Www.virgincare.co.uk HQIP Partnership Working Award Clinical Audit Manager (Community Services,...

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HQIP Partnership Working AwardClinical Audit Manager (Community Services, Surrey)

Tissue Viability Nurse Specialist (Community Services, Surrey)

Community Hospital Matron (Community Services, Surrey)

Tutor in Community Nursing at Surrey University

Private and confidential1


Aims – how the session is planned

Explanation of award category

Describe clinical audit project

Key reflection on success in partnership working

Achieving an ‘outcomes’ focus

Critical success factors

Discussion

The broader national context



‘part·ner·ship’ (n)

A collaborative relationship... based on trust, equality and mutual understanding for the achievement of a specified goal (World Health Organisation, 2009)

Arrangements typically involve joint working to achieve common goals, with partners sharing risks and rewards. (Audit Commission, 2012)



HQIP Partnership working award category

Projects submitted for this category must be:

– Jointly carried out with other organisations

– Could include working across NHS sectors

– Trusts from the same sector

– Social care, industry and/or independent healthcare organisations such as charities or private healthcare



Our entry

‘...Relentless pursuit of continuous quality improvement in the prevention and management of pressure damage, to eliminate avoidable harm, distress and discomfort, experienced disproportionately by older people in community settings’

Fulfils essential criteria for clinical audit

Florence Nightingale wrote in 1859

“If he has a bedsore, it’s generally not the fault of the

disease, but of the nursing”



What is a pressure ulcer?

“Localised injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear. A number of contributing or confounding factors are also associated with pressure ulcers; the significance of these factors is yet to be elucidated.” (EPUAP 2009)

Pressure damage is associated with:

longer hospitalisation

Increased complications and dependency

Increased vulnerability to infection

Pain, discomfort/infringement of dignity

Increased cost

A significant proportion are avoidable


www.virgincare.co.ukPrivate and confidential7


Pressure ulcer productivity calculator

Department of Health (June 2010)

Based on 2008/9 prices

– Category 1 = £1,000

– Category 2 = £6,000

– Category 3 = £10,000

– Category 4 = £14,000

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_116669



Clinical audit aims

Improve prevention

Minimise skin damage

Benchmark to drive improvement over time

Reduce inconsistency

Eradicate avoidable pressure damage

NHS Outcomes Framework:

Domain 4 – Ensuring a positive experience

Domain 5 – Safe environment



Audit methodology

On ‘audit’ day, all patients with pressure ulcers included

Process measures: Documented

1. Timely Waterlow risk assessment/review

2. Timely nutrition assessment/review

3. Individual care plan

4. Pressure relieving equipment

5. Incident form submitted (category 2, 3 and 4)

Prevalence

Outcome measure



Examples of key players in this partnership

Patients and carers

General Practitioners

Tissue viability nurse specialists

Community Hospital wards – multidisciplinary

Community nursing teams

Care homes (residential and nursing)

Acute hospital wards – multidisciplinary

Social care

Wound care companies

Safeguarding



Patient pathway

Own home

Acute hospital

Community hospital

Intermediate care

Step up/step down

Nursing home

Residential home

Community nursing team


Home


Resulting culture

Unavoidable complication of immobility?

Inevitable consequence?

Difficult to influence?

Reactive management versus proactive prevention



Successful partnerships depend on

1) Effective communication and leadership

2) Measurable outcomes

3) Sustained clinician engagement

4) Positive culture

5) Focussed education

6) Shared responsibility

7) Jointly devised solutions

8) Sustainability and ongoing improvements



Focus on each element of partnership working

In each aspect we:

– reviewed our processes and systems

– strived to work in collaboration with others

– talked and shared ideas

– were brave and changed the way we did things

Examples from each of the elements of partnership working that we hope will resonate with you

Allow time for questions and sharing of other examples/ideas



Communication

Raising awareness

Discussing progress

Cooperation

Sharing/transparency

Comparative benchmarking

– Over time

– Between participants



Measurable outcomes

Improved quality – experience and safe care

Incidence reduced

Prevalence reduced

Experience of pain and discomfort reduced

Time saved to be used more appropriately

Costs reduced

Length of stay reduced

Sustainability – continue to monitor over time



Sustained clinician engagement

Engagement of all – assessment tools

Consistency

Embedding changes into routine practice

Changed incident reporting form



Culture

Raised awareness of pressure damage

From ‘treatment’ focus to one of ‘prevention’

‘Unavoidable’ to ‘unacceptable’

Positive incident reporting – how?

Transparency – an open culture

Reflection on shared problem

Joint ownership of need for eradication

Shared drivers for change

Acceptance of ability to influence



Focused education

Internal and external

Collaboration – bring clarity to quality

One size does not fit all

Targeted education based on identified need

Skills sharing

Ongoing targeted support

Implementation of best evidence



Shared responsibility

Pressure ulcer pathway

– Prevention, treatment and reporting

– Responsibility, ownership and equality at each level

– Visible focus for action



Jointly devised solution

Safe Care Steering Group

Community SSKIN bundle

– five best practice elements

Use of SKIN bundle to support local incident reporting

Serious incidents

– Root Cause Analysis (RCA)

– RCA panels and action plans

– Shared learning



Sustainability


Incident reporting triggers routine clinical audit

Ongoing measurement

Triangulation of data

Education

Review of tissue viability specialist resource


Template discussion

Sharing of:

– thoughts

– solutions

– innovation

– one action you will take



National Safe Care CQUIN (May 2012)

Rationale

‘Whilst some 10-12% of all patients suffer from pressure ulcers, a substantial proportion of these can be avoided

More older people and more vulnerable patients suffer from pressure ulcers in community settings. The gap between the best and worst performers is substantial

Simple inexpensive nursing interventions can dramatically reduce prevalence’



‘Safety Thermometer’ CQUINimprovement goal 2013/14

Pressure ulcers originate across and outside of the health and social care system

No distinction should be made between ‘old’ (present on admission) and ‘new’ (developed post-admission) pressure ulcers for the improvement CQUIN

Organisations should work with partners across the health and social care system to address the causes and reduce their prevalence, regardless of source’

Commissioning for quality and innovation (CQUIN):

2013.14 guidance

Draft – December 2012. NHS Commissioning Board



Best practice evidence and drivers

The management of pressure ulcers in primary and secondary care – NICE CG 29 (2005)

Pressure ulcer treatment – EPUAP (2009)

Essence of Care – DH (2010)

SSkin Care Bundle – Health Improvement Scotland (April 2011)

Achieving consensus in pressure ulcer reporting – Tissue Viability Society (2012)

National monthly Safety thermometer census and Safe Smarter Care ‘harms’ measurement – CQUIN (2012)



Best ‘clinical audit’ practice and pressure damage

High quality care in pressure ulcer prevention depends on simple but consistent nursing (and other clinician) interventions to prevent ‘harm’

Clinical audit measures consistency across teams, settings and over time (re-audit)

Critical success factors: CIREM research

– strong likelihood of effective clinical audit

– high impact on patient outcomes



NHS Outcomes Framework

– 2. Enhancing quality of life for people with long term conditions

– 5. Treating and caring for people in a safe environment and protecting them from avoidable harm

Adult Social Care Framework

– 1. Enhancing the quality of life for people with care and support needs

– 4. Safeguarding adults who are vulnerable and protecting them from avoidable harm

Alignment between frameworks supports ‘partners’ to identify common ground for integrated working


HQIP Clinical audit: ten simple rules for NHS Boards:

‘Ensure with others that clinical audit crosses care boundaries and encompasses the whole patient pathway’


Questions

Food for thought on closing:

– ‘Some is not a number’

– ‘Soon is not a time’

– Our partnership audit has given us clarity

– Joint and clear expectation for continual improvement

– ‘Our contribution will be what did not happen to them’

‘The 5 million lives campaign: Institute for healthcare improvement 2006-8’


Www.virgincare.co.uk HQIP Partnership Working Award Clinical Audit Manager (Community Services,...

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