Amersham Hospital, Amersham

General Services Information

Hospital Questions

• How many single rooms are available to NHS patients at this hospital: 6

• Of these how many have an ensuite toilet: 5 Ecludes Community Beds

• Of these how many have an ensuite toilet and shower or bath: 5 Excludes Community beds

• Does this hospital operate an accident and emergency unit:

• How many specialist palliative care beds are available at this hospital: 0

• Does this hospital have a named private unit/service:

Trust Questions

• Does the Trust treat private patients:

Patient Safety

Trust Questions

• Is there a system for recording operations that resulted in a foreign body being left post surgery:

• What is the reporting system for a foreign body being left post surgery: An Organisation Wide Policy for the Management of Incidents including the Management of Serious Incidents

• Is there a system for recording operations that were cancelled due to missing notes:

• What is the reporting system for operations that were cancelled due to missing notes: An Organisation Wide Policy for the Management of Incidents including the Management of Serious Incidents

• Is there a system for recording operations that resulted in wrong site surgery taking place:

• What is the reporting system for operations that resulted in wrong site surgery taking place: An Organisation Wide Policy for the Management of Incidents including the Management of Serious Incidents

• During the period 01 April 2010 - 31 March 2011, how many operations resulted in a foreign body being left post surgery: 0

• During the period 01 April 2010 - 31 March 2011, how many operations were cancelled due to missing notes: 6 Data obtained from the Infomratoin team. All 6 were subsequently readmitted within 28 days

• During the period 01 April 2010 - 31 March 2011, how many operations resulted in wrong site surgery taking place: 0

• How many incident investigations using a full Root Cause Analysis did were carried out in 2010/11: 159 Serious Incidents have a root cause analysis investigation conducted and in 2011/2011 this is 159 Serious IncidentsIt. Is likely that more than 159 incidents will have been investigated using RCA as the Organisation Wide Policy for the Management of Incidents including the Management of Serious Incidents states all red (extreme) risks must be fully investigated and that Divisions must have a mechanism in place for the review of incidents and to determine the level of investigation required..

• What percentage of patient safety incidents resulting in severe harm or death had a full RCA initiated/completed: 100% Serious Incidents and those incidents that are not deemed as serious incidents but still are reported to the Serious Incident Group all have a root cause analysis investigation conducted.

• What percentage of acute inpatients have a track and trigger warning system in place for the duration of the admission: 100% The Trust uses an Early Warning Score (EWS) track and trigger system across all its acute in-patient beds.

• What percentage of patients are risk assessed for venous thromboembolism on admission: 61-90% Our reporting methods have changed this year. The Trust reports an average of 83% of all patients have been risked assessed across the first quarter of 2011/12. An audit of thromboembolism prophylaxis in one key specialty area reported 98% of patients had appropriate prophylactic treatment, indicating accurate assessments prior to treatment. Therefore, we feel 83% as a Trust average is apporpiate. Discussions with Robert Douce at Dr Foster confirmed this.

• Compliant with all relevant NPSA safety alerts issues in 2010/11 (you can find a full list of alerts issued at http://www.nrls.npsa.nhs.uk/resources/?p=3). : The Trust is compliant with all NPSA safety alerts issued during 2010/11 and for which the completion date has passed. The Trust is not overdue on any NPSA safety alert deadlines for 2010/11

• Does the Trust have a policy for providing educational programmes on using and interpreting clinical indicators: Whilst training on using and interpreting clinical outcomes is not routinely included in the Trust's Organisational Statutory and Mandatory Training Matrix currently, training has been provided on interpretation of mortality ratios to key members of staff. Requests for other training in the future will be considered.

• Does the Trust have a designated member of staff who supports teams in locating and analysing safety and quality data? (support): Associate Director Information,Associate Director of Healthcare Governance,Patient Safety Manager

• Is safety and quality data available on a central platform and actively disseminated to users: Divisional Scorecards, Reducing Harm Scorecards, Board report relating to Trust wide safety and quality data

Infection Control

Trust Questions

• Does the Trust employ an antibiotic pharmacist:

• Does the Trust operate a pre-admission assessment clinic or equivalent system where patients are screened and results returned in advance of the day of admission:

• Elective patient groups screened at the pre-op assessment clinic: All elective surgical

• Are all oncology patients screened at the pre-op assessment clinic: Not Applicable

• Are all chemotherapy patients screened at the pre-op assessment clinic: Not Applicable

• Are all elective neurosurgery patients screened at the pre-op assessment clinic: Not Applicable

• Are all patients with past history of MRSA screened at the pre-op assessment clinic:

• What method of MRSA screening is used when screening at admission: Culture based in 24-48hrs

• On admission, does topical suppression take place immediately: Only if history of MRSA

• Does the Trust have at least one accident and emergency unit:

• Are all patients admitted through A&E screened:

• Is screening done according to individual risk assessment:

• Does the Trust have a dedicated isolation ward:

• Protocol for isolating patients with infections: Use of an Isolation Policy Patients are allocated side-room on a risk-assessment basis.

• Does the Trust have an isolation policy:

• Where medically appropriate, are patients with C Diff isolated in single rooms as a matter of priority:

• Does the Trust have a policy to guide the use of metronidazole and vancomycin for C.difficile infected patients:

• Does the Trust routinely isolate all patients with diarrhoea:

Stroke Medicine

Hospital Questions

• Does the hsopital have a specialist stroke unit:

Trust Questions

• Does the Trust have a specialist stroke unit or units:

• Is the Trust part of a stroke care network:

• Details: South Central cardiovascular network

• How many emergency admissions with a primary diagnosis of stroke (ICD10 codes I60 - I64) did the Trust receive in the financial year (period 01 April 2010 - 31 March 2011): 535

• Of these, what was the number of patients given a Computerised Tomography (CT) scan within 24 hrs of admission: 125 The Trust use MRI as a first imaging diagnostic wherever possible. So figures are included for both MRI and CT within 24 hours

• Is thrombolysis for stroke patients provided 24 hours per day and 7 days a week :

• Are there any formal arrangements with neighbouring hospitals for the emergency transfer of stroke patients who would benefit from thrombolytic treatment:

Trauma & Orthopaedics

Trust Questions

• Does the Trust offer a trauma service:

• Does the Trust have a dedicated trauma list available 24 hours a day for the duration of the week, (Sunday to Sunday): Emergency capacity available over weekends

• Does the Trust offer an orthopaedics service:

• Do all the Trust's orthopaedic ward/team have a linked geriatric team with whom they have regular meetings at least once a week: Weekly meeting

• Does the Trust run a pre-operative patient education session/class for patients to attend prior to Total Knee Replacement (TKR) and Total Hip Replacement (THR)? : From May 2011 the Trust operate an enhanced recovery programme.

• Not able to put a figure on the percentage of all patients that attend the class prior to surgery: Figures not yet available

• Does the Trust have a standardised anaesthetic protocol for Total Knee Replacement (TKR) and Total Hip Replacement (THR) patients: Options are being assessed regarding the possibility of establishing a standerdised protocol.

• Not able to put a figure on the percentage of the Trusts total knee replacement (TKR) and total hip replacement (THR) patients walk within 24 hours of surgery: Unknown

• Does the Trust have a specialist orthopaedic physiotherapy service which is available 7 days a week:

• Not able to put a figure Patients' discharge delayed due to lack of physiotherapy services at weekends: A minority, currently being audited

• Are patients for total knee replacement (TKR) and total hip replacement (THR) admitted prior to the day of surgery:

• Are patient records routinely recorded using a specific multi-disciplinary team THR/TKR pathway document:

• Is this data used to monitor compliance with the agreed pathway: The pathway commences in pre-operative assessment, leading through to discharge. Compliance is not actively monitored but could be audited from the available information.

• Is criteria-based discharge used:

• Are patients routinely phoned in the first 48 hours after discharge to check on their progress:

Paediatrics

Hospital Questions

• Does the hospital have a paediatrics service: OP Services Only

Trust Questions

• Is the Trust's elective paediatric surgery carried out only by designated surgeons with at least six months training in a specialist unit:

• Do the Trust's anaesthetists with responsibility for paediatric anaesthesia participate in at least one paediatric list per week:

• Is a paediatrician on site (SpR or higher) 24 hours per day, 7 days per week:

• Are at least two registered children's nurses on duty 24hours per day in each children's ward:

• Is there a designated facility on site for parents or guardians to stay overnight: On wards

Palliative Care

Trust Questions

• Does the Trust provide a palliative care service:

• How is specialist palliative care delivered at the hospital: Other (please specify) Adult inpatient specialist palliative care hospice / A multi-disciplinary specialist palliative care team / A community based specialist palliative care team / Day Hospice / Lymphoedema specialist nurse / Children's Hospice at Home team / Bereavement support team

• Does the hospital's specialist palliative team includes: Other (please specify) A consultant in palliative medicine / palliative care nurses / palliative care OT / palliative care Physiotherapist / Lymhoedema Specialist nurse / Education lead in pallitive care / community team of cllinical nurse specialists and carers for adults and children / Chaplain

• Is the Trust's specialist palliative care team available 24 hrs a day seven days a week:

• Are facilities provided to support relatives and carers who wish to stay with a patient in hospital:

• Does the Trust routinely survey and evaluate the views of patients and bereaved relatives and carers regarding the delivery of care on the end of life programme:

Maternity Care

Maternity Sites

• Wycombe Hospital - Midwife Led

• Stoke Mandeville Hospital - Consultant Led

• How many women gave birth in the unit during the year? (not including home births): 5153 April 2010 - March 2011 (inc 20 BBA which could have been booked Home births)

• How many babies were born in the unit during the year? (not including home births): 5244 (inc BBA 20)

• How many women were booked for a home birth: 99

• How many women had a home birth? (not including births at home by accident): 73

• Number of antenatal rooms: 2 2 triage rooms on labour ward

• Total antenatal beds: 51 51 ante/post natal beds

• Number of assessment area rooms (for monitoring and / or induction): 3 Day Assessment Unit 3 rooms

• Total assessment area beds: 53 2 Triage beds on l/w- plus the 51 beds for the ante/postnatl ward

• Number of delivery rooms: 18 14 on main labour ward and 4 Aylesbury Birth centre beds.

• Total delivery beds: 18 14 on main labour ward and 4 Aylesbury Birth centre beds.

• Number of postnatal rooms: 6 51 ante/postnatal bedded ward- with 6 siderooms

• Total postnatal beds: 57 51 ante/postnatal bedded ward- with 6 siderooms

• Number of rooms in obstetric high dependency unit: 4 4 rooms/beds

• Total obstetric high dependency beds: 4 4 rooms/beds

• Number of single rooms used for both delivery and postnatal care (labour, delivery, recovery and postnatal, or LDRP, rooms): 18 all 18 beds on the labour wd / Birth centre can be used this way

• Amenity rooms; Are women able to book a single room in advance of their birth:

• If women can pay for a single room what is the average cost per night (GBP): 82 £195 amenity plus

• Does the maternity unit have a neonatal intensive care unit:

• Does the maternity unit have a neonatal high dependency unit:

• Does the maternity unit have a special care baby unit:

• Security measures - ankle bands for the baby:

• Security measures - cot alarms:

• Security measures - CCTV:

• Security measures - restricted access:

• Other security measures: Identification swipe cards

• Pain relief available - bath or shower: Provided by unit

• Pain relief available - birthing pool: Provided by unit

• Pain relief available - birth ball: Provided by unit

• Pain relief available - Massage: Provided by unit limited at present

• Pain relief available - Aromatherapy: Provided by unit limited at present

• Pain relief available - TENS: Provided by women

• Pain relief available - Epidural: Provided by unit

• Pain relief available - Mobile epidural: Provided by unit

• Pain relief available - Entonox (gas and air): Provided by unit

• Pain relief available - Intramuscular injection: Provided by unit

• Total number of WTE midwives at the unit in your funded establishment, including vacant posts: 155.5

• Total number of WTE midwives at the unit as staff in post, including agency and bank staff: 147.5

• Does the unit have midwives available to provide one-to-one care available 24 hours a day, 7 days a week: On site

• Does the unit have midwives available for home births available 24 hours a day, 7 days a week: On site

• Does the unit have midwives trained and experienced in water birth available 24 hours a day, 7 days a week: On site

• Does the unit have a paediatrician available 24 hours a day, 7 days a week: On site

• Does the unit have an obstetrician available 24 hours a day, 7 days a week: On site

• Does the unit have an anaesthetist available 24 hours a day, 7 days a week: On site

• Does the unit have a dedicated obstetric anaesthetist available 24 hours a day, 7 days a week: On site

Trust Questions

• Do all women have a choice about where they receive their antenatal appointments (i.e. at hospital or local health centre):

• Are NHS antenatal classes available (e.g. Parentcraft):

• Available during the daytime (until 5pm):

• Available in the evenings (after 5pm):

• Available at weekends (Saturday and/or Sunday):

• Available for women only groups:

• Available for other groups:

• Are all women routinely offered ultrasound scans:

• Scan 1 available between: 8-13

• Scan 2 available between: 18-21

Trust Statistics

Trust Questions

• You can view various measures relating to the Trust's performance by clicking the following link: Buckinghamshire Hospitals NHS Trust