Background
Instilling a culture of safety throughout the organisation has been a top priority for Salisbury NHS Foundation Trust for a number of years. It is this commitment that led to the trust winning the CHKS Patient Safety Award in 2008.
Scale of the challenge
Taking responsibility for patient safety is Director of Nursing Tracey Nutter. She explains: “We have introduced a number of projects including reducing hospital mortality and infection rates. While I have the overall responsibility for patient safety, the Chief Executive, other Executive Directors and the wider Trust Board take an active role in developing the safety agenda and the Medical Director leads on specific aspects of safety work, such as the mortality project.”
Meeting the challenge
Five years ago, a mortality group was set up to focus on reducing preventable deaths and helping patients expecting to die, to die with more dignity. The mortality group has played an important role in raising awareness of the importance of reducing mortality and associated issues with clinical staff. Tracey Nutter says: “The development of mortality groups at directorate level has resulted in more open discussion and learning taking place within and between clinical teams and across specialty areas.”
Other projects include the implementation of the Early Warning Scoring System, which makes it easier for staff to assess when a patient’s condition is getting worse and take action. This is currently achieving audited compliance of 96%. Other initiatives include a 24-hour Critical Care Outreach service to support ward staff in delivering care to cardiac arrest patients, improvements in handover to night teams, the introduction of the Global Trigger Tool that helps the trust understand the main causes of harm in the hospital and the introduction of VTE assessment for all patients admitted to hospital for which the Trust recently achieved exemplar status.
Improvements in hospital mortality have been mirrored in the trust’s achievements in reducing hospital-acquired infections. “We have a target zero approach to both MRSA bacteraemia and C.difficile and managing the prevention and control of infection is viewed as everyone’s responsibility”, says Tracey Nutter. Infection control is monitored from the ward right through to the board and initiatives such as the “bare below the elbow” policy for all clinical staff and a change from the traditional nurse’s uniform to “all scrubs” for nursing and therapy staff have
led to significant improvements.
In the last three years, cases of MRSA have reduced from 21 to 7 per annum and are continuing to fall. Cases of C.difficile are currently reducing by 75%. This has put the Trust in the upper quartile performance for reducing infection rates and efforts continue to reduce rates and
sustain improvements.
“Winning the CHKS Patient Safety Award (2008) was a welcome recognition of the hard work everyone at Salisbury has put into creating a safe environment for our patients” concludes Tracey Nutter. “The challenge now is to maintain our high standards through a continual programme of monitoring and improvement.”
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