Annual Quality Account
Quality Account - 'Have your say'
The Quality Account is our opportunity to share with our patients and the public where we think we are doing well, for example improvements we have made to our services; but also where we recognise we need to do better and how we intend to make improvements.
The Trust is currently planning the next Quality Account and we are keen to hear your views. Please take the time to complete our survey, which is now available here.
Annual Quality Account
This is our second annual Quality Account and was approved by the Board of Directors at the end of May 2011. It is a yearly report that tells patients, staff and the public what standard of care can be expected from us, how we measure those standards and how we plan to make improvements to the care we provide. It contains our priorities for 2011/12 and looks back on the quality priorities for the last year 2010/11. We need your involvement to help to shape the Quality Accounts of the future.
Quality Account 2010/11
Our 6 priorities for 2011/12 are:
Patient Experience Priorities
1.Achieve required level of improvement in the annual Care Quality Commission National Inpatient Survey - we want to improve on our results of last year.
2.Increase assistance for patients with eating and drinking and compliance with Malnutrition Universal Screening Tool (MUST) – this is an issue raised by patients, carers and Wirral Local Involvement Network (LINks).
3.Minimise unnecessary in-hospital bed moves – this is an issue identified through analysis of our complaints and incidents. It is also an issue raised by patients, staff and LINks. We will be developing the standard initially and then monitoring it.
Safety Priority:
4.Reduce the in-hospital risk adjusted mortality rate.
5.Improve discharge information.
Combined Clinical Effectiveness Priority:
6. Achieve Goals set out in the Safety Express Programme – this includes learning and improvement
in the prevention of hospital falls, pressure ulcers, venous thrombo-embolic (VTE) events (blood clots) and urinary tract infections associated with the use of catheters AND
Deliver the Advancing Quality initiative – this includes acute myocardial infarction (heart attack), community acquired pneumonia, stroke, hip & knee replacement and heart failure
Both these programmes are established and therefore we feel can be combined into one priority. Retaining this will assist in being able to continue to improve care continuing to focus on three of our priorities from last year; reduction of falls, development of pressure ulcers and improving key indicators for five specific conditions.
The priorities for last year (2010/11) were:
1. Reducing Hospital Acquired Infection – we have been successful in reducing both MRSA bacteraemia and Clostridium difficile this year but need to continue to work on this.
2. Advancing Quality Initiative – we have improved compliance on the four clinical conditions that we have data for (first six months of 2010/11); the clinical areas are: Acute Myocardial Infarction – known as a heart attack, Heart Failure, Hip and Knee Replacement Surgery and Community Acquired Pneumonia. Stroke is an additional clinical treatment area, added during 2010. Advancing Quality helps us to deliver the very best standards of patient care by identifying the best practice for each focus area.
3. Achieving NHSLA Level 3 - NHSLA risk management standards are key indicators of the safety and quality of an organisation. We are planning to have the level 3 assessment on the acute standards in July
4. Local Advancing Quality: In hospital Falls - The main focus this year has been to identify factors that could reduce the number of patients who fall and sustain serious harm, in particular, a fracture. We have increased awareness about repeating the falls assessment tool. All ward managers receive an automated daily risk alert report identifying all patients who have a high falls risk assessment score. This together with the introduction of a symbol on the patient board is helping staff to quickly identify a patient who is at high risk of falling and allows them to ensure the patient has had the appropriate interventions. During the year the Trust was accepted on a national programme called Safety Express which provides a structured methodology to rapidly improve areas that are recognised safety issues impacting on patients. There is proactive sharing of best practice in relation to the management and prevention of falls for in-patients.
5.Reduction in Hospital Acquired Pressure Ulcers - The degree of damage to the skin is assessed by using a grading system from 1 to 4 with 4 being the worst. This priority was a developmental standard and initially we needed to establish a baseline on which to set a target. All incidents of pressure ulcers graded 3 or 4 are reviewed in depth to identify possible causes and identify any actions that could have been taken to prevent the ulcer developing. We produced a standard form to assist in the review and ensure the correct questions are asked. We set up a tissue viability link nurse group to increase the level of awareness and provision of training of new developments and prevention techniques.
The Quality Account for 2009/10
Q2 Quality Account Report 2011/12
Q3 Quality Account Report 2011/12