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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)
slide11
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
slide12
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
slide15
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
slide16
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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