Two years to make a difference in Welsh Healthcare 2008-2010 1000 Lives Campaign reaches aim of saving 1,000 lives The Campaign is estimating that 1,199 additional lives have been saved by NHS staff in between April 2008 and April 2010.

Every health board and trust was involved in the Campaign, working on up to seven key content areas. These include reducing healthcare associated infections and surgical complications, and improving critical care and medicines management. The Campaign has used a new measurement tool which has enabled organisations to identify where harm occurs. This represents the first time harm has been measured on a national level and is to be the subject of a major four year research study. The final figures indicate that 50,000 episodes of harm have been prevented, but it is recognised that the solutions and ensure concerns are replacement of razors with surgical methodology needs further work quickly acted upon directly with senior clippers and better monitoring of in order to provide a greater degree managers. More than 600 WalkRounds patients’ temperatures before, of confidence. have already taken place across Wales. during and after surgery; “It’s important that we are able to Working with health boards and trusts • Worked with GPs to improve measure when, and where, harm takes over the last two years, the 1000 Lives the reliability of drug dosage place,” says Campaign Director Dr Campaign has: instructions given to patients, Alan Willson. “The work undertaken particularly in relation to Warfarin; Made sure that patients with by organisations through the Campaign • Improved treatment for patients deteriorating conditions are now • provides the basis for ongoing work to with chronic heart failure through being identified earlier, so that reduce harm in Welsh healthcare.” enhanced services, including nursing staff can intervene more improvements in diagnosis, Best initiative quickly and request medical medication and lifestyle advice; The Campaign has been effective in intervention; rolling out best practice across Wales, Developed a number of ‘trigger Implemented a procedure to prevent • as seen in the implementation of the • tools’, which are now being used by pressure ulcers, which has led to World Health Organization’s Surgical GPs, the Welsh Ambulance Service some wards having gone more than a Safety Checklist, which is now being and staff at Velindre Cancer Centre year without a case; used by operating theatre teams to identify and track potential harm. Changed attitudes towards throughout Wales. • Maintain the momentum infections caused by central lines – The checklist ensures that there is they are now regarded as avoidable “Patient safety is now on the agenda effective communication by those and often investigated as a critical of every health board and trust in involved in the surgery. It focuses on incident when they occur; Wales and the Campaign’s new ways of working are clearly making an impact,” basic good practice: checking the Made sure catheter related blood • says Dr Alan Willson. patient’s identity and the correct part stream infections (CRBSI) are now of the body for operation, ensuring all rare, rather than common events “However, it’s essential we maintain necessary equipment is available and in Wales; the momentum and don’t lose focus. providing an opportunity for discussing The ultimate goal will be to have this any complications that may arise. • Engaged patients in the safety agenda by using more of their good practice embedded in every WalkRounds stories to complement traditional organisation, so that it can be reliably Patient safety WalkRounds have been reports and data-based information and consistently delivered.” introduced in nursing homes, GP in board meetings; For further details on how the mortality practices and hospitals. These help • Reduced the number of infections and harm figures were attained, visit staff to raise safety concerns, suggest related to surgery – thanks to the www.tinyurl.com/3yvkcqw

2 Safer Patient Care The 1000 Lives Campaign aimed Introduction to save an additional 1,000 NHS staff save lives every day lives and prevent 50,000 episodes – the 1000 Lives Campaign has of harm in Welsh helped them save more. healthcare over a Two years to make a difference We know that modern healthcare can cause in Welsh Healthcare two year period. 2008-2010 harm – and yet we know that no-one working in healthcare goes into work each day to do less than Professor Sir Mansel Aylward CB a good job. The size of the system, the complexity Contents of the tasks and the diversity of treatments often conspires to work against the best endeavours of Introduction 3 individuals, ultimately causing patients harm. Empowering Frontline Staff to It was against this backdrop that the 1000 Lives Improve Patient Care 4 Campaign was launched in April 2008 – with the aim of saving an additional 1,000 lives and Improving Leadership for Quality 6 preventing 50,000 episodes of harm in Welsh healthcare. Reducing Healthcare Associated As you turn the pages of this report, which reflects Infections 8 Dr Chris Jones some of the Campaign’s major highlights, you will Improving Critical Care 10 read of the commitment and determination of NHS Wales staff – in both clinical and non-clinical settings – to introduce Improving Medicines Management 12 changes to improve the care they deliver. The 1000 Lives Campaign illustrates what can be achieved when we work Reducing Surgical Complications 14 together – and the final figures are evidence of the real difference that has been made. The changes that have been introduced in health boards Improving General Medical and and trusts throughout Wales will benefit generations of patients to come. Surgical Care 16 We want to say a sincere ‘Thank you’ to staff across Wales for the care Transforming Care at the Bedside 18 they provide to patients every day – and for taking up the challenge of the 1000 Lives Campaign and making it such a success. Measurement for Improvement 20 The Campaign’s achievements have provided a solid foundation for the 1000 Lives Plus national programme which has succeeded it. With a Putting the PR into Patient Safety 21 commitment to providing patients the care they need, by reducing harm, Patient Experiences Improving waste and variation, the programme will ensure that the Campaign’s aim Healthcare 22 to ensure consistent care across Wales will continue. This work is truly transformational. It enables staff to heal, not harm; to 1000 Lives Plus - The Next Step help, not hurt; and to bring life, hope and comfort to those who suffer for Healthcare Improvement 23 and are in pain. Thank you for your commitment, which has already achieved so much. It is a humbling and inspiring task to chair this programme as we move This report will shortly be available in forward. We welcome the opportunity to work alongside you as we Welsh, via the 1000 Lives Plus website. continue to build a better health service for the people of Wales. 1000 Lives Plus Office: 14 Cathedral Road, CF11 9LJ Professor Sir Mansel Aylward, CB, Chair, Public Health Wales Tel: (029) 2022 7744 Dr Chris Jones, Medical Director, NHS Wales Email: [email protected] Chairs, 1000 Lives Plus Web: [email protected] Twitter: www.twitter.com/1000livesplus

The 1000 Lives Campaign was run as a collaborative, which involved the National Leadership and Innovation Agency for Healthcare, National Patient Safety Agency, Public Health Wales and the Clinical Govenance Support and Development Unit. Support has also been provided by the Institute for Healthcare Improvement and the Health Foundation.

Introduction 3 Hospital staff walked a mile around Ysbyty Glan Clwyd in a local launch of the Campaign. Empowering frontline staff to improve patient care The creation of a culture where sustainable patient safety and quality care is at the top of the NHS agenda is one of the legacies of the 1000 Lives Campaign, according to its directors. Reflecting on the two year Dr Willson said, “We knew that the infections and ventilator associated Campaign, Drs Jonathon Gray and Campaign was ambitious, but we also pneumonias in critical care wards, Alan Willson explain why it has been knew that it was the right course of improved hand hygiene leading to a the small changes that have made action to improve patient safety in reduction in infections and action to the biggest difference to patient hospitals and community settings reduce pressure ulcers, with some care across Wales. across Wales.” wards going more than a year without a case. When the 1000 Lives Campaign Sustainable launched in April 2008, its leaders “Sustainable changes for the future The key, according to Dr Gray, has knew that the biggest challenge had to be made in many areas. Patient been to empower staff to deliver would be engendering a culture safety and quality has to be the main and accelerate change. change that would ensure improving focus for everyone and patients need He said, “We were aware when we patient safety became the norm for to be central to all that is delivered. began the Campaign that success everyone in NHS Wales. “We had to engender a culture change would only come if frontline staff And the key to this was to empower where situations were not accepted as were driving forward change and frontline staff to make small changes unavoidable, but solutions were sought were engaged in monitoring and that would improve patient care. that would deliver better care. delivering results. “Frontline staff have been “Organisations needed to own their able to implement small improvement work and this has been changes such as improved achieved by improved leadership and hand washing, listening better engagement with mortality to patients needs and data. spending more time at the “Measurement is now being used for bedside, that have made a improvement not for judgement and big difference to care.” there is a shared goal across NHS Existing initiatives Wales of ensuring that safe healthcare becomes a matter of routine. Building on existing initiatives and good “There are myriads of examples of practice, improvements staff applying interventions and making have been made in a simple changes to everyday practices. number of key areas, The Campaign has enabled not just one providing a new person to be responsible, but a whole standard of care for army of staff to bring about change to

many patients. improve care.” Dr Jonathon Gray, Mrs Jan Davies and Dr Alan Wilson prepare for the launch Significant developments delivered by And it is this reusable network of the Campaign in March 2008 staff have included the introduction of skilled frontline staff that has of care bundles to reduce central line delivered success, and will ensure 4 Empowering Frontline Staff Major successes • A reusable network of skilled staff to make change happen • Success delivered in every area of Wales • The creation of The Faculty for Healthcare Improvement • Use and acceptance of measurement • Improved communication • Total staff engagement in aims of Campaign • International recognition April 2008: The 1000 Lives Campaign is launched by the Minister for Health and that patient safety and quality that huge success has come from Social Services .at the Liberty Stadium, improvements continue in the future. nurses spending more time at the bedside or asking patients if there is Enthusiasm anything they need? Dr Willson said, “The enthusiasm, commitment and energy of NHS staff “But it is these small things that are over the Campaign period has been making a big impact in improving the remarkable. patient experience. “There has been staff engagement on The Campaign is succeeded by the a huge scale, the work captured hearts 1000 Lives Plus programme, which and minds and when we asked them to was launched in May 2010. improve, they all believed they could. Avoiding Harm “The buy in from those at the top was As a national programme in a five February 2009: Velindre Cancer vital and there was no argument about year strategic framework for NHS Centre marks its involvement in signing up to deliver the aims of the Wales, it will focus on giving patients the Campaign by releasing 1,000 Campaign. It was the right cause and the care they need by avoiding harm, balloons. the right time. waste and variation. “Now we have created a reusable The inclusion of the programme network of people who have the indicates just how far the patient belief and technical skills to make safety and improvement agenda change happen.” has come since the Campaign was launched in 2008. Patient pathway Wales has been able to make Dr Gray said, “We are confident improvements to the whole patient that patient safety will continue to pathway by becoming the first improve and that things won’t return country to include primary care, the to the way they were. ambulance service and oncology into “The Campaign has ensured that there April 2009. Staff from Betsi a patient safety initiative. University Health Board scale Snowdon is a focus on patient safety in every to mark the Campaign’s first anniversary. Dr Gray said: “The integrated nature health organisation of the health service has made and that staff at all innovation appropriate and success has levels are in the habit been delivered in every area of Wales. of actively supporting and delivering “Wales took improvement ideas and improvement. turned them into a Welsh product, which is now being looked at by “Everyone, wherever countries around the world.” they live in Wales, deserves world class For patients there have been visible healthcare and the signs of improvements including Campaign has the implementation of the surgical laid excellent checklist, Warfarin monitoring and foundations for this improved ward environments. to be delivered.” The introduction of patient stories has also enabled organisations to April 2009: Staff at Hywel Dda Health Board help celebrate the Campaign’s first learn from experiences and improve anniversary and its achievements within healthcare delivered. the organisation. Dr Willson said, “In terms of a national campaign, it may sound trivial to say Empowering Frontline Staff 5 Patient safety tops agenda of every health organisation in Wales Patient safety is now a priority in health organisations across Wales due to the Improving Leadership for Quality content area.

Senior leaders, staff and patients WalkRounds have become routine Patient Safety Fridays have worked together to help practice in secondary care. The improve the healthcare delivered. primary care sector has quickly Cardiff and Vale University Health Board followed, with WalkRounds taking Patient stories have become a introduced ‘Patient Safety Fridays’, the place in GP practices, community regular item at many board first of their kind in Wales. pharmacies and nursing homes. level meetings, creating a The initiative involved board members and patient-centred focus at the Primary Care WalkRounds directors dedicating Friday mornings to most senior level. Aneurin Bevan Health Board was engage with frontline staff, patients and one of the first to carry out a visitors to improve patient safety. Establishing communication WalkRound in a nursing home and Establishing board member Chair, David Francis, said “The ‘Patient found the experience strengthened WalkRounds has enabled staff Safety Friday’ initiative provided us with the relationship between the two in both primary and secondary an opportunity to bridge the gap that can organisations. care to talk openly to senior staff often open up between board members about their concerns and hopes for One staff member said, “The and frontline staff. improvement. emphasis on patient safety was “We wanted to support our staff, who work welcomed and it gave all staff the In turn, it has created a platform so hard to deliver high quality services, opportunity to demonstrate the for leaders and managers to understanding the pressures they face and quality of care.” engage in real dialogue with staff sharing our thoughts and observations.” about patient safety and enabled Most Executives described their organisations to take forward lead roles in WalkRounds useful changes to improve patient care. and energising, with evidence of learning and good practice. 6 Improving Leadership for Quality Staff appreciated the element of visible leadership, the opportunity to articulate Major successes concerns and to implement changes which could make a real difference to patients. • Patient safety topped all health organisations’ agendas Over 600 WalkRounds conducted in primary and secondary care An independent member said, “It is vital • to go on as many WalkRounds as you • Around 63% of GP practices in Wales participated in culture possibly can. It gives an enormous insight survey into the way your organisation works and • Patient stories used in Board meetings the issues that need addressing. It gives Faculty Member, Dr Andrew Goodall, Chief Executive of Aneurin you a better picture than any report.” Bevan Health Board, said, “We have empowered our staff to talk Surveying the culture openly about their concerns and hopes for improvement through Culture assessment surveys have also culture surveys, and through the establishment of patient safety provided organisations with a valuable WalkRounds. This has been a real success and now we must ensure insight into staff views about their own we continue these conversations so they become an integral part of working environment. our work in the future.” The survey looked at areas including leadership, communication, learning and innovation, relationships with the Walkrounds undertaken by Health Boards during the Campaign* organisation, staff engagement and 800 safety culture. 700 In addition to secondary care, Wales became the first country to arrange a 600 culture survey for its general medical 500 primary care services at a national level. 400 Response rates to this survey were excellent, with around 63% of GP 300 practices across Wales taking part. 200

The results enabled organisations to 100 prioritise areas for action and implement immediate changes that reduced the 0 April June Aug Oct Dec Feb Apr Jun Aug Oct Dec Feb risk of harm across the whole patient 2008 2008 2008 2008 2008 2009 2009 2009 2009 2009 2009 2010 pathway. *93 WalkRounds were carried out prior to the launch of the campaign.

Patient stories have opened up the lines of communication between patients and staff, which is incredibly important for maintaining and improving trust and confidence in the service. Patient stories open Board meeting “Patients have been able to tell their side of the story During the Campaign, the opening inform current practices and shape and staff have been given a item of every Welsh Ambulance future provision. rare glimpse into a patient’s Service board meeting involved One story illustrated how a a patient discussing a recent world. It’s simple, but it’s patient’s dignity was maintained experience of using the service. this simplicity that has made following a fall. It was used as an it such an effective tool for The patient either attended in example of good practice. person or their story was told healthcare improvement.” As one member of staff said, “This digitally via a short film or audio is not about blame, but about good Lisa Miller, Director of Operations, recording. patient care. The insights we have Velindre Cancer Centre The impact of sharing information gained inspired us to work together directly with senior staff has been to make improvements and deliver invaluable in helping the trust the best service we can.” Improving Leadership for Quality 7 Winning the battle against healthcare associated infections Better hand hygiene, cleaner clinical settings and more appropriate prescribing of antibiotics made a big impact on the ongoing battle to reduce healthcare associated infections.

Health boards and trusts have Staff have been able to challenge Cleaner commodes worked hard to prevent and their colleagues and feed back minimise infection and the biggest results on a weekly basis. reduce infections success has been the significant This has enabled a better improvement in hand hygiene A pilot project to ensure commodes are understanding of their own across Wales. cleaner has helped reduce healthcare performance and motivated them associated infections at wards in the Compliance with hand hygiene to achieve better results. Princess of Wales Hospital, and rates has increased to between Cleaner environments Morriston Hospital, Swansea. 95% and 100% on pilot wards Similar to the system guests find at toilets in all Welsh hospitals and this There has also been more in hotel rooms, a tape has been placed good practice is currently being monitoring of the time it takes over clean commodes. The tape is then spread throughout all healthcare to clean environments and better signed to confirm it’s been cleaned. organisations. checks to ensure that equipment and wards are as clean as possible. New wipes have also replaced water and The improvement is down to have been proven to destroy bacteria more awareness and better Another key area of success has including C.difficile, MRSA and E.coli. engagement with staff. come through improving the cleaning of ambulances and equipment to Sister Beverly Williams said, “Our Historically, hand hygiene audits ensure patients are treated in a safe commodes are spotless and this has gone have been done in hospitals by and infection-free environment. down well with patients. The feedback on external teams. Now staff have the cleanliness has been very pleasing.” ownership of audits at ward The Welsh Ambulance Services NHS level and this has made all the Trust has focused on ensuring there The initiative is being spread across Wales. difference. are adequate cleaning facilities and equipment at ambulance stations.

8 Reducing Healthcare Associated Infections Major successes • 30% increase in hand hygiene compliance – reaching an average of 90% across Welsh hospitals • Improved hand hygiene in nursing homes, GP practices and HM Prison Cardiff • Cleaner commodes, reducing rates of infection • More appropriate antibiotic prescribing • Improved cleaning of ambulances and equipment Faculty Member, Dr Eleri Davies, Director of Welsh Healthcare Associated Infection Programme, said, “We know we can never completely eradicate the risk of healthcare associated infections, but if we continue to take forward all the good practice we can bring rates down to a minimum.

“This will ensure the quality of the care we give patients is as good as it can be and that’s what the 1000 Lives Campaign was driving towards – to deliver a world class health service.”

The Trust has also worked with which can deliver a much greater health boards throughout Wales reduction in healthcare associated and bordering areas of England infections than we have done to to provide facilities to allow date.” Infection rates fall thanks ambulance crews to clean Antibiotic control to improvement measures vehicle interiors at Accident and Emergency departments. More appropriate prescribing Staff from board to ward have helped rates of antibiotics has also reduced of C.difficile and MRSA fall by 30% and 40% in Primary Care the risk of patients developing Aneurin Bevan Heath Board during the past Standards of hand hygiene have antibiotic-resistant infections. two years. also improved across primary care. In Anglesey, previously the highest Better hand hygiene, improved environmental In Cardiff, improved infection prescriber of antibiotics in Wales, cleaning and more appropriate antibiotic control measures were patients were given information prescribing have all contributed to the implemented in nursing homes, GP explaining why they were not success. practices and HM Prison Cardiff. prescribed an antibiotic for their Infection Control and Prevention Lead Nurse condition. The prison participated in an Liz Waters said, “The 1000 Lives Campaign infection control audit to improve Improved stewardship of was instrumental in improving infection hand hygiene, waste management antibiotics by pharmacists has control and ensured that hand hygiene was and environmental control. also proved successful in other finally taken seriously. areas of Wales and good practice Senior Nurse, Kath Hier said, “The “It got people talking, gave us the tools has continued to spread to all 1000 Lives Campaign has given us to make improvements and has enabled organisations. the opportunity to look at those a culture change that has been truly basic small changes in practice remarkable.”

Cardiff and Vale University Health Board % compliance with hand hygiene - Gynae IVF Wales If you don’t wash your hands and clean your equipment, 100 then someone may get an infection. It’s that simple. “Washing your hands has to become 80 a habitual part of the job to ensure our healthcare settings are as safe from infections as possible.” 60 Dr Kurt Burkhart, Infection Control Lead in Cwm Taf General Practice.

40 Jun Aug Oct Dec Feb Apr Jun Aug Oct Dec Feb Apr 2008 2008 2008 2008 2009 2009 2009 2009 2009 2009 2010 2010

Reducing Healthcare Associated Infections 9 Infection rates fall for critically ill patients Infection rates in critical care units across Wales have fallen significantly, thanks to new ways of working implemented in the Improving Critical Care content area.

Excellent progress has been made practice and nominated in the NHS wards in which it was tested. in reducing the rate of Ventilator Wales Awards 2010. Faculty Member and Intensive Associated Pneumonia (VAP) and Staff including a consultant urologist, Care Consultant at Abertawe Bro Central Line Infections (CLI), by microbiologist and nurses developed a Morgannwg University Health Board, implementing agreed care bundles and care bundle specifically for this area as Dr Dave Hope said, “We’ve shown ensuring compliance. there was not one available already. that by implementing evidence based In critical care, the bundle included procedures, better care and helping It was piloted in the Princess of Wales procedures for minimising infections patients before their condition Hospital in Bridgend and had great from equipment use, improved care declines, we can cut infection rates success with 100% compliance in the and early intervention before a across Wales.” patient’s condition declined.

Staff embraced the new procedures Aneurin Bevan Health Board % compliance with CVC and as a result, many organisations maintenance care bundle –Royal Gwent Hospital have gone months without any patients developing Central Line Infections. 100 Some hospitals have gone more than a year without a case. Several intensive care units across Wales have also reported months without Ventilator

Associated Pneumonias. Percentage 80 Examples of success Nov Jan Mar May Jul Sep Nov Jan Mar May Jul Sep Nov Jan Mar May Jul Cardiff and Vale University Health 2007 2008 2008 2008 2008 2008 2008 2009 2009 2009 2009 2009 2009 2010 2010 2010 2010 Board saw particular success in this area with the critical care unit at University Hospital of Wales going more than two years without a Central Line Infection since the introduction of the care bundle. Similarly, Llandough Hospital critical care unit has not had a VAP case for over a year. The new care procedures have been accompanied by a change in attitude towards CLI and VAP, which are now seen as something avoidable, rather than an expected complication. Velindre Cancer Centre In fact, the development of a CLI celebrates Sepsis success will now be investigated as a critical incident when it occurs. Improving rapid response to acute transferred to a District General illness in Velindre Cancer Centre has Hospital due to acute illness. Reducing catheter risk made a big impact on patient care. Ceri Stubbs, Velindre Cancer Centre In Abertawe Bro Morgannwg University The implementation of the Sepsis Clinical Lead, said, “You have to get Health Board, the work carried out to Six care bundle on a chemotherapy the basics right and by improving the reduce the risk of catheter associated ward, along with improved reliability reliability of observations we have infections was recognised as best of observations, ensured that ensured patients receive the best patients were less likely to be treatment as soon as they need it.”

10 Improving Critical Care Major successes • A reduction in Central Line Infections with organisations going months without incident • Catheter-related blood stream infections are now a rare, rather than common, event in Wales • Several intensive care units reporting months without patients developing Ventilator Associated Pneumonias (VAPs) • Improvements in severe sepsis treatment thanks to the implementation of Sepsis Six care bundle • Establishment of rapid response teams for acutely ill patients in wards across Welsh hospitals Faculty Member and Cardiff and Vale University Health Board Clinical Director, Dr Mark Smithies said, “We have continued Central Line Infections at zero to see a fall in the number of patients Cardiff and Vale University Health Board’s Central Line Infection contracting infections on critical care rates have fallen dramatically with no patient developing an wards. infection for more than two years. “This is particularly good news as these The critical care team improved practice by introducing Care infections were, until recently, considered Bundles, which were measured on a daily basis. an unfortunate, but inevitable consequence of modern healthcare. The excellent work of The health board also encouraged nurses to stop a procedure if staff in critical care units across Wales shows they felt full sterile status had not been maintained by a doctor. the progress made, making a real difference Consultant Nurse in Critical Care Services, Gemma Ellis said: to patients.” “The introduction of the care bundle has strengthened our team working and empowered the frontline nurse to stop a procedure if they felt it was necessary and start again. We are happy to “Critical care bundles have remind everyone, including doctors, to wash their hands and use really worked in intensive the alcohol gel.” care. They have helped us give the best treatment to our patients – every day – without fail. By continuing this work we can ensure patients have less chance of infection and recover more quickly so they can leave hospital faster and be home with their families.”

Chris Hancock, Improving Critical Care Lead, 1000 Lives Campaign

Improving Critical Care 11 Improving the safety and reliability of medicines Better monitoring of patients and clearer communication about dosage instructions has made the use of high risk medication safer and more reliable across Wales. Health boards have worked closely The work, which was part of the Improved access to monitoring for with GPs and pharmacists to deliver Improving Medicines Management patients on Warfarin has taken place vital changes to ensure patients content area, has concentrated on across Wales with new anti-coagulation receive maximum benefits from their improving the safety, reliability and clinics established and regular INR medication. management of high risk medication tests undertaken. such as Warfarin. Working in the community Health boards have worked with Green bags help ensure accurate drug history community pharmacists to encourage In , work was carried The scheme has helped improve patients to bring in their yellow record out to educate the public on patients’ medication knowledge and book, which includes information on the importance of bringing their reduced the need to re-book failed their INR level and dosage instructions medicines with them prior to surgery. out-patient appointments due to at the time that a new prescription is Patients were given green plastic absence of up-to-date information. dispensed. bags, with space for their personal Janet Thomas, Partnership This has ensured that it is safe for the details for transferring medicines. Pharmacist at Maelor patient to have their prescription and The bags have been used to keep Hospital, said “Getting the drug that they fully understood the correct emergency admission patients’ chart right is crucial and a medical dosage to take. medicines together before being review can happen more safely with GP practices have also carried out transferred to an admitting ward. an accurate drug history.” baseline assessments on patients using Warfarin to ensure patients receive the

12 Improving Medicines Management Major successes • Improved monitoring and reliability of instructions to patients taking the drug Warfarin by GPs • Improved medicines reconciliation across Wales • Pharmacists working closely with patients to ensure better understanding of dosage instructions Faculty Member and 1000 Lives Campaign Director Dr Alan Willson said, “There is much good work being carried out across the NHS and what is encouraging is the willingness to share the expertise that has been developed by these sites with other organisations.

“The work with Warfarin has been just the start. There are several other medicines which will benefit from a similar approach and we are looking forward to progressing this vital work.” maximum benefit and least harm been made in improving the safety from the therapy. of medicines administration in New clinic improves hospital wards. The tool acts as an aide-memoire monitoring and to raise key information like age, Aiding concentration history of uncontrolled blood Many organisations have treatment of pressure, falls, alcohol use, encouraged nurses to wear red Warfarin patients monitoring and mental capacity. tabards during drug rounds to Cwm Taf Health Board has developed a In South Wales, Cardiff and Vale alert others not to interrupt them new clinic to improve the monitoring and University Health Board have unnecessarily when they are treatment of patients taking the drug promoted the collection of data preparing medications. Warfarin. by incorporating an audit of The scheme was implemented Warfarin into their incentive by nurses in Cardiff and Vale The pharmacist-led clinic at the Royal scheme for GPs. University Health Board following Glamorgan Hospital, Llantrisant, acts as a one-stop shop for all patients, enabling a And in North Wales, Betsi the observation that a nurse who more efficient service. Cadwaladr University Health Board administered medications was has reduced the time it takes to interrupted up to 17 times during Patients are now being seen within stabilise patients on the right one drug round. an appointment system, have face- dose and to redesign Warfarin The red tabard has enabled the to-face consultation with healthcare prescription charts. nurse to concentrate without professionals and receive results during their appointment time. Both these examples of good distraction, with other members practice have been spread to other of staff aware of the job being This has ensured that regular checks can health boards across Wales. carried out. be made to ensure the dosage is correct Medicines reconciliation Llandough Hospital Medical and the patients understand how to use Rehabilitation Nurse, Ann Solonott the medication. Vital work has also been carried said: “Wearing a tabard is an out on reconciling discrepancies David Lewis, Medicines Management excellent idea and, for me, it and omissions at key points in the Lead, said, “The new clinic has been a means there is less room for errors patient’s journey, for example, much better experience for patients and whilst making people aware of when they enter and leave an improved use of resources.” what we do.” hospital. Checklists for community pharmacists and for secondary There is great support for the Improving Medicines care to complete before a patient Management content area as it has given us a clinical is discharged are now being used. impetus to focus on a challenging area of medicine that Medicines have also been might otherwise not receive the attention it deserves. managed more reliably through a tracking system called medicines “The work done has ensured medicines are safer and patients reconciliation which has helped receive maximum benefit from their treatment.” communicate changes to GPs. Dr Brendan Lloyd, Medical Director, Powys Teaching Health Board In secondary care, progress has

Improving Medicines Management 13 Safer surgery for patients across Wales The introduction of new measures have reduced errors and risks of infection.

The introduction of the World Cardiff and Vale University Health Health Organization (WHO) Safer Board received particular praise Surgery checklist was successfully for the way in which it educated spread to all organisations and has staff to get behind the checklist been mandatory for all operating and rapidly implemented it in all theatres since February 2010. its 44 theatres. The simple set of questions asked The organisation held learning during a surgical episode, has sessions to discuss how best to ensured the best standard of care implement the list, provided for patients, protecting them from written information for staff and potential harm. began with a month long pilot in Llandough Hospital before The process enables more moving to the main theatres in the effective communication amongst University Hospital of Wales. those involved in the surgery and provides a clear, consistent It then introduced the checklist approach. into a new theatre every week until all theatres were on board. It focuses on basic good practice: checking the patient’s identity, Simple and effective changes the correct site for operation In addition to the checklist, and provides an opportunity for hospitals have also focused on discussing any complications that other steps which have helped may arise. reduce surgical complications. It also highlights potential risks One of the simplest, yet of haemorrhage, reaction to potentially most effective changes antibiotics and allergies. the Campaign introduced was a

Hot air gowns reduce infections The introduction of specialised of stay in hospital was gowns in all Powys Teaching shorter and there were fewer Health Board’s operating re-admissions. theatres has made a major The innovative work scooped impact on the safety of an NHS Wales Award 2010 patient care. and was recognised as best The gowns, called Bair practice. Huggers, are filled with hot air Theatre Manager and Matron, to keep patients warm before, Rosanne Lyles said, “The during and after surgery. improved ways of working By maintaining a normal ensured our patients received Powys Teaching Health Board temperature, fewer patients safer care, recovered more won a number of awards for their use of Bair Huggers to maintain were developing infections quickly and spent less time in patients’ temperature. following surgery, their length hospital following surgery.”

14 Reducing Surgical Complications national change of practice in using The potential to reduce infections in Keeping patients warm clippers, instead of razors, to prepare this way also extended to patients who Another simple, but significant patients for surgery. sometimes shave before coming into consideration, has been the hospital for an operation. Shaving the body can cause tiny cuts, importance of keeping patients warm and research suggested that although Hospitals have encouraged patients not before and after surgery. they can’t always be seen, they may to shave the area of their body where Nursing staff across Wales closely lead to post-surgical infections. surgery is planned, for at least a week monitored patients’ temperatures before their operation. Recent studies revealed that if hair during each stage of their hospital stay. was removed with surgical clippers This has helped to lower infection By maintaining a normal temperature, in theatre, prior to surgery, the risk rates after surgery and also avoided patients were less likely to develop of infection could be significantly other problems, including further pain, infections following surgery and reduced. scars and a longer stay in hospital. recover more quickly. Major successes • Introduction and spread of the WHO Safer Surgery Checklist in all Welsh operating theatres • Razors replaced by surgical clippers in all Welsh hospitals, reducing chance of infection • Improved measures to address normothermia Dr Simon Noble • Improved team briefings resulting in better communication and handovers Reducing hospital • Reduction in incidents of hospital acquired thrombosis acquired thrombosis Faculty Member and 1000 Lives The number of patients you have the teeth to make Campaign Director, Dr Jonathon Gray developing a hospital acquired changes and with support at the said, “We know that if we reduce thrombosis fell from eight frontline you can ensure these surgical complications, we can make a a month to three thanks to changes are implemented.” huge impact on patient safety – possibly improvements delivered by staff The All Wales Thrombosis Risk reducing overall errors that occur in in Aneurin Bevan Health Board. Assessment tool enabled staff to healthcare around 40%. Buy-in from staff at all levels carry out a thorough evaluation to ensure all patients were of a patient’s risk of developing “That’s why the 1000 Lives Campaign properly risk assessed was a blood clot. was committed to reducing surgical crucial to the success. complications – it’s not only widely Once the risk was assessed, supported by staff throughout the NHS, Honorary Palliative Care simple treatment could ensure but vital for patient safety.” Consultant Dr Simon Noble, thrombosis was prevented safely said, “With support at the top and effectively. Improved communication meant that issues Powys Teaching Health Board % assessed for risk of DVT concerning allergies, correct 100 equipment and post operative care were addressed at the earliest

80 opportunity. The checklist gave everyone in the team a voice to express any concerns they may have 60 had. We questioned each other and invited the patient to question us, 40 so that the lines of communication were maintained.” 20 Helen Curtis, Theatre Practice Educator, Nevill Hall Hospital, Abergavenny 0 Nov Jan Mar May Jul Sep Nov Jan Mar May Jul 2008 2009 2009 2009 2009 2009 2009 2010 2010 2010 2010 Reducing Surgical Complications 15 New techniques helping to save lives Improved communication, better treatment for chronic heart failure patients and the development of new measures to identify harm have all made a fundamental impact on the quality of care delivered in Wales. Making communication between staff as frame a conversation or written report. the discussion and provides all the effective as possible was a key factor This includes transitions of care from information needed to put immediate in the Improving General Medical and one setting to another, for example, action into place. Surgical Care content area. admission unit to the ward, and shift Every Welsh hospital has tested SBAR handovers. All health boards and trusts in Wales and it’s also proved to be a very useful tested a new standardised method of Essential information tool for the Ambulance Service. communication which ensured that SBAR provides essential information Ambulance staff have found that it has accurate patient information was on the patient’s condition and gives enabled them to have a structured way passed on during handovers. consistency to handovers of patient of communicating with hospital staff SBAR (Situation, Background, care whilst developing teamwork and a when they handover a patient from Assessment and Recommendation) is a culture of patient safety. their care. framework for communication between It has already proved to be particularly A number of organisations in Wales members of the healthcare team about useful in areas where a patient is in have adopted the use of the SBAR a patient’s condition and is used to urgent need of help, as it structures tool for other communications, Track and trigger helps acutely ill patients An early warning observation system of patients from a large rural Wells Hospital, said, “In Powys, which alerts staff if a patient’s community. journey times can be long and condition deteriorates has been It was used to link the normal we don’t have a District General introduced in Powys community monitoring of the signs that indicate Hospital, so it’s important that we hospitals, enabling the correct action a patient’s condition, with a scoring know as early as possible about a to be rapidly taken every time. matrix that shows when a patient is deterioration in a patient’s condition. deteriorating and action is needed. The track and trigger tool was “The tool has helped to save lives.” designed to meet the needs Cathy Davies, Matron in Llandrindod

16 Improving General Medical and Surgical Care Major successes • Improved communication between staff, Faculty Member, Dr Brendan Boylan said, “Good particularly during handover, and calling for help communication in any environment can make a real for sick patients, thanks to SBAR difference – but within a healthcare setting it literally • Fewer unnecessary hospital admissions for patients can save lives. with chronic heart failure “The structured approach of SBAR offers every member • Development of track and trigger tools in primary of staff, whether junior or senior, a way to impart and secondary care to identify potential harm the essential information and guidance to ensure the patient receives the best possible care.” including reporting patient safety By optimising the use of these incidents to a review group and drugs and regularly reviewing Wales leads the way with communicating with the hospital the patient, chronic heart failure primary care trigger tool at night team. sufferers could see improvement The development in Wales of a primary in their symptoms, including more Reducing admissions care trigger tool enabled GPs to measure energy, and less likelihood of improvements in community healthcare. In other steps, health boards have admission to hospital. worked closely with GPs to reduce, The tool looks at harm caused by failure The improvements made by where possible, the number of to recognise or adequately manage a new working closely with GPs and unnecessary hospital admissions presentation of an acute illness. and re-admissions for patients with other primary care providers, have chronic heart failure. garnered praise from many other If a patient’s situation did not respond to countries including improvement treatment or they developed an adverse More than 80 GP practices across experts in the USA, who helped reaction, they were more likely to make Wales agreed to develop Local shape the concept of the 1000 another appointment. Enhanced Services for Cardiology Lives Campaign. that ensured patients with chronic It was these unscheduled re-attendances heart failure lived a better quality The quality of care for patients that could act as triggers of possible harm. across Wales was also improved of life. Dr Bill Whitehead, who led the work in by the development of a number North Wales said, “We have seen the The promotion of evidence-based of trigger tools which are being difference this trigger tool has made to procedures such as timely and used by GPs, the Welsh Ambulance the care we delivered, and we are looking accurate diagnosis, medication Services, Velindre Cancer Centre forward to spreading the learning to therapy, and lifestyle advice has and other organisations. had a significant impact on the help ensure GP practices are as safe as disease process. The tools identify and track possible.” potential harm by using a The new service has enabled GPs retrospective review of a random to provide care and support to sample of patient records to The 1000 Lives Campaign people closer to their homes. identify possible adverse events. is easily the best initiative It also looked at prescribing that I’ve ever been asked medicines to manage chronic heart to participate in and is exactly failure. aligned with what we needed to do in Powys to ensure that our Betsi Cadwaladr University Health Board – services were safe. Wrexham Maelor Hospital - % trained and using SBAR “The communication work has 100 given staff additional confidence in highlighting concerns about a patient and a clear approach to doing so.” 80 Ailsa Dunn, Consultant Physician, Powys Teaching Health Board

60 Oct Dec Feb Apr Jun Aug Oct Dec Feb Apr Jun Aug Oct Dec Feb Apr Jun 2007 2007 2008 2008 2008 2008 2008 2008 2009 2009 2009 2009 2009 2009 2010 2010 2010

% of staff trained in SBAR % of staff using SBAR

Improving General Medical and Surgical Care 17 Improving the patient experience Transforming Care at the Bedside has enabled frontline staff to deliver changes that have improved patient outcomes and their experience.

Transforming Care at the Bedside was time with patients at the bedside and Redesigning processes initially tested in three pilot sites – in turn, enabled patients to engage Using effective tools and methods, Abertawe Bro Morgannwg University, with staff and become partners in their frontline staff redesigned processes Hywel Dda and Betsi Cadwaladr own care. and ward environments to release University Health Boards – and The programme also delivered huge time, which was reinvested in patient delivered real, lasting improvements to success in reducing pressure ulcers, safety and quality of care. patient care. more commonly known as bed sores, Staff now spend around one third more It encouraged nurses to spend more and a reduction in patient falls. of their time with patients, which has improved care and communication, with patients able to express their The ‘not-so-secret’ diary needs and be listened to. This ensured the focus was on patient- of an NHS patient centred care and specific needs were Patients on one ward in Prince to discharge and included a range being met which led to a better Philip Hospital were given diaries, of information, from reflections experience in hospital and a faster as part of a pilot project to give and goal setting to treatment and recovery. them more ownership of their achievements. Redesigning wards with appropriate journey to recovery. The aim was to empower patients, and easily accessible equipment also The diaries were penned by whilst giving healthcare professionals ensured less waste and more efficiency. patients, clinicians, nurses and a patient-centred account of their Change in culture other healthcare professionals at experience. The diaries were also The work to reduce pressure ulcers the bedside. used as a communication tool for has delivered phenomenal results with family members. They were used from admission many wards going more than a year without a single incident.

18 Transforming Care at the Bedside Major successes • Significant reduction in patients developing pressure ulcers • Reduction in patient falls • Nurses spending more time at the bedside • Improved patient satisfaction with their experience of care Faculty Member, Annette Bartley said, “Transforming Care at the Bedside was important because it focused on improving patient outcomes and their direct experience of care.

“The work that has been done to prevent pressure ulcers developing has been a phenomenal success and has made a real difference to the patients’ quality of life and experience in hospital and their recovery. Nurses spend more

“Changing the way nurses work so they can spend more quality time at bedside time with patients has also made a big impact as it has improved Nurses in Hywel Dda Health Board have not only care, but communication.” spent up to a third more of their time at the bedside thanks to new ways of working. Intentional rounding guided nurses difference, sparing them distress, The redesign of work space has enhanced to deliver more structured care pain and a longer stay in hospital. efficiency and reduced waste. Work to and included hourly checks on Steps were also taken to reduce improve the organisation of storerooms on the patients to look at any potential patient falls. Hospitals have wards so nurses spend less time looking for risks such as the position they reported fewer falls in care of equipment, for example, released two and a were lying in and the condition of the elderly wards due to hourly half hours per day. their skin. checks on patients and ensuring This was the equivalent of 912 hours a year, There was a big cultural shift in equipment to help mobility is which can be invested directly into patient attitudes with staff moving from easily available. care. a passive acceptance that pressure Hywel Dda Health Board reported ulcers were unavoidable to a Other improvements included reducing nurse more than a year without a realisation that they can be avoided interruptions and improved communication fall on its pilot ward and other and taking preventative steps. between staff and patients. organisations have also gone For patients it has made a huge months without an incident. Senior Nurse, Gill Webber said, “We implemented numerous changes, including smarter placement of equipment within the ward and completion of patient paperwork at the bedside. These simple changes made a real difference to patients.”

Engaging with patients was vital and the safety cross, showing the number of days without a pressure ulcer on the Making pressure ulcers ward, was always clearly visible. “The positive press coverage also a thing of the past meant that patients understood Dozens of wards in Abertawe Bro Senior Charge Nurse Nigel Broad what we were trying to do. So much Morgannwg University Health said, “Pressure ulcers used to be so, that many patients rang up and Board went more than 100 days something which were expected without a pressure ulcer case and to happen. Now we have both the asked to be on that ward!” one ward more than two years. culture change and the model of Hamish Laing, Consultant Plastic Surgeon, care to ensure this is no longer The introduction of the SKIN Abertawe Bro Morgannwg University Health the norm.” bundle (Surface, Keep patient Board moving, Incontinence, Nutrition), Patients were regularly assessed which was a checklist of good for risk and the number of days practices for managing vulnerable a ward went without a pressure patients, ensured pressure ulcers ulcer incident was clearly could be avoided. recorded on a notice board.

Transforming Care at the Bedside 19 Measurement for improvement Measurement has been at the heart of the healthcare improvements delivered by the Campaign. This focus on measurement has Data collection Campaign Director Dr Alan Willson said, allowed organisations to determine The improvement in data collection, “Measurement for improvement and their current position and provided particularly process data, has not for judgement has become a focus the means to evaluate how successful enabled staff at all levels to engage and mantra for the Campaign and for efforts have been in improving with information proactively and healthcare teams at the frontline.” healthcare delivered. intelligently. Attitude For example, by recording incidents The development of the global “In the past two years we have a of pressure ulcers or wound infections trigger tool has been an excellent seen a definitive change in attitude for the first time, it has been possible example of this. to reporting data and in how data is to measure how much better the new being used to improve the healthcare By reviewing patient case notes, ways of working have been. we deliver. staff have been able to identify areas Culture change of potential harm before it happens “Everyone knows that in order to be Faculty Member and Director of Acute and put solutions in place to rectify able to make improvements you have Care at Abertawe Bro Morgannwg the issue. to be able to benchmark where you are Health Board, Hamish Laing said the and identify areas of concern. By measuring process, such as the widespread use of measurement has results of better hand hygiene leading “Only then can you begin to measure represented a culture change for the to a reduction in infections, it has been the quality of the services you are health service in Wales. possible to see what difference has delivering.” He said, “In the old days, hospitals been made to patient care as a result would not have known what their of changes in working practices. death rates were and so certainly Dr Brian Tehan, Assistant Medical would not have been able to discuss Director at Betsi Cadwaladr this out loud or with other hospitals. University Health Board, believes “This has been very much the start of a measurement has been vital to culture change for the NHS. improving patient safety. “Collecting clinically meaningful data He said, “Monitoring patient safety has to become an integral part of our in this way has given us an insight work. By recording incidents of in a into harm from a patient’s perspective highly visible way for the first time we and changed the perceptions of those have been able to measure how much delivering the care. better our new ways of working were. “Continuous measurement has And if you improve quality you improve ensured that patient safety continues safety and save money.” to improve through the implementation of evidence-based care and that the processes involved are totally reliable.”

Powys Teaching Health Board launch ‘Count me in!’ – adopted by the Campaign in the final six months.

Above: Dr Don Berwick, from the Dr Tony Jewell, Wales’ Chief Institute of Healthcare Improvement, Medical Officer lends his support commends Wales on progress being to the Campaign. made at Learning Session 2. Right: Members of the executive team of Cardiff & 20 Measurement for Improvement Vale University Health Board focus on hand hygiene. Measurement for improvement Putting the PR into Patient Safety The Campaign’s communications aimed to engage NHS staff, ensure key stakeholders were kept informed of progress and

impact, and raise public awareness of the The launch of the Campaign was covered improvements being made. extensively by the Welsh media. It worked closely with organisations Relationships were built with the across Wales to build its profile internally media in Wales, which resulted in with staff, and externally with the widespread, consistent and positive media. A robust communications strategy coverage of the Campaign. guided the work delivered during the Local progress two years and local action plans enabled organisations to support the Campaign. Stories of local progress and achievements took the 1000 Lives The focus of communications work was Campaign into the public sphere, the frontline staff who implemented the underlining that change can happen, interventions. This was summarised in healthcare can improve, and lives its key statement: “NHS staff save lives can be saved. every day – the Campaign will help them save more.” A monthly patient safety column in The has also been helpful Staff were regularly profiled in the The Ambulance Service supported the in profiling the various interventions, Campaign by badging up all its vehicles. monthly e-Newsletter, through a special achievements and milestones. poster campaign (‘Count me in!’) and local and national media coverage. They The creation of the Campaign’s also featured in over sixty videos, which e–Newsletter has been were included in presentations and made successful in spreading the available online. good work delivered by staff across Wales. It was Involving local teams recently awarded Gold The involvement of communications for Best Newsletter in the officers from health organisations CIPR’s PRide Cymru awards. throughout Wales was central to The Campaign’s online building a strong profile with staff, presence included an the public and the media. intranet site, English and Support was provided through special websites study days, WebEx sessions and and a YouTube page, conference calls, as well as resources, which carried interviews including template press releases and with frontline staff on the articles, PowerPoint presentations and improvement work in which imagery. they were engaged. Pat Tempest, Planning and Corporate Whilst it was the clinical Services Manager, Powys Teaching interventions which Health Board, said, “The Campaign directly saved lives, the understood the challenges we faced in communications work has local organisations, particularly with strengthened the case for internal communications. They have healthcare improvement, been a tremendous help, always willing taking frontline staff on the to share expertise and encouraging us journey. It has also helped in our work.” spread improvements across organisations to ensure they The development and management of become embedded in the care the Campaign’s brand ensured effective The Campaign’s launch posters given to patients. thank NHS staff “for the lives recognition, becoming well known and you’ll save today.” respected within NHS Wales.

Putting the PR into Patient Safety 21 Patient experiences help improve healthcare The introduction of patient stories into board meetings across Wales has helped inform current practices and shaped future healthcare provision. Whether a patient’s experience has Unlocking potential However, most organisations have been good or bad, the impact of The use of stories in board meetings found that the majority of patients sharing information directly with senior has provided a platform for have been more than happy to share staff has been valuable in helping growth of this powerful tool. Many their experiences – if they know it will organisations make vital changes. organisations have learned to unlock make a difference to someone else’s care. One staff member explained, “This the potential for using stories through has not been about blame but about the Campaign’s ‘1 story, 4 uses’ There have been numerous examples good customer care. The insights we framework. As a result they are now where patient stories have raised have gained have inspired us to work developing central repositories of issues that needed to be addressed and together to make improvements and stories to help share best practice. solutions found. deliver the best service we can.” Patient stories are proving a useful tool One intensive care ward addressed the Many organisations have opened each to increase patients’ participation and issue of noise levels after a patient was board meeting with a patient story and engagement. The learning acquired asked on discharge, what would have have found that it has encouraged staff during the Campaign is continuing to improved her experience – she replied to focus on the patient as a person, grow and is helping organisations to a good night’s sleep. rather than a condition or an outcome. become more proactive in seeking patient feedback and to learn from Protected meal times have also The patient has either attended in their stories. become more established because person or their story has been told patient’s comments and perspectives digitally via a short film or audio Using patient stories to complement have been heard and acted upon. recording. data reports has also increased focus and engagement with quality and Campaign Director Dr Jonathon Gray safety issues. said, “These personal insights have reminded us that the patient is at the Story reveals need For example, patient stories have heart of everything we do. for aftercare become well established as the first agenda item in all Quality and Safety “The voice of a patient in a board A recent patient story from Meetings in Cwm Taf Health Board. meeting, on the ward, in conversation Velindre Cancer Centre, revealed with a frontline member of staff has that although the treatment was The stories have been an invaluable helped to galvanise action, encourage considered faultless, the lack of tool for engaging all members in a and challenge the workforce and psychological support and access focused discussion on quality and ultimately bring about positive change. to counselling had left the patient safety issues. “Whether it was a prescribing error, feeling let down and isolated. Patient participation praise for outstanding care, a surgical As a result, staff worked to improve There has been a clear need for complication or a poor diagnosis, the access to counselling and shared the sensitivity and an ethical approach in real urgency has been to learn from story with all new staff as part of collecting stories to ensure the patient these episodes to ensure that good their induction process. has understood how the information practice was captured and spread, and will be used. lessons were learnt to ensure it didn’t happen again.”

A porter from Betsi Cadwaladr University Health Board provides the winning idea in the organisation’s first patient safety competition. Clinical staff and patients work together to reduce the noise levels on an Aneurin Bevan Health Board celebrate their 22 Patient Experiences Improving Healthcare intensive care ward. organisation’s progress in the Campaign. 1000 Lives Plus – the next step in healthcare improvement “It has enabled us to focus more closely on our patients and reminds me of why I went into the NHS – to save lives.” These words from a frontline member The programme incorporates several “Every health board and trust is of staff show how the 1000 Lives new areas of work and will focus on involved, with the focus on patients Campaign has captured the imagination reducing harm, waste and variation. having the right to expect the same of NHS staff across Wales. high quality of care wherever they In total, there are fourteen receive their treatment in NHS Wales.” Now 1000 Lives Plus, a national programme areas which are being programme to improve patient safety phased in over the next twelve Putting patients central and reduce harm, is aiming to build on months. These include; One of the key elements of 1000 Lives the successes of the Campaign’s work. • Preventing stroke and providing Plus is patient involvement and work Patient safety has become an integral better rehabilitation will continue to ensure patients are central to its initiatives. part of mainstream long term plans for • Preventing Acute Coronary Syndrome NHS Wales. • Preventing falls in community care Educating patients about their With an increased emphasis on patient- Enhanced Recovery After Surgery treatment, and encouraging them to • question the care they receive is vital. centred care and a commitment Improving maternity services to working across the primary and • Offering better treatment to those Some programme areas are very reliant secondary sectors, the programme • suffering from mental health on partnership between patients and will have a transformational impact on disorders staff. Enhanced Recovery After Surgery, Welsh healthcare. requires patients to follow nutritional A quality agenda NHS Wales Chief Executive, Paul guidelines and other preparatory Williams, believes 1000 Lives Plus is Many of these new areas involve measures in the run-up to surgery, in well placed to effectively introduce both primary and secondary clinical order for quicker healing afterwards. organisations, with a definite agenda change. Quality improvement also offers to institute quality ‘from board to opportunities for greater efficiencies He said, “I can’t think of a better ward to home’. way to engage all our colleagues and in many cases, higher quality can than the aim of delivering a safer The methodology introduced by the be achieved at a lower cost to the and quality service. As far as the Campaign – applying small tests of NHS. change before wider implementation – patient is concerned, quality is an Examples already achieved in this area will continue to be used. absolute right.” include the reduction in infections and 1000 Lives Plus was launched in May Work is already well under way in many pressure ulcers leading to shorter stays 2010 and organisations have outlined of the areas and 1000 Lives Plus will in hospital. continue to engage, support, equip and specific aims to reduce mortality Most importantly, 1000 Lives Plus motivate frontline staff to deliver the and harm. ensures that the improvement work changes needed. begun by the Campaign will continue Mrs Jan Davies, 1000 Lives Plus Director until every patient in Wales receives said, “The programme is committed the same level of quality care. to accelerating the pace of change to spread the new ways of working introduced by the Campaign from ward to ward, practice to practice and organisation to organisation.

Left: Paul Williams, Chief Executive of NHS Wales, showed his commitment to improving the quality and safety of patient care by launching 1000 Lives Plus in May 2010. Right: New programme areas in 1000 Lives Plus, like Enhanced Recovery After Surgery, are focussed on reducing harm, waste and variation. The Next Step 23 Giving the patient the care they need by reducing harm, waste and variation If we can improve care for one patient, then we can do it for ten. If we can do it for ten, then we can do it for a 100. If we can do it for a 100, we can do it for a 1000. And if we can do it for a 1000, we can do it for everyone in Wales.

www.1000livesplus.wales.nhs.uk