Small changes and real time monitoring are making a big impact on patient safety

At Northern Health and Social Care Trust a triumvirate of management has been created to drive clinical leadership and focus on patient safety. Each department has a director, a medical director and a divisional nurse, which gives a more clinical focus.

While implementing new service designs and new service models, it became evident to Director of Operations, Pamela McCreedy, that it was the front line staff who needed to be involved and who knew what needed to change.

She says: “We needed clinical staff on the ground to come up with ideas. That has made a big impact for all of us.” As part of a continuum of improved patient safety, the trust also launched IQI (Innovation and Quality Improvement), creating lots of innovative small changes that have a big impact. The Trust has introduced several systems to enhance safety and flow. The first is a piece of KPI software, which monitors safety parameters for nursing. It was introduced to help staff to monitor the safety of their ward in real time and make changes accordingly.

Pamela says: “They can use that information in whatever way leads to improving care, for example helping to prevent falls. It helps us to focus on incidents when they happen so that we can learn from them.”

The system can also look at staff ratio levels and staffing mix. While staff were initially skeptical of its value, they are now advocating it. Pamela says: “They realise now that it takes very little time in the morning to interrogate. They can look at issues and put in training for their teams. “The second system, ‘open ward’, allows them to identify, for example, dementia patients or patients at risk of falls.”

At the forefront of improving patient safety is the ability to communicate effectively and quickly. One of the most successful services to be introduced was the RAID team (Rapid Assessment, Interface and Discharge), joining up mental health teams with physical health teams. The RAID service is on hand 24 hours a day to help care for people who present with any form of mental health problems, for example, depression, delirium or dementia.

It helps to provide people with the appropriate care pathway as well as reducing re-admission and providing more streamlined care. Pamela says: “As a result of RAID a consultant was able to discharge someone home, straight from ICU. Linking hospital support to community support has enabled this. RAID supports both ED and the wards.”

Working in a multi-disciplinary team also enables mental health staff to transfer their knowledge to the acute teams. In many cases this has led to less need to call on the RAID teams, for example when dealing with delirium.