AH ANNUAL REPORT 2018

Recommendations

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Local Audit Emollient and bath pack re-audit Audit of the use of dexamethasone (a type of corticosteroid medication) for extubation on PICU. (Paediatric Intensive Care Unit). Audit of plaster cast wedging for lower limb fractures Pattern of paediatric vestibular referrals and the use of the video head impulse test in the paediatric population (new tehnology which can be used to investigate dizziness and balance malfunction) Audit of theatre turn over times. Actions The audit was presented to the Regional Dermatology meeting in January 2018. Action/Recommendation: • Continue to produce emollient pack, evolve in line with new products/research where available. • Possibly add urea based cream. • Liaise with pharmacology to ensure cost effective prescribing where possible. • Reinforce education with patients/parents regarding emollient types, application technique and volumes to apply. • Ensure letters to GP (General Practitioner) detail the importance of keeping patients stocked with emollient that suits them, and outline how much they should need. • No Re-audit required. The audit was presented to the educational supervisor in January 2018. Abstract submitted to conference. Action/Recommendation: • Development and implementation of an extubation pro-forma for use in PICU. • Completion of a further audit using the pro-forma. • Develop a guideline to rationalise the use of dexamethasone during extubation. • No Re-audit required until guideline developed. The audit was presented at the Alder Hey Orthopaedic departmental meeting in February 2018. Action/Recommendation: • Cast wedging should now not be performed after 10 days post injury due to lack of benefit. • Dissemination of information to plaster technicians and orthopaedic department to make them aware of new practice. • Guideline to be drawn up. • Re-audit in 2-3 years when sufficient numbers have been achieved. The audit was presented at the British Association of Audiovestibular Physicians National Audit meeting, Queen’s Square, London in November 2017. Action/Recommendation: • Engage a wider audience for raising awareness about paediatric vestibular disorders and disseminate training in the video head impulse test. • More engagement with professional colleagues especially G.Ps (General Practitioners). • Continue with video head impulse test. • Re-audit in 18 months. The audit was presented at the Alder Hey Department of Surgery Quality Improvement meeting in November 2016. Action/Recommendation: • No action plan was required for this audit. • Re-audit in 6 months. Alder Hey Children’s NHS Foundation Trust 94 Annual Report & Accounts 2017/18
Local Audit Retrospective audit looking at timing from clinician review to arrival in anaesthetic room in daycase, specifically comparing first patient on list to subsequent patients Audit of aortopexy and vascular ring surgery in paediatric patients at Alder Hey Audit of genetic testing in neonatal CHD. (Coronary heart disease) Post PEG insertion care - completeness of the PEG (Percutaneous endoscopic gastrostomy) pathway form. Actions The audit was presented at the Alder Hey Department of Surgery in December 2017. Action/Recommendation: • A pre 9 a.m. start for the first patient on the list should be possible if clinician review can be done in an expeditious manner. • Reduced pre-operative wait times have been maintained in the new daycase unit. These details will be fed back to the daycase departmental managers for circulation. • Re-audit in June 2018, following all medical student placements we will be able to re-audit daycase start times from September to June allowing us to look at seasonal variation. The audit was presented to the Alder Hey ENT (Ear, Nose & Throat) Department consultant and disseminated to the cardiothoracic consultants in January 2018. Action/Recommendation: • No significant issues arose from the audit. Results hold up well when viewed alongside those in published literature. • No changes were required as consolidated existing practice. • Re-audit in 5 years (infrequently performed procedure). The audit was presented at the Alder Hey monthly Cardiology and Cardiac surgery meeting in January 2018. Action/Recommendation: • Keep the same protocol for genetic testing, reinforce the guidelines. • Do not order microarray if not indicated by the protocol. • The consultants will be informed of the audit results and reminded to follow the protocol. No other action needed. • Re-audit in 12 months. The audit was presented to the Alder Hey Gastroenterology Department weekly meeting in March 2018. Action/Recommendation: • Digitisation of PEG pathway. Simplifying form as part of digitising process in GDE (Global Digital Excellence). • Specialist nurses to update risk register in regards to low levels of sign off for parents/guardians of PEGs. • Stoma nurse will continue to stress importance of parental sign off. • Discharging clinicians to ensure sign off is complete before discharge • To Re-audit digitised pathway once available (GDE will automatically do this so it will be an ongoing prospective audit. Alder Hey Children’s NHS Foundation Trust 95 Annual Report & Accounts 2017/18
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A E H E LD Y R ANNUAL REPORT & ACCO
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©2018 Alder Hey Children’s NHS F
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A MESSAGE FROM OUR CHAIR AND CHIEF
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PERFORMANCE REPORT OVERVIEW The fol
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Teenage Cancer Trust Honorary Patro
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OUR CQC RATINGS The Trust’s curre
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• Applied clinical research perfo
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The Trust’s performance against n
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‘Alder Play’ A new approach to
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KEY RISKS TO DELIVERY IN 2017/18 Th
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Regulatory Ratings NHS Improvement
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Expenditure Operating expenses tota
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ALDER HEY USES MRI/ CT DATA TO CREA
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Louise Shepherd CBE - Chief Executi
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Mags Barnaby - Interim Chief Operat
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NHS IMPROVEMENT’S WELL LED FRAMEW
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Clinical Educators The Trust has ag
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All complainants are offered the op
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have resulted in Memoranda of Under
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The Community Cluster Developed wit
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Alder Hey’s collaborative campaig
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Page 48 and 49: SALARY AND PENSION ENTITLEMENTS OF
Page 50 and 51: STAFF REPORT Analysis of Trust staf
Page 52 and 53: approach to internal materials and
Page 54 and 55: EXIT PACKAGES 2016/17 Exit Package
Page 56 and 57: As in 2016, we surveyed all staff i
Page 58 and 59: NHS FOUNDATION TRUST CODE OF GOVERN
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Page 62 and 63: Throughout our membership activitie
Page 64 and 65: Attendance at Board of Directors an
Page 66 and 67: External Audit In April 2017 new re
Page 68 and 69: Segmentation Alder Hey has been pla
Page 70 and 71: STATEMENT OF THE CHIEF EXECUTIVE’
Page 72 and 73: During the year the Trust sustained
Page 74 and 75: The Divisions report against CQC Fu
Page 76 and 77: organisation’s ability to continu
Page 78 and 79: Nursing, Deputy Director of Nursing
Page 80 and 81: THE YOUNG PEOPLE’S CANCER UNIT RE
Page 82 and 83: PART 2: PRIORITIES FOR IMPROVEMENT
Page 84 and 85: 2.1.2 Quality Improvements in 2017/
Page 86 and 87: National Confidential Enquiries Par
Page 88 and 89: 2.2.4 Actions arising from Local Cl
Page 90 and 91: Local Audit Retrospective Audit of
Page 92 and 93: Local Audit How often are high ferr
Page 96 and 97: Local Audit Has the introduction of
Page 98 and 99: The Quality Account deals with rese
Page 100 and 101: Indicator Indicator Description Tar
Page 102 and 103: • A Data Quality dashboard is emb
Page 104 and 105: in improved ward to board reporting
Page 106 and 107: Clinical Incidents Reported 2013/14
Page 108 and 109: Reducing Hospital Acquired Infectio
Page 110 and 111: 3.3.2 PRIORITY 2 - Increase Engagem
Page 112 and 113: Are you: 95 17% 8 1% Parent/Carer P
Page 114 and 115: • Improved the quality of room bo
Page 116 and 117: When a child has an asthma attack t
Page 118 and 119: The awards and review schedule is h
Page 120 and 121: F. The Alder Play App Aims: • To
Page 122 and 123: Developing a System of 7 Day Workin
Page 124 and 125: of staff and governors, assess each
Page 126 and 127: • Working with external organisat
Page 128 and 129: the Tate Exchange programme during
Page 130 and 131: experience. Medication errors are t
Page 132 and 133: • To complete and roll out the ne
Page 134 and 135: 3.3.8 Peri-operative Care The focus
Page 136 and 137: 3.3.9 Best in Operative Care The Be
Page 138 and 139: Improvements: • Increased the Bla
Page 140 and 141: and continues to work towards findi
Page 142 and 143: In November 2017, the National Qual
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3.3.14 Management of Complaints and
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Target or Indicator (per 2013/14 Ri
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I would recommend the Trust’s app
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Commentary from Clinical Commission
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STATEMENT OF DIRECTORS’ RESPONSIB
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• feedback from local Healthwatch
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AN EVENING CELEBRATING THE PASSION,
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STATEMENT OF COMPREHENSIVE INCOME N
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STATEMENT OF CHANGES IN EQUITY FOR
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NOTES TO THE ACCOUNTS 1. ACCOUNTING
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1.6 Expenditure on Other Goods and
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of Financial Position’ by the tru
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through the expected life of the fi
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Exchange gains or losses on monetar
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3.3 Overseas Visitors (Relating to
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5.1 Operating Expenses 2017/18 £00
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7.1 Retirements Due to Ill-Health D
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11. FINANCE EXPENDITURE Finance exp
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15. PROPERTY, PLANT AND EQUIPMENT 1
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15.3 Property, Plant and Equipment
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20. TRADE RECEIVABLES AND OTHER REC
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24. OTHER LIABILITIES 26. FINANCE L
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30. OTHER FINANCIAL COMMITMENTS The
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32.2 Carrying Values of Financial A
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32.5 Maturity of Financial Liabilit
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34. RELATED PARTIES (CONT’D) In a
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KEY AUDIT MATTERS Key audit matters
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AN OVERVIEW OF THE SCOPE OF OUR AUD
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“A matter is significant if, in t
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Alder Hey received visits from both
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AH ANNUAL REPORT 2018

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