year.

The clinical governance framework in the hospice covers all areas focusing on patient and

family carer support, as described in the following section.

St Wilfrid’s Hospice has a strong process of managing accidents, incidents and near misses (AINM). The incident reporting process was reviewed and changes implemented during the reporting year. Patient safety data is reported in detail in a subsequent section of this document.

Oversight of audit is incorporated within the Clinical Effectiveness group. Work to embed use of outcome measurement has been described in section 2.1.3.

The work undertaken to strengthen PPE was described in section 2.1.3 and its importance in the clinical governance structure in section 3.1 above.

The hospice’s infection control group guides work in this area. Membership includes clinical representation from all clinical areas and non-clinical staff. Members of the group have attended study days throughout the year on infection prevention and control. Throughout the reporting year there has been engagement with external scrutinisers who specialise in this aspect of quality assurance. Environment and hand hygiene audits are carried out monthly within all clinical areas to ensure high standards of cleanliness are maintained. There have been additional audits carried out throughout the year including audits on: Safe Handling and Disposal of Linen Management of Patient Equipment Management of Clinical Waste and Sharps Safe Management of Waste Management. Compliance and findings from all the infection control audits are discussed at Infection Control meetings and action plans agreed. Work has commenced to incorporate the Hospice UK Infection Control Audits into the infection control audit cycle. This revised practice provides assurance that the most current practices and legislation are being adhered to. ‘The Principles of Infection Control’ are presented at mandatory clinical training with positive evaluations. To increase engagement with clinical staff, infection control updates are circulated to all clinical staff following the infection control meeting, outlining a summary of the meeting, new developments, changes in practices and information on infection control-related policies and procedures which have been revised, renewed and agreed. The hospice participated in the Patient Led Assessments of the Care Environment (PLACE). Feedback on the cleanliness of the Inpatient Unit and the Wellbeing Centre was above the national average. St Wilfrid’s has reported a total of five infection control related incidents a slight decrease compared to 2015/16. None of the reported incidents were related to hospice-acquired infections during the reporting year.

The hospice’s Medicines Management Group comprises of a multi-disciplinary membership and has terms of reference to oversee practice across the hospice. 2016/17 has seen an increase in the number of drug-related incidents compared to 2015/16. A large proportion of

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the reported incidents were documentation errors. All of the incidents resulted in no or low levels of harm. Clinical Managers raise awareness of the drug-related incidents at clinical departmental meetings and in the annual clinical mandatory training cycle. Inclusion of discussion regarding medication incident trends within clinical training has enabled staff to discuss incidents openly. Through peer support staff have been able to look at adopting new practices with an aim to reduce medication incidents. St Wilfrid’s Hospice has budgetary control and responsibility for drugs delegated from Eastbourne, Hailsham and Seaford Clinical Commissioning Group (CCG). The Medicines Management Group provides scrutiny of the budget. Changes in practice have been identified, piloted and implemented to increase productivity, clinical effectiveness, positive patient experience and optimum patient safety including: Introduction of the medication on discharge document to ensure a clearer and more

concise document for patients and their carers to manage the risk of patients taking the wrong medication on discharge.

Gaining approval from the Clinical Governance Committee to introduce the use of Entonox gas for managing incident pain.

Changes to the medication chart following an increase in warfarin-related incidents.

Work has commenced on the introduction of nurse-led changes of dose medication within a syringe driver in a prescribed range. The practice of patients’ oral controlled drugs being administered from individual controlled cupboards within patients’ bedrooms has reduced the length of time from prescription time to administration. This innovative piece of work was a poster presentation at the Hospice UK conference. St Wilfrid's Hospice continues to be part of Hospice UK's national benchmarking for medication incidents. Further patient safety activity related to medicines management is reported in section 3.2.

The Patient Safety Group oversees the management of complaints and reports to the Clinical Governance Committee. The hospice actively encourages feedback and has an established policy and procedure to deal with complaints and concerns to encourage active escalation of concerns to be investigated. During the reporting year there were five complaints received relating to clinical care. Outcomes involved inclusion of good standards of record keeping as part of the mandatory clinical training, a plan to provide guidance on the subject of next of kin, communication skills training and a number of reflective discussions with staff members.

The hospice has a well-established Health and Safety Committee chaired by the Chief Executive which meets on a quarterly basis. Fire prevention and procedures have been a key focus during the reporting year with a review of the Fire Evacuation Policy and Procedure, and implementation of multiple fire drills to support staff to be familiar with the procedure. The Patient Safety Group also reviews and monitors non-clinical incident reporting quarterly. The hospice’s Business Continuity Policy and Procedure has been reviewed extensively in the reporting year, including training for key staff on their response in a major incident.

Information governance refresher training is mandatory for all clinical staff and volunteers with access to confidential information. The hospice achieved 86% of staff compliance in the reporting year compared to 63% the previous year. An Information Governance Group was further embedded in the reporting year, chaired by the Insight and Information Manager, and includes membership of the Caldicott Guardian and Senior Information Risk Officer.

This reporting year has seen a continued focus on the development of communication skills across the clinical team, with a particular emphasis on the management of psychosocial risk, including suicide, self-harm and safeguarding. Increasing staff confidence and competence with regards to mental capacity has been a priority, with the introduction of new mental

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capacity care plans and related training. The resignation of the hospice chaplain from his role provided the opportunity for a wide-ranging review of spiritual support, including broad stakeholder engagement. The review has significantly influenced the recruitment to a new spiritual support lead role.

St Wilfrid’s Hospice recognises the value of staff support and development in order to provide safe, effective care. Schwartz Rounds continued monthly in the reporting year, under the guidance of the Point of Care Foundation. The purpose of these regularly scheduled meetings is to explore the emotional and social impact on staff and volunteers of delivering services and care in the hospice. It is a staff support mechanism and fosters overall organisational cohesion, communication and emotional intelligence across clinical and non-clinical areas. In addition, two groups are established to provide group supervision to clinical staff. Other staff groups receive supervision from external supervisors. During the reporting year the hospice undertook a staff survey which will inform a people strategy, commenced this year, to guide the next five years. The Human Resource structure was reviewed and the role of Head of People developed to improve the support of staff and volunteers.

The hospice provides a learning environment for both its internal clinical staff and health and social care professionals working in the community. For internal staff there is a yearly two day mandatory training programme which includes a mix of interactive, practical and theoretical sessions along with an ongoing programme of online modules in Information Governance, Safeguarding, The Mental Capacity Act, and Health and Safety modules. In addition there is an internal learning and development programme with sessions appropriate for all clinical staff which ensures they are fully trained to give safe and effective patient care. The hospice is a Gold Standards Framework Registered Regional Centre for care homes and delivers end of life care workshops to staff working in Adult Social Care. The hospice also co-delivers a University of Brighton module on End of Life Care for people with long-term conditions. In addition the hospice provides a focused education programme for external health and social care professionals working in community settings. A work placement programme is also offered for medical, nursing and AHP students. The hospice has a planned programme of education for medical students.

Patient safety is a key domain of quality and when patients receive care from St Wilfrid’s Hospice there is a commitment to ensure a safe environment which causes no harm. The hospice has a culture of openness and transparency and encourages reporting of accidents, incidents and near misses. These are investigated to ensure lessons are learned, recommendations made and all appropriate actions implemented. St Wilfrid’s Hospice participated in the Hospice UK national benchmarking pilot on quality measures for medication, falls and pressure ulcer incidents enabling comparison with national hospice care. This is based on the National Patient Safety Agency incident reporting. One of the hospice’s strengths lies in networking with other organisations. By having an overview of the type of falls, medication and pressure ulcer incidents occurring in different hospices, trends can be identified, lessons shared and discussion had on how changes in practice have been introduced to reduce the level of harm to patients. Discussion of clinical incidents with external partners provides more substance, depth and dimension to the reporting process. The following section is a summary of patient safety data. This data includes all safety activity within the hospice whereas the data for Hospice UK national benchmarking includes only IPU activity:

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Medicines management

Level of harm as a result of medication incident

There have been a total of 53 reported medication incidents. A large proportion of the

reported incidents are documentation-related incidents All drug incidents resulted in no or low levels of harm to the individuals involved Each quarter, all incidents involving controlled drugs are reported to the Local Intelligence

Network (LIN) by the Accountable Officer There has been a 23% increase in incidents reported in 2016/17 with 50% of all incidents not

related to administration The analysis and learning from medication incidents continue to be scrutinised through the

clinical governance structure.

Level 0 Error prevented by staff or patient surveillance

Level 1 Error occurred: with no adverse effect to patient

Level 2 Error occurred: increased monitoring of patient required, but no changes in clinical status noted

Level 6 Error resulted in patient death

Level 3 Error occurred: some change in clinical status noted and/or investigations required: no ultimate harm to patientLevel 4 Error occurred: additional treatment required or increased length of patient stay, eg Naloxone required for opioid overdoseLevel 5 Error resulted in permanent harm to patient

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Falls management

Level of harm as a result of falls incidents

96% of all falls resulted in no or low harm; one incident resulted in a serious injury (fracture

neck of femur) which required notification to the CQC The hospice has seen an increase in falls activity in 2016/17 There is a small correlation with an increased fall activity and bed occupancy above 85%. A quality improvement priority for 2017/18 is to reduce falls activity Falls activity will be a clinical priority from April 2017 with more in-depth monthly monitoring Patients who fall more than once during an admission commonly have a higher than average

length of stay on the Inpatient Unit.

Death

Impact prevented - any patient safety incident that had the potential to cause harm but was prevented,

resulting in no harm to people receiving care

Harm requiring first-aid level treatment, or extra observation only. Any patient safety incident that required

extra observation or minor treatment and caused minimal harm to one or more persons receiving care

Harm requiring hospital treatment or a prolonged length of stay but from which a full recovery is expected

(eg fractured clavicle, laceration requiring suturing) Any patient safety incident that resulted in a moderate

increase in treatment and which caused significant but not permanent harm, to one or more persons

receiving careHarm causing permanent disability (eg brain injury, hip fractures where patient is unlikely to regain their

former level of independence). Any patient safety incident that appears to have resulted in permanent

harm to one or more persons receiving care

Where death is directly attributable to the fall. Any patient safety incident that directly resulted in the death

of one or more persons receiving care

No harm

Low Harm

Moderate

Harm

Severe Harm

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Pressure ulcer management

2016/17 was the first year of collecting these key safety metrics. The hospice will be comparing data in future years for comparison

There has been a steady increase in the number of unavoidable acquired pressure ulcers Areas for improvement and training needs identified forming part of ongoing work for

2017/18 within this aspect of patient safety There have been no avoidable pressure ulcers reported.

There have been five incidents reported in the category of infection control in 2016/17, a reduction by one on the previous year. Infection control has been discussed in further detail section 3.1.5.

Patient questionnaires are collated monthly and service managers required to respond to comments with actions where indicated. Throughout 2016/17, 139 questionnaires were completed representing a 17% return rate. Work will be undertaken in this year to review the patient questionnaire.

The report of the CQC inspection undertaken in August 2014 includes many highly positive comments and can be viewed in full at: http://www.cqc.org.uk/location/1-999808672#accordion-1

3.3.2 Comments from Clinical Commissioning Group

Eastbourne, Hailsham and Seaford and Hastings and Rother Clinical Commissioning Groups are pleased to comment on St Wilfred’s Quality Account for 2016/7. The CCGs note the Quality Improvements which the organisation will be focusing on for 2017/18. It is pleasing to see that the hospice has noted that it has seen an increase in the number of patient falls and is planning to put improvement work in place to address this. The work to support and develop spiritual care is also a welcomed initiative. The hospice has made clear improvements in the delivery of Patient Experience, Quality and Safety and is continuing to develop its Clinical Governance Structures to support learning and improve the patient’s experience. The CCG’s are looking forward to continuing to work with the hospice as we develop the East Sussex Better Alliance to support people who require palliative and end of life care. We would also like to recognise the significant contribution volunteers make to support the clinical team.

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The speed of support. The length of time spent with us. The relationship with us all. The desire to help … were all exceptional.

In my eulogy I wrote 'St Wilfrid's was a preview of what Heaven must be like'.

It would have been impossible for care to have been surpassed anywhere else.

Just keep going on, making the lives of ill people become more bearable.

Dr David Barclay, Medical Director Andrea Dechamps, Patient and Family Support Director Ruth Bacon, Inpatient Unit Nurse Manager Tara Schrikker, Inpatient Unit Nurse Manager Dr Farida Malik, Consultant in Palliative Medicine Susan Stocks, Learning and Development Manager Steve Clarke, Insight and Information Manager

Completed June 2017 Colin Twomey Nursing Director

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St Wilfrid’s Hospice (Eastbourne), 1 Broadwater Way, Eastbourne, East Sussex BN22 9PZ 01323 434200

Registered Charity No: 283686; Registered Company No: 1594410