Greater Manchester West Mental Health NHS Foundation Trust provides a range of mental health and specialist drug and alcohol services. It provides inpatient and outpatient services to a population of over 750,000 across fifty sites across the North West of England. In 2009 it achieved an 'Excellent' and 'Excellent' rating in the Care Quality Commission Ratings.
Like all Trusts, the safety of its patients and staff is a high priority. The Trust must meet government legislation on all aspects of clinical practice, healthcare and patient welfare. To meet these requirements, the Trust has invested in Datix patient safety and risk management software, which is now widely used throughout its directorates and sites since its implementation in December 2007.
The Datix main application provides a nine module central system that was fully mapped and coded to NPSA requirements, spanning across the key areas of the Integrated Governance department handling, claims, complaints, health and safety and governance information within six months, including initial research, development and training to all Integrated Governance staff.
As a disparate organisation stretching across seven boroughs, the Trust faced many challenges in capturing and reporting on data to meet the required standards for risk management and patient safety. Many different systems were used across the Trust to input, collate and report on data.
According to Dave Pilsbury, Deputy Director of Integrated Governance at the Trust, “Pre-2007, patient safety incidents were reported directly into our electronic patient records system (ICIS), which although invaluable to clinicians, created additional administrative processes for recording incidents.
“We identified that we required an integrated risk management system to provide a robust repository for the collection and analysis of risk and performance data. The Trust’s vision was to ensure full integrity of patient records by developing a solution that would automatically populate ICIS from Datix, meeting National Patient Safety Agency (NPSA) requirements and massively reducing front-line staff administrative time. In turn, this would lead to a higher quality of patient care.
In April 2007, Debs Smith, Datix project lead in the Integrated Governance Department undertook a thorough evaluation of Datix. Her role was to assess whether it could meet the Trust’s needs to capture and record incidents for effective reporting and action, as well as risk management. Following this research, a business case was prepared for the Executive Board.
“We really liked the versatility of Datix,” said Debs Smith. “It enabled us to develop the system to do exactly what we require and is very user friendly - an important aspect when we have such diverse users. We also liked the web element. We are located across a wide geographical area with very disparate locations and our IT infrastructure is quite complex. The web interface really does provide accessibility across the Trust, with minimal connection issues.”
The Datix Project Team worked on designing and developing a series of interactive forms for the three web-based modules: risk register, safety alerts and incidents. The first two web modules were fully set-up, training given and implemented Trust wide in May 2008 and September 2008 respectively and work then commenced on developing the innovative link between Datix and ICIS for recording of incidents, accidents and near misses.
The Datix, Patient Records (ICIS) and IT Project teams worked together to develop a technical solution to ensure that all patient safety incidents recorded in Datix would automatically populate the relevant ICIS patient record. Following a series of technical meetings and development, the Datix web Incident forms were designed specifically to capture patient ICIS information and thorough testing of the system took place. In January 2009 the Incident web, the largest of the three web modules, went live across the first two pilot sites.
"We really liked the versatility of Datix. It enabled us to develop the system to do exactly what we require" Debs Smith, Datix project lead in the Integrated Governance Department Greater Manchester West Mental Health NHS Foundation Trust
“The technical link between Datix and ICIS is the first of its kind across all Trusts using these systems,” said Mrs Smith. “It has been very well received at all levels of the organisation. We have had an increase in the number of incidents recorded and vastly improved data quality. Data now needs to be entered only once - the recorded incident then follows an authorisation process and is fed into the ICIS patient record. It allows us to keep the integrity of our patient records, as well as enabling us to meet reporting requirements of the NPSA.
A Project group comprising senior representation from all clinical and corporate directorates was set up, initially, meeting monthly, the group ensures that departments continue to work together and that staff are fully engaged in the implementation of the system.
One of the challenges the Trust faced was the move from paper-based manual systems to one integrated electronic system. “It was really important to get everyone on board from the start,” said Mrs Smith. “It was a huge culture change to stop using paper forms. We delivered tailored training packages to each Directorate on-site across the Trust and are on target to have fully implemented the Incident System to all 3500 staff by December 2009.” In addition, the Datix training team base themselves on-site post go-live for up to 3 weeks to provide on hand support and advice using the system. “It is vital that users have a positive experience during the early days of using the system so they are confident enough to keep using it and gaining the benefits it offers,” said Mrs Smith.
The response from staff has been very positive. Now, the incident is recorded once, rather than directly on ICIS, then duplicated onto a paper form and sent to Governance, or having to complete a staff accident form in a separate book. This has reduced the amount of paperwork which means that staff have more quality time to spend with patients.
As a result of manager awareness workshops during the initial pilot phase, the team worked together to develop a two-stage sign off process for incidents. During the pilot some concern was raised about the time that it was taking for incidents to be passed to ICIS.
Therefore an “ICIS Link Person” role was created; usually the nurse in charge or line manager on duty at the time the incident is recorded. It is their responsibility to approve the incident and check details to ensure that the incident is posted into ICIS in a timely manner. The team also designed a colour coded incident level system to provide guidance for users when recording the incident level and whether an investigation was required.
Datix now provides a single electronic integrated risk managementsystem. It enables the Trust to record, report and monitor all risk and performance issues, both internal and external across Greater Manchester West and gives Managers local access to run detailed packaged reports or design their own reports for use within their local risk management meetings. The Datix project team have set up a suite of standardised packaged reports that managers can access for specific category’s for example, Safeguarding or Medication incidents. The reports have been very well received and give managers the ability to look at trends and hotspots and put actions in place to reduce re-occurrence.
The Integrated Governance team also produce a monthly lessons learnt bulletin that is distributed across the Trust and to external partners. The bulletin covers topics, guidance and best practice learnt since the new integrated incident management system and is based on actual incidents and risks recorded.
Following the success of the implementation, Greater Manchester West Mental Health NHS Foundation Trust has shared its experience and practice with other Trusts throughout the UK and has become a beta testing and reference site for Datix.
Dave Pilsbury concluded, “The new arrangements in place have allowed us to report to external stakeholders such as the Health and Safety Executive (HSE), National Patient Safety Agency (NPSA), Strategic Health Authority (SHA) and Local Security Management Specialist board (LSMS) in a qualitative and quantitative manner in real time. We are satisfying regulatory requirements as well as providing local managers with real credible data on the safety performance of their service to allow the continual improvement of services through lessons learned.”