WATER HYGIENE & SAFETY


regime is identified by a name or number; and each ward has a list of all the outlets covered. The relevant person then simply accesses their pro forma via their PC and clicks to confirm which outlets have been flushed. To maximise compliance, the L8guard system automatically emails out the forms, which the designated personnel can quickly fill in on a PC to verify that the low-use outlets they are responsible for have been flushed. They then email back the returns with minimal effort. The returns go direct to L8guard, which manages the entire process, and staff at different levels subsequently receive regular reports providing a comprehensive picture of flushing compliance. We can thus easily identify areas where flushing compliance, or failure to send back returns, is a problem.”


A system of ‘escalation’


At the Northern Lincolnshire and Goole NHS Foundation Trust’s hospitals, the L8guard Pseudomonas module emails out flushing reminders to all designated contacts in augmented care areas, including HDU, ITU, and oncology wards, once a day, seven days a week, and the Legionella module issues the automated emails three times a week – on a Monday, Wednesday, and Friday. Emails are sent to a set of primary and secondary contacts – useful, for example, if a particular staff member is away for few days. If the system ‘sees’ that a Legionella return has not come back within 24 hours, the software automatically informs an ‘escalation contact’, say, a ward manager. If there is no response within 48 hours of the initial email, it will be a missed flush. Vince Tennison said: “The aim is to ensure that even if the primary contact does not respond and email back the return, the secondary or ‘escalation’ contact will, or will notify us why not. The reports generated – which reach me and a number of other users, such as members of our Water Safety Group and Water Safety Sub-Group – are invaluable. Not only can the recipients analyse the data and contact non-compliers directly if they wish to, but the reports are extremely useful in advance of, and during, our monthly Water Safety Sub-Group and bi- monthly Water Safety Group meetings. Staff Trust-wide involved in undertaking the actual flushing have embraced the system well, recognising that it is a major contributor to safeguarding patients against waterborne infection.”


A relevant background Vince Tennison believes the Trust is perhaps unusual as an acute NHS Trust in having a dedicated Compliance Team within its Directorate. He said: “Quality and compliance are very much in my blood, and throughout my career in various sectors, I have gained a lot of


The L8guard flushing compliance management system is designed to be easy to access and straightforward to use.


experience in how to integrate such considerations in very challenging circumstances. One of the goals of our director, as well as me and my team, is for the Trust’s Estates operations to achieve ISO 9001 accreditation, or, as a minimum, have the foundations of an ISO quality management system.”


He continued: “When I joined the Trust in 2018, I had to learn how L8guard worked. Emma Barrett, a colleague within the Compliance team, greatly helped me


with this. Today, another member of my team, Compliance Admin officer, Emma Drewery, not only extremely efficiently manages the administration and use of L8guard, but also increasingly goes out to see clinical and non-clinical personnel in a range of areas and departments – both to emphasise the importance of the system’s use, and put a human face to our compliance goals. She can also ask particular personnel why flushing return levels in, say, a particular ward,


Head of Compliance’s view


During my meeting with Vince Tennison, I also spoke by telephone to Bill Parkinson, the Trust’s head of Safety & Statutory Compliance, who has been with the Trust since 2002, and has even longer experience of the L8guard compliance management software system’s use. I asked him about the Trust’s introduction of the system, in 2015. He explained: “Our previous paper-based flushing compliance monitoring system was difficult to maintain and keep up to date, and also slow in notifying people if we had a potential issue. We needed a system to address these shortcomings. Before we introduced L8guard, a Compliance Team member generally had to ring the personnel in a particular department or ward if we uncovered a failure to send us back the paper returns. Sometimes this could be a week or more after the event, so where were we were missing data, it was difficult to keep on top of it. This all highlighted the need to switch to a new compliance management system.” He continued: “L8guard was introduced by my predecessor, Malcolm Hoggart, who had had considerable input and help from Digital Missives in getting it set up. One of the things I know we really favoured was the ability to email more than one contact per ward or department, and then for the system to send a further email to an ‘escalation contact’ in the event of no response. We now generally get responses and flushing returns very quickly. We had a fair task to get the lists of emails collated and over to Digital Missives, especially as, at the time, we were migrating over all our staff emails to ones with an ‘nhs.net’ suffix. “However, Digital Missives was extremely supportive throughout, and within three months of beginning collating all the data, we had the system up and running. “With the company very efficiently managing the system for us, our main administrative task is to ensure we update Digital Missives as contacts change. We were also keen to incorporate some basic awareness information onto the ‘log on’ page to remind users of the necessary actions, with which it also helped us. This information is useful both for new and experienced users. Overall, L8guard has been an extremely worthwhile and cost-effective investment.”


March 2020 Health Estate Journal 47


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