Agenda Item: 11.1
Author: Francesca Thompson, Director of Nursing
Public Trust Board: 16 June 2008.
Board Sponsor: Francesca Thompson, Director of Nursing
Status: Standing Item
Appendices: N/A
CLINICAL GOVERNANCE REPORT
1.
Introduction
This report covers the key clinical governance issues raised over the past
month.
2.
Background
This work supports the work undertaken by the monthly operational
governance and bi-monthly clinical governance committees.
3.
Key Issues
3.1
The RUH has contributed to the Wiltshire Local Safeguarding Adults
Annual Report by providing a summary report of activity. It is evident
that the profile of this important agenda will be raised over the
forthcoming year through national policy and a Healthcare Commission
specified interest with regard to care of older persons in NHS wards.
3.2
Current key strategic clinical quality reviews are outlined for information.
3.3
An RUH led mental health strategic committee has been established
which met in May 2008.
4.
Recommendations
Trust Board is asked to note this report.
Author: Francesca Thompson, Director of Nursing
Date: 05/06/2008
Review Date: N/A
Public Trust Board
16 June 2008.
Page 1 of 5
1.
Safeguarding Adults
This is a summary report for 2007/08 outlining the activity undertaken within
RUH in relation to safeguarding adults across BANES and Wiltshire. The
nominated Executive Lead is the Director of Nursing who is a full member of
the respective strategic committees including contribution to these annual
reports.
During the year both local authorities have reviewed their structure and
procedures in response to the establishment of local safeguarding boards and
"No secrets" guidance, Dept of Health 2000. Most recently the Government
have announced intended amendments to the Health & Social Care Bill and the
launch of a joint study with Comic Relief to better understand the risk of abuse
in care homes and the infringement of older peoples' dignity on NHS wards.
The study will run for three years until April 2011.
1.1
RUH Structure:
In addition to the Executive Lead, the RUH has three nominated leads
(two matrons and one nurse consultant). The Leads are the first point of
contact for referral and/or liaison with the lead agency Social Services.
An operational group also meets on a quarterly basis with good
attendance and widespread membership. The group meets to consider
local policy implementation and training requirements of staff.
1.2
RUH Activity:
The referrals have been increasing during this year. The increase in
activity is not always being formally recorded and an emphasis upon
improving the referral mechanisms and RUH involvement is currently
being addressed. A local database is being developed to assist in this
process.
1.3
Serious Case Review:
The RUH is currently responding to one domestic homicide case where
recommendations were accepted and endorsed at the Wiltshire LSCB
13/3/08. The RUH was not part of the panel as there was no acute trust
provision in the case.
1.4
RUH Education:
The nominated leads contribute to the mandatory induction and core skill
updates. A tailored education session is currently being planned for the
senior nurses, which will cover both alerter and investigator aspects.
Author: Francesca Thompson, Director of Nursing
Date: 05/06/2008
Review Date: N/A
Public Trust Board
16 June 2008.
Page 2 of 5
1.5
2008/09 objectives:



Delivery of training for senior nurses
Audit of the process and number of referrals received
Privacy and dignity work streams associated with older
persons to be linked with patient experience strategy
2.
Rapid Response Report from NPSA: Risks of chest drain insertion
2.1
This report was issued in May 2008 with a deadline for completed action
by 17 November 2008. The report has been distributed via our internal
SABS system with 3 clinical leads identified by Dr T Craft in his role of
Chair of Operational Governance.
3.
RUH Clinical Quality Reviews
3.1
The first RUH Clinical Quality Review meeting was held between the RUH
and local commissioners where the terms of reference were discussed
and agreed. As this process matures it is anticipated that it should
become a helpful vehicle for both commissioners and the RUH as a
provider to examine clinical outcomes related to resource. This forum
will also assist in the action plan associated with Core Standard 23:
Public Health.
3.2
During the month of June each ward within the RUH with the exception
of paediatrics, will be completing data collection towards a national
staffing/dependency tool. It is anticipated that other acute trusts data
will then be made available in order to benchmark ward based staffing
levels. This is timely for the RUH for a number of reasons underpinning
our twin pillar strategic objectives 2008/09 in patient safety and patient
experience. The programme is being led by the senior nurse in staffing
solutions who is working in conjunction with the senior nurses, ward
sisters and finance. The analysis will be brought to a future board in
order to construct a discussion relating to this key issue for both staff
and patients as evidenced in the most recent survey results.
3.3
The Department of Health are currently seeking assistance in developing
a set of clinical outcome indicators to support improvement. The vital
signs indicator set for PCT’s will provide a suite of measures of public
health and commissioner performance. The Department of Health view
is that they now need to be complemented by an equally strong set of
metrics.
The Department of Health will then select a first tranche of indicators to
be used for comparative benchmarking only. The follow up piece of work
will be to explore options to introduce more sophisticated measures and
Author: Francesca Thompson, Director of Nursing
Date: 05/06/2008
Review Date: N/A
Public Trust Board
16 June 2008.
Page 3 of 5
with the Strategic Health Authority identify the range of clinical indicators
to be used.
Currently Francesca Thompson is sitting on a National Role of the Nurse
Task and Finish Group to complete the work outlined above. The nursing
metrics are likely to be divided into 3 domains namely; effectiveness,
safety and humanity. The current essence of care benchmarks
predominantly rest within the humanity domain and part of the challenge
will be to harness these rather than lose the work to date.
In late April Francesca Thompson visited Poole Hospital to elicit their
progress and application of a IT system pioneered by the royal Mineral
Hospital, Bath. Vital Aspects of Clinical Safety (VACS) is a tool kit that
gives regular reports regarding patient and clinical safety and has been
developed as a bespoke software package to the cost of £42k and
£14.5k annually.
The conclusion from this visit was that this system has undoubtedly been
well received by nursing staff both at the origin and the one acute trust
site. The software has been problematical, although not insurmountable.
The recommendation, however, at this stage is to delay any decision for
3 main reasons in order of priority:
a)
The outcome of the DH work may well mandate what is required
and we would be in danger of unnecessary cost and duplication.
b)
The size and complexity of what can practically be measured in
relation to nursing care requires careful planning and our own local
approach must fit the LIPS 2 patient safety programme and
emerging matrons balanced scorecard and key performance
indicators for 2008/09.
c)
The introduction of the dependency tool data collection and web
based weekly hand hygiene auditing is already creating a pressure
for ward based staff and senior nurses. This is in addition to the
go live millennium date in July
4.
Mental Health
4.1
The mental health strategic committee has been re-established together
with the introduction of a new governance sub group to address front
line issues. This is a major step forward in assisting our staff with better
integration and understanding of mental health providers.
Author: Francesca Thompson, Director of Nursing
Date: 05/06/2008
Review Date: N/A
Public Trust Board
16 June 2008.
Page 4 of 5
4.2
The first strategic committee has been held with local commissioners and
critical operational decisions were directed which have been in abeyance
for some time in particular regard to older adults’ needs.
4.3
At the next strategic committee more time will be given to tackle the
clear inconsistencies in services provided for working adult and older
adult patients which the RUH finds unacceptable and must cease.
4.4
At the next strategic committee the application of mental health
legislation within the RUH will be formally reported upon.
5.
Pharmacy Controls
The incident involving missing non-controlled drugs in the ITU is
ongoing. The police investigation is closed and the setting up of an
internal investigation is currently being explored. The risks have been
minimised as far as possible within ITU itself with regard to drug stock
control. However, it is clear from the investigation to date that there are
trust wide implications and therefore, an action plan is being compiled
which will be monitored through the governance infrastructure.
6.
Conclusion
The areas outlined in this report are the key clinical governance issues
that have arisen during the previous month.
Author: Francesca Thompson, Director of Nursing
Date: 05/06/2008
Review Date: N/A
Public Trust Board
16 June 2008.
Page 5 of 5