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How to organise for Safety Express. Lisa Nobes Head of Nursing Development West Suffolk Hospitals Trust. Plan - Who . Strategic team Executive Chief Nurse Deputy Medical Director Governance and Safety Lead Head of Nursing Development Shared documentation

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How to organise for safety express

How to organise for Safety Express

Lisa Nobes

Head of Nursing Development

West Suffolk Hospitals Trust


Plan who
Plan - Who

  • Strategic team

    • Executive Chief Nurse

    • Deputy Medical Director

    • Governance and Safety Lead

    • Head of Nursing Development

  • Shared documentation

    • Discussed strategy document, driver diagram


Plan smart
Plan - ‘SMART’

Focusing on the harms as overall aim but using the drivers as a means to achieve that


Plan implementation
Plan - Implementation

  • Important to dovetail additional key initiatives into programme

    • HIA

    • Productive ward

    • Local projects

  • Not just another programme

    • Fits with strategic and operational direction and objectives


Plan where
Plan - Where

  • Identified wards

    • Poorest performing – wards that really need the input

      • Minimal recent attention

      • Initially a concern to share dataset

      • BUT programme about improvement

  • Intensive approach

    • Phased, ward by ward, multi driver approach


Plan measurement
Plan - Measurement

  • Incidence reporting mechanisms

  • Quality management systems

  • Introduced safety thermometer

  • Drivers impact on a whole range of our quality indicators

  • Baseline dataset

    • Harms

    • Other quality factors e.g. patient experience


Plan measurement1
Plan - Measurement

  • Set reduction trajectory based on national aim

    • Staged reduction over 15 months

    • Ceilings = figure staff are aiming to reduce to

      • Target = inappropriate

    • Used realistic, phased ceilings

      • E.g. Ideal falls ceiling = 2, Current falls =7

      • Ceiling Q1 = 5, Q2 = 4, Q3 = 3, Q4 = 2

      • Motivating staff at each Q, encourages buy-in


Plan who1
Plan - Who

  • Ward team

    • Productive ward facilitator

    • Matron

    • Ward manager

    • Band 6

    • Band 5

    • Assistant practitioners

    • Health care assistants

    • Allied Health Professional rep


Plan what
Plan - What

  • 3 x ½ day facilitated sessions

    • Session 1

      • SE documentation, driver diagram

      • Baseline data - safety thermometer, incident reporting

    • Session 2

      • How staff felt about the ward, ward organisation

      • Current ward processes, structure of a day on the ward, system of intentional rounding

    • Session 3

      • Implementation of drivers through intentional rounding, rounding log

      • Communication, leadership


Plan how
Plan - How

  • Parallel leadership sessions with ward leaders

    • Change management

    • Personal qualities

    • Driving improvement

  • Prior to ‘Do’ 3 sessions with all ward staff

    • Explain new process, rounding, drivers

    • Some resistance met

      • (now biggest advocates)

  • Additional resources required – TIME

    • Staff released to plan

      • (reduced as experience gained)


Do

  • Across 4 pilot wards

    • phased intensive implementation, ward by ward

    • 2/3 months

    • Ward managers very involved

    • Integrating other project learning / modules in

      • Productive meal times

    • Intentional rounding triggered by risk


Do

  • Adaptation of rounding tool

    • Stroke ward different to rehabilitation ward

  • Additional processes (re)launched

    • Introduction

  • Measurement

    • Safety thermometer data

      • Sample = 50% (approx 64 patients) per month

      • Collected by clinical project lead

    • Incident reporting / quality management data

      • Continued standard data collection by ward staff


  • Study
    Study

    • First impact = increased moral

      • Interest shown, improved processes = Happier staff

    • Harms reduced across all pilot wards

    • Reduction of harm to higher risk patients

      • Medium/low risk patients a strong theme in the data

      • Identified the ‘gap’


    Study1
    Study

    • Measurements

      • Falls

      • VTE

      • Pus

      • CaUTI


    Act

    • Adapted intentional rounding tool 2-3 times

      • For more vulnerable, high risk patients

    • Second type of rounding tool now in “Do” phase

      • For less vulnerable, medium/low risk patients

    • Leadership crucial

      • Clinical leadership programme planned for band 5’s

    • Different intensive periods with each ward

      • People dependant, different abilities, experiences, confidence levels


    Act

    • Discussed at matrons meeting

      • Internal/peer ‘competition’

      • ‘Whose ward at the top of the league?’

    • Equipment

      • Recognised need to provide the tools to deliver what begin asked of them

    • Risk management

      • Daily pro-active rounds by Matrons and ward managers

      • Assessing increased risk, before an incident occurs

    • Cycle of SE a self – fulfilling prophecy

      • Name of the project starts to proceed

      • Wards don’t want to be left behind


    Top tips for implementation
    Top Tips for Implementation

    • Are you the right person for the job?

      • You really have to want to do it

    • Do the people around you want to be involved?

      • You need a supportive team

      • Internal and external organisations

    • Do you have the will, the energy and all the right people on board?


    Key impacts from se
    Key impacts from SE

    • Increased confidence

      • Me, personally, professionally

      • The ward staff, professionally

      • Following a framework

      • Empowered by the approach


    Spread
    Spread

    • We are a Trust that wants to improve

      • Sustainability is bead by success

      • Rollout across all units

      • Continue testing/adapting low-medium risk intentional rounding tool

      • A vehicle for regional work, linking with partner Trusts


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