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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 . 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

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  1. How to organise for Safety Express Lisa Nobes Head of Nursing Development West Suffolk Hospitals Trust

  2. 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

  3. Plan - ‘SMART’ Focusing on the harms as overall aim but using the drivers as a means to achieve that

  4. 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

  5. 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

  6. 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

  7. 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

  8. Plan - Who • Ward team • Productive ward facilitator • Matron • Ward manager • Band 6 • Band 5 • Assistant practitioners • Health care assistants • Allied Health Professional rep

  9. 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

  10. 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)

  11. 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

  12. 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

  13. 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’

  14. Study • Measurements • Falls • VTE • Pus • CaUTI

  15. 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

  16. 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

  17. 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?

  18. Key impacts from SE • Increased confidence • Me, personally, professionally • The ward staff, professionally • Following a framework • Empowered by the approach

  19. 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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