Gillian Kelly, Acting Deputy Director of Nursing Francis Thompson, Head of Nursing Education & Standards Paul Knowles, Patient Safety Lead Enhanced Engagement and Observation:

Provide care and treatment for about 20,000 people a year and serve a population of 700,000 residents A large Trust employing some 4,300 staff and serve a local community of many races, religions and languages, across four London boroughs. This includes local mental health services for adults, older people and children in the boroughs of Ealing, Hammersmith & Fulham and Hounslow. Our high secure services at Broadmoor Hospital in Berkshire are internationally recognised. With our West London Forensic Service, they make us a leading national provider of secure and specialist mental healthcare. West London Mental Health NHS Trust

SUI’s 2013

Trustwide incidents

HSS Broadmoor Hospital Paul Knowles Patient Safety Lead/Practice Development Nurse & Modern Matron

Recent Historical Issues 2 Recent SUI reviews into patient deaths (last 2 years) highlighted contributory factors regarding EE&O practice (particularly during night shift). 5 staff have recently (last 2 years) been either dismissed or had local and or NMC sanctions against them for failing to adhere to policy re EE&O’s. Rooms and site poorly designed (particularly Victorian buildings) do not necessarily support EE&O’s.

Actions taken Routine review of CCTV by local nurse managers Routine audits of EE&O practice by Senior Clinical Mangers Unannounced out of routine hours audit of EE&O practice by Practice Development Nurses Review of mandatory training to include simulation of practice All staff to be assessed as having necessary skills and understanding by their local manager before carrying out EE&O’s Learning Lessons events with particular focus on EE&O practice SOP for nurses I/C of shifts with clear instructions for monitoring EE&O practice during the shift

Future developments Electronic Monitoring: a) Heart rate monitors b) CO2 monitors c) Movement recognition Recently announced rebuild a) Room design and observational windows reworked to take into account EE&O’s b) Line of site observation generally much improved part of design brief

Forensic Services Clinical audit and the cycle of improvement Gillian Kelly, Acting Deputy Director of Nursing

Aims Discuss experience and approach to EE&O audit with Specialist & Forensic CSU –What we found –What we did –What we still need to do

The Initial Audit Findings: What we found: July/Aug’ 12 Some good practice Areas of concern and significant risk Preventing suicide components particularly concerning –risk assessment and management, engagement, care planning, activities and documentation Staff awareness of requirements below acceptable standards Patient involvement and information sharing below acceptable standards –not feeling safe, respected and that privacy/dignity is not maintained –Not receiving copy of care plan

The Formula: What we did Monthly spot-check audits Approach: –Team working across operational/Practice Development Roles -real strength in approach / pooled resources / fun / enhanced ownership / variety of experiences –Spot-checking / clinical areas not notified in advance –Initial auditors: Senior Nurses (8a>) –Pre-audit meeting/planning (teams allocated) –Team/Buddy system - allocated areas outside of normal workplace –Audit Day nominated / combined with WM’s meetings

The Formula: What we did Immediate remedial actions are taken when auditors identify failures in EE&O practice –systemic and individual errors addressed Post audit debriefs/discussions of findings held with ward managers and senior nurses to discuss issues and remedial actions shared; identifying actions requiring follow-up and priority areas for improvement (lessons learnt) whilst awaiting formal data analysis from audit WM’s later involved in auditing to enhance ownership and raise awareness – healthy competitiveness developed / real pride in achievements Audit report also discussed at WM’s Meetings

Actions Taken GOVERNANCE EE&O included in CSU risk register EE&O included within Suicide Prevention Strategy Ongoing audit and reports discussed in Gov meetings PRACTICE Remedial actions/debriefs as described Directive from the DDN regarding accountability and areas for immediate action from DDN - commending improvements and highlighting areas for ongoing development TRAINING EE&O Tutorials Enhanced Engagement for HCAs and B5 workshops

Going Forward: What we still need to do Still room for improvements Serious Incidents / High Risk Areas –where should we focus practice development initiatives? (high and low usage areas) Quarterly V’s Monthly audit? Who should undertake the audit? (MDT involvement / Band 5 / preceptees / Senior Nurses Qrtly) Need for mandatory training in this area Next audit important for understanding if improvements have been sustained SU perspectives/involvement

Any questions / thoughts?