Presentation by the Associate Director of Nursing (Patient Safety & Governance), County Durham and Darlington NHS Foundation Trust  

The Associate Director of Nursing (Patient Safety and Governance) and Senior Associate Director of Assurance and Compliance gave a presentation updating Members on the progress against the interim improvement objectives for 2021/22.

Members were advised that the quality strategy, Quality Matters, was being refreshed through a wide programme of consultation; that a number of interim improvement objectives were put in place for 2021/22; and details were provided on the progress against the interim improvement objectives for 2021/22, where data was available.

Falls

Members were advised that the number of acute falls had decreased when compared to the same period in 2020; and noted that there were 6.3 acute falls per 1000 bed days and there were 7.1 community falls per 1000 bed days.

Members were pleased to note the publication of a new Falls Strategy; that a new Rapid Review and learning process from all falls had been implemented; and that recruitment was underway for a Quality Improvement Senior Sister that would lead improvement projects, initially focussing on falls.

Healthcare Acquired Infections

MRSA Bacteraemia – The Trusts target is zero and it was reported that there had been four cases reported to 31 December 2021.

Clostridium difficile – The target for Clostridium difficile infection (CDI) is no more than 45 cases and the trust had reported 35 cases up to 31 December 2021.

Members were informed that the blood culture policy was being updated in line with national guidance; that face to face Infection Prevention and Control training through ‘topic of the month’ sessions was being provided for front-line staff; that NHSE/I’s Infection Control Lead had visited the Trusts sites to review controls; and five Task and Finish Groups were in place and leading work to continually enhance the Trusts controls in line with good practice.

Care of Patients with Dementia

Members were informed of the ongoing work, including the re-launch of the lead dementia role and work to strengthen the role of dementia link nurses. Members were pleased to note the re-launch of John’s Campaign, use of carer passports and ‘This Is Me’ documentation and the introduction of a quarterly Dementia Care Newsletter for staff.

Pressure Ulcers

Members noted the Trusts zero tolerance for pressure ulcers resulting from lapses in care and the aim to have no Category 3/4 pressure ulcers and were pleased to note that the Trust was on track to meet the ambition.

Electronic Discharge Letters

Members noted the target of 95 per cent and were advised that during the first half of the year the Trust maintained performance in line with previous years, however this was not at the target; and that demand pressures in the second half of the year had impacted on performance. We were informed that the ‘Work As One’ initiative continued with a close focus on all aspects of discharge. 

Care of Patients with Sepsis

Members were informed of the aim to improve the percentage of patients

receiving antibiotics within 1 hour of diagnosis in the Emergency Department (ED) and the challenges in light of the increased demands on the ED.

Members noted the delivery of simulation study days to improve staff awareness and processes and the development of a Patient Group Directive which was being piloted in the ED in Darlington. A Lead Sepsis Nurse had been appointed and details were provided of the new sepsis 6 screening tool as part of the new electronic patient record system.

Nutrition and Hydration

Members noted that work continues to promote optimal nutrition and hydration for all patients. It was reported that high levels of compliance had been maintained; that focused support was provided to any wards or teams not meeting the 90% thresholds; and the Acute Kidney Injury nurse was well embedded.

End of Life and Palliative Care

Members noted that the Trust had engaged with partners to develop the Tees-wide palliative care strategy; work was ongoing in relation to recognition of dying in hospital; and care after death documentation had been reviewed and a checklist developed and rolled out to all teams.

Mortality/ Learning from Deaths

It was reported that the Summary Hospital Mortality Indicator (SHMI) was within expected limits for Darlington; that COVID-19 had impacted on the reliability of the SHMI; and that assurance could be taken from the mortality reviews undertaken by the Trust, which showed of the 1072 deaths reviewed in 2020/21, less than 1 per cent had evidence of lapses in care.

Maternity Standards

It was reported that work was in progress to appoint a fetal medicine consultant; the Head of Midwifery role had been upgraded, reporting directly to the Director of Nursing; staffing was under continual review and national funding had been secured to recruit beyond current vacancies and support resilience; and the Continuity of Carer programme had been rolled out to four teams.

Paediatrics

Members noted that the Paediatric Assessment Area at UHND was now open 24/7; acknowledged that due to estate constraints a similar facility could not be established in Darlington Memorial Hospital (DMH), however the complement of children’s nurses in A&E at DMH had been increased and training in paediatric competencies had been established for all nursing staff working that area; and a formal Partnership Alliance had been established to strengthen services for children and young people with mental health issues.

Excellence Reporting

Members noted that reporting of excellence in the organisation was promoted the via a quarterly Trust-wide bulletin and that excellence reporting was now tied in with patient compliments.

A&E Waiting times

Members noted the performance trends for Emergency Department and 4 hour wait performance over the period April to October 2021. Members were disappointed to note the deterioration in performance against the 4 hour wait but acknowledged the improvements in time to initial assessment.

Discussion ensued regarding work being undertaken to address concerns and complaints regarding wait times in the ED, with reference made to the impact of patients not being able to access GP appointments.  Members were assured that a comprehensive work programme was in place to optimise flow in the department and the hospital, ensuring patients were as safe as possible and in receipt of a good experience; an A and E system delivery group was in place to review at all aspects of the department; and in relation to ED attendance, the #doyourbitcampaign which was in place, aimed to raise awareness of the first routes people should take for urgent medical advice and treatment; and Members were informed that a number actions were in place to ensure the best use of the GP supported urgent care centre.

Members acknowledged progress against the priorities and the contribution from staff in the Trust, in a particularly challenging year.

IT WAS AGREED – (a) That the Associate Director of Nursing (Patient Safety and Governance) and Senior Associate Director of Assurance and Compliance be thanked for their informative presentation.

(b) That Members be provided with figures and trends for sepsis cases.

(c) That a visit to observe the sepsis screening tool be arranged for Members of this Scrutiny Committee.

(d) That this Scrutiny Committee receives an update at the next meeting regarding the programme of work in place to address A and E wait times.