1. 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?

2. What is the Safety Collaborative?

4. 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

5. 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

6. 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

7. 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

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

9. 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.

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

19. Simple Measures Hydration Mug

21. 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?

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