Ensuring the safety of everyone who uses health services is one of the most important challenges facing healthcare today.
Ensuring the safety of everyone who uses health services is one of the most important challenges facing healthcare today. Research from around the world estimates that one in 10 patients in hospital experiences an incident that puts their safety at risk, and that about half of these could have been prevented. Through its Safer Patients Initiative, The Health Foundation is working with hospitals in the UK and experts from the US, to explore the best ways of making hospitals safer for patients.
Down Lisburn Health and Social Services Trust (now South Eastern Health and Social Care Trust) joined the scheme in 2005, because patient safety was an area they wanted to prioritise. Alan Finn is Director of Nursing and Acute Services at the Trust. “Being selected to take part in the Safer Patients Initiative does not suggest that we’re perfect, although we already had a very strong track record in quality improvement through various accreditation schemes,” he says. “I think we were selected because we demonstrated a real commitment to improving things.”
Tried and tested
Since joining the scheme, the Trust has been working with experts from the US-based Institute for Healthcare Improvement (IHI) to introduce safety standards called ‘bundles’. “These are standards which have been tried, tested and proven to improve safety in US hospitals,” Alan says. “We’re applying them to clinical areas such as surgical theatres, as well as issues such as using them to help us ensure medicines are prescribed accurately.”
The Trust has also set up an early warning system, which works alongside regular patient charts and notes. “This helps staff to monitor patients’ vital signs, to recognise those who are going into a decline and take any necessary action,” Alan comments. “Monitoring these signs can help to predict a possible cardiac arrest. So making a special effort to record and take notice of them means that we can take action to reduce the likelihood of a patient suffering in this way. We’re aiming to reduce the incidence of cardiac arrest in these situations by 50 per cent.”
Another innovation is leadership ‘walk-rounds’, where senior managers visit wards and departments on a regular basis to talk directly with staff about their safety concerns. “The walk-rounds have helped to identify potential safety issues which we’re committed to dealing with as they crop up,” Alan says. “By acting on these things immediately we’ve been able to reduce the risk of harm to patients.”
“Our pharmacy and nursing staff have been working very hard to ensure medicines are accurately prescribed,” he continues. “They have introduced a system for tracking and managing the medicines that patients take. Combined with efforts to improve communication throughout the hospital, this has reduced the number of mistakes made, particularly on admission and discharge of patients.”
A learning process
The Trust’s perspective on safety has changed throughout the course of the scheme. “At the outset, we had our own ideas about what was important to the trust in terms of safety,” Alan says. “But our agenda changed after the first learning set with IHI, whose input is inspirational. We learned from them about evidence-based safety measures and the importance of having a structured approach. You have to be very specific about targets, and be clear about what has to be done, by when and by whom.”
“It’s been a fantastic opportunity to challenge our own thinking and for some of our staff to get exposure to world class experts in this field,” he continues. “Some of the staff have had the chance to make presentations about their work in other countries. We’re also learning from the other trusts involved in the initiative. We’ve taken part in conference calls together and organised site visits. It’s been extremely hard work - much more than we anticipated.”
It wasn’t all plain sailing, however. Alan says that some staff were initially a bit frightened, because they thought the process was inspectorial. “As we’ve continued with the ‘walk-rounds’, I’ve seen staff become more familiar with the process and they realise they’re not going to be blamed if there’s something wrong,” he says. “We don’t penalise people for making mistakes. The whole idea is that you learn from the findings and you learn from your mistakes.”
“As senior managers, meeting regularly with clinical staff makes us very aware of what’s going on in the departments and I think that has helped strengthen teamwork throughout the hospitals,” he adds.
Getting so much better
Alan says that there is clear evidence that things are getting better, particularly in certain areas. “We make monthly reports to IHI on progress against our targets, so that’s all being very carefully monitored,” he comments. “We haven’t got enough data yet to actually prove that we are safer as a whole – but that will come with time.”
“Although it’s called the Safer Patients Initiative it’s more than an initiative, it’s become a way of life. It’s the way we conduct our business. People are thinking safety now as a priority and it’s not an ad hoc thing, it’s a structured way of thinking,” he concludes.
We're aiming to reduce the incidence of cardiac arrest in these situations by 50 per centAlan FinnDirector of Nursing and Acute services
24 May 2006