Quality Account
2013/2014
Image: New Inpatient garden
Inset: Members of the clinical team in new uniforms
2
Rowcroft Hospice
Quality Account 2013/2014
Contents
Chief Executive’s introduction ..........................................................3
What our organisation is doing well and our
approach to Quality Assurance .........................................................4
Patient safety — delivering care .................................................................................................. 4
Clinical effectiveness — measuring impact ........................................................................... 5
Getting staffing right and measuring staff experience ..................................................... 5
Care Quality Commission (CQC) inspection ........................................................................ 5
Audit ......................................................................................................................................................... 5
Research ................................................................................................................................................. 5
Education 2013/2014 ........................................................................................................................ 6
Statutory information and some facts and figures .......................7
How we have performed against last year’s priorities
for improvement ..................................................................................8
Patient safety ........................................................................................................................................ 8
Getting staffing right ......................................................................................................................... 8
Clinical effectiveness — measuring impact ........................................................................... 8
Patient, family, friends and staff experience .......................................................................... 8
Outpatients ........................................................................................................................................... 8
Where we feel we can improve and our priorities
for 2014/2015 ........................................................................................9
Patient safety — delivering care .................................................................................................. 9
Patient family and friends experience ...................................................................................... 9
Rowcroft Hospice at Home ........................................................................................................... 10
Chapel area ........................................................................................................................................... 10
Wi-fi provision in the Inpatient Unit ......................................................................................... 10
Chairman of the Board of Trustees statement ...............................11
Annex .....................................................................................................12
3
Chief Executive’s
introduction
Rowcroft Hospice is the Independent Charity providing Specialist Palliative
Care to patients and their families in South Devon. Over 75% of the service
delivery is funded through the charitable giving of the people of South
Devon; the balance being funded through a block contract from the local
NHS. Wherever possible, we seek grant income for specific projects and were
fortunate to secure funding this year to improve access and interaction in our
gardens for the benefit of our patients and their visitors. You can see a small
part of this on our front cover.
This, our fourth annual Quality Account, aims to demonstrate to our
patients, their families and friends, the people of South Devon and our NHS
Commissioners, that Rowcroft Hospice delivers safe, effective, high quality
care. Whilst good care is, in reality priceless, we consider our care to be
responsible by representing very good value, in return for the community’s
charitable investment.
All of this is only made possible by the dedication of our staff and volunteers,
the Executive Team and our Board of Trustees. They are passionate in their aim
to deliver the best possible care to those who need it, whilst maintaining the
highest standards in Corporate, Financial and Clinical Governance.
This document is a fair and accurate account of the quality of service provided
by Rowcroft Hospice, an organisation of which I am deeply proud to be a part.
Giles Charnaud
CEO Rowcroft Hospice
What our organisation is doing well
What our organisation is
doing well and our approach
to Quality Assurance
Our focus, as always, remains on the quality domains of patient
safety, clinical effectiveness and patient / family experience.
Patient safety — delivering care
• Our Quality and Patient Safety Committee
continues to meet monthly. Clinical Incidents
are examined, using root cause analysis
where indicated to ensure that our processes
reflect best practice and to minimise risk.
Our incident reporting system is now sited
on an electronic database to ensure robust
investigation and reporting.
• We are pleased to report that, for the fourth
consecutive year of reporting for the Quality
Account, no patients acquired the reportable
infections MRSA, Clostridium difficile, ESBL,
Salmonella, Pseudomonas or Klebsiella
Pneumonia whilst in the care of the
Inpatient Unit.
• We have continued to report data to
benchmark slips, trips and falls, medication
incidents and pressure ulcers with our regional
hospice colleagues. We are pleased to report
that, from April 2014, this will be benchmarked
with hospices nationally via Help the Hospices.
• At the time of publication, the benchmarked
figures have not yet been reported. We will be
pleased to supply them on request once they
are to hand.
We are always vigilant in recording these
statistics, but realise that they must be taken in
context. All of our Inpatient beds are occupied
by people with acute and complex needs,
either because of a progression in their illness
or because they are in the last few days of their
lives. At the end of life, multiple organ failure
can occur, including breakdown of the skin.
We remain vigilant in assessment and planning.
A review of the pressure ulcers that occurred in
the hospice showed that all were unavoidable.
We have recently purchased several additional
high specification mattresses as part of our
rolling programme of equipment replacement.
We were concerned that we had reported
more drug incidents1 than the average for
south west hospices last year, so a medications
management task and finish group was
established to look for any underlying themes
or trends that required action.
• Every incident for the twelve month period
was revisited and re-analysed. No incident
resulted in harm to a patient, nor in any
change in their clinical condition.
It was also clear that some incidents were
beyond the organisation’s control, eg
equipment failure. However, we strive to be
a learning organisation and will continue to
monitor all incidents.
• An audit of controlled drug records noted
areas for improvement and a new process
for the recording of controlled drugs brought
into the hospice by patients is now in place.
• All registered nurses will attend a two
day medicines management course on
appointment, unless they have recently
attended training with their previous
employer. All existing staff will have access
to ongoing training online.
The results of this review are encouraging and
we plan to repeat the process in 2014/2015.
Number of patients who developed
new pressure sores (grade 2 and
above, per 1,000 occupied bed days)
whilst cared for on IPU.
Number of patient falls per 1,000
occupied bed days (Includes slips,
trips and falls).
Number of patient medication
incidents per 1000 occupied
bed days.
2013/14
2012/13
6.1
1.4
7
7.4
5.9
5.8
1
Any incident where there has been an error in the process of prescribing, dispensing, preparing, administering, monitoring or providing medicines advice, regardless of
whether any harm occurred or was possible. This is a broad definition and most errors result in no or low harm. (National Patient Safety Agency. Safety in Doses. (2007) pg.9.)
4
What our organisation is doing well
“A very professional a nd
welcome job providing exa ctly
the right level of care”
Clinical effectiveness —
measuring impact
A consultation with Inpatient nursing staff was
carried out to identify the best model for nursing
our patients, taking into account our staffing
levels, skill mix and geography of our Inpatient
Unit. Our aim is to ensure that our care is always
person centred, with a named nurse for each
patient on every shift. The new model was
piloted from October 2013 and fully implemented
in January 2014. Patients reported satisfaction
with the quality of care experienced to the Care
Quality Commission (CQC) Inspectors during
their inspection.
Getting staffing right and
measuring staff experience
The model discussed above has been well received
by staff, who have worked in smaller teams with
well documented lines of accountability. Although
it is too soon to measure the effect on their
job satisfaction, the Care Quality Commission
Inspectors commented that staff were satisfied
with improved team working.
Care Quality Commission
(CQC) inspection
Representatives from the CQC carried out a
routine inspection of the Inpatient and Hospice
at Home Services in November 2013 to check
that essential standards of quality and safety were
being met. The inspectors made their judgements
by a combination of methods including
observation, talking to patients, carers and staff
and reading documentation.
We were pleased that their report confirmed
compliance with the domains inspected, including
consent to care and treatment, care and welfare
of people using our services, cleanliness and
infection control, staffing and record keeping.
The full report can be viewed at:
http://www.cqc.org.uk/sites/default/files/old_
reports/1-106245011_Rowcroft_Hospice_INS1910153924_Scheduled_11-12-2013.pdf
5
Audit
19 Clinical audits were carried out during
2013/2014 and 7 are ongoing. All audits are
scrutinised by the monthly Quality and Patient
Safety Committee, who make recommendations
to ensure clinical effectiveness and best practice
are at the forefront in our approach to patient care.
In addition, the Infection Prevention Practitioner
manages 10 audits per month in respect of the
environment and working practices. Five annual
Infection Prevention audits are carried out,
including the Help the Hospices Policies and
Procedures audit to ensure that we are compliant
with current best practice.
We are also a member of the South West
Informatics Project. This comprises 10 South
West Hospices who participate in data collection,
surveys and audits. The surveys are used to
compare practice and set standards for future care.
Research
Social workers in the community team have
been taking part in a national research study:
‘Carer Assessment Study’ conducted by research
teams from the Universities of Manchester
and Cambridge. The study is helping health
professionals to make use of a carers needs
assessment tool that helps family members
looking after a person with a life-limiting illness to
identify their own needs.
The director of patient care has been acting as an
advisor on a study undertaken by the University
of Nottingham on ‘Cascading knowledge about
end of life care at home: the development and
piloting of a training programme for those who
help carers and a carer resource pack’. The
hospice education department are hoping to
pilot the training programme which has been
developed later this year.
What our organisation is doing well
Education 2013 / 2014
This year has seen further growth in our
educational provision with a further increase in
participant numbers.
We have also broadened the interest for our
courses and attracted more physiotherapists,
occupational therapists, social workers and
hospital doctors than in previous years
All education is linked to the national end of life
core competencies and underpinning principles1,
delivered through interactive workshops, study
days and more formal programmes. We also
work in collaboration with colleagues from other
specialist fields so that we can include education
about specific diagnoses such as dementia, motor
neurone disease, Parkinson’s disease and chronic
obstructive pulmonary disease (COPD).
The educational events [124 in total] range from
2 hour Palliative Care Updates, to 5 day taught
programmes with 2 day clinical placements
with Specialist Palliative Care Teams [Enhancing
Palliative Care Skills]
Our courses, study days and workshops have
evaluated well:
• Level of interest/stimulation: average score
of 4.5 [1 – poor/uninteresting; 5 – very good/
stimulating].
“ I do think that
this has been
invaluable in my
line of work”
Participant at
Diagnosing and
Discussing Dying
workshop
Designation of delegates
at Rowcroft Education 2013/14
Care Home Proprietor/ Manager
Other
Educators
Paramedic
Doctor (GP, Hospital, Devon Doctors)
Skilled non-registered
Administration
(e.g. coordinators of electronic EoL register)
35
27
14
1
72
632
33
2%
2%
1%
0%
4%
36%
2%
Volunteers
Physiotherapists
Occupational therapists
Registered Nurse
Dietitian
Speech Therapists
Social Workers
Therapists (e.g. complimentary, art, music)
123
27
51
666
7
1
25
18
7%
2%
3%
39%
0%
0%
1%
1%
Annual participant numbers
1800
1600
1747
1400
• Participants also reported significant increases
in their confidence levels as a result of
attending sessions across all End of Life Care
competencies1 and about different diagnoses.
In addition to the formal courses provided,
many healthcare staff and students access
education placements with the hospice Multi
Disciplinary Teams.
“ Excellent presentations and
su mmarising of evidence. Good
discussions and giving of insight
into GPs viewpoint”
Participant at GP and Hospital Doctor Study Day
1
National End of Life care Programme (2009) – Common core competences
and principles for health and social care workers working with adults at the end
of life. Available at http://www.nhsiq.nhs.uk/resource-search/publications/
eolc-competences.aspx
1465
1200
1000
1118
800
1235
600
400
200
203
2009/10
2010/11
2011/12
2012/13
2013/14
6
Statutory Information
7
Statutory information
and some facts and figures
This section includes statutory statements about how Rowcroft Hospice
is regulated and also describes where we believe we can make further
improvements in the quality of care we provide.
Rowcroft Hospice provides
the following services:
• 17 bedded inpatient unit.
• Community specialist palliative care service.
• 24/7 Hospice at Home service.
• Outpatient services.
• Chronic Oedema service.
• Bereavement service.
• Education and training for health and social
care staff, volunteers and carers, in palliative
and end of life care.
Rowcroft Hospice is required to register with
the Care Quality Commission and is currently
registered (2010) under the following categories:
treatment of disease, disorder or injury;
diagnostic and screening procedures; transport
services, triage and medical advice provided
remotely and ‘personal care’ for our enhanced
Hospice at Home service.
Rowcroft Hospice has the following conditions
on registration:
• The establishment may provide overnight
beds for a maximum of 19 patients at any one
time. We are currently equipped to care for a
maximum of 17 inpatients.
• The establishment may not treat patients
under the age of 18 years.
• The prior written approval of the Care Quality
Commission must be obtained at least one
month prior to providing any treatment
or service not detailed in the statement of
purpose.
Rowcroft Hospice is subject to periodic review
by the Care Quality Commission (CQC). The last
inspection was in November 2013 as detailed in
part one.
Numbers of patients
receiving care in 2013/2014
• The Inpatient Unit admitted 317 patients.
• The Community Team received 1106 referrals,
887 being new patients to the service.
• Rowcroft Hospice at Home had 376 patients
referred, nursing people mainly in their own
home or care home in the last weeks of life.
• The Bereavement Service provided support to
181 bereaved people.
• Outpatient Centre — 225 patients were seen by
various services, a majority for multiple visits.
These figures are taken from the Minimum Data
Set supplied annually to the National Council for
Palliative Care and do not include patients with
Chronic Oedema, who also receive care from our
service, an average 160 outpatient appointments
per month.
“ When the ‘tea m’ ca me, the
a nxiety was lifted a nd we
had respite from a physically
tiring a nd e motionally
draining situ ation.”
How we have performed against last year
8
How we have performed
against last year’s priorities
for improvement
In the Quality Account for 2012/2013, we set out our priorities for 2013/2014 and
the following is a report of what actions have been taken to achieve our aims.
Patient safety
Medicines Management — A task and finish group
have examined all drug incidents and established
training needs for current and new staff. Minor
changes have been made to prescription of
medicines outside normal drug rounds and to
documentation.
Initial results from the audit of pressure ulcer
documentation and care planning showed an
encouraging correlation between education
delivered and standards being met. This audit will
therefore be repeated during 2014/2015.
Audit of inpatient falls. As the data collection
for this audit was completed at the end of
2013/2014, the results and recommendations
will be carried forward.
Getting staffing right
We identified the need for additional Occupational
Therapy and Physiotherapy hours. We have
appointed to these hours and are now fully staffed
in these disciplines.
A further Specialist Practitioner in Education has
been appointed.
A Speciality Doctor has been appointed to provide
additional medical cover for the Community Team
Clinical effectiveness —
measuring impact
A new nursing model has been piloted and
implemented. Measurement of patient and staff
satisfaction subsequent to this is ongoing.
Non Medical Prescribing. The first Clinical Nurse
Specialist has recently completed the training.
Governance procedures are in place to support
this practice.
Patient, family, friends
and staff experience
An independently facilitated Hospice User
Advisory Group has been established and is now
meeting regularly.
Following a successful bid for department of
health funding, the garden area to the Inpatient
Unit has undergone significant transformation,
making it more attractive and accessible to bed
bound patients and wheelchair users.
Outpatients
An Outpatient Strategy has been written and will
continue to be reviewed.
Additional signage has been placed to assist new
patients to find the Outpatient building.
SMS text reminders for Outpatients. We will
implement the reminder service on 1st July,
once appropriate policies are in place to ensure
compliance with data protection and patient
consent.
Our priorities for 2014 / 2015
Where we feel we can improve
and our priorities for 2014/2015
Patient safety —
delivering care
Patient family
and friends experience
We consider that we deliver excellent care, but
need to have robust measures for evidencing that
this is the case. We are currently in the process
of defining the knowledge, skills and attitudes
(competencies) required for all roles within our
service so staff can be further supported in their
professional development. We have explored the
evidence base and the competencies defined in
other Specialist Palliative Care services.
For the past two years, we have gained valuable
periodic feedback from users of our services
supported by Picker Institute Europe. However, we
would like to give all patients and carers at least
one opportunity to feed back on the care received
from our services. We have identified a system
(iWantGreatCare) that seems to meet our needs.
Patients and carers can complete a simple card or
feed back their views online. We can benchmark
our feedback with 7 other hospices in the south
west region.
Priority for 2014/2015
• To agree a core set of workable
competencies for all staff.
• To agree a set of discipline specific
workable competencies or where these do
not currently exist, to agree a mechanism
for developing these as part of a planned
programme.
Outcome Measure
• Set of workable competencies
documented and agreed by 31/3/15.
“ The kindness shown was
wonderful a nd the help
we received made things
easier a nd ena bled us to
be calm.”
“ Ou r fa mily was so
lu cky to gain a ccess
to Rowcroft a nd you r
superb tea m.”
Priority for 2014/2015
• Patient feedback system to
commence 1/4/14.
Outcome Measure
• Every patient / carer offered opportunity to
feed back (audited).
• Full year benchmarked feedback available.
9
Our priorities for 2014 / 2015
Rowcroft Hospice at Home
Rowcroft Hospice at Home has evolved and grown
over the two years since the enhanced service
was launched in Dec 2011, and many more people
have been offered an increased level of care in
the place of their choice. Over the coming year,
we will re-evaluate the service to determine what
further developments are needed and achievable.
Wi-fi provision
in the Inpatient Unit
Due to the layout of our Inpatient Unit, we have
experienced problems with the Wi-fi provision on
the unit. This was installed to enable patients to
use their own laptops /tablets or make use of the
two iPads available to patients.
Priority for 2014/2015
Priority for 2014/2015
• Evaluation completed, needs identified
and options evaluated.
• Diagnose and fix the problem with the
Wi-fi provision. As the router is in a
patient area, it is proposed to carry out
this work during the annual summer ward
maintenance programme.
Outcome Measure
• Plan written and agreed.
Chapel area
It is felt that our Chapel requires refurbishment
to make this a brighter spiritual / quiet space for
patients and families of all faiths or none. Funds
have been set aside for this project.
Priority for 2014/2015
• Refurbishment plans agreed and
work undertaken.
Outcome Measure
• Work progressed and completed or near
completion by the end of March 2015.
“ Words ca nnot express the
difference the Rowcroft Hospice
at Home tea m made to us. I
ca nnot tha nk the m enough”
“ We were equ ally e mbra ced
by the staff, whose warmth
a nd hu ma nity made it a very
special pla ce to be”
Outcome Measure
• Wi-fi available to patients and relatives
following ward maintenance programme.
“ It was so reassu ring to have
the tea m not only visit him,
but also me. Having a phone
nu mber to ring day or night
made su ch a difference.”
10
11
Chairman of the Board
of Trustees statement
The Board of Trustees is pleased with the progress made in the last year
and remains committed to developing services in line with the needs of
our patients and their families and friends.
To this end, we are introducing a new patient feedback system this year
and every patient and carer will be offered the opportunity to tell us what
they think of our services and, importantly, how they feel improvements
could be made.
We have invested in increased Occupational Therapy and Physiotherapy
provision for patients in the Community and plan further development
of our Hospice at Home Service. This investment in Community based
services is being made with a view to offering real choices about where
people wish to be cared for. For many, this will be well beyond the physical
walls of our Inpatient Unit. Rowcroft Hospice is a service, not a building.
As Chairman of the Board of Trustees, I endorse this report. The Board will
continue to support the Executive Team and the Staff of Rowcroft Hospice
in achieving the key priorities for 2014/2015.
Mrs Sue Newman
Chairman, Board of Trustees
12
Annex
NHS South Devon and Torbay Clinical
Commissioning Group statement:
Quality Accounts 2013-14
South Devon & Torbay Clinical Commissioning
Group (SD&T CCG), as the lead NHS commissioner
for Rowcroft, is pleased to provide our
commentary on this Quality Account for 201314. SD&T CCG has taken reasonable steps to
corroborate the accuracy of the data provided
within this Quality Account and considers it
contains accurate information in relation to the
services provided.
We have reviewed and can confirm that the
information presented in the Quality Account
appears to be accurate and fairly interpreted, from
the data collected regarding the services provided.
The CCG is pleased to see the additional staffing
that has been provided, with the appointment of
a further Specialist Practitioner in Education, and
a Specialty Doctor for the Community Team. The
changes to the nursing team, with the introduction
of non-medical prescribing, and a new nursing
model, along with the implementation of the
Outpatient Strategy, should bring real benefits to
patients, families and carers, and we look forward
to seeing the results of the on-going measurement
of patient and staff satisfaction. SD&T CCG were
also pleased to see the positive CQC report
demonstrating that Rowcroft was compliant with
the domains that were inspected.
SD&T CCG see Rowcroft as a key partner in the
delivery of integrated end of life care, and we value
the excellent open and regular communication
we have with them. For 2013 onwards, we have
agreed a unique, three-year rolling contract
(reviewed annually) as a clear commitment to
working together.
Looking Forward
Looking Back:
We look forward to the implementation of the
patient feedback system and will take an interest in
the feedback received, trends identified and what
Rowcroft will do in response to this information.
Rowcroft Hospice committed last year to
prioritising eleven key areas relating to patient
safety, clinical effectiveness and enhancing patient
and their families’ experiences of their hospice
services. As commissioners we monitored these
improvements through the contract review
meetings we held with Rowcroft.
Through the year we have seen evidence of this
commitment and we recognise that Rowcroft
continues to benchmark quality requirements
against other SW hospices, and will be comparing
quality performance with hospices nationally from
April 2014.
We are pleased to note that Rowcroft undertook
an audit of medication during the year. We
are pleased to see that they have focused on
improving systems and training in relation to
medicines management.
The CCG is happy to support the quality
improvement priorities chosen for next year as
set out in the Quality Account. We are pleased to
note the continued focus on patient safety and
improved experience.
We acknowledge the important role of the Hospice
at Home service and look forward to working with
Rowcroft to further develop this service.
General Comments
Quality Accounts are intended to help the general
public understand how their local health services
are performing and with that in mind they
should be written in plain English. Rowcroft have
produced a comprehensive, attractive and well
written Quality Account which is easy to read and
clearly set out.
Overall we are happy to commend this Quality
Account and Rowcroft for its continuous focus on
quality of care.
NHS South Devon and Torbay Clinical Commissioning Group
13
Annex
The Torbay Carers Forum statement:
These Quality Accounts demonstrate the difference that Rowcroft has made to
people’s lives. They describe well your strong commitment to your objectives, and
Carers across Torbay recognise your compassion and care.
Torbay Carers Forum appreciates the fine work being done by Rowcroft Hospice to
support Carers and those they care for.
Accordingly, the Forum would like to thank the staff, volunteers and management
of Rowcroft Hospice for their work with Carers, and those they care for, in our three
towns. We, consequently, take pleasure in endorsing these Quality Accounts.