Adding life to days ………
Quality Account 2010 - 2011
Both my wife and I were very satisfied with
the way all the staff showed us both respect,
understood the problem, had the ability and
desire to help resolve the problem and
throughout my stay with you, showed genuine
love and care for us both at all times
Patient survey 2010
Waverley Lane,
Farnham,
Surrey, GU9 8BL
Tel: 01252 729400
www.phyllistuckwellhospice.org.uk
Phyllis Tuckwell Memorial Hospice Ltd. Limited by Guarantee.
Incorporated in England and Wales. Registered No. 1063033 registered Charity No. 264501
Chief Executive’s Statement
On behalf of myself and the Board of Trustees, I am delighted to
introduce our first Quality Account for the year April 2010 – March 2011.
This is the first time we have produced such a document and we hope
that you will find it interesting and encouraging to read how we have
been striving to provide high quality and cost effective patient care as
well as to learn about the quality improvement work that we have
recently completed.
Phyllis Tuckwell Hospice has a well-established and effective clinical
governance function, incorporating a quality and audit programme, which
acts as the driver for continuous improvement in the quality of patient
care. The views, experiences and outcomes for patients and their
families are paramount to quality improvement and are of great
importance to us. Questionnaires, surveys and feedback cards are just
some of the ways we listen. From this we are able to learn, develop and
improve the services we provide.
I would like to thank all of our staff and volunteers for their hard work and
achievements over the past year. Despite the current economic climate,
the hospice has continued to provide high quality services to an ever
increasing number of patients. Thanks to the generous support from our
local community we continue to be financially sound as an organisation
but recognise there is no room for complacency and work hard to ensure
that we use our resources wisely and efficiently.
I am responsible for overseeing the preparation of this report and its
contents. To the best of my knowledge, the information reported in this
Quality Account is accurate and a fair representation of the quality of
healthcare services provided by our hospice.
Thank you for your interest in the work of Phyllis Tuckwell Hospice.
Sarah Brocklebank
Chief Executive
August 2011
Section one – Improvements present and future
Quality improvements Phyllis Tuckwell Hospice has been working on
Phyllis Tuckwell Hospice (PTH) has undertaken a series of quality initiatives, all
with the aim of ensuring that care is safe, effective and provides patients and
carers with a positive experience
Quality initiative: Quality and Audit Programme
We wanted to introduce a more structured approach to service evaluation and so have
developed a Quality and Audit programme to allow us to monitor the quality of service
in a systematic way. The programme acts as a framework which identifies areas for
audit. The findings are discussed, recommendations made and action plans developed.
This is a continuous process and has resulted in raising standards and improving the
quality of care.
Quality initiative: Training for care home staff
The need for palliative care training in care homes was identified by both care home
and hospice staff. Patients (and their carers) resident in care homes, particularly those
known to the hospice, were also of the view than more training was required.
Training is now delivered, by an experienced clinical nurse specialist, in varying aspects
of palliative care. The sessions have been rolled out to many of our local care homes
consisting of both visits to homes themselves and study days at the hospice. The
training has been a great success with care home staff reporting that they are more
knowledgeable and confident in end of life care.
Quality initiative: Ward Audit programme
Clinical audit is a quality improvement process that seeks to improve patient care and
outcomes through the systematic review of care. To achieve ownership by staff, it is
preferable that staff themselves conduct audits and influence change. The ward audit
programme comprises 6 clinical audits identified by the team as possible areas for
improvement. The audits are conducted by nurses every four months, enabling
discussion and change to be implemented throughout the year. This programme has
proved very successful and has increased staff morale and consistently raised
standards.
Quality initiative: Clinical Management system (patient’s records)
The need for a more coordinated approach to the information stored in patients’ records
has long been high on the agenda for both patients and health care professionals.
Crosscare (a computerised clinical records management system) has been phased in
over several years at the hospice supported by an education programme and user
reviews/evaluations. All multidisciplinary team members are competent users and are
able to access patient information from password protected terminals throughout the
hospice. The system is efficient and effective in promoting a coordinated approach to
care whilst providing valuable data for service and patient outcome analysis.
‘
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Section one - Improvements present and future
Areas that we have identified for improvement in the coming year
PTH is committed to the delivery of high quality care. We know that the
cornerstone of improvement is listening to what patients tell us about our
services. Guided by what we have been told and by looking at our work over
the last year, we have been able to identify key areas where we would like to
see service development and improvement – three of these priorities are
detailed in the following section.
The first two priorities are about looking ahead and developing our service with
a focus on flexibility and choice.
The third is an example of the day to day issues that effect patients on the
ward. We believe that it is important to look at all processes, and how they
affect the people involved - often small changes make a big difference.
Priority one:
Development of the ‘Dove Centre’ - To offer more choice and flexibility to
community patients and their carers about where and when they can receive
care, treatment and advice.
How was the priority identified?
The collation of patient activity data and the feed back from several focus groups,
attended by patients, carers and health care professionals.
How will the priority be achieved?
The Dove Centre, a new community focussed outpatient facility has been developed.
The centre comprises a day hospice and a selection of outpatient treatment and
consulting rooms. Patients and carers will be able to access therapies such as
physiotherapy, complementary therapies and counselling. Medical and specialist nurse
consultations will be available and in addition a new ‘drop in’ service is being
developed.
How will progress be monitored?
A series of questionnaires will provide feedback from patients, carers and healthcare
professionals. Patient activity data will identify how and when services are being
accessed enabling modifications to be made.
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Priority two:
The development and delivery of a ‘Hospice Care at Home’ service - supporting
and caring for patients in their homes
How was the priority identified?
The Hospice Care at Home Service - research has found that the preference of many
patients is to receive care in their own homes. The Hospice conducted a small ‘Hospice
at Home service’ pilot in 2009 and received positive feedback from patients and other
healthcare professionals. The hospice concluded that there was a need for a
responsive service and has since been raising the necessary funds to set up a small
service
How will the priority be achieved?
The service will be developed in the coming year, enabling patients known to PTH to
remain at home and feel confident that their palliative care needs will be met in their
place of choice. The care will be coordinated and delivered in conjunction with the
Primary Health Care Team and complement any existing care package.
How will progress be monitored?
The continued development and hopeful expansion of the service will be determined by
patient, carer and health care professional feedback and analysis of patient activity
data, as well as the availability of sustainable ongoing funding.
Priority three:
Review of meal times - to ensure the best possible experience for patients while
making the delivery quick and easy for staff
How was the priority identified?
Feedback from staff and patients initiated this review. The different departments
involved in the delivery of patient meals feel that higher standards could be achieved if
a more coordinated approach was adopted. Patient survey results indicated high levels
of satisfaction with the catering service but again it was felt we could improve the
overall patient experience.
How will the priority be achieved?
A working group will review the meal time experience for patients using the Productive
Ward Series – Department of Health. The results of catering questionnaires and
observation of the current processes in place will indicate areas for review and
refinement. In addition a recent refurbishment of the hospice kitchen will ensure more
efficient cooking and preparation and a higher quality end product.
How will it be monitored?
A series of questionnaires will provide feedback from patients and staff will be given the
opportunity to discuss and review the new systems put into place.
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Section Two – Statutory Information
This section includes:
Information that all providers must include in their quality account (Some of
the information does not directly apply to specialist palliative care providers).
Review of services
During 2010 – 2011 PTH provided five services
•
•
•
•
•
In – Patient - Unit
Day Hospice
Out - Patients
Community
Bereavement
PTH has reviewed all the data available to them on the quality of care in all of these
services. The income generated by the NHS represented just 12 per cent of the total
income required to provide the services which were delivered by PTH in the reporting
period 2010/11.
Participation in clinical audits
As a provider of specialist palliative care PTH is not eligible to participate in any of the
national clinical audits or national confidential enquiries. This is because none of the
audits or enquiries related to specialist palliative care.
PTH’s quality and audit programme facilitated many audits during 2010. The Hospice
also used a number of ‘Help the Hospices' Audits Tools - Infection Control,
Management of Controlled Drugs, General Medicines, and Medical gases. The tools
are relevant to the particular requirements of hospices, allowing our performance to be
benchmarked against that of other hospices. PTH is a member of a regional audit
group and benchmarks the results of these audits on a regular basis. Our compliancy
results have been high - achieving above average in all the audits compared in 2010.
Data quality
For the year 2010 -2011 PTH submitted audit data to the National Minimum Data Set
for specialist palliative care. Results are available publically from the National Council
for Palliative Care. www.ncpc.org.uk
.
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Research
There were no opportunities for PTH to take part in any local or national ethically
approved research but we are establishing links locally to facilitate contributing to
multi-centered research in the future.
Whilst not research in its purest form Dr Helen Burgess (Locum Consultant in
Palliative Medicine) undertook a service development project to evaluate potential
ways to achieve PTH’s clinical strategy of broadening the delivery and availability of
specialist palliative care (SPC) to all disease groups by being a partner in shared care
with other healthcare professionals. There were three main aspects to the project; a
review of the literature, discussions with national SPC providers, and discussions with
local stakeholders. The project reported to the Clinical Strategy Board Sub Committee
and ultimately to the Board where the recommendations where accepted. As a result
of this project, the Hospice is in the process of recruiting a third Consultant to lead on
this important service development.
.
What others say about us
PTH is required to register with the Care Quality Commission, a regulatory body that
ensures that we meet our legal obligations in all aspects of care. In March 2011, PTH
was contacted by the Care Quality Commission (CQC), and asked to provide
evidence that the hospice was complying with the Essential Standards of Quality and
Safety. This was followed by an unannounced inspection in May. The CQC found
that PTH was meeting all the essential standards of quality and safety. It also
reported very positive feedback from both patients and their families.
.
Quality improvement and innovation goals agreed with our commissioners
PTH’s income in 2010/11 was not conditional on achieving quality improvement and
innovation goals through the Commissioning for Quality and Innovation payment
framework.
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Section Three – Quality overview
This section provides:
•
•
•
•
Data and information about how many patients use our services
How we monitor the quality of care we provide
What patients and families say about us
What our regulators say about us
The National Council for Palliative Care; Minimum Data Series
The Minimum Data Set (MDS) for Specialist Palliative Care Services is collected
on a yearly basis, with the aim of providing an accurate picture of hospice and
specialist palliative care service activity.
Phyllis Tuckwell Hospice
(PTH)
2010- 2011
2009- 2010
%
Increase
In – Patient - Unit (18 beds)
Total number of patients
New patients
% Occupancy
Patients returning home
Average length of stay - cancer
374
332
76%
31%
11
331
309
73%
40%
11
13%
7%
4%
-9%
-----
98
63%
59%
18%
183 Days
114
75%
60%
21%
159
-14%
-12%
-1%
---------
787
550
3057
36%
12%
733
509
2276
37%
13%
7%
8%
34%
---------
Day Hospice
Total number of patients supported
% New patients
% Places used
% Places booked but not used
Average length of stay
Community service:
All clinicians and therapists
Total number of patients supported
New patients
Face to face contact
% Home deaths
% Care Home deaths
Bereavement Service
Total number of users supported
% Of New Patients
Non – Cancer diagnosis
In – Patient - Unit
Day Hospice
246
2010- 2011
2009- 2010
15%
16
10%
15%
%
Increase
39%
5%
6
In – Patient - Unit
In the In – Patient - Unit the average length of stay for patients is 12 days although
there is wide variation according to need. The majority (72%) of patients who were
discharged from the unit returned to their homes. There was a significant increase in
the number of new patients admitted to the inpatient unit with a non – cancer
diagnosis.
Day Hospice
The Day Hospice continues to support patients and their carers. The total number of
patients attending Day Hospice fell by 14% from the previous year. The average
attendance was 59% and patients attended for an average of six months. The
percentage of patients unable to attend their day hospice place was 15%. This is
because patients may not be well enough to attend or because they have to attend
hospital appointments.
In response to this the hospice is in the process of expanding its outpatients facility,
offering patients more choice and flexibility about where and when they can receive
care, treatment and advice. It is expected that as a result patients will feel more
comfortable about accessing the available services earlier in their disease.
Community
The number of patients supported in the community continues to increase, with face
to face contact increasing by 34% from the previous year. There have also been
significant increases in the number of patients supported by our patient and family
services team and therapists.
Quality Markers
We have chosen to measure our performance against the following metrics.
Indicator
2010 - 2011
Complaints
Total number of complaints
All three complaints were resolved satisfactorily
3
Patient safety incidents
The number of serious patient safety incidents
(excluding falls)
Number of falls
No falls per bed per year
The number of patients who experienced a fracture or
other serious injury as a result of a fall
Indicator
0
52
2.88
(Average % of 5 local hospices – 4.3)
0
2010 - 2011
Patient safety incidents
Total Number of patients know to be infected with
MRSA whilst on the In - Patient - Unit
Total Number of patients know to be infected with C.
difficile whilst on the inpatient unit
0
0
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Clinical audits 2010 - 2011
To ensure that we are continually meeting standards and providing a
consistently high quality of service, PTH has a Quality and Audit Programme in
place. The programme allows us to monitor the quality of service in a
systematic way, identifying areas for audit in the coming year. It creates a
framework where we can review this information and make improvements
where needed. Regular Clinical Governance meetings provide a forum to
monitor quality of care and discuss audit and quality evaluation results.
Recommendations are made and action plans developed.
National audits (Help the Hospices)
These audits are benchmarked with other hospices in the south, enabling us to
discuss results and action plans promoting development and learning.
Help the Hospices audits completed
Compliancy
Infection control
Assessment of environment
Compliancy with the Health and Social Care Act 2008, Code of
Practice on the Prevention and Control of Healthcare Associated
Infections
96%
98%
Medicines Management
Medicines Management
Management of controlled drugs
Management of medical Gases
98%
100%
89%
A sample of clinical audits completed at Phyllis Tuckwell
Audit
Health records
Documented
consent
Patient
information
leaflets
Blood transfusion
monitoring (reaudit)
Recording of
resuscitation
status
Findings, recommendations and actions
to be taken to improve
compliance/practice
Good compliancy - 96%
Minor shortfalls will be addressed by the newly
established computerised record system
100% compliancy in 3 out of the 4 areas.
Shortfalls identified in the final area have been
fed back to staff and will be re-audited as part of
the continuous ward audit programme
All leaflets are managed by the relevant
department manager and undergo a formal
review annually. All leaflets met the criteria
stipulated in the assessment tool. No action
required.
Actions from a previous audit had been
completed. Significant improvements have been
achieved. Recommendation – to re-audit
annually
Minor shortfalls identified; these will be
addressed by the newly established
computerised record system. To continue will
biannual audits
Action plan
Completed
Completed
Completed
N/A
Completed
Completed
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Findings, recommendations and actions
to be taken to improve
compliance/practice
Audit
Nurse dispensing
Documentation of
patients preferred
priorities of care
Action plan
Completed
The audit found that the policy was complied with
well. Recommendations included review of
medications for nurse dispensing list (some
medications are becoming more common).
Maintenance of a training log
The audit highlighted that information was being
stored in too many places and not easily
accessible to all of the team. It was
recommended that the new electronic patient
record system store this information in a specific
window, accessible by all. The importance of
recording this information was reiterated to staff.
For re-audit annually
Completed
Completed
Ward audit programme results
Audit 1
Audit 2
Audit 3
Feb
May
Nov
87%
87%
93%
80%
88%
98%
30%
70%
100%
Risk assessment documents (standard required 100%)
63%
87%
95%
Consent – catheterisation (standard required 100%)
70%
100%
100%
Bowel management
(Standard required 80%)
73%
70%
85%
Ward Audit programme 2010
Hand washing (standard required 100%)
Sharps - looking at several areas, i.e. Boxes, disposal
(Standard required 100%)
Unqualified staff entries - are signatures countersigned
(Standard required 100%)
The nursing staff completing these audits embraced the idea of evaluating standards
of care and the processes in place. They discussed the results as a team, made
recommendations and initiated change where needed.
All areas experienced improvements in compliancy with the exception of one where
further discussion has taken place; this will be audited on a continuous basis for the
rest of the year.
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What patients and families say about the services they receive
The views and experiences of patients and their families are important to
the Hospice and enable us to look at how we can learn, develop and
improve the services we provide. The hospice undertakes a series of
questionnaires, surveys and focus groups on a regular basis.
Patient Survey
The PTH survey includes questions relating to information giving by staff,
staff attitudes, involvement of patients in care planning, privacy and
courtesy, catering and cleanliness. The surveys are designed for selfcompletion by patients. One survey evaluated Day Hospice services and
another Inpatient’s services.
In - Patient - Unit
The results revealed high levels of patient satisfaction. All patients said
they understood explanations about their care always or most of the
time. Patients reported high levels of courtesy and efforts to meet their
needs. Ninety-five per cent of patients felt their privacy was respected
and 100% thought that the different health care professionals involved in
their care were aware of updates and changes to their care always or
most of the time. There were high levels of satisfaction with cleanliness
with 85% reporting it as excellent. There were somewhat lower levels of
satisfaction with food with 43% scoring the food as excellent and 40% as
good. However all patients surveyed reported the flexibility of the
catering service as excellent.
Day Hospice
The results were very positive with many complimentary comments. The
survey revealed that the majority of patients didn’t know what to expect
on their first visit but 89% left feeling more relaxed and reassured. The
patients who used PTH transport reported prompt pickups, and felt
comfortable and safe during the journey. Patients experienced high
levels of courtesy and felt their individual needs were met.
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Individual comments:
"Every member of staff makes you feel important.”
"The care was very good; I particularly like all the banter, the staff
are fun."
"The Day Hospice is absolutely wonderful. The support to patients
is second to none."
Day Hospice focus sessions
The aim of running the focus groups was to look at how we could
promote the service more effectively, so patients feel encouraged to
access therapeutic input earlier and subsequently feel better able to
cope with their deteriorating illness when the time comes. The group
consisted of both patients and health care professionals from the
community and local hospitals.
The feedback indicated that the service needed to have a less ‘hospicy’
feel and be more flexible (this was key in the development of the Dove
Centre). There were new ideas on how to promote the Hospice,
engaging public and healthcare professionals’ interest.
Feedback from the unannounced provider visit
The Board of Trustees undertake two unannounced visits to the Hospice
annually. Two members of the Board talk to staff, patients and carers.
Patients and carers are asked about their views and experiences, the
following is an example of one of the reports from 2010:
“We jointly interviewed a patient whose son was visiting at the time. It
was her third period of stay in the In-Patient-Unit. She found PTH
“wonderful” especially compared with hospital. There was a welcoming,
relaxed atmosphere, immediate treatment, very good pain control and
responsive staff who gave honest answers. The food was excellent with
good choice. All the staff were friendly (she mentioned the cleaners as
well as the nurses). Her son felt the Hospice offered a great period of
respite care and shared his mother’s dislike of hospitals. He liked the
cafeteria sandwiches and is keen to help us in raising funds.”
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What our regulators say about Phyllis Tuckwell Hospice
The Care Quality Commission (CQC), a regulatory body that ensures
that we meet our legal obligations in all aspects of care. In March 2011,
PTH was contacted by and asked to provide evidence that the Hospice
was complying with the Essential Standards of Quality and Safety. This
was followed by an unannounced inspection in May. During the visit the
CQC observed how people were being cared for, talked with people who
use services, talked with staff, checked our records, and looked at
records of our patients. The CQC found that PTH was meeting all the
essential standards of quality and safety. It also reported very positive
feedback from both patients and their families, reporting:“Patients that spoke to us advised that staff had discussed their personal
needs and involved them in agreeing a plan of care. All the patients that
responded to our questions felt that they were safe in the Hospice and
that they had been involved in decisions regarding treatment and care.
One patient said that he definitely felt very much that the staff treated
him with dignity and respect and said “Staff go that extra mile.”
Although compliant in all areas the CQC suggested that we review our
system for recording the maintenance of equipment. This will be
actioned as a priority and an audit completed within six months.
The Board of Trustees’ commitment to quality
The Board of Trustees is fully committed to the quality agenda. The
Hospice has a well established governance structure, with members of
the Board having an active role in ensuring that the Hospice provides a
high quality service in accordance with its terms of reference. As above,
Members of the Board undertake an unannounced visit twice a year gaining first hand knowledge of what the patients and staff think about
the quality of the service. The Board is confident that the treatment and
care provided by the Hospice is of high quality and is cost effective.
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Phyllis Tuckwell Hospice:
Some pictures from our album