When you, or a loved-one, is a patient at Bedford Hospital, you want to know that the care we provide is of the highest possible standard or quality.
Quality care at Bedford is about keeping you safe and treating you well; it is also about learning and listening so that we can continue to improve our care and services. We monitor ourselves against a number of quality indicators to ensure that these standards are being met and that improvements are being made.
Our quality is not only monitored by ourselves, but also by the Care Quality Commission (CQC). Further information about the CQC and how they monitor our quality of care can be found here.
The way we work
We are responsible for the quality of care we provide and our commitment to our patients is set out below.
By having good leadership, a common vision, with shared values and purpose we can work together to improve the care we provide to our patients.
Keeping you safe
Our highest priority during your hospital stay is to keep you safe. This means reducing the risk of infections, pressure sores, falls and blood clots. It also means making sure you are well nourished and hydrated and that have your medicines at the right time.
Treating you well
Patients deserve to be cared for by competent, kind and supportive staff. We want our patients to feel well looked after and as comfortable as possible. Our patient survey, which includes the national Friends and Family Test, gives patients the opportunity to provide feedback on the care and treatment they receive.
Listening and learning
When things go wrong, or nearly go wrong, we need to find out why they happened so that we can take steps to avoid them from happening again. This helps us to make Bedford Hospital an even safer environment for our patients and staff.
Measuring the care and services we provide also tells us how well we are doing and helps us to check whether we are listening, learning and improving.
Monitoring and improving the quality of care at Bedford Hospital
We monitor our quality of care on an ongoing basis against a number of safety and experience indicators. Our Quality Board meets on a monthly basis to review performance under each of these indicators and to discuss how we can work to improve our quality further.
Here are some of the topics that we monitor ourselves against:
When a patient or carer complains about the care we provide, we investigate what happened and set out the steps we can take to help prevent it from happening again.
Between July and September 2013, Bedford Hospital recevied 74 complaints. Below are some of the themes from complaints:
- Concerns about nutrition
- Environmental cleanliness
- Concerns about discharge
- Unclear communication between clinical staff
- An operation was postponed several times during a patient’s stay
- That a patient had been discharged too soon
- About a patient’s dignity
- Concerns about the frequency of observations and the delay in referring a patient for senior opinion
- Concerns where a patient’s previous medical history/complications were not taken into account
- Cancellation of an outpatient appointment was not acted on by a member of staff
- Lack of information regarding end of life care
- Access to pressure relieving mattresses
- Attitude of staff member
- Failure to accurately diagnose a patient’s medical conditions
- Pain relief not being administered in a timely fashion
- Waiting too long to be treated
- No refreshments offered while being treated in the Emergency Department
- No follow up appointment as promised by the hospital
- Used injection needle not disposed of properly
An incident is an event or circumstance which could have resulted, or did result in unnecessary damage, loss or harm, such as physical or mental injury to a patient, staff and others, data or property.
When something goes wrong, or nearly goes wrong, our staff are encouraged to report this as an incdient. This means we can investigate the incident to find out why it happened so that we can take steps to avoid it from happening again. Our reporting also allows the learning from the incident to be shared across the hospital.
During July, August and September staff reported more than 1,300 incidents onto the incident reporting system – 1,000 of these involved patient care.
The top five incidents involving patients included:
- Patient falls
- Failure to follow best practice guidelines
- Failure to communicate/inform satisfactorily
- Complications of maternity procedures
- Drug related incidents
Of the 1,300 incidents reported, five (0.3%) resulted in severe harm or death. In the event of any incident resulting in severe harm or death a full investigation is undertaken.
Serious incidents and never events
A Serious Incident is an incident that results in either an unexpected or avoidable death or serious harm of one or more patients, staff, visitors or members of the public. A Serious Incident can also be an event that prevents (or threatens to prevent) our organisation’s ability to continue to deliver healthcare services, for example, actual or potential loss of personal/organisational information, damage to property, reputation or the environment or IT failure.
All grade 3 and 4 pressure ulcers developing whilst the patient is in hospital and fractured neck of femurs resulting from a patient fall are reported as Serious Incidents.
Between July and September 2013 there were 14 Serious Incidents.
- Grade 3 pressure ulcer (9 incidents)
- Fractured neck of femur
- Confidential information breach
- Increased prevelance of Clostridium difficile
- Intra-operative burns
- Sub-optimal care of a deteriorating patient (2 incidents)
Never Events are serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented. A Never Event includes:
- Wrong site surgery
- Wrong implant/prosthesis
- Retained foreign object post-operation
- Wrongly prepared high-risk injectable medication
- Maladministration of potassium-containing solutions
- Wrong route administration of chemotherapy
- Wrong route administration of oral/enteral treatment
- Intravenous administration of epidural medication
- Maladministration of Insulin
- Overdose of Midazolam during conscious sedation
- Opioid overdose of an opioid-naïve patient
- Inappropriate administration of daily oral Methotrexate
- Suicide using non-collapsible rails
- Escape of a transferred prisoner
- Falls from unrestricted windows
- Entrapment in bedrails
- Transfusion of ABO-incompatible blood components
- Transplantation of ABO or HLA-incompatible Organs
- Misplaced naso- or oro-gastric tubes
- Wrong gas administered
- Failure to monitor and respond to oxygen saturation
- Air embolism
- Misidentification of patients
- Severe scalding of patients
- Maternal death due to post partum haemorrhage after elective Caesarean section
Between July and September 2013 there were no never events recorded at Bedford Hospital.
Learning, responding and improving
Bedford Hospital promotes a culture of learning and responding and in addition to learning from complaints and incidents, we also also use feedback from the Friends and Family Test, compliments from patients and relatives and taking part in national initiatives to improve our quality of care.
Here are some examples of the work which has been undertaken recently to improve safety, quality of care and patient experience. Some initiatives have been implemented on individual wards and units, whilst some have been implemented throughout the hospital:
- For our patients’ safety we will be piloting non-slip socks (Harpur Ward)
- We have a daily multidisciplinary team (MDT) meeting with nursing and medical staff, occupational therapists, physiotherapists, ward social worker and our own discharge planners
- Parents of babies admitted to the neonatal unit are provided with information from BLISS (babies born too soon, too small, too sick), including a free help and advice line (Meadowbank Ward)
- The ‘Best Beginnings Project’ provide a ‘Small Wonders’ DVD which is given to parents of babies admitted to our neonatal unit (Meadowbank Ward)
- All parents whose babies are discharged from the neonatal unit are encouraged to participate in infant life support training which we provide (Meadowbank Ward)
- We have two Community Neonatal Nurses who provide support and advice following discharge from the neonatal unit, including those babies who are discharged with a naso-gastric tube (Meadowbank Ward)
- We are part of the East of England Neonatal Network which includes groups for benchmarking, clinical governance and nurses and clinicians’ development (Meadowbank Ward)
- A bell is rung to alert staff and patients before protected mealtimes on our wards begin
- We have two doctors dedicated to ensuring that whenever possible medication is prescribed the day before a patient’s discharge
- An ‘All About Me’ booklet is completed for patients with dementia or cognitive impairment
- Our Matrons speak with patients about their care during weekly ward rounds
- All our incidents and complaints are discussed at ward meetings to ensure we can share learning and discuss how we can prevent a recurrence
- We have introduced the S-SKIN Bundle to reduce the risk of patients developing a pressure ulcer
- We have implemented ‘FallSafe’, (Royal College of Physicians, 2012) resources, to plan and implement our improvement project in reducing inpatient falls
- An elderly care pathway has been introduced, one aspect of which is to minimise the number of ward moves thereby reducing the risk of inpatient falls. The pathway will be audited to ensure its effectiveness.
- High risk patients are identified and discussed at a daily Matrons Board Round, chaired by the Deputy Director of Nursing
- A 24-hour infection control hotline has been established
- An awareness campaign is being led by the Infection Control Team to ensure patients with diarrhoea are identified, escalated, isolated and tested appropriately
- To enhance patients’ privacy and dignity we now have fewer trolleys in each bay
- All of our pre-operative assessments are now done centrally in our Pre-operative Assessment Centre (Tavistocvk ward)
- To reduce the time some patients wait before their operation we have staggered some of our operating lists (Tavistock Ward)
- Equipment has been purchased to give patients the opportunity to engage in purposeful activities whilst staying at hospital. This includes memory boxes and rummage bags which contain puzzles, books and DVDs to stimulate good memories and conversation (elderly care wards)
- Dementia friendly clocks which display the time, day, date and year have been purchased which will be used throughout the hospital
- We conduct daily comfort and safety rounds for all patients (Shand Ward)
- We have introduced the butterfly scheme. The blue butterfly is for people with a known diagnosis of dementia and it provides a simple, practical strategy for meeting their needs.
Being open and transparent
We also publish ward-level information about our quality of care. This can be found on noticeboards on each of our wards; however if you would like this information prior to visiting the hospital you can request the information by emailing us.