Patient Safety in Scotland

Source: Scottish Government Posted on: 9th September 2009

A national improvement programme to drive up health standards in the NHS will be showcased to Health Secretary Nicola Sturgeon during Patient Safety Month which gets underway today.

The Scottish Patient Safety Programme aims to reduce hospital mortality by 15 per cent and adverse incidents by 30 per cent. Ms Sturgeon says it is achieving this through a whole range of projects in Scottish hospitals.

To highlight the work being done across Scotland, Ms Sturgeon will see a variety of these projects, starting with a visit today to Stirling Royal Infirmary’s Critical Care Unit.

Ms Sturgeon heard that NHS Forth Valley has not had a patient with an infection in a central line – a tube used to give drugs and food to patients – since January 2008. This is a significant reduction on previous infection rates.

This has been achieved by:

* Measuring and evaluating the processes staff need to go through to prevent such infections to make sure they are carried out every single time
* Using multidisciplinary rounds – this is where everyone involved in looking after a patient meets to discuss their care
* Setting daily goals – deciding what will be achieved for that patient that day

This strategy has also seen a reduction in ventilator-acquired pneumonia and the length of time patients stay in intensive care.

Ms Sturgeon said:

“The Scottish Patient Safety Programme is achieving great results in driving up standards across our hospitals.

“It’s not about new-fangled ideas, employing more staff or buying more equipment, but about enabling staff to ensure that every single process they need to carry out to care for a patient is carried out every single time. It’s about the reliable application of best practice. And it is about making the best use of the commitment of NHS staff to improve care for every patient.

“The proof of the success of the Scottish Patient Safety Programme is in projects like the one I am visiting at Stirling Royal Infirmary today. Central line infections are one of the most common causes of infection in intensive care so this strategy really is safeguarding patients’ health and ultimately saving lives.”

NHS Forth Valley Chairman Ian Mullen said: “We pride ourselves on our high standards of patient care. The 600-day mark is an incredibly important achievement in NHS Scotland and everyone in NHS Forth Valley is immensely proud of the efforts of our critical care staff. These are some of the early results of the Patient Safety Initiative in Forth Valley. Over the coming months, we will be applying the valuable lessons from this success to improve all of our services.”

The Scottish Patient Safety Programme works by giving front-line staff permission to make changes to the way they work.

What is done to change the culture might be as simple as a chart on the wall where staff tick off carrying out each process one by one to make sure they are done each time.

Projects are trialled in individual health boards before being rolled out across Scotland. For example, all hospitals have implemented executive walkrounds, a pre-operative surgical checklist to reduce complications in the operating theatre and the strategies to reduce infections in critical care units being highlighted at Stirling today.

It is now planned to roll out the programme’s principles to other areas of the NHS including mental health and primary care.

Dr. Frances Elliot, Chief Executive of NHS Quality Improvement Scotland, said:

Patient safety is at the centre of our role in supporting NHS boards in Scotland to improve the quality of patient care and we welcome patient safety month and its focus on highlighting the importance of safety in all areas of the NHS.

“As the managers and co-ordinators of the Scottish Patient Safety Programme, we can see tangible progress in the work done to date and we look forward to working with NHS boards to further improve the care patients receive in the NHS in Scotland.”

The other projects Ms Sturgeon will visit are:

NHS Greater Glasgow and Clyde (Tuesday, September 15) The Cabinet Secretary will be visiting an Intensive Care Unit which has also reduced central line infections, pneumonia and length of stay. The longest period it has had between infections is 300 days and it has reduced length of stay by a day and a half.

NHS Fife (Wednesday, September 22)

The health board has implemented project to reduce “crash calls” – calls for an emergency response. Staff are ensuring patients avoid gradual deterioration, which can lead to cardiac arrest, by giving their vital signs a score. A low score means the patient is deteriorating, so they are monitored more closely. If the score falls below a certain threshold, the hospitals “rescue system” is called. This will be a team of staff who will intervene to improve the patient’s condition, avoiding the need for a crash call.

Early evidence is showing this is having an impact on reducing crash calls.

NHS Lanarkshire (Wednesday, October 14) – better monitoring and application of standards has reduced C.diff infections in the wards piloting the programme by around 50 per cent. This is done by applying best practice – hand washing, cleaning, reducing patient movement. These interventions have now been spread to all clinical areas in NHS Lanarkshire’s three main hospitals.

NHS Tayside (Tuesday, October 20) – leadership walkrounds

A senior executive visits one ward or area every week to hear first hand of issues/problems being experienced by front-line staff. This is effective as the senior managers have the power to effect rapid change.

So far Tayside has carried out 150 walkrounds and every board in Scotland is now doing this.

NHS Grampian (Thursday, October 22) – A medicines reconciliation project is aiming to reduce the opportunity for error and harm to patients by making sure they are given the right medicines at every stage of their care.

Every patient is asked to bring in all their medication. This often includes old medicines that are no longer appropriate, drugs prescribed for other people or over-the-counter drugs. Between admission and discharge a doctor uses information from the patient, their Emergency Care Summary, GP and relatives to make sure they’re on the right regime.

The programme is currently 20 months into its five-year lifespan.

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