England’s 15 Academic Health Science Networks (AHSNs) and the Patient Safety Collaboratives (PSCs) they host are making a significant contribution to the NHS Patient Safety Strategy, through the PSCs’ work supporting the delivery of the National Patient Safety Improvement Programmes and the AHSNs’ focus on accelerating innovation.

‘Patient safety in partnership: Our plan for a safer future 2019-2025’ has been developed to support the NHS Patient Safety Strategy published in 2019, and details how AHSNs will work more closely with health and care organisations to improve safety both in hospitals and community-based services, such as care homes.

 

Patient safety during COVID-19

We have developed a range of resources to help staff and support patient safety during the COVID-19 pandemic, including managing deterioration, pulse oximetry, tracheostomy safety, webinars for GPs and advice for care homes. Read more here.

The AHSN Network published a report on Safer care during COVID-19 in September 2020 as part of the NHS Reset campaign. It illustrates some of the creative ways PSCs supported their local systems during the pandemic and how this experience will be built into future patient safety programmes.

 

Improving safety in care homes

This report, published in 2019, explores case studies of ways safety for residents of care homes is being improved. The publication showcases over 30 examples of projects in medicines safety, dementia, monitoring and screening, and workforce development. You can download the report here.

 

Patient Safety Collaboratives

England’s 15 Patient Safety Collaboratives (PSCs) play an essential role in identifying and spreading safer care initiatives from within the NHS and industry, ensuring these are shared and implemented throughout the health and care system.

PSCs are funded and nationally coordinated by NHS England and NHS Improvement, and hosted locally by the Academic Health Science Networks (AHSNs).

They deliver the National Patient Safety Improvement Programmes (NatPatSIP), which are a key part of the NHS Patient Safety Strategy, and collectively form the largest safety initiative in the history of the NHS.

The programme’s aim is to continually reduce error, harm and death as a result of failures in the system, so the NHS becomes comparable with the safest health care services in the world by 2025. They do this by working with maternity units, emergency departments, mental health trusts, GP practices and care homes in the following areas:

  • Culture: They promote positive safety culture, encouraging staff to gain insight and share learning from both good and poor practice.
  • Evidence-based improvement: They support evidence-based, quality improvement (QI) methodology, ensuring change is consistently measured and evaluated.
  • Quality improvement (QI) capability: They grow QI capability in trusts and local healthcare systems so they can continue to improve.
  • System-level change: They enable regional and local health systems to identify improvement priorities and share learning.

 

The programme has had a number of achievements to date, including:

  • 100% of ambulance trusts and 98% of acute trusts have adopted the National Early Warning Score (NEWS).
  • A standardised benchmarking tool (LPZ) for care homes: predicted £4.5m savings by reducing pressure sores over, if scaled up over three years to 500 care homes, a saving of £3,440 per home.
  • Hydration projects showed a reduction in hospital admissions and falls.
  • Acute kidney injury projects resulted in 30-day mortality reduction by 47%.
  • Safety huddles aimed at falls: showed a 107% return on investment, giving £2 back for every £1 spent.
  • A catheter associated urinary tract infection collaborative achieved a 30% reduction across the participating trusts.
  • During 2019/20, 71% of emergency units had adopted the ED safety checklist.
  • During 2019/20, 90% of units had adopted one or more elements of the COPD discharge care bundle.
  • During 19/20, 82% of eligible mothers had received MgSO4 through the PReCePT programme.

 

The NatPatSIP’s current work is focused across five safety improvement programmes, as shown in this ‘driver diagram’ (click to download a PDF):

NatPatSIP driver diagram

 

Key enablers

The delivery of the five programes is shaped by the following key enablers:

  1. Addressing inequalities: understand local health inequalities to ensure selected interventions improve the lives of those with the worst health outcomes fastest.
  2. Patient and carer co-design: employ a co-production approach with patients, carers and service users who represent the diversity of the population served.
  3. Safety culture: use safety culture insights to inform quality improvement approaches.
  4. Patient safety networks: coordinate and facilitate patient safety networks to provide the sub-regional delivery architecture for improvement.
  5. Clinical leadership: identify and nurture clinical leadership to lead improvement through the networks.
  6. Building QI capacity and capability: use the Institute for Healthcare Improvement’s (IHI) dosing approach to build quality improvement capacity and capability.
  7. Measurement: develop a robust measurement plan including relevant process, balancing and outcomes metrics, using the IHI’s Model for Improvement.
  8. Improvement and innovation pipeline: undertake horizon-scanning and prioritisation to inform future national workstreams.

 

Managing Deterioration (ManDetSIP)

The ManDetSIP aims to reduce deterioration-associated harm by improving the prevention, identification, escalation and response to physical deterioration, through better system co-ordination and as part of safe and reliable pathways of care by March 2024.

Key ambitions:

  • To support the spread and adoption of the acute Paediatric Early Warning Score (PEWS) and a system-wide paediatric observations tracker for children across all appropriate care settings in England by March 2024.
  • To support an increase in the adoption and spread of deterioration management tools (e.g. NEWS2, RESTORE2, RESTORE2 mini, SBARD etc.), reliable personalised care and support planning, and approaches encompassing end-of-life care principles.
  • Specifically to support learning disabilities, mental health and dementia care management in relation to deterioration, in at least 80% of all appropriate non-acute settings across health and social care by March 2024.

 

Maternity and Neonatal Safety Improvement Programme (MatNeoSIP)

The MatNeoSIP aims to reduce the rate of stillbirths, neonatal death and brain injuries occurring during or soon after birth by 50% by 2025.

Key ambitions:

  • Contribute to the national target of increasing the proportion of smoke-free pregnancies to 94% or more by March 2023.
  • To support the spread and adoption of the preterm perinatal optimisation care pathway across England to 95% or more by March 2025.
  • To support the development of a national pathway approach for the effective management of maternal and neonatal deterioration using the Prevent Identify Escalate Respond (PIER) framework across all settings by March 2024.
  • To work with key stakeholders to support the development of a national maternal early warning score (MEWS) by March 2021, and spread to all providers by March 2024.
  • To support the spread and adoption of the neonatal early warning ‘trigger and track’ score (NEWTT) to all maternity and neonatal services by March 2023.

 

Adoption and Spread Safety Improvement Programme (A&S-SIP)

A&S-SIP aims to identify and support the spread and adoption of effective and safe, evidence-based interventions and practice across England by March 2022.

Key ambitions:

  • Increase the proportion of eligible patients receiving the chronic obstructive pulmonary disease (COPD) discharge care bundle.
  • Increase the proportion of eligible patients receiving the asthma discharge care bundle.
  • Increase the proportion of and the emergency laparotomy care bundle.

 

Medicines Safety Improvement Programme (MedSIP)

MedSIP aims to reduce severe avoidable medication-related harm by 50% by March 2024.

Key ambitions:

  • To reduce medicine administration errors in care homes.
  • To reduce harm from opioid medicines by reducing high dose prescribing (>120mg oral Morphine equivalent), for non-cancer pain.
  • To reduce harm by reducing the prescription and supply of oral methotrexate 10mg.

 

Mental Health Safety Improvement Programme (MHSIP)

The MHSIP aims to improve safety and outcomes of mental health care buy reducing unwarranted variation and providing a high-quality healthcare experience for all the people across the system by March 2024.

Key ambitions:

  • Reduce suicide and deliberate self-harm in inpatient mental health services, the healthcare workforce and non-mental health acute settings.
  • Reduce the incidence of restrictive practice in inpatient mental health and learning disability services.
  • Improve the sexual safety of patients and staff on inpatient mental health units.

 

You can find out more about the National Patient Safety Improvement Programmes and view more resources here.

If you would like to get in touch with your local Patient Safety Collaborative, please use the contact details for the AHSNs.