Tracey McErlain-Burns, Chief Nurse, to present
Minutes:
Tracey McErlain-Burns, Chief Nurse, gave a half yearly update on the Quality Account.
2014/15 Quality Objectives
- Safe – Harm Free Care
· The aim across the NHS was to get a 95% harm free care position. The national average across all England, including hospitals those which did not necessarily provide Community Care was currently 94%. The Trust had set itself a stretched target of 96%
· This time last year the Trust’s position of harm free care was a little over 90%
· In November and October the Trust had exceeded 95%
o Safe – Mortality – Deliver a 4 point reduction in HSMR
· It was believed that the Trust would be able to achieve the target and would be demonstrated at year end with a revision of the SHMI (Summary Hospital Level Mortality Indicator)
· It would be a recommendation that the Priority be carried forward into 2015/16 as it was the original suggestion that it be a 3-5 years long term Strategy
Zero avoidable Pressure Ulcers Grade 204
· Primary focus on preventing avoidable pressure ulcers particularly in those patients living in their homes within the community
· Still some progress to make within the Community
· 94% rate in hospital
- Reliable – Achieve all national waiting time targets
A&E
· Quarter 3 target had not been reached (see Minute No. 78), therefore, the year end position in relation to the emergency 4 hours target could not be met
- Caring and Reliable – Friends and Family
· Looked to increase the net promoter score for Maternity Services, Inpatients and A&E
· The Test had been rolled out to all Services including Outpatients, Paediatrics and GPs
· Current focus to drive the Test and get a representative view of Services, target 75%
2015/16
- The 2013 inpatient survey had been reviewed and would be repeated. The 2013 results along with the Friends and Family Test and complaints had generated a number of issues which had been considered by the Quality Assurance Committee. The Committee had recommended that the Trust look at improving the position and the number of patients whose condition acutely changed and the Trust needed to ensure that that acute change was picked up to prevent further deterioration whilst on the Wards
- Missed or delayed diagnosis. There was a national prerogative that the Trust ought to consider its rates of missed or delayed diagnosis. The Trust had signed up to the National Patient Safety website and made a pledge to improve patient safety and ensuring patients did not deteriorate in its care and did not delay or misdiagnose
- Discharge management and improving the care of patients with Dementia
- Complaints management – both Louise and Tracey managed the process very closely and read every complaint that was received with Louise signing all the responses. However, it was acknowledged that the process was not as effective as it could and there would be some quality improvement priorities set
Infection Control
- MRSA – there had been no cases during 2014/15. The Trust was getting better at preventing infection and increasingly knew how many people may come into contact with the Hospital Services who were carrying the bacteria without any ill effects
- When there had been examples of Norovirus in the Hospital it had been managed without rampant outbreak and contained within 1 or 2 Wards. This was a good marker of Infection prevention
- Clostridium Difficile – The Trust had been set a target of no more than 24 cases in 2014/15. There was currently the 24th case so it was likely that the Trust would exceed the target. The Chief Executive and Board had been advised and a meeting held with the Care Quality Commission and Monitor to make them aware. All cases were subject to a root access analysis which was then peer reviewed by Public Health England and the Clinical Commissioning Group to ensure the Trust had not overlooked anything. With the exception of 1 case they were suggesting that all of the cases were unavoidable and, therefore, if unavoidable it was difficult to know how the numbers could have been reduced
Discussion ensued with the following issues raised/clarified:-
- At the moment there were 25 vacancies across the Ward base but also vacancies in areas such as Outpatients and Endoscopy and approximately 50 Band 5 vacancies
- The vacancy level was higher as the Trust was looking at investing in development of Services such as a nurse leading the management of the Admission and Discharge of all patients from hospital
- Last year’s recruitment campaign had been successful but approximately 6-10 nurses would leave on a monthly basis
- All of those nurses leaving were offered the opportunity of an interview with the Human Resources Director or Chief Nurse to understand the reasons for their resignation
- It was often found that nurses wanted to be in control of their rotas and when they worked which was why some choose to be agency nurses. Rotas were based around service needs first but with some flexibility for staff
- There would be approximately 3 nurses retiring a month. The age of a retiring nurse had reduced as many had protected their right to retire at 55 years of age
- The results of the national staff surveys and the national Inpatients and A&E surveys were public documents. It was not known when the results would be received but they were published by the Care Quality Commission
Tracey was thanked for her report.
Resolved:- That a year end report on the Quality Account be submitted to the April meeting.