Memorandum by Independent Healthcare Advisory
Services (IHAS) (PS 61)
PATIENT SAFETY
INTRODUCTION
The IHAS brings together members and specialists
across the health care industry in all four countries, to share
a unique level of knowledge, experience and understanding in order
to:
— facilitate effective communication
between all its subscribers, the government and external organisations
— strive to develop and drive policy
advancement through shared subscriber input and consultation
— deliver focused, practical information
and guidance in all areas of regulation and policy, sharing and
distributing knowledge
The IHAS's primary focus is in the area of operational
policy and the regulation of the sector. As such it seeks to:
— Facilitate the development of operational
policy, through consultation with its member organisations
— Provide its members with accurate
and timely information regarding regulatory and policy matters
— Administer an independent complaints
process
— Develop a range of quality initiatives
to raise awareness of good practice within independent providers
— Represent independent health care
providers on matters of quality and regulation to government,
external organisations, and the public, providing a channel for
effective communication and dialogue
The IHAS welcomes the opportunity to submit
evidence to the Patient Safety Inquiry. The IHAS has a number
of working groups that address patient safety issues such as the
IHAS Quality group chaired by Jane Cameron Ramsay Healthcare UK,
the Perioperative Care Working chaired by Miranda Eyles HCA International,
Decontamination chaired by Chris Ayton BMI Healthcare, the Infection
Control Group chaired by Sue Manning BMI Healthcare and Critical
Care Group chaired by Sally Taber IHAS. Our response is set out
in respect to the terms of reference with submissions from our
member organisations. The details of the person/s submitting are
included in the relevant sections.
The chairman of IHAS Board is Stephen Collier
BMI Healthcare. He has the independent sector place on the Patient
Safety Forum chaired by Sir Liam Donaldson and David Nicholson
and ensures that the National Patient Safety Forum agenda is communicated
to the IHAS Board at the quarterly meetings
The IHAS would be very prepared to give oral
evidence to the committee.
PATIENT SAFETY
ISSUES DEMONSTRATED
FROM IHAS WORKING
GROUPS
Critical care Transfer
Independent Healthcare providers completing
the IHAS 2007 Hospital Profile carried out 631, 000 procedures
each year—of these a tiny proportion have unexpected complications
that require specialised care including within NHS critical care
facilities. The number of cases that need to be transferred to
the NHS is less than 0.5% of the total cases. The transfer document
has been put together to ensure that the safety of patients is
a high priority and is enabling in order to:
(a) To facilitate escalation of care when
appropriate for all patients in a timely fashion
(b) To ensure that all independent hospitals/clinics
fulfill that there is a requirement for independent hospitals
and treatment centres to have in place written policies and procedures
for the transfer of patients to another hospital where required.
The critical transfer paper has been prepared
in conjunction with the Intensive Care Society, the Critical Care
Network Managers, the Department of Health (England) and the National
Critical Care Stakeholders Forum.
Perioperative Care Collaborative
The IHAS is currently chairing the Perioperative
Care Collaborative which is made up of the Association of Perioperative
Practice (AfPP), British Anaesthetic and Recovery Nurses Association,
British Association of Day Surgery, College of Operating Department
Practitioners, PROPRIUS—Forum for Perioperative Education,
Royal College of Nursing and The Royal College of Surgeons (England).
The work around patient safety issues has included addressing
how surgical procedures are performed in primary care. With the
continued drive to move services from secondary care to primary
care the Perioperative Collaborative members have been concerned
that there is a lack of assurance with regards standards, governance
and a clear framework to ensure safe delivery of services which
protect patients. The AfPP have produced Standards and Recommendations
for Surgery in Primary Care and the Collaborative members
are ensuring that these are widely circulated.
IHAS Members have been addressing Correct
Site Surgery following the issue of the NPSA Correct Site
Surgery alert in March 2005 with a 12 month implementation date.
Evaluation of the implementation of the Alert has caused concern.
It has been agreed that this should now be taken up by the Perioperative
Care Collaborative. The Collaborative will be following the agenda
of the World Health Organisation (WHO) who are promoting correct
site surgery through the development of standing operating procedures
and the Safer Surgery check list as well as obviously the NPSA.
Self regulation agenda for Cosmetic Injectables—The
IHAS have been taking forward this agenda and signed up to NPSA/Healthcare
Commission Patient Safety Charter in order to address the issues
of Patient Safety for patients wishing to receive cosmetic injectables.
Issues such as remote prescribing and the cosmetic injectables
being given by an appropriately trained practitioner have been
taken forward. The IHAS has been delighted that the Nursing and
Midwifery Council, the General Medical Council and the General
Dental Council have all responded in ensuring that appropriate
guidance is available to address poorly performing practitioners
to ensure patient safety.
ISSUES ADDRESSED
UNDER THE
QUESTIONS POSED.
What the current effectiveness is of systems for
incident reporting, risk management and safety improvement in
ensuring patient safety
Jane Cameron, Director of Clinical Services, Ramsay
Healthcare UK
Patient identification
Ramsay Healthcare UK, following a successful
trial, is adopting Laserband to replace patient identification
wristbands. This product rules out human error related to handwriting
on bands. Laserband technology is linked to the Patient Administration
System (PAS): the patients' data is printed direct from the Pas
onto the Laserband in the clinical ward area.
Fit for surgery and Pre-operative assessment
Ramsay Healthcare UK has redesigned existing
patient assessments to meet evidence based practice. The revised
patient questionnaire pinpoints significant medical history and
risk factors to identify a specific group of patients who require
further investigation and work-up before surgery. Following a
pilot study the new process has been rolled out across the organisation.
The pilot demonstrated that over 50% of patients only require
a telephone assessment, permitting clinical resource to be focussed
on face to face assessment of at risk patients. Outcomes in terms
of perioperative complication rates are being tracked to measure
efficacy.
Anaesthetic safety
Anaesthetists practising in Ramsay Independent
Sector Treatment Centres have adopted an electronic assessment
tool which permits the clinician to evaluate multiple patient
medications (including herbal remedies) as part of the anaesthetic
patient assessment. The assessment pinpoints any potential contraindication
and hyperlinks to guidance sheets.
Dr Andrew Jones, Medical Director, Nuffield Health
As part of the overall commitment to improving
Integrated Governance processes, in 2007 Nuffield Health
implemented the Datix Risk Management System for reporting
and management of incidents, risks, complaints handling and claims
and for governance reporting. The Datix system has transformed
the incident reporting and management processes at Nuffield Health,
resulting in a 100% increase in the number of incidents reported.
In 2007 Nuffield Health published the first Integrated Governance
Report which outlined the main activities to develop and promote
integrated governance reporting.
Nuffield Health has recently introduced a Quality
Performance Indicator (QPI) reporting framework, reflecting
activity across all Nuffield Health Divisions and includes:
— Statutory/regulatory reporting requirements
such as the NHS Litigation Authority.
— the management of risks and patient
safety
— Department of Health policy
Nuffield Health's approach to Integrated Governance
is to realise opportunity, support the demands of compliance,
and help to provide treatments and services that are safe, quality
assured and cost effective. The Datix system is then used to collate
significant events and "near misses" by categories.
Between January and August 2008 Nuffield Health identified 187
potential errors in the blood transfusion policy. This led to
work streams to remedy the main factors with a substantial reduction
in errors.
Evidence source: Integrated Governance Report
2007, Nuffield Health
A systematic approach to health and safety has
reduced incidents by one third.
Nuffield has set up a series of 6 sterilisation
hubs with a fall from the industry standard defect rate from 0.5%
to current rate of 0.2%. The first three units have all been accredited
to the new MHRA standards for operating equipment.
Rosemary Hittinger, Director of Clinical Governance
HCA International
HCA employs the Datix system which is
common to all our sites. The system is centrally managed to allow
for commonality of thresholds to cover adverse incidents, adverse
incidents no harm, near misses, peri-operative/procedure complications,
complaints and claims. This allows a fully integrated register
to identify common trends and analysis. This is a particularly
useful coordination for consultants who have practising privileges
at more than one of our facilities. HCA hospitals are independently
accredited which requires identification of incidents that change
practice and forms part of each hospital's annual report. We are
introducing bar coding for patients and medications and have a
Positive Patient Identification Project ongoing. HCA also has
a traffic lighted balanced scorecard which is reviewed quarterly
with the Chief Executive Officers (CEOs). This covers a number
of clinical and non clinical performance issues including infection
rates and is designed to take accountability to the highest level
embedding quality indicators with business practice. E.g. if there
are any infections the relevant CEO is required to explain the
findings of the root cause analysis and provide a remedial plan.
Amongst other measures we have
— implemented the SSI care bundle and
ventilator bundle in ITU.
— introduced a blood transfusion tracking
system
WHAT THE
CURRENT EFFECTIVENESS
IS OF
EDUCATION FOR
HEALTH PROFESSIONALS
IN ENSURING
PATIENT SAFETY?
Dr Andrew Jones, Medical Director, Nuffield Health
Nuffield Health has Infection Prevention
Control Link Practitioners (Alps) in place within 30 Hospitals
and their role is to support the Hospital Matron in the detection
of risks and implementation of Best Practice. 87.5% of Nuffield
Health Hospitals have a trained ICLP who have completed the Royal
College Nursing (RCN "Principles of Infection Prevention")
Accredited course. 57.5% of Hospitals have an ICLP in every clinical
area. ICLP programme has produced dramatic results with average
scores exceeding 90% in the 10 key areas of infection prevention.
Nuffield Health completed 89,000 orthopaedic cases in 2008 with
only one case of MRSA.
Rosemary Hittinger, Director of Clinical Governance
HCA International
HCA has an assigned Infection Control Nurse
for every facility as well as site link nurses. They have a strong
educational function as well as a monitoring and advisory one.
Feedback on incidents and adverse events is disseminated at each
site to the department heads via the Clinical Governance Team
in order that events are learnt from. There is also a corporate
forum to share learning. Each site is required to cascade any
Alerts and guidance relevant to their practice to those that are
actually delivering the care and at the Corporate Clinical Governance
Steering Committee there is a standing agenda item on "Horizon
Scanning" when new guidances etc. are considered as relevant.
This committee had representation from every site and meets monthly.
WHAT THE
CURRENT EFFECTIVENESS
IS THE
NHS LITIGATION AUTHORITY
IN ENSURING
PATIENT SAFETY?
Dr Andrew Jones, Medical Director, Nuffield Health
Nuffield Health's collaborative approach to
claims, complaints and incidents resulted in a 20% reduction in
litigation and insurance premiums in 2007. What the current
effectiveness is of national policy in ensuring patient safety?
Dr Jean-Jacques de Gorter, Director of Clinical
Services Spire Healthcare
Spire Healthcare is committed to infection control
excellence, evidenced by its infection control strategy, implemented
by Infection Control Leads at each of its 36 hospitals
and coordinated by a national Head of Infection Control with experience
of working for the Health Protection Agency. Over the past 3 years,
Spire has reduced surgical site infections by up to 75%, and has
an enviably low rate of MRSA bacteraemia and C. difficile.
The national guidance for MRSA screening
(Department of Health Operational Guidance for MRSA Screening
31 July 2008) raises some concerns regarding evidence to support
this approach. Whilst Spire Healthcare has a screening programme
in place for high risk patients, it believes in maintaining a
focus on the fundamentals of a robust infection control programme
and on targeting resources into improving clinical practice. It
believes this is a view shared and supported by many experts in
the field.
Adverse events related to blood transfusion
account for a significant proportion of total clinical adverse
events. Clear standards were set out in the Serious Hazards
of Transfusion (SHOT) guidelines in 2005. Spire hospitals
adopted these standards soon after their release and following
focussed attention, succeeded over a period of 3 years in reducing
blood cross-matches by 47%, and blood transfusion by a fifth as
a result of embedding these into care pathways resulting in safer
patient care and more appropriate use of blood products.
Finally, Spire Healthcare has since 1998 run
a Patient Reported Outcome Measures (PROMS) programme—the
most mature active programme of its kind in the UK, with data
on approximately 200,000 patient episodes. This provides information
on the degree of health improvement experienced by patients following
treatment, and is incorporated into Spire's overall clinical governance
framework. As a vocal champion of PROMS for many years, Spire
is pleased that the NHS intends to roll out this approach starting
in April 2009.
September 2008
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