Chester Clinic

Project brief

Matrons Board Report – Quarter 3 2012
Paper for
Board of Directors on 27 March 2013
Director
Lisa Knight, Director of Patient Care/Chief Nurse
Paper prepared by:
Jane Naish, Deputy Chief Nurse/Head of Quality
Jon White, Senior Nurse (Practice Development and Rapid Response)
This report is the third quarterly Matrons' Board Report for 2012 / 2013. Matrons are required to report quarterly to Trust Boards on cleanliness and infection control with a focus on compliance with statutory obligations. In addition this report should provide Trust Board with quality assurance across a range of activities in nursing and midwifery. In November 2012 senior nurses met to discuss the key areas for care quality improvement at the trust. These were identified as: In patient falls Nutrition and hydration Patient observations and failure to identify the detoriating patient quickly Pressure ulcers Infection Control Medication incidents Patient experience Care of the patient with dementia Embedding the learning from Serious Incidents Therefore future matrons reports to board will reflect and emphasise work on the above list with an evidence base of change made where possible. As referred to in the Quarter 2 Matrons Board report, the weekly inspection round by matrons on Tuesday mornings is now more structured with a specific focus each week and targeted at identified care quality issue(s). This change began in Quarter 3 so only one targeted matrons round for December 2012 is reported in this paper. There are a number of factors that contribute to the selection of a focus for a matrons round. For example a change in data that indicates a priority for action, such as a rise in the incidence of patient complaints or in patient falls; action needed following an external inspection visit by the Care Quality Commission or Clinical Commissioning Group; a national patient safety themed week such as that on nutrition and hydration; and so on. The December 2012 targeted matrons round reported in this paper focussed on action taken following a serious incident to embed learning across clinical areas and put in place a process that makes it easy for staff to do the right thing in administration of intra venous medication. Matrons rounds are also now usually undertaken in partnership with another staff group or department, such as pharmacy, clinical governance, or dietetics. This is because so many care quality issues have dimensions that cut across any one staff group; and also because we want to embed quality as everyone's business across the trust rather than only or mainly the province of senior nursing. However, the key function of a matron role is care quality assurance and we have undertaken work to further develop the matron role in this area. This includes all the matrons (together as a team) undertaking a customised module from the MBA programme at the university of Bedfordshire on quality improvement – theories, techniques, processes, metrics (starts January 2013). As part of this they will each implement a management project in their clinical area to improve the quality of care. Topics range from shift nurse leadership to improving patient health outcomes in the out patient department and progress reports will be presented in future matrons reports to trust board. Finally the matrons round now uses a variety of ways to drive quality improvement i.e. it is not just an inspection of the environment. Sometimes matrons will talk to patients about the care they have received; talk to nurses and other staff about how they provide care, including sometimes a test of their knowledge and/or skill; measure patient observations and documentation (we will be implementing ward care metrics that allow comparison of performance between wards in the very near future). The Board of Directors is asked to note the progress and performance set out in this assurance report. Not set out in this paper. All strategic objectives strategic objectives: This conforms to Trust Equality framework Previous Matrons' Board Reports. As set out throughout the paper. This report is the third quarterly Matrons' Board Report for 2012 / 2013. This paper will report on cleanliness and infection control plus a targeted matrons round to correct and embed practice and learning following a medication Serious Incident. 2. Infection Control
MRSA: Bacteraemia Bacteraemia = zero Bacteraemia = zero (T =0) Bacteraemia = zero (T = 0) ( trajectory for month = 1) Clostridium difficile November
December
2 cases; 1 in medicine and 1 in 3 cases; 2 in medicine and 1 in surgery 2 cases; 1 in medicine and 1 in surgery (T = 2) surgery (trajectory = 2) Vancomycin resistant enterococci (VRE) glycopeptide resistant enterococci (GRE) and extended spectrum beta- lactamase (ESBL) November
December
ESBL = 1 for medicine Outbreaks and Incidents
Ward 3: female medicine with a focus on the older patient was closed to new admissions for the period 21st
to 27th November 2012 due to a number of patients and staff becoming unwell with gastroenteritis type
symptoms. Samples sent to the Cambridge reference laboratory confirmed the presence of norovirus.
Preventative measures within the hospital contained the outbreak to this one ward.
3. Cleanliness Monitoring

Matrons and Senior Sisters/Charge Nurses continue to receive monthly individual Credits for cleaning
(C4C) scores for their clinical areas. Matrons are responsible for ensuring that Senior Sisters/Charge
Nurses, nursing and domestic staff implement corrective actions where required.
Improvement has been demonstrated in areas where weekly monitoring has been implemented as part of a
corrective action programme:
Average YTD Target Significant Risk Area
Each category of risk for credits for cleaning has a different percentage for their target rating which is
nationally set, the amber and red rating is an internally set target.
Very high risk – These areas are monitored weekly and the score are continuing to improve and are
consistently maintained as ‘green'.
High risk – These areas are monitored monthly and the score are continuing to improve and are
consistently maintained as ‘green'.
Significant Risk – These areas are monitored on a 3 monthly basis and consist predominantly of
outpatient settings. They have maintained a ‘Green' status overall.
The Table below illustrates the scoring for nursing, by risk category benchmarked against national
standards of cleanliness according to the Credits for cleaning initiative.
Very high risk –The rating trend has achieved ‘Green' status consistently.
High risk – The rating trend has achieved ‘Green' status consistently.
Significant Risk – Nursing has remained a ‘Green' status this quarter.
5. Learning from Serious Incidents
In December 2012 a serious ‘near miss' incident (SI) occurred when a patient nearly had medication (lignocaine which is used as a local anaesthetic) administered intravenously which by this route would have caused serious damage to the patient and possibly death if it had not been noticed in time. The junior doctor concerned was seen, counselled and competency assessed. However, the underlying context to this incident was that it was an ambulance ‘red call' patient who was being resuscitated immediately on admission, and the box of IV flush ampoules had been contaminated by another drug – lignocaine - because the box top had been taken off and the errant drug placed in there by mistake. The underpinning cause to this SI is both individual and system error and the key learning for future practice and patient safety was to ensure it is hard to mix up IV access drugs because they are stored separately and securely in their own packaging i.e. the aim is to make it easy for staff to do the right thing. Therefore as a first step an audit was undertaken of all clinical areas and IV access flushes. The results in summary were: Stored in original
Sizes stored
Products
Ampoules checked
container with
separately?
all in date (none
lids on and
separately?
expired)? Y/N
closed? Y/N
TOTAL YES
Not applicable (n/a) e.g. no ampoules or
only one drug held in the area
Total
% YES (meet standard) of all applicable
No indicates areas of high or highest risk The following lignocaine (‘lidocaine') proximity issues were observed: Ward/Area
Proximity with Lidocaine Comments

Theatres Phase 2 Lidocaine stored next to water for injection and sodium chloride ampoules Lidocaine stored in same cupboard - in original boxes with lids Lidocaine stored away from water for injection/ sodium chloride, however next to a box of Salbutamol nebules Theatres Phase 1 Lidocaine stored on same counter as water for injection /sodium chloride 0.9% injection, but separately, in own box Lidocaine only - no water or sodium chloride OPD Fracture Clinic Lidocaine box with lid stored in same cupboard Lidocaine on drug tray in own box - water for injection and sodium chloride Lidocaine stored in locked cupboard behind nurse station separate to store Sodium chloride ampoule found in Lidocaine box Sodium chloride ampoule found in Lidocaine box There were issues of significant concern in both the above. Therefore subsequently action was taken with a targeted specific matron round in partnership with the pharmacy department and clinical governance facilitators to: physically change errant storage arrangements educate staff about the importance of correct storage.

Source: http://www.mkhospital.nhs.uk/index.php?view=download&alias=562-item-06b-matrons-report-quarter-3&category_slug=march-27-2013&option=com_docman&layout=table&Itemid=641