Royal Brompton & Harefield NHS Foundation Trust has a strong record in patient safety. Performance is monitored continuously, and openness and transparency is encouraged from all staff.
Clinical outcomes are discussed openly and in detail at public board meetings each month, when members of the public and non-executive directors can challenge executive directors if they have any concerns about how services are being delivered.
Governors also undertake a similar role at their council meetings where the same information is presented and discussed.
Patient safety is an integral part of performance reporting and the Trust was an early supporter of the Patient Safety First! campaign – a national campaign to promote patient safety in a variety of ways.
A commitment to patient safety comes from the top of the organisation – the Trust board has pledged that creating a safety culture is a shared priority – and should be reflected by every individual, team and department.
Sign up to Safety is a national initiative hosted by NHS England with the aim of delivering harm-free care to every patient and halving avoidable harm over the next three years.
All healthcare providers, individuals and organisations are eligible to join and membership requires commitment to develop a safety improvement plan (SIP) based on five pledges:
- putting safety first
- continuously learning
- supporting staff and patients when things go wrong.
Within Royal Brompton & Harefield NHS Foundation Trust, development and implementation of a SIP based on the five pledges will contribute to the safety domain of our quality and safety strategy 2015-
By joining the Sign up to Safety initiative, the Trust confirms its commitment to improving quality and safety by:
- describing the actions we will undertake linked to the five pledges
- developing a SIP to reduce avoidable harm and death
- identifying those areas on which we will focus our improvement efforts
- detting out how we will engage with and involve patients, staff and the public
- making our SIP public and regularly providing updates on our progress.
Over the next three years Royal Brompton & Harefield NHS Foundation Trust pledges to:
Put safety first: commit to reduce avoidable harm and make public our goals and plans
- Achieve significant reduction in the incidence and impact of acute kidney injury through a suite of measures to improve recognition, and prompt early documented consultant review and appropriate management, especially in at-risk groups such as diabetic patients
- Further develop the NEWS & PEWS systems for monitoring adult and paediatric patients to ensure prompt identification, escalation and management of deteriorating patients
- Implement national guidance for the identification and management of sepsis by integrating a sepsis scoring system into our adult and paediatric early warning scoring (EWS) protocols and continue work to reduce surgical site Infections and hospital-acquired infections
- Improve care of the elderly (>70 years) with emphasis on reducing falls and improving care and management of delirium, dementia and frailty
- Set stretch goals of zero never events and 50% reduction in procedural complications
- Zero new grade three and four pressure ulcers
- Reduce avoidable cancellations by 50% and improve tracking of patients with zero tolerance of loss to follow-up
- Improve medical and nursing handover through implementation of a standardised process and ultimately an integrated digital care record by 2018
- Improve reporting of incidents relating to medication and devices as part of a programme to improve medication and device safety
- Develop a comprehensive approach to accessing and acquiring patient experience feedback on all aspects of their care
Continually Learn: make our organisation more resilient to risks by acting on feedback from patients and continuously measuring how safe our services are
- Make the Trust more resilient by identifying areas of risk through review of serious incidents and incidents linked to the patient advice and liaison service (PALS), complaints, claims, inquests and patient experience feedback
- Ensure recommendations and action plans from serious incidents, complaints and clinical audits are realistic, implemented in a timely manner, monitored through continuous tracking of recommendations and actions, and reported regularly
- Improve capacity and capability for quality improvement by providing access to training for staff
- Develop quality and safety dashboards for wards, units, services and care groups, which include sampling errors, reporting and alerting of imaging abnormalities, and patient identification errors
- Make quality, performance and outcome data available to all staff through divisional reports and intranet pages
Honesty: be transparent with people about progress tackling patient safety issues and support staff to be candid with patients and their families if something goes wrong
Acknowledge when things go wrong – between staff, colleagues, teams, management and clinicians, and with patients.
- Promote awareness of our duty of candour as an organisation and as healthcare professionals, ensuring openness and transparency with patients supported by appropriate documentation and correspondence
- Support for staff in relation to writing of statements, psychological and professional support, training and education
- Provide training in being open for relevant staff
- Publish quality, safety and outcome data on the Trust website
Collaboration: take a leading role in supporting local collaborative learning so that improvements are made across all the local services that patients use
- Work with commissioners to ensure safe, high-quality care
- Work with, engage and involve patients through bespoke events, committees and patient panels to ensure their views are acknowledged and used to guide service delivery and development
- Commit to the NHS England Sign up to Safety initiative
- Become an active participant in the Imperial College Health Partners Patient Safety Collaborative
- Open an Institute for Healthcare Improvement (IHI) Open School chapter at Royal Brompton & Harefield NHS Foundation Trust with plans to spread across the Trust and partner organisations.
- Continue to develop links with LiverpooI Heart and Chest Hospital NHS Foundation Trust via Imperial College School of Medicine expanding its remit to include quality and safety improvement
- Continue to share our experience of innovation and research
- Continue to develop and implement human factors and simulation training for all staff groups
- Continue to promote reflective practice and feedback through clinical governance sessions and Schwartz Rounds
- Continue to use an annual staff safety climate survey and ensure each clinical unit addresses one action for improvement.
- Develop clear guidance for junior staff (all professions) for reporting and investigation of incidents
- Enhance new consultant induction, mentoring and introduction to the Trust