Powys teaching Health Board 10th June 2011 Powys teaching Health Board Presenter: Dr Brendan Lloyd

Area: Understanding Mortality Aim Drivers Interventions Tests of Change Continue participation in DH Death Certification Pilot Independent medical review of all Powys in-patient deaths Provide assurance to Board regarding local services and the HSMR of provider hospitals Mortality HSMR Palliative Care Collect HSMR data from both Welsh & English providers – monitor through Quality & Safety committee Improve quality & choices for Powys residents HSMR data features in all Quality Reports Increase choices available to Powys residents through extended palliative care, nursing and social service teams Increase choices for Powys residents in line with Last Days of Life pathway

Outcomes The findings from 401 case reviews (all Powys in-patient deaths September 2009 to present) : None of these deaths were preventable A small number of these deaths whilst sudden, were still considered expected Scrutiny did not result in any ‘cause for concern’ DATIX reports about poor or insufficient care The quality/accuracy of the Medical Certificate of Cause of Death has improved

Reduce Harm and Mortality Next steps Aim Drivers Interventions Tests of Change Reduce Harm and Mortality 604 Powys residents are dying in hospitals outside of Powys – why? Map place of death for all Powys residents Better understanding of reasons why so many Powys residents die in DGH’s outside of Powys Audit records of Powys residents who die in provider hospitals outside of Powys People who choose die at home or in a local hospital should have care planned to enable this to happen Actions to reduce harm and mortality are focused and based upon evidence

Area: VTE Prevention Aim Drivers Interventions Tests of Change Introduction of Powys wide VTE risk assessment form Monthly audit of all Powys in-patients To prevent the occurrence of Venous Thrombo- embolism in all Powys in- patients Provision of prophylactic drug therapy to prevent VTE

Area: Pressure Ulcer Prevention Aim Drivers Interventions Tests of Change Improved clinical assessment of skin integrity in all care settings Implement a standardised clinical assessment tool for risk of pressure ulcers in all care settings SKIN bundle assessment and care package now in place on Brecon, Bronllys, Llandiloes and Welshpool wards (40% of total wards) Reduce number and severity of pressure ulcers across hospital, community and care home sector Improved clinical care of patients at medium and high risk of pressure ulcers Implement a pressure ulcer care bundle that can be used in various settings Welshpool District Nursing team developing bundle for use in the community Improve whole systems care – incorporating community hospitals, community and care homes Explanation of the SKIN bundle concept given to Residential Home Link Nurses in March One home, Cwrt Enfys has volunteered to pilot the SKIN bundle approach there

Thank You