Vista Healthcare
Quality Account 2012
Vista Healthcare Independent Hospital
Quality Accounts
Vista Healthcare Quality Accounts 2011/2012
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Vista Healthcare
Quality Account 2012
INDEX
Statement from CEO
Page 3
Board Directors
Page 4
Priorities for 2012/13
Page 5
Quality Improvement Priorities 2011/12
Page 6
Audits
Page 8
ESSENs
Page 22
Patient Experience
Page 26
Patient Movements Information – over last 5 years
Page 28
Mental Health Act
Page 30
Conclusion and Contact Information
Page 31
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Vista Healthcare Quality Account 2012
Statement from Chief Executive Officer
I am pleased to present Vista Healthcare annual Quality Accounts. This is our opportunity as an
Independent sector specialist learning disability and mental health service to provide you, the public,
with information about the quality of the services we provide; and to demonstrate to you that we
are committed to a continuous focus on quality improvement, that is evidence based and regularly
reviewed and scrutinised both by the Board, our patients, staff and by external stakeholders.
Vista Healthcare services are commissioned exclusively by the NHS – either by individual PCTs or
through Specialised Commissioning Groups on behalf of their host PCTs. We believe the needs of
patients can be more safely and efficiently met where there is a seamless relationship between
independent and NHS providers. In these times of collaboration and cooperation, it remains the
ambition of Vista Healthcare to become fully integrated into the developing provider landscape
Quality is central to the delivery of our strategy and through the hard work and commitment of our
staff we continue to deliver safe, effective and high quality services whilst at the same time working
with our patients, staff and other stakeholder to prioritise areas for improvement.
Our vision as a service is to demonstrate good practice, high standards of care and partnership
working through articulating and living our vision and values; we aim to show that the people who
use our services are at the centre of everything we do; that we value our staff; and that our
partnerships are important to us.
For 2011/12 Quality Accounts, we are making a commitment that in 2012/13 we would undertake to
deliver high quality services, whilst at the same time identifying priority areas for improvement. This
report provides details of:
• Achievement of our quality initiatives in 2011/12.
• Description of our quality initiatives for 2012/13.
• Details of how we aim to embed and maintain the improvements we have already made.
• How we have met the requirements of the CQC.
Other successes include:
• Significant reduction in the omission of medicines
• Improvement in the effectiveness of reporting and learning from incidents.
• Achievement of quality improvements (CQUIN targets) required by our commissioners
Next year will challenge us further as we continue to improve the quality of services we deliver
within a tight financial envelope. Building on the progress we have made to date I look forward to
sharing our progress in our Quality Accounts for 2012/13.
Ian McComiskie
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Board Directors
In preparing this quality report the directors have taken steps to satisfy themselves that:
The content of the quality report meets the requirements set out by Vista Healthcare
The content of the quality report is not inconsistent with internal and external sources of
information including:
• Board minutes and papers from the period April 2011 to June 2012
• Papers relating to quality reported to the Board over the period April 2011 to June 2012
• Vista Healthcare complaints report
•EssenCe report 2011/12
• Vista Healthcare Audit’s
The quality report presents a reflection of Vista Healthcare performance over the period covered;
the performance information reported in the quality Account is reliable and accurate; there are
proper controls over the collection and reporting of the measures of performance included in the
report.
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Priorities for 2012/13
Patient Engagement
1. To encourage the use of the recovery principles by using recovery star and achieving 90%
compliance of engagement with recovery star
2. Ensure all elements of care are patient focused and allows for patient input in line with the
recovery principles
3. Further increase meaningful engagement (aim for 100%)
4. Provide high quality new information for patients as well as relatives and carers
5. Continue to carry out patient-focused audits as appropriate
6. Ensure that 95 % of patients are trained in Safeguarding
7. Ensure that 95 % of patients are trained in Recovery Star Principles
8. Ensure that all wards have weekly community meetings
9. Ensure that there is a monthly hospital wide patient meeting (patients assembly)
10. Re audit the patient observation and engagement audit
Safety
1. To improve medicine management processes through audits and training
2. Improve infection control within all patient environments through training and audits
3. Improve the ward atmosphere through conducting EssenCES surveys and make changes as
appropriate in response to the findings
4. Further training of staff to Advanced level of Team Teach
5. Ensure that 100% of staff are trained in Safeguarding
6. Re audit the ligature audit carried out in the 2011/12 year
Effectiveness
1. Further develop the Recovery approach; embed the Recovery star within My Shared Pathway and
the CPA process
2. Review current clinical outcomes with a view to continual improvement
3. Working with internal and external stakeholders to further improve the patient’s care pathway
4. Improve consistency of clinical systems
5. Raise the standard of record keeping with others through improvement of our IT structures by
enhancing the Electronic Patient Record system
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Quality Improvement Priorities 2011/12
Introduction
Vista’s commitment as an organisation is to continue the focus on delivering high quality, safe and
effective services. Each year Vista Healthcare is faced with the challenge of balancing the competing
number of quality improvement initiatives against tight financial resources, whilst continuing to
deliver value for money, high quality care and service provision. Vista continues to work to the
premise that “people who use our services are at the centre of everything we do” and therefore, the
views and opinions of our patients are key to shaping the quality improvement agenda.
Vista Healthcare has chosen to align our quality improvement priorities to the Commissioning for
Quality and Innovation (CQUIN) scheme as agreed with our commissioners. The report provides
information to demonstrate the improvements made by Vista against the areas of medicines
management, safety, patient experience and some of the CQUIN requirements.
Medicine Management
The aim of this priority is to improve effectiveness of care by ensuring that medication is
administered as prescribed by ensuring that the rationale for any omissions has been correctly
documented.
Target:
No unintentional omission of critical medicines should occur. Unintentional omission of other
medicines should be minimal and represent a decreasing trend.
Rationale:
The omission of medicines has the potential to result in harm to patients including fatalities
inadvertent omission should easily be noticed at the next medicines round, since the administration
box will remain blank, and remedial action can be taken. Failing to record intentional nonadministration, using omission codes, can result in patients receiving double doses, which has the
potential to result in fatalities or severe harm.
Vista Healthcare has looked at means of ensuring that medication management is of the highest
standard and as such has agreed to implement the following throughout 2012/13:
•
•
•
•
•
A number of policies and procedures will be produced or revised to support the prescribing,
supplying and administration of medicines
Policy implementation to be supported through the continued roll out of Medicines
Management Training
A new handover form will be introduced onto wards which will require staff to review the
medicines cards and document unintentional omissions.
Systems for the supply of medicines within and out-of-hours to be reviewed to check for
robustness.
Datix system in place, this will enable staff to complete incident reports when errors in
medicine administration and recording are seen.
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•
•
•
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Nurses involved in medicines errors will be supported through operation of the medicines
administration competency framework
Medicines management Annual Report will be produced and will include in 2012/13, the fall
in unintentional omissions to 2% and unintentional omission of critical medicines to 0%.
Performance and monitoring of unintentional omissions will be reviewed through the
Medicines Management Committee Quarterly reports. Progress against the CQUIN will be
reviewed by the Medicines Management Committee and Clinical Governance Committee.
The following audits cover the areas of patient’s safety and the patient’s experience and form the
basis for Vista to evaluate its position with regards to these areas and take actions based on the
recommendations to improve safety and increase the patient’s voice in improving the service and
individual patient care. The aim of this priority is to develop and strengthen systems and processes
that routinely gather real time information from our patients and use this information to further
enhance and develop the quality of the services we provide.
Vista Healthcare had already implemented a process for capturing and responding to real time
patient’s feedback. We have learnt that, in order to capture feedback from our patient population
effectively, we needed to develop and implement a range of methodologies to ensure service
improvement was specific to local need as well as addressing organisational wide priorities. This
work has been underpinned by the appointment of a Patient Experience Manager (PEM).
We have also appointed a safeguarding manager responsible for leading and coordinating the
safeguarding process in line with local policy and working closely with ward staff and other agencies
to ensure that any safeguarding issue is investigated and dealt with in a timely manner.
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Audits: Ligature Points Audit
Executive Summary
Suicide is a devastating event that has been noted to generate emotional problems as well practical
difficulties for families, friends and healthcare professionals. It is the commonest cause of death in
the United Kingdom, particularly for men under the age of 35 years (Hawton et al, 2003). It is
claimed that one person dies every two hours in England from suicide (DH, 2002). People with
mental health, and / or learning disabilities problems are more at risk of dying from suicide relative
to the general population. Thus, preventing its incidence should be an integral part of all quality
improvement strategies of healthcare organisations, particularly those with responsibilities for the
care and treatment of people with mental health and or learning disabilities problems. Research
and audit should occupy a critical position in these strategies, a view acknowledged in the
document, “National Suicide Prevention Strategy for England” (DH, 2002).
This report is a critical examination of the ligature points of all the clinical areas of Vista Healthcare
Independent Hospital. It employs an audit framework, Ligature Points Audit Tool (LPAT). Embedded
in this tool are five areas or dimensions considered important for determining aspects of the clinical
environments with risk for suicide by hanging. The result identified only a small number of areas
that present a significant risk for suicide. This suggests that a large number of areas are reported to
be at low risk for patients hanging themselves. Taking into account the potential impact of suicide,
recommendations are presented for addressing the areas for improvement.
Background
The prevention of suicide is not an exclusive responsibility of any one aspect of society, or of health
service providers like Vista Healthcare Independent Hospital. Carers, researchers and educationist
with interest on this subject do also have a role to play, as they are also aware of at least some
factors that may cause death by suicide. The factors associated with suicide are many and wide
ranging. Examples of these include significant life events, mental health and learning disabilities
problems, and access to means or methods to do so.
There is a range of methods people use to commit suicide. Self-poisoning is noted to be the most
common approach employed in our communities. However, in mental health and learning disability
environments including secure settings, hanging is considered as one of, if not the most common
method of suicide (Bennewith et al, 2005; Gunnell et al, 2005). This is also the case for patients with
these problems in community settings. Clearly, preventing or reducing access to lethal method(s),
such as means of hanging, is an effective approach to suicide prevention. This assertion is also
attributable to the view that suicidal behaviours are sometimes impulsive; as people tend to use
means that are easily accessible without time for reflection. Implicitly, obvious ligature points,
which can be reached with ease, present a significant risk. Thus, removing or covering these points,
as highlighted in the “National Suicide Prevention Strategy for England” (DH, 2002), would help in
the prevention of this behaviour. For in-patient mental health services in particular, the strategy
stressed that all likely ligature points in these areas must be removed or covered. However, it must
be taken into account that it is practically impossible to remove all the ligature points in clinical
environments. This indicates the need for clinicians to make clear judgement about ligature points
that pose significant suicide threats. In other words, they need to make decisions about the degree
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of lethality of ligature points. Conducting an audit is one approach that will help in making such a
decision. Vista Healthcare Independent Hospital is therefore required to carry out a ligature point
audit because of the recent structural changes to the clinical areas. These include the introduction
of new bedroom furniture and other furniture for the communal clinical areas. But clinicians should
remember the notion of method substitution, as patients can try to use other means for hurting
themselves when their preferred choices are removed. This advice is taking into consideration
during this audit.
Aim
The focus of this audit is on ligature points. It intends to identify likely ligature points on all the
clinical areas of Vista Healthcare Independent Hospital, including its perimeter. The aim is also to
liaise with the Registered Manager and Director of Estate to remove or cover identified ligature
points considered as significant risk factors for suicide. These aims are likely to be achieved by
implementing the following objectives.
Objectives
The person responsible for conducting the audit to:
1. Develop a comprehensive understanding of the Ligature Points Audit Tool
2. Work in partnership with members of the nursing team to compile a list of areas to be audited.
3. Identify all areas to which patients have access
4. Check areas systematically and note each ligature identified
5. Understand the findings and develop an action plan for addressing areas of concern
6. Inform the management team of the outcomes.
Methodology
The Ligature Points Audit Tool (LPAT), developed by Greater Manchester West Mental Health NHS
Foundation Trust, was used to evaluate the degree of lethality of ligature points in all clinical areas
of this hospital. Lethality in this context refers to the likelihood of death occurring when a ligature
point is used. This means that some ligature points carry a serious risk of causing death, whilst
others are of a lesser risk. For every ligature point, this risk falls somewhere along the continuum of
“no chance of dying” to “high chance of dying”. This risk or chance is identified in this audit using
the LPAT.
The audit tool is made up of four dimensions for identifying risk factors for suicide in clinical
environments. They are as follows: room designation, patient profile, ligature point and
compensating factors. Each of these dimensions has ratings from 1 to 3 with 1 representing low risk,
2 medium and 3 high risk. These ratings denote the degree of lethality of every identified item of
the dimensions.
The room designation dimension focuses on assessing the opportunity patients` could have to use a
ligature point. It is therefore associated with degree of supervision healthcare professionals,
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including nursing staff, offer to patients. The patient profile dimension relates to patients` mental
state and or learning disability statuses, as these are believed to play part in enhancing or decreasing
their propensity for suicide, in other words, their use of ligature points. The ligature rating or
dimension takes into account the type and position (height) of ligature points, which is believed, will
help determine the likelihood of death when utilised. The final dimension, compensating factors
concerns permanent features in the clinical environment, such as those which relate to its design
and practices (e.g. general observation) that could help reduce patients` risk of suicide.
The LPAT was applied by two healthcare workers familiar to all the clinical areas. They identified all
areas that are accessible to patients and systematically checked the same for ligature points. Scores
were awarded in line with the degree of lethality to every point from which patients can hang
themselves.
Results and Discussion
The results for each dimension are presented and simultaneously discussed to illustrate their
relationships to the risk of suicide by hanging. Starting with room designation, some areas in the
clinical setting were considered to present significant risk for suicide and therefore given a rating of
3. These areas, which relate to all clinical environments, include bedrooms, communal toilets and
shower rooms, as patients sometimes spend time in the rooms without direct supervision from
clinical staff. The risk for the rest of the rooms in the clinical environments was believed to be low,
awarded a score of 1. This indicates the strength of the organisation in the context of its
commitment in continually creating and maintaining safe environments for both staff and patients.
The score of 1 means that the patients are always closely supervised or observed in these rooms or
environments and therefore have less opportunity to use ligature points noted in them. Examples
of these rooms include corridors, dining areas, lobbies, visitors` rooms and nursing stations. Clearly,
the more supervised an environment is, the less the chance for patients to engage in suicidal
behaviours. This was observed to be case for all communal areas of the clinical environments, which
were noted to have a high presence of nursing staff. Arguably, effective supervision or observation
is a critical approach for suicide prevention.
In relation to the patient profile rating or dimension, all the patients were considered vulnerable and
susceptible to suicide and were therefore given a score of 3. This score was a function of their
presentations, which include challenging behaviours such as aggression and violent behaviours,
unpredictability of these behaviours, and chronic mental health and learning disability problems.
However, the score of 3 does not indicate the differences in vulnerability of members of the patient
groups. Even though all the patients were rated 3, it was believed that some may have a higher risk
of suicide than the others. Identifying these differences would help in the development of an
effective treatment and care package for addressing suicidal behaviours.
Some ligature points were given ligature ratings of 2 or 3, meaning they were considered medium or
high risk for patients to kill themselves by hanging. The wall bracket in the shower room of the High
Dependency annexe of Prandle Ward and television bracket in bedroom three of Watson Ward, and
doors of the lower and upper built-in wardrobes in patients` bedrooms were assigned a rating of 3.
A rating of 2 was given to the door handles of the bedroom doors and curtain rails or window levers
of bedrooms. The physical structures highlighted offer good points from which patients can hang
themselves. They are therefore rated as high risk (3) or medium risk (2). Good points mean that the
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physical structures are at a reasonable height (above 700mm and below 4 metres), and most
importantly, the rooms in which they are situated are not frequently supervised by nursing staff and
other healthcare workers. In other words, the degree of supervision of these areas is limited.
Apart from the above ligature points, a rating of 3 was assigned to the ligature points in the garden
areas of all wards (e.g. Garden fences, wooden benches and trees on Watson ward). Even though
this is the case, a closer look at the ratings revealed that the risk identified in the garden areas can
be re-graded to 1. This is because patients are always under rigorous supervision when in their
respective gardens. Therefore, they have very limited opportunity to hang themselves. The door in
the lobby of the main ward was also given a score of 3. Again, taking into account the regular and
frequent presence of healthcare workers in this area, it presents a low risk of suicide.
Compensating factors relate to those features of the ward environment that may improve the
effectiveness of patients` observation and engagement. The bedrooms, as reflected in the result,
are barriers to effective observation because of their design, which limits nursing staff supervisory
practices. They were rated 2, medium risk. Associated with effective observation is the issue of
staffing levels and mix. Observation of poorly designed areas, like the bedrooms, noted by raters,
can be enhanced if the staffing levels are appropriate, in other words, increased relative to the
patient population. It is sometimes difficult to amend the structure or design of the environment.
Even though this is the case, the efficiency of supervisory or observational practices can be improved
if the “right and appropriate number of staff” are available to work with patients. Certainly, such an
approach, as noted in the literature, would hinder patients` attempts at harming and or hanging
themselves.
Recommendation
• Discuss outcome of the audit at Clinical Governance
• Discuss with senior management the possible strategies for addressing high risk outcomes
• Re-audit after six months, following implementation of management strategies
Healthcare Workers: Observation and Engagement Audit
Executive Summary
Observation and engagement is an important aspect of care commonly used in learning disability
and mental health services for the management of challenging behaviours, such as violence and selfharm. Yet most staff involved with this practiced claimed not to have any form of training. It is a
practice that is apparently considered as a low skilled activity, as most people allocated to observe
patients are non-registered healthcare workers. It is certainly an important facet of care that
requires skills and effort for effective implementation.
Generally, healthcare workers are aware of the meaning of observation including process and
categories. Even though this is the case, it is in the main not consistently implemented. In addition
to lack of or limited training, this is a function of shortage of staff and limited communication
between episodes of observation. The need for an MDT approach to observation was highlighted
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during this audit. It is believed that its application can be improved by addressing a range of
recommendations particularly that which relates to training.
Background
Observation is one of the most common interventions in in-patient mental health and learning
disability settings used for the management and prevention of challenging behaviours like self-harm
and violence (Bowers & Park, 2001). There are variants of this approach. The category used at any
one time is usually dictated by the acuity or severity of patients` illnesses or presentations. For
presentations considered to be of high risk, patients are generally observed closely to prevent their
occurrence. This manner of observing patients with the potential, for example, of hurting
themselves is what is referred to as “specialling” or level 4 observations in this hospital (Duperouzel
& Fish, 2010). Irrespective of the level used in applying observation, the practice is in the main
considered by patients and some healthcare workers as intrusive, restrictive and controlling. Such
restrictive approaches could perpetuate the need for more challenging behaviours. Thus, a change
in philosophy of the conduct of observation from control to care is critical for ensuring effective
management and prevention of challenging behaviours.
The practice of observation has evolved from the age-old manner of healthcare workers checking
patients` safety and well-being to care with the view of reducing the incidence and prevalence of
challenging behaviours as well as enhancing the effectiveness of care provision. This philosophical
shift is reflected in the changes in the terms used to describe this approach. It was initially referred
to as “observation”, then “supportive observation” and now engagement and observation (DH,
2002). The final term serves as a reminder from the Department of Health of a key principle of the
process of observation; it MUST be both safe and therapeutic.
Patients on observation are usually on a temporary period of increased need. So, irrespective of the
cause of this need, these patients require safety, compassion, understanding, and appropriate
treatment and care (Bowlers et-al.2002). The question now arises, what is appropriate treatment
and care? This, in essence relates to those which are patient focused, delivered within the
framework of true partnership between healthcare workers and the former. Acknowledging this,
engagement and observation should be undertaken by skilled and well intentioned healthcare
workers whose remit is to create opportunities for therapeutic engagement and intense
assessments of patients` mental states and behavioural presentations. This is consistent with the
principle of “reciprocity” which states that if “we restrict a patient`s freedom because of observation
requirements, then we (healthcare workers) are obliged to provide high quality care and
engagement to the patient” (Scottish Government, 2002). Taking this into account, a structure is
needed to ensure quality care provision during periods of distress. Hence, the engagement and
observation policy, developed by the Management Team of Vista Healthcare Independent Hospital.
It is believed that using it effectively would enable healthcare workers to balance patients` safety
and well-being with their therapeutic needs. It therefore deserves to be examined.
Aim
This audit intends to explore healthcare workers, specifically, nurses, adherence to the application of
the engagement and observation policy (WH 19). The intention is also to explore the general
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perception of this healthcare worker group about this approach to care and to provide suggestions
for improvement. These aims are likely to be achieved by addressing the following objectives.
Objectives
• Explore nurses` meaning and purpose of engagement and observation
• Explore nurses` perception of the context and setting of observation
• Identify barriers to effective implementation of the policy
Methodology
This audit was conducted using a tool, Enhancing Engagement and Observation (EEO), developed by
Vista Healthcare Independent Hospital in accordance with its policy (standards) for balancing
patients` safety and care provision, following an extensive literature review and consultation with
purposively selected clinical staff. The EEO is divided into two sections; staff survey and
documentation. As the name implies, the staff survey section focuses on exploring healthcare
workers` meanings and general perceptions of the practice of engagement and observation, its
purpose, barriers to implementation and suggestions for improvement. The documentation section
concerns with issues to do with entry or record making. The intention in this case is to identify
whether the practice of engagement and observation is evidenced or reflected in patients` clinical
records.
The EEO was applied to healthcare workers and clinical records of five clinical areas of both Low
Secure and Autistic Spectrum Disorder services at the hospital. A total of 32 healthcare workers
participated in the audit. This was a purposive sample that includes both permanent and regulartemporary healthcare workers. A total of 20 clinical records of patients on observation discussed
during data collection were examined. The clinical areas and respective number of healthcare
workers are listed below. “N” represents number of healthcare workers.
• Low secure Services: Maple House (n=5), Ash Ward (n=4), Watson Ward (n=13)
• Autistic Spectrum Disorder services: Larch Ward (n-4), Prandle Ward (n=6)
The data collected from patients` documents and healthcare workers were manually analysed with
the help of a robust framework, Interpretative Phenomenological Analysis (IPA), developed by Smith
(2005). A number of themes emerged from this analysis. The outcome of this analysis (results) is
now presented.
Results
1) Meaning and purpose of engagement and observation
Almost all the healthcare workers audited were knowledgeable about observation in the context of
its meaning and purpose. One healthcare worker stated:
Observation is about maintaining patients` safety as well as engaging them in meaningful activities.
It should also involve observing patients for changes in mood, mental state and behaviour.
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Most healthcare workers were able to clearly state and describe the level of observation they were
assigned to do. Added to this, they gave succinct reasons for observing patients, as articulated by
one.
I know there are so many reasons why we put patients on observation. Here we mainly do so
because they self-harm and when we sense the tendency of violence. Sexual vulnerability is another
reason why some patients are placed on observations.
Although this was the case, unclear explanations about the levels of observations were provided by
some healthcare workers. There were unable to differentiate between levels 4 and 3 and their
implementation processes. Level 3 was not considered as one-to-one engagement, only level 4.
Difficulties were experienced by some healthcare workers in articulating reasons why patients were
placed on observation. They were also unsure about the level of observation they were allocated to
do. However, they presented during discussions generic rationales for placing patients on levels of
observations. A healthcare worker stated that “We only observe them because of challenging
behaviours”. A detailed explanation was provided when asked to articulate what challenging
behaviour means.
Prevention of harm to self and others is one reason. Any attempt to escape or abscond from care is
another reason for observation. It is also a good idea to observe them closely when they are
physically unwell and when they have taken a known and unknown substance.
Clearly, there is a range of reasons for placing patients on observation. One healthcare worker
described it as a process that is adhered to in a mechanistic manner that mainly involves watching
doors and guarding patients. According to some healthcare workers observation of any patient
should be taken as an important task for assessing patients` mental state and general presentations.
Hence, the practice of this approach has training implications.
2) Training and education
A good number of healthcare workers revealed that they have not had any form of training and
education in the process of observation. It is therefore not surprising for some to state that they are
not aware of what exactly they should be looking for when conducting observation. Lack of clarity
was also noted during discussions with some healthcare workers of what should be documented
after periods of observations. One of them stated:
Nobody tells you what to do and what to write. You are expected to get on with the job. I just sit
and watch the patient, sit close to the door. Sometimes you are not even told the level of
observation, but I try to do my best for the patient. I write what I think is appropriate, the way I see
the patient.
One member of staff was clear about what should be documented following a period of observation.
The patient mental state and general presentation must be written down. Key issues, such as
intentions to self-harm, that relates to the reason for observation must also be documented.
Patients’ whereabouts should be noted down.
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An examination of the records of all patients under observation in the hospital revealed that over
half of them have their mental states and behaviours documented. Evidence of patients`
whereabouts was also noted in the multi-disciplinary files.
3) Ward atmosphere and context of observation
Generally, observation is an approach used for patients who are thought by healthcare professionals
to pose a significant risk to themselves or others. Thus, the assessment of risk should be a critical
element of this approach. The quality of this assessment can be influenced by the manner in which
observation is carried out. It is therefore imperative for it to be conducted in a less intrusive way. A
good healthcare worker-patient relationship would minimise the intrusive nature of observation.
Nurses are in a unique position to build good relationships with patients through daily activities.
Attempts were made by all nurses during the period of data collection to engage patients under
observation in activities.
What we do on this ward, we occupy them in activities, board games for example. When we do this,
we bond, they learn about us and we learn about them. What is important is that we stop them
from hurting themselves. I think, this is achievable when they know you and your face is familiar.
Evidence of engagement in both ward-based and out-of-ward activities was noted in patients`
records. However, the documentation was not clearly presented in some instances. This in essence
relates to the types of activities and duration of engagement. Even though engagement was
observed to be a sort-of routine practice, the use of unfamiliar bank staff was described in some
clinical areas to generate in patients feelings of anxiety and intimidation. Such experiences could
perpetuate patients` need to engage in more challenging behaviours. Another factor believed by
participants that could lead to more challenging behaviours is limited ward based activities for
engagement.
It is not just unfamiliar staff that causes problems for us, we do not have enough activities on the
wards for the patients. We need more activities, games.
Shortage of staff was identified as a reason for the use of unfamiliar bank staff. Most nurses
believed that other disciplines have a role to play in implementing observation, as they are also
familiar to patients. Involvement of other disciplines in this practice would enable them to develop
better understanding of patients in tormented or distressed states.
It would be nice for others to help out in observing patients. If they do, it will help them to
experience and learn more about what goes on the floor. It will make it easier for them to
understand when we discuss issues about patients.
4) Adherence to observation and engagement policy
A reasonable percentage of nursing staff, 35%, claimed that they did not take breaks between
observations. This was noted to be more of a problem on Watson ward where a significant number
declared during the audit period to have not taken their breaks between episodes of observations.
This issue of breaks was attributed to the limited number of nursing staff available to carry out
observational tasks. Most of these tasks are usually delegated to and implemented by junior nursing
staff (therapy assistants). Claims were made that observation levels are normally declared to
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patients including reasons for the same. A good number of nursing staff stated that there are hardly
any communications between episodes of observation by allocated staff. It was noted in one clinical
area that healthcare were not allocated to observe patients. This is inconsistent with the observation
policy, which requires healthcare workers to be allocated to specific patients when indicated.
Discussion
Observation is an important skill for all healthcare workers. Training in this practice is noted in this
audit as an issue that requires lots of attention. Nursing staff are the professional group in this
hospital that have assumed the responsibility of conducting observation. Yet most of the nursing
staff claimed that they have not received any formal training and education in the process of
observation. However, few stated that they have received some guidance, though not adequate, on
how to carry out observational tasks. It is therefore not surprising for some nursing staff to note
that they are generally not aware of what to look for during observation and what to document
following each episode. This is certainly a recipe for confusion and inconsistencies in this practice,
which is believed, could lead to inadequate assessment and care provision.
Undoubtedly, observation is not considered by the management team of Vista hospital as a custodial
activity. It is perceived as an opportunity for the healthcare workers to interact in a therapeutic way
with patients on a one-to-one basis. Even though this is reflected in this audit, it is apparently seen
by most registered healthcare workers as a “less skilled practice”. This assertion is a function of the
view that almost all healthcare workers allocated to observed patients during the audit period were
not registered practitioners; they were therapy assistants. It is important to state that it requires
considerable skills and effort and can be demanding for both patients and healthcare worker
involved. Hence, the need for training which should include assessment of mental state,
development of rapport and relationship with patients being observed. Arguably, although
observation is a therapeutic activity that embraces the notion partnership in care, excessive use of
bank staff that are not familiar to the ward setting can impede the development of good
relationships between patients and staff.
Observation was seen as a partnership between members of the multi-disciplinary team, patients
and carers. A similar view is shared by the Department of Health in their guidance on the conduct of
observation (DH, 2006). To ensure achievement of this partnership it is imperative that both the
reasons for and process of observation are transparent to all parties. Most healthcare workers were
aware of the reasons and processes for observing patients. Although this was the case, there was
lack of handover between episodes of observation, an approach that is inconsistent with the
observation policy. It was also noted that some healthcare workers were not very clear about the
implementation process of the levels of observation particularly 3 and 4. Such confusion could lead
to inadequate and inconsistencies in the practice of observation.
Conclusion
In the main the findings of this audit are encouraging, as most participants were aware of the
meaning of observation including its categories. Added to this, a call is noted from participants of
the need for a MDT approach to observation. However, some areas of concerns were identified.
These relate to limited training in the practice of observation, healthcare workers not having breaks
and lack of communication or handover between periods of observations. Noting the lack of and
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limited training expressed by some participants, it was not surprising to observe inconsistencies in
the practice of observation. It is therefore imperative to consistently apply this practice to all
patients when indicated. Hence, the recommendations below:
Recommendations
• Review the engagement and observation policy and take out the levels and just describe what they
stand for. Doing so would enhance understanding of the role of healthcare workers during episodes
of observation.
• Discuss with other healthcare professionals their role in and possible contribution to the practice
of observation
• To develop and implement a training package of the practice of observation.
• Conduct a re-audit of adherence to the observation policy in a year`s time using a focus group
approach following implementation of training package.
Patients: Observation and Engagement Audit
Executive Summary
Observation and engagement is an important and common practice used in learning disability and
mental health services to manage challenging behaviours. There is a different perception among
patients about the usefulness of this practice. The gulf in perception appears to have an impact on
patients` adherence to the same. This audit therefore focuses on patients` perception and
experience of observation. It is conducted in the low secure and Autistic Spectrum Disorder Services
of Vista Healthcare Hospital. 19 patients and their respective clinical records were purposively
selected.
The data were analysed using Interpretative Phenomenological Analysis. The findings indicate that
patients have mixed perceptions towards observation, but mainly negative ones, which in the main
relate to the high level of intrusiveness sometimes necessary when observing someone. These
findings have implications for effective implementation of observation and recommendations are
made to improve this. Patients should be actively involved in the observation process in order to
enhance their adherence and positive experiences. Engaging patients in meaningful activities was
also considered as useful to positively improving patients` experiences of this practice. Generally,
the findings of this audit provide much needed information to assist healthcare workers improve the
implementation of the observation and engagement policy.
Background
One of the primary focuses of practitioners in mental health and learning disabilities settings is on
decreasing challenging behaviours, such as aggression and violence. Interventions that encourage
interactions with patients are considered to be effective in achieving this goal. Observation is one of
such interventions commonly used in these settings to manage challenging behaviours (Bowers &
Park, 2001). Yet they are perceived by patients as intrusive and controlling. Healthcare workers
have reported it to be a useful but demanding practice (Wallace, 2007). Taking into account these
negative impacts, the Department of Health (DH) (2006) stipulated that the practice of observation
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must be a partnership approach between healthcare workers and patients, where the needs of the
latter are recognised and respected. Simply, observation must be implemented in a manner that
would enable patients to experience it as both a healing and compassionate practice. It should
therefore not to be presented in a controlling manner, as doing so would perpetuate the need for
more challenging behaviours. James and Warner (2005) agree with this. They mentioned in their
study that patients in secure services always try to take some control of their lives, and added that
failing to recognise this by the use of restrictive approaches like observation tends to maintain selfharming behaviours. Thus, a change in philosophy of the conduct of observation from control to
care is critical for ensuring effective management and prevention of challenging behaviours.
The practice of observation has evolved from the age-old manner of healthcare workers checking
patients` safety and well-being to care with the view of reducing the incidence and prevalence of
challenging behaviours as well as enhancing the effectiveness of care provision. This philosophical
shift is reflected in the changes in the terms used to describe this approach. It was initially referred
to as “observation”, then “supportive observation” and now engagement and observation (DH,
2002). The final term serves as a reminder from the Department of Health of a key principle of the
process of observation; it MUST be both safe and therapeutic.
Patients on observation are usually on a temporary period of increased need. So, irrespective of the
cause of this need, these patients require safety, compassion, understanding, and appropriate
treatment and care (Bowlers et al.2002). The question now arises, what is appropriate treatment
and care? This, in essence relates to those which are patient focused, delivered within the
framework of true partnership between healthcare workers and the former. Acknowledging this,
engagement and observation should be undertaken by skilled and well intentioned healthcare
workers whose remit is to create opportunities for therapeutic engagement and intense
assessments of patients` mental states and behavioural presentations. Taking this into account, a
structure is needed to ensure quality care provision during periods of distress. Hence, the
engagement and observation policy, developed by the Management Team of Vista Healthcare
Independent Hospital. It effectiveness therefore deserves to be examined. One way to objectively
evaluate its effectiveness is to audit patients` experiences of observation.
Aim
This audit intends to explore patients` perceptions of the practice of engagement and observation.
This aim is likely to be achieved by addressing the following objectives.
Objectives
• Explore patients meaning and purpose of engagement and observation
• Explore patient’s perception of the context of observation
• Explore patients perception of when being observed and suggestions for improvement
Methodology
This audit was conducted using a tool, Views of Patients (VOP), developed by Vista Healthcare
Independent Hospital in accordance with its policy (standards) for balancing patients` safety and
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care provision, following an extensive literature review and consultation with purposively selected
patients and clinical staff. The VOP consisted of 12 short and simple questions, which in the main
focus on the following areas: meaning of observation, feelings about observation, engagement, and
suggestions for improvement. Authorisation to conduct the audit was sought and obtained from the
Responsible Clinicians of the Forensic and Autistic Spectrum Disorder services of the hospital. The
VOP was applied only to some patients identified to have capacity using a Mental Capacity
Assessment Tool (MCAT). The VOP was also applied to clinical records of patients identified as
capable to participate in the audit. A total of 19 patients and 19 clinical records were audited. This
was a purposive sample. The clinical areas and respective number of patients are listed below. “N”
represents number of patients and clinical records.
• Low secure Services: Maple House (n=3), Ash Ward (n=3), Watson Ward (n=9)
• Autistic Spectrum Disorder services: Larch Ward (n-2), Willow Ward (n=2)
The data collected from patients and clinical records were manually analysed with the help of a
robust framework, Interpretative Phenomenological Analysis (IPA), developed by Smith (2005). A
number of themes emerged from this analysis.
Results
5) Meaning and purpose of engagement and observation
Most patients interviewed knew the levels of observations they were on. However, some claimed
that they were not provided explanations of the purposes of observation.
I would like to be informed about my level on a daily basis. “Most times, they come and sit down,
not talk to me”.
One of the main reasons for engagement and observation is to develop relationships with patients
with the view of working with them to address their needs. Certainly not talking to patients would
hinder understanding of the underlying reasons for challenging behaviours. Although this is the
case, some patients claimed that they would sometimes like some degree of “space”; not wanting to
actively engage. This need for space was noted in one clinical area to be communicated nonverbally. For example, a patient shut his room door when on level 4 observation. An attempt was
made by the allocated healthcare worker to open the door which resulted in a violent outburst; a
cup of tea was thrown at the same. A close examination of the records revealed that the patient in
question sometimes likes to keep the door to his room shut. The allocated healthcare worker was
not aware of this. It is therefore important for healthcare workers responsible for carrying out
observation to be appropriately briefed about patients` presentations and needs.
6) Observation: feelings and context
Observation is one of the most common methods used in managing patients` self-harming and other
challenging behaviours such as violence and aggression. It is in the main negatively perceived by
patients in the context of it being a controlling and intrusive approach (Duperouzel and Fish, 2010;
Sandy and Shaw in press). This was noted in this audit when patients were asked to describe their
feelings during observation. One patient responded:
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I don’t like it, I find it annoying because I don’t feel free. They follow me around. It is not helping
me.
Similarly, another patient expressed her experience of observation:
I am usually unhappy when under observation. I don’t like it. I am scared of it.
When asked what she was scared about, her response was that:
It is the thought of being observed and not knowing what they are looking for, and particularly loss
of privacy.
Although most patients felt negatively about observation, they considered it as a useful approach:
“I would have hurt myself more if I was not on observation”.
Even though observation was perceived by few participants to be helpful and necessary in these
settings, most suggested that its practice could be improved if patients were actively engaged in
activities, listened to, rights to occasional silence respected and not too restrictive. Most patients
also added that the use of permanent and regular bank healthcare workers would improve their
experience of observation. Evidence of engagement in both ward-based and out-of-ward activities
was noted in patients` records. However, some patients requested more activities particularly ward
based. They claimed that the availability of more activities would reduce the intimidating and “I
don’t like it” feelings they sometimes experience when being followed around in the clinical areas.
7) Activities: engagement
Most patients were out of their bedrooms during data collection. While some sat in the communal
areas and not verbally interacting with anyone, some were noted to move about and socialise with
other patients and allocated healthcare workers. Very few patients were in their bedrooms during
data collection, and all of these patients stated that they do not like to be observed. All patients
stressed that being on observation did not prevent them from engaging in their planned therapeutic
activities including those outside the clinical areas.
Discussion
Observation is a therapeutic activity that requires healthcare workers to actively engage with
patients. It is usually applied to patients in distressed states with the view of alleviating the same.
Yet patients often perceive it as a controlling and intimidating activity that may cause them more
distress. It is therefore not surprising for participants of this audit to express dislike of it as they feel
it denies them privacy, dignity, respect as well generates some degree of discomfort.. Hence, it is
important for healthcare workers applying levels of observation to minimise the degree of distress it
causes. To achieve this, a careful balance of activity, silence and privacy must be obtained. Such
balance will be different for each patient and may vary across time.
The request made for more activities in the clinical areas cannot be underestimated. Activities can
divert patients’ attention from engaging in challenging behaviours. They can also serve as a medium
for assessing patients` level of functioning and mental states. It is evident in this audit that patients
may sometimes not like to partake in activities or even talk to others; they would prefer to be left
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alone. In such instances, patients` rights for silence and wishes for space are to be respected. With
regard to the latter, the need for space, it is critical for this to be done within safety boundaries.
The practice of observation can evoke varying degrees of stress in both patients and healthcare
workers. The outcome of this audit revealed that these experiences could lead to aggressive and or
violent outburst. Acknowledging this, it is imperative for healthcare workers allocated to carryout
observation to be appropriately briefed about patients` presentation. The experiences of stress on
the part of patients could also be attributed to the use of unfamiliar bank healthcare workers. Their
use is claimed by patients to sometimes create in them feelings of anxiety and intimidation. On the
other hand, the appearance of a familiar and friendly face, some patients claimed, may create an
opportunity for engagement.
Conclusion
In sum, it is apparent that patients were not actively involved in the observation process, as its
purpose was not revealed to most of them. Limited or lack of patient involvement has implications
for practice. It could lead to lack of or passive adherence to this practice, which in turn could
perpetuate the need for more challenging behaviours which led to the implementation of
observation. Patients related both negative and positive experiences of observation with the former
mainly attributed to the high level of intrusiveness sometimes necessary when observing someone.
The need to balance this practice with respect for patients` dignity, silence and space is therefore
noted to be an important facet of care. Examples of approaches participants felt could help achieve
this were engagement of patients in meaningful activities, appropriate briefing, training and limited
use of unfamiliar bank staff.
Recommendations
• Patients to be actively involved in the observation process, which should include provision of
explanations of its purpose
• Healthcare workers and patients to set up a forum or focus group to discuss good practice. This is
to ensure that patients` wishes are taken into account when being observed.
• Nurses to participate in the implementation of observation; model good practice.
• Allocated healthcare workers should be provided with adequate information about patients’
presentations, mental states and rationale for observation.
• Clinical areas should make effort to limit their use of unfamiliar bank staff
• Conduct a re-audit of patients` perceptions of observation in a year’s time.
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EssenCES
A supportive ward atmosphere is professed by many to be a necessity for successful treatment on
forensic wards. EssenCES is a climate evaluation tool which has been designed to be used on wards
to assess the fundamental traits of the social and therapeutic atmosphere. After initial factor
analysis fifteen climate characteristics were chosen that are robust and relevant to a range of
institutional settings. These features were split into the following three areas: experienced safety,
therapeutic hold and patient cohesion.
The 15 item EssenCES questionnaire was completed by the majority of patients and staff on Watson,
Maple and Ash wards at Vista Hospital. The data produced was collected and analysed and a report
detailing the results was written.
The results varied across all three wards and between patients and staff in terms of the three areas
highlighted. Results indicated there were areas to be developed further but the EssenCES survey has
its limits and is unable to pinpoint these exact areas and to state the ideas the staff and patients
have for implementing changes in these areas.
As a result the focus groups were recommended to gain more in-depth information. The Psychology
department together with the patient advocate took responsibility for advertising and planning
focus groups with patients and staff from all three wards. Additional support was provided from the
Social Work student.
Questions were formulated based on the EssenCES results in an attempt to both give the sessions
structure and to elicit further information on perceived strengths and weaknesses across the three
wards.
The findings outlined in this report are a result of the focus groups run with both staff and patients
and reflects the views put forward in those groups.
It was decided that focus groups would be held separately for both patients and staff on all three
wards as it was thought that this would generate the most useful information by facilitating an
environment where people felt able to speak openly.
Staff involved in facilitating these groups were chosen as they had little direct contact with patients
and staff and were not directly employed by the organisation. The work carried out was supervised
by a chartered psychologist.
The ideas and dates for the focus groups were communicated to patients through community
meetings on the ward and by the use of posters located in prominent places around the wards.
Focus groups took place over a two week period on Ash which is a rehabilitation ward and on Maple
and Watson which are low secure wards. One focus group was held on each ward.
For staff the majority of focus groups took place at the training venue in Farnborough. They were
arranged after training sessions as this appeared to be the best opportunity to gather together a
representative group of staff from each ward without disrupting the day to day running of the ward.
Additional focus groups were held on Ash ward with staff as this ward was not adequately
represented in the training groups during the two week period.
Two focus groups were held with staff on Watson ward and they both contained day and night staff.
On Ash ward again two focus groups were held, one with day staff and one with night staff. On
Maple ward one focus group was held with night staff.
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All patients and staff were given the option of having an individual or small group session if they felt
that they were not able to speak openly in a group situation.
During the focus groups where an issue/concern was raised attempts were made to explore
suggestions for improvement to address concerns raised.
Findings of the original EssenCES survey
Experienced safety – Both patients and staff on all three wards reported feeling ‘unsafe’ on average
between ‘some of the time’ and ‘quite a lot of the time’. The exception to this were staff on Ash who
had reported feeling unsafe on average between some and a little of the time. These results show a
discrepancy on feelings of safety between the patients and staff on ash ward.
14
14
12.5
12.5
12
12
10
10
8
8
Average
Average
score
score
6
6
7.53
7.53 7.27
7.27
8
8
8
8
7.27
7.27
4
4
2
2
0
0
Watson
Watson
Ash
Ash
Ward
Ward
Patients
Patients
Maple
Maple
Staff
Staff
Therapeutic hold – The results for
therapeutic hold varied more markedly.
Results indicate cohesion between staff
and patients on Watson ward who
thought on average that there is quite a
lot of support/interest taken in the
patient’s therapeutic progress. On both
Maple and Ash wards there is
inconsistency between the views of the
patients and staff. The staff on Maple
felt there is on average quite a lot of
support whereas in contrast the patients
feel there is between a little and some.
The disagreement is less pronounced on
Ash ward with the staff average falling
between some and quite a lot and the
patients feeling there is support some of
the time.
16
14.89
14.13
14.89
14
12.8
12
9.67
10
8
Average
8
score
6
4
2
0
Watson
Ash
Maple
Ward
Patients
Staff
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Patient cohesion – Again on Watson ward there was consistency between the views of patients and
staff. The general feeling is that there is some support for patients from other patients. The other
two wards show variation in their reported feelings. On Maple ward the staff felt there is some
patient support for each other where-as the patients feel this support is only a little. On Ash ward
again the variance is smaller: staff felt there is some patient support for other patients and the
patients themselves feel this falls between a little and somewhat.
12
10.73
10
10.6
9.75
8
A verage
score
9.75
7.33
5.5
6
4
2
0
Watson
A sh
Maple
Ward
Patients
Staf f
Findings
The findings show that the areas for greatest concern as reported by the patients on all wards were
as follows:
Experienced Safety:
• feeling unsafe when other patients become aggressive
• more support from staff in coping with emotions and behaviours
Therapeutic Hold:
• lack of awareness as to who their key workers are
• shortage of interaction time between patients and staff
Patient Cohesion:
• more opportunities for patients to be able to get to know each other better
• wanting more assistance from staff on how to support each other
For staff the results indicate the areas of greatest concern as expressed by the staff are as follows:
• experienced Safety:
• staffing levels on the wards
• the proportion of bank staff
• restraint procedures and problems with alarms
• therapeutic Hold:
• teamwork across the Multi Disciplinary team could be improved
• no clear idea of the role of the key worker
• need for more activities both on and off the ward
• perceived lack of staff structure
• promotion opportunities on the wards
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Patients and staff have made some suggestions as to how the above concerns can be addressed;
these have formed an action plan, which Vista Healthcare will be evaluated on a quarterly basis. The
EssenCE survey will also be repeated to evaluate the impact that addressing the contents of the
action plan has on the various areas of the above areas of concerns.
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Patient Experience at Vista Healthcare
Reviewing the services enabled funding and the appointment of a full time post of Patient
Experience Manager’s (PEM) post:
• Service User Experience Lead post aligned to quality improvement initiatives to ensure service user
feedback informs service improvement.
• Through consultation with service user groups, a range of methods have been identified for
capturing service user feedback; these include focus groups, ward community meetings, patient
reported outcome measures and stakeholder events
The PEM aim to get as much patient involvement as possible in the journey being undertaken from
admission to discharge, she is leading, with Occupational Therapy, the introduction of “My Shared
Pathway” and this is putting the patient at the heart of their care and planning. Through greater
choice, and greater responsibility, the patient is being as fully involved as they want to be in their
pathway of care. As a result of this initiative, there are a number of patients who are involved as
representatives in all of the meeting, on and off site, regarding My Shared Pathway. Several patients
have been using the resource pack as a trial, and now the system is live many more patients are now
involved in designing their own pathway. This has been received very well by the patients at Vista
Healthcare.
Branching off this initiative, there is now a Joint Recovery and Outcomes Group, of which patient
representatives play a major part. Their experiences with the Shared Pathway will inform the CQUIN
measures required as part of the Contract.
There are Patient Assemblies held bi- monthly at the hospital, and other patient meetings held more
regularly as and when required, for any questions to be answered there and then, and also a time
where staff can give out information which is useful to patients.
Patient Assembly
Our continuous quality improvement builds on our previous success by enabling our patients to
make informed choices by creating an environment where they are encouraged to take greater
responsibility for their care and well-being. One way of giving patients information and knowledge is
through our Patient Assembly, which have been running for six years.
Our Patient Assembly has been running at Vista for 6 years. It is an opportunity for patients to get
together in the same place, have a drink, and let management know what is going on for them on
their wards. The meeting is minuted, has an agenda, and patient representatives from each ward
are encouraged to attend. It is an opportunity for patients to get their questions answered there and
then, and for management to listen and learn about life on the wards and how things are working or
not. External speakers are also invited. Recently we had a presentation from Carewatch who
provide a community access service; Apetito our food provider has presented ideas and asked for
feedback on the food here at Vista. We have also had external speakers talking about funeral plans
and making wills. The meeting is designed to empower patients and it is taken very seriously by the
management team, not only that, it is enjoyed by all who attend. Attendance is often in excess of 20
patients with each ward nominating a spokes person.
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Patients have been involved in “interview panels”, where they have asked questions of prospective
staff members. When recruitment went off site, this came to an end, but Vista Healthcare is now
looking at training some patient representatives to take this up again. The involvement of patients
in staff recruitment is invaluable and the input of the patients has been missed of late.
The patients have the opportunity to air their views on any subject they need to before their
forthcoming CPA meetings. The PEM sees each patient before the CPA and we go through every
aspect of their care and discuss what is going on for them. This way they are more prepared for the
meeting and know what they want to focus on. These records are kept and form part of the CPA
pack.
Patients have the opportunity to air their views in several ways. There are daily/weekly community
meetings which deal with everyday matters. There are CPA’s held regularly where more serious
matters are discussed with care managers and social workers. There is the Patient Assembly where
all sorts of issues are discussed. There are patient representatives on various committees such as
the Joint Recovery and Outcomes Group and the Patient Feedback Group. There is also independent
advocacy available as well as statutory IMHA and IMCA. The PEM have had a number of external
speakers in to talk to the patients on matters such as the provision of food, the provision of
supported access to specific community based activities, the making of wills and funeral plans and
educational literacy. A local theatre company invited our patients to the dress rehearsal a few
weeks ago, and this fitted in perfectly with our Social Inclusion Policy. It was a great success.
The patients here have all been trained in Safeguarding and this was received very well. A few
patients were selected as representatives to be trained in the Recovery Star, which works in
conjunction with My Shared Pathway and is also well liked on the wards. More training is planned
for patient representatives to take part in a recruitment panel. Also, several patients have been
trained in Makaton and have received certificates for this.
The PEM is involved in various behind the scenes projects to ensure the experience of the patient is
as good as it can be. She is a member of the Safeguarding team, and bringing external training to
the hospital about this topic was invaluable. She is also instrumental in ensuring various out of
hour’s activities take place, so that patients do feel a part of society. For example, they had a Jubilee
Party on each ward with banners, flags, special food etc. and this was well received. They have had
parties for Christmas and New Year so the patients can celebrate. All birthdays are celebrated with
cakes and special fuss. The patients are involved in the Open Days and make suggestions as to what
they would like to see; animals from a local farm, face painting, ice cream van etc. She often
conducts food surveys to ensure this is as good as it can be; other surveys are carried out twice a
year to monitor and improve the services offered to patients. The REM has demonstrated great
passion about patient experience at Vista Healthcare and is working well to ensure the journey of
each patient is as good as it can be.
Quality Checking of Policies & Procedures
Vista Healthcare policies and procedures are audited, reviewed and updated at regular intervals but
no longer than three years. They are also reviewed in light of legislative change, updated NICE
guidance and recommendations from inspections and audits. This ensures that current best practice
is reflected and that policies are fit for purpose. All policies are ratified through a Corporate
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Governance structure and the Senior Management Team. Lead directors are accountable for any
updating required.
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Patient’s movement information over the last 5 years
50
46
2008
2009
2010
2011
2012
45
40
40
35
37
33
30
25
22
20
20
17
10
15 15
14
13
14
15
8
9
8
4
5
12
11
3
3
1
7
3
2
0000
00
0
Referrals
Admitted
Withdrawn
Vista Healthcare Quality Accounts 2011/2012
Refused
Discharged
Deceased
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Quality Account 2012
Mental Health Act
Vista Healthcare has continued to focus on maintaining compliance with the legal requirements of
the Mental Health Act and ensuring that comments received from the Care Quality Commission are
taken on board and addressed. In the year 2012/13 there will be regular audits carried out by the
Mental Health Act Office to ensure adherence to the requirements of the Mental Health Act (MHA).
In particular to the issues highlighted with respect to section 132 (the provision of information
regarding the rights of detained patients), section 17 leave documentation and the requirements of
statutory consultees to complete a record of discussions with Second Opinion Appointed Doctors
who visit Vista Healthcare to complete second opinions for patients’ treatment. All wards will be
made aware of areas that need particular focus to ensure any CQC visit feedback received in future
is positive.
Mental Health Act training sessions will be increased to enable more staff to update their skills in a
shorter time period. Other forms of training include on-line training and the use of workbooks is also
being implemented.
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Conclusion
Regulation 5 of ‘The National Health Service (Quality Accounts) Regulations 2010’ sets out the
requirement for Quality Account to include any written statements sent to Vista Healthcare from the
appropriate commissioning primary care trust (PCT), Local Involvement Network (Link) and/or
Overview and Scrutiny Committee (OSC) in relation to their view of the provider’s Quality Account.
This is an area that Vista need to improve on in 2012/13 as there is limited involvement in input for
the 2011/12 Quality Accounts. Patient and staff involvement will also be strengthened.
If you require clarification or further information please contact my office at the following address
on:
Ian McComiskie
Vista Healthcare Independent Hospital
Odiham Road, Winchfield,
Hampshire, RG 278BS
Telephone: 01252845826
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