Cardiff and Vale UHB Dr Graham Shortland Clostridium Difficile Infection Thromboprophylaxis Rapid Response to Illness Skin Care Other specific areas; Current Success -Surgical safety briefing Future Work -Falls prevention and bone health framework

Clostridium Difficile Content Area Drivers Interventions Tests of change Antimicrobial Prescribing Cefuroxime and Ciprofloxacin restricted use from 1st June 2010 Improved antimicrobial prescribing practices and review of prescriptions Clostridium Difficile AOF Target 20% Reduction >65 population for Apr 2010- Mar 2011 Higher Reduction Planned Historical high level for Wales Pilot Ward – Testing change on Renal Ward with successful reductions Improving outcomes Mortality Resource Release Measurement of Clostridium Difficile Rates Monthly Surveillance April 2010 >65 37 (49) April 2009 > 65 48 (56) Leadership from the Board Implementation plans across Divisions Isolation & Treatment of patients with diarrhoea Hand Hygiene Prevent Transmission Environmental cleaning Refurbishment programme Staffing Levels

Risk Assessment of all Patients for Hospital Acqiuired Thrombosis Content Area Drivers Interventions Tests of change Thromboprophylaxis Risk Assessment of all Patients for Hospital Acqiuired Thrombosis 100% Risk Assessment Leading to 60% reduction venous thrombo-embolism 236 patients primary diagnosis saved admission Previous Audit Information Demonstrates Poor Performance Review UHB Committee Structures High Priority of Medical Director Thromboprophylaxis Group reports to Quality and Safety Committee Audit of ; Patients Risk Assessed Patients Receiving Prophylaxis (Audit tool identified undergoing PDSA cycles and testing) Leadership from the Board Divisional Director Agreement Patient Safety Friday Presentation Improving outcomes (Community and Hospital) Mortality Morbidity Resource Release Measurement of VTE Events (Exact definition needed) Monthly Surveillance And Run Chart Agreement of all Divisions to Risk Assessment Tool Local versions developed Empowering Patients NICE Guidance Staff Education and Communication Plan

Rapid response to Illness Content Area Drivers Interventions Tests of change Rapid response to Illness Early Warning Scores Rapid Response Team Recognition of the Acutely Deteriorating Patient Link with hospital at Night Pilot Study of Model Improved Documentation Interventions Drug Changes 28% Fluid Changes 25% Oxygen Changes 25% SBAR Audits Palliation Plans Leadership from the Board Divisional Director Agreement Patient Safety Friday Presentation Improving outcomes Mortality Morbidity Resource Release Roll-out of Model to all Acute Areas Expansion of Hours (8-10 hours / 7 days per week) Measurement of Hospital Standardised Mortality Ratio’s Compliance with Sepsis Six Resuscitation Bundle in Receiving Units Local Developments e.g. Maternity specific EWS Sepsis Care Bundle – Spread throughout hospital acute areas Reduction in Global Trigger Tool Events NICE Clinical Guidance 50

Content Area Drivers Interventions Tests of change Skin Care 20% Reduction in Pressure Ulcer Prevalence Improving outcomes – Reduced Length of Stay and Improved Capacity Planning SAFER Patient Network Mentor Site – Roll Out UK Wide Pilot Area Successes – Critical Care Areas >95% Reliability with bundle Measurement of days between pressure ulcers Leadership from the Board Zero tolerance to pressure damage Divisional Leads Identified Compliance with Skin Bundle and Pressure Ulcer Prevalence Resource Release Care Bundle Implementation for skin care and pressure damage Monthly monitoring introduced and data shared with Divisional leads