KSS Patient Safety Collaborative Pressure Damage Moving in the Right Direction? Drivers Revisited working towards an integrated approach to preventing & reducing pressure damage e outcomes for patients?

What is the Safety Collaborative?

IHI Improvement Methodology What are we trying to accomplish? Create an aim - how much, for whom, by when Reduction in hospital acquired grade 2 pressure damage to zero, on Ward 12 by September 2017

IHI Improvement Methodology How will we know that a change is an improvement? Outcome measures – how will we know we are meeting our aim Reduction in numbers of hospital acquired grade 2 pressure damage recorded – Safety Crosses recording Process measures – what are the things we need to do consistently to deliver reductions risk assessments completed SSKIN Bundle compliance Numbers of staff trained Equipment availability Balancing measures Falls

IHI Improvement Methodology What change can we make that will result in improvement? Education Classification of damage Risk assessment including body mapping Related risk assessments, MUST score, Falls, Manual Handling Patient and carer engagement Mattress and equipment availability Use of SSKIN Bundle Policy Champions or Link Nurses

So what does it look like for Pressure Damage? 1 Clinical Ref Group – Meet quarterly 2 Collaboratives a year 2 Clinical Leads – 1 day per month Clare Stone, Chief Nurse, North West Surrey CCG - Commissioning and clinical expertise Sherrie Ryder, Service Lead Tissue Viability, Kent Community Heath Foundation Trust – Provider and specialist clinical expertise 1 Improvement Manager 2.5 days per week

Aim To reduce the incidence of pressure damage in all care settings in Kent Surrey and Sussex

Driver Diagram Aim Outcome Primary Drivers To reduce the incidence of pressure damage in all care settings in Kent Surrey and Sussex A reduction in pressure damage (greater than grade 2) developed in every care setting in KSS PD1: Improve clinical practice in primary prevention and treatment of pressure damage. PD2: Improve measurement and reporting of pressure damage in KSS PD3: Improve patient, family and public awareness and involvement in prevention of pressure damage PD4: Improve focus on commissioning for best practice on pressure damage prevention and treatment.

For each of these areas what specific action might you take? For each driver What change focus area do you think would deliver improvement ? Talk on your table – fill in the A3 sheet take 15 mins They fill in the A4 sheets which we put on tables and feedback

Improve clinical practice in primary prevention and treatment of pressure damage. Improve risk identification Purpose T user group – answer questions, develop business case template Audit and demonstrate benefits Implementation of the SSKIN Bundle Standardise minimum data set Sharing of audit tools and action plans How can we test effectiveness? Education for health & care staff on assessment and SSKIN bundle React to Red for use in primary care and care homes Off the shelf mandatory training package – recommended competencies and content session / e learning Communication – care home forums, MDT focus SO Essentially we have areas of work beneath each of the secondary drivers In order to move these forward I want to propose a new way of approaching making progress across these areas – which recognises that the energy and work for this is happening all over the region and that there are individual activists who can’t make it along to the CRG but want to work with colleagues to improve prevention and treatment of PD across KSS. So I am asking people who feel they want to be in a small time limited group to produce tools / products that will support work in these key areas we think will prevent and reduce the incidence of Pressure Damage – that people can use and also know what kind of improvement it delivered So if you feel like you would be an ACTIVE member in short pieces of work – please note that down if you are passionate in any of the focus areas – it would take the form of call, agreeing the piece of work that you are going to produce and then doing that NOTE IT DOWN ON YOUR SHEETS IF YOU WANT TO WORK ON THIS

Improve measurement and reporting of pressure damage in KSS 1/2 Education for staff to ensure knowledge and understanding of improvement methodology and data for improvement SI document/training package Ward to board awareness exemplar reports / access to others as examples Improved confidence in reporting methodology and provide useful information for local use] Pooling of information to see across Kent Surrey and Sussex Loading data to platform What does data tell us? Are there any regional steps we could take to improve that? For Improvement methodology – we will be hearing later from Sarah Leng who is leading a work stream re supporting people and organisations to grow improvement expertise will talk to us about the improvers network and also the LIFE system Developing improvement projects which use an improvement science approach to testing changes to see if they give an improvement and also measuring that. In this way others who might have the same challenge can learn from your efforts This item is about helping ourselves and colleagues think about improvement methodology as a way of working rather than something we do intermittently – it becomes how we work and how we work with others

Improve measurement and reporting of pressure damage in KSS 2/2 Robust comparable, transparent baseline , common definitions and reporting methodology SI reporting Consistent approach to reporting Managing SIs in PD SI data National alignment Develop ability to track patient pathways and risk across whole system Data collection system for Datix Whole system reporting Test area Tackling Information Governance

Improve patient, family and public awareness and involvement in prevention of pressure damage 1/2 Patient and carer information on assessment and reassessment to include 'self care Examplar Use of multiple avenues for providing patient and family information e.g. community pharmacy Basic information/leaflets Community pharmacy Voluntary charities Patient and carer integral to treatment process Self-care - See Sustainability and Transformation Plans

Improve patient, family and public awareness and involvement in prevention of pressure damage 2/2 Continuous communications among team and with patient and carer Documentation/record keeping Exemplar Case studies Improvement projects PDSA – pilot Use of mirrors Communications on transition between care settings Health & social care integration agenda Learning from SIs

Ambition of the work What have we learned Challenges High desire and will Excellent practice Lack of standardisation of approach Challenges Measurement Measurement across the patients journey Consistency Differences in commissioning approaches How to build a vibrant local network? Create added benefit across journey Replicating with tweaks great ideas – no blank page Getting ahead of the curve – Future response to new models of care

Shared Learning Collab Events (align the collab event learning to drivers) Purpose T master class React to Red SSKIN Prosper - Essex County Council’s Promoting Safer Provision of Care for Elderly SEM Scanner Sally Sore Georges story – CCG work in identifying on gap analysis and improvement work across system with acute community care home providers Coventry CCG aligning with quality with social care Reliance on Carer screening tool for nutrition and hydration Through our collab events we have heard improvement stories from inside KSS and also externally Go through presentations – align to drivers give examples Put a picture of the Mug Picture of sally sore

Simple Measures Hydration Mug

Next Steps Re-align specific actions and timescales against reviewed drivers Measurement focus and drive to support whole system reporting Pit stop review of actions taken and implemented Review the membership and engagement in the collaborative via the DoNs network Review commissioner levers following new CQUIN guidance Develop Quality Strategy across the STP How to maintain the profile of pressure damage through changes in new models of care?

Pauline.smith7@nhs.net @Smith7Pauline Thank you Pauline.smith7@nhs.net @Smith7Pauline