Butterwick Hospice Care
Butterwick Adult Hospice
Stockton on Tees
Quality Account
2012-2013
Butterwick Hospice
Middlefield Road
Stockton on Tees
TS19 8XN
Registered Charity 1044816
1
Our Mission Statement and Philosophy
Why we are here
We aim to improve the quality of life for those who have a progressive life limiting
illness and those close to them and to offer positive support for every challenge they
may encounter during their illness and to see death as part of life’s journey.
In particular we will:
Provide supportive and specialist palliative care for adults with progressive life
limiting conditions
Ensure each person receives care in a homely environment whilst maintaining
privacy, dignity and choice.
Provide holistic centred care by responding to and respecting the patient and those
close to them by meeting their individual, physical, social, cultural, educational,
spiritual and emotional needs throughout the illness and bereavement.
Acknowledge and respect the way those close to the patient care for them and
endeavour to continue their chosen pattern of care.
Work together in developing an environment based on support and mutual respect.
Maintain the high quality of the service through ongoing reflection, evaluation and
education.
Communicate effectively and efficiently both within the Hospice and with external
agencies, to ensure continuity of care and promote service development.
2
Part 1:
Chief Executive’s Statement
It gives me great pleasure to present this first Quality Account for the
Butterwick Adult Hospice, Stockton on Tees.
The Hospice is an integral part of Butterwick Hospice Care (registered
charity 1044816) which provides services from three separate Hospices in
the North East of England. All the Hospices’ services are provided totally
without charge to our patients and their carers.
The day to day management of the Butterwick Adult Hospice, Stockton on
Tees clinical services is under the leadership of Mrs Carole Harrison who is
designated the Registered Manager in the Hospice’s registration with the
Care Quality Commission.
The Butterwick Hospice endeavours to provide an excellence in evidence
based palliative care for all patients regardless of age or diagnosis; to be a
centre of expertise and a specialist resource within the community as a
whole.
The needs of patients and their carers are paramount to the Charity’s
existence and are the root and focus of all we do.
Quality is at the core of the Charity’s strategic and operational priorities.
An independent impartial assessment of the quality of care provided
was obtained when the Care Quality Commission performed a routine
unannounced inspection of the Hospice in June 2012. Their Report
showed that the Hospice was meeting all of the required standards. A
copy of their full Report is available at: www.cqc.org.uk/directory/1113000508
During the last year we have worked effectively in partnership with NHS
Tees and we look forward to working in future with the Hartlepool &
Stockton on Tees Clinical Commissioning Group for the benefit of the
community we freely serve.
In the year the Hospice has achieved the Commissioning for Quality and
Innovation (CQUIN) outcomes detailed in the 2012/13 Contract with NHS
Tees.
3
As stated in 2.6 below, in 2012/13 the Hospice was not required to
demonstrate compliance with the NHS Information Governance Toolkit.
This is, however, a requirement of the 2013/14 contract with Hartlepool &
Stockton on Tees Clinical Commissioning Group and will be reported on in
the Hospices Quality Account next year.
The Charity only achieves its key objectives because of the professional
skills, commitment and enthusiasm of our staff and volunteers
I am responsible for the preparation of this report and its contents. To the
best of my knowledge, the information reported within this Quality Account
is accurate and a fair representation of the quality of healthcare provided by
our Hospice.
Graham Leggatt-Chidgey
Chief Executive
May 2013.
4
Part 2: Priorities for improvement and statements of assurance
from the board (in regulations)
1.
IMPROVEMENT
Within the Organisation quality is fundamental to improvement and accountability.
The Board of Trustees continues to support and promote the ongoing development
and improvement of services to ensure that the care and support provided evolves to
meet patient and carer needs.
The priorities for quality improvement for 2013/14 are set out below.
These priorities have been identified in conjunction with patients, carers, staff and
stakeholders. The priorities we have selected will impact directly on each of the three
priority domains:

Patient safety

Clinical effectiveness

Patient experience
Part 2 Priorities for improvement 2013-2014 and Statements of
assurance from the Board (in regulations)
Section 2.1 Priorities for improvement 2013-14.
Patient Safety

Priority One
To strengthen the medical and nursing team in order to provide
increased specialist palliative and supportive care.
How was this identified as a priority?
In 2010/11 a revised nursing structure was established and successfully
implemented in 2011/12 with key posts of a Clinical Lead for Adult Services
supported by Clinical Team leaders being introduced. This structure was supported
by a Clinical Strategy, the key aim of which is to ensure we continue to meet the
current and future needs of patients and their families in regards to palliative,
supportive and end of life care needs within a changing health arena.
Key objectives in the clinical strategy for 2013/14 is to continue to up-skill the
nursing staff in several clinical skills such as cannulation, intravenous drug
administration, phlebotomy etc. as well as supporting the Clinical Team Leaders to
achieve advanced skills in regards to independent prescribing and clinical assessment
skills. All of the qualified staff were trained in the former skills during 2011 and
three of our Clinical Team Leaders have recently completed either independent
prescribing or clinical assessment skills course.
Alongside the increasing of nursing skills we have been striving to strengthen our
medical team for some time but without success.
With our existing Hospice
5
physician moving to another post and the Palliative Care Consultant from the local
Trust retiring in December 2012 this need became even more relevant.
Whilst recruitment took place for Hospice Physicians we have used a team of locum
GP’s and continued to provide palliative, supportive and end of life care for a wide
range of patients. However, in order to ensure safe and appropriate medical care we
have been using revised admission criteria which has resulted in patients with
complex symptom control needs being admitted to other local hospices or the acute
trust.
Following the recent successful recruitment of two Hospice Physicians, we will now be
in a position from June 2013 to begin to re-establish specialist palliative and
supportive care enabling patients with more complex needs to be admitted and cared
for nearer to home.
The medical staff are also fully supportive of the nursing staff developing additional
skills and mentorship for specific university modules.
How will Priority One be achieved?
Continued professional development of the nursing staff is a key objective in the
2013/14 Clinical Strategy Action Plan. We aim for more staff to undertake either
independent prescribing or clinical examination skills courses.
The local NHS Trust has successfully appointed a replacement Palliative Care
consultant and we expect to benefit from the three planned consultant sessions
which is part of an agreement with the Commissioners and the Local Trust.
A meeting has recently taken place between the hospice and the local NHS Trust to
discuss the job plan for the new consultant and their input into the hospice.
We are planning for an outpatient clinic to be conducted from the day care
department by the new Palliative Care Consultant from September 2013 and
anticipate that this will be welcomed by GP’s as well as having a positive effect of
increasing the use of specialist resources within the hospice.
The new Hospice Physicians and Consultant will also participate in education and
training events for clinical staff at the hospice.
Communication is to be sent out to General Practitioners and other appropriate
professionals within our catchment area to inform them of our new team of doctors,
our admission criteria in light of the expertise which will be available within the
hospice, as well as the other services and facilities available for patients and their
families.
How will progress be monitored and reported?
The key objectives relating to this priority are included in the Clinical Strategy Action
plan which is updated monthly and discussed at the Clinical Manager’s meeting. This
will include the number of staff being trained in additional skills, education and
training, bed occupancy, etc.
The minutes of the clinical meeting are circulated to the management team and
reports in regards to clinical objectives are also reported into the Clinical Strategy
6
and Governance Committee which includes representatives from the Board of
Trustees.
We anticipate that effective use of resources such as bed occupancy will be positively
affected by this strengthened team.
The range of patients and their complexity of needs will be monitored via the weekly
multi-disciplinary meeting where patients’ are discussed and, where necessary, their
cases referred to the weekly Specialist MDT.
We will also monitor any patient transfers from the In-patient unit to the acute trust
in regards to the reasons for transfer and whether these conditions or patient needs
could have been managed within the hospice at the time or there is the potential to
do so in the future.
The number of advice calls to the palliative care consultants and details of these is
recorded on a log sheet and we anticipate that these will decrease with the
commencement of our recently recruited Hospice Physicians.
2b Clinical Effectiveness

Priority Two
To enable patients to receive blood transfusions and intravenous
medication within the hospice.
How was this identified as a priority?
Patients are currently being transferred from the hospice to the acute trust if they
require a blood transfusion or intravenous medication which can cause distress for
patients and relatives.
We are also aware that some palliative care patients require regular blood
transfusions and are being admitted to the acute Trust for this. We believe that the
hospice environment would be more appropriate and comfortable for the patients as
well as removing the costs associated with these procedures for the acute trust.
Blood transfusions and intravenous medication were conducted at the hospice
several years ago and it has been a key objective to re-establish these procedures as
part of the hospice’s clinical strategy.
How will priority two be achieved?
The recruitment of two hospice physicians, who are confident in these procedures
being re-introduced into the hospice, will support the staff in undertaking blood
transfusion and the administration of intravenous medication appropriate to patient
need and the hospice environment.
The competencies of the clinical team in regards to blood transfusion are being updated and liaison is taking place with the Blood Transfusion Practitioners at the local
hospital to provide training sessions for staff and key trainers. This is part of our
Service Level Agreement for Blood Transfusion Services with the Trust.
7
All qualified nursing staff have received training in cannulation and administration of
intravenous antibiotics and the IV policy and procedures are being put in place. Staff
competencies are being assessed.
The Quality and Practice Development Nurse will work closely with the Clinical Lead
for Adult Services to ensure the staff have undertaken all required training and their
competencies assessed prior to the commencement of these procedures.
We are aiming to re-commence Blood Transfusions within the in-patient unit by the
end of June 2013 followed by the administration of intravenous medication.
A letter will be sent out to General Practitioners and the community team to inform
them that we will be able to undertake these procedures at the hospice.
How will progress be monitored and reported?
The key outcomes relating to this priority are included in the Clinical strategy Action
plan which is updated monthly and discussed at the Clinical Manager’s meeting. The
Clinical Lead for adult services will update the plan and feed back to the clinical
team.
We will monitor the transfer of patients to the acute trust as these should no longer
occur once we start to administer blood and intravenous medication.
Progress in regards to this priority will also be reported to the quarterly Clinical
Strategy and Governance Committee as part of the Director of Clinical Services’
report.
2c Patient Experience

Priority Three
Pre and post Bereavement Support – Direct GP access
How was this identified as a priority?
Pre and post death bereavement support is an essential part of end of life care for
the relatives or carers of the patient and their children.
To date, Butterwick has only provided pre and post bereavement support and family
support to relatives and carers of patients known to the Hospice.
However, we frequently receive requests from GP’s and multi-disciplinary
professionals asking our Family Support Team if they can provide bereavement
support to clients not known to us which we have had to decline due to our current
resources being fully utilised by providing support to patients and their families who
are or have accessed our services. These requests often include a need for child
specific bereavement counselling within the local area.
Being able to access services in a timely manner is extremely important and we are
aware that often clients currently have to wait up to 6 weeks to access support via
their GP.
8
We would like to use the skills and resources at the Hospice to provide a high quality
bereavement support service to a wider group of clients, thereby responding to the
requests of local GP’s and other professionals.
This priority will enable direct access for GPs to refer patients who are not currently
accessing Butterwick Hospice services; therefore adults and children will be able to
access the full range of specialist bereavement support services at the Hospice.
This development is in accordance with an established, highly successful service
offered by our Bishop Auckland Hospice which provides similar specialist services in
County Durham and Dales for both adults and children.
How will priority three be achieved?
We will use the skills of our existing family support staff at Butterwick Hospice as
well as trained volunteer counsellors.
Letters and referral forms have been sent to local GPs explaining the services
available and posters are being designed and produced to be displayed in GP
surgeries which will enable potential clients to be aware of the services and ask their
GP to refer them.
The new development has been discussed at our weekly clinical meeting attended by
representatives of the multi-disciplinary team and external health professionals.
Information will also be included on the Hospice website.
The following services will now be available for clients who have not previously been
able to access Butterwick’s Family Support Services:










Individual counselling for patients pre death. (Coping with a bad prognosis)
Preparing to say goodbye etc.
Preparation for death with the use of letter writing, memory boxes, family
D.V.D messages, funeral plans and wishes of the dying or terminally ill patient
etc.
Pre death and post death counselling for relatives and friends of the patient.
Home visits if the client is not able to come into the hospice.
Children’s support. Preparation for the death of a parent or relative by
individual play and support sessions for young children with preparation and
post procedural play carried out by qualified staff.
Young persons counselling pre and post bereavement
Home or school visits if deemed more suitable for the child or young person.
Telephone support if distance is a problem
Bereavement groups which include a thriving drop in which takes place every
Monday 10 till 12.00 for the newly bereaved and 1.30 till 3.30 for those
further along in their grief (except for bank holidays) And a monthly evening
support group for people who work.
We also run 7 week M.O.T (moving on together group) several times a year
for people who prefer a more structured approach to loss.
Twice Yearly bereavement service’s which serve to unite the bereaved in their
loss with an average attendance of 400/500.people
Children’s bereavement group fortnightly.
As we do not know what the demand will be for the services and wish to ensure we
continue to provide a high quality, timely service, the direct access project will be
rolled out to groups of GPs on a planned basis whilst monitoring the impact on
current resources.
9
This project is a pilot up to the end of March 2014 and we hope that if successful
there is potential for this to be funded by the Clinical Commissioning Groups in the
future.
How will progress be monitored and reported?
Increased statistical data is to be recorded including time from referral to first
appointment and whether the patient is an adult or child.
Completion of the Help the Hospices national audit tool will be used to provide a wide
range of measurements in bereavement support. We also plan to use the new pre –
bereavement audit tool from Help the Hospices.
Qualitative data will be recorded via evaluation forms for group support, one to one
sessions and children specific activity.
All audit data is collated and reported into the Integrated Governance Meetings which
are held every 6 weeks.
Section 2.2 Review of services
During 2012/13 the Butterwick Adult Hospice at Stockton on Tees provided three key
services:

To provide a 24 hour, 7 days a week in-patient service.

To provide a day hospice service four days each week (Tuesday to Friday).

To provide nursing, medical care, counselling, advice, complementary therapies
and bereavement support to patients, their carers and relatives.
The Butterwick Adult Hospice at Stockton on Tees has reviewed all the data available
to us on the quality of care in all of the above services.
The income generated by the NHS services reviewed in 2012/13 represents 100% of
the total income generated from the provision of NHS services by the Butterwick
Adult Hospice, Stockton on Tees for 2012/2013. The income generated from the
NHS represents approximately 28% of the overall patient care costs incurred by the
Hospice.
Section 2.3 Participation
Enquiries
in
Clinical Audits, National Confidential
10
During 2012/13 no national clinical audits and no national confidential enquiries
covered NHS services relating to palliative care.
During that period Butterwick Adult Hospice, Stockton on Tees, participated in no
national clinical audits and 0% national confidential enquiries of the national clinical
audits and national confidential enquires. The Butterwick Adult Hospice, Stockton on
Tees only provides palliative care therefore were ineligible to participate.
The following mandatory statements are therefore not applicable to Butterwick Adult
Hospice Stockton on Tees:
“The national clinical audits and national confidential enquiries that [name of
provider] was eligible to participate in during [reporting period] are as
follows:[insert list].”

“The national clinical audits and national confidential enquiries that [name of
provider] participated in during [reporting period] are as follows: [insert list].”

“The national clinical audits and national confidential enquiries that [name of
provider] participated in, and for which data collection was completed during
[reporting period], 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. [Insert list and percentages].”

“The reports of [number] national clinical audits were reviewed by the provider in
[reporting period] and [name of provider] intends to take the following actions to
improve the quality of healthcare provided [description of actions].”
Local Clinical Audit and Service Improvement
Butterwick Adult Hospice undertakes a series of audits in accordance with Butterwick
Hospice Care’s comprehensive annual audit programme.
The audit programme includes nationally validated audits from Help the Hospices
where available, internally designed audits and external infection control audits in
line with the Service Level Agreement with our local NHS Trust.
Some examples of these audits, undertaken in the Adult Hospice during 2012/13, are
included in this report on the following pages.
11
Butterwick Hospice, Stockton
Annual Infection Prevention and Control Audit Report
November 2012
1
Background information
This was a planned annual re-audit following on from the unannounced audit
performed in May 2012.
This audit was performed with Kath Murphy, Day Unit and Helen McIntyre,
Children’s Unit.
2
Methodology
The standards used to measure compliance are based on national evidencebased guidelines for preventing healthcare associated infections.
3
Results
Individual audit results are attached (Appendix 1 – Adult results, Appendix 2 –
Child results).
Audit
Adult
4
2012
95% 
Nov 2011
97%
Discussion
It is encouraging to see the general high standard of infection prevention and
control practice has been maintained from the previous year’s annual audit,
however improvements have been highlighted regarding cleanliness of shared
patient equipment in the inpatient unit. The hospice overall compliance with
audited standards has been maintained at 98% from the previous year’s
announced audits.
5
Recommendations
An action plan is attached (appendix 3) for completion as appropriate and return
to the Infection Prevention and Control Department, University Hospital of North
Tees.
6
Conclusion
There continues to be a high standard of infection control practice evident
throughout the hospice. The issues highlighted can easily be rectified.
7
Acknowledgements
Many thanks to all staff, particularly Kath and Helen, for assisting with the audits.
Julie Olsen
Assistant Matron
Infection Prevention & Control
26.11.12
12
Butterwick Hospice, Stockton, Annual IPC Audits:
16.11.11 Auditors: Julie Olsen, Kath Murphy
Calculation:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Adult Environmental Audit
yes x 100%
yes + no (do not include N/A responses)
Audit score
86%
Yes


The environment is uncluttered, dust free and visibly clean.
Bins are foot operated and in working order.
Waste is segregated correctly, labelled and stored safely in a
designated secure room prior to collection.
Linen skips are used appropriately, not overfilled and stored safely in a
designated secure room prior to collection.
Detergent wipes are stored in wipe dispensers and are readily
available.
Storage areas are uncluttered, clean and equipment is stored off the
floor.
Communal facilities eg toilets and bathrooms are clean.
There is no evidence of inappropriate use of communal toiletries.
Multi patient equipment is dust free, visibly clean and cleaned after
each use.
There is evidence of a weekly cleaning programme for patient
equipment.
A cleaning programme is in place for toys.
Toys are visibly clean.
Wheelchairs are clean and serviceable.
Furniture is intact, covered in impermeable material, able to be cleaned
easily.
Patient wash bowls are washed, dried and stored appropriately,
inverted after each use.
Telephones and computer keyboards are clean.
The kitchen is clean and tidy.
Single patient use slings are available for use with hoists.
Bed area curtains and blinds are visibly clean.
Staff know where infection prevention and control policies are located
(question two staff).
Disposable suction liners are in use and changed between each patient
use.
Mattress covers are intact with no evidence of staining or contamination
to the foam interior (inspect two mattresses-remove cover, inspect
outside and inside surface and foam interior).
There is an up to date record of mattress inspection available.
Pillow covers are fully sealed and intact with no evidence of
contamination to the foam interior (inspect pillows from two beds).
There is planned programme of maintenance and water testing for the
hydrotherapy pool.
No
N/A























Adult Sharps Safety Audit
Calculation:
1
2
3
4
5
yes x 100%
yes + no (do not include N/A responses)
Audit score
Staff are aware of the waste disposal and accidental exposure to bodily fluids
policies and where they are located (question two staff).
Sharps bins are correctly assembled and an assembly poster is displayed.
Sharps bins are signed and dated.
Sharps bins are less than two thirds full and free of non sharp items.
Sharps bins are closed when not in use.
100 %
Yes
No





13
N/A
Appropriately sized sharps bins are available.
Sharps bins are positioned safely.
Sharps are disposed of at the point of use (observe/question two staff)
Locked sharps bins are stored in a designated secure room prior to collection.
Blood glucose meter storage boxes are free of used sharps.
An ‘accidental exposure to bodily fluid’ poster is on display.
Staff know what actions to take in the event of a needlestick injury (Q two staff).
Staff understand what (PEP) is, and how to access it (question two staff).
Adult Hand Hygiene Audit
Calculation:
yes x 100%
yes + no (do not include N/A responses)








6
7
8
9
10
11
12
13
1
Staff comply with Uniform Policy and bare below the elbows guidance.
There are posters displayed at clinical wash hand sinks showing correct method
of hand decontamination.
Liquid soap is available at all hand wash sinks.
Alcohol handrub is available at the entrance/exits to depts and patient areas.
Dispensers are clean and filled and drip trays are clean.
Dispensers are labelled correctly.
Clinical staff carry personal dispensers of alcohol handrub.
An approved wall mounted hand cream dispenser is available in each clinical
dept.
Staff decontaminate their hands before serving meals to the patients
(observe/question two staff).
A poster is displayed to make visitors aware of the importance of hand hygiene
before entering and leaving the dept.
Up-to-date hand hygiene promotion posters are on display.
Hand wash sinks are accessible, clean, free from plugs, overflows, equipment,
and patient’s property.
Hand towel dispensers are filled and staff are aware of where supplies are kept
(question two staff)
Elbow operated or sensor taps are available at all clinical hand wash sinks.
Staff are aware of the Hand Hygiene Policy and its location (question two staff).
Staff are aware when it is not appropriate to use alcohol handrub (Q two staff).
Patients are offered the opportunity for hand hygiene after going to the toilet and
before meals (Q two patients)
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Adult Personal Protective Equipment (PPE) Audit
yes x 100%
yes + no (do not include N/A responses)
Audit score 100 %
Yes
Staff are aware of the standard precautions policy and its location

(question two staff).

There is an adequate supply of gloves available.

There is an adequate supply of aprons available.

Glove/apron dispensers are available in patient areas.

Gloves are worn as single use items

Face masks are available (surgical and FFP3).

Face visors are available.

Staff are observed using PPE appropriately
Audit score
Yes
No

















Calculation:
1
2
3
4
5
6
7
8
9
10
11
12
PPE is disposed of appropriately.
Staff are observed decontaminating their hands after removing PPE.
Visitors are given guidance on PPE when appropriate for their use
(question two staff)
Staff are aware of correct procedure to follow when dealing with
blood spillages (question two staff).
No
N/A




14
100 %
N/A
Audit
Medicine Kardex
In-Patient Unit
18th August 2012
INTRODUCTION
The audit tool is to be used for auditing the standards of medication prescribing and
completion of Medicine Kardex within the In-Patient Unit.
The tool is based around Sub Topic 4 of the Help the Hospices National General
Medicines Audit tool and tailored around the medicine kardex used by the
organisation.
The tool is designed to audit up to 6 kardexes. The amount of kardexes audited will
be determined by the patient activity at the time of the audit.
AIM
To evaluate the standard to which the Medicine Kardexes are completed and
information recorded.
CRITERIA
There are 4 main criteria which are each split into specific tasks.
Criteria 1 focuses on the specific patient identification information recorded.
Criteria 2 focuses on information recorded for regular prescribed medication.
Criteria 3 focuses on information recorded fro PRN prescribed medication.
Criteria 4 focuses on the standard of recorded information i.e. legible etc.
RESULTS
Overall results are good, achieving above 91% compliance with 3 of 4 criteria
assessed and 100% compliance with the remaining criteria.
Criteria 1: has 4 sub criteria and achieved 95.8% compliance. One kardex did not
have the patient’s hospice number on.
Criteria 2: has 10 sub criteria and achieved 91.3% compliance with the applicable
criteria. One sub criteria was not applicable at the time of the audit. One entry did
not indicate the route of administration. One entry did not indicate the date of
prescribing. 2 kardexes did not indicate any information known about allergies or
hypersensitivities although this information was recorded in the patient’s medical
notes.
Criteria 3: has 6 sub criteria and achieved 97.2% compliance. One entry did not
indicate the dose of the medication.
Criteria 4: has 3 sub criteria and achieved 100% compliance.
ACTION PLAN
A memo will be circulated to inform members of the clinical team of the audit results
and to highlight the discrepancies in information recorded.
A lot of the information had been recorded by locum doctors who are not familiar
with the kardex system used by the hospice.
Nursing staff will be reminded of the need to check the kardexes when administering
the medication and point out any omissions to the doctor concerned.
CONCLUSION/ RECOMMENDATIONS
The audit will be repeated bi-monthly as part of the annual audit plan unless any
concerns are raised between audits.
15
BUTTERWICK HOSPICE CARE
MEDICINE KARDEX AUDIT TOOL
This audit tool is to be used for auditing the standards of medication prescribing and completion of Medicine Kardex within the
In- Patient Unit. The tool is based around Sub Topic 4 of the Help the Hospices National General Medicines Audit tool and tailored around the
medicine kardex used by the organisation.
This form can audit up to 6 kardexes. The number of kardexes audited will be appropriate to the number of patients in the unit at the time of the audit.
TITLE OF AUDIT.
MEDICINE KARDEX
Dept/Site to which
IN-PATIENT UNIT
Date of audit
the audit relates
Audit undertaken by:Name and Designation
Sue Smurthwaite
Clinical Team Leader
Number of Kardexes audited.
6
Pal care No of
Kardex
SIGNATURE:
20120129
20120126
20120131
20120093
20120083
20110056
TOTALS
Yes
Yes
Yes
Yes
Yes
YES
Criteria: 1
Patient information.
Yes
1.1
The name of the patient?
√
√
√
√
√
√
6
1.2
Date of birth of the patient?
√
√
√
√
√
√
6
1.3
1.4
Hospice number of the patient?
Information on any known allergies or
hypersensitivities?
Regular medicines prescribed have the
following
Name of medicine using the generic or
brand name as appropriate?
Dose of medicine?
Date of prescribing?
√
√
√
√
√
√
√
√
√
√
√
5
6
√
√
√
√
√
√
6
√
√
√
√
√
√
√
√
√
√
6
5
n/a
n/a
n/a
n/a
n/a
n/a
2.5
Weight of patient where the dosage of
medication was related to weight?
Route of administration of medicine?
√
√
√
√
√
5
2.6
Frequency for administering each dose?
√
√
√
√
√
6
Criteria: 2
2.1
2.2
2.3
2.4
No
√
X
No
No
No
X
√
No
No
X
NO
n/
a
1
1
6
1
16
BUTTERWICK HOSPICE CARE
MEDICINE KARDEX AUDIT TOOL
Number of Kardexes
audited.
2.7
2.8
2.9
6
Pal care No of Kardex
20120129
20120126
20120131
20120093
20120083
20110056
TOTALS
Yes
√
√
√
Yes
√
√
n/a
Yes
√
√
Yes
√
√
n/a
Yes
√
√
n/a
Yes
√
√
YES
6
6
1
No
No
No
No
No
No
3.1
3.2
Time for administering each dose?
Signature of prescriber?
Information on any known allergies or
hypersensitivities?
Any special requirements/instructions?
As required (PRN)/ Variable doses
prescribed have the following:
Name of medicine
Dose of medicine
3.3
Route of administration of medicine
√
√
√
√
√
√
6
3.4
Signature of prescriber
√
√
√
√
√
√
6
3.5
Date of prescribing
√
√
√
√
√
√
6
3.6
Frequency/Instructions
√
√
√
√
√
√
6
Criteria: 4
4.1
Each prescription is:
Written clearly (handwritten or
preferably computer generated)?
Indelible (handwritten or preferably
computer generated)?
Entries for replaced prescriptions are
deleted clearly, preferably as a
strikethrough to avoid duplication of
medication.
√
√
√
√
√
√
6
√
√
√
√
√
√
6
√
√
√
√
n/a
√
5
2.10
Criteria: 3
4.2
4.3
RESULTS:
TOTAL COMPLIANCE
CRITERIA 1
CRITERIA 2
CRITERIA 3
CRITERIA 4
COLLATED BY:
n/a
n/a
√
√
√
PERCENTAGE
95.8%
91.3%
97.2%
100%
LESLEY BLAKEMORE
Quality and Practice Development
Nurse.
X
X
X
√
n/a
n/a
n/a
1
√
√
√
√
√
√
√
√
6
5
NO
n/a
2
3
5
1
1
SIGNATURE:
17
COMMENTS AND ACTION PLAN FOLLOWING AN AUDIT
This form is to be completed following the audit. Please give comments where appropriate where criteria are not fully met and complete
action section to show how your department aims to increase the level of achievement for the specific criteria.
Please send a copy of your results to the Quality and Practice Development Nurse for monitoring purposes and collation into
the organisation’s audit log.
Title of audit
Dept/Site to which the audit
relates
Action Plan Completed by:
Signature
Criteria No.
1.3
2.3
2.5
2.9
3.2
Medicine Kardex
In-Patient Unit
Date of audit
Audit undertaken by:-
Lesley Blakemore
Name and Designation
Comments
Action Plan
One of the kardex’ did not have the
hospice number of the patient recorded.
One of the entries did not indicate the date
of prescribing
One of the entries did not indicate the
route of administration for the medication
A memo will be circulated to inform members
of the clinical team of the audit results and to
highlight the discrepancies in information
recorded.
2 kardexes did not indicate any
information known about allergies or
hypersensitivities although this
information was recorded in the
patient’s medical notes.
One of the entries did not indicate the dose
of the medication.
18th August 2012
Sue Smurthwaite
Clinical Team leader
Lesley Blakemore
Quality & Practice Development Nurse
A lot of the information had been recorded by
locum doctors who are not familiar with the
kardex system used by the hospice.
By whom
LESLEY
BLAKEMORE
By when
20th August
2012
Quality & Practice
Development
Nurse
Nursing staff will be reminded of the need to
check the kardexes when administering the
medication and point out any omissions to the
doctor concerned.
18
Patient/carer satisfaction
Patient/user satisfaction is an important part of our measurement of quality and
an essential part of knowing whether, from the patient or carer perspective, we
are providing a quality service that fully meets the needs of our patients and their
families.
As well as analysing the results of questionnaires we also collate comments from
letters and thank you cards and these form part of our quality assurance to the
commissioners of our adult services.
We have therefore included a small selection in this report below:‘As soon as my mum arrived she was overwhelmed with the calming
atmosphere and wonderful staff. She was overjoyed with the room she
was allocated and commented she would like to end her days there, and
indeed she did. We believe the fact that she could relax, be calm and
know we were taken care of. We were taken aback by the smallest details
ensuring privacy, dignity and personal wishes were respected.
The
amount of support to the whole family was incredible. The family room
made available to us was a godsend as were the big ‘bear hugs’ and
endless boxes of tissues. I am so pleased my mum got her wish to end her
days in such a lovely place. Thank you again’
‘I just wanted to say thank you to every one of your staff and volunteers who looked after my
brother during his last few weeks. The way you looked after his children when they visited was
especially nice, spoiling them with ice creams etc. I know you all do your jobs because you enjoy
what you do, but you go the extra mile. You all made an incredible difference to his last few weeks
and knowing he was in such good care made it a lot easier when we couldn’t be there.’
‘I can’t believe it’s a week since I managed to return home. I would like
to thank you all for my stay at the Butterwick, and the invaluable help
in getting me home. My stay with you was wonderful ‘respite’ from the
hustle and bustle of Ward 25. I will always remember my first Jacuzzi.
Once again a heartfelt thank you to you all, especially for a friendly
face in the middle of the night.’
‘ I would like to express my sincere thanks to all the staff who cared for my husband ‘M’ while he
was a patient in the Hospice until his death. Nothing was too much trouble for any of you and the
kindness and sense of humour shown by you all helped to ease a difficult time. ‘M’ was a very
special man and will leave a huge void in my life and the lives of his children and grandchildren.
Once again many thanks to you all – you are very ‘special people’.’
19
Annual Patient satisfaction survey results 2012/13
Services used
Which Service was used
%
100
80
61
60
37
40
20
1
0
0
Day hospice Bishop
Auckland
Outreach at
Sedgefield
Outreach at
Stanhope
0
0
0
In patient unit
stockton
Day hospice
stockton
Outreach at Barnard Home Care Durham
Castle
Dales
Overall Impression of Hospice Services
Impressions
very satisfactory
Satsified
somewhat satisfied
very dissatisfied
Not Applicable
100
80
60
8
00
5
10
3 20
5
00
6
0 00
6
2 00
6
Overall
impression of
the hospice
5
92
Staff Attitude
0 00
94
89
Patient
information
2 00 3
86
Regular
handwashing
or using hand
gel by staff
6
87
Explanation of
facilities
2 00
95
Did you feel
safe
6
Reception
area and
greeting
0
00
The
cleanliness of
the hospice
20
5
95
92
89
The hospice
facilities
40
20
Satisfaction survey cont….
How beneficial did you find this?
Were you offered Complementary Therapy?
100
100
80
80
79
60
60
97
40
40
20
0
0
Somewhat
Satisfied
Very
Dissatisfied
0
2
2
No
No answer
Very
Satisfactory
0
Yes
13
8
20
Satisfied
How well did we communicate information to you?
Very Satisfactory
Satisfied
Somewhat Satisfied
Very Dissatisfied
Not applicable
100
80
83
22
20
10
0 0
10
8
0 0
3 0 0
0 0
On your first
visit
Before you
arrived
0
73
21
16
Explaining you
treatments
19
76
During you
stay
59
65
24
22
10
3 0 2
2 0
Communication
with you
carers/family
75
40
Involvement in
decisions
making
60
Catering how well did you rate it?
Very Satisfactory
Satisfied
Somewhat Satisfied
Very Dissatisfied
Not applicable
100
80
60
40
67
22
20
8
2 2
73
68
27
59
19
5 2
8
73
16
3 2
10
8
0 2
70
13
10
3 2
14
5 2
10
0
The quality of Menu variety Presentation
the food
and choice
Prompt
service
Correct
orders
Overall
impression of
catering
services
21
Not applicable
Satisfaction survey cont….
How satisfied were you with other team members?
Very Satisfactory
Satisfied
Somewhat Satisfied
Very Dissatisfied
Not applicable
100
80
92
60
40
57
84
40
62
20
24
40
56
56
13
38
11
5
0 2
0 0
6
3 2 0
2 0 0
Chaplain
Day Hospice
Volunteers
5
5
0 0
0 0
0
Catering staff
Complementary
Therapist
Doctors
Family support team
100
80
73
67
60
60
59
52
51
43
38
40
38
35
25
20
11
0 0
5
21
8
0 0
6
0 0
6
0 0
0 0
2 0 0
0
Housekeeping
In-patient volunteers
Maintenance Team
Physiotherapists
Reception team
Volunteer drivers
22
Family Support
As well as providing direct nursing care, Butterwick Adult Hospice provides
counselling and pre and post death bereavement support to adults and children
via our Family Support Team, who provide this support either in one to one,
group or telephone support. This service helps in our ability to provide true
holistic care to patients and their families.
We have included a selection
evaluations of the services.
of
comments
below
from
patient/relative
‘When my husband passed away in July 2010 my whole world fell apart, he was my whole life. We
did everything together. When I first came to the Butterwick I thought this is not for me. I
persevered in coming, and it is he best thing I ever did. Looking back the way I was and the way I
am now is so different. The service you provide is marvellous, it is lovely to think if you feel the
need to talk to someone, there is always someone close by to share your thoughts. I have made some
lovely friends. Thank you Butterwick from the bottom of my heart.’
‘I enjoy coming to the drop in. The women in charge talked to me one to one for quite a while due to
my anxiety and phobias.
I’m now settled at a small table with about six other people, which I can cope with.
Without this service I wouldn’t have anyone to talk to, apart from my two sons, and this is the only
place I go to, apart from food shopping, since my wife died.
I appreciate everyone that sits and talks to me as I suffer from intense loneliness, as I was with my
late wife for over thirty years. We just lived for each other and our two sons.’
‘It is comforting to talk to other parents going through the same experience and if you have members in the
area at various times they can share their experiences. We have all found this beneficial and comforting – to
know you are not alone is very important. We all know life goes on, but it’s good to see people coping, as it
gives you the strength to know you can do it as well.
Grief is crippling and it comes in waves, you feel okay and then you don’t. each of us in the group can relate
to each other and the stage of grief that you are at.
This group is key to both the children and adults; talking about grief in this way is key to how we will live the
rest of our lives. Do not underestimate the work you are doing – it is priceless. Without this forum we would
struggle to cope. [I would be happy to contribute financially if needed]Thank you’
‘I find the group very good, as it has helped me open up and talk about the loss of my parents. I
have met some really nice people and made some good friends. My two children really look forward
to coming here, especially my 9 year old, he had really come out of his sad stage in life.
Would be grateful if it continues to go on, for the help of grief and loss of our loved ones.
My 9 year old has now started to take about his granddad, and can now say his name without
crying.
This group has helped our family loads.’
23
Research
The number of patients receiving NHS services provided by or sub contracted by
the Butterwick Adult Hospice Stockton on Tees in 2012-2013 that were recruited
during that period to participate in research approved by a research ethics
committee was: none. Butterwick Hospice Care’s current policy is that we do not
undertake primary research within the hospice.
Section 2.4 Use of the CQUIN payment framework
A proportion of Butterwick Adult Hospice’s income in 2012/13 was conditional on
achieving quality improvement and innovation goals agreed between Butterwick
Hospice Stockton and NHS Tees, through the Commissioning for Quality and
Innovation payment framework.”
“Further details of the agreed goals 2012/13 and for the following 12
month period are available electronically at [N/A]”
Section 2.5 What others say about us
Statements from the CQC
Butterwick Adult Hospice, Stockton on Tees is required to register with the Care
Quality Commission and its current registration status is:


Diagnostic and screening procedures
Treatment of disease, disorder or injury
Transport services, triage and medical advice provided remotely
Butterwick Adult Hospice, Stockton on Tees has the following conditions on
registration:Conditions:‘The Registered Provider must ensure that the above regulated activities are
managed by an individual who is registered as a manager in respect of this
location.’
“The Care Quality Commission has not taken enforcement action against
Butterwick Adult Hospice, Stockton on Tees during 2012/13.
Butterwick Adult Hospice, Stockton on Tees has not participated in any special
reviews or investigations by the CQC during the reporting period.
The Butterwick Hospice is subject to periodic reviews by the Care Quality
Commission and its last review was July 2012
The Butterwick Hospice was fully compliant and rated as low risk following
assessment by the Care Quality Commission.
We have included some comments from our last inspection below.
24
Selection of comments from the last CQC compliance assessment:‘We spoke with two people who were in-patients at the hospice. They told us that
they were treated with dignity and respect at all times.’
‘One person told us, “I have been involved in my treatment and care plans at all
time, I have been fully consulted and am aware of my discharge
plan/arrangements.”
‘We spoke with two relatives of a person receiving care at the hospice. They also
said, “in here they give him the dignity, privacy and respect that they have had
all of their life.”
‘One person told us, “it is an excellent standard of care, I have been very
surprised, I see the doctor every day.” Another person said, It has been very
nice here, very good and I have been well looked after.”
‘The provider had an effective system to regularly assess and monitor the quality
of service that people receive.’
The full compliance report can be viewed at www.cqc.org.uk .
Section 2.6 Data quality
NHS Number and General Medical Practice Code Validity
Butterwick Adult Hospice, Stockton on Tees did not submit records during
2012/13 to the Secondary Uses service for inclusion in the Hospital Episode
Statistics which are included in the latest published data.
The following mandatory statement is therefore not applicable to Butterwick Adult
Hospice Stockton:[Name of provider] will be taking the following actions to improve data quality [insert actions].
Butterwick Adult Hospice, Stockton on Tees was not subject to the Payment by
Results clinical coding audit during the reporting period by the Audit Commission.
Information Governance Toolkit attainment levels
Butterwick Adult Hospice, Stockton on Tees was not required to undertake the
Information Governance Toolkit therefore the following mandatory statement is
not applicable.
Butterwick Adult Hospice, Stockton on Tees’s Information Governance
Assessment Report score overall score for [reporting period] was [percentage]
and was graded [insert colour from IGT Grading Scheme]”
25
Part 3 Review of quality performance 2012/13 (provider
determination)
This report is the first Quality Account produced by Butterwick Adult Hospice,
Stockton on Tees therefore there are no specific priorities for 2012/13 to review.
However in relation to the Business Plan for 2012/13 and linked to the Hospice
Clinical Strategy Action Plan several areas were highlighted as priorities. Three
developments were chosen for review in this Quality Account to enable us to
demonstrate the quality of the Hospice services provided.
Development 1: Patient Safety
Up-skilling of nurses in Independent Prescribing
State how development was identified
In 2011 a new clinical structure was implemented with the introduction of new
Clinical Team Leader posts. At the time of recruitment a key requirement of
these roles was to either hold or obtain, as soon as possible, advanced skills such
as independent (non-medical) prescribing and clinical assessment skills.
In developing the structure it was felt vitally important that the hospice
developed a nursing structure able to support the current and future needs of
palliative and supportive care as well as being able to readily respond to service
development opportunities and challenges. Having a nursing team with these
skills was seen as a priority and was therefore identified as a key objective in the
supporting clinical strategy.
We believed that these skills within the nursing team were needed to help support
the small hospice medical team and also promote safe prescribing practice out of
hours when an on call doctor may be required to visit a patient.
When a nurse with an independent prescribing qualification is on duty, calls to the
out of hour’s doctor can be avoided, especially where it is only an amendment to
current medication or a medication requirement that can be safely dealt with by
the nurse. Where medical advice is required out of hours a medication can be
prescribed following discussion with the doctor without their having to come out,
thereby freeing up the doctor to visit a patient who may have a more urgent
need.
How was it achieved?
Two of the Clinical Team Leaders attended an Independent Prescriber’s course at
the local university.
They attended study days at the University and were
mentored by one of the Hospice Physicians; undertaking the required number of
days shadowing the doctor in order to complete the required practical assessment
of the course.
Following successful completion of the course, arrangements were made to
shadow doctors in a nearby hospice for additional experience and to gain
confidence.
26
Amendments were made to the Medicine Management policy and job descriptions
to include independent prescribing.
A meeting was also held with the Director of Clinical Services, Quality and
Practice Development Nurse and the two newly qualified prescribers to agree a
list of drugs that was felt to be appropriate within the hospice environment for the
Clinical Team Leaders to prescribe and also to clarify what the expectations were
and safe prescribing boundaries within their roles.
Review and evaluation of success of development
Over the last couple of months the Clinical Team Leaders have begun to prescribe
within their practice.
This has enabled prompt prescribing out of hours and avoided delays in
medication being commenced when waiting for an out of hours doctor to arrive.
This has therefore had significant benefits for patients.
The increased knowledge in regards to assessment of patients and prescribing of
medication gained during the course has enhanced the nurse’s roles and given
them increased confidence to support health professionals less experienced in
prescribing for patients with palliative care needs.
This has been particularly relevant over the last few months whilst recruiting for
replacement hospice physicians at the hospice and our use of locum medical staff
in the interim period.
Other members of the nursing team have also been able to benefit through their
teaching of colleagues whilst on duty.
Discussions have taken place for peer support to be arranged for the prescribers
by meeting with other non-medical prescribers from the community.
We will be continuing our commitment to increase the number of staff with
prescribing qualifications in 2013/14 as part of our clinical strategy.
Development 2
Same Day transfers from Acute Trust to Hospice
State how development was identified
We were aware that patients were unable to be transferred to the hospice from
the local hospital as soon as a bed became available due to difficulties with
ambulance transportation within the time period when a doctor was available.
We also knew that on occasions patients requiring end of life care were often
waiting over a weekend to be transferred to the hospice and we believed that the
hospice environment would be much more appropriate for them and their
relatives rather than an Acute Admissions Unit.
The Hospice is located adjacent to the Hospital within the grounds of the
University Hospital of North Tees.
27
How was it achieved?
A successful bid for non-recurrent funding therefore enabled us to create a
Hospice Assessment Outreach Team which facilitated quicker transfer of patients
from the acute trust to Butterwick Hospice out of hours e.g. evenings and
weekends.
Meetings took place with members of the hospice clinical team and the Consultant
in charge of the Emergency Assessment unit. A protocol was drawn up and
agreed and distributed to the relevant wards and departments at the Hospital.
The patient’s initial assessment takes place on the referring ward at The
University Hospital of North Tees by either the Hospice Physician or Clinical Lead
for Adult services and the initial assessment documentation and medication
kardex completed. This therefore enables a patient to be transferred to the
Hospice out of hours when a bed becomes available rather than waiting until the
next day or several days if a bed becomes available over a weekend.
Review and evaluation of success of development
This development has enabled several patients to be transferred to the hospice
on the same day where the environment is often much more conducive to their
needs and those of the family. In many cases it can help to achieve the patient’s
preferred place of care or death.
In liaison with the community and hospital specialist palliative care team,
specialist symptom control management can begin in hospital prior to transfer,
thereby benefiting patients from earlier intervention of hospice care on an
outreach basis.
Quicker transfers can ensure that patients therefore benefit from the Hospice’s
supportive environment and holistic care at an earlier stage with access to clinical
staff experienced in palliative and supportive and end of life care as well as
supportive services such as complementary therapies and family support.
The ability to take patients at an earlier stage has benefits for the acute trust as it
enables more cost effective care and treatment of patients in the hospice; a
saving compared with acute trust costs. It also ‘frees up’ beds within the Acute
Trust for more appropriate patients.
This development has also contributed to the achievement of a key objective
within the clinical strategy in regards to helping to promote effective use of
Hospice beds and maintaining good bed occupancy.
At the time this project was accepted by the PCT and therefore prior to
implementation, the hospice had two hospice physicians in post. One of the
physicians however took up a new post at short notice which had an impact on
the staffing resources available to assess patients in the hospital. Despite this we
felt this was an important project and therefore proceeded to implement it.
The numbers of patients assessed on the ward and transferred the same day
have therefore not been as high as we initially anticipated or would have liked.
We are still confident however that those patients who have been transferred on
the same day and their families have benefitted significantly.
28
Now that we have recruited a new team of hospice physicians we are looking
forward to increasing the number of patients being assessed on the ward and
same day transfers facilitated where appropriate.
We also believe that this development has further potential to enable patients
already assessed as appropriate for hospice care and known to the hospice team,
to be admitted directly from home rather than via an acute admissions unit. This
will require further discussion with the emergency out of hour’s medical team and
commissioning groups.
Development 3
Patient experience
Introduction of a condition-specific day care service
State how development was identified
The aim was to provide a dedicated day care facility for patients with progressive
Neurological conditions based on a highly successful service provided at Bishop
Auckland and our outreach centres for patients in Co. Durham and the Dales.
A successful non-recurrent funding bid enabled us to pilot a similar provision at
Stockton site for patients within the North of Tees area.
This was an 8 week rolling programme which enabled patients to receive a fully
holistic service from a specialised multi-disciplinary team as well as receiving
advice from other specialist professionals relevant to the needs of those patients
with neurological conditions e.g. continence and benefits advice etc.
The article below was used in the bid to highlight an increased demand for
specialist neurological provision for patients with progressive, life limiting
neurological conditions.
HEALTH & PHARMACEUTICALS NEWS
Tuesday 17 January 2012
Charities have warned that the NHS is facing a 'time bomb' as the number of people with
conditions such as Parkinson's and motor neurone disease rises, according to the Daily
Telegraph (Staff Reporter). Parkinson's UK predicts that there will be 28% more people with
the condition by 2020, a rise from 127,000 to 162,000, while the number of motor neurone
sufferers is set to rise 27% in the same period. The Daily Mail (Sophie Borland) says a report
by the Neurological Alliance, formed by the charities, warns that services are already
struggling to cope and patients are frequently shunted into hospital against their will when
they could be better cared for at home. It adds that patients are at the bottom of the
Government's 'to-do list'.
How was it achieved?
The service consisted of one three hour session per week for 8 weeks on a rolling
programme basis and was nurse-led by an experienced Registered Nurse.
Patients were assessed by a specialised multi-disciplinary team and benefited
from receiving patient-focused treatments and services from staff including:-
29






Nursing assessment by a lead nurse
Advice and support from specialist neurological practitioners i.e. MND
nurse and MS nurse.
Neurological-specific physiotherapy
Complementary therapies known to benefit patients with neurological
conditions delivered by highly experienced staff.
Counselling Services for patients and their carers.
Access to Hospice Physician if required
We have excellent relationships with and access to neurological-specific
physiotherapy services and this team also provides our services at the Neuro
days at Bishop Auckland Hospice and outreach centres. We therefore used to
services of one of their physiotherapists.
Our team of complementary therapists within Butterwick are also experienced in
delivering complementary therapies to this group of patients and a senior
therapist provided this service.
The Specialist Practitioner for patients with Motor Neurone Disease was very keen
to support the hospice in having a Neurological specific day care facility for
patients within the Tees area and believed there would be an increasing demand
for this service.
A protocol and referral criteria was therefore established and the service was
publicised via leaflets to local GP’s health professionals.
Two 8 week sessions were conducted prior to a patient evaluation being
undertaken. A meeting then took place between the Director of Clinical Services,
and key staff to discuss the pilot, the evaluations and to decide whether it should
continue.
Review and evaluation of success of development.
The patient evaluations were very positive in regards to having a specific day care
facility for them to attend.
They particularly enjoyed the complementary
therapies and physiotherapy and found these very beneficial for their individual
needs.
The attendance numbers however were very small and there was also a potential
limitation on the number of patients who would be able to receive complementary
therapy during the session if numbers were significantly greater due to the
availability of one complementary therapist and the time available.
Some patients commented that although they found the physiotherapy beneficial
there was a need for a specialist wide plinth to enable the physiotherapist to work
alongside the patient more easily. We were aware that this facility is available at
our Bishop Auckland site in a specific room which was designed as part of the
refurbishment of a discussed wing of the building.
As a team we felt very strongly that we wished to provide an effective service
with the appropriate equipment and resources but even if we purchased a wide
plinth there was no suitable room large enough for this to be placed and used.
We also became aware that there were other services available in the Stockton
area for the patients that were attending these sessions and many of them were
attending these.
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On reflection we also felt that the need for this type of service at the time was
very different to that in the Durham and Dales area; due in some respect to the
large incidence of Multiple Sclerosis in the Co-Durham and Dales area.
For the reasons given above we therefore decided not to continue with this
project.
In the months following this however, we have continued to work very closely
with the Specialist Nurse for Motor Neurone Disease and had several meetings
with him and a senior representative from the Motor Neurone Disease Society.
These discussions highlighted the need for a different kind of service for patients
with Motor Neurone Disease and other neurological conditions, in particular those
patients who are newly diagnosed who would like to access complementary
therapy and family support but do not wish to attend for a full or half day and
may have some reluctance to attend a hospice because of their perceptions.
Discussions then took place with the specialist nurse for Parkinson’s disease as
well as the recently appointed Consultant Neurologist in a nearby Trust in regards
to a different model to support this client group and the potential demand.
A new Neurological Support Network group commenced at the hospice in April
2013, on a Friday afternoon which is very flexible and enables patients with a
recent diagnosis or in the early stages of a neurological condition such as MND,
Parkinson’s disease or Multiple Sclerosis, to attend for a complementary therapy
treatment, an appointment with family support and if they wish can stay to talk to
other patients for support.
Early indications are that this is being well received by patients and health
professionals and referral numbers are increasing.
3.2 An explanation of those involved in this quality account
The Quality Account was discussed at the Hospices Management Team meeting
which is chaired by the Chief Executive and includes clinical and non clinical
managers, the Director of Clinical Services and the Director of Finance.
The task of writing it was delegated to the Registered Manager with a statement
from the Chief Executive.
The Quality Account was also discussed at the Senior Clinical Meeting where the
quality priorities were agreed.
It has also formed part of an Agenda item of the Clinical Strategy and
Governance Committee which is a key element of the Charity’s governance
structure: the Minutes of which are distributed to the Board of Trustees as will a
copy of this Quality Account.
Once completed the Quality Account was distributed to Clinical and non clinical
Managers for comment and approval. The completed Quality Account was then
forwarded to Hartlepool & Stockton on Tees Clinical Commissioning Group and the
local Healthwatch team to approve and comment on the quality priorities
mentioned in the report.
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ANNEX: Statements from Commissioning Group and Local
Healthwatch team.
The Quality account was sent to Stockton on Tees Healthwatch and the
representative for the Clinical Commissioning Group on 25th May 2013.
Response from Health watch
Thank you for your email dated 24th May 2013, providing the opportunity for
Healthwatch Stockton-on-Tees to make comment on Butterwick Hospice
(Adults) Quality Account 2012/13.
Healthwatch Stockton-on-Tees was launched on 1st April 2013 and we are
currently in the process of recruiting our membership and from there a
Board will be appointed. We therefore feel it would be inappropriate to
make a comment on the Quality Accounts for 2012/13.
However, we would welcome the opportunity to meet with yourself and/ or
Graham Leggatt-Chidgey to discuss working together in the future and
ensure an informed comment can be made in 2013/14 when the
Healthwatch Stockton-on-Tees Board is in place.
If you have any questions or would like any further information please
contact my colleague Heather McLean on 01642 688312 or email
heather.mclean@pcp.uk.net.
Yours sincerely
Liz Greer
Healthwatch Transition Manager
Middlesbrough, Stockton-on-Tees, Redcar & Cleveland and Sunderland
Liz.Greer@pcp.uk.net
Response from local commissioning Groups.
Please see next page
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