Sign up to Safety
Sign up to Safety is a patient safety campaign, launched by the Secretary of State of Health in June 2014, with the mission of strengthening patient safety within the NHS to make it the safest healthcare system in the world.
We were one of the first Trusts to ‘sign up’ and we developed an action plan around the following five core pledges.
- Putting safety first Commit to reduce avoidable harm in the NHS by half and make public our locally developed goals and plans.
- Continually learn Make our organisation more resilient to risks, by acting on the feedback from patients and staff and by constantly measuring and monitoring how safe our services are.
- Being honest Be transparent with people about our progress to tackle patient safety issues and support staff to be candid with patients and their families if something goes wrong.
- Collaborating Take a lead role in supporting local collaborative learning, so that improvements are made across all of the local services that patients use.
- Being supportive Help people understand why things go wrong and how to put them right. Give staff the time and support to improve and celebrate progress.
Since developing the plan, work has taken place across the Trust to support the pledges. This includes:
Reducing patient falls
The most common patient safety incident reported in hospitals in England is patient falls. According to the National Patient Safety Agency around 282,000 falls are reported to the NHS England's Patient Safety division from hospitals and mental health units.
A huge amount of work has taken place across the Trust to reduce the number of patient falls. In September 2015, Helen Cripps, staff nurse commenced her role as falls lead. She has undertaken face to face falls training with almost 700 of our nursing staff. Training at induction has also been improved and now includes Healthcare Assistant training. Equipment has been purchased to support falls simulation training for junior doctors and multi-professional teams.
Further steps taken across the Trust to continue to reduce the number of patient falls includes:
- 9am safety briefings with doctors, nurses and allied health professional teams to highlight who is at risk of falling.
- New bed rail magnets to ensure bed rails are used for the right patients.
- The introduction of a daily falls map to ensure patients are cared for in the right location on the ward.
- The use of falls sensors on the wards to alert staff if a patient has moved from their bed or chair.
Our falls prevention group continues to develop falls interventions throughout the Trust and aims to continue to reduce the number of patient falls.
Further projects which are contributing to achieving our pledges include:
Meaningful activities project improving patient safety
At the start of 2016, Nicola Stirling, Occupational Therapist led the meaningful activities project with support from colleague Clare Waggett. Taking place on complex care wards 28a and 28b, the project aimed to support and empower all ward staff to have a greater understanding of person centred care and the value of meaningful activities. This understanding would then be incorporated into each patient’s planned care.
Along with gaining a better understanding of person centred care, the project also focused on taking a proactive approach to safety and focusing on patients who come to hospital with cognitive needs associated with cognitive impairment.
Nicola worked hard to promote the project and emphasise the importance of person centred care. She said “Engaging patients in meaningful interactions really supports them to maintain their physical and cognitive skills and encourage a safe and positive experience whilst in hospital. Examples of activities which could support patients range from having a conversation, looking at photographs or playing cards.”
When speaking to staff during the project, Nicola discovered that when staff engaged patients in their own care though enhancing behaviours and encouraged them to take part in meaningful activities that meant something to them, this had a greater impact on levels of wellbeing and helped to promote an improves experience overall for the patient.
This project has taken a real proactive approach to safety and we know that patients with complex needs are less likely to get distressed if they have a better experience, which in turn helps to reduce incidents and falls.
Leading the way in Enhanced Care
The use of additional staff over and above the funded establishment, to care for patients in hospital with cognitive impairment or a high risk of falls and general frailty has increased in the last five years. Last September, along with 11 other Trusts, we signed up to a 90 day national innovation project called Enhanced Care. The project aimed to improve the experience of patients receiving one-to-one care while also reducing the cost of providing this level of care.
One-to-one care is used to lower the risk and incidence of harm to vulnerable patients and reduce anxiety. Wards 6b, 28b, 25b and 34a, took part in the trial which relies on a full team approach and involved analysing current practice, testing out different ideas for engaging with patients, and implementing new assessment tools.
In just 90 days the pilot wards significantly improved the experience of patients through better engagement, daily senior care plans and clearer handover of care. Early findings showed a reduction in the cost of Enhanced Care by 20%, without compromising patient safety.
Mandy Freeman, Clinical Tutor/Clinical Lead Neurosciences and Christine Morgan, Senior Nurse, have both been the driving forces behind implementing the project across the trust and are passionate about the difference Enhanced Care can make to improving patient safety, reducing falls and enhancing patient experience.
All wards now use the Enhanced Care model and all patients are now risk assessed prior to initiating Enhanced Care, a care plan is put in place and they are reviewed by a senior nurse at least every 24 hours to ensure they still need the same level of care. The nursing staff complete a 24 hour activity chart which details any triggers for the patient’s behaviour, how the behaviour is exhibited, the interventions used to manage the behaviour and how the patient responded to the intervention.
This approach has increased the confidence of unregistered staff when aiming to understand and respond to patient’s needs as well as enabling registered staff to make the decision to discontinue Enhanced Care on the evidence gathered by activity charts.
Learning from the pilot, wards demonstrated the importance of early involvement of the ward sister to encourage staff engagement.
Marc Evans, Staff Nurse, 28b was recently nominated for an NBT Heroes award for his dedicated and enthusiastic approach to Enhanced Care when it was rolled out on 28b. Christine said “This is a great example of how Enhanced Care has been embraced and with the ongoing support of our nursing teams should continue to benefit patients in our care.”
Patient safety briefing film
Patients at NHS hospitals across the country will soon be benefitting from ‘airline style’ safety advice about their stay in hospital in an attempt to reduce avoidable complications – such as blood clots, pressure ulcers, or falls. Based on the concept of safety advice given on aeroplanes before they take off, patients will be shown a film and provided with an information card to read to help them look after themselves during their hospital stay. The safety advice is being supported by the Health Secretary, Jeremy Hunt, and the national Sign up to Safety campaign, which has a mission to improve patient safety in the NHS and make it the safest healthcare system in the world.