Patient safety and experience: our response to Covid-19

May 29, 2020

Patient safety and experience: our response to COVID-19

Our Patient Safety and Experience, Healthy Ageing and Digital Transformation Teams have been working in partnership to support our local health and care system response to Covid-19.  Working as part of the NHS National Patient Safety Improvement Programmes, our work over the next six months will focus on the following areas to contribute to the NHS response to Covid-19.

Deterioration

Failure to recognise or act on signs of deterioration can result in missed opportunities to provide necessary care and give patients the best possible chance of survival (Patient Safety Alerts 2016, 2018). This area therefore continues to be a major patient safety priority for the NHS during the Covid-19 outbreak. A good system of managing deterioration includes processes and solutions that enable:

  • Early detection of physical deterioration. This includes a physiology assessment and early warning tools such as soft signs and the NEWS2 score. A growing number of digital solutions to support these processes are also available.
  • An understanding of what is “normal” for a resident.
  • Staff knowing what to do next if a person’s health deteriorates. Agreed escalation processes are required, including end-of-life preferences, advanced care and treatment escalation plans.
  • Staff to effectively communicate their concerns. This includes human factors and structured communication.

We already have a south London managing deterioration improvement programme as part of the national patient safety improvement work. Consequently, our team is contributing to national developments and assisting regional and local efforts aimed at optimising patient outcomes during the pandemic. We are also building connections with a growing number of digital projects aimed at enabling remote assessment and monitoring of patients within the community setting.

Our Programme Director for Patient Safety and Experience, Catherine Dale, is a national co-lead for the Patient Safety Collaboratives on deterioration and was instrumental in the delivery of a very successful national webinar for GPs working hard at the front line to tackle Covid-19.

Our Tracheostomy programme as part of the Patient Safety and Experience team’s wider response to Covid-19. Through the South London Critical Care Network and other local colleagues, we have been exploring what inpatient tracheostomy care looks like currently in trusts and how teams can be supported to improve it and make it even safer during these challenging times. The team are also starting to think about what service provision is available for tracheostomy care in the community, for those discharged from hospital. Find out more about the AHSN Safe tracheostomy care work here.
Our Patient Safety and Experience team is still working in collaboration with Revealing Reality and Hill+Knowlton Strategies, adapting our previous work on Behavioural Insights into Catheter Careto support and protect the health and wellbeing of healthcare staff during the current pandemic. Many staff in the NHS and beyond have found themselves in strange new territory or have been greatly affected by this global crisis. We are applying our experience of Behavioural Insights and Quality Improvement to a new project that aims to support south London staff and equip them to face the challenges ahead.
Care and outcomes for women and babies remains a priority during the pandemic. The team has been working with local trusts, as well as teams nationally, to support the sharing of intelligence and spread of innovations with the aim of maximising learning and improving safety.

We are supporting four units in south London to adopt a standardised assessment and triage system called The Birmingham Symptom-specific Obstetric Triage System (BSOTS). This provides a framework for women to be assessed quickly and reliably when presenting with concerns and those who need urgent care are prioritised, rather than reviewing women in order of attendance.

We have also been supporting the spread of the QUiPP app – a locally born clinical decision-support tool that helps to predict the likelihood of preterm delivery when a woman presents at hospital. The supporting toolkit for adoption has been rapidly rolled out during the pandemic as this innovation helps to decrease unnecessary admissions and transfers.

In partnership with our London colleagues, we have also begun to consider safety practices and cultures in maternity and neonatal care in the coming months as we enter the next phase of the pandemic.

There is evidence that patients who have information about their medicines when they are transferred to their usual community pharmacy are less likely to be readmitted to hospital. In the current Covid-19 response, with large numbers of patients being discharged quickly, it is imperative that medication safety is not overlooked. TCAM schemes are a structured way to pass on medicines information from hospital settings to community pharmacies. Trusts that already have TCAM schemes in place are asked to review their referral criteria to make sure patients at the highest risk and with the greatest need are prioritised.

We are are working with trusts who are yet to establish TCAM schemes by engaging with hospital pharmacists, community pharmacists and local pharmaceutical committees (LPCs) in those areas.

“High quality, safe care can be achieved through preparation, planning and education; the National Patient Safety Improvement Programme has created this important national program to rapidly develop the skills and knowledge for bedside staff to deliver safe tracheostomy care everywhere.”
Brendan McGrath – National Clinical Advisor for National Patient Safety Improvement Programme Covid-19 Response (Safe Tracheostomy Care); Intensive Care Consultant, Manchester University NHS FT

The team will be very happy to hear from you if you want to know more about any of our projects above or discuss support for your local work, contact hin.southlondon@nhs.net

You can also access nationally available resources and webinars on the AHSN Network Patient Safety COVID-19 webpage here.

By Rahel Gerezgiher

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