SAFE Care - ‘Safety Express’ – Mental Health & Learning Disabilities In Mental Health & Learning Disabilities the QIPP workstream is focused onto 4 main harms : Self harm, Violence & Aggression, Slips, Trips & Falls and Medication errors Aim Primary Drivers Secondary Drivers To deliver a reduction of harm within mental health and learning disability services from incidents involving : Self harm Violence & aggression Slip, Trips, Falls Medications errors by Dec 2012 Leadership and Safety Culture Clinical Care 95% reliable Supportive infrastructure Service user and family-centred care Effective risk assessment Robust care planning Promoting choice, dignity & respect Information giving Effective working between teams Sound evidence based practice Clear clinical leadership Education and Training Active patient/carer involvement Clinical supervision / Mentoring/Preceptorship Access to therapeutic interventions Safe clinical environments Effective learning safety culture Access to equipment Operational systems/ policies Meaningful activities and engagement Learning from patient/carer feedback Visible/ ongoing Executive support Promoting physical health including nutrition and hydration

QIPP Safe Care – Acute Settings The QIPP Safe Care workstream is an improvement programme designed to help organisations reduce harm. In Acute Services Safe Care tackles 4 major harms in the NHS; Falls, VTE, Pressure Ulcers, Catheter Acquired UTI by 50%,

50% reduction in in-patient physical assaults each year until 2012 Measurement Leadership Communication (SBARD) Reliable risk assessment Collateral information Aim Primary drivers 50% reduction in in-patient physical assaults each year until 2012 Secondary drivers Local feedback Standardised care Training Supportive eRecord Michael.sykes@nhs.net

Driver Diagram - STAR Unit Secondary Drivers Primary Drivers A. Raise awareness B. Introduce a SU advanced statement re management of V&A. Care Planning Aim A reduction in incidents of violence& aggression by 20% in the STAR Unit during 2012/13 A. Post all records (agreed actions) of the community meetings in a central area. B. Post a weekly activity programme at a central point on the ward. Environment A. Develop a formal process regarding the planning of social & therapeutic activities. B. Introduce a community meeting. C. Redesign role of staff member – activity co-ordinator. Therapeutic Interventions A. Review and compare data – make data easily available to staff.. B. Identify specific times/places/ personnel involved in V&A. C. Provide poster for staff comments re new PDSAs. D. Provide staff with written updates re V&A to inform staff on return from days off. E. Recruit permanent staff to vacant posts. A driver diagram is used to conceptualise an issue and determine its system components which will then create a pathway to get to a goal. Use driver diagrams to build a theory about the system that underlies your improvement project topic Workforce © 2010 AQuA Secondary drivers are interventions associated with primary drivers. They can be used to create projects or change packages that will affect the primary driver. Primary drivers are the systems changes which will contribute to achieving the Aim outcome measure. 4 4

Trust Harm Reduction Strategy Driver diagram PRIMARY OUTCOME (Measure) Sustained reduction I the frequency of the three most common types of incident each year (20% annually for each year over five years from April 2011) Incidents are: -Falls, -Violence and Aggression -Self Harm Balancing Measure Ensure other types of incidents are not neglected and increase as a result of targeted intervention. Governance Structure Report to H&S bi-monthly actions and incident data Executive lead Kim Crowe to report to board Tony Crumpton to report to H&S Leadership Identify and inform Stakeholders Engage early implementers Identify strategic and clinical leads Monitoring Policy compliance Incident data Implementation strategies Secondary Drivers - Identify reporting lines - Strategy Lead and clinical leads (x1 for each harm) -Identify external groups Safety Express to develop comparison data B C - Engage AQuA in supporting the process- -Identify with CBU’s wards / units for implementation - Support unit managers in adopting change process -identify change champions B C - Implement measures based on PDSA cycles - Share good practice / share successes - Share / report findings -Develop sensitive measures / baseline data -Identify and support clinical champions C Primary drivers are system components which will contribute to moving the primary outcome Secondary drivers are elements of the associated primary driver. They can be used to create projects of change packages that will affect the primary driver Trust Harm Reduction Strategy Driver diagram Definition: A driver diagram is used to conceptualise an issue and determine its system components which will then create a pathway to get to the goal

Aim To reduce physical assaults to staff by 20% in one year on the 2011-12 Trust baseline Safe Environment Staff Experience Communication   Handovers Patient Experience Primary drivers describe the systems / larger components which will contribute to achieving the overall aim. Each usually has an associated measure Secondary drivers are elements of the associated primary driver. They are interventions which can be used to create projects or change packages that will affect the primary driver.

Aim 50% reduction on numbers of detained patients absconding from acute Inpatient wards by Dec 2012 Evidence based policy and guidance that is implemented Therapeutic milieu Person Centred approach Audit of baseline Develop understanding of existing literatiure RA to include risk of AWOL, staff trained Identifying and dealing with patients concerns Risk assessment, profiling and management Patient activities  Safe and appropriate environment Primary drivers are systems components which will contribute to moving the primary outcome. Secondary drivers are elements of the associated primary driver. They can be used to create projects or change packages that will affect the primary driver. Driver diagram Driver diagrams are a type of structured logic chart with three or more levels (see example below). These would include: 1. a goal or vision 2. the high-level factors that you need to influence in order to achieve this goal (called ‘primary drivers’) 3. specific projects and activities that would act upon these factors We decided upon 2 projects initially – Audit of baseline Develop semi structured audit tool – in red This information lead us to complete a PDSA ..