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Ensuring quality and safety

Ensuring quality and safety

Ensuring the highest quality of care and safety for our patients and clients, and for our own people, is at the heart of all our health and social care services.

We achieve this by keeping robust systems and reporting structures in place and auditing our services regularly. 

Our integrated governance system operates at every level, from the Board to clinical leaders, and covers all services. We liaise with external professional bodies such as the Royal College of Nursing and the Care Quality Commission in England, as well as the Care Inspectorate in Scotland and the Care and Social Services Inspectorate in Wales, to ensure that our care is maintained at the highest level, with clinical leaders working on practical ways to protect patient safety.

Examples of this can be seen in the extremely low level of infections in our hospital settings.

  • Zero cases of MRSA, MMSA or E coli bacterial infections at our healthcare facilities in 2013-14.

Our record on venous thromboembolism (VTE) is also consistently strong – following National Institute for Clinical Excellence (NICE) guidance that patients should be assessed for VTE risk.

  • 0.03% VTE rate was well below the national average in 2013-14 because of a rigorous clinical approach.

We take part regularly in both national and local audits. In 2012-13, we participated in two national audits, with 100 percent of eligible patients taking part, and we held 18 local clinical audits for ISTCs and 14 for CATS, all of which are reviewed at Board level, and which bring together national best practice guidelines and input from professional bodies and institutions, providing benchmarking.

Our own audits, such as those to ensure that we comply with the World Health Organisation’s (WHO) surgical safety checklist, have been improved with a second layer of checks using direct observation and rolled out across all our surgical services. We target 100 percent compliance, because we consider this such a vital aspect of patient safety, and back up our processes with detailed clinical documentation audits.

We are upgrading the systems we use for what might be considered standard tasks, such as creating duty rotas – we now use an electronic rostering system to ensure that we can demonstrate compliance with quality guidelines on the numbers of suitably qualified professionals to meet all patient needs. This means that senior clinical colleagues can focus on their vital role of patient care across all our ISTCs and CATS, while the rotas, including working hours, requests for leave and other variables, are created to reflect and respond to patients’ needs.

Maintaining best practice often brings about practical solutions which have widespread benefits. The need to cut Inadvertent Perioperative Hypothermia (IPH) was the starting point for practical and innovative solutions pioneered at the North East London NHS Treatment Centre. IPH causes a range of postoperative problems, prolonging recovery and causing longer hospital stays.

Simple steps, such as warming intravenous fluids before use, having thermometers in all theatres and using an insulating sheet called Mediwrap before and after operations, brought the number of patients suffering IPH down to 4.3 percent, as against the Royal College of Anaesthetists’ target of less than 5 percent.

A combination of such clinical leadership and a base of effective training creates a robust and effective approach to care – we invest in learning at all levels, including introducing e-learning for almost all essential skills so that our people can access information wherever they are.

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