30
years of caring
Annual Quality Account
2011 - 2012
Registered charity no.297798
Chief Executive’s Statement
Hospiscare is committed to providing high-quality
palliative care, in all settings in our locality, that
exceeds patient and family expectations.
I am pleased to present this Quality Account 2011/12 and
confirm, to the best of my knowledge, that it is
accurate and a fair representation of the quality of
healthcare services
provided by Hospiscare.
We provide high-quality care at our hospice in Exeter,
through our community palliative care teams, day care
services and through our hospital support team at the
Royal Devon and Exeter Foundation Trust.
Glynis Atherton
Chief Executive Officer
Hospiscare is a charity and raises 75% of its income from Hospiscare
voluntary sources and receives the remaining 25% as a
grant from NHS Devon.
Our commitment to quality is underpinned by a robust
clinical governance structure that includes meetings of
the Clinical Governance Committee (a sub-committee
of the Board of Trustees) significant event analysis and
regular audits.
“I would like to say a big ‘thank you’ to
everyone at Hospiscare, which includes
cleaners, kitchen workers and volunteers.
The compassion and dedication of
everyone is truly amazing.”
(Relative)
Hospiscare was registered with the Care Quality
Commission on 1 October 2010. They assessed our
declarations and evidence and found that we were
meeting all their standards.
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Hospiscare’s Values
Hospiscare's values underpin everything we do and flow
to meet the spiritual, emotional, social and physical needs of
people approaching the end of their lives.
throughout the organisation.
We provide timely and accessible services
We strive to make Hospiscare’s service accessible to all who
need it when it is needed. We work to remove unnecessary
barriers to access, and have a ‘no waiting’ culture.
Why we are here:
We believe that dying is an important part of living
The last chapter of people’s lives is of high value, so we strive for
the best possible quality of life, including freedom from pain and
fear, during this period.
We make best use of the resources given to us by the
community
The effectiveness and sustainability of Hospiscare depends on
robust systems which promote efficiency and accountability and
reassure supporters that best value is delivered.
Respect for the individual
We respect individuals’ choices for how they live every moment
of their life. We treat every patient as an individual, personalising
our service to their needs.
Balance in life to achieve well-being
For patients, we recognise the need to balance unpleasant
treatments with positive therapies such as massage. For patients’
relatives, we recognise the need to grieve, but we encourage
them to live as well. For staff, we recognise the importance of a
work/life balance.
We act fairly according to the needs of patients and our staff,
both paid and voluntary
We value equity: impartial provision of service that is fair
according to need. Our aim is to ensure that similar levels of
need are met to similar degrees, but we recognise that achieving
this does not necessarily require identical services everywhere or
identical conditions for all staff.
How we behave:
We put the needs of patients, and those close to them, at the
centre of all we do
The needs of patients are the reason we exist as a charity. As
long as there are incurable diseases, Hospiscare will strive
We are sensitive, honest and clear in all our communications
Communication is key to our work. We listen carefully to patients,
staff and volunteers to find out how they feel and what their
needs are. With patients, we explain the situation clearly and
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honestly and support them in the choices they make.
We recognise times when honesty may be distressing, but even
then we will not mislead people. We communicate clearly and
consistently about the services we provide.
We work in teams, cooperating with colleagues internally and
externally
Hospiscare is committed to working cooperatively as the best
means of meeting the needs of patients and their families.
We recognise that good teamwork requires consultation and
listening, and a willingness to make and back decisions which
will sometimes be difficult or unpopular.
We employ a multi-disciplinary team to work in close
collaboration with other government and non-government
agencies that can provide a benefit for patients. Our volunteer
groups work closely with our nursing teams to provide the best
service in patients’ homes and in the hospice.
“Thank you for the personal care you gave
to Mum and the nursing care you arranged
towards the end of her life. This allowed
Mum to fulfil her wish to die at home. Words
cannot express the amount of gratitude we
feel as a family.” (Relative)
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Hospiscare’s Services
Hospiscare is a local charity that delivers and develops adult
end-of-life care across Exeter, mid and east Devon. We achieve
this through the expert treatment, care and support provided by
our specialist teams at Exeter Hospice, at our day care centres, in
the Royal Devon and Exeter NHS Foundation Trust and at our 10
community nursing bases. All our services are supported by the
extraordinary efforts of our team of volunteers and are free at the
point of delivery.
a seven-day service and an invaluable overnight advice line via
the Hospice in-patient unit. This means that our health and social
care colleagues can access our expert knowledge and advice
around the clock.
Hospital Support Team
Hospiscare employs and jointly funds the team of specialist
nurses and doctors who work alongside the medical and nursing
teams looking after patients in the Royal Devon and Exeter
Hospiscare Community Teams
Hospital. Hospiscare’s specialist nurses and doctors visit patients
Hospiscare has an average caseload, at any one time, of around and their families on the wards, helping them to discuss their
650 adults living with a life-limiting illness. Most of these patients feelings, their illness and how it affects them, their treatment and
wish to remain in their own home, or within a familiar community future options.
setting, supported by the expertise of our community palliative
care teams.
Hospiscare’s Hospital Support Team works closely with other
services provided by Hospiscare, as well as NHS and social care
The teams are based at GP surgeries, community hospitals or
teams.They do their best to ensure that, with the patient’s permisHospiscare centres. They work closely with existing NHS and
sion, appropriate information is shared with colleagues to
social care teams to facilitate the wishes of individual patients
facilitate the best possible outcome for them and their families.
and their families. The person with the illness is central to all our
care and the specialist nurses, registered nurses and assistant
The Hospice
practitioners work together to provide the best possible personal- The Hospice in Exeter provides 12 beds for patients whose sympised care, irrespective of diagnosis or circumstance.
toms are complex and difficult to control, or who require roundthe-clock nursing care at the end of their life. Hospiscare employs
Our community nurses have immediate access to Hospiscare’s
a team of specialists in palliative medicine who are available to
multi-disciplinary team based at Exeter Hospice. They provide
assess and respond to patients’ medical needs 24 hours a day.
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The average length of stay is 10 days and around 50% of
patients are discharged home or into other care settings. Exeter
Hospice aims to provide treatment and care in a pleasant,
comfortable environment with maximum emphasis placed on
the comfort, dignity and wishes of the individual patient and
family. Overnight accommodation is available for visitors and the
staff will do everything in their power to meet the needs or wishes
of individual patients and their families. Meals are freshly cooked
on the premises by Hospiscare’s chefs.
Hospiscare also provides a chaplain, care managers,
complementary therapists, bereavement support and volunteer
services. All of these can be made available to patients as
appropriate.
Hospiscare Day Care Centres
Hospiscare has three day care centres; at our Mid Devon Day
Hospice in Tiverton, at Exeter Hospice, and in Seaton
Community Hospital. The centres are open between two and four
days a week and offer an individualised patient-needs
assessment, bathing, hairdressing and a range of therapies
including complementary and craft-based therapies,
alongside social activities. All three centres are staffed by
Hospiscare trained staff who are supported by Hospiscare
trained volunteers. In many cases, transport to and from the
centre is also offered.
Day care such as this offers real benefits to patients and their
families when a life-limiting illness is making it hard to get out,
curbing normal physical activities, or causing social isolation and
loneliness. Carers and families can enjoy a day for
themselves without worrying about their friend or loved one.
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Hospiscare Multi-Disciplinary Team
Hospiscare provides a range of services from the allied
professionals who make up our multi-professional team. This
includes carer support, care management and onward care
planning, religious and spiritual care and pre and postbereavement care for the patient and family if required. All these
services are based at the Exeter Hospice but are available to any
patient referred to Hospiscare.
Complementary Therapy
Hospiscare offers complementary therapies within the Hospice;
at our three day care centres, at our carer and bereavement
support groups, in the RD&E Hospital and at community
hospitals, at care homes or in the patient’s own home.
Hospiscare has approved the use of massage, reflexology,
Indian head massage and aromatherapy. These therapies are
used alongside conventional medicine to relieve stress and
tension, to aid relaxation and to promote a sense of wellbeing.
Therapies also help some patients with symptom control.
Hospiscare complementary therapies are available to the patient
as well as the patient’s family or carer.
Education and Learning
Hospiscare’s education and training team work together with
local and regional colleagues to share best practice in education
and information on topics relating to end-of-life care. Hospiscare
is committed to supporting our staff, volunteers and others in
their professional and personal development. We offer a range of
education events, placements and learning opportunities to help
inform and educate.
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Priorities for Improvement 2012 -2013
Hospiscare is being funded by the Phoebe Wortley-Talbot
Charitable Trust to pilot this service at our Mid Devon Day Hospice
in Tiverton from October 2012. The aim of the service is to offer
specialist palliative and end-of-life care to those who have
complex needs that are not met by current day care services. A
project group has been formed and sub-groups are working on
several areas, such as recruiting volunteers who have experience
in dementia care, developing a dementia education programme
with Devon County Council’s support; identifying staffing needs
and training and designing referral criteria, processes and
systems of work in partnership with local interest groups and
Devon Older People’s Mental Health Services.
Future planning
Priority 1
Day care for people with a diagnosis of dementia
Hospiscare is committed to offering expert specialist end-of-life
care treatment and support to adults suffering from a life-limiting
illness, irrespective of diagnosis or circumstances. We aim to
share our knowledge, skills and experience with local health and
social care professionals as well as the community at large.
Devon is home to a growing aging population and as people live
longer they are more likely to be struggling with co-morbidities,
one of which could be a dementia diagnosis. The National
Dementia Strategy (2009) cites the increase in the population
over 85 years old and the need for more effective end-of-life care
pathways and carer respite. The more recent National Institute
for Clinical Excellence (NICE) Quality Standards for Dementia
describes 10 Quality Statements for dementia patients and their
carers, three of which relate directly to end-of-life care and carer
respite.
This is a real opportunity to address the unmet needs of people
who are suffering from dementia as well as other life-limiting
conditions such as Parkinson’s disease, heart disease, cancer
and motor neurone disease.
Priority 2
Developing palliative care at home services
Over half a million people die in England each year, two-thirds of
these are aged over 75. The majority of deaths in the last century
follow a period of chronic illness such as heart disease, cancer,
stroke, chronic respiratory disease, neurological disease or
dementia.
Hospiscare has proven expertise and experience in these areas
which we believe we can share by working more closely with
our colleagues in the area of mental health in older people,
and through the provision of dedicated day care for dementia
patients.
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The End of Life Care Strategy (2008) aims to improve quality of
care and enable greater choice and control for all dying people,
regardless of their diagnosis and place of care. Given a choice
most people would prefer to die in their own home, but in reality
most people die in hospital.
“It is with great enthusiasm that the
DNs applaud Hospiscare for piloting
this service that we have needed for
so long.” (District Nurse)
Hospiscare has a reputation for working closely with primary
care practitioners in Exeter, east and mid Devon. Our figures
show that 88% of patients referred to Hospiscare’s community
nursing service will die at home or near to home (38% home, 14%
care home, 18% hospice, 18% community hospital); 12% die in the
acute hospital. This is significantly different to the Devon average
of 49% of deaths in acute hospitals.
The RT works collaboratively with existing services and has set
up systems of effective communication to prevent confusion, aid
structured case review and to avoid burdening patients and their
families.
The RT sits within the Exeter community nursing team and
includes an experienced Staff Nurse and an Assistant Practitioner.
The RT operates for 22.5 hours a week on Monday, Thursday and
Friday and includes bank holidays.
On 1 March 2012 a Hospiscare Response Team (RT) pilot scheme
was set up to provide an additional layer of expert palliative
and end-of-life care in complex cases. It identified that highly
responsive, hands-on nursing care alongside the clinical nursespecialist community service could facilitate greater numbers of
‘good’ deaths in the patient’s preferred place of care.
In the first three months, the RT received 38 referrals to the service
and carried out 62 separate episodes of care. Of these referrals,
93% of the patients were seen within two hours of receipt of the
referral, and the remaining 7% were seen later on the same day
or the following day.
Hospiscare recognised that working in an integrated partnership
with health and social care colleagues presented an alternative
to the traditional ‘hospice at home’ model, enabling smoother
continuity of care, greater shared learning and the opportunity
to build relationships. Patients and their families coping with
deteriorating circumstances or the dying phase of an illness need
practical support, confidence that help will be on hand and that
the professionals giving the care are skilled, experienced and
can access assistance if needed.
Of the 38 patients referred to the RT, 76% died within 6 weeks and
the average time spent on the RT caseload was 11 days - and
90% of these patients have died in their preferred place of death.
Of those patients who did not achieve their preferred place of
death, two had an appropriate admission to the RDEFT due to
medical emergencies and one had an appropriate admission
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to Exeter Hospice due to carer exhaustion. The remaining 24%
remain in their preferred place of care.
It is intended that during the remainder of the pilot period the RT
will continue to collect evidence to demonstrate
• The RT’s contribution to preventing inappropriate admissions to
acute hospitals
• The wishes of the carer regarding their preference for place of
care and death and how this contributes to the eventual outcome
• The views of GPs, District Nurses and Social Care professionals
regarding the value and effectiveness of the RT as a partner.
We aim to build on this experience to develop a flexible and
expert nursing response team that the people of Exeter, east
and mid Devon need and our colleagues value. As finances
and commissioning opportunities arise, Hospiscare will invest
in the growth of this type of skill mix within each locality, while
continuing to explore the impact on patients and their families.
Priority 3
Monitoring and measuring performance
Hospiscare staff and volunteers strive to provide the highest
quality treatment and care to our patients, their families and
other service users. Hospiscare’s internal clinical governance
mechanisms and incident and accident reporting systems are
robust and regular minutes and reports are reviewed by the
Senior Management Team and Board of Trustees.
A User Feedback Leaflet is available in the hospice and
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Priority 4
Developing staff
Hospiscare is committed to developing its clinical staff to ensure
they grow in skill, knowledge and expertise. Throughout the
Formal complaints are low, so a mechanism for auditing and
coming year the Nurse Leadership Team will continue to develop
analysing Significant Events (SEA) was introduced to encourage
competency frameworks for all staff providing nursing treatment
a culture of root cause analysis and structured criticism. Over the and care. These competencies will be based on the Knowledge
next 12 months we plan to divide SEA’s into ‘internal’ and ‘external’ and Skills Framework and St Christopher’s Hospice End of Life
performance, to identify those incidents which relate specifically
Care Competency Framework, and formed around four domains
to Hospiscare’s performance and those that relate to external
of management and quality, clinical practice and leadership,
partners. We will agree and implement, with our external provider communication and education and training.
partners and commissioners, which mechanisms are the most
effective for reporting SEAs and monitoring outcomes.
In addition, Hospiscare’s In-patient managers and our Learning
and development officer are working with our health care
Hospiscare is an active member of The South West Regional
assistants (HCA) to ensure they access and complete nationally
Hospice Group. Best practice and innovative mechanisms for
recognisable qualifications in health and social care.
benchmarking performance quality are shared and developed
through this group and the South West Clinical Informatics
Hospiscare has commenced a programme encouraging and
Project. Recent audit work has focused on analysis of
promoting clinical staff to rotate into our daycare centres and
inappropriate admissions to acute hospitals and how this might community services. It is our intention to develop more structured
be prevented in future, and the standardisation of medicines
career opportunities for both registered and unregistered nursing
incidents reporting and monitoring.
and care staff, commencing with registered nursing staff by the
end of March 2013.
Hospiscare’s In-patient Unit manager developed a root cause
“...visits to the house when things were very
analysis tool following a number of unconnected low-level
medicines incidents. This form of enquiry asks what, why and
difficult and reassuring telephone calls when
how, rather than seeking to find blame and encourages a culture
things were okay made all the difference.
of real understanding of system weakness or risks, which in this
Prompt action with provision of equipment
case led to a simple but effective resolution provided by the staff
concerned.
was very helpful.” (Relative)
distributed to all service users. Staff and volunteers are
encouraged to log verbal feedback with the appropriate line
manager or direct to the Director of Nursing.
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Review of Quality Performance 2011 -2012
Priority 1
Mid Devon Day Hospice, Pine Lodge, Tiverton
Following a successful grant application to the DoH and the
extraordinary support of the local community, Hospiscare
opened a new Day Hospice at Pine Lodge, Tiverton, in June 2012.
out-patient appointments, complementary therapies, as well
as meeting and education space. Hospiscare’s Tiverton Support
Group, Carers and Bereavement Group meet at Pine Lodge and
local health and social care groups can also use the facilities.
Priority 2
The single-storey building in a rural setting is attractive, inviting
Dignity in Care
and wheelchair friendly. It provides day services on Wednesdays Hospiscare staff and volunteers strive to ensure that all service
and Fridays for up to 10 patients, including bathing, hairdressing, users are afforded the same dignity and respect we would
complementary therapies, crafts, specialist out-patient review,
expect for ourselves and our families. It is important to us as an
care planning, social support, stimulation, and carer respite.
organisation that the end-of-life care we deliver is offered with
openness and compassion, and gives service users opportunities
Meals are freshly prepared by a Hospiscare chef on the
to make choices in their treatment and care.
premises, and the gardens and pathways surrounding the
building have been designed by the distinguished gardener
In 2011 Hospiscare underpinned its commitment to this high
Michael Hickson. The garden provides a beautiful and enjoyable standard of care by introducing the role of Dignity Champion
environment, with areas of seating for relaxing and private
and by forming a Dignity in Care Group chaired by the Director
reflection, aided by stunning views of the local countryside.
of Nursing. Mrs Mavis Seeley, a Hospiscare Trustee, became the
Patients and their families tell us the new centre is bright, sunny
first Dignity Champion and a core member of the Group.
and very welcoming and is giving patients with more complex
physical needs the chance to access local specialist facilities for
The role of the Dignity Champion is described on the Hospiscare
the first time. The Day Hospice is staffed by Hospiscare staff and
website and service users are encouraged to contact Mrs Seeley,
local Hospiscare volunteers.
in addition to the normal feedback or complaints procedure,
if they feel this would be more appropriate or easier for them
Hospiscare’s Tiverton specialist community nursing team have
to describe their worries or concerns. Mrs Seeley has met with
an office in Pine Lodge and can use the facilities there to offer
day care patients, carers and bereaved carers in informal focus
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groups to listen to their feedback and inform them of her role.
The Dignity in Care Group meets quarterly to identify and act on:
• Themes or dignity in care issues identified in feedback,
complaints or significant event analysis
• Education and training initiatives
• Information, media and relevant documentation
• Local or national dignity agendas
• The most effective methods to help keep staff and
volunteers informed and aware of this subject matter and their
responsibilities.
Regulatory Agency (MHRA). Hospiscare is also a member of the
South West Hospices Informatics Project and utilises the
in-patient unit quality metrics benchmarking process to capture
and compare common areas of information relating to pressure
ulcers, falls and medication incidents.
The hospice in-patient services managers and Hospiscare’s
infection prevention and control champion have considered user
All staff attend Essential Staff Updates each year. In 2012, this
includes a session on Dignity in Care facilitated by a member of
the group. The Dignity in Care Group makes recommendations
to the Senior Management Team and the Clinical Governance
Committee, a sub-committee of the Board. The Dignity Champion
presents an annual report to the Board of Trustees.
Priority 3
Patient and service user safety
Hospiscare’s 12-bed hospice in-patient unit collects and reports
incidents such as trips and falls to the Clinical Governance
Committee. It complies with the Reporting of Injuries,
Diseases and Dangerous Occurrences Regulations (RIDDOR) and
the Care Quality Commission (CQC) regarding reporting of
serious accidents or incidents.
Hospiscare logs, records and reports outcomes to the Clinical
Governance Committee or the Health and Safety Committee all
relevant ALERTS received via the Medicines and Health Products
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feedback, conducted ‘tests of change’ and reviewed current
policies and procedures, the results of which have led to the
following initiatives.
the viability and reliability of the Graseby syringe driver pump,
Hospiscare changed to the McKinley syringe driver. This decision
was made because of accumulating evidence that the McKinley
driver was safer and because this pump could generate a digital
record of its use which made it easier to spot faults or errors. In
the 12-month period January 2010 to 2011, prior to the change
of pump, the In-patient Unit reported three incidents relating to
syringe-driver failure, since January 2011 just one incident has
been reported. This is a significant improvement in patient safety
in an area where use of syringe drivers is commonplace.
• A thorough and comprehensive review of Hospiscare’s
prevention and control of infection policies taking into account
national legislation, the local NHS Infection Control Link Group
and Regional Hospice Control of Infection Network Group
recommendations. This has resulted in new policies being
generated and cascaded to clinical staff regarding; MRSA,
clostridium difficile, decontamination, gastro-intestinal illness,
hand hygiene, standard precautions, source and aseptic
technique policies, plus a new overarching infection, prevention
and control policy.
• Even in a hospice environment where staffing ratios are much
higher than average, patients can still feel isolated or anxious,
or be at additional risk due to their deteriorating health and
increased frailty. This is more likely if the patient concerned is in a
side room and is not aware of when they are being observed by
staff. As a result of patient and family feedback and consultation
with the in-patient staff an ‘intentional rounding’ tool was
designed and introduced in February 2012.
• The development of a new handbook entitled ‘infection
prevention and control information for all staff and volunteers’.
This handbook provides staff and volunteers with the principles
of good infection prevention and control, as well as more
detailed guidance and signposting for frontline clinical staff
and volunteers. It has been issued both in hard copy and
electronically to all staff and volunteers.
The purpose of the tool is to identify and monitor patients who
would benefit from an additional ‘check’ from staff. It is designed
to ensure they are comfortable, safe and that they feel cared for
and reassured. This is particularly important in the case of bedbound, highly dependent patients, and for those whose mental
acuity is failing and thus find it more difficult to remember simple
instructions. The tool requires specific questions to be asked and
responses recorded. It helps to identify a pathway of decline that
may require additional staff or resources to be utilised.
• The purchase of a hand hygiene glow box and facilitated
informal handwashing drop-in sessions raised hand-hygiene
awareness generally, and has been an effective tool in the
teaching of handwashing techniques for clinical staff.
• In the first quarter of 2011 as a result of a ‘test of change’
and in response to information received from the MHRA as to
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Priority 4
Improved volunteer training
The recruitment, training and retention of volunteers is vital to
maintaining the high standard of Hospiscare’s services. Our
success was evidenced by being awarded the Queen’s Award
for Voluntary Service in June 2011. Added to this, of our 977
volunteers more than 420 of them have given more than five
years of service, providing valuable, well-experienced and
knowledgeable support.
A review of recruiting and training volunteers has helped to
highlight areas of success and areas where improvements
can be made. There has been a steady increase in the
number of requests for drivers and homecare support. After
a meeting between the community clinical nurse specialists
and volunteers, the need for a more centralised approach was
identified. Standard forms were introduced to give relevant
information before a visit with a reflective feedback form, helping
volunteers to carry out tasks with maximum confidence and
professionalism. Importantly, the feedback prompts the volunteer
to make any concerns or unexpected problems known to the
clinical team.
To fulfil requests for more homecare support and drivers,
one-to-one training has been developed. Alongside the training,
comprehensive role guidelines have been developed for
reference on what to do in unexpected situations and for general
support.
As a result of work completed by our education team, more
volunteers now attend education sessions. These sessions give
them the skills and confidence to work closely with patients and
families as well as learning to care for themselves emotionally
and enjoy a good volunteering and life balance.
A new Volunteer Handbook was introduced, together with
guidelines on specific volunteer roles. This means that staff and
volunteers have a clear understanding of expectations and
boundaries, reducing risk and increasing productivity.
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Hospiscare volunteers offer warm, caring, friendly support to
patients and their families. Sometimes this can be emotionally
draining and distressing for volunteers. The impact of
accumulated loss or sadness, if left unresolved, can have
a lasting effect on the volunteers. To value and equip our
volunteers for the challenges of their role, a workshop has
been devised and implemented to promote appropriate coping
strategies, raise awareness of potential risk to the volunteer’s
well-being and guide them in how to work within the emotional
boundaries of their roles.
will now be described as belonging to one of three different
domains:
• Service user compliments and ‘thank yous’
• Significant event analysis - internal Hospiscare events
• External significant events involving health and social care
partners
Service user compliments and ‘thank yous’ 2011 - 2012
Number of Route/
comments method of
logged
delivery
What patients and families say about the service they receive
We believe it is important to capture accurately the experience
and feedback of those who use our service in all clinical
environments. At Hospiscare, we understand that it is important
to enable service users to have a voice, and to have concerns or
issues heard, understood and acted upon where appropriate.
86
57 - Letters
and cards
4 - Website
3 - Verbally
22 - Feedback
forms
Emerging issues Outlines and
or service user communications
themes
to staff/line
managers
5 suggestions
2 – catering
relating to
2 – inpatient
• Menus
services manager
• Overnight kit 1 – control of
• Fridges
infection lead
• Newspapers
It is appreciated that these numbers do not accurately reflect
the significant number of verbal and written compliments and
‘thank yous’ received by Hospiscare staff, but is an initial attempt
to capture such comments. In the coming year each service user
will receive a Hospiscare feedback form during each episode
of care, and the Hospiscare website will be updated to facilitate
easier online feedback. It is hoped that the Hospiscare Dignity
Champion will also present an opportunity for feedback via focus
groups and the Dignity Champion telephone number.
Hospiscare took part in the Help the Hospices 2010/11 Hospice
Patient Survey alongside 38 other hospices, which was carried
out by the Centre for Health Studies at the University of Kent.
This activity helps us achieve compliance with the Care Quality
Commission (CQC) Essential Standards of Quality and Safety
2010.
During the past year work has been undertaken to explore and
develop the different types of feedback we receive, how best to
capture and analyse the feedback and how to report the actions
that occur as a result. As a consequence, Hospiscare feedback
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Significant Event Analysis
Significant event analysis (SEA) presents an opportunity to
reflect on an episode, or a whole period of treatment and care
received by a patient under the care of Hospiscare. Our aim is
to learn from our experience in order to improve the quality of
treatment and care we provide, while influencing and facilitating
improvements in the treatment and care provided by others
where appropriate. The Hospiscare SEA process cultivates a
positive culture of investigation, learning, change and resolution
for all concerned including the service user where possible.
For SEA diagrams see pages 18 and 19.
patients preferred place of care or death, use of the national
end-of-life care register and the availability of an advance care
plan. This will be done through Hospiscare’s electronic patient
record system.
Throughout the past year Hospiscare has worked with nine other
hospices in the south west to produce data relating to In-patient
Unit patient falls, pressure ulcers and medicines management
incidents. This work has been collated by the South West
Informatics Project and shared between participating hospices in
order to facilitate joint working and to raise awareness of good
practice.
Formal service user complaints (2011 - 2012)
For the 12-month period under review benchmarked against the
other regional hospices Hospiscare has reported:
Number of Investigating manager Result of
complaints / director
investigation
5
3 – Director of
Nursing
1 – Chief Executive
1 – Community
Cluster Team Leader
3 – not upheld
following investigation
2 – partially upheld following
investigation and learning or
service improvements
applied as appropriate
Hospiscare
Hospice Average
8.4 falls*
0.3 pressure ulcers*
5.7 medicines incidents*
Occupied bed days 76.2%
8.5
3.5
6.2
75.4%
* Per 1000 occupied beds
Audit
Hospiscare carries out regular audits relating to patient
experience, safety and quality of service. Hospiscare also
submits data to the National Minimum Data Set for specialist
palliative care, and participates in audits carried out by the
Peninsula Cancer Network. In the next year Hospiscare will
further develop the ability to collate quantitative data relating to a
Care Quality Commission (CQC)
Hospiscare is subject to periodic review by the CQC and was
re-registered by the CQC under the Health and Social Care
Act 2008 on 1st October 2010 following the completion of a
compulsory self assessment. Hospiscare has not participated in
any special reviews or been the subject of any CQC enforcement
action or investigations during 2011/12.
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Significant event analysis - internal Hospiscare events
Number
of events
reported:
7
Hospiscare Departments:
4 – in-patient unit
2 – community team
1 – overnight advice line
Outcomes and service improvement
recommendations made as a result of
the SEA investigation:
•
•
•
•
•
•
•
•
Pilot and introduction of new complex assessment tool
Review and changes to discharge care plan
Improve record keeping / staff understanding
Identify training needs for bank staff
Purchase of new models of higher quality device
Pilot and introduction of ’intentional rounding’
Flagging system for staff awareness
New community team leaflet planned and being produced
September 2012 with clarity of service
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Emerging issues or
service user themes:
1 – assessment of highly
complex needs
1 – discharge planning
2 – checking out patients
own drugs
- medication skills of bank
staff
1 – quality of listening
devices and monitoring
of those patients without
speech
1 – user information as to
our role
External significant events involving health and social care partners
Number
of events
reported:
10
Health and social care partners involved:
3
4
– NHS provider weekend services
– DDOC*
1
– RDEFT**
2
- SWAST***
Outcomes and service improvement recommendations made as
a result of the SEA investigation:
• Reminder to DDOC of the availability of Hospiscare advice line service and the
expert resource available
• Pilot of Response Team commenced in Exeter Cluster May 2012
• Review with GP and key family member following the death. Benefits of
proactive prescribing in allaying family fears
• Unable to move patients within their own home as not within contract.
Agreement for funding required in advance. Led to 1 patient being
inappropriately admitted
• October 2011 – discussion between Hospiscare and SWAST*** plans made to
prevent this happening again
• August 2012 – following a number of phone calls and meetings instigated by
Hospiscare and subsequent contract review, static movement is now within the
SWAST*** contract
• Led to patient’s admission to the hospice for robust assessment and care
planning
• Discussed with RDEFT Ward involved
• Palliative Discharge Team commenced May 2012 -RDEFT** and Hospiscare pilot
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Emerging issues or
service user themes:
3 – OOH**** assessments.
Understanding what we
have to offer
2 – capacity of weekend
provider service to respond
to complexity/deterioration
– challenges of the informal
carer role when supporting
a dying relative at home
2 – movement of ‘static
patients’ contract
1 – inadequate discharge
planning and lack of
communication with family
* Devon Doctors
** Royal Devon and Exeter Foundation Trust
*** South West Ambulance Service Trust
**** Out of hours
Statements from LiNK Devon Exeter and East Devon Locality
and NHS Devon
LiNK Devon Exeter and East Devon Locality
Though LiNK were very happy to receive a copy of this Quality
Account Caroline Lee, LiNK Devon Community Involvement
Co-ordinator reported that unfortunately due to capacity issues
during the transition period they were unable to comment.
Caroline has however included Hospiscare in the information
for Healthwatch regarding organisations who are expected to
submit a Quality Account in 2013/14.
NHS Devon
This Quality Account has been sent to the nominated individual at
NHS Devon for comment.
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