1. EFFECTIVE C difficile (over 65) Apr-Jun 14 MRSA bacteraemia Apr-Jun 14 MSSA bacteraemia Apr-Jun 14 For the 2 month period July- August 2014, there were 10,426 admissions to NHS Fife Hospitals. Of which 5,446 were unplanned, 1,433 planned and 3,547 day cases. In addition there were 16,616 new outpatient attendances and 40,916 reviews. SAFE NHS Fife HealthCheck July-August 2014 Presented to NHS Fife Board on 28 th October 2014 REDUCE HARM Lower is better Higher is better Lower is better

2. Activity Total activity for the period July-August 2014 was 67,958. This included 10,426 admissions to NHS Fife Hospitals and 16,616 new out-patient attendances and 40,916 reviews. Hospital Standardised Mortality Rate (HSMR) The last quarterly data to March 2014 was published in August 2014. This shows a HSMR of 0.78 for Fife. The HSMR data shows an improvement however the quality of the data return has reduced due to coding backlog. There are a number of actions underway to improve the quality of the coding returns. It is difficult at this point to assess the impact of the improvement work which is currently in progress to reduce mortality. 95% Harm Free Care At this time, Catheter Associated Urinary Tract Infection (CAUTI) has been excluded from the SPSI to allow testing and establishment of the outcome measure in NHSS boards. Testing and reporting of process and outcome measures for CAUTI remains a priority for the Acute Adult programme with the aim of including CAUTI within the SPSI when consensus is reached on a scalable definition. Cardiac Arrests – Failure to Rescue has been a theme identified through the SAER process and the mortality reviews. Identifying deteriorating patients has been identified within the SPSP programme as an area to focus improvement activity. There are multiple strands under this broad heading which include Sepsis, and DNACPR. Pressure Ulcers – There has been an increase in the number of reported pressure ulcers in July and August. The reason for the increase is multi-factorial and partly due to increased awareness of reporting, change in reporting in certain grades of pressure ulcer. Whilst there has been an increase this does not necessarily mean that these pressure ulcers have been acquired whilst under care from NHS Fife. Work is underway to review the pressure ulcer incidents and data to identify the key improvements across the system which are required to reduce the occurrence of pressure ulcers acquired under NHS Fife care. Falls – In addition to looking at the 25% reduction in all falls (with and without harm) a chart depicting the 20% reduction in falls with harm is included. This is to support the strategic priority of reducing inpatient falls. The Frailty Steering Group (and the groups who report directly to the Frailty Steering Group) have initiated a number of improvement activities which include initial frailty screening of all patients on admission to hospital; Immediate implementation of “safety bundle” for those at risk; Equipment review; Staff training; Robust implementation of comfort rounds; Review of observation policy; Review of patient pathway; Review of medical pathway; Documentation review with a view to integration and removal of duplication; Environmental review. Significant Adverse Events Review (SAER) There were a total of 2257 incidents reported from July 2014 to August 2014. Of these 3% (78/2257) reported were graded as major/extreme and 6% (5/78) of those have been commissioned for an internal SAER. These were categorised as tissue viability (2); unwanted behaviours, violence and aggression (1); Healthcare Acquired Infection (1); and clinical (1). Readmissions Readmissions data is currently being reviewed with a view to using validated national data provided by ISD rather than locally derived data. Complaints The formal definition of complaint is ‘an expression of dissatisfaction about an action or lack of action or standard of care provided’. In Fife our approach is to make direct contact with the individual raising the complaint or concern, to be clear about any issue and to distinguish how this is coded on the system. Our policy in Fife is to seriously consider all forms of feedback and to act on and learn from them. There were 71 formal complaints (with multiple issues) reported in July and August 2014. The 3 key themes from these formal complaints were: clinical treatment 44% (120/274); attitude and behaviour 23% (64/274); and communication (oral) 16% (45/274). Staff Experience A national tool, i-Matter, is being developed. Work is in progress to determine whether this would be an appropriately sensitive measure to capture staff experience. Your Care Experience Scottish Public Services Ombudsman (SPSO) Four decisions were reached by the SPSO during July/August; two relating to GP practices and two relating to Acute Services. The SPSO upheld one of the practice cases, concluding that the GP failed to make a timely referral to a specialist and only did so when prompted by the family. It was also considered that referral to a geriatrician rather than a psychiatrist would have been more appropriate. The Practice were asked to feedback the failings identified to the staff involved and to offer the family a written apology. All recommendations have been completed. In the second case the SPSO did not uphold the complaints that a GP failed to perform an appropriate examination to establish the cause of symptoms and failed to offer a NHS referral. There was recorded evidence of the examinations undertaken and no evidence of service failure identified in reviewing the complaint. SPSO did not uphold a complaint regarding the provision of appropriate care and treatment concerning an injured knee. The non surgical approach taken by the Orthopaedic Consultant was in keeping with NICE guidelines and was therefore considered reasonable. The SPSO upheld a complaint that the Board failed to provide appropriate and co-ordinated medical treatment to a patient when it was evident that the patient’s condition had deteriorated. The SPSO also upheld the complaint that the Board failed to provide the family with appropriate palliative care. A number of recommendations were made including; the offer of an apology, a case review to identify ways of improving communication, an audit of compliance of monitoring pain levels and consideration of ways to better involve community palliative care teams. The Associate Medical and Nurse Directors within Acute are leading on the actions being put in place as a result of the recommendations made. The theme for Person Stories at today’s Board is the importance of the links between health and education in terms of mental health and wellbeing. The Board will hear from Ms. A who has received support from the mental health Occupational Therapy service in order to help her transition into higher education. Data The source of data contained within this document varies and can be derived from validated published sources, official government returns and databases, and local activity data and management information from a variety of internal sources. The frequency of data updating also varies, with some data being updated monthly and others quarterly. Data correct as at 30/09/2014. PERSON-CENTRED Lower is better Higher is better Data from Your Care Experience No data collected from inpatient areas Outpatient data are from 1 outpatient area –collected August 2014 (n=51)