1. Patient Comfort Rounds
Our experience of rapid adoption and spread methodology
Sarah Fiori
Senior Nurse Quality & Safety Team

2. York Hospital serves a wider population of 500,000 in North Yorkshire
Opened in 1976 and gained Foundation Trust status in April 2007
Healthcare provided to around 700 beds on the main site
Serve local community units across North Yorkshire
Provide a full range of specialist services including Cancer Care, Child Health, Renal Services and Sexual Health
Affiliated to the Hull and York Medical School (HYMS) in 2003

3. Falls and Pressure Ulcers
Not nice things happen in nice places too

5. What went well? Doing it all together Nurse led
Framework with timescales
Working with DH team
Ideas and approaches not tried or thought of before
Built confidence
Blame the DH!
Raised profile of the Implementation Team and of the issue
Exposed and focused ‘festering issues’
Rapid immersion event
Comms activity
Would we do this again……..?

6. The format of the day was very different to our usual approach
Visual commitment used during the Immersion event and around the Trust using screen savers. Similar pictures of Matrons and ward Sisters displayed on individual wards demonstrating their commitment.
The nurse led event brought back pride to the nursing profession enabling us to re-connect with the core values of nursing.
Having all Matrons and Sisters in one room enabled them to learn from each other and share experiences from their areas.
The format of the day was very different to our usual approach 6
26 April, 2017

7. What were / are the challenges?
Legacy of previous patient safety successes and current use of PDSA
Existing Champions
Too fast for some and too fast between immersion and getting started
The skill of winning hearts and minds is not inbuilt
Our internal structures hampering success
Baseline data . 7
26 April, 2017

8. What were / are the challenges cont’d?
Timing of getting together the delivery team, survey, stakeholder analysis
Managing the message of results
Sustainability to be built in throughout
Ability of hindsight
Mattresses – national shortage &
our processes
Changing Documentation . 8
26 April, 2017

9. Impact Everybody’s talking! Complete shell shock on start day Workload
Raised profile in cost savings of improving quality
Patients have equipment they need
Improved communication
Improved data and assurance
2 grade 4 hospital acquired ulcers in past year . 9
26 April, 2017

10. Nursing Staff at York have triumphed!!!!!!!!!
National prevalence: 8-10%
York Hospitals prevalence 2010: 7%
York Hospitals prevalence 2011: 5%
Approximate hospital acquired 2010, YorkHospitals:4%
Approximate hospital acquired 2011, YorkHospitals:2%
Despite this however, nursing staff at York have triumphed- only 2 ha grade 4 pu last year. The sacrum was found to be the most predominant area of pressure ulcer damage. The previous audit placed the heels as predominant site. There has been a successful and significant drop in heel pressure ulcers. Incidence data identified common locations for development of pressure ulcers were found to be sacrum, heels and buttocks; all these were grade 1 and 2 pressure ulcers. There were no grade 3 and 4. 10

11. Cost Savings of Pressure Ulcer Associated Costs
2009: £5,730,590
2010: £4,526,695
2011: £3,103,221
A saving accomplished over the past year of £1,423,474!!!!!
Total of £2,627,369!!!!!!!
Finance important but the cost to our patients is even higher.

12. Falls focus on.. Lying / Standing BP Toilet Tagging
Dementia Assessments / care plans
Comfort Rounds
Post Falls Procedure
Medication Reviews
Appropriate Footwear / slipper socks?
OOH access to walking aids
Patient Information Leaflets
Representation at Falls Group meetings

13. Whats Next…………… Spread to Scarborough Hospital Community hospitals
Virtual wards
Sharing practice with other Trusts
Method of measurement for safety thermometer

14. Definition = absence of VTE, pressure ulcers,
falls and ca-uti.

15. A Patients Perspective;
‘I had just been told I had cancer.
I was worried about losing a chunk of my breast, worried that I might get lymphoedema from losing my lymph nodes and worried that the cancer might have spread.
I wasn't, worried about the nursing.
It had never occurred to me that the thing you should worry about when you went into hospital was the nursing’.
Christina Patterson
The Independent, 2012

16. But…………
'Nurses do not wake up each morning intent on delivering poor care...'
Christina Patterson
The Independent, 2012

18. Patients are at the heart of everything we do
Patients are at the heart of everything we do. They inspire us to change. We are committed to improving their experience of healthcare and protecting them from harm.