St Oswald’s Hospice Quality Account
St Oswald’s Hospice
Quality Account
2014
St Oswald’s Hospice Quality Account
St Oswald’s Hospice Quality Account 2012-2013
PART 1: Quality Statement
Statement from the Chief Executive
I am responsible for the preparation of this report and its contents. To the
best of my knowledge, the information reported in this Quality Account is
accurate and a fair representation of the quality of healthcare services
provided by our Hospice.
As we enter our 27th year of providing hospice services to North East adults,
children and young people, a commitment to first class, quality care
remains at our very core.
‘Quality time for everyone’ is our strap line and it is an objective rooted in
every element of our work.
We measure patient experience in a number of ways: through
questionnaires, focus groups and face to face interviews and we
continuously seek to improve our processes, so we can deliver the very
best services we can to local people.
This year we introduced and implemented a ‘stakeholder experience’
policy and procedure, throughout the organisation, which included the
launch of our own ‘Feedback Bank’.
The Feedback Bank involves gathering comments from all our stakeholders
– patients, visitors, staff and volunteers, supporters and customers collating them centrally for analysis and then action where necessary.
We publicise our follow up actions on our website, to demonstrate to
everyone involved in our work that we are listening to them and we are
wholly committed to improving what we do and how we do it.
In doing so, we are sticking to our founding principles and enabling our
‘communities’ to continue to help shape and guide St Oswald's and make
it the incredible organisation that it is.
Thank you to everyone who has contributed to our work this year.
James Ellam
Chief Executive
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St Oswald’s Hospice Quality Account
PART 2: Priorities for Improvement and Required Statements
Review of services:
During 2013/2014 St Oswald’s Hospice provided and/ or sub-contracted two NHS
services.
• Outpatient Lymphoedema Service
• Outreach Lymphoedema Service
St Oswald’s Hospice has reviewed all the data available to them on the quality of care in
two of these NHS services.
In addition the Hospice has provided the following services through grants & charitable
funding:
• Children’s Service
• Young Adults Transition Service
• Day Hospice
• Outpatient Clinic
• Complementary Therapy
• Physiotherapy
• Occupational Therapy
• Social Work
• Bereavement Support Team
• Chaplaincy
The income generated by the NHS services reviewed in 2013-2014 represents 30 per
cent of the total income generated from the provision of NHS services by the St Oswald’s
Hospice for 2013-2014.
Participation in clinical audits:
During 2013-2014, no national clinical audits and no national confidential enquiries
covered NHS services that St Oswalds provides.
St Oswald’s regularly audits various elements of clinical and non-clinical practice both via
internal procedures and with the support of internal and external audit partners.
The Clinical Audit Group and the, newly formed, Nursing Audit Group focus on developing
audit within St Oswalds and continuously improving the quality of care provision.
Audits undertaken in 2013-2014 are listed below.
Audit Title
Outcome of initial audit (including deadline for action and
responsible person/group)
Audit of Medical Reviews
on Inpatient Ward
80% standard achieved
Blue team median 1 day, mean 1.9,
Red Team median 0, mean 0.4
Audit of Interim Discharge
Information
A proforma on SystmOne is used to produce timely discharge
information incorporating medical and nursing elements. In the
latest audit all but two patient summaries were created using the
proforma, the remaining two were dictated. The system of
producing summaries ready for discharge is well embedded.
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St Oswald’s Hospice Quality Account
Audit of RIP Letters
Ketamine Audit
Thromboprophylaxis
The Practice of the
application of the Mental
Capacity Act (Cycle 1)
The Practice of the
application of the Mental
Capacity Act (Cycle 2)
Children’s Advice Line
Family Tree Audit
The average length of time for a letter to be sent to GPs following
the death of a patient was 6 days. As a result a proforma will be
designed to simplify the process and standardise it with the
discharge process.
At St Oswald’s Hospice; use of Ketamine as an analgesic is
generally in accordance with the regional guidelines, although with
less opioid reductions and slower titration than recommended, but
with safe levels of side effects (33.3%) and fairly good efficacy
noted (73.3%) plus a good level of cessation where appropriate.
Limitations to this audit include the small numbers, and the drop out
rates from the palliative population
Recommendations would include a standard 10,20,40,60mg
titration regime, even over a weekend, and a review of the coanalgesics at the 100mg qds stage
14 current in-patients notes reviewed - (8 male, 6 female) 8
patients identified with PBCN guidelines updated and no longer
contain THRIFT criteria.
To revise the form.
13 sets of notes surveyed 12 (93%) of cases in which at least one
episode of cognitive impairment during the admission, 6 (46%) with
persistent cognitive impairment. 2 procedures acrried out and
median number of key care decisions = 7.5
Only one set of
notes (10%) had documentation of capacity. None had best
interests decision documented.
12 sets of notes surveyed 7 (58%) of cases in which at least one
episode of cognitive impairment during the admission, 5 (43%) with
persistent cognitive impairment. 5 procedures carried out and
median number of key care decisions = 4
Three set of notes
(25%) had documentation of capacity. None had best interests
decision documented. 4 case notes (33%) indicated that staff
understood the process of decision making. 2 (17%) had MCA 1
completed, but none had MCA 2 completed. 100% of notes had
blank MCAs within them (ie they are being put in the notes.)
The average request for advice for Children’s Palliative Care is 1
call per month, but the majority of calls come via our Children’s Unit
rather than via the advice line.
Most are answered within one-two hours, and require time spent
listening to acknowledge the distressful situations at the other end,
as well as pain and symptom and drug advice
More than half require/ were able to have a follow up review of the
child by one of our Palliative care team; this is possibly as a result
of more than half being from the GNCH or the Newcastle area. This
may also be as a result of the work, presence and repeated
awareness from within the Great North Children’s Hospital about
Palliative care in general, and the advice line.
We will repeat the availability of the advice line at the restored
regional Paediatric palliative Care forums.
We will continue to respond to any calls for advice regarding
Children with life threatening or limiting conditions from all
professionals in the area.
To improve awareness within the team of the value and importance
of the early documentation of details within the family tree; on the
potential emotional impact of the patients during their stay as
information is shared, and for their family afterwards for
bereavement follow up.
Also to promote the need to continue to add significant details to the
tree as knowledge of the patient within the context of their family
increases during their stay
To encourage the BST to audit the quality of the information from
their Vulnerability forms received for this same group of patients, to
see whether the apparent lack of information collates with family
tree documents or completion of the Vulnerability forms
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St Oswald’s Hospice Quality Account
Audits underway with reports still required.
Moving and Handling Practice
Infection Control re-audit
Audit of ad-hoc medical input to Lymphoedema Service
Audit of medical input into joint medical and nursing lymphoedema clinics
Audit of the current use of compression bandaging
Audit of lymphoedema assessment documentation within in-patient care plans as used by the
lymphoedema team for ward patients
Figure 1
A pilot is also underway to develop a Quality Assurance Tool for Caring for the Dying
Patient. This has been developed in response to the national issue relating to the
Liverpool Care Pathway. This has led to additional work to extend the document to use
in the care of all patients.
It remains a priority for 2014-2015 to continue to improve the engagement of
nuring staff in the development of audit with a focus on training in the coming year.
An audit email briefing was introduced in December 2013 and this will continue on
a regular basis.
Participation in clinical research:
The number of patients receiving NHS services provided or sub-contracted by
St Oswald’s Hospice in 2013-2014 that were recruited during that period to participate in
research approved by a research ethics committee was zero.
Use of the CQUIN payment framework:
St Oswald’s Hospice income in 2013-2014 was conditional on achieving quality
improvement and innovation goals through the Commissioning for Quality and Innovation
payment framework.
All CQUIN targets set for North of Tyne and South of Tyne contracts were achieved.
Targets achieved were as follows
North and South of Tyne
o Exception Report for all inpatients with a length of stay over 14 days.
o Submission of a monthly dataset of quality requirement figures for KPI
performance measuring.
o Completion of action plan associated with average length of stay.
o Completion of the End of Life Quality Assessment Tool
Statements from the Care Quality Commission:
St Oswald’s Hospice is required to register with the Care Quality Commission (CQC) and
is currently registered to carry out the regulated activities:
•
•
•
Treatment of disease, disorder or injury.
Diagnostic and screening procedures.
Transport services, triage, medical advice provided remotely.
St Oswald’s Hospice has the following conditions on registration:
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St Oswald’s Hospice Quality Account
1. The registered provider must ensure that the regulated activities are
managed by an individual who is registered as a manager in respect of the
activity, as carried on at or from the location St Oswald’s Hospice
2. This regulated activity may only be carried on at or from the following
locations: St Oswald’s Hospice, Regent Avenue, Gosforth, Newcastle
Upon Tyne, Tyne & Wear, NE3 1EE
St Oswald’s has the following additional conditions:
1. The registered provider may accommodate no more than 19 service users
in the adult unit at St Oswalds Hospice
2. The registered provider may accommodate no more than 8 service users,
aged from birth to eighteen, in the children’s unit at St Oswalds Hospice
The CQC has not taken enforcement action against St Oswald’s Hospice during 20132014
St Oswald’s Hospice has not participated in any special reviews or investigations by the
CQC during the reporting period.
An unannounced inspection from CQC was carried out in December 2013 and no
recommendations for improvement were made. A full report can be found on the CQC
website.
An unannounced inspection from CQC was carried out in December 2013
and NO recommendations for improvement were made.
Data quality:
St Oswald’s Hospice continually works to improve the quality of information provided.
St Oswald’s Hospice did not submit records during 2013-2014 to the Secondary Uses
service for inclusion in the Hospital Episode Statistics which are included in the latest
published data, however St Oswald’s did continue to participate in the National Council for
Palliative Care MDS project.
Information Governance Toolkit attainment levels
St Oswald’s Hospice Information Governance Assessment Report score overall for 2013204was 82%.
The Information Governance Group will be taking forward the action plan from the 2014
toolkit audit over the course of 2014-2015. There are a number of improvements to be
made to further improve the level of compliance.
In March 2013, the Information Governance, Clinical Informatics and Documentation
Groups were amalgamated to form the new Information Governance and Quality Group.
Terms of Reference have been developed and agreed. The Group meets monthly and
each meeting has a specific focus, i.e. organisational or clinical and the membership is
adjusted accordingly around a core of members who attend each meeting. We will
continue to monitor the functionality/effectiveness of the new group going forward.
Detailed below is an update on the work undertaken or initiated:
•
•
The Information Governance Policy and Procedure was reviewed and approved in
July 2013
Approval of Mental Capacity Documentation and subsequent implementation plan
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St Oswald’s Hospice Quality Account
•
•
•
•
•
Continued SystmOne development and the implementation of SystmOne on the
Adult In-patient Unit
Consideration of going paper light In Day Services
Work continues on the Information Governance Toolkit Action Plan 2013
Data Quality Scorecard template developed
Staff Skills Audit Tool Template has been developed
Sunderland Internal Audit Services carried out their annual audit on our information
systems. There was one medium risk issue was identified in relation to the SharePoint
data server was not backed up 71 times between Dec 2012 to Feb 2013, however it was
noted that back ups had taken place some errors had been identified and that the IT
team have taken steps to ensure that these were resolved. Two low risk issues were
identified which were that passwords should be 8 characters not 6, and that windows
2003 does not conform to Microsoft’s recommended monitoring configurations.
The Copyright Licensing Agency Ltd (CLA) will be undertaking a data collection exercise
on the copying and digital re-use of copyright material at St Oswald's. The exercise on
14th October and end on 6th December 2013.
Clinical coding error rate:
St Oswald’s Hospice was not subject to the Payment by Results clinical coding audit
during 2013-2014 by the Audit Commission.
Priorities for improvement:
St. Oswald’s remains committed to the continuous development of the whole service and
through an active approach to patient and stakeholder involvement keeps the service
users at the heart of decision making and service improvement.
The key objectives for 2014-2015 are as follows:
1. To maintain and develop high quality Hospice services accessible to the local
community. Achievement of this is monitored though patient and stakeholder
feedback continuing to show high levels of satisfaction.
2.
To continue to develop the Hub and Spoke service model for Lymphoedema,
providing services closer to patient’s homes. Success will be monitored by the
attendance rates at outreach clinics and positive patient feedback.
3. To develop the education and awareness programme for Lymphoedema patients
and associated Health Care Professionals. Meeting this objective will be
measured by the existence of a plan of events and associated evaluations.
4. Due to an influx of referrals in 2013-2014, waiting times for first appointments and
intensive treatment plans have increased significantly. Though a process of
service evaluation, redesign and expansion an objective for 2014-2015 is to
reduce the waiting times for Lymphoedema Services in full consultation with
patients, staff and commissioners. Waiting times will of course be monitored as a
measure of success against this objective. This item depends upon increased
commissioning funding in 2014/15, under discussion at the time of preparation.
5. To implement the bereaved relatives survey for patients who die at St Oswald’s.
Results from the surveys will be monitored alongside other surveys.
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St Oswald’s Hospice Quality Account
PART 3: Review of Performance and User Involvement
Ensuring a quality service
We are committed to providing a first class patient experience at St Oswald’s and we
harness feedback from patients and families in a number of ways. In 2013-2014 the
concept of the Feedback Bank was developed and implemented and essentially brings
together the various routes through which patient experience is monitored into a central
store.
A summary of the feedback gathered is prepared for the Clinical Governance and Quality
Committee on a six monthly basis and an action plan produced.
Policy
A new policy relating to Patient and Stakeholder Experience was approved in 2013 and it
is envisaged that with the implementation we will be able to bring together in a more
comprehensive fashion than ever before, all the feedback that we receive which
influences the experience of patients, carers and other external stakeholders and
ultimately the reputation of St. Oswald’s.
Patient Surveys
In the period April 2013 to December 2013 the following surveys were carried out and a
full report from each survey can be found on SharePoint. We are currently working on a
central Feedback Bank on Sharepoint to store all related reports in a central space.
Children and Young Adults Survey June 2013
The results of this survey were extremely positive with 100% of families telling us they
would recommend St Oswald’s to their family and friends.
90% of families feel their child enjoys their stays at St Oswalds whilst the remaining 10%
(one response) felt unable to tell if they enjoyed it or not.
The type of comments received were
“When he comes through in to the lounge his eyes twinkle and he smiles and knows
where he is which makes me happy.”
“Don’t know as only had a few visits but been cut short.”
“She always seems content when we return.”
“Always smiling. Happy and relaxed when he's at St Oswalds.”
“Relaxed and vocal with her carers. She would be quiet and moody if she wasn't
happy and crying all the time.”
New Outpatient Feedback - Quarter 3
Every new patient to Day Services is sent a survey to monitor the service they received
during their first encounter with St Oswald’s.
When asked to rate the service out of 10, 99% of people rated between 7-10.
67% said 10/10
18% said 9/10
14% said 8/10
1%
said 7/10
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The patients gave very positive comments like
“The service I received reminded me of the care delivered when I started my nurse
training in 1976. Emphasis on individual quality of care delivered by skilled
professional practitioners.”
“The level of kindness and caring I have experienced in my brief knowledge of the
day service has been outstanding. Truly wonderful people.”
“Quality of care is very good, welcoming staff and volunteers set you at ease very
quickly”
“Very professional & friendly, impressed with the dignity is which I was treated &
made to feel welcome.”
They also provided some suggested improvements.
“Patient transport for taster sessions even if there was a nominal charge for
mileage. Perhaps have evening taster sessions which also include a gentle exercise
class for Lymphoedema”
“Shorter waiting time till first appointment”
“Consider supplying addressed envelopes for these surveys; it could increase your
response rate. Allow parking bays for patients”
These suggestions have been passed to the relevant departments for consideration.
Lymphoedema Review patient Feedback – April to December 2013
A random sample of review patients are surveyed each month from the Lymphoedema
service and the results always indicate high levels of satisfaction.
In April to July 247 surveys were issued and 128 returned, a response rate of 52%. (37%)
of the responses were from patients attending the service for more than three years and
the others for less than three.
The survey questions were very positive with 124 out of 128 patients stating that the effort
was made to meet their needs and wishes was met most or all of the time, the remaining
patient felt this was some of the time.
There were a significant proportion of patient who felt they did not know how to make a
complaint, however it is hoped this will be addressed by the new TV screen being placed
in the waiting area, a set of key messages to be included on the reverse of all letters and
also the proposed revamp of the suggestion boxes to feedback points. Patients will also
be informed of a patient feedback email address.
Patients told us
“Compared to other hospitals I have been treated at, St Oswalds staff, services and
facilities are brilliant. I cannot fault anything. Keep up the good work!”
“In my opinion you have this service just right.”
“Very helpful and good service.”
“Couldn’t be better.”
Ideas for improvements were
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St Oswald’s Hospice Quality Account
“It would be easier to make the next app when I was leaving. Have had to change
appointment numerous times.”
“My only complaint is that the porter asked me to return the wheelchair to the dept
it had come from which was a long way from the car. I had to leave my 90 year old
mother who was the patient on her own for 5 mins. I had no intention of leaving it in
the car park but I think the nearest entrance should have been acceptable.”
“I like to be able to attend the clinc at St Oswalds for any check ups. Wouldnt feel
quite so at ease attending the outreach clinic.”
“Drop in clinic. Great difficulty in making an appointment. Do you have enough staff
to man the service which you want to deliver. Difficult to accept that there is no
significant improvement.”
Outreach Lymphoedema Service Patient Survey
Patients are selected following a review appointment to complete a satisfaction
questionnaire evaluating the Hospice following their last visit at our clinic in North Tyneside
(this will be extended to Blaydon and Morpeth in due course).
67 surveys were sent out with 27 returning completed, a 40% response rate.
Summary
• Patients are then asked to rate how anxious they were before and after their visit to the
service: 0 being “Not Anxious” and 5 being “Extremely anxious”
SCALE
0
1
2
3
4
5
BEFORE
APPOINTMENT
6
7
3
3
6
2
%
AFTER APPOINTMENT
%
22%
26%
11%
11%
22%
7%
16
5
4
0
2
0
59%
19%
15%
0%
7%
0%
Figure 2
• 70% of all patients are “Very Satisfied” with the planning of their care. 22% of patients
were “Satisfied.
• 81% of all patients feel staff make every effort to meet their individual needs and wishes
“All of the time”, 11% of patients felt staff made every effort “most of the time”
• 100% of all patients felt they are treated with courtesy “All of the time”
• 100% of all patients felt their privacy is respected “All of the time”
• 17 out of the 27 patients who returned a questionnaire are aware of the procedure for
making a complaint.
Patients told us:
“At the moment I could not think of any way to improve the service but that may change in the
future. The staff are caring and friendly.”
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St Oswald’s Hospice Quality Account
“I have been very pleased with the service I have received.”
“I can’t imagine needing to make a complaint, I only see one nurse and she is very
good at explaining things”.
Patients Ideas for improvements were:
“Think the staff you are seeing should be informed when you arrive.”
Inpatient Surveys - Quarter 3
A volunteer surveys any patients who are well enough on a weekly basis. Depending on
turnover and the wellbeing of the patients, the surveys taken each week can vary from nil
to five. Numbers in quarter three were low at four surveys for the quarter. Results remain
very positive with the vast majority being highly satisfied with all aspects of care. The full
report is available however some of the patient comments are shown below.
Areas for improvement included
“Very nice stay.”
“No control for patient with both lights. Lights could be brighter. Menu is repetitive
and marked lack of protein, rather boring. People are very helpful and kind. Could do
with ensuite in room. Water is tepid, could be warmer for shaving.”
“Awaiting hairdresser to come, didn't turn up on Friday and still awaiting podiatrist.
Feel very safe and cared for here and needed that. At peace here.”
“Could do with a dimmer bed light so don't disturb others. Also hard to reach. New
TV’s nice but remote control not long enough to reach when sitting in chair (spring
back to wall).”
Patient Focus Groups
Over recent years focus groups have been used more frequently to gather the views of
patients on specific issues and developments. In 2013-2014 to date there was one in
Lymphoedema focusing on the Discharge of Patients from Clinic.
On the whole there was some anxiety from patients, particularly around being discharged
into the care of their GP who in their experience has little knowledge of managing
Lymphoedema, and suggestions were made for the development of education packages
for GPs and/or a comprehensive discharge pack.
The word discharge is also anxiety provoking in patients and thought is being given to rewording this to something like ‘Self Management Phase’ to emphasize the control patients
can take over their own condition and also to reassure that there will be telephone access
to the team during that phase.
This is a particular issue for long standing patients, which is expected to be less so for the
new patients coming into the service with different expectations.
Complaints
In the period April 2013 to December 2013 seven complaints were recorded.
Retail – 3 complaints.
Lymphoedema – 2 complaints. (surrounding an issue with not receiving an appointment
letter in time, one issue of a telephone call regarding an appt not being returned to
patient).
Fundraising - 2 complaints.( One issue around misaddressed communications, and a
donors relative unhappy with some cash donations made to Hospice by patient).
Social Media
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Facebook, Twitter and email are all now very common place for many people and it is a
good opportunity to make an immediate connection with our supporters. We intend to
start to gather this feedback into the Feedback Bank and report on any themes in this
report.
A total of 13 contacts were made via social media, 9 of which were expressions of
gratitude or congratulations on great care for patients such as:
“Just like to thank all the staff at St Oswald's for looking after my friend in his final days.
You helped his passing be as comfortable as possible and all the staff we met were so
warm and caring, a real credit to the Hospice.”
Two people expressed concerns over the length of time taken to process a volunteering
application and a further two were in relation to fundraising and retail, with one person
highlighting problems with registration for an event and another the collection of donated
goods in the ‘bag drop’ bags.
Awards
In October 2013, the Lymphoedema service received recognition for the development of
the Patient Education Programme by being presented with the Award for Innovation in
Practice by the British Lymphology Society.
In March 2014 the Lymphoedema Nursing Team took third place as Lymphoedema Nurse
of the Year in the British Journal of Nursing awards.
Both awards are testament to the hard work and commitment of the Lymphoedema team
to providing high quality care and effective outcomes for all patients.
You Said, We Did.
In order to reassure patients that the feedback we receive is used to improve services, a
summary called ‘You said, we did’ is accessible via the website.
Examples include
You said...Provide new patients with more detailed and relevant information about
our Lymphoedema Service.
We did...We devised a Patient Information Booklet for new Lymphoedema patients.
This outlines what will happen at a first appointment, how to find us, who’s who, data
protection and more.
You said...A newsletter, specifically for Lymphoedema patients would be extremely
useful in keeping them up to date and informed.
We did...We’ve launched Lymph-notes – a newssheet we produce four times each year
which includes hints and tips, directing patients to useful forums and websites and
providing them with details of service developments.
You said...The speed bumps in the Outpatient and Children’s Car park are very high
and uncomfortable when passing over them.
We did...We reduced the gradient of the speed bump so that it was more comfortable
for our patients when driving over them.
You said...When meals are being served on the inpatient ward they are occasionally
cold by the time they make it around the entire Ward.
We did...We purchased a new hot catering trolley for serving meals. This ensures that
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St Oswald’s Hospice Quality Account
food is kept warm for patients. However, the trolley also reduces handling and ensures
that portion control is maintained as all food is plated up in the kitchen, thus reducing
the time that lunches are given out. Additionally, both hot and cold food can be
delivered by the one trolley. This has proved so successful, that an additional trolley is
currently on order for Day Hospice.
You said...It would be great if we could request certain dates for our child to stay
with you.
We did...The families always get a chance to book their child in to stay with us if they
have a wedding, birthday party or special occasions to attend. We’ve previously
enabled a little girl to go to her Mum’s wedding and then stay with us whilst her Mum
was on honeymoon.
You said...Sometimes there isn’t much choice on the menu
We did...We recently extended the menu to include soup of the day, a main course,
alternative main course, toasties, jacket potatoes, beans on toast and patients are also
able to make special request.
Compliance
Formal feedback was also received from our regulators, the Care Quality
Commission (CQC), after an unannounced visit to both our Adult and Children and
Young Adults service.
We were compliant in all five outcomes assessed with no recommendations for
improvement.
The CQC team focussed on Care and Welfare of People who use services, Safety
and Suitability of Equipment, Requirements Related to Workers, Assessing and
Monitoring the Quality of Service Provision and Records. The Inspector and an
expert patient chatted to patients and carers during their visit and we were
delighted to receive very positive feedback. For example on patient said “They
(staff) could not do more for you", and, "I have only to mention something and
something is done about it."
As well as ensuring compliance with external regulators, such as CQC, Internal
Audit, Commissioners, the Charity Commission etc, we also have a range of
internal measures in place to ensure we continue to provide excellence in
palliative care. .
Activity Levels 2013-2014
Adult Inpatient Unit
The Adult Inpatient Unit has 15 beds plus an emergency 16th bed used for urgent
admissions when staffing levels allow.
Referrals are monitored daily Monday to Friday and admissions arranged based
on urgency for individual patients.
In the period 1/4/2013 to 31/3/2014, there were 326 referrals for admission, of
which 208 were admitted (64%). This is a 22% increase in referrals compared to
2012-2013 and although the length of stay decreased and the number of
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St Oswald’s Hospice Quality Account
admissions increased by 12%, 64% of patients were admitted compared to 69% in
the previous year.
Figure 3 below shows a summary of activity for the Adult Inpatient Unit.
2012-2013
Average
Admissions
Percentage Occupancy
Discharges
Deaths
Finished Admissions
% Deaths
Average Age
Average LOS
Minimum LOS
Maximum LOS
Average Wait
Total Referrals
2013-2014
Total
15
89.80%
7
8
15
53.20%
66
27
3
77
9
24
Average Total
185
84
98
182
66
27
1
116
9
268
17
208
86.2%
8
103
9
103
17
206
51.0%
68
68
21.9
21.9
2
1
74
166
7
7
27
326
%
Change
12%
-4%
23%
5%
13%
-2%
3%
-19%
0%
43%
-22%
22%
Figure 3
As can be seen from figure 3 above, average length of stay reduced from 27 days
in 2012-2013 to 21.9 days in 2013-2014, a reduction of 5 days. Consistent with
this the average waiting time for admission reduced from 9 to 7 days.
Figure 4 shows the breakdown by age of the patients admitted for 2012-2013 and
this year. The charts show a widening range of ages, with one person in the 19-24
age group but also a much greater proportion of 85+. The average age has
increased from 66 to 68.
2012-2013
2013-2014
Age Group
85+
0%
75 - 84
17%
65 - 74
50%
25 - 64
33%
19 - 24
0%
16 - 18
0%
Under 16 Years
0%
0%
10%
20%
30%
40%
50%
60%
Figure 4
Day Hospice
Day Hospice is open Monday to Friday, however regular attendances are kept to
Tuesday to Friday and Monday’s are reserved for new patient assessments.
178 referrals were received for Day Hospice services this year, which is exactly
the same number as 2012-2013.
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St Oswald’s Hospice Quality Account
Physiotherapist
2%
Referrals bySource
Hospice
2%
Consultant
2%
Other
1%
GP
6%
Specialist Nurse
7%
District Nurse
10%
McMillan Nurse
27%
Hospital Palliative
Care Team
11%
Community
Palliative Care
Team
15%
Internal
17%
We are gradually moving away
from the descriptor of McMillan
Nurse and towards Hospital or
Community Palliative Care
Team. As can be seen from
figure 5, these teams supply
most of the referrals. There
are a significant number of
referrals internally from the
ward and other services.
22% of referrals were for noncancer diagnoses such as
MND, heart conditions or
respiratory diseases.
Figure 5
On average the attendance rate into Day Hospice was 76% over the year and
this is affected significantly by the health of the patients on a particular day.
A significant amount of work has been undertaken this year on the Celebrate
Life Project which is introducing different themed activities into Day Hospice,
including Digital Media, Music, Horticulture, Mindfulness, Reminiscence. The
team continue to look at the potential developments for Day Hospice and
adjusting the provision to meet the needs of the patients currently accessing
the service as well as looking to appeal to a wider group of palliative care
patients.
Outpatients
A number of services are offered in the Outpatient Suite including Medical
Outpatients, Complementary Therapy and Lymphoedema. By far the largest
proportion of the workload is Lymphoedema, which continues to grow in
referrals year on year.
In 2013-2014, particularly in the first 6 months of the year, there was a marked
increase in the number of referrals to the service. In the year there were 616
referrals compared to 529 in 12-13 (21% increase) and a 75% increase in the
last five years.
Lymphoedema Referrals
700
616
600
481
500
529
507
2011-2012
2012-2013
352
400
300
200
100
0
2009-2010
2010-2011
2013-2014
Figure 6
The vast majority of referrals are from GPs and the majority of the increase
has been from GPs in Newcastle.
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St Oswald’s Hospice Quality Account
Lymphoedema Source of Referral
Community Palliative
Care Team
2.6%
Physiotherapist
McMillan Nurse
3.2%
Hospital Palliative
3.2%
Care Team
3.7%
Other
2.1%
Internal
5.4%
Specialist Nurse
5.7%
GP
56.2%
District Nurse
7.0%
Consultant
10.9%
Figure 7
A great deal of work is being carried out to provide the most effective and efficient
service for patients and feedback is sought on a regular basis in relation to
developments.
The latest developments have been the introduction of an Outreach clinic in
Blaydon for uncomplicated patients living in Gateshead and South Tyneside areas
and also a clinic in Morpeth for patients living in Northumberland, both clinics
started seeing patients in February and initial feedback is very positive, although
there are a small number of eligible patients for whom the outreach services are
not appropriate.
Lymphoedema is different to all other services in that it treats the full range of
ages in clinic. There were 13 referrals for children in the last year and 42 in the
over 85 category at the other end of the spectrum.
Age
Range
<16
16-18
19-24
25-64
65-74
75-84
85+
Total
Figure 8
Referrals
7
6
3
271
168
119
42
616
%
1.1%
1.0%
0.5%
44.0%
27.3%
19.3%
6.8%
100.0%
Home visits continue for those who are housebound and one patient for whom an
individual agreement is in place for twice weekly visits.
Work continues with the commissioners to monitor and plan for the continued
growth of Lymphoedema.
Children and Young Adults
The Children and Young Adults services continue to develop, the latest addition
being a Day Service for young adults where there is no other provision. This will
start in May with one young man who is already known to the service.
In 2013-2014 there were 51 children accessing the unit alongside 10 young
adults.
The age range of the children is shown below. The babies and toddlers are a large
group with the remaining children spread evenly to 18.
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St Oswald’s Hospice Quality Account
Age
0-3
4-6
7-9
10-12
13-15
16-18
Total
18+
Figure 9
No.
16
7
6
7
7
8
51
10
%
33%
14%
12%
14%
14%
16%
100%
All the young adults are men and within the children’s unit 63% are boys and 37%
girls.
In April 13 to February 14 there were 493 children’s stays and 105 young adult
stays amounting to 1755 nights.
The average night’s stay for under 18s is 2.75 nights and for young adults 3.79
nights. Initially the young adults were closer to 5 days so a possible change in stay
patterns may be emerging.
Balanced Scorecard
The Hospice has developed a Balanced Scorecard over a number of years which
contains a range of measures aimed at giving a broad overview of performance in
different areas of the hospice.. The Balanced Scorecard is shared with Council, HMT,
OSG and Clinical Governance and Quality Committee.
The indicators in the scorecard are reviewed on an annual basis to ensure that an
adequate overview of priority and critical indicators are included.
A paper is currently with council for consideration in terms of new indicators to measure,
particularly around staff engagement, appraisal and training.
Risk Management and Monitoring
Adverse events are submitted throughout the organisation and cover a wide range of
incidents and failure in procedure, all forms are reviewed by the relevant line manager for
investigation and signed off by the department director. Lessons learned and shared form
part of every event. Summaries of the incidents reported are also produced in order to
spot trends in events and prevent reoccurrence. A full report is produced on a regular
basis however a summary of incidents relating to patient experience is given below.
Patient, Carer & Visitor - RI TYPE
Admin
Clinical
Equipment Failure
Falls
Information Governance
Accidental Injury
Medical Devices
Medication
Moving & Handling PT
Nearmiss
Needlestick
Other
Theft
Vehicle - Patient
Violence or Aggression
Total
Figure 10
Q1
19
1
1
9
0
1
0
0
0
0
0
0
0
0
2
33
Q2
8
3
0
23
1
4
1
1
2
1
0
1
0
2
0
47
Q3
7
2
0
9
2
1
0
1
1
1
1
2
1
0
0
28
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Q4
6
0
1
3
0
0
0
0
1
0
0
1
0
0
0
12
Total
40
6
2
44
3
6
1
2
4
2
1
4
1
2
2
120
%
33%
5%
2%
37%
3%
5%
1%
2%
3%
2%
1%
3%
1%
2%
2%
Average
Risk
Rating
3
4
5
4
4
3
6
5
4
4
6
3
6
2
4
St Oswald’s Hospice Quality Account
As can be seen from the table above, there were 120 adverse events in 2013- The most
common type of event is Patient falls on the inpatient unit. Admin events include
breakdowns in process or procedure for example patients attending for appointments
when a letter has been sent to rearrange but not reached the patient. Patients failing to
attend appointments because transport was not arranged etc. Incidents of this nature are
discussed at team meetings and the outpatient reception team in particular are being
rearranged as a result to minimise interruptions as this was a common cause of error.
Medication Incidents
Medication errors are monitored on a separate form to other adverse events. All medication
errors are reviewed by the Medicines Management Group, which meets monthly.
22 incidents have been reported in 2013-2014, this is lower than the 27 incidents reported
in 2012-2013.
A significant piece of work was undertaken in the year to introduce annual drug
assessments for the nursing team. It is envisaged that this will continue to impact positively
on the level of medication incidents.
The Medicines Management Group is also looking to introduce a revised drug Kardex that
is being developed internally in order to minimise the scope for error.
The table (Fig. 11) below shows the mix of contributory factors reported following
investigation of medication incidents. The most common issue reported is communication
between staff involved or documentation on the unit. It is hoped that the new kardex will
help to address this. Many reports include multiple factors hence the total being higher
than the number of incidents.
Contributory Factors 1
Grand Total
Arithmetic error/miscalculation
Communication between staff involved
Communication: documentation on unit
Device not used effectively
Device not working effectively
Double check error
2
7
6
1
1
6
Interruption / Distraction
Interruption/Distraction
Knowledge deficit
Labelling error
Length of staff experience
Patient status/presentation
Personal stress
Protocol or policy broken
Stock control substandard
Workload high
TOTAL Factors reported
Figure 11
3
2
1
1
1
1
1
2
1
1
37
St Oswald’s has a robust system in place for monitoring performance and risk in the
organisation. On an annual basis a summary report is prepared on behalf of the Risk
Management Group and the Clinical Quality Group highlighting the work of the previous
year and is presented to the Clinical Governance and Quality Committee for
consideration.
Risk Management and Clinical Quality are an important component of Clinical
Governance. The Risk Management Group was established in June 2008 and
The Clinical Quality Group was established in December 2011 and replaced the Clinical
Services Group which had been in place for many years previously.
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St Oswald’s Hospice Quality Account
The Clinical Governance and Quality Committee also receive reports from the various
clinical areas across the year, such as a focus on nursing, medics or allied health
professionals. The October meeting is reserved for a focus on risk and human resource
departments.
St Oswald’s is committed to providing an effective, safe
and quality service for the people requiring our support.
Finally, our commissioners said the following after reading this Quality
Account.
Newcastle Gateshead Alliance
Riverside House
Goldcrest Way
Newburn Riverside
Newcastle upon Tyne
NE15 8NY
Statement from Newcastle Gateshead Alliance in respect of the Quality
Accounts for St Oswald’s Hospice
The CCGs welcomed the opportunity to hear the presentation from the team at St
Oswald’s Hospice and to review the written quality accounts for 2013/14 and offer
the following comments.
The CCGs commend the staff of the Hospice for the high quality of care delivered
this was evidenced in the quality accounts through the results of patient and carer
surveys and achieving consistently high scores with 100% confirming they would
recommend the Hospice as a place to receive high quality care.
The quality accounts further outline a number of clinical quality audits which also
demonstrate high levels of compliance with standards.
The CCGs look forward to working with the Hospice team during 2014/15 on the
many quality priority areas outlined in the quality accounts.
In so far as we have been able to check the factual details, the CCGs view is that
the report is materially accurate. It is clearly presented in the format required by
NHS England and the information contains accurately represents the Trust’s
quality profile.
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St Oswald’s Hospice Quality Account
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