St Christopher’s
Quality Account 2014-5
(Photo to be supplied by Nicola)
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St Christopher’s Quality Account 2014-5
Part 1
Statement on quality from Joint Chief Executives
As new Joint Chief Executives we have deliberately taken time in this our first
year since appointment to get to know staff and to understand and appreciate
the breadth of services delivered by St Christopher’s. We were heartened by
the enthusiasm and involvement of staff and volunteers in the ‘values events’
which we set up to discuss, review and refresh the underpinning values of St
Christopher’s and indeed that work has informed the strategic direction for
2015-6.
This Quality Account described some of the quality initiatives that St
Christopher’s has undertaken during 2014-5, as well as the methods of quality
assurance employed. We are pleased to note that efforts to deliver high
quality care are combined with enthusiasm and energy for innovation.
Improving end of life care
This Quality Account reports on the improvement indicators we set ourselves
for 2014-5 and sets new indicators for 2015-6. We are also proud of what we
have achieved in a number of new and recent developments, and describe
these briefly below.
Health and social care
In last year’s Quality Account we referred to our developing work to bring
together health and social care to reduce fragmentation of care at the end of
life. All our services aim to help people die with dignity in the place of their
choice, and to reduce unnecessary hospital admissions.
The Bromley Care Coordination Service, commissioned in December 2013 by
the Bromley Clinical Commissioning Group, is no exception. It was set up to
enable people with progressive and advanced illness or frailty to receive
timely and well-coordinated care and has played an important part in helping
patients to access other health and social care services, speeding up access
to equipment and booking Marie Curie Nurses for the borough. The service
has been highly successful in providing end of life care to people who have
traditionally failed to access specialist palliative care services, in particular
people with conditions other than cancer. BCC’s annual review highlights the
following successes:
 Prevention of hospital admissions through good care coordination and
a rapid response
 Just under 80% of those who received the service died at home, where
they wished
 GPs have welcomed the service and make use of it
 Patients with more complex needs have been transferred swiftly to the
specialist community palliative care service
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This truly integrated service is a first point of contact for patients, families and
professionals and aims to speed up and smooth any transfers of care from
one service to another for people whose health and social care needs are
changing fast. We are delighted to have received national recognition for our
innovative approach having both been shortlisted for the HSJ Patient Safety
and Care Awards 2014 in the end of life care category, and won the Hospice
UK ‘Innovation in Care’ award.
Our Bromley Personal Care service delivers personal care to people thought
to be in the last 6 months of life who are being discharged from the Princess
Royal University Hospital. We receive Health funding to take 260 referrals in
the course of a year. Our aim is, first, to keep clients in their own homes in
their last weeks and months of life. We achieve this through engaging a mix of
experienced end of life nurses and highly trained carers who are able to
manage the client’s often fluctuating and unstable condition, thus reducing
preventable hospital admissions. We work with the family to help them
understand the symptoms so they are less likely to call for an ambulance
unnecessarily. If clients are admitted to hospital our nurses collaborate with
hospital teams to enable safe and timely discharges. The service is able to
react quickly to the needs of the hospital and can expedite discharge seven
days a week.
Our personal care service in Croydon is funded by the Local Authority and is
aimed at people thought to be in their last year of life. The average length of
contact is 12 weeks. Given the choice, most people would prefer to die in their
own home. To date, our Bromley service has achieved a home death rate of
70% (141 clients), with only 8% of clients (17) dying in hospital. This is a
remarkable achievement give the average hospital death rate in Bromley for
people with chronic conditions is 56%. In Croydon we have achieved a home
death rate of 66% over the last year. Feedback from both services has been
outstanding.
Young adults
During 2013/14 we ran a pilot project to identify and support young adults
across South East London who were living with a life-limiting illness and
moving from children’s to adult services. Many of these young adults find that
their age prevents them from accessing supportive paediatric care and yet
they do not quite fit into adult services. After consulting with the young adults
we set up regular social and theraputic days which we have run weekly since
January 2015. Siblings and friends also attend. The value of these days is
expressed by one of the young people who said “ The support is amazing,
getting young people out more and showing them there is more to life than we
think, interacting with others and engaging in activities..In fact just the going
out and meeting people is really good, who support you and make us feel
normal instead of being in the same place every day and being around the
same people can get boring.”
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Education and training
We see education as a key contributor to the vision of St Christopher’s, of a
world in which all dying people and those close to them have access to
appropriate care and support, when and wherever they need it and whoever
they are. Key to our strategic ambition, is the support of high quality care
delivery for people who are dying or who face loss whether they live locally, or
elsewhere in the UK or the world. We will achieve this, in no small part,
through education and training. Our education strategy reflects this conviction
and our 5 year business plan supports our intention to lead on the design and
delivery of an effective and innovative education programme to health and
social care staff. We aim to reach both registered professionals and support
workers, from all care settings.
The past year has seen the delivery of national vocational and accredited
qualifications through our City & Guilds approved centre. This development
includes two new qualifications exclusive to St Christopher’s; the ‘Care
Certificate (Cavendish) and 3-day and 6-day courses in ‘first-aid’ cognitive
behavioural therapy (CBT) skills. CBT is a recommended intervention for
patients with anxiety and depression, for use by health care staff caring for
people with long- term conditions and at the end of life. Our robust quality
assurance processes are externally monitored by City & Guilds.
We continue to work collaboratively and strategically with partner
organisations. In particular we have worked closely with our local FE college
to deliver an apprenticeship framework which includes a new health and
social care diploma in long term conditions, frailty and end of life.
Whenever we can we share our teaching resources and expertise with other
hospices. It is our hope that NHS partners including acute trusts and
independent care providers such as care homes will increasingly recognise
the hospice sector as a valuable palliative and end of life care training
resource. To this end we have invited other hospices to register with us as
satellite centres so that they can deliver the same high quality training.
We have formed a partnership with the British Medical Association to publish
our end of life care journal which now includes social care as well as nursing.
We hope that the BMA’s national and international profile will increase access
and expand our readership.
Our Care Home Team (see dedicated pages on the St Christopher’s Hospice
website: www.stchristophers.org.uk/care-homes ) has continued working with
local care homes (nursing and residential) across five local CCGs, and the
team are actively involved in research to improve care and provide an
evidence base for activities such as advance care planning and to
disseminate learning from projects like the Namaste programme for people
with very advanced dementia.
In this, our fifth Quality Account, we identify our priorities for quality
improvement for 2014-5, and review our performance against the quality
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indicators we selected last year. We have been closely involved in this review
and in developing these measures, which have been endorsed by the Board
of Trustees. I am able to confirm that the information in this Quality Account
is, to the best of our knowledge, accurate.
Heather Richardson and Shaun O’Leary, Joint Chief Executives
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Part 2
Priorities for improvement
We have identified three areas for improvement in the coming year, under
each of the domains of quality set out in the Department of Health Report
High Quality Care for All: patient safety, clinical effectiveness and patient
experience.
1. Patient safety
One of the most common clinical incidents in the inpatient setting is
patient slips, trips and falls. These take place most often as a result of
extreme weakness or confusion when patients attempt to go to the
bathroom without calling for help. While we have a number of strategies
to prevent and reduce the impact of falls, we also want people to retain
their independence for as long as possible.
What are we aiming to achieve?
Because of the frequency of incidents of slips, trips and falls we regard
this as a priority area which we continue to monitor, despite the fact that
only 1% of such incidents result in harm (e.g. laceration or fracture).
During 2015-6 we are setting up a Prevention and Confidence Group,
aimed at patients that have had, or are at risk of, falls or who are anxious
about falling. Family members and carers will also be actively encouraged
to attend with or without the patient. Topics and discussions will include
causes of falls, improving the safety of the environment at home, what to
do if you fall, how to get up, how to help a patient/ relative and exercises
to strengthen and improve balance. All participants will be provided with a
booklet containing the information discussed and a tick sheet to monitor
exercise progress. The group will be facilitated by our occupational
therapists and physiotherapists.
How will we know what success is?
We will monitor the number of sessions delivered and attendance at each
session. We will seek feedback from participants and, where appropriate,
use the Modified Falls Efficacy Scale (adapted from Tinetti et al, 1990; Hill
et al, 1996) to measure change in confidence levels in carrying out a
range of tasks.
2. Patient experience
What are we aiming to achieve?
Earlier this year we introduced the Family and Friends Test (FFT)
question (How likely are you to recommend St Christopher’s to friends
and family if they needed similar care?) to patients on discharge from our
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inpatient unit. We plan to continue to do so throughout the current year
(April 2015 to March 2016).
We are also asking bereaved carers the same question as part of the
VOICES-Hospices survey which we send to the main carer following the
death of the patient.
How will we know what success is?
Since this is the first year of operation, we do not yet have a baseline
measurement. However, we aim to find ways of benchmarking the first
year results with those of other hospices using the FFT in order to set
ourselves a target in future years.
3. Clinical effectiveness
What are we aiming to achieve?
During 2014-5 we began participating in the OACC (Outcome
Assessment and Complexity Collaborative) led by the Cicely Saunders
Institute. The project builds on and feeds into national and European work
on outcomes measurement initiatives and aims to provide a common
language within and between palliative care providers to achieve better
care for patients and families, drive improvements and provide evidence
of the impact of care. The OACC measures have been selected to
monitor changes in key domains relevant to patients receiving palliative
care, and their families. We began using most of the measures in January
and are beginning to receive initial results from the data we have
submitted.
How will we know whether we have achieved this?
During 2015-6 we will implement all of the measures and develop a set of
baseline results against which we can assess the effectiveness of the
care we provide.
We will review progress in relation to each of these 3 priority areas at Board
meetings twice a year.
Review of indicators for 2014-5
Patient safety
Because of increasing numbers of patients with tracheostomies who are
admitted to the inpatient unit, last year we said we would deliver training in
tracheostomy care to between 45 and 50 registered inpatient nurses
(depending on vacancies). We wanted to develop competency-based
workbooks to evaluate the learning of nurses who participated in the training.
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What we did:
Our advancing practice team trained 58 of our inpatient unit registered nurses
(as well as a number of HCAs and clinical nurse specialists working in home
care). The workbooks have been developed to assess competency and when
patients with tracheostomies are admitted to the inpatient unit, we assess
their practice against the competencies in the workbooks.
Clinical effectiveness
Last year our target was to enter the details and wishes of 90% of our new
patients on the Coordinate My Care (CMC) information system. This system
is a patient consented networked palliative care information system which
assists shared decision making, particularly out of hours. Our aim was that
new patients at home or due to be discharged home should be entered onto
this record, so that all the healthcare professionals who might be involved in
the care of a person was aware of their wishes and of the other professionals
involved in their care.
What we did: By the end of March 2015 we had entered 99.04% of new
patients onto the CMC with their consent. The discussions that take place
with patients about sharing their wishes with other key health professionals is
a routine part of practice and the CMC has proved to be a useful vehicle for
enabling care to be coordinated especially out of hours.
Patient experience
Last year we said that we would survey the views of patients on the ward
about the quality of the food they were served. We introduced an à la carte
menu and greater flexibility to permit patients to eat when they wanted rather
than at set mealtimes. We also wanted to make sure that nutrition
assessments were being carried out of all patients on admission, and decided
to audit this for a period of time and report on the results.
What we did: We surveyed the views of 40 patients during the autumn of
2014, seven of whom had been on the inpatient unit for less than a week and
8 for more than 2 weeks. Eighty seven percent (87.5%) rated both choice and
presentation as good or excellent (4 or 5 on a scale of 1-5); 85% of
respondents rated quality as good or excellent (4 or 5 on a scale of 1-5). Most
respondents said that their portion sizes were about right (72.5%), though
portions were too big for some and too small for others. The majority of
patients (75%) were aware that they could order food between meal times.
The results of the survey have been conveyed to the catering team and
clinical staff who scrutinise the experience of service users and we will
continue to find ways of responding to individual needs.
We undertook an audit of nutrition assessments carried out on patients
admitted to the inpatient unit between April 2014 and mid- March 2015 to
check that the assessments were completed promptly (within 3 days of
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admission). The audit found that 96% of assessments were completed within
the target timeframe. Nurses were reminded to complete assessments when
they had not done so. Records showed that referrals to the dietician and/or
speech and language therapist took place where needed.
Participation in clinical audits
As an independent hospice, St Christopher’s does not participate in the
national NHS clinical audit programme that covers subjects that do not apply
at the hospice. However, we regularly undertake audits which we select
according to regional, local or internal priorities.
Audits we have carried out in 2014-5:
Completed audits 2014-5
Subject matter
Implication for practice/outcomes of
audit
Follow-up actions
Mattress audit
Mattresses are serviced annually.
Monthly audits identify any actions that
may be required between services. For
example any stained mattresses are
cleaned and sent for decontamination.
Continue to audit
Nutrition
assessment audit
An audit was undertaken of nutrition
assessments carried out on patients
admitted to the inpatient unit between
April 2014 and mid- March 2015 to
ensure that they were completed within
3 days of admission. The audit found
that 96% of assessments met this
target. Nurses were reminded to
complete assessments when they had
not done so. Records showed that
referrals to the dietician and/or speech
and language therapist took place
where needed.
Continue to audit
Site waste
management reaudit
A site audit of waste was carried out by
our waste disposal company in May
2014 and by the Head of Facilities in
Sydenham and Matron in April 2015.
The hospice was found to be
compliant. Improvements in the
Re-audit annually
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Follow up Actions
Subject Matter
Implication for practice/outcomes of
audit
Site waste
management reaudit cont.
external bin storage area at the
Sydenham site were recommended
and are planned.
A pool car audit was carried out in April
2015. Nurse managers have been
advised to ensure that sharps and
medicines are not left in cars and that
any sharps are transported in specific
containers.
Sharps
management
reaudit
A sharps management audit was
carried out by Daniels Health Care and
Matron in March 2015. Mandatory
sessions continue to include training in
the assembly of sharps containers,
labelling and storage and closure of
containers.
Re-audit annually (and
in 3 months for
community teams)
Annual infection
control audits
An annual infection control audit was
carried out by the Infection Prevention
& Control Matron, Lewisham and
Greenwich NHS Trust & St
Christopher’s Matron.The ward
environments were fully compliant. A
recommendation was made to review
the storage in the bathroom areas to
reduce as much as possible equipment
that was being stored there.
Regular audit
Hand hygiene reaudit
These audits occur monthly and have
highlighted the need for non- clinical
staff to be reminded about hand
hygiene. Additional annual training has
been provided for volunteers, orderlies
and stewards
Continue to audit
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Subject matter
Implication for practice/outcomes of
audit
Aseptic technique
Practice guidance in relation to
venepuncture and care of central
venous access devices and dressings
has been revised and standardised
Isolation
precautions
Observation of practice showed that
staff were implementing effective
isolation practices.
Audit of patient
slips, trips and falls
Audit of care home
deaths
Family perceptions
of care (FPC) in
care homes
Falls during the 12 months 2014-5
have been benchmarked against those
in other large participating hospices.
Our results show that we had 14.4 falls
per1000 occupied bed days compared
with the category average of 12.3,
however we have a higher % of falls
that result in no harm or where harm is
prevented (near miss) than the
category average, and a lower % of
falls resulting in low and medium harm.
The care home project team working in
collaboration with local care homes is
continuing its long-term programme to
reduce the number of inappropriate
deaths in hospital of care home
residents. Rates of death in care
homes (as opposed to hospital)
continue to increase, as does the use
of end of life care tools such as
advance care planning. In 2013-4 the
% of care home deaths across 72
nursing care homes was 77%
(compared with 57% across 19 nursing
care homes in 2007-8).
The FPC audit aims to capture the
family’s satisfaction with the quality of
care provided to nursing home
residents in their last month of life.
Forty nine homes took part in the audit
and there was a 44% response rate
from families. The results of the audit
are being used to put together plans
with each care home to improve the
end of life care they deliver, as well as
to help homes learn from each other.
Follow-up actions
Continue to audit
Continue to audit
Continue to audit
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Subject matter
Implication for practice/outcomes of
audit
Follow-up actions
Pressure ulcer
audit
Pressure ulcers that have developed in
inpatients in 2014-5 have been
benchmarked against those occurring
in other large participating hospices.
Our results show that we had 6.3
pressure ulcers per 1000 occupied bed
days compared with the category
average of 4.1. However, 97% of
theses were assessed as unavoidable,
as compared with 94% in
the category average.
Continue to audit.
Medical Discharge
summaries April
2014 to March
2015
99% of all medical discharge
summaries were completed as
required. 95% were sent within the
standard of 3 working days.
This is a regular annual
audit to monitor the
consistency and
timeliness of medical
team communication
with GPs.
Repeat audit 2016/2017
Re-audit of consent Repeat audit (previous 2009) to review
for Interventional
progress on the 2009
pain procedures.
recommendations. Further
recommendations added. Main
problems identified were administrative
(patient details not being fully entered
on forms) and the patient information
sheet not being used in every instance.
Re-audit of oxygen Repeat audit to review progress on
prescribing and
2009 audit and 2010 revised clinical
use on the
guidelines. In most patients an
Inpatient Unit
appropriate concentration of oxygen
was prescribed and appropriate
equipment used; however, the
rationale for oxygen use was not
always clearly documented in the
notes, the recording of oxygen use was
sometimes incomplete and a number
of patients were given oxygen without
a prescription. Recommendations for
reviewing oxygen prescription and for
nurse and doctor training were made.
Information
- Confidentiality audit continues to raise
Governance Audits the profile of good practice and identify
areas for improvement.
- Electronic Patient Record (EPR)
consent to share patient information
launched, audited and reminder pop-up
to fill in added to EPR to encourage its
use.
Repeat audit once
recommendations
implemented.
-Annual.
-Repeat audits 2015
before and after
reminder added to EPR.
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Participation in clinical research
St Christopher’s has been involved in conducting several clinical research
studies, either alone or in partnership with others.
1.
The Bromley Research Project in Palliative Care for Heart Failure
(Developing and testing a new model of palliative care for people with
chronic heart failure: a feasibility study) received ethics approval in
2014. Recruitment is complete and the research is under way.
2.
We are participating in the ACCESSCare Project funded by Marie
Curie Cancer Care and led by King’s College Hospital exploring the
experience of care of people who identify as LGB and/or T and are
facing the later stages of a life-limiting condition or illness.
3.
The OACC project (Outcome Assessment and Complexity
Collaborative) led by the Cicely Saunders Institute, seeks to implement
outcome measures into palliative care in South London to measure,
demonstrate and improve care. Our involvement in this is described on
page 6. Another arm of the study aims to assess whether a full trial on
effectiveness and implementation of outcome measurement in
palliative care is possible and to inform its planning. C-Change is
another related study led by the Cicely Saunders Institute. The project
aims to explore the understanding of patients, carers, health care
professionals, managers and commissioners into how specialist
palliative care services are able to meet need based on the criteria of
complexity and case mix. Additionally, the research seeks to
understand how outcomes (symptoms and quality of life) can be
improved and how healthcare resources should be allocated.
4.
We are participating in research carried out by the Royal Marsden NHS
Foundation Trust to understand the genetic mechanisms, due to
changes in DNA (mutations), which have caused the patient’s breast
cancer to progress and spread from the breast throughout the body
and stop responding to medical treatments.
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Staff publications in the past year
Books
Broadbent A. We need to talk about grief. How to be a friend to the one
who's left behind London: Piatkus, 2014
Farrant C, Pavlicevic M, Tsiris G. A guide to research ethics for arts
therapists and arts and health practitioners. London: Jessica Kingsley
Publishers, 2014
Hartley N. End of life care: a guide for therapists, artists and arts therapists.
London: Jessica Kingsley Publishers, 2014 (first available in 2013). Contains
chapters by a number of St Christopher’s staff.
Tsiris G, Pavlicevic M, Farrant C. A guide to evaluation for arts therapists and
arts and health practitioners. London: Jessica Kingsley Publishers, 2014
Book chapters
Oliviere D. Social work: a relational process In: Wasner, M, Pankofer, S
(eds). Soziale arbeit in palliative care. Stuttgart: W Kohlhammer GmbH,
2014; 18-20
Journal articles
Addington-Hall J, Hunt K, Rowsell A, Heal R, Hansford P, Monroe B, Sykes
N. Development and initial validation of a new outcome measure for hospice
and palliative care: the St Christopher’s Index of Patient Priorities. BMJ
Supportive and Palliative Care 2014; 4 (2): 175-181
Becker C, Clark E, Despelder L A, Dawes J, Ellershaw J, Howarth G,
Kellehear A, Kumar S, Monroe B, O’Connor P, Oliviere D, Relf M, Rosenberg
J, Rowling L, Silverman P, Wilkie D J. A call to action: an IWG charter for a
public health approach to dying, death, and loss. Omega 2014; 69(4): 401420
Bristowe K, Shepherd K, Bryan L, Brown H, Carey I, Matthews B,
O’Donoghue D, Vinen K, Murtagh F. The development and piloting of the
Renal specific Advanced Communication Training (REACT) programme to
improve advance care planning for renal patients. Palliative Medicine 2014;
28 (4): 360-366
Hockley J, Stacpoole, M. The use of action research as a methodology in
healthcare research. European Journal of Palliative Care 2014; 21 (3): 110114
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Kinley J, Hockley J, Stone L, Dewey M, Hansford P, Stewart R, McCrone
P, Begum A, Sykes N. The provision of care for residents dying in UK nursing
care homes. Age and Ageing 2014; 43 (3): 375-379
Kinley J, Stone L, Dewey M, Levy J, Stewart R, McCrone P, Sykes N,
Hansford P, Begum A, Hockley J. The effect of using high facilitation when
implementing the Gold Standards Framework in Care Homes programme: a
cluster randomised controlled trial. Palliative Medicine 2014; 28 (9): 10991109
Scott H. Communication vignettes: ‘I don’t think I can cope nurse.’ End of Life
Journal 2014; 4(2): 6p http://eolj.bmj.com/content/4/2/1.3.full (you need to
register for access)
Stewart R, Hotopf M, Dewey M, Ballard C, Bisla J, Calem , Fahmy V, Hockley
J, Kinley J, Pearce H, Saraf A, Begum A. Current prevalence of dementia,
depression and behavioural problems in the older adult care home sector: the
South East London Care Home Survey. Age and Ageing 2014; 43 (4): 562567
Stacpoole M, Hockley J, Thompsell A, Simard J, Volicer L. The Namaste
care programme can reduce behavioural symptoms in care home residents
with advanced dementia. International Journal of Geriatric Psychiatry 2014;
(Published ahead of print October 22 2014). Report available on our website
http://www.stchristophers.org.uk/sites/default/files/education_downloads/Nam
aste%20Care%20Study%20research%20report%20(final%20Feb2014).pdf
Talbot Rice H, Malcolm L, Norman K, Jones A, Lee K, Preston G,
McKenzie D, Maddocks M. An evaluation of the St Christopher’s Hospice
rehabilitation gym circuits classes: Patient uptake, outcomes, and feedback.
Progress in Palliative Care 2014; 22(6): 319-325
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4230333/
Thompsell A, Stacpoole M, Hockley J. Namaste care: the benefits and the
challenges The Journal of Dementia Care 2014; 22 (2): 28-29
Tsiris G, Dives T, Prince G. Music therapy: evaluation of staff perceptions at
St Christopher's Hospice. European Journal of Palliative Care 2014; 21 (2):
72-75
Abstracts of conference proceedings
Sykes N. Planning and developing a regional palliative care service.
Abstracts of the 4th International Symposium for Education and Training of
regional palliative care, Japan. January 2014: 3, 6-16
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Goals agreed with commissioners
Use of the CQUIN framework
A proportion of St Christopher’s income during 2014-5 was conditional on
achieving quality improvement and innovation goals through the
Commissioning for Quality and Innovation payment framework. Each of these
was achieved as follows:
CQUIN1:
By the end of the financial year to ensure that 100% of patients known to St
Christopher’s Home Care team or being discharged from the inpatient unit
have a Coordinate My Care (CMC) record that complies with the local CMC
Quality Guideline or have a documented refusal. Achieved.
CQUIN2:
By the end of the financial year, 80% of St Christopher’s clinical staff have
received training (sourced from Bromley Local Authority and CCG) in the
principles of the Mental Capacity Act, when and how to assess mental
capacity, making best interest decisions and applying the Deprivation of
Liberty Safeguards. Achieved.
What others say about St Christopher’s
St Christopher’s is registered with the Care Quality Commission (CQC) and is
registered to provide the following regulated activities:
o
o
o
Treatment of disease, disorder or injury
Diagnostic and screening procedures
Transport services, triage and medical advice provided remotely
The St Christopher’s Personal Care Service is registered with the CQC to
provide
o
Personal care
The CQC has not taken enforcement action against St Christopher’s during
2014-5.
St Christopher’s is subject to periodic reviews by the Care Quality
Commission, the last of which was in December 2013. The CQC’s assessed
the hospice as being compliant with all the outcomes inspected.
St Christopher’s has not participated in any special reviews or investigations
by the CQC during the reporting period.
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Data quality
St Christopher’s is not required to submit records to the Secondary Uses
service for inclusion in the Hospital Episode Statistics. In accordance with the
Department of Health, it submits a National Minimum Dataset (MDS) to the
National Council for Palliative Care.
The hospice regularly quality assures the data provided to CCGs (patient
demographics, inpatient, day care and home care activity summaries, place of
death etc.) All reported errors of entries made on the electronic patient
records are recorded and scrutinised quarterly by the Information Governance
Committee.
Information Governance Toolkit attainment levels
St Christopher’s is an NHS business partner and therefore is required to meet
29 of the Information Governance toolkit requirements. We have completed
the IG requirements to level 2.
Clinical coding error rate
St Christopher’s was not subject to the Payment by Results clinical coding
audit during 2014-5 by the Audit Commission.
Part 3
Review of quality performance
In the course of 2014-5 we undertook an extensive review of our governance
arrangements and membership of our various governance committees. We
are confident that the work of the committees, made up of staff from a wide
range of departments, enables us to assure the quality of the service we
provide in our inpatient unit, outpatients and in the community.
We review all our services regularly and our clinical governance summary is
evidence of the way in which we track critical areas of care. It also highlights
that we have low rates of complaints and infection rates on our inpatient unit.
(See page 17 for the scorecard covering the 12-month period to March 2014).
The benchmarking exercise we undertook with Hospice UK showed that over
the year 2014-5 medication errors where no change to the patient’s clinical
status was noted amounted to 96% of errors. The remaining 4% of errors (n=
4) were level 3 errors where some change of clinical status noted and/or an
investigation was required but no ultimate harm to the patient occurred. The
hospice had a higher % of level 2 and level 3 medication errors than the
category average (25+ beds). We continue to monitor all incidents.
Our average total falls per 1000 bed days is higher than the category average
for large hospices (more than 25 beds), but 99% of our falls during the year
17
resulted in no or minor injury. Only 1% of falls resulted in moderate harm (e.g
fracture/laceration requiring treatment), which is lower than the average in
comparable hospices and all adult hospices.
This year we have completed a new and comprehensive safeguarding policy
for adults which has been approved by the Co-ordinator of the Bromley Adult
Safeguarding Board. A policy in relation to safeguarding and children is
outstanding and will be developed during 2015-6. We have also mapped our
safeguarding training programme against staff function to ensure that all staff
are fully briefed.
Our audit programme reviews the effectiveness of our clinical care as does
feedback from patients and carers. We are reviewing the function and
membership of our Audit Committee and aim to ensure that a wider range of
staff participate in and contribute to audits to drive improvements in care.
The indicators for 2015-6 highlight some areas where we expect to be able to
produce baseline data against which we can compare future performance.
As indicated above (see page 5), we stopped using our SKIPP outcome
measure in December 2014. The SKIPP results for the 9 months April to
December 2014 show that of patients surveyed within 3 days of admission to
the inpatient unit 79% (149/189) said that in relation to the problem that was
of greatest concern to them ‘things had got much better’ or ‘a little better’
since their admission.
Eighty five percent (85%) of patients felt that the hospice had’ made a
difference to how things are going at present’. The hospice had made a
‘great’ or a ‘very great’ difference to 37% (70/189) of those surveyed.
Ninety percent (90%) (106/118) of bereaved carers said that the patient had
received exceptional or excellent care from the ward nurses.
In our community palliative care service, 74% (147/199) of patients surveyed
within a month or so of initial contact said that in relation to the problem that
was of greatest concern to them ‘things had got much better’ or things had
got a little better since the nurse started visiting them. The community team
had made a ‘great’ or a ‘very great difference to how things are going at
present’ to 62% (122/198) of those surveyed.
Eighty one percent (159/197) of bereaved carers said that the care from the
home care team was exceptional’ or ‘excellent’.
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St Christopher’s summary clinical governance overview (April 2014- March 2015)
Incidents
Written complaints
Number received: 5 ( 2 upheld; 1 partly upheld; 2 not
upheld)
Written complaints by 6-month period
April-Sept 2014
Oct 2014 –March 2015
2
3
Oral complaints n= 3
Service User Experience
(April-Dec 2014)
SKIPP (patient feedback)
In relation to their most pressing concern
 Inpatients: Things have got a little/much better
since admission = 79% (149/189)

Community patients : Things have got a little/much
better since the nurse started visiting = 74%
(147/199)
VOICES-SCH (Bereaved carers)
 90% (106/118 )of carers thought that the patient had
received exceptional or excellent care from the
ward nurses
 81% (159/197) rated the care from the community
teams as exceptional or excellent
Total clinical incidents:
Total health and safety incidents
Total medical device incidents:
Total medicine- related incidents
Total n of RIDDOR reports:
Oct 13 to
Mar 14
93
22
3
31
2
April- Sept
2014
54
24
1
42
2
Oct 2014 –
March 2015
118
20
0
58
1
Notifications to Care Quality Commission
Notification of injury: n=15 (Pressure ulcers n=12; fracture n=2; attempted
suicide n=1)
Completed actions arising from incidents, root cause analyses, risk
assessments, audits:










Key members of staff trained in root cause analysis
Review of documentation of pressure ulcer documentation
Introduction of repositioning charts on the wards
Consultation group set up with other hospices re wound care/falls
management
Training on assessment of psychological distress delivered to all
clinical staff
External consultant commissioned to review our lone working
procedures (due to report 2015-6).
Development of status reports on patient and organisational safety to
track areas of concern
Participation in first year of national hospice benchmarking exercise
on patient safety indicators
Water management group set up
Commissioned a review of health and safety management (to take
place 2015-6)
Alerts
Total alerts from
CAS
47
CAS alerts on which
action required and
taken
Total MHRA drug
alerts
n. MHRA alerts on
which action
required and
taken/information
shared
3
18
3
Infection control
n patients during period who
developed C Diff/ MRSA while
on inpatient unit*:
C Diff (toxin
+ve)
MRSA
bacteraemia
1
2**
* = patients admitted with unknown
infection status who develop
symptoms 3 days or more after
admission.
**Neither bacteraemia infection
was attributable to actions by staff
at St Christopher’s.
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Feedback from patients and carers
Feedback from patients and carers is one of the most important ways in which
St Christopher’s measures the quality of the care we give. We receive many
compliments and positive comments from patients and families. Here is a
selection from the most recent surveys of patients and bereaved carers:
“My stay here has alleviated a lot
of the worries I had about
coming to a 'hospice'. They have
been lifted and I now look at it as
a happy place”
(Inpatient)
“Been a tough year, only
since I've been here have I
been able to talk to people
who understand”
(Inpatient)
The carers and nurses are wonderful people
and we feel they are like family to us and
always look forward to their visits. I feel that
more people should know about this
wonderful organisation, St Christopher’s,
and I will certainly write to the Prime
Minister about it!
(Client of Personal Care service)
“I found it extremely helpful to have a nurse from the
team say that we should just support my mum but let
her go. It was very decisive and the correct decision.
And knowing pain relief was available helped too.”
(Bereaved carer)
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“St Christopher’s makes such a
difference to my life. Coming here lets
people feel not alone, it’s like a second
family to me”
(Patient attending Anniversary Centre)
“I find it very helpful to discuss symptom control
and quality of life when I come to St Christopher's”
Patient attending outpatient appointments
“In hospital I’d lost confidence- this is the first
time I’ve really felt happy”. (Inpatient)
“I know I’m dying but it’s like being given
a second chance- you’re treated like a
human again”
(Patient)
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Statements from external bodies
Statements from our Clinical Commissioning Groups and Bromley
Healthwatch are set out below. We also sent our draft Quality Account to the
Bromley Health and Scrutiny Committee but did not receive a response.
CCG comments on St Christopher’s Group Quality Account 2014-2015
The CCG Joint Commissioners welcome St Christopher’s participation in the
OACC (Outcome Assessment and Complexity Collaborative) and the
measures selected to monitor key quality performance indicators for patients
receiving palliative care and their families/carers. We will continue to keep
quality high on the Agenda for 15/16 consortium contract meeting, and will be
interested in the results of the Priorities for Improvement and outcomes
achieved through CQUIN schemes. Finally, we are pleased that St.
Christopher’s hard work for innovation in high quality co-ordinated palliative
care has been recognised by the Hospice UK “Innovation in Care” award.
Endorsed by Corinne Moocarme, Associate Director, Physical Disability, NHS
Lewisham
CCG, Richard Croydon; Commissioning Manager & Continuing Healthcare Lead, NHS
Lambeth CCG; Peter Lewis Senior Community Commissioning Manager, Bromley
CCG; Kate Moriarty-Baker, Head of Continuing Care and Safeguarding; Southwark
CCG, Cynthia Abankwa, Commissioning Manager, Older Adults, Croydon CCG.
Bromley CCG appreciates the dedication and determination shown by St.
Christopher’s Bromley Care Coordination Service, which has resulted in great
improvements in supporting the end of life pathway for Bromley patients. We
look forward to working with you in 2015/16 to improve the referral rates so
more patients may benefit from this excellent service. We also support the
joint work of St Christopher’s and Bromley’s Adult Safeguarding Board that
has resulted in a new and comprehensive safeguarding policy for adults and
understand that work is in progress regarding the development of a
safeguarding children policy in 15/16.
Maria Davison, Contracting and Development Manager, Bromley CCG.
NHS Lewisham CCG was saddened at the departure of Barbara Monroe,
Chief Executive in 2014 but look forward to working with the new Joint Chief
Executives (Heather and Shaun).
Lewisham have just begun a 2 year End of Life Transformation Programme
(sponsored by Macmillan Cancer Care) and we appreciate the involvement of
St Christopher’s in the programme’s development and in helping us achieve
our aim of taking a whole system approach to identifying current
barriers/obstacles that are hindering the level of collaboration and
coordination required to ensure that all residents of Lewisham approaching
the end of life die well.
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We are particularly inspired by the work that St Christopher’s is doing in Social
Care around workforce development for Social Workers and Homecare
Agencies/Care Home staff.
We look forward to continuing to deliver the best End of Life Care that we can
to our Residents with St Christopher’s as one of our Strategic Partners on this
journey.
Corinne Moocarme, Associate Director, Physical Disability, NHS Lewisham
CCG
Healthwatch Bromley commentary on St Christopher’s Group Quality
Account 2014-15
St Christopher’s Quality Account 2014-15
Healthwatch Bromley & Lewisham Feedback
From a Healthwatch Bromley and Lewisham perspective, this is a wellpresented, positive and encouraging report from St Christopher’s. There is a
clear focus and strong emphasis throughout on continuous improvement in
both the range of services offered and on providing the best possible quality of
care for patients, service users and their families.
Areas of success
The report demonstrates that these goals are being achieved through:
 a range of initiatives and service developments across inpatient and
domiciliary services
 a sustained commitment to staff training and development across
settings and teams and ensuring that staff at all levels of the
organisation are involved
 a continued commitment to engaging with patients and their families,
obtaining and valuing feedback and using this to contribute to the
review and improvement of services, particularly through the Friends
and Family Test
 a strong commitment to developing integrated teams and to partnership
working across health and social care and between hospice, hospital,
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

care home, community and primary care in order to achieve the most
integrated service for patients and families
a clear commitment to research and development and to sharing
learning with others
a clear commitment to regular auditing
Following on from the 2013/14 audit it is particularly encouraging to see this
year:





the successful development of the Bromley Care Coordination Service
and the Bromley Personal Care Service, both of which are enabling
service users to have greater choice and involvement in their end of life
care, in their chosen place of death, and avoid unnecessary
admissions to hospital
the evidence from the work of the St Christopher’s nurse specialists
with care homes across Bromley (and adjoining boroughs), particularly
in developing the use of advanced care planning, enabling people to
receive end of life care in the care homes, avoid unnecessary
admission to hospital and reduce deaths in hospital
the development of the service for young adults with life limiting illness
a survey of inpatients at St Christopher’s about food quality
clear evidence that patients and staff are being involved in assessing
and measuring service quality and effectiveness e.g. through seeking
feedback from participants in a patient safety group and in the use of
the Friends and Family test
Areas for improvement and clarification
It would have been helpful to have seen some background information in the
report such as data on bed numbers, home visits, nurse numbers, discharges
and emergency readmissions.
June 2015
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Opportunities to give feedback on this quality account
We welcome feedback on this quality account. If you would like to do this,
please email jointchiefexecutives@stchristophers.org.uk or write to:
Joint Chief Executives
St Christopher’s Hospice
51-59 Lawrie Park Road
Sydenham SE26 6DZ
25