Putting patient safety first

Patient Safety First recently celebrated a year since its launch by announcing that 92% of acute Trusts, 154 in total, have officially signed-up to the campaign, with 100% sign-up among acute Trusts in the Northwest, Southwest and Yorkshire and Humber regions. The campaign is part of an international move to make healthcare safer and supports Trusts in making recommended changes to practice that are proven to reduce the level of avoidable harm. The campaign is sponsored by three organisations who are leading the agenda for quality and safety improvement in the NHS: the National Patient Safety Agency (NPSA), the NHS Institute for Innovation and Improvement and The Health Foundation. The campaign is not Government-led but enjoys high-level support from the Department of Health and the NHS Board. Led by a team of dedicated clinicians and managers from across England, Patient Safety First is initially focused on the implementation of five interventions. These are: • Leadership for safety – getting Trust boards to clearly demonstrate that patient safety is their highest priority. • Care of deteriorating patients in acute care – to reduce in-hospital cardiac arrest and mortality rate through earlier recognition and treatment of the deteriorating patient. • Reducing harm in critical care – improving the care of patients receiving critical care through the reliable application of care bundles. • Reducing harm in perioperative care – preventing surgical site infection and implementing the World Health Organisation’s Safe Surgery Checklist. • Reduction of harm from high-risk medication – including anticoagulants, opiates, injectable sedatives and insulin. Since the campaign was launched at last year’s NHS Confederation conference, the signed-up Trusts are showing good progress in actively promoting patient safety improvement in their organisations. Successful activity ranges from Trusts raising awareness and declaring their commitment to putting patient safety first and stating their aims, as well as actively implementing and measuring the evidence based interventions promoted by the campaign. Sharon Beamish, chief executive of George Eliot Hospital in Warwickshire commented: “We are very proud of the progress we have made in creating a healthy attitude to patient safety in our Trust. Since joining Patient Safety First, we have ensured patient safety is at the top of the agenda at board meetings and we have introduced leadership walkrounds so that the executives can hear the views of those staff who work with patients on a day-to-day basis. The need to make patient safety a priority has filtered through the whole organisation and we are confident that our results will continue to improve.”

Case study: Salford Royal NHS Foundation Trust

At the Salford Royal NHS Foundation Trust, a major reduction in cardiac arrest has been achieved by implementing improved safety measures. Installing an old-fashioned sphygmomanometer beside every hospital bed may seem at odds with 21st Century quality healthcare, but recalling this “key cornerstone in nursing provision from the past” has already contributed to a 30% reduction in unexpected cardiac arrest outside critical care, since signing up with Patient Safety First in 2008. An expert multi-disciplinary steering group investigated Salford Trust’s rate of unexpected cardiac arrests. While this rate is within national averages, Salford wanted to learn how they could be better. The group found that there was opportunity to further improve the standard of recording and responding to acutely unwell patients. The solution chosen was to move away from electronic clinical observations and return to using the manual blood pressure machine. “At first, the idea that taking blood pressure manually could be the more accurate option seemed crazy,” commented Peter Murphy, assistant director of nursing for quality improvement since March 2009. “In fact, it makes good sense,” he explained. “When you take blood pressure manually, you also check the pulse and touch the patient’s skin and look at their face, all very important clinical observations. Having a nurse on hand to explain what is happening, especially if there is a problem is a better experience for the patient.” The sphygmomanometer’s reappearance, however, will be a gradual process with the pace dictated at ward level – an essential characteristic of Patient Safety First’s philosophy of small steps to achieve sustained change. “Our success is due to executive support with our Trust Board signed up to the whole programme,” said Peter Murphy who has been closely involved from the outset in his previous role as nurse consultant in critical care. “But that support is very different from targetsetting.” Change, he explained, is decided at ward level. “It is a continuing opportunity for healthcare teams to redefine their roles and redesign their own working practice.” During the first year of Patient Safety First, the “deterioration” interventions have been tested in 12 wards at Salford with the highest rates of unexpected cardiac arrest, by implementing the Institute for Healthcare Improvement’s “Breakthrough Series Collaborative Model”. A driver diagram, now part of Patient Safety First’s suggested guidance, was constructed during a “highly focused” half day by the expert group that included all key stakeholders from consultants to porters. This democratic approach to patient safety is reflected in the change package. A “Code Red” alert is designed to ensure that every member of staff on the ward, from housekeeper to visiting consultant, is aware that a patient has suddenly become unwell. Identified by a red spot beside the patient’s name on the board by the nurses’ desk, the alert is also communicated verbally in a matter of seconds, so that everybody is watching out for that patient. A “nurse-led response to acute illness” initiative means that, when appropriate in response to an elevated early warning score, nurses are encouraged to first sit the patient up, put oxygen on the face and make sure that medication is up to date. A “Ward Round Checklist”, identifying the essential components of the regular consultant ward round, has proved popular throughout the hospital. The checklist ensures that every component of the ward round is covered reliably for every patient. Underpinning these life-saving initiatives is a decision-making tool around the escalation of care, based on a “Ceiling of Care” document. It provides clarity for staff to reliably identify in advance whether a seriously ill patient will benefit from resuscitation in the event that they suffer a cardiac arrest.