St Christopher’s Group Quality Account 2010-11
Part 1
Statement on quality from Barbara Monroe, Chief Executive
St Christopher’s and Harris HospisCare set out to provide the best possible
care for people with life-limiting illnesses and those close to them, and all
our staff and volunteers participate in this endeavour. Our mission is to
promote and provide skilled and compassionate palliative care of the
highest quality and we have a national and international reputation for
providing care, delivering teaching and engaging in research. We are
committed to finding ways continuously of improving our services to
patients and families and we have a robust clinical governance framework
that enables us to do this.
In the past year we have implemented two new validated outcome tools
that tell us what patients and carers think of the services they received
from us; we have delivered a wide range of courses to increasing numbers of
generalist and specialist health and social care professionals; we have
participated in important research including research on the prevalence and
nature of depression in a palliative care population; we have continued to
develop our work with care homes so that people who live in those homes
can also benefit from high quality end of life care; we have extended our
health promotion programme into more schools and care homes to help
dispel some of the myths about illness, dying and hospices.
In this, our first Quality Account, we identify our priorities for quality
improvement over the year to come, and review our quality performance
over the past 12 months. I and my team of senior managers 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 my knowledge,
accurate.
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Part 2
Priorities for improvement
We have identified four 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
In 2010-11 we have worked closely with the London Borough of Bromley’s
Emergency Planning Department and the Emergency Services to refine
our major incident plan.
Our priority for 2011-12 will be to test out this comprehensive plan,
purchase ski pads for the evacuation of non ambulant patients and
train staff in their use.
We plan to achieve this by having a drill to a specific scenario and we
will be setting up further drills from time to time to ensure that all staff
are familiar with the procedures. We will also train ward staff to use the
ski pads, and will regularly check on their ability to use them. The
outcomes will be reported to the Senior Management Team.
2. Clinical effectiveness
In 2009-10 we reviewed our existing nursing skills and competency
framework in the light of national work that had been completed in this
area. We tested a new version of the framework that took these into
account so that our nursing staff could be assessed and appraised against
these revised competencies that cover the complete range of specialist
skills that nurses at each grade are expected to demonstrate. During
2010-11 all nursing staff have been assessed and appraised against the
new competencies.
In 2011-12 we will develop a comprehensive programme of workshops
to support managers as they make use of these tools.
We will measure this by assessing the quality of appraisals and seeking
feedback from nurses and their managers. Feedback will inform the
development of the competencies.
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3. Patient experience
i) During 2010-11 we started using 2 new tools for measuring patient and
carer experience in palliative are. These tools are the result of research
commissioned by St Christopher’s and developed by Prof Julia AddingtonHall and her research team at Southampton University.
SKIPP, the St Christopher’s Index of Patient Priorities, asks patients to
identify what their area of greatest concern was before and after they
came into contact with the hospice team, and what the impact of the
hospice has been on them.
VOICES-Hospices-SCH, is a survey of bereaved carers, and asks them for
their views about well we cared for the patient and for their feedback on
the support they themselves received from the hospice.
In 2011-12 we will:
- organise a national conference to disseminate information about
SKIPP and VOICES to other hospices and palliative care units
- explore the possibility of benchmarking our results with other
similar organisations
- maintain the high standards we reached in our first 6 months of
results
ii) In response to the findings of research undertaken by one of our
specialist nurses, we have developed a new project to offer trained
‘Community Support Volunteers’ to patients in Bromley who have
recently been discharge from our services, or who need additional
support at home. We have begun training a cohort of carefully selected
volunteers who will be supervised and will liaise closely with the
patient’s home care nurse. They will be available to spend up to three
hours a week with patients, befriending them, and offering practical
help with simple tasks at home or accompanying them to appointments
and so on.
During 2011-12 we will start running the pilot and evaluate with a view
to rolling the project out across our 5 boroughs early next year,
extending the support of these volunteers to care homes too.
Feedback from patients, volunteers and staff involved in the pilot will
help us refine the project as necessary, and our aim is eventually to
publicise it so that others can develop similar schemes.
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We will review progress in relation to each of these 3 priority areas at Board
meetings twice a year.
Review of services
During 2010-11 The St Christopher’s Group provided specialist palliative care
(inpatient care, home care, out of hours advice and visiting service 24 hours
a day and 7 days a week) to the NHS.
In the past year we have registered with the Care Quality Commission and
confirmed our compliance with the regulations as set out under section 20
of the Health and Social Care Act 2008.
We regularly review our data on the quality of care which we share with our
commissioning PCTs (Bromley, Croydon, Lewisham, Southwark, Lambeth)
from whom we receive 32% of our funding. We have a robust clinical
governance framework and a programme of audits to evaluate our practice
against evidence-based standards.
Participation in clinical audits
As an independent hospice, St Christopher’s does not participate in the
national NHS clinical audit programme, which covers subjects that do not
apply at the hospice. However, we regularly undertake audits which we
select according to network, local or internal priorities. Audits and
evaluations we have carried out in 2010-11:
Subject matter
Implication for practice/outcomes of audit
Follow-up actions
Review of
admissions –
September 2010
– March 2011
Audit of nursing
admissions
No changes required- target timescales
of admission achieved and exceeded
n/a
Nurses are involved in admitting
patients to the inpatient unit but this is
not always reflected in the record of
the patient’s admission which tends to
be medically led
Most respondents were very confident
about their role and that of the multiprofessional team in giving spiritual
care
-Ensure that nurses
receive sufficient
training in the use of
electronic patient
notes
- Publicise internally
hospice spiritual care
liaison group
Average ratings for quality of food was
4 on a scale of 0-5.
Average rating for presentation of food
was 4 on a scale of 0-5.
77% of patients said that portion sizes
were ‘about right’
-Increase variety of
dishes offered,
including those
suggested by
respondents
-Ensure that all
patients are aware
that they can order
drinks and snacks
Survey of staff
confidence in
delivering
spiritual and
religious care
Inpatient food
survey
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Cleaning audits
A very high standard of cleanliness was
found in all clinical areas
Laundry
facilities
Some renovation of the laundry
required and to ensure complete
separation between dirty and clean
laundry
Gold Standard
Framework
(GSF) meetings
in primary care
St Christopher’s nurses assessed their
contribution and that of the other
professionals in primary care GSF
meetings against the national
standards. Croydon meetings were
generally well-developed, whereas
Lambeth, Lewisham and Southwark
were still implementing the framework
Audit of patient
falls
Evidenced that falls risk assessments
were taking place and that staff were
using a range of strategies for
preventing falls in patients who were
assessed as being at high risk of doing
so
Results of this audit for the period
October 2010 to February 2011 were:
Croydon N 63/112 , or 56% of HC
patients achieved their PPC (with
26/112 or 23% unknown)
Croydon S 55/88, or 63% achieved their
PPC (with 3/88 3% unknown)
Lambeth 54/75, or 72% achieved their
PPC (with 12/75 16% unknown)
Southwark 55/75, or 73% achieved their
PPC (with 6/75 8% unknown)
Lewisham 49/61, or 80% achieved their
PPC (with 3/61 5% unknown),
Bromley SCH 116/155, or 75% achieved
their PPC (with 20/155 13% unknown)
Audit of
preferred place
of care (PPC)
amongst home
care (HC)
patients
between meals
Minor changes to sink
plugs carried out, and
toilet roll holders
changed
Minor changes to sinks,
replacement of pipes
etc
Repeat checks of
processes in laundry
- Continue to support
primary care
implementation of GSF
through regular
attendance and
contribution
- Further
improvements made to
the electronic incident
reporting database
Participation in clinical research
St Christopher’s has been involved in conducting 7 clinical research studies,
all of which received research appropriate ethics approval. In the last 3
years 18 publications have resulted from our involvement in research,
helping to improve patient outcomes and experience.
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Goals agreed with commissioners
Use of the CQUIN framework
A proportion of St Christopher’s income during 2010-11 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: To undertake an audit of falls (quarter 2) Achieved. (See audit
section above)
CQUIN2: To undertake an audit of advance care planning. Achieved (See
audit section above)
CQUIN3: To implement SKIPP (see above) reaching 70% attainment level.
Achieved
CQUIN4: To improve internal communications at St Christophers and
between the Hospice and PCTs in relation to continuing care funding for
patients. Achieved.
What others say about St Christopher’s
St Christopher’s is required to register with the Care Quality Commission
(CQC) and its current registration status is that it must accommodate a
maximum of 48 service users at the Hospice. The CQC has not taken
enforcement action against St Christopher’s during 2010-11.
St Christopher’s is subject to periodic reviews by the Care Quality
Commission, the last of which was on 14th May 2009. The CQC’s assessment
of St Christopher’s following that review was that all the standards
inspected were met.
St Christopher’s has not participated in any special reviews or investigations
by the CQC during the reporting period.
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 undertakes regular quality assurance checks of its data. We
have monthly meetings of representative users of our electronic patient
record system as a result of which any integrity issues are identified and
corrected. In addition we regularly quality assure the data provided to PCTs
(patient demographics, inpatient, day care and home care activity
summaries, place of death etc)
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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 are at
level 2 across each of these (i.e have implemented the requirements).
Clinical coding error rate
St Christopher’s was not subject to the Payment by Results clinical coding
audit during 2010-11 by the Audit Commission.
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Part 3
Review of quality performance
We review all our services regularly and our clinical governance scorecard is
one of the ways in which we keep track of trends in relation to quality and
patient safety (See page 9 for the scorecard covering the 6-month period to
March 2011). This is evidence of the way in which we track critical areas of
care. It also highlights that we have low rates of complaints, infection rates
on our inpatient unit, and medication errors. We assess each patient on
admission to the inpatient unit in relation in order to put measures in place
to reduce the likelihood of a fall while allowing them the freedom to move
around as they wish. Our falls rate in the inpatient unit is 0.015 falls per
occupied bed per 6 months, which is very similar to that of other hospices
and palliative care units.
Our audit programme reviews the effectiveness of our clinical care as does
feedback from patients and carers.
The result of the first 6 months of the SKIPP patients outcomes measure
shows that of patients surveyed within 3 days of admission to the inpatient
unit 36% (n= 44) said that that in relation to the problem that was of
greatest concern to them ‘things had got much better’; 40% (n=49) said
that ‘things had got a little better’ and 14% (n=17) that there had been ‘no
change’ since their admission.
The hospice had made a ‘great’ or a ‘very great difference to how things
are going at present’ to 63% of those surveyed.
In home care, 32% 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’ (n=41) since the nurse started visiting
them; 40% said that ‘things had got a little better’(n=53) and 17% (n=21)
that there had been ‘no change’. The home care team had made a ‘great’
or a ‘very great difference to how things are going at present’ to 72% of
those surveyed.
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Summary clinical governance overview ( October 2010- March 2011)
Written complaints
Number received: 3
- number upheld: 1
- unsubstantiated : 2
Written complaints by 6-month period
April-September 2010
4
Alerts
Incidents:
October 2010-March
2011
3
Oral complaints n= 4
(2 substantiated, 1 not substantiated, 1 ongoing)
Wider actions taken by the hospice following
complaints during this period.
-Patients’ valuables. Ward staff have been
advised to seal patient items in an envelope and
clearly label. The policy on patients’ valuables
has been reviewed and will make it clearer that
the hospice cannot be held responsible for the
loss of items that are not handed in for safekeeping.
-The Director of Nursing has met with home care
managers and agreed that ‘just in case’ boxes of
medication should be provided early in the
deterioration of patients with haematological
cancers, as their prognosis is especially
unpredictable.
-Review of protocol for completion of benefit
claim forms in Welfare Dept
Total clinical incidents/near misses:
Total non clinical incidents/near misses:
Total medical device incidents/near misses:
Total fire incidents:
Total security incidents:
Total information security incidents:
Total medicine- related incidents/near misses
Total violence /aggression incidents:
Total ‘other’ incidents:
Total n of RIDDOR reports:
April
10Oct 10
Oct
10Mar
2011
140
43
8
3
1
43
5
0
3
133
34
1
0
1
2
49
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2
Risk Register
Completed actions arising from incidents, alerts and risk assessments
in previous period:
-
Technical system improvements made in the email to fax system
-
Amends made to Safeguarding Policy to ensure availability at all
times of managers to staff reporting safeguarding concerns
-
Improvements made to Patient Valuables Policy to clarify
relative responsibilities of staff and patients
Total alerts
from Central
Alerting System
(CAS)
CAS alerts on
which action
required and
taken
Total MHRA
drug alerts
n. MHRA alerts
on which action
required and
taken
52
0
22
0
Infection control
n patients during period
who developed C Diff/
MRSA while on IPU*:
C Diff
MRSA
2
7
* These figures represent patients
admitted with unknown infection
status who develop symptoms 3
days or more after admission.
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During 2010-11 we have also undertaken a comprehensive evaluation of the
operation of our Anniversary Centre and presented it to Trustees and
relevant staff, and will be implementing changes in 2011-12 to improve and
refine joint planning with patients between our therapeutic and social
programme in the Centre and our home care services.
Feedback from patients and carers
Feedback from patients and carers is one of the most important ways in
which St Christopher’s and Harris HospisCare measures the quality of the
care they give. We receive many compliments and positive comments from
patients and families. Here is a selection from the most recent survey of
bereaved carers:
The care that we received and the support was
faultless, and with a smile. I don't know how
we'd have coped with certain questions we
had, had we not had that help.
I did think that nursing my
husband at home was more
emotionally and physically difficult
than I thought it would be, but I'm
really glad I did it. The support
from Harris HospisCare was
wonderful, we are so grateful.
Staff went out of their way to treat my
husband with every kindness and dignity
in a professional manner. The work done
by all staff at the hospice is first class. Just
keep the same quality of staff and know
that people are dying with dignity and in
comfort and pain free
Although initially wanted to die at home, because of the care received
at the hospice was happy to die there. He felt 'relaxed and safe'- his
words.
I was given excellent help from the chaplain
regarding funeral arrangements, and excellent
help regarding benefits from the welfare
officer.
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I would like to say that the staff treated my husband
with the utmost respect and allowed him to keep his
dignity to the end. When I wrote my letter of thanks I
mentioned that when the staff looked at him they
saw the man he was and not the patient, for which I
am truly grateful.
The patient's diagnosis came as a shock to us as a
family and so our boat as a family has been rocked. I
did not know what to expect. Without a doubt had it
not been for the exceptional expertise, humane and
professional approach, guidance and support from
the hospice staff, I wonder where we would be with
regards to family's emotions and sanity.
I think my husband and I considered it a
great privilege to have received treatment
from St Christopher's. I was given
counselling on one occasion when he was
in great pain. I was also given free
massage which was most helpful. The
volunteers in the Anniversary Centre were
most caring and the food was excellent.
Thank you
St Christopher’s is a wonderful, caring, safe place. My dad died
there 6-7 years ago. It has got better and better. My children were
so supported during my husband’s last days. It gave me the
opportunity to prepare them for what they were going to
experience. They loved St Christopher’s and its staff across all
disciplines. Thank you from the bottom of our hearts. “The
people looked really cared for here Mummy!” (my daughter, 7
years old)
The care we received was exceptional. My husband came out of
hospital in August and died November. I cared for him as much
as I could. The support from the CNS [home care nurse] was
superb. All my dealings with St Christopher's towards the end of
his life and since his death have been faultless. The social
worker, welfare officer and nurse have been my life-savers. I
would not have been able to cope during and after my husband's
illness/death without the invaluable support of St Christopher's.
Most importantly, he was treated as himself, and not as ‘a
patient’. The CNS dealt with him with compassion and empathy
and dignity, traits which are sometimes lost in the NHS hospital.
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Statements from PCTs, LINks
Bromley LINk welcomes the opportunity to comment on the Quality Account
for St Christopher's Group. Whilst we are not in a position to respond to the
Account in depth, comments we received from LINk members about quality of
care at the Group's Bromley sites were universally positive, and we
congratulate the St Christopher's Group on this. We look forward to working
with the Group in the future
Bromley PCT As the lead commissioner, Bromley PCT commissions services
from St Christopher's Hospice with Croydon PCT, Lambeth PCT, Lewisham
PCT and Southwark PCT. The commissioners formally meet with the Senior
Management Team of the Hospice bi-annually and discuss the services
provided and their quality. We review the quarterly data the Hospice produce
to evidence this. We also agreed four schemes under the Commissioning for
Quality and Innovation (CQUIN) payment framework in 2010/11 and we can
confirm that the Hospice successfully achieved all their requirements. Further
schemes are being developed for 2011/12.
One example of the high standards of work undertaken by the Hospice is the
comprehensive end of life training programme that St Christopher’s organised
over a wide variety of staffing groups in Bromley and Lewisham. Also, the
Palliative Care in Care Homes project which has seen hospital admissions
from care homes decrease at the end of life and care home staff becoming
much more confident about caring for end of life patients and enabling them to
die in the home.
Opportunities to give feedback on this quality account
We welcome feedback on this quality account. If you would like to do this,
please email b.monroe@stchristophers.org.uk or write to :
Dame Barbara Monroe
Chief Executive
St Christopher’s Hospice
51-59 Lawrie Park Road
Sydenham SE26 6DZ
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