Garden House Hospice
Quality Account 2014 – 2015
“I think the Hospice is a lovely place.
It is not at all what most people think its going to be.”
Quote from a Family Carer Questionnaire 2014
Garden House Hospice
Part 1: A Statement on Quality from the Hospice Management Team
Welcome to the fourth Quality Account of Garden House Hospice; a summary of our
performance against selected quality measures for 2014 - 2015 and our initiatives and
priorities for quality improvement in 2015 - 2016.
It has been produced to inform service users (current and prospective), their families, our
staff, our supporters, commissioners and the public.
Garden House Hospice
Philosophy of Care
Palliative care is the total care of patients at a time when
their disease is no longer responsive to curative treatment and
when life expectancy is relatively limited.
Our philosophy of care is based on the following principles:
That palliative care
respects the patients wishes
T
is a team approach composed of
both professional staff and
trained volunteers
integrates psychological and
spiritual care for patients, so
that they may come to terms
with their own death as fully and
constructively as they can
aims to provide relief for
patients from pain and other
distressing symptoms
helps the family cope during the
patient’s illness and in
bereavement
offers a support system to help
the patient live as actively and
creatively as possible until death
affirms life and regards death as
a normal process; it seeks
neither to hasten nor to
postpone death
To achieve the level of care we aspire to requires a dedicated multi-professional team
supported by trained volunteers. We recognise that attention to detail can contribute
significantly to the patient and family experience. As a management team we have also
worked with our colleagues to ensure the safety of our patients and families, the
information we hold about them, and that our services are effective. These aspects are
documented in the main body of the report.
The following quotes illustrate the regard in which the hospice is held by those who have
experienced the care for themselves or their loved ones from the community it is our
privilege to serve:
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Garden House Hospice
“A wonderful resource which has helped so much in coming to terms with the knowledge
that although my life expectancy is limited, I am being helped to live the life I have left in
the best way possible. The staff, volunteers, and calm atmosphere of the hospice help
more than I can express in words – thank you all”
“We were all unfamiliar with the surroundings but your own warm welcome, the
immediately attentive care and realisation of the high quality environment and facilities
put our minds at rest and enable us to focus on being close to R for our last precious
hours together.
“Coming from a medical family she had come to terms with the reality of her condition
and prepared herself for this moment but I know she was so relieved to be in the hands of
such caring and confident professionals. Please pass on our heartfelt and grateful thanks
to each and every one of your team; you and they have much to be proud of.”
As a Management Team, we are responsible for this report and its contents. To the best of
our knowledge, the information reported in this Quality Account is accurate and a fair
representation of the quality of the healthcare services provided by our Hospice.
Dr Viv Lucas
Medical Director
Sally Alford
Matron
Jenny Lupton
General Manager
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Garden House Hospice
Part 2: Priorities for Improvement and Statements of Assurance
from the Hospice Management Team
Priorities for Improvement
North Herts Hospice Care Association is the governing body for Garden House Hospice.
Garden House Hospice is situated in Letchworth Garden City. It opened in 1990 to provide
specialist palliative care to the residents of Stevenage and North Hertfordshire. Due to its
location, close to the Bedfordshire border, some patients come from Bedfordshire.
Since 1990 the services offered by Garden House Hospice have grown and developed to
meet the needs of the community. From an initial In-Patient only service, Garden House
Hospice now provides: -
12 bedded In-Patient Unit
Hospice at Home
Day Services; including Outpatients
Family Support Services
Specialist Palliative Care Advice Line
Mission Statement
Garden House Hospice offers hospice care and support to patients with life limiting
illnesses and their families.
All those who work at Garden House Hospice, in whatever capacity, share in the
common purposes, to: provide relief for patients from pain and other distressing symptoms.
help patients to live their lives with dignity, by bringing together the
psychological, emotional, spiritual and physical aspects of care.
provide care in a variety of settings, appropriate to the individual needs of each
patient.
offer support to families and carers both during a patient’s illness and into
bereavement.
Garden House Hospice is constantly seeking ways to improve the quality of care provided,
for patients and their families.
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Garden House Hospice
Garden House Hospice was inspected by the Care Quality Commission on 23rd September
2013.
These are the results of our most recent checks showing
whether this care service is meeting each of the standards
that the government says you have the right to expect.
1 Standards of treating people with respect and involving them in their care
Overall
2 Standards of providing care, treatment and support that meets people's needs
Overall
3 Standards of caring for people safely and protecting them from harm
Overall
4 Standards of staffing
Overall
5 Standards of quality and suitability of management
Overall
Key to our latest checks on standards
All standards were being met when we last checked.
Summary Inspection Report
People we spoke with during our inspection who used the service were very positive
about the care and support they received. One person said: “It is a wonderful place”.
Another person told us they had regained their appetite and said: “The food is
excellent”.
Assessments of people’s needs were centred on their preferred priorities for care and
support and were completed by a multi-disciplinary team of staff trained in palliative
care. The hospice had systems in place to ensure that care was planned and delivered
to meet people’s needs, and the needs of those close to them, at every stage of their
care.
There were effective arrangements in place to protect people in respect of the
prevention and control of infection and the safe use and management of their
medicines.
People who used the services were cared for in safe, accessible surroundings that
promoted their wellbeing.
We spoke with members of staff from a range of roles within the staff team. They all
confirmed that they received good support and appropriate training to enable them to
carry out their roles effectively.
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Garden House Hospice
Priorities for Improvement 2015 – 2016
Safety
Priority
Garden House Hospice will continue to develop systems and practices which promote and
protect patients’ confidentiality.
How was this identified as a priority?
Whilst achieving Level 2 compliance with the Information Governance Toolkit Garden
House Hospice identified further areas for development, in order to safeguard patient
confidentiality.
How will this be achieved?
A new system will be devised so that individual contractors entering the Garden
House Hospice are required to read and sign a confidentiality statement.
At present, in accordance with the Information Governance Toolkit, assurance on
confidentiality is sought from companies who send contractors; the Hospice
Information Governance Committee decided that (especially when dealing with
large companies) this was too removed from the individual working at the Hospice.
Fax Header Sheets will be standardised so that no patient identifiable information
appears on them and must only be stored and accessed from the templates folder
on the computer.
Frequently used fax numbers will be programmed into the fax machine to reduce
the risk of dialling errors and faxes going to the wrong location.
The Hospice will look to increase the amount of patient information that can be
sent and received using a secure NHS Mail Account rather than being faxed.
The Senior Sister IPU is responsible for coordinating a working group to draw up
working procedures for the NHS Mail Account and determine what types of patient
information transfers it is possible and appropriate to use it for.
How will progress be monitored and reported?
The Quality Assurance Project Worker is responsible for designing a confidentiality
agreement system for individual contractors, rationalising Fax Header Sheets and
coordinating the programming of the fax with frequently used numbers.
The Quality Assurance Project Worker reports directly to the Information Governance
Committee and the Clinical Governance Group.
The NHS Mail Account working group will report to the Information Governance
Committee who will be responsible for the final agreement of any proposed processes.
New processes will be reported to the Clinical Governance Group, which is attended by all
Heads of Department who are responsible for cascading information to their teams.
Training will be provided to appropriate individuals for any significant changes to practice.
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Garden House Hospice
Effectiveness
Priority
The patient handover, between the morning and afternoon nursing staff on the In-Patient
Unit (IPU), will be reviewed in order to ensure it is used efficiently and effectively for the
benefit of patients, families and Hospice Team Members.
How was this identified as a priority?
Members of the Nursing Team highlighted that a lot of information is exchanged at the
patient handover but this is not always the most important or appropriate information.
New Nursing Team Members shared experiences of what had worked well in other
organisations where they had worked previously.
Currently the Nurse In Charge of the morning shift endeavours to liaise with the rest of
the Nursing Team on the shift before handing over all patients to the afternoon shift.
How will this be achieved?
The Senior Sister IPU, IPU Sisters and Practice Development Nurse will consider what is
working well with the patient handover and what could be improved. Any relevant
research will be reviewed.
The In-Patient Nursing Team will be asked for suggestions of ways to improve the patient
handover.
Discussions will take place around which suggestions to trial.
An Action Plan will be formulated by the Senior Sister IPU and Practice Development
Facilitator detailing what new approaches are to be trialled, when, who is responsible for
communicating this to the Nursing Team and how.
Nursing Team members will be asked to comment on the success of the new approaches.
How will progress be monitored and reported?
The IPU Sisters will monitor if the new approaches improve the efficiency and
effectiveness of patient handovers.
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Garden House Hospice
Experience
Priority
Garden House Hospice will make more, appropriate, activities available to patients (Day
Services and In-Patients) and adult family members.
How was this identified as a priority?
The Clinical Commissioning Group (CCG) for Garden House Hospice undertook a Quality
Assurance Visit, on 14th January 2015. The resulting Action Plan required Garden House
Hospice to look at the activities it provides in Day Services.
The Hospice Management Team recognised that consideration also needed to be given to
the activities provided for patients on the In-Patient Unit and families.
The need to have ‘activities’ available for adult family members was highlighted by one
family who were at the Hospice for an extended period but ‘didn’t know what to do with
themselves’.
How will this be achieved?
Patients in Day Services are to be surveyed to ascertain which activities they may wish to
be available in the future. The survey will be conducted, in person, by the Quality and
Practice Development Facilitator, who is a trained nurse but does not routinely have
contact with patients in Day Services. The survey will be made up of a single question;
“If we could do just one more thing to make your experience at Garden House Hospice
better, what would it be?”
The results from the survey will be presented at the Day Services Meeting where
discussion will take place around which ‘one more things’ can be offered. Decisions will be
made at the meeting on who, how and by when each ‘one more thing’ is to be introduced
by.
Informal patient feedback will be recorded on the response to any ‘one more thing’ trialled
or introduced.
The patient survey will be repeated every three months to ascertain the views of different
patients attending Day Services.
The Day Services Team will continue networking with other Hospices and sharing ideas of
what has or might work well.
The Therapy Team have agreed to promote activities for patients on the In-Patient Unit
and adult family members.
How will progress be monitored and reported?
Progress on activities in Day Services will be monitored by and reported to the Day
Services Meeting. A summary of new initiatives will be reported to the Hospice’ Clinical
Governance Group.
The Therapy Team will report directly to the Hospice Management Team and Clinical
Governance Group.
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Garden House Hospice
Priorities for Improvement 2014 – 2015
Safety
Priority
Garden House Hospice will achieve Level 2 compliance with the Information Governance
Toolkit.
What has been achieved?
Information Governance is about ensuring the necessary safeguards are in place so that
information is processed legally, appropriately, securely, efficiently and effectively.
The Information Governance Toolkit is the way that health and social care organisations
can demonstrate that they are meeting the required standards for processing information
based on best practice guidance and the law. Members of the public are able to view an
organisations’ Information Governance Toolkit assessment online.
There were 19 Information Governance Toolkit Requirements that Garden House Hospice
needed to demonstrate it complied with. The Requirements were grouped in to four
categories;
Information Governance Management
Confidentiality and Data Protection Assurance
Information Security Assurance
Clinical Information Assurance
By 31st March 2015, Garden House Hospice had achieved Level 2 compliance with each of
its Information Governance Toolkit Requirements.
An Information Governance Committee was formed to manage Information Governance at
the Hospice. Membership of the committee includes: -
Hospice Medical Director; Information Governance Lead, Caldicott Guardian and
Freedom of Information Act Lead
General Manager; Data Protection Lead and Senior Information Risk Owner
Director of Nursing and Hospice Care; Registered Manager
Data and ICT Manager
All Hospice Team Members (staff and volunteers) undertook in-house Information
Governance training during 2014 – 2015 and this training is now an annual mandatory
requirement. Further training was undertaken by those with extended Information
Governance responsibilities.
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Garden House Hospice
Information Governance incidents or near misses are identified, reported and investigated
separately. They are discussed by the Information Governance Committee and reported to
both the Clinical Governance Group and Health and Safety Committee. Information
Governance is a standing Agenda item for the Clinical Governance Group which is
attended by all Heads of Department. Any changes in practice are taken to the Clinical
Governance Group and cascaded to the appropriate team(s) via their Head of Department.
Of the Information Governance incidents or near misses reported between 1st June 2014
and 31st March 2015, none resulted in a significant loss of patient identifiable information
which needed to be reported to the Care Quality Commission or the Information
Commissioners’ Office.
During the year changes to further safeguard patient information were made to Hospice
practice as a result of reported incidents or near misses and in order to comply with the
Information Governance Toolkit Requirements. Examples of changes in practice include: -
Strengthening fax usage procedures
Reducing non essential traffic at the Nurses Station
Enhanced computer security
The following Hospice policies and procedures have been written or revised to ensure they
are fully compliant with the Information Governance Toolkit: -
OM31
Information Governance Policy
OM12
Confidentiality Policy and Procedure
OM13
Policy and Procedures for the Management of Health Records
OM32
Privacy Impact Assessment Policy and Procedures
OM33
Information Technology Security Policy
OM34
Network Security and Infrastructure Policy
RM01-P02
Procedure for Reporting and Investigating Accidents, Incidents and
Near Misses
RM13
Security Policy
RM14
Emergency Contingency Policy (and associated procedures)
CM14
Access to Health Records Policy and Procedure
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Garden House Hospice
Effectiveness
Priority
The Distress Thermometer will be implemented across the Hospice and used for all
patients.
What has been achieved?
Over the past year we have spent time researching the variety of patient assessment tools
available, and what is being used locally both in the community and in the acute trust.
Our aim is to avoid overburdening patients and their families with assessments, making
sure we only use the tools that provide the richest information and therefore mean the
patients are required to undertake fewer assessments.
The Distress Thermometer has not been implemented across the organisation; however, a
holistic assessment is still undertaken at the start of every new episode of care and inpatients are assessed weekly using the PEPSI COLA holistic needs assessment tool.
Currently we are carrying out a whole documentation review, and the implementation of a
new holistic assessment tool will be part of this review.
We hope to have this implemented within the coming year.
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Garden House Hospice
Experience
Priority
Garden House Hospice In-Patient Unit will pilot planned respite for patients that have been
referred to the Hospice.
What has been achieved?
On 1st December 2014 Garden House Hospice began a pilot offering short admissions of
three/ four nights; either 2 pm Tuesday to 10am Friday, or 2pm Friday to 10am Tuesday;
for people who meet ALL of the following criteria.
Criteria
•
The patient fulfils the criteria for a referral to Garden House Hospice (GHH).
•
Patient has been referred to GHH, and their case has been discussed at the GHH
referral meeting.
•
The patient either has a DNAR order, which they will bring with them, or have been
informed that only basic life support can be offered at GHH.
•
The request must come from the community team on a short respite referral form.
•
The patient has a carer that needs a short break.
•
The patient has a care package in place which is working and will recommence
on the day of discharge. We are unable to initiate commencement OR arrange
changes in care packages from GHH for these patients.
•
The patient is symptom controlled – The patient’s condition will be assessed one
week prior to admission by the person requesting the admission.
•
The patient will supply their own medication for the admission, and has sufficient
supply for their discharge home.
•
The community team requesting the admission will arrange transport for admission
and discharge.
The patient is discharged on day 3/4 providing their condition has not changed, so it is
vital that all the above criteria are met.
The admission is nurse led, although the patient will be seen on the day of admission by a
member of the Hospice Medical Team.
The respite can be repeated, although it is anticipated this will not be more frequently
than 6 weekly.
A nursing discharge summary is sent home with the patient.
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Garden House Hospice
Currently only 3 patients have been admitted for short stay planned respite. Anecdotally,
this worked well on 2 occasions, the third patients condition changed during their respite
stay, and their status was changed to symptom control admission and their stay extended.
Formal audit has not yet taken place due to the small numbers involved.
The pilot was planned in conjunction with the community team and will continue, so that
we can evaluate the effectiveness of, and need for, this service.
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Garden House Hospice
Statements of Assurance from the Hospice Management Team
The following are statements that all providers must include in their Quality Accounts.
Many of these statements are not directly applicable to specialist palliative care providers;
explanation of these statements and why they do not apply to Garden House Hospice has
been included, in italics, where appropriate.
Review of Services
During 2014 - 2015 the Garden House Hospice provided the following NHS services: -
In-Patient Unit
Hospice at Home
Day Services – including Outpatients
Family Support Services
Specialist Palliative Care Advice Line
Garden House Hospice has reviewed all the data available to them on the quality of the
care in all of these NHS services.
The income generated by the NHS services reviewed in 2014 - 2015 represents 100% of
the total income generated from the provision of NHS services by the Garden House
Hospice for 2014 - 2015.
The income generated from the NHS in 2014 - 2015 represents 34% of the overall running
costs of Garden House.
The remaining 66% of overall running costs is sourced through voluntary income
generation; donations, fundraising, charity shops, lottery activity and income from
investments.
Participation in Clinical Audit
Garden House Hospice was not eligible in 2013 - 2014 to participate in any national clinical
audits or national confidential enquiries and therefore there is no information to submit
This is because Garden House Hospice only provides palliative care and none of the 2014 2015 national audits or confidential enquires related to specialist palliative care.
Research
The number of patients receiving NHS services provided or sub-contracted by Garden
House Hospice in 2014 - 2015 that were recruited during the period to participate in
research approved by a research ethics committee was NIL.
While Garden House Hospice has not recruited any patients to participate in research in
2014 - 2015 it has fully supported any patients who were participating in research for
other providers during this period.
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Garden House Hospice
Use of the CQUIN Payment Framework
A proportion of Garden House Hospice income in 2014 - 2015 was conditional on
achieving quality improvement and innovation goals agreed between Garden House
Hospice & NHS Hertfordshire and Garden House Hospice & NHS Bedfordshire, through the
Commissioning for Quality and Innovation payment framework.
Further details of agreed goals for 2014 - 2015 and for the following 12 month period are
available on page 17.
For NHS Hertfordshire the CQUIN payment equates to 2.5% of their total contribution.
Statement from the Care Quality Commission
North Herts Hospice Care Association is required to register with the Care Quality
Commission and its currently registered to carry out the following regulated activities:
a.
Diagnostic and screening procedures
b.
Personal care
c.
Treatment of disease, disorder or injury
For Regulated Activities a. and c. the Nominated Individual is: Vivian Lucas
For Regulated Activity b. the Nominated Individual is: Sally Alford
North Herts Hospice Care Association has the following conditions on registration:
1.
The Registered Provider must ensure that the regulated activities a. b. or c. is
managed by an individual who is registered as a manager in respect of the
activity, as carried on at or from the location Garden House Hospice.
2.
This Regulated Activity may only be carried on at or from the following locations:
Garden House Hospice, Gillison Close, Letchworth Garden City, Hertfordshire,
SG6 1QU
The Care Quality Commission has not taken enforcement action against Garden House
Hospice During 2014 - 2015.
Garden House Hospice has not participated in any special reviews or investigations by the
Care Quality Commission during the reporting period.
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Garden House Hospice
Data Quality
Garden House Hospice did not submit records during 2014 - 2015 to the Secondary Uses
service for inclusion in the Hospital Episode Statistics which are included in the latest
published data.
This is because Garden House Hospice is not eligible to participate in this system.
Information Governance Toolkit Attainment Levels
Garden House Hospice Information Governance Assessment Report score overall score for
2014 – 2015 was 66% and was graded green, satisfactory; Level 2 or above evidenced for
all requirements.
Clinical Coding Error Rate
Garden House Hospice was not subject to the Payment by Results clinical coding audit
during 2014 - 2015 by the Audit Commission.
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Garden House Hospice
Part 3: Review of Quality Performance
The National Council for Palliative Care (NCPC): Minimum Data Sets
The NCPC minimum data sets are the only information on hospice activity collected
nationally. The figures provide one measure of activity and outcomes of care for patients,
at Garden House Hospice, during the period 2014 – 2015 (2013 – 2014 figures provided
for comparison).
In-Patient Unit
2014 - 2015
2013 - 2014
Total number of admissions
258
260
Total number of patients
232
215
Number of new patients
214
197
% Occupancy
72
71
% Patients returning home
37
39
Average length of stay – cancer patients
12.6 days
12.4 days
Average length of stay – non-cancer patients
12.5 days
7.9 days
2014 - 2015
2013 - 2014
Total number of patients
109
125
% New patients
62.3
83.2
% Patient attendances
82
87
% Patient non attendances
18
13
2014 - 2015
2013 - 2014
Total number of patients
234
239
% New patients
95
92
% Re-referred patients
2
3
Total face to face contacts
2621
2270
Total telephone contacts
229
954
12.7 days
17.7 days
Day Services
Hospice at Home
Average length of care
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Garden House Hospice
Outpatients
2014 - 2015
2013 - 2014
62
89
Patients Diagnosis; Cancer/malignant diagnosis
58
68
Other diagnosis
3
16
Not recorded
1
5
% New patients
68
56
% Re-referred patients
8
6
Seen by Palliative Care Doctor (1st and follow up visits)
100
78
Seen by Physiotherapist
44
52
Seen by Complementary Therapist
109
229
2014 - 2015
2013 - 2014
Total service users
95
107
Number of telephone contacts
182
126
Number of individual counselling sessions
510
408
Number of group counselling sessions
49
65
Total number of patients
Bereavement Support
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Garden House Hospice
Performance against Commissioning for Quality and Innovation
(CQUIN) Payment Framework 2014 - 2015 - NHS Hertfordshire
Indicator Weighting
(% of CQUIN
scheme available)
Implementation of Friends and Family Test
1.25%
CQUIN Achieved
Comprehensive Holistic Assessments
1.25%
CQUIN Achieved
Commissioning for Quality and Innovation (CQUIN) Payment
Framework 2015 - 2016 - NHS Hertfordshire
Garden House Hospice is in discussion with East and North Herts Clinical Commissioning
Group about its CQUIN targets and payment framework for 2015 – 2016.
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Garden House Hospice
Complaints
During the period March 2014 – March 2015: Total Number of Complaints
2
Total Number of Complaints Upheld in Full
0
Total Number of Complaints Upheld in Part
0
Total Number of Complaints Not Upheld
1
Total Number of Complaints Still On-Going
1
Complaint Upheld in Part:
Initially Written Complaint via Family/ Carer Questionnaire, then telephone call; Lack
of support whilst caring for Father dying at home
Findings;
o Questionnaire received, followed by a telephone call and discussion with
Family Support Team Leader
o Meeting with Matron offered and accepted
o Complaint was particularly regarding care/ support received by District
Nurses and Community Macmillan Team.
o Concerns were passed on to the relevant teams and actions/ apology
received back.
Complaint Still On-Going
Written complaint regarding communication between multiple agencies involved in
care
Findings;
o Letter sent to complainant to ask for permission to share information with
other agencies so that the complaint could be investigated
o 12 months have passed there has been no response from complainant.
Concerns
During the period March 2014 – March 2015 no concerns were raised.
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Garden House Hospice
Patient Accident, Incidents and Near Misses
The following patient related accidents and incidents were reported and investigated
during the period 2014 – 2015 (2013 – 2014 figures provided for comparison).
Medicines Related Incidents
39
(10)
Slips, Trips and Falls
45
(32)
Other*
40
(43)
Pressure Damage on Admission
22
(48)
Pressure Damage During Admission
09
(08)
No serious incidents were identified during the period 2014 – 2015
It is felt that the increase in the number of accidents, incidents and near misses is mainly
due to improvements in the reporting process.
Following medicines related incidents, where appropriate, the clinician involved is asked to
reflect on the incident and produce a report. Nurse team members may be required to
retake their medication competencies, before being allowed to administer further
medication.
All patients are risk assessed for pressure area damage on admission. Any patient found
to have pressure area damage, or assessed as being at high risk of developing pressure
area damage, is nursed on a pressure relieving mattress and chair cushion, and is
repositioned regularly. The risk assessment is reviewed on at least a daily basis, and
additional measures are taken as necessary.
The majority of slips, trips and falls related to deteriorating patients trying to maintain
their independence. After each patient fall, the team consider possible reasons for the fall
and additional safety measures that may prevent a further fall without removing the
patient’s independence. Additional safety measures may include; low level bed, crash
mats, regular toileting and reviewing medication.
Examples of Others
* Transport that was booked for 15.00 hours to take patient home did not arrive until
23.40. Patient was offered the choice to stay overnight and go home the next day, but
patient insisted on going home.
* During H@H team visit to a patient, an envelope was delivered through the post and
when opened by the patient wife, it was found to contain a Do Not Attempt
Cardiopulmonary Resuscitation (DNAR) form for her husband. Patient’s wife was very
upset as she had no idea what the form was for. It appears that she was unaware of
any discussion regarding her husband DNAR status. This incident was taken to the
relevant Gold Standards Framework meeting.
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Garden House Hospice
* A patient informed a member of staff that she believes her children were stealing her
money from her bank account and also her jewellery and therefore does not feel able to
return home to live with them. Safeguarding procedures followed.
* Hospice at home team arrived at patient’s home and were unable to gain access as
patient had fallen in the kitchen. District Nurse had visited 10mins earlier and left a
note to say no answer at which point patient had been on the floor for 1½ hours.
District Nursing team leader informed of incident and to investigate.
* A patient was discharged from IPU to a Nursing home. On arrival, it was discovered that
oxygen had not been ordered for patient, the Nursing home could not accept the patient
as there was no Oxygen for patient to use. Patient had been on continuous oxygen
during his stay on IPU.
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Garden House Hospice
Clinical Audit
During the period 2014 - 2015 the following, audits, were undertaken, using national audit
tools designed specifically for hospices, by Help the Hospices.
Audit Title
Date
Recommendations
Actions
Completed
Infection Prevention and Control
1. Policies and Processes
12/14
Add transmissible spongiform
encephalopathies to infection
control policy when next
reviewed.
Due for review
July 2015
2. Hand Hygiene
03/15
None
N/A
3. Patient Areas
O3/15
None
N/A
4. Clinical Rooms
12/14
None
N/A
5. Bathrooms
08/14
None
N/A
6. Patient Toilets/Bidets
12/14
None
N/A
7. Sluice/Dirty Utility
05/14
None
Yes
8. Domestic Rooms
05/14
None
N/A
9. Care of Deceased Patients
09/14
None
N/A
10. Sharps
12/14
None
N/A
11. Protective Equipment
12/14
None
N/A
12. Kitchen Areas
(excluding Main Kitchen)
07/14
Some repairs required
Yes
13. Public Areas
07/14
None
N/A
14. Toilets for Public Use
04/14
None
N/A
15. Offices within Clinical Areas
04/14
None
N/A
16. Visitors’ Accommodation
12/14
Communal items found in Removed
ensuite bathroom to be removed immediately
02/14
None
Bereavement Support
Bereavement support service
audit tool
N/A
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Garden House Hospice
Internal clinical audits in the period 2014 - 2015 included: -
Actions
Audit Title
Date(s) Recommendations
Discharge Audit
01/03/14
–
31/05/14
Carry out a real time discharge
audit, as discharge plans are being
made, to uncover any problems.
Real time audit
Real Time Discharge Audit
01/09/14
–
31/10/14
Plans for discharge need to be
better recorded in the patients
notes. More detail is needed on the
review page and the discharge
paperwork
To be
re-audited in
12 months
Consistency of paper and
IT records Audit
01/10/14
–
30/11/14
From this sample of notes, specific
items / treatments are poorly
recorded on iCare.
Permission to Share Information is
not being documented correctly.
Also, for Information Governance
Toolkit requirements, consideration
needs to be given to seeking
permission whenever a patient has
‘new’ contact with the Hospice.
Permission to
share
information
documentation
altered /
permission to
share
information
now
documented
on each ‘new’
contact with
the Hospice
End of Life Care Audit
Aug
2014 –
To ensure it is well documented if a Re-audit in 6
patient
does
not
require months
psychological or spiritual support
when it is offered.
Oct 2014
RAG tool audit
Assessment of Capacity
Audit
Nutrition Tool audit
01/01/14
–
31/12/14
All relevant data to be stored
together so reports can be run
more easily. Data collection tool to
be streamlined.
24/04/14 Clinical Team to be reminded of the
value of completing the Assessment
of Capacity Sheets
Re-audit in 12
months
29/05/14
Re-audit in 12
months
Allergies to be marked as Not
Applicable if there are none.
The review date should always be
completed.
Re-audit in 6
months
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Garden House Hospice
Feedback from Patients and Families on Services
Garden House Hospice values the feedback we receive from patients and families; the
Hospice Team is constantly looking for ways to maintain and improve the quality of care
for patients and their family/carers.
Patient Questionnaires are given out during a patient’s stay on the In-Patient Unit, in
conjunction with their first Day Hospice Review (usually the 4th visit) and by the
Hospice @ Home Team, to respite patients, on their fourth visit. Matron reviews returned
questionnaires and acts on any issues raised, immediately. Questionnaires are confidential
but patients are given the option to give their name; if they would like a written response
or the opportunity to comment further on our services. Questionnaires are audited every
six months.
Family/Carer Questionnaires are sent out, via the Family Support Team, with the offer of
bereavement support, six weeks after the patient’s death, given to family/carer on a
patient’s discharge from the In-Patient Unit and displayed around the Hospice for families
and carers to pick up. Matron reviews returned questionnaires and acts on any issues
raised, immediately. Questionnaires are confidential but family/carers are given the option
to give their name and address; if they would like a written response or the opportunity to
comment further on our services. Questionnaires are audited every six months.
Family Support Service Questionnaires are handed to all individuals who have completed a
series of planned support sessions, with the Family Support Service, at their last support
session. Occasionally questionnaires are sent out. The Family Support Service Manager
reviews returned questionnaires and acts on any issues raised, immediately.
Questionnaires are confidential but individuals are given the option to give their name and
address; if they would like a written response or the opportunity to comment further on
our services. Questionnaires are audited every six months.
All these questionnaires ask the individual to score statements, about the various Hospice
Services and Departments, from 1 – 4; 1=very dissatisfied, 2=dissatisfied, 3=satisfied,
4=very satisfied N/A=Not Applicable.
Doctor Feedback Questionnaires are sent out (with a reply paid envelope) when any
doctor sees a patient for the first time as either an outpatient or at a home visit. There are
ten questions about the consultation which can be scored; Yes definitely, To Some Extent,
Not Really, Definitely Not or Does Not Apply. There is an additional question, ‘Overall, how
satisfied were you with the doctor that you saw?’ This can be scores; Very Satisfied, Fairly
Satisfied, Not Really Satisfied or Not At All Satisfied.
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Garden House Hospice
Patient Questionnaires
Comments relate to Patient Questionnaires received back between 1.1.2014 and
31.12.2014. During this year 31 Patient Questionnaires were received back.
Care and Support
Overall, how would you rate the quality of care/treatment you received?
Scored 110/112; 98% satisfaction
“When I first arrived, I had no idea what to expect. What a gem! Friendly, attentive staff –
nothing too much trouble. Full access to two principle doctors, a physio and spiritual
helpers. A 100% supportive visit”
“We are very lucky to have such a terrific facility in N. Herts.”
Admission/Arrival at the Hospice
Welcome given on arrival
Scored 114/116; 98% satisfaction
Facilities
Cleanliness
Scored 104/108; 96% satisfaction
Nutrition and Diet
Were your dietary needs met
Scored 81/88; 92% satisfaction
“First class welcome and introduction. High quality food and spotlessly clean. A very
impressive hospice. Staff are exceptionally friendly, helpful and caring.”
Day Hospice
Structure of the day
Scored 71/76; 93% satisfaction
“I can say I never expected anything as clean and caring of all staff and all treated like a
family. I look forward to each Tuesday. No one could believe unless they go and see for
themselves. I thank whoever enabled me to go.”
Hospice at Home
Is the service reliable? (Yes/No response)
Scored 11/11; 100% satisfaction
“All the nurses have been excellent, understanding and have shown compassion. I think
this service should be extended as it provides a sevice that is valuable to the patient and
provides support to the family.”
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Garden House Hospice
Family/Carer Questionnaires
Comments relate to Family/Carer Questionnaires received back between 1.1.2014 and
31.12.2014. During this year 138 Family/Carer Questionnaires were received back.
How would you rate the quality of the care/treatment you and your relative received?
Garden House Hospice Overall
Scored 487/488; 99.7% satisfaction
“I have no criticism about the wonderful staff and facilities at the Hospice. Even I as the
carer feel relaxed when visiting and confident having left the one I love”
“A fantastic welcoming homely environment for all the family at such a difficult time.”
“The decision for mum to go to the GHH was made by luck than judgement and we regard
ourselves to have been very lucky. Availability of other rooms for family to wait while we
visited, especially for children, was a great benefit too.”
In Patient Care
Information regarding changes in care
Scored 286/304; 94% satisfaction
“We as a family were overwhelmed by everyone’s commitment towards my wife’s every
need – as well as ours which enabled us to spend time together. Thank you all.”
“In the short time that my husband was with you, you all managed to give him back his
dignity and pride. I will always be so grateful to you all.”
Drop In
Usefulness of information received
Scored 109/116; 94% satisfaction
“The 4* areas above were invaluable to us in the beginning so we knew what would be
available when needed. Many thanks.”
(* Welcome given on arrival; Usefulness of hospice tour; Usefulness of information
received; Availability of access to the hospice team)
Day Hospice
Availability of access to the Day Hospice Team
Scored 70/72; 97% satisfaction
“Allows connection between patient and the Hospice and gives reassurance.”
Hospice at Home
Frequency of visits
Scored 199/204; 98% satisfaction
“Without the care at home team we would not have been able to carry out my sister’s last
wishes.”
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Garden House Hospice
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“The nurses were always friendly, respectful and professional – a very valuable
service.”
-
“An overnight service provided by you would have been a great help, as I know he
would have excellent care and I could relax and sleep well.”
-
“Would like to see even more involvement from the nurses as visiting the Hospice
becomes more difficult.” (In relation to Hospice at Home)
Garden House Hospice is currently in talks with the clinical commissioners with the aim of
increasing the services Hospice at Home can provide, subject to funding.
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Garden House Hospice
Family Support Service Questionnaires
Comments relate to Family Support Service Questionnaires received back between
1.3.2014 and 28.02.15. There was a response rate of 47% (27/57).
Before your first appointment
Was the time you waited for your first appointment acceptable?
Scored 104/108; 96% satisfaction
“I was extremely pleased with every aspect of the bereavement counselling I received at
GHH. Thank you! D quickly arranged my first session for me and I always felt entirely
secure, supported, helped and listened to by my counsellor A P. She helped me through
some very difficult times in my grief and I am very grateful.”
Your sessions with the Family Support Service
Were you helped to feel comfortable and at ease in the session?
Scored 106/108; 98% satisfaction
“X is a really superb counsellor who was warm and engaging and helped me loads. I’m
incredibly grateful.”
Do you feel the person supporting you understood what you talked about in the
sessions?
Scored 108/108; 100% satisfaction
“Just a big thank you to G. I really feel she understood and cared.”
Now your sessions with the Family Support Service have come to an end
Do you feel the support from the Family Support Service has been helpful to you?
Scored 100/104; 96% satisfaction
“G has been a wonderful support, helping me through my dark period of grief. She is an
attentive, empathetic counsellor and I really appreciated her time. G has not just helped
me through the journey of grief but other issues that have arisen from my bereavement.
Thank you from the bottom of my heart - I will never forget G.”
“As you can see from my answers I was quite happy with the sessions but I am not sure
where it leaves me at the end and what was the real purpose of the counselling.”
How likely would you be to recommend the Family Support Service to another person?
Scored 103/104; 99% satisfaction
“A big thank you. The service was excellent. It has really helped me at a very difficult
time. It allowed me to talk to someone who was independent from the family. I had some
M time to express my feelings it allowed me to feel how I feel.”
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Garden House Hospice
Doctor Feedback Questionnaire
Doctor Feedback Questionnaires are sent out when any doctor sees a patient for the first
time as either an outpatient or at a home visit. Questionnaires and comments are
reviewed, as soon as they are returned, so that any necessary actions can be taken.
Questionnaires are audited annually.
No actions have been necessary to date.
The following comments relate to the 32 Doctor Feedback Questionnaires, relating to
consultations with four doctors, received back between 1.05.2014 and 30.4.2015.
Overall, how satisfied were you with the doctor that you saw?
Very Satisfied
32/32
Fairly Satisfied
0/32
Not Really Satisfied 0/32
Not At All Satisfied
0/32
“He was very patient, and gave me all the answers I needed about my condition. Thank
you.”
“Fantastic support from all departments, very happy indeed.”
“Dr Y was very understanding and put me and my partner at ease straight away.”
“The doctor was very kind and understanding.”
“A very enjoyable appointment – I felt that Dr Y was really listening to what I had to
say…... Thank you.”
“Dr Y took the time to listen to how I was Feeling and explained the treatment I could
have and did not try to fob me off.”
“Dr Y was very re-assuring & informative regarding my condition. The consultation was
kept at a relaxed pace, helping me to understand.”
“The doctor was very compasionate & caring. Thank you.”
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Garden House Hospice
External Statements:
NHS Hertfordshire
East and North Herts Clinical Commissioning Group’s Response to the Quality
Account provided by Garden House Hospice, Hertfordshire
East and North Herts CCG (ENHCCG) has reviewed the information provided by
Garden House Hospice and we believe this is a true reflection of performance during
2014/15, based on the information submitted during the year as part of the on-going
quality monitoring process.
During 2014-15, Garden Hospice continued to deliver high quality care to the
population of Hertfordshire. The Quality Account clearly sets out achievement
against the priorities set for 2014-15 and demonstrates continued quality
improvement with a number of improvements being made to ensure the safety of
patients receiving care.
The Hospice continues to ensure the service user’s feedback and involvement is key
in supporting all areas of service development, and service user feedback is actively
sought through feedback questionnaires. The quality of service provided is evident
through the positive feedback received from patients and relatives throughout the
year.
The priorities set out for 2015/16 build upon the successes of 2014/15 and
demonstrate a commitment to developing services further whilst maintaining a focus
on improving quality as well as staff and patient experience.
During 2015-16 the CCG looks forward to building on the relationship already
developed with the hospice to ensure open dialogue and continued quality
improvement for the population of Hertfordshire.
Healthwatch Hertfordshire
No response was received from Healthwatch Hertfordshire.
Hertfordshire Health Scrutiny Committee
No response was received from Hertfordshire Health Scrutiny Committee.
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Garden House Hospice
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Garden House Hospice
Garden House Hospice
Gillison Close
Letchworth Garden City
Herts
SG6 1QU
Telephone: 01462 679540
E-mail: enquiries@ghhospice.co.uk
Website: www.ghhospice.co.uk
North Herts Hospice Care Association Registered Charity Number 295257
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