Monthly archives: December 2018

Met Office: Cold weather alert planning advice

Though we’re not expecting any severe weather during the next few days, we’re expecting cold temperatures across the West Midlands later this week with widespread overnight frosts and freezing fog patches.

Please see January Cold Weather Alert Planning Advice for full details.

Unity – A prescription for safer care

By Dr Roger Stedman, Consultant Anaesthetics and Critical Care Medicine

The chain of events that starts with a decision to treat, through the writing of a prescription, dispensing of medication and administration to a patient is fraught with risk. This risk is manifest on a daily basis at SWBH as is evidenced by the number of reported medicines related incidents – over 1,200 a year at this trust with 28% of these resulting in some degree of harm to the patient.

When this process is managed by the traditional paper based work flow – underpinned by the drug prescription chart – we know that it is subject to errors due to: Illegible prescriptions, wrong drug / dose prescriptions, inappropriate drug combinations, inadequate allergy recording and absence of the chart altogether. The standard paper based prescribing workflow demands a minimum of two manual transcription tasks (admission drugs to inpatient prescription, inpatient prescription to TTO prescription) for every admission. However in addition to this the average medical inpatient will have 2 – 3 re-writings of the drug chart during their stay. All of this results in a prescription error rate of 15%.

When it comes to administering medicines from a paper chart the story isn’t much more cheerful.  The drug administration error rate is in excess of 10%; including wrong drug, wrong patient and wrong dose errors. This rises significantly if you include late and missed dose errors.

The paper prescription chart is without doubt the weak link in the inter-professional communication required to safely deliver medical treatment to our patient’s. Not only that – it fails to tell us how  we are doing in this critical task – the laborious job of auditing prescribing and administration processes giving us late, inadequate data on the safety and efficacy of our medicines management practice.

When Unity goes live the EPMA (electronic medicines and administration) functions in Unity will almost completely eliminate these errors. The EPMA has the entire hospital formulary built into the system, with ‘order sentences’ for the commonest doses and routes for most medicines. Not only that the system has an interaction checker that will ensure that serious drug incompatibilities will be highlighted immediately to the prescriber. The system mandates that allergies are recorded and verified on a regular basis, and that goes for patients’ weight as well. When the same system was implemented at another major NHS hospital the result was astonishing:

• Incomplete prescriptions fell from 62% to 0%
• Weight based dose calculation resulted in inappropriate doses falling to 0%
• Legible prescriptions and signed prescriptions 100%
• Allergy recording increased from 80% to 100%

The other major advancement that comes with Unity EPMA is the ‘Closed loop’ medicines administration system. The use of barcode scanning of both the patient and the medicine and triangulating this with the electronic prescription results in dramatic falls in drug administration errors as well. The same trust implementation saw the prevention of over 2,000 wrong drug administrations and nearly 400 wrong patient administrations in a 12 month period.

Users of the system also reported the following:

• No missing drug charts
• 8 hours a week in trainee doctor time saved rewriting drug charts
• Ability to prescribe remotely, no more telephone orders
• Ability to screen drug charts remotely
• Improved audit trail – ability to feedback errors directly to individual users
• Standardisation of complex prescribing (e.g. insulin, anticoagulation)
• Formulary adherence
• Improved antibiotic stewardship
• Electronic ordering of drugs and ward stock control
• Safer and faster dispensing
• Improved surveillance and reporting

The case for EPMA is so compelling that many trusts have implemented it even before a full EPR.  Trainee doctors rotating to SWBH from other organisations that already have EPMA report that it is like returning to the dark ages having to write (and re-write) prescription charts.

The introduction of EPMA at SWBH will bring about a step change in the safety of patients cared for at SWBH – and it cannot come soon enough.

#hellomynamesis… Roger

#Unity – releasing time to care

Give your colleague a shout out

Shout out is a way for colleagues to be recognised for their excellent work, delivering first class healthcare to our patients just like Amanda Healy who was acknowledged by Roisin Bailey.

The shout outs we publish on Connect are a mixture of patient feedback (from our website and social media) and shout outs from colleagues.

If you believe a member of your team, or someone from elsewhere in the organisation deserves a mention, then head to Connect and give them a shout out.

They may have gone out of their way to help you with something or you may have witnessed them make a difference to a patient or colleague.

Each month we will choose a top shout-out and the winner (and their nominator) will both receive a £10 voucher.

Shout outs will also appear in Heartbeat.

If you have any questions about shout out, please contact the comms team on swbh.comms@nhs.net or ext. 5303.

When to use a Surgical Face Mask or FFP3 Respirator

Masks are necessary for serious infections spread by an airborne route – for example Tuberculosis or Flu.

FFP3 masks must be individually fit tested on staff by someone trained to do so.

You should ensure that all masks are always fitted correctly, are handled as little as possible & never reused.

Please refer to the information sheet below for further details:

When to use a Surgical Face Mask or FFP3 Respirator information sheet

Join transcription team as part of full dress rehearsal and Unity ‘Go Live’

There is an exciting opportunity for prescribers to join the transcription team as part of the preparation for full dress rehearsal and Unity ‘Go Live’.

We require teams of prescribers for Monday 11 February (based at Sandwell or Rowley) and Tuesday 12 February (based at City) from 5.30am-12pm to transcribe patient medicine charts onto Unity. You will be supported on the day by pharmacy and consultants who have been involved in similar exercises. For the FDR there are a total of 11 wards involved in transcription.

In addition to the shifts, you will be required to attend a 90 minute transcription workshop for training and expectations for transcribing on Unity. Workshop dates are listed below.

For further details please contact the Unity team at Unity.Cutover@nhs.net

Note: Names are required by Friday 4 January.

Chief Executive’s Message – Friday 28 December

It is my last message of the year, and there is much to look forward to, and some things to celebrate.  Last week I hoped to announce today that we won some GP contracts, and to name the medical leaders who will take up deputy roles to David Carruthers, our medical director. Both are delayed another week, one over contractual niceties I suspect, and the other is because some of our successful candidates are on well-deserved leave. So hopefully next week we will also have our OJEU advert out for the final contractor for Midland Met, and thereby have a hat trick of good news!

Thank you, of course, to everyone who has worked so hard over the festive period. Whilst our waiting times for care have not met our hopes, we have stayed safe and within our bed base. The first fortnight of January will be distinguished by our work on safe discharge, and in December we met our own aim to reduce long stay patients in our acute bed base to below 100. This is a good step because we want to make sure the right patient is in the right environment. Compared to this time last year, we are making huge strides, with older people looked after in our specialist wards, and with cardiac, respiratory and gastro-intestinal patients seen by specialist teams. During January we will introduce much more visible ‘turnaround’ standards for patients having acute care, so that referring teams can set expectations of support teams and of those from whom tertiary opinions are sort.

One of the strengths of our Trust is that each New Year does not bring changes of plan or approach. So I wanted to use this message to highlight some continuity of emphasis into 2019.

Our number one quality priority will remain Sepsis. We continue to miss some screening opportunities for patients, and the Clinical Leadership Executive has agreed how we can in January work with ward clinical teams to learn from each missed check. As with our safety plan we want to make these checks an ‘always event’, and vitalpacs, for all its frustrations, does give us data with which to do this, as will Unity when it is installed. Unity will of course offer that facility to our community wards too.

Purple Point and our Speak Up days are two sides of the same coin. The first, our work to make sure carers and patients can thank individuals or raise concerns, the second, our campaign to make sure you are heard and feel safe to raise issues. In February we will feedback on the actions taken since our all employee referendum on your top three priorities, which concluded we had work to do on flexible working, internal communications and IT. After several weeks of success we have had IT issues in ED and blood tracking this week. From February everyone in our organisation ought to have access to a monthly face to face team brief, and we will publish a full set of schedules of how and where. In addition, we will be working with our Freedom to Speak up Guardians in the next three months to develop a new management code of conduct. I am hoping this will empower anyone with concerns about behaviours from line managers or senior leaders to feel able to step forward if they have behavioural concerns. Equally it will help line managers to be permitted to manage, which should usually involve inspiration and persuasion, but rightly will sometimes necessitate instruction.

The biggest single contributor to care in our system remains not us, but thousands of unpaid carers and volunteers. Some time ago, with Richard Samuda, our Chairman, very much championing this, we agreed that we wanted to do more to support carers. We have funded a variety of projects with this in mind and are always looking for more. Equally we know that for those who are alone, loneliness at a time of crisis is a major public health issue. Indeed loneliness can be the underlying cause of unhealthy behaviour or misuse of care facilities, like A&E. The Sapphire project is a patient-befriending scheme which reaches beyond hospital walls and supports people at home and when in hospital. Of course Sapphire also provides an opportunity for people to volunteer and thereby socialise themselves. I am delighted that this Your Trust Charity funded scheme has now got statutory pick up funding into 2019-21. Tackling loneliness is part of our Trust’s Public Health Plan, and a vital step in building community resilience in Ladywood, Sandwell and Perry Barr. If we can succeed in helping to do that it will address some of the acute pressures we face. So whilst it may seem nice to have, as a leadership team we believe it is an essential part of the work we do. With over 500 volunteers now working alongside our organisation, the start of 2019 will see a big push to bring more volunteers into our care teams. Here to stay, and part of our wider care effort.

Join transcription team as part of full dress rehearsal and Unity ‘Go Live’

There is an exciting opportunity for prescribers to join the transcription team as part of the preparation for full dress rehearsal and Unity ‘Go Live’.

We require teams of prescribers for Monday 11 February (based at Sandwell or Rowley) and Tuesday 12 February (based at City) from 05.30am-12pm to transcribe patient medicine charts onto Unity. You will be supported on the day by pharmacy and consultants who have been involved in similar exercises. For the FDR there are a total of 11 wards involved in transcription.

In addition to the shifts, you will be required to attend a 90 minute transcription workshop for training and expectations for transcribing on Unity. Workshop dates are listed below.

For further details please contact the Unity team at Unity.Cutover@nhs.net

Note: Names are required by Friday 4 January.

Unity end user training to be completed by 31 January

New dates have been released for the Unity end user training, and managers are asked to ensure their teams are trained by Thursday 31 January.

To book onto a course see the training schedule on Connect. Courses are also available for those who need ‘view only’ on Unity. Unity end user training will be delivered by role – please see Course Content Brochure.

There is a how to book Unity training guide available too for your reference.

If you would like a member of the Unity team to come to your area to assist with the booking of your staff, please contact swbh.informaticsbookings@nhs.net giving availability and a contact number, and arrangements will be made at a suitable time for you. The team will also help with any queries regarding the training and the booking system.

Heartbeat: Simulation 2020 – improving outcomes by better integration

Pushing the fast forward button to April 2020, set the scene for a large scale event held earlier this month to simulate challenges and generate responses that will be needed to improve health outcomes for our population in the near future, by working together across organisational boundaries.

The event included almost 80 representatives of senior staff from partner health organisations such as Sandwell and West Birmingham Clinical Commissioning Group (SWBCCG), Healthwatch, mental health and GP colleagues, and informed patients.

Our Chief Executive, Toby Lewis said: “This event was not about building a plan of things to do. Instead it recognised that locally we have been on a journey to better care coordination for many years. We need to improve relationships and understand how individual and organisational behaviour works if we are to move at the speed of our ambition and patient needs.

“I welcome the commitment of local organisations, especially the emerging GP networks to this programme. I am optimistic that in 2019 and 2020 we will see real improvement.”

The day started with a brief for colleagues to work together to come up with the questions they need to consider in April 2020, and moving forward until March 2021.

Focussing on ways of working and relationships that will help improve health outcomes for our communities – using available resources – meant that participants considered both the opportunities, and the hindrances to embedding truly integrated care.

Participants were challenged with media reporting of their decisions, as they happened, and were given the opportunity to correct assumptions made by the media, and put their key points across in very tight timeframes. Then they were asked to report in to two health and wellbeing boards as they would in real time.

Andy Williams, SWBCCG Chief Accountable Officer said: “It was an absolutely superb opportunity for all the partners in the system to come together today and really think about how we can work better together for the future and to really work differently to improve health and wellbeing outcomes for the population we serve.

“There are almost 600,000 patients registered with our GP practices currently, with the majority living in areas deemed to be amongst the most disadvantaged in England. Our population growth is approximately double the national average, and experiences ill-health and death earlier than most areas.

“Men and women typically live 57.4 years disability free (five and six years less respectively to National average). We have a population which is one of the most diverse multi-racial, ethnic and cultural populations in England.

“Although approximately 1 in 5 people currently smoke – which is higher than 1 in 6 for England average – the number is reducing. But we have a stretching public health agenda to support people to make healthy lifestyle choices, and reduce our mortality rate for under 75s which is significantly higher than England.”

Pam Jones, Patient Representative and former Healthwatch chair, said: “I think this is a very useful event. It is getting all agencies together and they are learning from each other about the things they can do and the difficulties they might find on the way.

“I think working together is achievable on a larger scale. I think an alliance between statutory organisations would work by focusing on smaller geographical areas forming partnerships, rather than one covering the whole of Sandwell and Birmingham.”

She added: “I think a large number of patients would be pleased to hear that people from different organisations are seeing how they can work together more effectively so that they can improve healthcare for patients.”

Participants attended the event in the same role they currently hold, enabling them to bring existing skills and experience to the task in hand. They were asked to consider working in a system with capitated budgets (meaning that every patient has a set figure allocated for their care, whether or not they seek treatment.) And, commit to improving the outcomes that local people experience. In particular, in the year from 2020-21, they addressed some key local priorities including:

• The first and last 1000 days of life
• Diabetes and obesity
• Mental health
• Childhood health and wellbeing

Domestic abuse training update: 25 January

We are hosting a domestic abuse training update on Friday 25 January on Archer Ward in training room 1 at Rowley Regis Hospital from 11am-12pm.

The training is aimed at at all clinical colleagues from healthcare assistants to ward managers and will involve a general update around identifying and responding to domestic abuse in the NHS.

Note: Spaces are limited so please book as soon as possible.

For more information and to book your place, please email amanda.millard@nhs.net.