Rennie Grove Hospice Care
Quality Account
2013 - 2014
Vision Statement
Rennie Grove Hospice Care passionately
believes that every adult and child with advanced
progressive, life-limiting illness deserves, and
should receive, the care they need to live as fully
as possible at home or wherever they choose to
be, to the very end of their life.
Charity No. 1140386
www.renniegrove.org
1
Part 1
RENNIE GROVE HOSPICE CARE Chief Executive Statement
It gives me great pleasure to present the second Quality Account for Rennie Grove
Hospice Care (RENNIE GROVE HOSPICE CARE) for 2013/2014.
We welcome the
opportunity to provide the wider population with an annual report about the high quality of
services we provide for our patients and carers. This report allows us to demonstrate to
the public, our stakeholders, our trustees and our staff the commitment we have to quality
improvements so that we can give the best possible quality care to all our patients and
their carers, at the same time delivering a cost effective service.
Quality is at the heart of all that RENNIE GROVE HOSPICE CARE does and we evidence
that through Clinical Governance which ensures continuous quality monitoring, in which
any shortfalls are identified and acted upon quickly. It also ensures a patient centred
service and one that can deliver the aspirations laid out in our Mission Statement.
Following the merger of Iain Rennie Hospice at Home and Grove House a full rebranding
of the organisation has taken place and the organisation is now operating as Rennie
Grove Hospice Care. This strengthening of our joint brand has put us in a strong position
to face tough care and funding challenges as patient numbers and diversity of needs
continues to increase. In the last year RENNIE GROVE HOSPICE CARE has cared for
over 2,500 patients and their families - around 12% more than in the previous year
because more patients are turning to us for support. We provide our care at no cost to our
patients and families thanks to huge local fundraising and our hospice shops which pay for
85% of the costs of our care.
Our high quality care is only possible thanks to our dedicated staff and the commitment of
over 1,500 volunteers.
I am responsible for the preparation of this report and its contents. To the best of my
knowledge, the information reported in this Quality Account is accurate and a fair
representation of the quality of health care services we provide.
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Our Mission Statement;
To provide the care and support our patients and their families and carers need, when and
wherever they need it through a dedicated local service, delivered through:
• 24/7 responsive Hospice at Home nursing care
• Skilled and dedicated Day Hospice care
• Assessment and holistic care services to meet the personal needs of patients
• Support for families facing loss and bereavement
• Partnerships with other health and care professionals
• Engagement with our wider community through the support of volunteers and supporters
Jennifer Provin
Chief Executive
Part 2
Priorities for improvement and statements of assurance from the Board (in regulations)
Improvement
As of 1st April 2013, Iain Rennie Grove House Hospice Care will be trading as
Rennie Grove Hospice Care, incorporating Iain Rennie Hospice at Home and Grove
House. The founding charities that formed Rennie Grove Hospice Care have nearly
half a century’s combined experience of caring for patients with cancer and other
life-limiting illnesses and have supported more than 15,000 local families to date.
The Board of Trustees continues to support the continuous development and
improvement of its services to ensure that the care and support it provides evolve to
meet patient and carer needs.
The priorities for quality improvement we have identified for 2013/14 are set out below.
These priorities have been identified in conjunction with staff, stakeholders and as far as
possible by consulting our patient and carer group. The priorities we have selected will
impact directly on each of the priority areas:
Patient safety - Medicine management protocol/training/ Medication matrix
Clinical effectiveness-Implementation of the electronic database across all clinical services
and record keeping audit
Patient experience – Information from the National CQUIN indicator for friends and
families
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1a
Priorities for Improvement 2013-2014
Patient Safety
Priority One
Medicines management is a core element of the service provided by our hospice at home
team. The increase in patient numbers and associated medicine requirements calls for
more stringent protocols, monitoring and training to ensure patient safety.
All Healthcare Assistants in addition to qualified staff will be trained in medicines
management.
The Rennie Grove Hospice Care Medicine Guidelines, which include
updated protocols, will be disseminated to all nursing staff and a new medication matrix for
assessing risk following drug errors has been adopted. Additional training will be provided
for all staff using the McKinley syringe pumps which will be introduced in 2013.
Continuous audit of training and numbers of errors will be undertaken to monitor
performance and patient safety.
How was this identified as a priority?
This was identified as a priority following the considerable increase in patient numbers and
an increase in medication incidents. We have also identified that the introduction of the
McKinley syringe pumps represents a significant risk to the organisation. The key
outcomes are to prevent errors associated with the new pumps and to reduce adverse
drug incidents.
How will priority one be achieved?
Our medicine protocol has been updated and will be disseminated to all nursing staff and
health care assistants. Current healthcare assistants will receive medicines management
training. Training for the use of McKinley syringe pumps is planned. The use of the
medication matrix has been implemented.
How will progress be monitored and reported?
Progress will be monitored through audit of training received and use of the medication
matrix will enable more effective audit of adverse medication incidents and assessment of
the level of risk to patients.
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Clinical Effectiveness
Priority Two
Accurate and timely clinical record keeping is a key element to excellence in patient care
in the community by enabling effective and safe communication.
Following merger it was identified that there were a range of databases being utilised to
facilitate patient care. This hindered cross organisation communication and for many
clinicians it created the need for multiple data entry for individual patients. This was time
consuming, inefficient and posed a potential risk to patient safety.
How was this identified as a priority?
This was identified as a priority as patient numbers increased and the need for developing
capacity for caring highlighted the fact that nurses were required to multi enter data
regarding patient visits, treatments and interventions. A time and motion study of nurses’
activities highlighted significant time being spent on administrative tasks, reducing their
capacity for direct patient contact time.
How will priority one be achieved?
A single database has been identified and is being implemented across all clinical services
on a phased basis. All nurses will receive training in inputting relevant data and
administrators will be able to undertake a greater degree of the data input and will be able
to generate reports as necessary.
How will progress be monitored and reported?
An ongoing time and motion study is underway across the teams where the system is
currently operational. The expected outcome is an increase in patient contact.
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Patient Experience
Priority Three
The organisation conducts ongoing surveys of patient and family experience of the
services provided. As part of the national CQUIN incentive an additional question to
identify the quality and experience for patients and families will be included asking whether
the service would be recommended to other family members or friends. By responding
‘yes’ to this question it will indicate that we have fully met their needs.
How was this identified as a priority?
Positive patient experience is often reflected in the responses received currently from
surveys. Although this gives good insight into the experience of patients a question which
would give a more conclusive response was necessary to indicate the quality of service
provided to patients and families.
How will priority one be achieved?
The additional question has been included within the ongoing surveys from 1st April 2013.
How will progress be monitored and reported?
The quality of the patient experience will be identified from ongoing audit of the satisfaction
surveys with particular attention paid to the outcome of this question.
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1b. Review of Priorities for Improvement 2012-2013
Patient safety
Modular mandatory training workbook.
All clinical staff will complete a modular mandatory workbook which will ensure that their
compulsory training needs are met as well as some of their in house training requirements.
Non clinical staff and volunteer role requirements will be met using individual sections of the
workbook that are appropriate to their roles. The workbook contains a wide range of modules
that reflects the organisation’s current policies and procedures. The portfolio includes health
and safety, infection control, safeguarding vulnerable adults and children and equality and
diversity. At the end of each module the staff member was required to complete a short
knowledge questionnaire to ensure understanding of the programme. This workbook
complemented the current induction programme and the in house training that is already
provided.
1) A system has been introduced to enable clinical staff to access infection control and
safeguarding workbooks, complete knowledge questionnaires and receive certificates.
2) Identified volunteer roles have completed education sessions and/or workbooks.
3) Additional modules on data protection, equality and diversity, consent and capacity are
being introduced in 2013.
4) We have identified the need for the use of e-learning modules for non clinical staff due
to the number of people requiring training.
5) An example of cost and time saving due to the use of the infection control module is that
40 people took 30 minutes to complete this compared to a minimum of 1.5 hours
workshop and travel time.
Priority two
Clinical Effectiveness
Health Care Professional Survey
Iain Rennie Hospice at Home merged with Grove House based in St. Albans in 2011 and now
offers a wider range of patient clinical services, including a day hospice, within Hertfordshire
with the strategy to expand these services into Buckinghamshire. We recognised that in order
to ensure a co-ordinated seamless service for our patients and their families we needed to
enhance our professional working relationships with other health care providers. During 201213 we sent a health care professionals’ satisfaction questionnaire to all our colleagues which
was analysed, an action plan has been formulated which will be implemented during 2013.
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The survey was distributed to all GPs, District Nursing teams, Community Specialist
nurses, Site Specific Macmillan nurses, Children’s Community staff, Community Matrons,
Allied Health Professionals, Intermediate Care teams and local hospice settings. It was
given out by the nurses attending multi-disciplinary team meetings, and Gold Standard
Framework meetings with a request to complete the survey and return the survey using
the Free Post envelope. As Rennie Grove Hospice Care worked in collaboration with two
Primary Care Trusts during 2012-13 it was decided to separate the survey so that issues
within each trust could be indentified.
The HCP (Healthcare Professional) survey was sent to 52 Bucks and 50 Herts based
healthcare professionals. A total of 31 (59%) completed surveys were returned in Bucks
and 27 (54%) were completed in Herts.
Positive Comments from Bucks survey
Agree
strongly
I have a good working
relationship with the IRGH
team(s)
IRGH respond efficiently to
requests for help
The involvement of IRGH
promotes patient choice
The additional resources
IRGH brings can help a patient
to stay at home
Agree
No
opinion
21
9
21
7
1
19
5
6
22
6
1
Disagree
Disagree
strongly
1
1
‘Have found IRHH nurses extremely helpful at all times and a great source of knowledge’
‘Patients and family always commenting how good / supportive IRGH are’
Less positive feedback
‘Making a decision if offering specialist palliative care service or hospice at home service,
where if patients are end of life whether Iain Rennie will provide end of life care by carrying
out personal care, because patients can wait for a long time for care packages and patients
may then be too poorly to transfer to home’
‘I feel IRGH is now more of a specialist palliative care team and less of a hospice at home.
This might be the way things should be going but I am not as confident in referring patients
who choose to die at home. It appears that there are more requests to re-admit to hospital
or hospice. Would be interesting to look at figures of where people die. Still a great service
but has changed over the years. Resource is probably a big factor in this as within NHS’
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Positive Comments from Hertfordshire survey
Agree
strongly
I have a good working
relationship with the IRGH
team(s)
IRGH respond efficiently to
requests for help
The involvement of IRGH
promotes patient choice
The additional resources
IRGH brings can help a patient
to stay at home
Agree
17
8
17
9
17
4
19
7
No
opinion
Disagree
Disagree
strongly
1
4
1
‘It is an exemplary service!’
‘The service is very prompt, excellent communication. Patients and carers always speak
highly of the service’
‘Especially useful monthly palliative care meeting’
Less positive feedback
‘Your service is not always known to the wider HCP and public. It would be good for
hospitals to be provided with info on your services’.
‘I think hospice at home (nationally) can give people false expectations of the amount of
support that is actually available’.
All the data was collected and the action plan containing the full results and findings
circulated to all clinical staff, trustees, the clinical governance committee and our patient
and carer group. The action plan was formed through discussion with clinical senior
management. All qualitative data was analysed and discussed and feedback will be acted
upon to ensure good, stable working relationships with all health care professionals we
liaise with.
Priority Three
Patient Experience
Communication and Documentation Protocol for Advance Care Planning
The aim of the protocol was to improve the documentation of patients’ Advance Care Plans
(ACP) and prompt discussions, along with improving the internal and external communication of
patients’ ACPs. An ACP Checklist will be placed in the shared patients’ records with their
consent which will inform other healthcare professionals of the progress of patients’ end of life
discussions.
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A programme of education was planned during 2012 in order to raise awareness of the
protocol and ensure usage of the proforma for documentation of the patient’s end of life
wishes. Twelve H@H nurses, 2 Community health professionals, and 2 paediatric
community nurses attended two training sessions. In total 17 nurses attended the first
session of Advance Care planning awareness and 9 nurses attend the second session,
Advance Care planning in practice. See table below.
Band
Irhh or Ext
Team
Advance
Care
Planning
Awareness
Advance
Care
Planning in
Practice
5
Irhh
Sth Bucks
24/09/2012
CNS 7
Irhh
DACORUM
26/04/2012
5
Irhh
PAEDIATRIC
24/09/2012
08/11/2012
08/11/2012
5
Irhh
DACORUM
24/09/2012
bank 5
Irhh
Grove House
24/09/2012
5
Irhh
PAEDIATRIC
26/04/2012
11/06/2012
5
Irhh
DACORUM
24/09/2012
08/11/2012
CNS 7
Irhh
RIDGEWAY
24/09/2012
5
Irhh
DACORUM
26/04/2012
11/06/2012
5
Irhh
DACORUM
26/04/2012
11/06/2012
Irhh
26/04/2012
11/06/2012
Irhh
OTHERS
St Albans &
Harpenden
26/04/2012
08/11/2012
5
Irhh
DACORUM
26/04/2012
11/06/2012
Bank 5
Irhh
DACORUM
Community
Dietician
26/04/2012
26/04/2012
26/04/2012
7
Irhh
DACORUM
24/09/2012
A repeat audit of a set of 20 electronic patient records based in Hertfordshire took place in
early 2013 to establish the use of the protocol and to compare results of documentation of
ACP in 2012 with those in 2013.
The table below shows the 2013 audit results which indicate that 85% of patients have had
their Advance Care Plan needs addressed and documented when compared to only 30%
in the 2012 audit. This clearly identifies an increase in ACP documentation and
communication of patient needs.
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Advanced care Planning Audit Results
ACP
Communication to
other HCP
Other Aspects of
ACP e.g. feeding,
wishes re treatment
Yes
17 (85%)
No
2 (10%)
n/a
1(5%)
17 (85%)
2 (10%)
1 (5%)
6(30%)
14 (70%)
Comments
1 (5%) Patient
admitted to acute
hospital.
1(5%) Patient
short intervention.
The outcome of implementing the ACP Protocol is that patient end of life experience is
improving, with 85% of patients are having their ACP wishes addressed when compared
with previous audit of 30%. Which highlights that we are starting to prompt more
conversations with patients and their families around more complex issues associated with
ACP such as feeding and possible treatment options (30%). The documenting and
communicating of patient ACP wishes is resulting in better patient outcomes by having
their needs met effectively at end of life.
STATEMENT OF ASSURANCE FROM THE BOARD
The following are statements that all providers must include in their Quality Account. Many
of these statements are not directly applicable to specialist palliative care providers, and
therefore explanations of what these statements mean are also given.
2a. Review of Services
During 2013/14 it is Rennie Grove Hospice Care’s intention to provide NHS
Hertfordshire Trust and NHS Buckinghamshire Trust’s commissioning priorities with
regard to the provision of local specialist palliative care in the community by
providing:
Part funded Hospice at Home
In addition Rennie Grove Hospice Care will support the Trusts by providing the
following services through charitable funding:
Day Hospice
Occupational Therapy
Physiotherapy
Home sitters
Cancer Information
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Complementary Therapies
Cancer the Next Step
Family Support Services, including bereavement support services and spiritual
care
The income generated by the NHS services reviewed in 2012/13 represents below
15% cent of costs of our care generated from the provision of NHS services by
Rennie Grove Hospice Care for 2012/13.
The palliative care funding review in 2012/13 is focused on the provision of community
hospice at home specialist palliative care. Rennie Grove Hospice Care is funded through
an NHS grant and the remaining income is generated through fundraising activity, shops,
lottery activity and investments.
2b. Participation in Clinical Audit
During 2012/13 and prior to this document, no national clinical audits or confidential
enquiries covered NHS services provided by Rennie Grove Hospice Care.
During that period Rennie Grove Hospice Care participated in no national clinical
audits and no confidential enquiries of the national clinical audits and national
confidential enquiries as it was not eligible to participate in any.
The national clinical audits and national confidential enquiries that Rennie Grove
Hospice Care are eligible to participate in during 2012/13 are as follows: NONE.
The national clinical audits and national confidential enquiries that Rennie Grove
Hospice Care participated in during 2012/13 are as follows: Not applicable
The national clinical audits and national confidential enquiries that RENNIE GROVE
HOSPICE CARE participated in and for which data collection was completed during
2012/13 are listed below alongside the number of cases submitted to each audit or
enquiry as a percentage of the number of registered cases required by the terms of
that audit or enquiry. Not applicable
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The reports of 0 national clinical audits were reviewed by the provider in 2012/13.
This is because there were no national clinical audits relevant to the work of RENNIE
GROVE HOSPICE CARE.
RENNIE GROVE HOSPICE CARE was not eligible in 2012/13 to participate in any
national clinical audits or national confidential enquiries and therefore there is no
information to submit.
What this means:
As a provider of specialist palliative care RENNIE GROVE HOSPICE CARE is not eligible
to participate in any of the national clinical audits or national confidential enquiries. This is
because none of the 2012/13 audits or enquiries related to specialist palliative care. The
Hospice will also not be eligible to take part in any national audit or confidential enquiry in
2013/14 for the same reason.
2c. Research
The number of patients receiving NHS services provided or subcontracted by
RENNIE GROVE HOSPICE CARE in 2012/13 that were recruited during that period
to participate in research approved by a research ethics committee was NONE.
During 2012 Rennie Grove Hospice Care was asked to become one of six hospices
to participate in the implementation of evaluation of the Carers Special Needs
Assessment Tool (CSNAT). This is a research project supported by Manchester
University and Cambridge University. At present 2 nursing teams are participating in
the project which aims to enable clarity on how carer needs should be assessed in
practice and evaluate the impact of care-giving on carers. CSNAT is an evidencebased direct measure of carer’s support needs in 14 domains and suitable for both
end of life research and practice.
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2d. Use of the CQUIN payment framework
Up to 2.5% of RENNIE GROVE HOSPICE CARE income in 2013/14 is CQUIN
dependent and conditional on achieving quality improvement and innovation goals
agreed between RENNIE GROVE HOSPICE CARE and any person or body they
entered into a contract, agreement or arrangement with for the provision of NHS
services, through the Commissioning for Quality and Innovation payment framework.
2e. Statement from the Care Quality Commission
RENNIE GROVE HOSPICE CARE is required to register with the Care Quality
Commission and is currently registered to carry out the regulated activities:
Treatment of disease, disorder or injury and personal care.
Statement of reasons
The registration of the provider of these regulated activities is subject to a registered
manager condition under Regulation 5 of the Care Quality Commission (Registration)
Regulations 2009.
These regulated activities may only be carried out from the following locations:
Grove House
Gillian King House
Rennie House
Waverley Road
Three Households
Unit 3
St. Albans
Chalfont St. Giles
Tring Industrial Estate
Herts
Bucks
Tring
AL3 5QX
HP8 4LS
Herts
T 01494 877200
HP23 4JX
T 01727 731000
T 01442 890222
The Care Quality Commission has not taken any enforcement action against RENNIE
GROVE HOSPICE CARE during 2012/13.
RENNIE GROVE HOSPICE CARE has not participated in any special reviews or
investigations by the Care Quality Commission during 2012/13 and was inspected at all
three sites during 2012/13 and was assessed as fully compliant with the Essential
Standards of Quality and Safety
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2f.
Data Quality
Statement of relevance of Data Quality and actions to improve Data Quality.
RENNIE GROVE HOSPICE CARE did not submit records during 2012/13 to the
Secondary Users service for inclusion in the Hospital Episode Statistics which are included
in the latest published data.
Why is this?
This is because RENNIE GROVE HOSPICE CARE is not eligible to participate in this
scheme. However, in the absence of this we have our own system in place for monitoring the
quality of data and installed a new electronic patient information system during 2012/13 with
the aim of combining the nursing and clinical services databases. This is important because,
with the patients’ consent, we share data with other health professionals to support the care
of patients in the community. An audit of the signing of patient consent forms occurs
annually. Our data protection policy is regularly reviewed and updated.
2g.
Information governance toolkit attainment levels
We will be putting in place the relevant framework documentation, policies, training and
security infrastructure to be able to report on attainment levels in 2013/14. This means
that we will be compliant with Connecting for Health’s standards and provide patients with
the confidence that their information handled safely. Work on this commenced in May
2013.
2h.
Clinical coding error rate
RENNIE GROVE HOSPICE CARE was not subject to the Payment By Results clinical
coding audit during 2012/13 by the Audit Commission. This is because RENNIE GROVE
HOSPICE CARE receives payment under a block contract and not through tariff and
therefore clinical coding is not relevant.
Part 3: Review of Quality Performance
Following the merger RENNIE GROVE HOSPICE CARE are in the process of
consolidating the data from the clinical, nursing and family support services databases.
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This will occur in 2013/14 and next year we will present information from the National
Council of Palliative Care (NCPC) Minimum Data Set which is the only information
collected nationally on hospice activity.
Quality Markers we have chosen to measure – out of hours care.
In addition to the limited number of suitable quality measures in the national data set for
palliative care and hospice at home, we have chosen to measure our performance against
the following:
Clinical Complaints
Deaths At Home
Patients Achieved Preferred Place of Care (if wish expressed)
Medication Errors
Clinical Adverse Incidents
INDICATOR
April 2012/13
Total number of complaints (clinical)
4
The number of complaints completed
4
The number of complaints ongoing
0
INDICATOR
April 2012/13
No. Patient Deaths at Home
492
No. Patient’s achieved Preferred Place of
471
Care ( if wish expressed)
INDICATOR
April 2012/13
Medication Errors
8
Clinical Adverse Incidents
9
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Drug Error Reflection Form
This form is to be used for all medication incidents.
The aims of completing this form are
to assist staff who have made an error to reflect on why the error occurred and learn from it
to develop an action plan with their manager
to enable the learning from incidents to be shared (anonymously)
to inform risk management strategies for reducing drug incidents
All drug incidents should be recorded on a Medication Incident Form
This reflection form should be completed by the person involved in the incident as soon as
practical after they are aware of making an error. This will then be used to form the basis of
discussion with the Locality Nurse Manager, Professional Development Lead or Deputy/Director of
Nursing Services.
A copy of the completed form will be held centrally by the Locality Nurse Manager. The Clinical
Audit Lead will be sent the medication incident form for logging and reporting to governance
committees.
Date and time of medication incident:
1. Describe what happened.
2. Can you identify any factors which may have contributed to the error? Please tick as many
factors which apply.
1. Communication: verbal – with other
HCP
2. Communication: verbal - with hospice
team
3. Communication: written - in notes
4. Communication: written - on
prescription chart
5. Labelling error
6. Variable strength medication
7. Similar drug name
8. Similar/same patient name
9. Policy/guidelines not followed
10. Interruption/distraction
11. Device not working properly
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12. Device not used properly
13. Arithmetic error/miscalculation
14. Knowledge deficit
15. Knowledge misapplied
16. Inexperienced staff
17. Skill mix poor
18. Workload high
19. Staffing levels low
20. Personal stress
21. Lapse in concentration
22. None identified
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3. How did you feel when you were aware you had made an error?
4. What were the consequences or potential consequences of your actions on:
The patient.
Others(staff, self, organisation etc)
5. On reflection, what might you have done differently?
6. What factors influenced the way you were thinking, feeling or responding?
7. To what extent does this experience connect with previous experiences? i.e is there any
pattern?
8. What improvements can you make to your working practices? Could something be
learnt from this experience?
9. What learning or development need has this experience highlighted for you?
Date section completed:
Next section to be completed with manager
10. Action plan
Date and time action plan agreed:
Name of manager:
Signature:
Name of person involved in incident:
Signature:
All medication errors are debriefed by the Locality Nurse Manager and the learning for the
individual or the team as a result of the incident is identified. The Professional Education
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Lead trains staff using the incidents as scenarios and the outcomes will be shared to all
staff via the nursing and clinical audit group representatives. The Clinical Governance
Committee will discuss all incidents and a report of high risk events will be sent to
Trustees.
Medication Incident Report
The form should be completed by any clinician who may be involved in, or witness a work-related
medication incident that did or could have caused harm.
Any medication incident must be discussed and then completed together with your Line
Manager/Locality Nurse Manager.
Date of incident:
Name of clinician reporting:
Time of incident:
Date
Name of person affected: (Patient/carer)
Team:
Witnesses if present (Staff, D/N, Carer,
Patient) (inc. contact tel)
Address:
Witness statement attached Y
N
What Happened?
(mark with X)
Family informed?
GP?
DN?
Y
Y
Y
N
N
N
Rennie Grove responsibility? Y
Other HCP responsibility?
Y
X
X
X
X
X
X
N
N
Immediate Action Taken
Cause/s of Incident: (mark with X)
Human Error
Idiosyncratic reaction
Lack of guidelines/procedure
Drug interaction
Lack of training
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Other – Details

Equipment failure
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Action/Outcome/System Change:
By when (date):
Action category: : (mark with X)
Learning for group
Learning for individual
System redesign
No further action required
Proposed guideline or policy
Incident type: : (mark with X)
Recording/Documentation
Drug Error
Incorrect prescribing
Drug related Near Miss
Other
Dispensing error
Professional Development Lead team comments (if required)
Incident completed?
AO report?
Safeguarding
Bucks
Herts?
Yes
Date
Yes
Date
Yes
Date
Date
No
Date expected for completion
No
No
Clinical Audit
Clinical audit is a way in which the organisation can learn and improve the delivery of its
services, the outcomes for patients and the experience they have. The Clinical Audit
groups have undertaken a programme of audits during 2012/13 including infection control
which is based on national audit tools designed specifically for hospices. Clinical staff are
involved in the audit processes and a number of staff have led audits, in particular the
reviews related to the family support service and hand hygiene. If issues are identified
during audit an action plan is developed and reviewed. Progress on the action plans is
monitored through the Clinical audit groups and reported to the Clinical Governance
Committee to ensure that they are completed. We will then undertake a further audit to
see if the actions we have taken have resolved the issues identified.
The table on the following page shows the audit plan that was undertaken in 2012.
Charity No. 1140386
www.renniegrove.org
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Audit
Month
Independent Nurse prescribing
Clinical governance newsletter (Biannual)
Infection Control (Laundry) (GH
building)
Provisional start date for 1:1
bereavement visitor review
June 2012
Completed
Completed
Completed
Survey results being collated on an
ongoing basis
COSHH audit
Living with Cancer – MYCAW review
Provisional start date for implementing
CORE with counsellors
July 2012
Completed
Completed
Collation of CORE feedback forms
ongoing
Patient records (clinical services)
August 2012
Completed
Consent (all services)
Infection control GH building
Data Protection (including
confidentiality) (all 3 sites)
Patient records (H@H) Using the Help
the Hospices Community audit tool
Review Quality Accounts priorities
nd
Living with Cancer/2 MYCAW review
Prep/training for Cambridge Carer’s
research project (CSNAT)
Lone worker/out of hours audit
CSNAT Cambridge Uni carers’
research project start
Evaluation of life coaching (MYCAW)
Syringe driver audit
Winter clinical governance newsletter
Review Quality Accounts priorities
Medicines management
Charity No. 1140386
www.renniegrove.org
September 2012
Completed
Completed
Pending Information Governance review
Not completed due to delay in
implementing new patient database
Regular review
October 2012
Completed
Completed
Organisational policy review completed
November 2012
Project ongoing
Completed
Audit postponed due to work on new
syringe driver provider. Subsequent
policy review and training identified as
key priority
December 2012
Completed
Regular review
Completed
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Feedback from patients and carers on services
We value the feedback we receive from patients and their carers as this is an important
way in which staff can identify issues, resolve problems and improve the quality of the care
we provide. As part of our commitment to ensuring patients and their carers have a voice
we send Hospice at Home patients a survey after 6 clinical visits and a carer satisfaction
survey 6 weeks post bereavement. The patients and their carers who receive clinical
services based at Grove House receive a survey once every 6 months. These surveys are
evaluated every 6 months and the results sent to all clinical staff including trustees. The
surveys are anonymous but where concerns are raised and the respondent can be
identified, their issues are followed up and resolved to learn from what went wrong. As
required by Care Quality Commission (2009) Essential Standards of Quality and Safety
the questions asked to the patients and carers reflect their treatment and the care they
receive from the services.
The Patient Satisfaction Survey October 2012– March 2013
Question
Response
Skipped
question
Answer
Results
Sept 12
On the whole do you find
the experience of H@H
caring for you:
65
2
94%
4%
2%
58
7
89%
11%
Do you feel your privacy
and dignity are respected?
61
6
100%
57
4
93%
7%
Do you feel the RGHC staff
make an effort to meet
your individual needs and
wishes in relation to
culture, faith and disability?
Do you feel you are treated
with courtesy by H@H
staff?
58
9
Very satisfactory
Satisfactory
Dissatisfactory
Very dissatisfactory
Always
Most of the time
Some of the time
Never
Always
Most of the time
Some of the time
Never
94%
6%
52
5
0
1
90%
8%
0%
2%
62
5
98%
2%
61
1
98%
2%
Always
Sometimes
Occasionally
Never
Results Mar 13
Some of the comments we have received from our patients in the last six months:

The whole team has been fantastic, practical, sensible, realistic advice. They
completely understand the issues cancer patients face and speak plainly so we can
get the advice we need.

Thanks to your nurses for being so vigilant, helpful and conscientious – they are
brilliant.
Charity No. 1140386
www.renniegrove.org
22

...I was amazed how helpful the advice I received was. This applied to financial,
medical and the emotional aspects of my illness.

Kind, friendly, compassionate, understanding nurses

This is a wonderful service, kind, considerate, professional people who really
understand the issues of having cancer
The Carer Satisfaction survey October 2012 – March 2013
Question
On the whole did the
service you received from
IRGH meet your
expectations?
Response
Skipped
question
149
6
Answer
Yes
No
Results
Oct 12
99%
1%
Results Mar 13
146
3
98%
2%
Some comments made by carers selected from the recent survey.

The service received exceeded all expectations, it was excellent.

The nurses were perfect. They carried out my husband’s wishes, they respected
him, listened to him, and gave him the perfect end to his life.

Totally professional and very considerate.

They always had the best interests of both the patient and us, her family, in mind at
all times and were very caring and reassuring. Also great patient advocates.

Always explained medication. Always confident and capable. Always kind and
caring. Nothing was too much trouble.
Charity No. 1140386
www.renniegrove.org
23
STATEMENTS ENDORSING RENNIE GROVE HOSPICE CARE QUALITY ACCOUNT
2013-2014
Aylesbury vale and Chiltern Clinical Commissioning Groups response to Rennie Grove
Hospice Care Quality Account 2012/13
The Clinical Commissioning Groups have reviewed the Rennie Grove Hospice Care Quality
Account against the three domains of quality: patient experience, patient safety and clinical
effectiveness. There is evidence that Rennie Grove Hospice Care has relied on both internal and
external assurance mechanisms and the commissioners are satisfied as to the accuracy of the
data contained in the Account.
Within the report the Hospice clearly identifies their achievements to date, but also areas within
their service delivery requiring improvement. The CCGs welcome the openness of this approach
and is committed to supporting the organisation in achieving improvement in the areas identified
within the Quality Account through existing contract mechanisms and collaborative working.
One of the purposes of the Quality Account is to support the Rennie Grove Hospice Care Board in
assessing quality across the totality of the services they offer. The document does this. The other
purpose is to help patients assess the quality of services and make choices between different
providers. The commissioners would encourage that IRGH further develop ways of supporting
patients in making informed choices based on quality of services.
Rennie Grove Hospice Care clearly demonstrates that it values feedback about the patients’
experience and uses this to help shape improvements for the future.
The commissioners note the feedback from patients and carers which are reviewed every six
months. The Commissioners were pleased to note that the responses to the patient satisfaction
survey described a consistent delivery of quality care. We note that the carers survey also
described great satisfaction with the service.
The quality markers described in the report are appropriate but it would support patients and carers
more in interpreting them if they were described as a rate, rather than a number.
The Future
The 2012/13 priorities contained in the Quality Account are consistent with priorities agreed with
the commissioners in improving the care of patients accessing these services.
Conclusion
This Quality Account provides a comprehensive overview of the quality of care within the Rennie
Grove Hospice Care and commissioners look forward to continuing to work alongside Rennie
Grove Hospice Care in meeting the quality aspirations of local users, carers, partners and staff.
Feedback from the NHS Lead for End of Life and Palliative Care, Hertfordshire
Rennie Grove Hospice Care has continued in 2012/13 to maintain the high standards of care and
intervention expected by its Hertfordshire Commissioner.
Offering a range of services for those with palliative care needs and particularly those within the
last year of life, the Hospice remains a valued and valuable resource to its patients as well as
relatives and carers.
Charity No. 1140386
www.renniegrove.org
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Of particular note is the willingness of the Hospice to support a range of initiatives which has
included supporting the education of health and social care students, supporting Dying Matters
week and the Hospices involvement in the local community.
Under new CCG arrangements, the Hospice remains a keen and willing partner to continue to
develop best quality practice in supporting those who are at the end of life or need a Hospice
environment and to be involved in the further development of services for those with a palliative
care need.
The Hospice will in 2012/13, be further developing it’s learning through implementation of the
Friends and Family Test, as well as monitoring those it cares for through use of the NHS Safety
Thermometer.
Healthwatch Hertfordshire’s response to Rennie Grove Hospice Care Quality Account
2013
Healthwatch Hertfordshire thanks Rennie Grove Hospice Care for the opportunity to read
and comment on their draft Quality Account. However we do not feel that we are in a
position to make comments about the quality of service provided this year but note the
following:
It is clear how the priorities have been identified and how they will be achieved.
The Hospice has embraced the merger of the two organisations in order to provide
support for the increased numbers accessing their service.
Actions taken to increase direct patient contact with nursing staff is welcome.
It is good to see that the results of the Advanced Care Planning Audit has resulted in an
improvement in the patient end of life experience.
We look forward to seeing the results from your chosen priorities and would value
increased engagement with the Hospice through our Stakeholder Panel.
Sarah Wren MBE, Chairman Healthwatch Hertfordshire, June 2013
Charity No. 1140386
www.renniegrove.org
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