THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST
Board Paper - Cover Sheet
Date: 23rd March 2016 / Report Title: Clinical Assurance Toolkit (CAT) / Agenda Item A5(iv)Lead Director
Report Author / Nursing & Patient Services Director
Helen Lamont, Nursing and Patient Services Director
Elizabeth Harris, Deputy Director of Nursing & Patient Services (RVI)
Classification / NHS Unclassified / NHS Protect / NHS Confidential
Purpose (Tick one only) / Approval / Discussion / For Information
Links to Strategic Objectives / · To put patients and carers at the centre of all we do and to provide care of the highest standard in terms of both safety and quality
· To continue to be recognised as a first-class teaching hospital, counted amongst the top 10 in the country, which promotes a culture of excellence, in all that we do
Links to CQC Domains/
Fundamental Standard(s) / Regulation 9, 11, 12, 13, 14, 15, 17, 18
Identified Risk? (If yes, risk reference) / None
Resource Implications / No additional resource implications
Legal implications and equality and diversity assessment / Failure to assure high quality and safe care may lead to patient harm, litigation against the Trust and loss of reputation.
There are no specific equality and diversity implications from this paper.
Benefit to patients and the public / Assuring patient safety
Report History / This is a regular monthly update to the Board on the results from the Clinical Assurance Toolkit (CAT) and to provide assurance of the progress and priorities attaches to a range of patient safety and quality issues.
Next steps / To read, discuss and note this paper
THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST
CLINICAL ASSURANCE TOOLKIT (CAT)
EXECUTIVE SUMMARY
This paper provides the regular monthly report to support Nursing and clinical quality assurance.
The Board is aware that the Clinical Assurance Toolkit (CAT) is a monthly self-assessment process undertaken by Sisters/Charge Nurses, regarding clinical standards at Ward and Department level, as well as environmental cleanliness checks by the Matrons (in the acute setting) which are peer reviewed quarterly. This month’s report contains the following:
· Trend information demonstrates that the overall CAT score continues to be above 96% in February. Clinical staff are being consulted during March on question changes, which will take effect from April in line with previous question changes (except October 2015, when changes were minor), this is expected to result in lower scores when April’s results are reported (May’s Board paper). Question changes include IPC staff knowledge and new Outpatient questions.
· Each month an aspect of CAT is analysed in more detail. This month the focus is on the National Early Warning Score (NEWS) documentation, at a Trust level. Scores for these questions are high overall, which demonstrates that patient vital signs are accurately recorded and appropriate interventions are undertaken.
· An overview of the areas with red scores for two months that have been escalated to Matrons. There were 6 areas in February, compared with 4 in January. Cleanliness checks were not red in any areas for the two months ending February.
· Details on the progress in the Acknowledging Continuous Excellence (ACE) Awards, four applications for an ACE Award have been accepted.
RECOMMENDATION
To (i) note the content of this report (ii) comment accordingly.
Mrs Helen Lamont
Nursing & Patient Services Director
Mrs Elizabeth Harris
Deputy Director of Nursing & Patient Services (RVI)
16th March 2016
THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST
CLINICAL ASSURANCE TOOLKIT (CAT)
1. INTRODUCTION
This is the third monthly report since the updating of questions in the October 2015 CAT survey.
2. CAT REPORT SUMMARY
2.1 Scores & Trends
The table below demonstrates the trends within CAT over a period of six months. Scores by Directorate can be found in Appendix 1. Staff Knowledge scores are now ‘amber’ at Trust level for the first time in a year, due to a steady improvement in scores. Questions around safeguarding relating to consent and capacity are now well embedded in the CAT, having initially led to some low scores across the board.
The scores from Environmental Cleanliness continue to demonstrate high standards across the Trust. It is noteworthy that Matron peer review of cleanliness (last undertaken in January 2016) yielded slightly higher scores than usual.
2.2 National Early Warning Score (NEWS) Documentation
This month, the focus and analysis in this section is on National Early Warning Score (NEWS) documentation. NEWS draws together a key set of patient vital signs which are critical to identify deteriorating patients and forms part of the Sign up to Safety campaign. Depending on the score, different actions are triggered, including a review of the patient by medical staff, increasing the frequency of observations and involvement of Critical Care. As part of CAT, the NEWS observations of five patients are reviewed.
In February, 338 sets of NEWS observations were reviewed. The minimum six observations (temperature, systolic blood pressure, heart rate, respiratory rate, oxygen saturation and AVPU) were recorded in 99% of cases. Similarly, the score had been correctly calculated in 99% of cases – this is important to ensure that the correct level of intervention is put in place.
Some aspects of NEWS are only relevant to certain patients. For patients who required piped oxygen, 91% had an oxygen prescription target identified on the NEWS documentation. The urine output had been added to the NEWS score in 100% of cases.
There was an appropriate response to the NEWS score documented in 98% of cases and a documented review by a NEWS Responder in 93% of cases.
Overall, NEWS compliance was 96% in February. This is accounted for by the fact that if any aspect of the NEWS process is incomplete, the whole document for that patient is counted as incomplete; expected standards are very high.
February’s results relating to NEWS documentation are consistent with previous months (ranging from 92% to 96% in the last six months) and demonstrate high levels of compliance with documentation. External audits of NEWS are undertaken periodically by the Clinical Governance & Risk Department. The CAT audit demonstrates excellent practice.
Next month the focus will be on Paediatric assurance measures.
2.3 Escalation of ‘Red’ Areas
Any area that receives a red score (less than 91%) for the whole of the CAT over two consecutive months will appear on the escalation report. There were six areas with an overall red score for two consecutive months in February, compared with four in January. It is worth nothing that any changes made to CAT questions from April are likely to have an impact on the number of areas receiving a red score, as we have seen in previous question changes. The exception to this was October 2015, when changes were minor and were mostly used to clarify existing questions (for example, incorporating the use of new Nursing assessment documentation) or to broaden other questions (for example, expanding venepuncture observations in Outpatients to include observations of any procedure requiring ANTT). CAT users are being consulted throughout March, following discussion at the inaugural CAT User Group in February, in order to mitigate the chances of red scores resulting from a lack of understanding or clarity about the questions.
The same process for two months of consecutive red scores applies to the Matrons’ cleanliness checks. There were no areas with an overall red score for two consecutive months in February, the same situation as in January. This is very reassuring about the levels of cleanliness across the organisation. To give additional assurance, unannounced Deputy Director of Nursing & Patient Services cleanliness audits are undertaken on an ongoing basis, with input from the IPC Team and Hotel Services.
2.4 ACE Awards
The Acknowledging Continuous Excellence (ACE) awards continue to be high priority, and the Senior Nursing Team are working to develop the application process further and continue to highlight the fantastic work that underpins this process. Any clinical area which maintains high CAT scores for four out of six months is eligible to apply. Almost all areas completing CAT are eligible to apply for their Environmental Cleanliness ACE award due to the high standard across the Trust.
There are four applications for awards have been accepted. This is the first time that areas have been eligible for all five sections of the ACE Award. The next step is a visit from a Governor and Matron to validate these results prior to the award.
3. QUESTION CHANGES IN APRIL
The six-monthly changes to the CAT questions are due to take place in April. The following changes are in draft form and are under consultation with the users:
· Cannula insertion observation questions replaced with more general questions about observing procedures requiring an aseptic approach (ANTT).
· IPC staff knowledge in Inpatient Wards will now focus on the current Trust priorities relating to reducing MRSA, C. difficile and MSSA. Questions about when to isolation patients and send samples, along with questions for Nursing and Medical staff about peripheral cannula care will replace current questions.
· New questions for Outpatients will replace the smoking cessation questions. The new questions relate to recording patient’s height and weight, recording smoking status, documentation of Nursing advice, ensuring that privacy and dignity were maintained (asking the patient after their appointment), monitoring the availability of health promotion material in waiting rooms, and ensuring that the reading material available for patients in the waiting room is suitable for the patient demographic.
· Matron cleanliness checks will now include checks of ‘circulation areas’ for damage to the fabric of the building and furnishing/fittings, i.e. the areas adjacent to clinical areas (lift areas and corridors) that are not currently subject to Nursing checks.
4. RISKS AND RISK MITIGATION
The key focus of CAT is to mitigate risks through the monitoring of a range of patient safety issues. Ward Sisters/Charge Nurses and other Clinical Leaders are encouraged to view their results alongside other assurance data, such as the results of other audits and their Care Summary reports, in order to build a complete picture of their area’s strengths and weaknesses.
Monitoring NEWS documentation is one way of mitigating the risk of a patient becoming seriously unwell on a Ward by ensuring that regular monitoring of vital signs is undertaken and acted upon.
The Board has previously been made aware of the escalation process which highlights issues within clinical areas. No major issues or risks were identified from the red scores.
5. SUMMARY
The CAT continues to be viewed as a positive assurance method. Continued involvement from clinical staff in the development of the CAT ensures that the tool provides relevant assurance across a range of clinical settings. The focus of this month’s paper demonstrated the importance of NEWS documentation, ensuring that vital signs are accurately recorded, prompting a speedy response when necessary.
6. RECOMMENDATION
To note the contents of this report and comment accordingly.
7. KEY
Main CAT Measures
/ Less than 91%/ Between 91% and 97.9%
/ 98% or more
Mrs Helen Lamont
Nursing & Patient Services Director
Mrs Elizabeth Harris
Deputy Director of Nursing & Patient Services (RVI)
16th March 2016
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