Safety

At Birmingham Children's Hospital we are proud to be part of the Government-led 'Sign-up to Safety' campaign.

Sign up to safetyAt Birmingham Children's Hospital we are proud to be part of the Government-led 'Sign-up to Safety' campaign that aims to make the NHS the safest healthcare system in the world. Sign up to Safety requires NHS organisations to:

  • Listen to patients, carers and staff
  • Learn from what they say when things go wrong
  • Take action to improve patients’ safety

The campaign is designed to encourage NHS organisations to be part of a system devoted to continuous learning and improvement.

Sign up to Safety aims to deliver harm free care for every patient, every time, everywhere.  It champions openness and honesty and supports everyone to improve the safety of patients.

The Sign up to Safety pledges

By being part of the campaign we have committed to setting out actions that we will undertake in response to the following five pledges:

  1. Put safety first. Commit to reducing avoidable harm in the NHS by half and make public the goals and plans developed locally.
  2. Continually learn. Make their organisations more resilient to risks, by acting on the feedback from patients and by constantly measuring and monitoring how safe their services are.
  3. Honesty. Be transparent with people about their progress to tackle patient safety issues and support staff to be candid with patients and their families if something goes wrong.
  4. Collaborate. Take a leading role in supporting local collaborative learning, so that improvements are made across all of the local services that patients use.
  5. Support. Help people understand why things go wrong and how to put them right. Give staff the time and support to improve and celebrate the progress.

 

The five Birmingham Children's Hospital Sign up to Safety pledges

At Birmingham Children's Hospital we pride ourselves on placing quality and safety at the heart of all we do. 

1. Put safety first

Commit to reducing avoidable harm in the NHS by half and make public our goals and plans developed locally.

We will continue to work towards our strategic objective that ‘Every child and young person cared for by Birmingham Children’s Hospital will be provided with safe, high quality care, and a fantastic patient and family experience’.

Underpinning all of our strategic objectives is a series of stated priorities. One of these is ‘To further innovate our systems to promote and enhance patient safety and reduce avoidable harm’.

Our three year Safety Strategy aims to engender a culture of proactive safety management. It reflects the need to consider safety as the ability to succeed under varying conditions, so that the number of intended and acceptable outcomes is as high as possible. By looking at what goes right as well as what goes wrong with the clinical care we deliver, we learn from what succeeds, as well as from what fails

The strategy comprises five domains:

  1. Ensuring that things go right - a proactive approach to safety
  2. Build workforce capability in quality improvement and patient safety science
  3. Design human factors into our clinical systems
  4. Continual learning - better use of patient safety and quality information
  5. Transparency of our patient safety and quality information

We have specifically targeted the following areas for improvement:

a) Sepsis

Sepsis is a significant cause of death and disability in the UK. Evidence supports prompt administration of antibiotics following the recognition of sepsis. We are introducing a new sepsis pathway across the Trust, the Paediatric Sepsis 6 (PS6), to enable early sepsis recognition and management, including a shorter time between diagnosis and administration of antibiotics.

b) Neutropenic Sepsis

Neutropenic sepsis is a potentially fatal complication of chemotherapy and early administration of antibiotics has been shown to significantly reduce morbidity and mortality. We plan to re-design the neutropenic sepsis pathway to enable us to achieve a ‘door to needle’ time of less than one hour.

c) Central Line Blood Stream Infections (CVC-BSI)

CVC-BSIs are a significant source of morbidity for some of our sickest patients. We have made significant progress in reducing CVC-BSIs in patients on the intensive care unit; however CVC-BSI rates remain high in other clinical areas, in part due to the challenges of diagnosing CVC-BSI. We plan to undertake systems diagnostics to understand factors contributing to BSIs and use this information to design a safer clinical system.

d) Medication Safety

We are developing a Medication Safety Audit to improve reliability of reported medication error rates which will be in place within the next year.

We are also looking at better ways to record the severity of medication incidents. The current data that is recorded suggests that the vast majority of reported medication errors do not lead to patient harm. We plan to introduce a more reliable way of classifying reported medication incidents (US National Coordinating Council for Medication Error Reporting and Prevention (MERP) classification), to make our reporting even more accurate.

We plan to undertake systems diagnostics to understand factors contributing to medication incidents and use this information to design safer medication pathways.

The prescribing information and communication system or ‘PICS’ is a system developed by University Hospitals Birmingham (UHB). The system has a range of functions including Electronic Prescribing and Medicines Administration (EPMA).   We are working with UHB to develop a paediatric EPMA. Currently, there is no other comprehensive, hospital wide fully integrated system of this type in any children’s hospital in the world.  We believe that the system will enable more decision support for clinical staff than in any other system, safety alerts, hospital wide real time patient level drug data and up to 80% reduction in drug errors.  We plan to have piloted and implemented the system by 2016.

2. Continually learn

Make our organisation more resilient to risks, by acting on the feedback from patients and by constantly measuring and monitoring how safe our services are.

We will continue to deliver our strategic priority ‘To further develop the way that we gather feedback from staff, children, young people and families to ensure that their voice is heard at every level of the organisation’.

The Safety Strategy contains a commitment to continual learning and better use of patient safety and quality information. As we transition from reactive to proactive safety management, we need to critically review our measures of safety to ensure that there is a balance of measurement of past harm and proactive safety measures.

We have a wealth of patient safety and quality information constantly streaming into the Trust and we are looking at how we can use this information even more effectively to better inform decision makers and provide greater assurance

We’ve also been looking at how we can make the NHS Safety Thermometer © responsive for children’s health risks, and launched our own tool – SCAN – Safer Children’s Audit No Harm. This has been endorsed by NHS England for a country-wide roll out.

We have developed our Board Report on Quality, Safety and Patient Experience by aligning the content to the five domains described in the Health Foundation paper, ‘The Measurement and Monitoring of Safety’

We are innovative in the way that we receive, respond to and use feedback and aim to be open and transparent to encourage frank conversations. Our award winning feedback app give us real time feedback, both good and bad, which staff are able to respond to directly  We also encourage and monitor feedback through social media platforms Facebook and Twitter to make giving feedback as easy as possible for people of all ages.  

The Collaboration for Leadership in Applied Health Research and Care - West Midlands (CLAHRC- WM) have agreed to work with us on a research project designed with the intention to produce insights for developing the capacity needed to translate evidence into practice for quality improvement, specifically in the domain of patient safety. The research will study the use and flow of patient safety evidence, including patient experience feedback, at BCH from ‘Board to Ward’ and vice versa.

3. Honesty

Be transparent with people about our progress to tackle patient safety issues and support staff to be candid with patients and their families if something goes wrong.

We will strive to deliver the stated Safety Strategy intent of Transparency of our patient safety and quality information

Openness and sharing of our patient safety and quality information is a must if we are to progress to delivering the safest clinical care.  Such openness engenders trust from children, young people and families and promotes an enhanced safety culture within our organisation which drives service development.

We are planning to actively engage our staff, users of our services, other NHS organisations and the wider public in the sharing of our patient safety and quality data and develop the use of safety cases to explicitly state the safety and vulnerability of our clinical systems.  A Safety Case is a structured argument, supported by evidence, intended to justify that a system is acceptably safe.  Safety cases are often used in highly regulated industries such as the nuclear industry to demonstrate that systems and processes are safe, prior to their implementation.  Until recently their use in healthcare has been limited to the use of medical devices. We intend to explore the feasibility of using the safety case methodology across an existing complex clinical pathway.

We will continue to demonstrate our compliance with the 'Duty of Candour' and monitor our performance at Board level on at least a quarterly basis. Not only will we always inform families of all moderate harms we will endeavour to be transparent whenever there is harm, regardless of the level.

The patient feedback App has been designed to make it quicker and easier to send thoughts and comments directly to the ward or area visited with the simple click of a button.  The message goes directly to the manager in charge so it can be addressed straight away, and as part of our commitment to openness and transparency, we publish the feedback and our responses on our website in real-time.

4. Collaborate

Take a leading role in supporting local collaborative learning, so that improvements are made across all of the local services that patients use.

We hosted the Paediatric Patient Safety Congress Day in May 2013, where over 60 delegates from around the world came together to share best practice. A significant outcome has been the creation of a new working group, called MIST – Making it Safer Together – a collaboration between staff from children’s hospitals across the country whose aim is to share safety data and best practice. We will continue to develop the group and work together on our shared safety goals, including the reduction of adverse drug events, central line associated blood stream infections and readmissions and further hospital acquired complications.

As stated in our strategic objectives, ‘We will continue to develop Birmingham Children’s Hospital as a provider of outstanding local services: ‘a hospital without walls’, working in close partnership with other organisations’. To achieve this we have prioritised developing relationships with our partners and commissioners to support high quality, high value healthcare, for children and young people across the West Midlands and beyond.

5. Support

Help people understand why things go wrong and how to put them right. Give staff the time and support to improve and celebrate the progress.

We will deliver our People Strategy which  sets out our commitment and plans for developing and supporting every member of staff to be the best they can be.

We believe that patient safety is linked to the well-being and safety of our staff, and our annual 'InTent' week is focussed on "Caring for Team BCH".  This will include the Human Factors approach and Chimp Mind Management Training.  The Chimp Model is a simple but accessible approach to understanding and managing thinking and emotions to improve quality of life.

We believe that training plays a critical role in the success of our people, and amongst our ongoing training programmes, a key area of focus will be equipping managers with the skills and knowledge to support staff to deliver better services. Our 'Team Maker' Programme is the cornerstone of this. 

We will appoint an Ambassador for Cultural Change to work alongside our Chief Executive to improve safety and quality for our children and families. They will have total autonomy to highlight areas of concern, support staff to speak out and enable us to learn from and improve what we do.  The new role will ensure that we continue to have an open, inclusive and collaborative culture. Part of this is welcoming and appreciating the raising of concerns, seeing them as opportunities to learn and continually improve.

We have recently appointed a Head of Staff Experience and Culture Development.  The focus of this unique role will be on 'Team BCH' and caring for, developing and managing our teams – a key part of our People Strategy.  The post holder will develop a range of tools, practices and models that will enable our leaders to embed positive culture and behaviour and make BCH a place that people want to work.

We will build workforce capability in quality improvement and patient safety science and design human factors into our clinical systems.  We plan to build a patient safety and quality improvement faculty, bringing all this expertise together with patient representatives into a multi-professional team. The faculty will deliver training in quality improvement and patient safety science to the rest of the workforce. Additionally, members will coach frontline teams to implement patient safety and quality improvement initiatives. The faculty will champion patient and parent engagement in the co-design of service improvements, enhance our workforce capability and enable frontline teams deliver service redesign at scale.

We plan to take the application of human factors science a stage further and use it to design safer clinical systems, effectively to boost our performance by minimising performance influencing factors and making error prone activities failsafe.

Situational Awareness

Situational awareness is the ability to perceive change in one’s environment, comprehend the current state and project into the near future the likely implications of the change detected.  This cognitive process is fundamental to successful adaptive behaviour in a dynamic environment such as healthcare.  In a clinical setting, loss of situational awareness can result in staff being unable to recognise deterioration in the clinical status of patients and the failure to escalate clinical concerns represent one of the highest frequencies of clinical incident types reported. We plan to focus on two key pathways to improve situational awareness across the organisation.

a) Clinical Handover

Clinical handover remains an area of vulnerability within healthcare systems. Our Hospital Handover Project, funded through the Health Foundation, was piloted on a number of wards to vastly improve the quality of information shared between clinicians. Following great staff feedback we are due to roll this out across the trust.

b) Safety Huddles

Failure to recognise and treat clinical deterioration remains a source of serious preventable harm for patients in hospital. Many hospitals have introduced Safety Huddles to promote situational awareness and improve patient safety. Safety Huddles are typically short briefings designed to give frontline staff and bedside caregivers’ opportunities to stay informed, review events, make and share plans for ensuring well-coordinated patient care. We plan to implement ward based huddles which feed into a ‘whole hospital’ inpatient huddle. This will be delivered in partnership with the RCPCH- Closing the Gap in patient safety project.

We are introducing bespoke 'Prepare & Support' training to help staff manage the stress associated with critical incidents.

PREPARE is the training we offer to prepare staff to cope/perform better and be more resilient.

SUPPORT provides structured feedback and language skills to enable better management and support to teams after an event has occurred.  This intervention isn't limited to use after a clinical critical incident, it can also be also be helpful during every day difficult conversations that we have with colleagues and families.

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