World Patient Safety Day 2020 logo

This year's theme for World Patient Safety Day is Health Worker Safety because safe health workers, safe patients. Speak up for health worker safety! 

What is World Patient Safety Day about?

Recognizing patient safety as a global health priority, all 194 WHO Member States at the 72nd World Health Assembly, in May 2019, endorsed the establishment of World Patient Safety Day (Resolution WHA72.6), to be marked annually on 17 September. The objectives of World Patient Safety Day are to increase public awareness and engagement, enhance global understanding, and spur global solidarity and action to promote patient safety.

What is Greater Manchester Mental Health is doing for health worker safety?

Here at GMMH, we take the safety of our staff and service users very seriously. You can find out more about what we've been doing this year below:

Infection Prevention & Control

The IPC Team are committed to keeping everybody safe, we believe that Infection Prevention and Control is everybody’s business, that good IPC needs to be preventative, integrated, accessible and sustainable.

The GMMH Infection Prevention and Control Team (IPCT) are committed to patient and staff safety, the team plays an important role in creating and maintaining safe environments for patients, visitors and staff – working in partnership with operational and corporate services.   They also provide advice and education regarding a wide range of topics such as COVID-19, outbreak management, hospital acquired infections, cleaning/decontamination, Influenza, Hepatitis, Personal Protective Equipment (PPE) and needle-stick-injuries to note a few.  The team are responsible for keeping up-to-date with regional and national guidance so that practice, policies and procedures are current, as well as undertaking a wide range of quality assurance audits so to ensure that best practice is taking place across the Trust.  The team offers bespoke training for services so that they are able to operate safely; this has been more frequent during the COVID-19 pandemic.

  • Daily reviews of regional and national guidance so to ensure that the Trust is up-to-date and patients, visitors and staff are safe.
  • Undertake supportive visits to the clinical areas to ensure that staff are aware of guidance and are practicing safely.
  • Support services to develop and review local risk assessments/plans.
  • Deliver specific training sessions; Fit Testing, Influenza and COVID-19.
  • 24-hour IPCT advice line during the COVID-19 pandemic in order to support staff with their clinical decision-making.
  • Dedicated ‘duty system’ which ensures timely responses to email and telephone queries.
  • Work collaboratively with other departments and agencies so to ensure that guidance is implemented and sustained. 
  • Lead on the Personal Protective Equipment for the Trust.
  • Take into account the diverse range of people and communities that we meet or come into contact with; ensuring the best care possible.
  • Offer consistent communication around IPC standards working closely with our Communications Team.

Practice Education

2020 preceptorship pack

Support was offered by the Practice Education Facilitator (PEF) team for our newly qualified starters, there was an option to complete the preceptorship programme early. We revised the existing Preceptorship pack so this would help the staff to progress safely to complete the preceptorship programme within 12 weeks, so they were prepared should the pressure of the pandemic leave practice short staffed.

The role of the aspirant nurse and deployment

All students and placements had a COVID risk assessment before deployment and received a contract of employment to access staff benefits.

The role of the 2nd year and early 3rd year students was to be deployed as Band 3 and were able to supplement practice staff during the pandemic and also enable them to continue their studies and progress to the next part of their course.

The role of the final placement 3rd year students was deployed as Band 4 which again provided support to practice but enabled them to complete their training and be able to qualify on time to join our workforce as qualified nurses.

The aspirant nurse roles were funded by Health Education England (HEE) so this became an additional resource for practice to cope with staff absences during the pandemic.

The support system for the aspirant nurse

All students were given a dedicated PEF for support and had regular communication with the students and the placement areas. All students had an Assessor/supervisor for additional support on the placement area. We also had a web page with details of the Chaplaincy, SHOUT and other student support services. The students were given an induction to areas in order to practice safely and complete mandatory e learning and packages developed for the pandemic such as infection prevention. PMVA training was organised for the students for their own and patient safety.

Return of the student nurse and risk assessment

All students have a covid risk assessment before placement commences. An infection prevention training bundle has been put on the university Blackboard site so students have access to training before practice. A virtual welcome induction and refresher session have been organised to remind students of their responsibilities in the current climate.

Post Incident Debrief Support (PIDS)

PIDS is an organisational intervention to support the health and wellbeing of GMMH staff in recognition of the emotional impact of the work they undertake in supporting the mental wellbeing of those in our care. The approach draws on the literature on general psychological resilience (i.e lack of social support increases vulnerability to a psychological disorder, that resilience following trauma is promoted by responses that promote a sense of safety, self & community efficacy and empowerment, connectedness, calm and hope), on expert consensus and on good practice guidance. PIDS is an opportunity for people to discuss what has happened to them as a group of peers, to consider the likely reactions to such an event and to provide immediate support and guidance. Overall the aim is to facilitate normal recovery through promoting the person’s own coping mechanisms and support structures. Although a PIDS meeting is normally undertaken with a group of staff peers, 1:1 debriefing support will be provided if indicated. Attendance at debriefing support meetings is voluntary and matters discussed in the meeting are confidential.

Each PIDS session is evaluated and the service reviewed on an annual basis.  The 2019 review yielded the following re staff feedback from those who have been involved in a review.

Prevention and Management of Violence and Aggression Training

Background

In order to reduce the risk of infection spread during the COVID-19 pandemic the Trust took the decision on the 13 March 2020 to suspend all face-to-face training, including Prevention and Management of Violence and Aggression (PMVA) training. The training compliance period was temporarily extended to 18 months. This is in line with the practice of many other mental health Trusts and was agreed in consultation with operational services.

Restrictive interventions

There had been a recent increase in the use of restrictive interventions (restraint, seclusion and rapid tranquillisation) between March and May 2020.

PMVA training is vital to the safety of staff and service users. Appropriate training can reduce the use of restrictive interventions which can be traumatic for both patients and staff. It is possible to safely deliver PMVA training with the additional safety measures described. The Positive and Safe training team feel comfortable with delivering physical training, and are knowledgeable about appropriate actions that must be taken to minimise transmission and risk to staff. An environmental risk assessment was undertaken to support the new training environment. Staff side were also engaged in the plans. 

Recommendation

It was recommended that PMVA resumes as described with the additional safety measures in place in order to increase safety for staff and patients whilst minimising the risk posed by the pandemic.

Actions Taken

PMVA theory training courses

It was identified that as staff were being re-deployed from the community to inpatient units, they required up-to-date PMVA training focused on reducing restrictive interventions. A one-day theory training course was developed with the aim of reducing the likelihood of escalation of aggression and agitation and therefore reducing the need for restrictive interventions. This course had been designed to include de-escalation, trauma-informed approaches and information about the law as well as the latest guidelines in relation to restrictive interventions during the pandemic. This course is also available to aspirant nurses.

Dates of courses were made available on the Learning Hub with further dates to be added as required according to need. The courses were delivered face-to-face with numbers limited to 10 per group in order to allow for social distancing.

PMVA practical training courses

A proposal for practical training was developed after consultation with similar Trusts. A full 5-day PMVA course was offered for all new starters and aspirant nurses.

Training was adapted in order to minimise physical contact by grouping the same people together throughout the course, and reducing the number of practical role plays. Course sizes will be reduced to 10 in order to observe social distancing principles. Trainees will be asked to bring a change of clothing and footwear. PPE will be used when required as recommended in the restrictive interventions’ guidelines for involvement in physical restraint. Hand gels and access to handwashing facilities will be made available and training areas will be disinfected daily. The physical health declaration form will be expanded to include Covid-19 symptoms. Anyone reporting or displaying COVID-19 symptoms will be asked to leave the course and isolate.

In order to ensure that the revised programme was delivered as proposed there was further investment in the Positive and Safe Team with a Positive and Safe Assistant acting up into a Positive and Safe Trainer role and a Positive and Safe Assistant seconded, both for a period of 6 months.

Additionally, air conditioning was installed in both of the PMVA training rooms and new mats purchased for one room to provide a safer, more comfortable environment for staff.

Quality Improvement

Positive Support Plans – the trust developed a template for Positive Support Plans (PSPs) which is simple and easy to use for patients and staff. This allows patients to communicate their preferences, both for activities they like doing when they’re feeling good, and for how they would like to be supported at difficult times. This has reduced the risk of iatrogenic harm for patients as they are able to communicate their unique preferences. It also improves the relationship between staff and patients, therefore reducing the likelihood of a patient becoming distressed. PMVA training includes how to use a Positive support plan as a preventative approach to managing aggression or agitation.

Debriefs – after an incident where restrictive interventions have been used, the Trust requires staff to carry out a debrief, and where possible to include the patient in the debrief. This enables staff to reflect on what happened and to think about how the use of restrictive interventions could be avoided in the future. The patient debrief allows patients the opportunity to reflect on what happened and to discuss future coping strategies with staff. This can also be used as an opportunity to update the PSP if there are additional considerations that should be included in their plan. This is covered in PMVA as a mandatory part of any restraint and is role modelled by the trainers. Debrief templates have been developed and approved at the Trust Positive and Safe meeting – these are due to be distributed to all wards once comms have had them printed.

Trauma-informed care (TIC) – the training for PMVA has evolved over the past 2 years to include more and more preventative strategies. The latest of these is to increase the focus on understanding for staff  on  the impact of trauma on a patient’s presentation. The PMVA trainers have received training on the principles of trauma-informed care and its application in relation to the prevention of incidents of aggression and self-harm (which may lead to the use of restrictive interventions). Following receiving specific training on TIC, this has been woven throughout staff PMVA courses and conflict resolution. The next step is a bespoke session for GMMH staff which will initially be delivered by a psychologist (and later the PMVA trainers) which will provide staff attending PMVA courses more information about trauma and how it can impact both patients and staff. This is intended to encourage staff to see patient behaviour through a ‘trauma lens’, which in turn may alter the response the staff have to that behaviour.

Quality Improvement projects – Irwell ward joined the RCPsych national collaborative which supported participating wards to reduce the use of restrictive interventions. They were very successful and as a result have found there are less incidents on the ward, staff wellbeing has increased, and the ward attracts students and staff from other areas as it is known as a ward which follows the principles of least restrictive practice. Carers and patients have reported they are happy with the care on this ward. Patient and staff safety has significantly increased over the course of the project as the levels of incidents reduced. Following on from the success of this, 7 wards across GMMH will be involved in a similarly structured collaborative project. The wards with the highest levels of incidents have been selected with the aim of reducing the use of restrictive interventions by 20% over the participating wards. Ideas from these wards will be shared at the P&S meeting with a view to them also having an impact on wards which are not part of the collaborative. This will run for 1 year, with further wards being involved the following year and so on.

Safewards – the Safewards intervention is an evidence-based intervention based on a successful randomised controlled trial carried out over a number of trusts. The key principles are developing relationships between patients are staff and empowering patients to make choices about their care with a view to reducing the use of restrictive interventions. This has now been implemented over our 58 wards, leading to a reduction in the use of restrictive interventions Trustwide. There are ongoing challenges with implementation and sustainability, therefore the project remains a high priority for the Trust. Safewards is fully embedded into training programmes and is a key part of care delivery and incident management Trustwide.

Risk and Safety Team

The Risk and Safety Team put people at the centre of everything we do. We look after our staff so they can look after patients. If we have a staff group that promote safety and feel valued and listened to, this then leads to a positive patient experience, with care provided in a safe, clean and friendly environment.

The Risk and Safety Team are focused on ensuring safe working for staff. We understand that staff who feel safe and valued are better empowered to provide a high quality service. We do this through developing safe working policies, carrying out health, safety and security audits to evaluate risks and offering recommendations on how to address and reduce any identified risks. We are a point of contact and actively encourage and support staff to raise concerns. We provide support and guidance to managers to enable them to reduce staff safety risks. We work with other departments to offer advice and guidance on new builds and refurbishments to ensure that staff safety has been addressed.

We review and carry out investigations into accidents or incidents so we can fully understand all the factors, using these to learn lessons and take action to avoid reoccurrence. We provide support and guidance to staff who have been victims of violence and aggression. We act as a liaison between staff and police to pursue the desired outcome for the staff member. We recognise each staff member as individual who’s feelings and experience are unique to them. Where we see a staff safety issue we raise awareness at the relevant committee to ensure positive actions are taken. By helping staff to focus on their own psychological health and well-being, we will promote happier staff, reduce stress and again produce a positive patient experience.  The above is achieved by our team, through investigation, audit, support and embracing change when this is required, all for the very reason we come to work, our patients.

 

 A working group has produced a hate crime protocol which was approved at the RMC meeting early this month.  The purpose of this protocol is to raise awareness of what a hate crime is and to encourage the reporting of any hate incident or hate crime. The protocol will be launched as part of the National Hate Crime Awareness week in October 2020.

Safeguarding

We continue to monitor, assess and develop the arrangement’s which we have in place to safeguard children, young people and adults at risk.  Safeguarding children, young people and adults at risk being a fundamental part of patient’s safety.

Messaging around staff protecting their own safety and that of the people they care for

We have:

  • Published Covid-19 and Safeguarding Guidance in relation to what to do if you or someone you know is being harmed or neglected.  This guidance provides information in relation to what is abuse and neglect, the signs of abuse and neglect and what to do, including contact numbers, helplines and sources of support.
  • Published remote working and safeguarding guidance to assist staff to identify and respond to safeguarding concerns during phone/video consultations.  This included potential signs/indicators of abuse, questions to ask and what to do if staff had concerns.
  • Updated and publicised our Domestic Violence and Abuse policies and procedures for both staff and patients.

 

Improving staff knowledge, skills and competencies for safety in healthcare

We have:

  • Published monthly safeguarding newsletters and 7 min briefings to share key safeguarding messages, learning from reviews, guidance and local and national updates.
  • Published 7 min briefings to share learning from reviews.
  • Developed bespoke specialist training modules to support key roles and responsibilities, for example, Domestic Violence and Abuse, Section 42 enquires, and the Mental Capacity Act and Reflective Practice.
  • A comprehensive suite of safeguarding policies, procedures and practice guidance.
  • Audited the effectiveness of our safeguarding training, policies and procedures to ensure that they remain effective.

Stores and Transport

Stores are currently holding over 2 million units of PPE Including over 550,000 face masks, 550,000 pairs of gloves, 700,000 aprons and 40,000 visors. Accepting daily PPE deliveries on top of what they already receive.

Transport are delivering over 126,000 units of PPE per week to eleven Hubs across the GMMH foot print, dropping items as far as Carlisle. This ensures staff have access to adequate PPE at all times ensuring their safety and that of the patients/service users in their care.

Facilities implemented a stock monitoring system allowing for the recording of incoming and outgoing items of PPE as well as items stored onsite and out in PPE hubs, this has allowed us to monitor our stock levels and ensure that hubs stock never drop below an agreed level.

During the worst few months of COVID transport staff worked around the clock ensuring COVID swabs were collected and delivered for testing within hours of them being taken. This allowed for results to be obtained quickly helping the Trust to understand where they needed to isolate COVID positive patients and therefore reducing the chances of the virus spreading to others.

Supervision

Supervision is an integral component of support to promote wellbeing and safety for all the workforce in Greater Manchester mental Health NHS Foundation Trust.

Supervision links professional standards, the Trust values and strategies. Supervision promotes the quality and safety of service delivery across the Trust.

Good quality supervision contributes to personal and professional development of all staff and therefore promotes high morale and the wellbeing of staff. The Trust is committed to positively supporting staff to understand their role, responsibilities, key objectives and enabling them to undertake their job safely and as effectively as possible. The supervision of staff is one of the key processes by which this can be achieved.

All staff working in GMMH consider their role in safeguarding the needs of the patients: the vulnerable adult, child and family. Supervision provides an opportunity to focus on safeguarding and is a standing agenda item.

In GMMH, managers via supervision focus upon the wellbeing and health of their staff. Being a compassionate manager during the pandemic has been a key message in the Trust with support and guidance of how to keep in touch with the workforce working remotely in challenging times. We have started a campaign within the Trust to let staff know how often supervision should occur, how to record supervision and why supervision is important.