One in 10 patients experience some form of avoidable harm


David Williams and George Wellby


david.williams@emap.com


More than 20% of patients experience avoidable harm during their care at some trusts, a national survey of frontline NHS services has revealed. The NHS Safety Thermometer, launched in April, gathers data submitted by all NHS providers on a set of four key care-quality indicators linked to nursing: pressure ulcers, patient falls, urinary infections from catheters and new venous thromboembolisms (news, 20 March, page 6). Data has been collated via a


monthly series of snapshots, gathered by frontline staff. The July survey included data from more than 141,000 patients across 205 organisations, including private providers of NHS-funded care. It shows that in July 91% of NHS patients were “harm free” and 9% experienced an avoidable harm. Analysis of the figures by


Nursing Times revealed the five trusts with the highest reported rates of patients with avoidable harm from April to July were: » Torbay and Southern Devon Health and Care Trust (23.5% of patients)


» City Hospitals Sunderland Foundation Trust (23.1%)


» Airedale Foundation Trust (20.5%)


» Sussex Community Trust (19.3%)


» Chesterfield Royal Hospital Foundation Trust (16.9%). The median rate was 8.9%,


but 24 trusts had an overall rate of harm of less than 5%. Airedale and Sunderland


were the only two trusts to report more than 10% of their patients acquired a VTE under their care. However, Airedale


Pressure ulcers constitute one form of harm that could be avoided


FT has since said the VTE figures they submitted were wrong, and its overall harm rate should be 9.7%. Twelve trusts stated over 6% of their patients had suffered falls, led by York Teaching Hospital Foundation Trust, North West


gether Foundation Trust in Gloucestershire. Seven trusts reported that


London Hospitals Trust and 2


more than 3% of their patients had developed a new pressure ulcer on their watch. Croydon Health Services Trust, City Hospitals Sunderland FT and Leeds Teaching Hospitals Trust had the highest rates. Nationally, there has been


modest improvement across all indicators since April 2012, when the overall harm-free figure stood at 90%. Nursing Times’ analysis


shows some harms are more prevalent in different care settings. Hospital wards have lower rates of harm in all areas except VTE and urinary infections, while community hospital patients have a much higher rate of overall harm, with pressure ulcers being more prevalent. Patients cared for in their own home have a lower prevalence rate of all harms except pressure ulcers. JP Nolan, nurse adviser for


acute and emergency care at the Royal College of Nursing, welcomed the thermometer as “a fantastic piece of work”, but said local qualitative root- cause analysis of harm caused to patients will be critical to driving improvements. He said: “Patient safety


from a nursing perspective is about people being cared for in an appropriate setting, and having the appropriate number of staff on duty. When we look at the patients who have incurred harm during their care it’s the root-cause analysis that’s important, rather than a number. “It’s very important that


this isn’t a performance measure for trusts but a patient safety measure used to look at avoiding harm.” Jacqui Fletcher, tissue


viability nurse and fellow of the National Institute for Health and Clinical Excellence, told Nursing Times the overall figure of 91% of patients being harm free was “better than expected”, given that many trusts have not monitored these harm indicators before. She said the thermometer was encouraging trusts to make changes that “ground-level clinicians have been wanting to do for a long time”.


Managers “block” use of evidence- based practice


Nurse managers are often “serious barriers” to preventing the implementation of new evidence-based practice by other nursing staff, US researchers have claimed. Ohio State University researchers surveyed around 1,000 members of the American Nurses Association and found that less than half of respondents (46.4%) agreed new research findings were routinely put into practice at their organisation. Identified barriers to this included “politics and organisational cultures that avoid change”. Lead author Bernadette


Melnyk, dean of OSU’s college of nursing, said such barriers were a “huge problem” that prevented the best outcomes for patients. But she added: “Another disconcerting finding was that a substantive number of nurses said their leader or manager is resistant to evidence-based practice. “If leaders do not role


model evidence-based decision making and are not providing tools, education and resources for their clinicians to get the knowledge and skills they need to implement this, it’s probably not going to happen nor will it be sustained.” She suggested widespread


cultural change in healthcare settings and nursing education might be needed. “Many nurses are practising


the way they were taught or steeped in the tradition of the healthcare system in which they work,” she said. She suggested nursing faculties tend to focus on teaching research methods and critiquing research, rather than how to put findings to use in clinical settings. The study is published in


the Journal of Nursing Administration.


www.nursingtimes.net / Vol 108 No 36 / Nursing Times 04.09.12 5


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