The Scottish Patient Safety Programme (SPSP) is now part of Healthcare Improvement Scotland’s Improvement Hub supporting improvement across health and social care. This is a unique national programme that aims to improve the safety of healthcare and reduce the level of harm experienced by people using healthcare services.
SPSP aims to support National Health and Wellbeing Outcome 7: People using health and social care services are safe from harm. The Acute Adult aim continues to be to reduce harm and mortality in hospitals.
The Acute Adult programme will continue to work with NHSScotland boards to test and implement processes that will further improve reliable care delivery across a range of clinical areas.
Additional information and resources can be found in the members area of this website. (N.B. Access to this portal requires registration and is currently available to NHSScotland staff only).
Measurement and Reporting
Overarching aims have been developed to support each of the key themes, with supporting outcome measures in relation to each specific topic area. Whilst the aims will be set nationally, NHS boards will set locally-specific aims against the supporting measures based on existing baselines.
Testing, implementing and measurement of processes are essential components on efforts to improve outcomes. National data reporting will focus on key theme aims and supporting outcome measures, with support around the use of process measures, focusing on development of guidance on potential measures and, where required, advice on how to use them.
Since its launch in 2008, the Acute Adult programme has contributed to a significant reduction in harm and mortality to acute adult inpatients through:
- introduction and development of quality improvement methodology through testing of focused safety interventions
- testing and implementation of leadership activities that provide organisational support for safety
- building of capacity and capability within clinical and non clinical roles
- tangible patient impact on patient outcomes through reduction of infection rates such as Ventilator Associated Pneumonia and Central Line Bloodstream Infections
- widespread implementation of safety briefs, daily goal setting in ICU and surgical brief and pause
- improvement in the recognition and treatment of Deteriorating Patients and Sepsis, and
- transition of now well-established interventions from improvement to day to day care through the Patient Safety Essentials.
In 2012, the Cabinet Secretary for Health & Wellbeing announced stretching new aims for the Acute Adult programme:
- To further reduce mortality in Scotland’s acute hospitals
- To further reduce harm experienced by patients in Scotland’s acute hospitals
To achieve these aims, the Acute Adult programme will continue to work with NHSScotland boards to test and implement processes that will further improve reliable care delivery across a range of clinical areas.
An Acute Adult 'infographic' has been developed by Healthcare Improvement Scotland as a prompt for healthcare professionals to help teams understand why continuous improvement is so important.
Additional information and resources can be found below and in the member's area. (N.B. Access to this portal requires registration and is currently available to NHSScotland staff only).
- Tools and resources
Below you will find links to tools and resources relating to the Acute Adult programme.
National Early Warning Score (NEWS)
The Scottish Patient Safety Programme is encouraging the use of the National Early Warning Score across Scotland.
NEWS is an evidence based tool to support recognition and response of acute physiological deterioration which is recommended by the Royal College of Physicians.
WebEx are a way for the SPSP Acute Adult to share learning and provide support to NHS boards working to achieve the aims of SPSP. The Acute Adult team host WebEx calls focusing on CAUTI, Cardiac arrest, Deteriorating patient, inclucing sepsis and Pressure ulcers. The WebEx provide an opportunity for participants to share good ideas, ask questions, as well as keeping participants up to date with progress across all NHS boards. Slides and recordings from previous WebEx are available here
- Failure Modes and Effects Analysis (FMEA)
- Leadership Walkrounds
- Measurement of QI
- Using Model for Improvement
- Implementing Safety Briefings
- SBAR Guide
The Health Foundation
Improving handover at night (video)This video shows how staff at NHS Lothian went about improving patient safety by focusing on Hospital at Night (HAN) handovers – identifying the problems and trialling solutions. This work came out of NHS Lothian's involvement in the Health Foundation's Safer Clinical Systems programme.
Patient Safety Brief - Haelo
Based on the concept of safety advice given on aeroplanes before they take off, patients in NHS hospitals can now be shown a film to help them look after themselves during their hospital stay.
Hospital Standardised Mortality Ratio (HSMR) Toolkit
- Using the Hospital Standardised Mortality Ratio to help improve patient care
- NHS Modernisation Agency 3x2 Matrix Tool
- NHS Fife Preventing Harm Action Plan
- NHS Tayside Driver Diagram
- NHS Tayside Flowchart
- IHI Global Trigger Tool (UK Version)
- Early Warning Systems: Scorecards That Save Lives - IHI
- SIGN 139 • Care of deteriorating patients
- National Early Warning Score (NEWS)
- NHS Scotland NEWS and Sepsis Screening Tool
- Flash reports and publications
SPSP Acute Adult - End of phase report (Published by Healthcare Improvement Scotland, August 2016)
Acute Adult and Primary Care Programmes: 90-Day Process Report (Published by Healthcare Improvement Scotland, June 2016)
Evaluation of the Scottish Patient Safety Programme sepsis VTE collaborative: Short Report (Published by the University of Leicester, 2015)
- Data and assessment
Data provides rich, valuable information that allows us to understand variation in our system. Data collection is fundamental in quality improvement and there are many types of data that are helpful in supporting changes that result in improvement, including continuous measurements and counts of observations.
The Acute Adult programme reviewed and published a revised measurement plan in November 2015. Data is collected at ward level, with collated measures across the board submitted by NHS boards to the national team, within an agreed data reporting and assessment of progress schedule. Learning from data is key and supports staff to implement the changes required to achieve the aims of the programme. Feedback reports of data assessment are agreed in collaboration with Programme Managers.
- Useful links
Fiona Elizabeth Agnew Trust (FEAT)
FEAT was founded in memory of the late Dr Fiona Agnew and her daughter Isla, who both died after contracting Sepsis in August 2012.
Sepsis arises when the body’s response to an infection damages its own tissues and organs. It can lead to shock, multiple organ failure, and death, especially if it is not recognised early and treated promptly. Sepsis kills 37,000 people in the UK every year and is the acute bodily reaction to infection.For more information visit, www.featuk.org.uk/
UK Sepsis Trust
The UK Sepsis Trust (UKST) was established as a charity in 2012 with the objective of saving 12,500 lives every year. UKST is committed to changing the way the NHS deals with Sepsis, to increasing public awareness and supporting those affected by Sepsis. For more information, visit sepsistrust.org/
Scottish Partnership for Palliative Care
The Scottish Partnership for Palliative Care is an umbrella and representative organisation which, through a collaborative approach, supports and contributes to the development and strategic direction of palliative care in Scotland. For more information, visit www.palliativecarescotland.org.uk/
The Health Foundation is an independent charity working to improve the quality of healthcare in the UK by supporting people working in healthcare practice and policy to make lasting improvements to health services. The Foundation’s work is focused on two priority areas: Patient Safety and Person-Centred Care. The Foundation carries out research and in-depth policy analysis, runs improvement programmes to put ideas into practice in the NHS, support and develops leaders and share evidence to encourage wider change. For more information, visit www.health.org.uk.
Health Protection Scotland (HPS)
Health Protection Scotland (HPS), a division of NHS National Services Scotland, was established by the Scottish Government in 2005 to strengthen and co-ordinate health protection in Scotland. HPS plan and deliver effective and specialist national services which co-ordinate, strengthen and support activities aimed at protecting all the people of Scotland from infectious and environmental hazards. For more information, visit www.hps.scot.nhs.uk.
Institute for Healthcare Improvement (IHI)
The Institute for Healthcare Improvement (IHI), an independent not-for-profit organization based in Cambridge, Massachusetts, is a leading innovator, convener, partner, and driver of results in health and health care improvement worldwide. IHI's work is focused in five key areas, one of which is Patient Safety. For more information, visit www.ihi.org.
NHS Education for Scotland (NES)
NHS Education for Scotland are a special health board responsible for supporting NHS services in Scotland by developing and delivering education and training for those who work in NHSScotland, and have worked closely with Healthcare Improvement Scotland to develop a number of the tools used in the Scottish Patient Safety Programme. For more information, visit www.nes.scot.nhs.uk.
- Contact the team
To make an enquiry please contact firstname.lastname@example.org
To contact a member of the Acute Adult team, please click on the relevant name below.