Item 8 - Sheffield Health and Social Care

How did we do?We have made really good progress. We have introduced screening for falls within 72 hours ofadmission, Personal Falls Plans, improved assessment of our building environments for falls hazards andhazard reduction opportunities. We have supported our staff through better training and are exploringways to use Assistive Technology to reduce falls (for example, using alarms and sensors in beds andchairs so we know when someone is getting up).The consistent approach to assessing people’s needs, along with the staff support provided has madea clear difference this year. However we need to establish better ways of monitoring that this happens.In 2011/12 there were 516 falls that resulted in harm. This year we wanted to reduce that by 5%to 490. The number of falls resulting in injury has reduced by 21% to 403 this year.Service User falls that resulted in harm 2012/135004003002001000516490Falls with injury 2011/12 Our target for 2012/13Falls with injury 2012/13Of those who experienced harm from a fall, 52 people needed to attend hospital or A&E for treatment,compared to 61 in 2011/12.Next year we intend toContinue with our plans, as they have had a positive effect this year. We plan to• Ensure falls that result in harm do not exceed 439 (our original two year target)• Ensure people admitted to our older adult wards are assessed for risk of falling and monitor this effectively• Evaluate the use of assistive technology, such as the bed and chair sensors• Implement the risk assessment process (MFRA) to the residential care services that we provide support to.403Quality objective 2: To reduce theincidence of violence and aggressionand the subsequent use of restraintand seclusionWe chose this priority becauseWhen violence or the potential for violencehappens, it causes harm, distress, anxiety and fearfor both service users and our staff. This will clearlyhave an impact on how people feel in receiving careor providing care within our inpatient services. It isin everyone’s interest to reduce violence and the fearand anxiety associated with violence.In the past we have reported lower rates of violenceand aggression when compared to other mentalhealth trusts. Benchmarking information fromthe National Patient Safety Agency for the first 6months of 2011/12 showed that 15.5% of patientsafety incidents reported by the Trust were relatedto disruptive, aggressive behaviour, in comparisonwith 19% of incidents reported by mental healthtrusts nationally.However, our own data showed that violentincidents made up a large proportion of our overallincidents. As well as this the CQC Staff Surveyfor 2011 showed the Trust fell into the highest(worst) 20% of staff from all areas of the trust whoreported that they had experienced physical violencefrom patients, relatives or the public in the previousyear. The proportion of staff who said they hadexperienced harassment, bullying or abuse frompatients, relatives or the public in the previous12 months was also above the national average.We said we wouldWe have introduced a programme called RESPECTwhich is an ethical approach to managing aggressionand violence.Its aim is to support staff to empathise with theservice user, to understand that the service usermay well be frightened and that may be whatis informing their aggressive presentation. Theprogramme promotes early recognition of thesigns of pending aggression which supports moreappropriate de-escalation approaches but alsoacknowledges that, on occasion, violence will beinstrumental and that intervening physically willbe the only safe response.We have trained our staff to respond to thesecircumstances safely and with sensitivity. Theprogramme will touch everyone in the organisationas it also focuses on exploring the environment andthe context that the aggression is displayed withinand what we can do to make improvements to theway we provide our care generally.Through this programme, during 2012/13 ourplans were to:• Continue to deliver the Respect training forall of our ward staff by the end of this year• Continue to monitor the incidents of violenceand aggression at team level, and analysetrends over time• Establish reliable and consistent methods forthe recording of restraint and seclusion on allinpatient areas, and establish clear baselinesto inform ongoing evaluations• Establish service level plans for the reductionof the use of restraint and seclusion in allinpatient areas• Establish reliable and consistent reporting onthe use of restraint in our community settings,establish baselines and set local reductiontargets and agree actions.The outcome we wanted to achieve wasBy the end of this year we wanted to ensure allinpatient nursing and support worker staff withinour inpatient services had been trained in theRespect Approach.Through this year and by the end of next yearwe wanted to:• To reduce the use of seclusion and the useof restraint• To increase the percentage of service users inacute wards who report experiencing a safeenvironment in local surveys• To reduce the number of staff reporting thatthey have experienced physical violence andharassment, bullying or abuse from service users,relatives or the public in the CQC Staff Survey.9192