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Clinical case tutorial

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UHS adult major trauma guidelines

Description: Adult Major Trauma Guidelines University Hospital Southampton NHS Foundation Trust Dr Mark Baxter Director of Major Trauma, Consultant in Older Persons
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Papers Trust Board 28 March 2019

Description: Agenda Group Name: Date of Meeting: Venue: Time: Apologies to: Trust Board – Open Session 28 March 2019 Conference Room, Heartbeat Education Centre, F Level, North Wing, SGH 9.00am Sue Diduch, Corporate Affairs Administrator 9.00 1. Chair’s Welcome, Apologies and Declarations of Interest 2. Minutes of Previous Meeting held on 28 February 2019 3. Matters Arising/Summary of Agreed Actions 9.15 9.30 9.35 9.40 9.45 10.30 10.40 10.50 4. Quality, Performance and Finance 4.1 Patient Story (Derek Sandeman, Medical Director) 4.2 Briefing from Chair of Audit & Risk Committee for review (Simon Porter, Chair, A&RC) 4.3 Briefing from Chair of Quality Committee for review (Mike Sadler, Chair, QC) 4.4 Briefing from Chair of Strategy & Finance Committee for review (Jane Bailey, Chair, S&FC) 4.5 Integrated Performance Report for Month 11 including Quarterly Patient Experience Report (QIF) for review 4.6 Informatics Update for review (Jane Hayward, Director of Transformation & Improvement/ Adrian Byrne, Director of Informatics) 4.7 2018 NHS National Staff Survey Results for review (Paula Head, Chief Executive/Steve Harris, Director of Human Resources) 4.8 Finance Report for Month 11 for review (David French, Chief Financial Officer) Oral Oral Oral Oral 11.00 5. Chair’s and Chief Executive’s Reports 5.1 Chief Executive’s Report for review and Chair’s Actions for ratification (Paula Head, Chief Executive/Peter Hollins, Trust Chair) 11.05 6. Corporate Governance, Risk and Internal Control 6.1 Feedback from Council of Governors’ Meeting 12 March Oral 2019 to note (Peter Hollins, Trust Chair) 11.15 7. Any other business 8. To note the date of the next meeting: Tuesday, 30 April 2019 in the Conference Room, Heartbeat Education Centre, F Level, North Wing, SGH In Attendance: Adrian Byrne, Director of Informatics Steve Harris, Director of Human Resources Vicki Havercroft-Dixon, Head of Patient Relations (shadowing Gail Byrne) EXCLUSION OF PRESS, PUBLIC AND OTHERS The public and representatives of the press may attend all meetings of the Trust, but shall be required to withdraw upon the Board of Directors resolving as follows “that representatives of the press, and other members of the public, be excluded from the remainder of this meeting as publicity would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted” 11.30-11.45 Follow-up discussion with governors Items Circulated: The following items have been circulated to the Board since the last meeting. Executive directors are happy to take questions from individual members, before the meeting, by e-mail or telephone, or to meet separately to discuss in more detail. 25 February 2019 Press Release: Hospital first to offer all patients chance to manage healthcare online 7 March 2019 Press Release: Eight-week breastfeeding supplement prevents weight loss in premature babies after discharge 12 March 2019 Press Release: Leading doctor warns use of blood test to diagnose heart attacks is “flawed” 15 March 2019 Press Release: Healthcare scientists “hamstrung” by lack of awareness and investment Trust Board Minutes – Open Session Minutes of the Open Trust Board meeting held on Thursday 28 February 2019, in the Conference Room, Heartbeat Education Centre, North Wing, University Hospital Southampton, commencing at 0900 and concluding at 1100. Present: Mr P Hollins, Trust Chair Mrs P Head, Chief Executive Mr D French, Chief Financial Officer & Deputy Chief Executive Mrs G Byrne, Director of Nursing & Organisational Development Ms J Hayward, Director of Transformation & Improvement Dr C Marshall, Chief Operating Officer Dr D Sandeman, Medical Director Mr S Porter, Senior Independent Director/Deputy Chair Ms J Bailey, Non-Executive Director Prof C Cooper, Non-Executive Director Ms J Douglas-Todd, Non-Executive Director Ms C Mason, Non-Executive Director Dr M Sadler, Non-Executive Director PTH PHe DAF GB JH CM DS SP JB CC JD-T CMa MS In Attendance: Mr C Helps, Interim Associate Director Corporate Affairs CH Mr N Pearce, Associate Medical Director for Patient Safety NP Mr M Green, Head of Bereavement Care MG Ms V Boland, Corporate Affairs Manager (minutes) VB Ms S Herbert, DHN/P, Division A (shadowing Mrs G Byrne) SH 1 member of staff 2 governors 19/19 20/19 Apologies Apologies were received from Jenni Douglas-Todd, Non-Executive Director. Chair’s Welcome, Opening Comments and Declarations of Interest The Chair welcomed everyone to the meeting, specifically welcoming back VB. The chair congratulated CMa for her successful appointment as Chair at Solent NHS Trust. Action By There were no declarations of a conflict of interest with any items on the agenda. 21/19 Minutes of Previous Meeting (Agenda item 2) The minutes of the meeting held on 31 January 2019 were AGREED as an accurate record subject to amendments to: 6/19c) the last sentence of the second paragraph was deemed inaccurate and should state that the key performance indicator (KPI) for emergency readmissions be reviewed for next year. 6/19g) date of the major incident that occurred on 30th November 2018 to be provided in full. 22/19 22/19 a) Matters Arising/Summary of Agreed Actions (Agenda item 3) Minute Ref 143/18a) Complexity of Employee Relations Cases and Minute Ref 159/18a) Integrated Performance Report (specifically relating to Diabetes) – It was agreed that the Trust Board Study Session forward plan would be discussed during the closed Board session, to include these items. Page 1 of 6 22/19 b) Minute Ref 6/19j) Staffing – GB confirmed that a more detailed update in relation to the appraisal target would be included in the next Human Resources Report. 22/19 c) The Board noted the latest position on the actions in summary of actions. 23/19 Quality, Performance and Finance Patient Story (agenda item 4.1) DS introduced the patient to the Board. The Board heard a first-hand account of their experience of the Trust’s services. It was noted that the patient felt their experience fell short of their expectations and provided specific examples where the standard of care was disappointing. The patient reported a high standard of care from medical staff. The importance of listening to patients and responding appropriately, and ensuring patients basic needs as well as medical needs were met was emphasised. The Board thanked the patient for attending and providing an overview of their experience noting the value of this. It was confirmed that this information would be used to improve the care provided by UHS. 24/19 Integrated Performance Report for Month 10 including Quarterly Infection Prevention & Control Report (Agenda item 4.2) a) Safe GB advised that there was nothing specific to highlight from the report. There were no further comments or questions. 24/19 b) Caring GB provided an update noting the initiatives being introduced to improve the quality of response to patient complaints and concerns. A patient panel has now been introduced to assist in collecting and understanding patient feedback. It was confirmed that this would be discussed in more detail at the March Quality Committee. The decrease in the percentage of patients with a nutrition care plan was noted. GB will be working with the matrons and ward leaders for areas that are not achieving the expected standard. 24/19 c) Effective DS advised that there was nothing specific to highlight from the report. MS sought additional detail in relation to the four national reports with areas of concern within section E1.2. DS gave a brief overview of these reports noting that diabetes will be scheduled for discussion at a future Trust Board Study Session. 24/19 d) Activity CM highlighted the increase in Emergency Department (ED) attendances compared to the previous January, the significant reduction in non-elective length of stay and the reduction in the percentage of elective operations cancelled as a result of this. The increase in ED attendances was attributed to the opening of the Paediatric ED. An increase had been anticipated however data was being reviewed to confirm the cause as increased paediatric attendances. PHe emphasised the importance of ensuring that the increased attendances do not adversely affect the patient experience. MS congratulated those involved in reducing non-elective length of stay. Page 2 of 6 24/19 e) Emergency Access CM provided an overview noting that ED performance was the average of our local peer group despite the significant increase in attendances. The time to initial assessment metric is currently under development following the introduction of a new triage process within ED. JB drew attention to the continued reduction in eye casualty performance noting the difficulties already within Ophthalmology. CM confirmed that this was being addressed and more detail could be provided if required. PHe introduced the “Best March Ever” concept. CM provided an overview of the steps being taken to achieve this including working with community providers to reduce delayed transfers of care and patients referred to ED, for example, by GPs. PHe added that ED targets were being reviewed and new targets were expected. 24/19 f) Referral to Treatment Time (RTT) CM summarised RTT performance noting improvements in the number of patients waiting over 18 weeks and the number of patients on an incomplete pathway. Patients waiting longer than 52 weeks had been reviewed; patient choice was the reason for delay and there were no clinical concerns due to delayed treatment. 24/19 g) Cancer CM provided an overview of Cancer performance noting a number of measures had not been achieved. CM outlined a recent visit to the Imperial group of hospitals to learn about data analysis that enables better forward prediction and therefore providing more insightful information for the organisation/Board. MS noted the 6-8% increase in cancer activity year on year and suggested that the executive team consider a more a transformational change to address this to ensure this does not have an adverse effect on patients. JH emphasised the increased pressure on services due to identification of cancer at an earlier stage and new initiatives such as lung cancer screening. This would provide better outcomes for patients however would increase the number of patients being treated; this therefore needs to be planned for as part of the Trust’s strategy. PHe summarised the work that is ongoing with commissioners and the Cancer alliance to enable providers to achieve the cancer targets with the increased activity. It was agreed that further information be provided to the Board in relation to this. Action: Update in relation to planning for cancer targets to be provided to the PHe Board. GB noted that a process for reviewing harm as a result of patients waiting longer than 104 days for cancer treatment was being agreed with commissioners. CC queried whether there was any data providing a longer term perspective i.e. over the past five years. JH confirmed this could be made available if requested. 24/19 h) Infection Prevention Report GB provided an update noting that there would be a hand hygiene campaign in March/April 2019 which should have a direct impact on infection control. 24/19 i) Staffing GB summarised the challenges currently being experienced with nurse staffing particularly due to vacancy levels and the steps taken to address this on a daily basis. Page 3 of 6 24/19 j) RESOLVED That the Board NOTE the Month 10 Integrated Performance Report including the Quarterly Infection Prevention & Control Report. 25/19 Learning from Deaths Quarter 3 Report (Agenda item 4.3) a) DS and NP introduced the report. MS thanked NP for a clear report and the reassurance provided by the small number of avoidable cases. MS sought clarification of the personnel involved in reviewing cases and whether any audits were undertaken to ensure the process was working effectively. NP described the process in use. A new medical examiner service would commence in April. PTH queried whether the process identified the consequences for patients who had experienced repeated delays in treatment. NP advised that previous admissions were reviewed however a more formal process would be instigated once the medical examiner service was in place. CC asked whether there was potential for external validation and comparison of availability. NP has been working with other Trusts to ensure their processes mirror UHS’ to allow a comparison between organisations. JH informed the Board that the Hospital Standardised Mortality Ratio (HSMR) is expected to change from April once Countess Mountbatten Hospital becomes independent from the Trust. 25/19 b) RESOLVED That the Board NOTE the Learning from Deaths Quarter 3 Report. 26/19 Freedom to Speak Up Report (Agenda item 4.4) a) GB presented the report summarising the work undertaken and cases received to date. CC confirmed that all cases appeared to have been dealt with appropriately and had not required his involvement. CMa queried whether any trends had been identified so far. GB advised that some cases were protracted Human Resource cases where action had previously been slow. Learning points were being shared when possible, given the need for confidentiality, and this was encouraging others to speak out. 26/19 b) RESOLVED That the Board NOTE the Freedom to Speak Up Report. 27/19 CRN: Wessex 2018/19 Quarter 3 Performance Report (Agenda item 4.5) a) DS provided an overview of the report noting the good performance of the network. MS asked when the last review by the National Institute for Health Research (NIHR) had taken place and the outcome of this. DS confirmed that this took place 6 to 8 weeks ago and positive feedback had been received. MS asked that this information be included in future reports. Action: Future reports to include the outcome of NIHR reviews. DS 27/19 b) RESOLVED That the Board Page 4 of 6 28/19 Briefing from Chair of Strategy & Finance Committee (Agenda item 4.6) a) JB provided an overview of items discussed at the February meeting: • Outcome of 2017/18 reference cost index submission. • Review of latest financial position. • Operational plan 2019/20 update. 28/19 b) RESOLVED That the Board NOTE the update. 29/19 Finance Report for Month 10 (Agenda item 4.7) a) DAF presented the month 10 Finance report, noting for January: • The Trust delivered a control total surplus excluding Provider Sustainability Fund (PSF) of £2.8m. Year to date the Trust is on plan. • In month once non-recurrent items were excluded was break-even, against a Plan target of £2.8m surplus. • Under the single oversight framework the Trust delivered a score for Finance and Use of Resource of a ’1’. • Cost Improvement Plan (CIP) delivery in the month was £2.5m against a target of £2.8m. • Pay has increased by £1m since month 9 due to an increase in substantive, bank and agency costs month-on-month. A proportion related to December pay enhancements for bank holidays. PTH highlighted elective income as £2.9m behind plan year to date. This was attributed to gaps in spinal and cardiac surgery; these tend to be high value cases. PHe noted that whilst the Trust performed well against the NHS Improvement temporary staff pay ceiling, the total head count had increased. DAF confirmed that the data will be reviewed to better present the overall position. CMa asked whether the invest-to-save negative variance related to delays in the replacement of Princess Anne Hospital (PAH) windows. DAF advised that this related to delays in some estates projects such as PAH windows and theatre modernisation due to the requirement to close services to enable work to be undertaken. 29/19 b) RESOLVED That the Board NOTE the month 10 Finance Report. Chair’s and Chief Executive’s Reports 30/19 Chief Executive’s Report (Agenda item 5.1) a) PHe provided an overview of the requirement for the Trust to formally report progress with the flu vaccination programme and approve the achievement of 7 day services standards self-assessment. MS drew the Board’s attention to the percentage of staff concerned about possible side effects from the flu vaccine despite the evidence available to support that they are limited and manageable. PHe highlighted the importance of influencing perceptions of the vaccine and the need for the Trust to target its messages. DS plans to target messages by staff group. 30/19 b) RESOLVED That the Board NOTE the Staff Flu Vaccinations Update and APPROVE the Achievement of 7 day Services Standards Self-Assessment. Page 5 of 6 30/19 c) Items for Ratification Actions taken by the Chair as set out in paragraphs 3.1 – 3.2 were ratified. Strategy and Business Planning 31/19 Revised Equality, Diversity and Inclusion (EDI) Strategy (agenda item 6.1) a) GB presented the updated strategy which has been consulted upon and comments considered and included where appropriate. MS supported the amended strategy. CMa identified that the ‘white other’ group was classified differently within different sections of the strategy. Action: Ethnic group classifications to be consistent within the Strategy. GB The Board discussed the difference between reducing equality and reducing inequity and how this can be addressed alongside the wider health system. 31/19 b) RESOLVED That the Board APPROVE the Equality, Diversity and Inclusion Strategy subject to one minor amendment as outlined above. 32/19 32/19 a) Any Other Business MS provided an update on the recent Diabetes screening event held at the Southampton FC v Cardiff FC football match. 103 people were tested and 2 cases of undiagnosed diabetes identified. The event raised awareness as well as highlighted the value of co-operation between the organisations involved. PHe thanked those involved for their hard work in organising this event. 33/19 Date and Time of Next Meeting Thursday, 28 March 2019 commencing at 0900 in the Conference Room, Heartbeat Education Centre, F Level, North Wing, SGH. Page 6 of 6 UHSFT – Directors’ Actions Summary for 28 March 2019 Trust Board – Open Session ___________________________________________________________________________________________________________________________________________ Action & Minute Reference By whom Target Date Current Status Trust Board 28 February 2019 Integrated Performance Report for Month 10 (Minute Ref 24/19 g) Cancer - Update in relation to planning for cancer targets to be PHe provided to the Board. CRN: Wessex 2018/19 Quarter 3 Performance Report (Minute Ref 27/19 a) Future reports to include the outcome of NIHR reviews. DS Revised Equality, Diversity and Inclusion (EDI) Strategy (Minute Ref 31/19 a) Ethnic group classifications to be consistent within the Strategy. GB as at 18/3/19 Page 1 of 1 Cover sheet for a report to the Trust Board of Directors dated Thursday, 28 March 2019 Title: Integrated Performance Report Month 11 Category Quality, Performance, and Finance Agenda item 4.5 Sponsor Director of Transformation and Improvement Author Trust Performance Manager Provenance Report to the Board provided by the Trust Executive. Purpose The paper is presented for the Board for Review The Board is requested to consider the performance metrics provided, identify any elements, trends or emerging themes it wishes to pursue further. Relevant to Board  Goal 1 – Trusted on  Goal 2 – Delivering for  Goal 3 – Excellence in goals Quality Taxpayers Healthcare Board Assurance This report relates to all of the aims and objectives contained in the Board Framework links Assurance Framework. Equality Impact Assessment The Trust aims to ensure that any change in performance does not affect one or more cohorts of people with specific protected characteristics. This equality monitoring is conducted operationally. Other standards affected NHS Provider Licence and Constitutional standards. Integrated KPI Board Report covering up to Feb 2019 Executive Sponsor - Jane Hayward, Director of Transformation Jane.Hayward@uhs.nhs.uk March 2019 Overview Safe Amber Caring Green Safe remains amber this month as UHS has failed some KPI's yet we have seen continued good performance in other areas. There were no never events reported in February. There were no avoidable high harm falls or MRSA infections/contaminants in February. C.Diff performance remains better than year to date target. In 18/19 the Trust planned to reduce pressure ulcers by 20% compared to last year, this trajectory has not be met in 18/19, however to date the number of pressure ulcers is very similar year on year. The themes are being collated and the learning is being shared through Pressure Ulcer Panel. VTE risk assessments remain an area of focus for the Trust with the new IT solution being piloted in AMU, Surgery and T&O in January 2019. A decision will be made in March by the Thrombosis committee to roll out trust wide. Complaints were low during November, December and January and increased slightly to levels seen previously in February. The rate of complaints against activity level remains consistent and within target range. Negative ratings through the FFT are under the trust threshold with patients continuing to rate their experience positively. Same Sex Accommodation breaches have fallen to under the trust target. Effective Green There were four national reports published and reviewed in Feburary, of these reports one raised an area of concern (National prostate Cancer Audit Annual Report 2018). There are now 218 outcomes being reported to TEC from 46 specialities. Of these the majority are green (78%) and only 7% graded red. Emergency readmissions was at 10.8% in December which is just below the average of last 2 years (11%). HSMR remained stable in November well below the national benchmark and crude mortality dropped slightly to 3.7% Activity Red Flow Amber New referrals recieved are following expected seasonal variation but continue to be higher than 18/19 in the month, quarter and year to date. New urgent cancer referrals in January did not decrease as seen last year instead are showing a 16% increase in the month. Main ED attendances remain exceptionally high in February compared to previous years. This is contrary to the normal seasonal trend which sees a reduction in the volume but not complexity of attendances, paediatric attendances have increased the most, but other streams also have increased compared to 17/18. There have been a number of changes year on year in services provided and how services are recorded that make year on year comparison difficult, this includes the Lymington surgical services and outpatients (up from August 17, impacts electives and outpatients), the change in TrehceoardveinrgagCeDnUucmhbaeirrso(df oDwelnayfreodmTrSaenpstfeemrsboefrC1a7r,eiminptahcetsTrounstnoinnFeelbercutiavreys)r,etmheairneecdoradti9n4g.oTfhtehenuremsbpeirraotofrpyacteiennttrsew(Ahporihla1v8e, dbaeyecnaisnehs otospoituatlpfaotriegnrtesa)t.er than or equal to 7 days / 21 days also increased yet remained lower than February 2018 by 2% and 4% respectively. Emergency Access Main ED (Type 1) performance reduced in February to 71.4%, compared to UHS February 2018 77.2%, and were 4.8% below the average of our local peer group. This performance was impacted by ED attendances significantly exceeding volumes in previous years and the onset of winter pressures in the inpatient service. Red RTT & Diagnostics Both RTT and diagnostic performance improved again in February. The trend of patients waiting greater than 52 weeks continues downwards and the patients waiting at the end of February have now been treated. Amber Diagnostic performance also improved and achieved the target in February. Pleasing to see Average weeks waited for first outpatient appointment continues to reduce. Cancer Red Cancer performance is currently rated red as we are not achieving a number of measures. Recovery of the Treatment started within 62 days of urgent GP referral wait, is likely to be slow and significant challenges are being experienced linked to significant growth in referrals and the number of additional cancers being treated (192 year to date). Improving trends in waiting times for initial appointment, waiting times for radiology and patients waiting for treatment are encouraging. Research & Dev Research and Development has been rated Amber this month. October recruitment benefitted from activity on a high recruiting meningitis prevention study. Whilst recruitment to this study has ended recruitment Amber projections to year end are satisfactory. Complexity (weighted) performance is also satisfactory with UHS ranked 2nd in the UK for a number of consecutive months. Staffing Amber Staffing remains amber overall because some key targets have been missed including those for turnover, non-medical appraisal completion, total nursing and registered nurse vacancy rates. However, UHS has seen improvements in the following: sickness absence (which has never been lower), turnover (the lowest rate since November 2017), decreases in total nursing and registered nurse vacancy rates and percentage of BME staff at Band 7+ (the highest rate it has been). CHPPD is within normal range this month as expected, after seasonal effects in January and it reflects high patient numbers. Estates Green Estates has been rated green this month as we are meeting all targets in February. The target missed on a 3 month rolling average is for percentage of help desk requests completed on time. Digital Green DigiRounds has demonstrated both time saving in reviewing the patient record during ward rounds, but also the quality of the review that is carried out, as clinicians are able to easily see all the significant elements of the record. It saves junior doctors time in preparing information for consultants (transcribing relevant results etc) prior to the ward round. Records accessed using Digirounds increased to 98,573 in February. Also in February the number of alerts sent using Medxnote increased again to 4079. 1 Chart Type Cumulative Column Example Cumulative Column Year on Year Line Benchmarked Line Percentiles Control Chart Variance from Target Report Guide Explanation A cumulative column chart is used to represent a total count of the variable and shows how the total count increases over time. This example shows quarterly updates. A cumulative year on year column chart is used to represent a total count of the variable throughout the year. The variable value is reset to zero at the start of the year because the target for the metric is yearly. The line benchmarked chart shows our performance compared to the average performance of a peer group. The number at the bottom of the chart shows where we are ranked in the group (1 would mean ranked 1st that month). A line percentiles chart is used to represent the distribution of a variable. The 50th percentile shows the median value, we also show the 5th, 25th (lower quartile), 75th (upper quartile) and 95th centiles. A control chart shows movement of a variable in relation to it's control limits (the 3 lines = Upper control limit, Mean and Lower control limit). When the value shows special variation (not expected) then it is highlighted green (leading to a good outcome) or red (leading to a bad outcome). Values are considered to show special variation if they -Go outside control limits -Have 6 points in a row above or below the mean, -Trend for 6 points, -Have 2 out of 3 points past 2/3 of the control limit, -Show a significant movement (greater than the average moving range). Variance from target charts are used to show how far away a variable is from it's target each month. Green bars represent the value the metric is achieving better than target and the red bars represent the distance a metric is away from achieving it's target. 2 March 2019 Safe Safe remains amber this month as UHS has failed some KPI's yet we have seen continued good performance in other areas. There were no never events reported in February. There were no avoidable high harm falls or MRSA infections/contaminants in February. C.Diff performance remains better than year to Amber date target. In 18/19 the Trust planned to reduce pressure ulcers by 20% compared to last year, this trajectory has not be met in 18/19, however to date the number of pressure ulcers is very similar year on year. The themes are being collated and the learning is being shared through Pressure Ulcer Panel. VTE risk assessments remain an area of focus for the Trust with the new IT solution being piloted in AMU, Surgery and T&O in January 2019. A decision will be made in March by the Thrombosis committee to roll out trust wide. MMoonntthhllyy Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Target YTD YTD Target S1.1 Never Events 1 1 1 - 3 0 1 S1.2 Avoidable High Harm Falls =95% 98% > =95% S1.12 % Thromboprophylaxis . Patients Assessed 95% 93.3% 92.8% > =95% 93% > =95% S1.12 - The IT solution within e prescribing was piloted from 24th January. This has demonstrated improvements in compliance particularly in AMU. This will be seen in April's report containing Feb data. There will be a discussion at thrombosis committee on 21st march about whether we can roll out the IT solution trust wide to increase compliance further. 100% S1.13 Patients appropriately . screened for sepsis 76% 76% 85% 98% 98% 60% 90% S1.14 Sepsis Patients Treated in a . timely manner 82% 77% 86% 82% 85% 60% 90% - - 90% - - 4 March 2019 Caring Green Complaints were low during November, December and January and increased slightly to levels seen previously in February. The rate of complaints against activity level remains consistent and within target range. Negative ratings through the FFT are under the trust threshold with patients continuing to rate their experience positively. Same Sex Accommodation breaches have fallen to under the trust target. C1.1 FFT response rate - Inpatients Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb 27% 15% 9% Monthly Target > =20% 0% 0.9% C1.2 FFT Negative Score - Inpatients 5% 0.9% =20% 2.4% =95% 75% C1.6 Although we are maintaining above 90% we are still not reaching 95%. Therefore some focus work to drive this is being done with the ward areas that are consistently achieving below this requirement, as this is reflective of a small pocket of areas. C1.7 Total Complaints Received . 37 48 40 33 44 37 43 44 44 32 50 28 31 32 42 - C1.8 Complaints per 1000 units . 0.50 0.42 0.00 500 C1.9 Bereavement Survey Response Count 0 15% C1.10 Bereavement Survey Negative Score Core Questions - % 0% C1.9/C1.10 - Figures will be updated quarterly (next month) 0.42 =7days Census average 550 Extended LOS Census average 300 256 RF1.8 (Patients with LOS > =21days) 94 =30% 20.9% 66.2% > =80% 95.5% 90-95% 2 8 4 44 46 44 41 42 19 1 12 15 29 32 8 56 40 3 - 150 77 84 - 0 YTD 23.84% 63.17% - RF1.13 - currently undertaking investigation to understand cancelled operations figures 55 RF1.14 Last minute cancelled operations not 5 . readmitted within 28 days 0 2 - - RF1.15 % elective operations cancelled and not 5% 6.5% . readmitted within 28 days 2.4% 314445224641146 70% 100% 92.3% 94.9% RE1.2 Eye Casualty (Type 2) 90.4% - RE1.3 Lymington MIU (Type 3) 85% 100% 99.7% 99.4% 99.6% - 95% RE1.4 UHS Total 85% . . 70% 97% RE1.5 Local Delivery System . . 80% 82.1% 87.5% 90.0% 81.5% 77.9% > =90% 95.0% 83.3% 85.9% > =95% UHS Total (RE1.4) includes SGH all types and lymington. Local Delivery System (RE1.5) is UHS Total and Southampton Treatment Centre (RSH MIU). 14 March 2019 Emergency Access Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Target R-3M RE1.6 % patients who left the department 5% 4.7% . before being seen UHS Total 6.8% =92% 80% 4700 4111 3993 RR1.2 Total patients waiting over 18 weeks (in . backlog) - 1700 7 RR1.3 . Patients waiting > 52 weeks for treatment 2 0 RR1.4 Total number of patients on an . incomplete pathway RR1.5 Patients on a surgical waiting List 36000 26000 6900 5900 7,700 RR1.6 Patients waiting for diagnostics RR1.7 . RR1.8 . 5,500 4% % of Patients waiting over 6 weeks for diagnostics 0% Average weeks waited for first outpatient 9.5 appointment 6.5 30978 6541 6651 3.65% 8.44 30037 31297 6701 - 7700 - 0.71% 93% 41 of 1513 90% RC1.2 . Breast symptoms referral seen in 2 weeks 69.1% 25.9% 50.7% => 93% 32 of 75 51% RC1.1 & RC1.2 - Performance has improved significantly in January and February following commencement of a new Consultant Radiologist in post in January. RC1.3 Treatment started within 62 days of . urgent GP referral 89.4% 79.9% 70.5% => 85% 71.4% 18 of 134.5 71% RC1.4 Treatment started within 62 days of . referral (Breast, Cervical & Bowel . Screening) 87.8% 72.0% RC1.4 - All 5 January breaches related to breast surgery RC1.5 62 Day - Consultant Upgrades 86.00% 54.2% => 90% 3 of 24 79% 79.17% 85.71% => 86% 0 of 3.5 86% 17 March 2019 Cancer Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Target no. patients to recover target QTD RC1.6 Treatment started within 31 days of . decision to treat 98.7% 94.9% 91.1% RC1.6 Half of the 41 breaches in January related to either Urology (mainly Prostate) or Breast Surgery => 96% 27 of 341 88% 87.98% Second or subsequent treatment (surgery) RC1.7 started within 31 days of decision to treat 89.5% 76.0% RC1.7 - Approximately 2/3 of the breached pathways in January were for skin surgery, and the remaining pathways were for prostate surgery => 94% 16 of 118 81% 80.51% Second or subsequent treatment (anti 100% RC1.8 cancer drugs) started within 31 days of decision to treat 95% 100% Second or subsequent treatment RC1.9 (radiotherapy) started within 31 days of decision to treat 95% 100.00% 100.00% 100.00% => 98% 0 of 172 100% 99.05% => 98% 0 of 211 99% RC1.10 104 day waits (treated in month) 16 16 16 11 18 20 17 23 26 17 - - - Principal reasons impacting RC1.10 are prostate surgery (same as RC1.3 & RC1.7), also late referrals of patients referred from other trusts and extended waits due to patient choice. 18 March 2019 Research and Development Amber Research and Development has been rated Amber this month. October recruitment benefitted from activity on a high recruiting meningitis prevention study. Whilst recruitment to this study has ended recruitment projections to year end are satisfactory. Complexity (weighted) performance is also satisfactory with UHS ranked 2nd in the UK for a number of consecutive months. CRN Recruitment WR1.1 Participants Recruited WR1.2 Weighted Recruitment WR1.3 Weighted National Ranking - All Studies WR1.4 Specialties Recruiting Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb 3000 YTD YTD Target 1602 500 13,729 7,501 1,273 10842 1 1 1 1 2 2 3 4 4 4 5 6 57 1236 12073 14473 60396 60217 - Top 5 53 - tbc The number of research active UHS specialties has been introduced as a new metric this year in response to implementing the new research strategy and the aim for all specialties to be research active. Having identified whether a specialty is research active or not, we are now trying to understand levels of activity in relation to size of department for this to be more meaningful. BRC 200 WR1.5 Papers published in partnership with UOS 0 94 99 153 120 112 Number of BRC papers published are in line with expectations and more detailed analysis is informing the next BRC bid preparations. Activity/Staffing Balance £8,000 6531 WR1.6 Income per WTE £4,000 385 400 4878 - - 19 March 2019 Staffing Amber Staffing remains amber overall because some key targets have been missed including those for turnover, non-medical appraisal completion, total nursing and registered nurse vacancy rates. However, UHS has seen improvements in the following: sickness absence (which has never been lower), turnover (the lowest rate since November 2017), decreases in total nursing and registered nurse vacancy rates and percentage of BME staff at Band 7+ (the highest rate it has been). CHPPD is within normal range this month as expected, after seasonal effects in January and it reflects high patient numbers. WS1.1 HR - Turnover - Rolling 12-months Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Monthly Target 13.67% 13.17% 13.1% 13.0% 92% WS1.4 . Nursing Vacancies (Total Clinical Wards) 11% 13.04% =76% WS1.7 Statutory & Mandatory Training . Achieving Target - 5 5 7 6 7 7 7 7 7 7 8 9 8 8 8 9.5 7 7 5 6 5 5 5 5 5 5 4 3 4 4 4 WS1.8 Total nursing staff all inpatient areas - 8.4 . Care hours per patient day (CHPPD) 8.0 8.3 - WS1.8 The CHPPD for ward based areas in the Trust has decreased from last month to RN 3.7 (previously 3.8) HCA 3.3 (previously 3.3) overall 7.0 (previously 7.2). 6.0 WS1.9 Registered nursing staff all inpatient . areas - CHPPD 5.1 5.0 3.5 3.3 WS1.10 Unregistered nursing staff all inpatient . areas - CHPPD 2.5 5.1 - 3.2 - 9% WS1.11 Black & Minority Ethnic Band 7+ . Percentage 7.5% 7% WS1.11 UHS has a target of 15% Band 7+ BME staff by 2023. WS1.12 Quality of practice experience for doctors . in training (annual report with quarterly . qualitative updates) Minor Risk Minor Risk Minor Risk Minor Risk 8.3% - Minor Risk No risk 21 March 2019 Estates Green Estates has been rated green this month as we are meeting all targets in February. The target missed on a 3 month rolling average is for percentage of help desk requests completed on time. Reactive Maintenance Monthly Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Target 2500 R-3M PE1.1 Number of defect work orders and 1300 2197 - - 2078 percentage completed on time 86.2% 86.7% > 85% 89.2% Preventative Maintenance 74.42% 200 PE1.2 Number of statutory maintenance jobs planned and percentage 50 69 - - 131 completed on time 98.6% 94.09% > 95% 98.3% 98.5% 600 308 PE1.3 Number of mandatory maintenance jobs planned and 250 percentage completed on time 98.8% 96.13% 419 - - 99.5% > 95% 99.5% PE1.4 Number of routine maintenance jobs planned and percentage completed on time 125 75 97.7% 92.29% 80 98.8% 88 - 100.0% > 85% 99.7% 2500 PE1.5 Number of Help desk requests and 1000 percentage completed on time 100% 85% Unresolved help desk requests PE1.6 Unresolved help desk requests PE1.7 (over 30 days old) 50% 1500 500 600 1000 200 0 1737 82.3% 1007 498 1640 - 86.6% > 85% 84.3% 569 =95% - - SD1.4 acknowledgment > =95% - - through eQUEST - rolling 3M 85% Release 29 of CHARTS goes live on 23rd January 2019. This includes enhancements to histopathology requesting from the Endoscopy Unit and should result in an increase in both requesting and acknowledgment - this will first appear in the April 2019 data extracts. SD1.5 digiRounds patient records accessed 200000 0 98573 eQuest Results Alerts Sent SD1.6 Decision support notifications (email alerts) 20,000 9345 0 5000 SD1.7 Medxnote 4079 0 SD1.8 InfoQlik (Daily) Activity 50 20.1 35.4 0 100 SD1.9 Sap BI (Daily) Activity 40.0 0 500 351 SD1.10 My Medical Record - UHS patient registrations 0 2,000 SD1.11 My Medical Record - UHS patient logins 968 0 23 March 2019 Changes and Corrections Page Staffing KPI WS1.11 KPI Name Type Black & Minority Ethnic Band 7+ Change - Display Percentage Detail Long term target added 24 • Improvements made to the processes for managing complaints have driven significantly better performance in the timeliness of responses. For January and February, the trust closed 82% of complaints within 35 working days, with an average response time of 30 working days. This is a significant improvement from Q3 where the trust closed just 42% of complaints in the timeframe, with an average response time of 38 working days. • The complaints quality improvement work continues to deliver benefits for patients. The trust has slightly increased the % of complaints being managed informally to 44% of the overall number received (compared to 42% this time last year). There is a plan to return to clearly distinguishing between the PALS function and formal complaints process, and this will likely improve this further and offer patients and families greater access to support in getting early resolution to their concerns. • Good progress is being made in improving how the trust supports patients and carers with disabilities through compliance with the Accessible Information Standard. A flag is now available in ECAMIS, which pulls through into other systems, to alert staff that a patient has information and / or communication support needs. There is also a Staffnet resource to guide staff in how to meet needs. The Experience of Care team are currently working on a number of projects to enable needs to be identified and recorded on the system, while project teams on E2 ward and Princess Anne Outpatients work on embedding and testing the processes and resources. • Patient feedback remains generally high, although with more local variation in FFT feedback scores. Response rates have declined generally, with a significant factor being survey fatigue experienced by both patients and staff. While the FFT remains mandatory, it is often too generic to gain a sense of local ownership. With a new survey contract, the FFT will be augmented with more locally-relevant questions to better empower staff to use feedback to identify improvements, and this sense of ownership will drive better staff engagement and improve responses. Low recommend scores in ED are due to extremely low response rates. • A review of the trust’s provision of interpreting services is underway, with the aim of ensuring that patient needs are being met effectively and that the trust is receiving value for money. Part of this work is looking at the variability of interpreting provision across the trust, identifying areas for piloting efficiency improvement projects. There is a lack of data on how the impact of poor provision of interpreters (as well as other communication support) affects attendance rates, involvement in care, and overall experience- and this review will look at capturing some of this information. • The number of people applying to volunteer increased in Q3 to 98 (from 57 in Q2). Overall for the year to date, the trust has had 242 applications with 115 of these starting and a number of applications still being processed. Retention of volunteers continues to be an issue, with too many new volunteers still leaving within the first 6 months. The team is reviewing its support and supervision processes, but with 824 active volunteers, it remains an ongoing challenge. • The trust successfully bid for funding from the Pears Foundation to develop and grow a youth volunteering programme. The funding will be for two years and will pay for a project worker to lead on collaboration with local schools and colleges to provide short to medium term placements for young volunteers (16-18). • The trust welcomed the first cohort of employee volunteers from the local NHS England team in March. NHSE staff are able to take up to five days each year in order to volunteer within their local community and the trust has agreed a pilot with NHSE to test out new volunteer roles with the group to assess feasibility and value. This includes getting qualitative feedback from patients and carers, a new role in AMU, and supporting the pharmacy team. 25 Complaints PALS Friends & Family Test Volunteers Indicator Complaints received Complex concerns received Complaints closed within 35 days Average working day to close PALS contacts Inpatient positive score Outpatient positive score Maternity positive score ED positive score Applications received New starters Target Q1 Q2 Q3 Q4* n/a 124 120 109 74 n/a 88 91 110 42 = > 66% 64% 59% 42% 82% 95% 97% 97% 96% 97% = > 95% 95% 96% 96% 93% = > 95% 99% 97% 90% NA = > 95% 94% 96% 85% 71% n/a 87 57 98 NA n/a 57 28 30 NA * Data is provisional and for the quarter to date. NA denotes data not yet available. Jan 32 24 81% 31 324 Feb 42 19 78% 30 275 26 Nursing and midwifery staffing hours - February 2019 Report notes Our staffing levels are monitored daily and we will risk assess and fill any gaps to ensure that safe staffing levels are always maintained The total hours planned is our planned staffing levels to deliver care across all of our areas but does not represent a baseline safe staffing level. We plan for an average of one registered nurse to every five or seven patients in most of our areas but this can change as we regularly review the care requirements of our patients and adjust our staffing accordingly. Staffing on intensive care and high dependency units is always adjusted depending on the number of patients being cared for and the level of support they require. Therefore the numbers will fluctuate considerably across the month when compared against our planned numbers. Enhanced Care (also known as Specialling) Occurs when patients in an area require more focused care than we would normally expect. In these cases extra, unplanned staff are assigned to support a ward. If enhanced care is required the ward may show as being over filled. If a ward has an unplanned increase or decrease in bed availability the ward may show as being under or over filled, even though it remains safely and appropriately staffed. CHPPD (Care Hours Per Patient Day) is a measure which shows on average how many hours of care time each patient receives on a ward /department during a 24 hour period - this will vary across wards and departments based on the specialty, interventions, acuity and dependency levels of the patients being cared for. The maternity workforce consists of teams of midwives who work both within the hospital and in the community offering an integrated service and are able to respond to women wherever they choose to give birth. This means that our ward staffing and hospital birth environments have a core group of staff but the numbers of actual midwives caring for women increases responsively during a 24 hour period depending on the number of women requiring care. WARD C4 (Solent ward) C4 (Solent ward) C6 C6 C6 (Teenage Cancer Trust unit) C6 (Teenage Cancer Trust unit) D2 D2 D3 D3 Surgical high dependency unit Surgical high dependency unit Registered nurses Total hours planned Registered nurses Total hours worked Unregistered staff Total hours planned Unregistered staff Total hours worked Registered nurses % Filled Day Night Day Night Day Night Day Night Day Night 1303.5 975.5 2572.1 1850.0 645.0 610.8 1196.0 943.0 1507.9 944.8 1230.8 910.8 2267.3 1740.5 661.3 513.0 1184.8 943.8 1325.9 932.4 915.0 644.0 174.5 0.0 332.2 0.0 1055.5 770.5 731.5 641.3 1281.3 829.0 209.5 99.5 166.2 79.0 1136.4 816.5 799.0 798.8 94.4% 93.4% 88.1% 94.1% 102.5% 84.0% 99.1% 100.1% 87.9% 98.7% Day Night 1962.1 1843.2 1865.4 1831.7 312.4 322.0 374.7 321.0 95.1% 99.4% Unregistered staff % Filled t Comments 140.0% Safe staffing levels maintained; Support workers used to maintain staffing numbers. 128.7% Safe staffing levels maintained; Support workers used to maintain staffing numbers. 120.1% Support workers used to maintain staffing numbers. Shift N/A Safe staffing levels maintained. 50.0% Safe staffing levels maintained; Staffing appropriate for number of patients. Shift N/A Staffing appropriate for number of patients; Staff moved to support other wards. 107.7% Safe staffing levels maintained. 106.0% 109.2% Safe staffing levels maintained. Safe staffing levels maintained. 124.6% Safe staffing levels maintained. 119.9% 99.7% Safe staffing levels maintained. Safe staffing levels maintained. Page 1 of 5 Cardiac intensive care unit Cardiac intensive care unit General intensive care unit A General intensive care unit A General intensive care unit B General intensive care unit B Neuro intensive care unit Neuro intensive care unit E5A E5A E5B E5B E8 E8 F11 F11 F6 F6 F5 F5 Acute medical unit Acute medical unit D5 D5 D6 D6 D7 D7 Day Night Day Night Day Night Day Night Day Night Day Night Day Night Day Night Day Night Day Night Day Night Day Night Day Night Day Night 4911.3 4752.0 4116.4 3848.5 3657.1 3526.0 4334.7 3836.5 1151.2 645.0 1274.0 639.0 1961.3 961.0 1914.6 966.0 2016.5 966.5 1821.0 966.0 3826.1 3202.5 1621.6 972.6 1079.3 667.3 841.7 645.0 4309.8 3986.0 3757.0 3793.5 3438.1 3140.0 4218.1 3649.5 904.2 587.0 1117.0 622.5 1356.9 978.3 1236.9 814.0 1535.9 887.0 1172.9 828.0 3750.9 2871.3 1027.5 794.5 987.0 668.8 816.7 634.0 1123.8 794.3 890.5 644.0 507.8 322.0 694.3 587.0 615.4 322.0 727.5 322.0 1496.0 860.0 726.2 322.0 620.9 644.0 876.4 644.0 3032.7 1808.5 957.0 524.0 1451.7 690.5 949.3 300.0 607.8 472.5 722.9 453.5 373.6 274.5 510.0 545.0 707.0 472.5 724.0 398.2 1592.6 1208.4 629.6 587.5 962.5 736.5 1415.2 1068.0 3772.3 2468.3 1250.1 1077.0 1373.0 777.0 1030.3 323.0 87.8% 83.9% 91.3% 98.6% 94.0% 89.1% 97.3% 95.1% 78.5% 91.0% 87.7% 97.4% 69.2% 101.8% 64.6% 84.3% 76.2% 91.8% 64.4% 85.7% 98.0% 89.7% 63.4% 81.7% 91.5% 100.2% 97.0% 98.3% 54.1% 59.5% 81.2% 70.4% 73.6% 85.2% 73.5% 92.8% 114.9% 146.7% 99.5% 123.7% 106.5% 140.5% 86.7% 182.4% 155.0% 114.4% 161.5% 165.8% 124.4% 136.5% 130.6% 205.5% 94.6% 112.5% 108.5% 107.7% Beds flexed to match staffing; Safe staffing levels maintained. Beds flexed to match staffing; Safe staffing levels maintained. Beds flexed to match staffing; Safe staffing levels maintained. Beds flexed to match staffing; Safe staffing levels maintained. Beds flexed to match staffing; Safe staffing levels maintained. Beds flexed to match staffing; Safe staffing levels maintained. Beds flexed to match staffing; Safe staffing levels maintained. Beds flexed to match staffing; Safe staffing levels maintained. Safe staffing levels maintained; Band 4 staff working to support registered nurse numbers. Safe staffing levels maintained;Additional staff used for enhanced care - Support workers. Support workers used to maintain staffing numbers; Band 4 staff working to support registered nurse numbers. Safe staffing levels maintained; Additional staff used for enhanced care - Support workers. Support workers used to maintain staffing numbers; Band 4 staff working to support registered nurse numbers. Safe s
Url: /Media/UHS-website-2019/Docs/About-the-Trust/Trust-governance-and-corporate-docs/2019/Papers-Trust-Board-28-March-2019.pdf

Communicating risk: words or numbers?

Description: Is it better to communicate risks to patients with words or statistics?
Url: /HealthProfessionals/Clinical-law-updates/Communicating-risk-words-or-numbers.aspx

Be informed; then disclose

Description: Be informed; then disclose
Url: /HealthProfessionals/Clinical-law-updates/Be-informed-then-disclose.aspx

72 hour (three day) fast - patient information

Description: Your doctor has recommended that you have a test which requires you to fast (not eat) for 72 hours (three days) to test your insulin levels. This factsheet aims to answer some of the initial questions you may have about what's involved.
Url: /Media/UHS-website-2019/Patientinformation/Tests/72-hour-three-day-fast-732-PIL.pdf

Annual-report-2018-19

Description: ANNUAL REPORT AND ACCOUNTS 2018/19 incorporating the quality account 2018/19 Presented to Parliament pursuant to Schedule 7, paragraph 25 (4) (a) of the National Health Service Act 2006 University Hospital Southampton NHS Foundation Trust Annual report and accounts 2018/19 incorporating the quality account 2018/19 Presented to Parliament pursuant to Schedule 7, paragraph 25 (4) (a) of the National Health Service Act 2006 3 ©2019 University Hospital Southampton NHS Foundation Trust 4 TABLE OF CONTENTS Overview and performance report Welcome from our Chair 7 A word from the chief executive 8 Overview of the Trust Statement of purpose and activities 9 History of UHS 9 Our executive team structure 10 Structure of our services 11 Our vision and values 12 Our priorities, key issues and risks 13 Performance report Going concern disclosure 16 Reporting structure 16 Key performance indicators 17 How we monitor performance 18 Detailed analysis and explanation of the development and performance of UHS 18 Regulatory body ratings 23 Environmental matters 24 Social, community, anti-bribery and human rights issues 25 Accountability report Members of the Trust Board 27 Trust Board purpose and structure 31 Board meeting attendance record 2018/19 32 Well-led framework 33 Strategy and finance committee 34 Quality committee 34 Audit and risk committee 35 External auditors 36 Governance code 36 Performance evaluation of Trust Board and its committees 36 Remuneration 36 Countering fraud and corruption 36 Independence of external auditor 37 Internal audit service 37 Better payment practice code 37 Statement as to the disclosures to auditors 37 Disclosures 37 Income disclosures 38 Governance disclosures 38 Approach to quality governance 38 Council of Governors 40 Annual remuneration statement 49 Remuneration and appointments committee 52 Governors’ nomination committee 54 Staffing report 58 Staff survey results 62 Trade union facility time 66 Statement of chief executive’s responsibilities as the accounting officer 69 Annual governance statement 70 Voluntary disclosures Equality, diversity and inclusion 78 Environmental sustainability and climate change 80 Southampton Hospital Charity 84 Developments in informatics 85 Leading research into better care 85 Investing for the future 86 Quality account and quality report 2018/19 Chief executive’s welcome 88 Our approach to quality assurance 90 Our commitment to safety 90 Duty of candour 91 Our commitment to staff 91 Freedom to speak up 94 Our commitment to education and training 95 Our commitment to staffing rota gaps 96 Our commitment to technology to support quality 97 Our commitment to the Care Quality Commission 98 Our commitment to improving the environment for our patients 100 Review of quality performance 101 Clinical research 101 Review of services 102 CQUIN payment framework 103 Data quality 103 Participation in national clinical audits and confidential enquiries 104 How we are implementing the priority clinical standards for seven day hospital services 105 Learning from deaths 106 Progress against 2018/19 priorities 109 Priorities for improvement 2019/20 128 Conclusion 132 Responses to our quality account 133 Statement of directors’ responsibilities 138 Independent auditor’s report 139 Quality account appendix Appendix 1: Our quality priorities 2019/20 143 Appendix 2: Quality performance data 144 Appendix 3: CQUIN data 151 Appendix 4: Clinical audit and confidential enquiries data 154 Appendix 5: British Society of Urogynaecology 156 Appendix 6: National clinical audit: actions to improve quality 157 Appendix 7: Local clinical audit: actions to improve quality 161 Appendix 8: Shared decision making 173 Appendix 9: Registration with the Care Quality Commission 174 Annual accounts Statement from the chief financial officer 177 Foreword to the accounts 178 Independent auditor’s report 179 Financial accounts and notes 186 5 OVERVIEW AND PERFORMANCE REPORT OVERVIEW AND PERFORMANCE REPORT Welcome from our chair 2018/19 was a year of change in the leadership of UHS. Following the departure of Fiona Dalton in March 2018 to run a hospital group in Canada, David French took on the role of interim chief executive officer. On behalf of the Trust Board I would like to thank David for agreeing to do so and also for doing such an outstanding job. During the year we welcomed three new non-executive directors to the Trust; Jane Bailey, Professor Cyrus Cooper and Catherine Mason. Catherine’s talents were also recognised by Solent NHS Trust and she has since left to help lead their organisation as chair. We were delighted to welcome Paula Head as chief executive in September after a rigorous and robust recruitment process. Paula’s experience as chief executive of Royal Surrey County Hospital NHS Trust and, prior to that of Sussex Community NHS Foundation Trust, shone through and we were confident that under her leadership UHS would continue to develop, grow and improve. Demand for our services continues to rise rapidly as the result of a changing demographic and other factors, and at a rate far greater than our income. Despite this our staff continue to deliver exceptional care. I was delighted that this was recognised by the Care Quality Commission in their recent inspection when they again rated us as Good. The revised NHS Long Term Plan will inevitably require us to adapt to the changing pattern of healthcare, but we do so with enthusiasm. This year has shown just how adept we are as an organisation at responding positively to change, not only rising to the challenges it presents, but thriving with it. This is evident in the significant investments we have made in the Trust’s estate this year. Phase one of our new children’s emergency department is complete thanks to the continued support of the Murray Parish Trust. We also approved one of the largest capital investments in our history with the updating and expansion of our general intensive care unit. We recognised that it was as crucial to invest, not just in the physical environment within which we provide healthcare, but within the digital environment too, acknowledging that UHS is an NHS digital exemplar. We have invested significantly in information technology to enhance accessibility and improve both patient and staff experience. We look forward with confidence to helping lead the NHS into a new phase of delivering health and care for the United Kingdom into 2019/20. Peter Hollins Chair 7 OVERVIEW AND PERFORMANCE REPORT A word from the chief executive Since arriving at UHS to take up my position as chief executive officer, I have heard and witnessed some incredible achievements by staff at the Trust. Dr Joanne Horne was named biomedical scientist of the year at the Advancing Healthcare Awards for her work in histopathology; Dr Beth McCausland, quality improvement fellow in dementia care, was named foundation doctor of the year by Royal College of Psychiatrists; Sarah Charters, consultant nurse and mental health lead for the emergency department was awarded an MBE for services to vulnerable adults and her vulnerable adult support team were also winners of a Nursing Times Award in the emergency and critical care category. The medicine for older people therapy team led by Hannah Wood was named most inspiring team at the national #EndPJParalysis awards while Marie Nelson, matron in research and development, and senior research sisters Jane Forbes and Kirsty Gladas won the silver award for clinical research site of the year at the PharmaTimes International Clinical Researcher of the Year Awards. Jean Piernicki, senior nurse manager in occupational health, was awarded the title of Queen’s Nurse in recognition of her high level of commitment to patient care and nursing practice. Fiona Chaâbane, a senior clinical nurse in neurosciences was named winner of the nursing and midwifery award at the BBC’s The One Show Patients Awards. The medicines advice service, led by Dr Simon Wills, picked up the HSJ Value Award for training and development for its medicines learning portal and Matthew Watts, head of news, was named operational services support worker of the year for the south of England at the Our Health Heroes Awards 2018. We were also delighted that the energy and sustainability team collected the clinical NHS Sustainability Award for its green wards project. These are just a few of the individual and team successes achieved this year. Our entire organisation can also be incredibly pleased and encouraged by the outcome of the recent Care Quality Commission (CQC) inspection, which rated UHS ‘good’ overall, with many individual areas being recognised as outstanding by the CQC. You can find full details of the inspection on page 98 of the quality account. Such positive inspection results link to equally positive staff survey results which saw UHS ranked as the second highest acute trust for staff satisfaction and fifth highest for staff recommending the Trust as a place to work and receive treatment. It’s made me incredibly proud to be able to say that I am part of such a driven team and it’s clear that the UHS team share my drive and determination to improve things for patients and staff every day. This is evident in both the successes I have already mentioned, but also in the pioneering work that is taking place across every department. Informatics has been pioneering new digital initiatives which they recently shared with Hadley Beeman, chief technology adviser to the secretary of state and social care. Surgeons Bhaskar Somani and Stephen Griffin have created a ‘twin surgeon’ model that has revolutionised the treatment of kidney stones in children. Dr John Paisey, consultant cardiologist, and his team were among the first in the world to implant and programme a pacemaker using Bluetooth technology. They performed four of the first five procedures in the world. While Professor Mike Grocott and his team created ‘surgery school’ which is transforming the fitness of patients prior to their operations and thereby reducing length of stay. These are by no means the entirety of our achievements this year and I would like to take the opportunity to thank every single member of staff at the Trust who continues to make UHS one of the leading trust’s in the UK. Paula Head Chief executive officer 8 OVERVIEW AND PERFORMANCE REPORT Overview of the Trust Statement of purpose and activities UHS is a large teaching hospital located on the south coast of England. We have a tripartite mission to provide clinical care, educate current and future healthcare professionals, and undertake research to improve healthcare for the future. Our clinical care encompasses local acute and elective care for 680,000 people who live in Southampton, the New Forest, Eastleigh and Test Valley. We also provide care for the residents of the Isle of Wight for many services. As the major university hospital on the south coast, UHS provides the full range of tertiary medical and surgical specialities (with the exception of transplantation, renal services and burns) to over 3.7 million people in central southern England and the Channel Islands. UHS is a centre of excellence for training the doctors, nurses and other healthcare professionals of the future. We work with the University of Southampton and Solent University to educate and develop staff at all levels, including a large apprenticeship programme, undergraduate and post-graduate education. Our role in research, developed in active partnership with the University of Southampton, is to contribute to the development of treatments for tomorrow’s patients. This work distinguishes us as a hospital that works at the leading edge of healthcare developments in the NHS and internationally. In particular we have nationally-leading research into cancer, respiratory disease, nutrition, cardiovascular disease, bone and joint conditions and complex immune system problems. We are one of the largest recruiters of patients into clinical trials in the country. Over 11,900 people work at the Trust, making it one of the area’s biggest employers. We also benefit from the contributions of over 1,000 volunteers. Our turnover in 2018/19 was more than £878m. History of UHS The Trust has its origins in the 1900s when the Shirley Warren Poor Law Infirmary was built on the site of what is now Southampton General Hospital. In the early half of the century, the site began to expand, including the opening of the school of nursing and the creation of the Wessex Neurological Unit. In 1971 a new medical school was opened in Southampton and the 1970s and 1980s saw a significant building programme encompassing the current footprint of Southampton General Hospital, Princess Anne Hospital and Countess Mountbatten House. During the 1990s, services were increasingly centralised at the general hospital, with the eye hospital and cancer services being relocated from elsewhere in the city. The Wellcome Trust funded a clinical research facility at the hospital in 2001 and this unit remains the foundation for much of the Trust’s groundbreaking medical research. In the last decade, development has continued with the opening of the North Wing Cardiac Centre in 2006, the creation of a major trauma centre with on-site helipad and the opening in 2014 of Ronald McDonald House for the relatives of sick children. Organisationally, Southampton University Hospitals Trust was formed in 1993, creating a single management board for acute services in Southampton. Eighteen years later, University Hospital Southampton NHS Foundation Trust (UHS) was formed (1 October 2011) when Southampton University Hospitals NHS Trust was licensed as a foundation trust by the then regulator, Monitor (now known as NHS Improvement (NHSI)). 9 OVERVIEW AND PERFORMANCE REPORT Our executive team structure Associate director of corporate affairs (interim) Charlie Helps Constitution; Council of governors; legal services; insurance; risk management; policy management; freedom of information (FOI) general data protection regulations (GDPR) Chief executive Paula Head Director of HR Steven Harris Employee relations; pay and reward; resourcing and temporary staffing; staff engagement; staff performance and appraisal; occupational health and wellbeing; childcare services; communications Medical director Dr Derek Sandeman MD for research & development; clinical effectiveness; clinical practices and outcomes; professional regulation & standards; GP relationships Director of nursing & organisational development Gail Byrne Chief financial officer & deputy chief executive David French Clinical governance & patient safety; education; patient experience; clinical practice & outcomes; professional regulation & standards; complaints/PALS; HR/workforce; voluntary services; fundraising Caldicott Guardian Financial management; financial strategy; investment & ROI; audit; procurement; capital programme management; estates; Commercial development Division A Surgery Cancer care Critical care & theatres Chief operating officer Caroline Marshall Major incident planning; security Division B Division C Emergency medicine Women & newborn Specialist medicine/ ophthalmology Pathology Child health Support services Director of transformation & improvement Jane Hayward Division D Cardiovascular & thoracic Neurosciences Trauma & orthopaedics Cost improvement & transformation; information technology; information governance; core platform systems; informatics development; strategy; commissioning; business & capacity planning Senior Information Risk Owner (SIRO) Radiology 10 OVERVIEW AND PERFORMANCE REPORT Structure of our services Our organisation is split into five areas, with our clinical services grouped into four divisions. Within each division there are care groups. Each division, with the exception of Trust headquarters, is led by a divisional management team consisting of: • divisional clinical director (DCD) • divisional director of operations (DDO) • divisional head of nursing/professions (DHN) • divisional research and development lead • divisional finance manager • divisional planning and business development (or strategy) manager • divisional education lead • division HR business partner • divisional governance manager (DGM) The diagram below outlines the five divisions and care groups/services within each. Each care group has a clinical lead, care group manager and matron/s for specific services as a minimum. Division A Surgery Cancer care Critical care Theatres Division B Emergency medicine Medicine for older people Pathology Specialist medicine and ophthalmology Genetics Division C Child health Women and newborn Support services Division D Cardiovascular and thoracic Neurosciences Trauma and orthopaedics Major trauma centre Radiology TRUST HQ Corporate affairs Communications Finance Human resources Informatics Patient support services Claims and litigation Cost improvement and transformation Estates and capital developments Research and development 11 OVERVIEW AND PERFORMANCE REPORT Our vision and values Our Forward vision outlines who we are and what we stand for, as well as describing the current challenges we face and our priorities for the future. It also provides an in-depth review of our three Trust values, which are summarised below: putting patien putting patien putting patien putting patien putting patien putting patien putting patien putting patien putting patien king together king together king together king together king together king together king together king together king together ts first ts firwsotr ts firwsotr wor ts first ts firwsotr ts firwsotr wor ts first ts firwsotr ts firwsotr wor always imparlwovaiynsg imparlwovaiynsg improving always imparlwovaiynsg imparlwovaiynsg improving always imparlwovaiynsg imparlwovaiynsg improving ts first ts first ts first wor wor wor putting patien putting patien putting patien king together king together king together always imparlwovaiynsg imparlwovaiynsg improving Patients and families will be at Our clinical teams will provide the heart of what we do and services to patients and are their experience within the crucial to our success. hospital, and their perception We have launched a leadership ofmtheeasTurruensgtop,aftwiesnuitlslcfbcnigreesptsaosti.euntrs fnigrsptatients first clsintrrikacintageltgomgyetahtnherkraianggtteoegmnetsehuernkrrintegstteoogaeumthresr are engaged in the day-to-day management and governance of the Trust. alw alw alw Our growing reputation in research and development and our approach to education and training will continue ays improtvoinagiyns icmoprropvionagrysaitmeprnoveinwg ideas, technologies and greater efficiencies in the services we provide tients first tients first tients first together together together mproving mproving mproving putti putting pa putti putting pa putti putting pa wo working wo working wo working always i always i always i 12 OVERVIEW AND PERFORMANCE REPORT Our priorities, key issues and risks Our top eight priorities 1 Promote and live our values. We will: • be clearer about the behaviours we expect from our staff • recruit, train and promote people who demonstrably share our values in everything they do 2 Improve safety, quality and productivity. We will: • Sign up to safety and deliver on our promises to patients as part of this campaign • Focus on improving outcomes by measuring and publishing clinical outcomes for all specialties • Focus on improving the whole patient experience, so that patients feel treated with compassion by all staff in every contact • Develop the concept of excellent administrative care, organising our services well so that the patient journey runs smoothly • Commit to productivity improvement across all areas • Develop innovative solutions that allow us to deliver services more efficiently while making better use of our capacity 3 Our staff and education mission. We will: • Attract the best staff by offering them a better deal and the best place to work • Continue to invest in education and training opportunities for our staff including leadership development • Ensure that our leaders and staff understand and deliver our equality and diversity agenda • Prioritise excellent communication that allows the voice of our staff to be heard and acted on • Focus on the staff of the future by developing our education and training capability for clinical and non-clinical staff • Work with our local education providers to offer excellent education opportunities and bring high calibre people into healthcare roles in our hospitals 4 Become a hospital without walls. We will: • Increase the number of patients we care for who are not inpatients within the hospital. Some of these will be cared for in another residential location or at home in partnership between ourselves and other organisations • Be clear about services where we wish to provide end-to-end integrated care, and those where we wish to work with partners to integrate care across organisations • Work with health and social care partners (public, private and third sector), where necessary using new organisational models, to ensure that patients are always cared for in the right setting • Work more closely with general practices and support innovation being led by primary care 13 OVERVIEW AND PERFORMANCE REPORT 5 Specialised services. We will: • Engage with commissioners to plan changes in service models according to national service specifications • Continue to plan and manage the ongoing drift of sub-specialist work particularly in paediatrics and complex surgical services • Maintain and develop the critical mass that is increasingly required to care for complex and specialist patients • Work with Salisbury NHS Foundation Trust, the University of Southampton and other partners to play our part in the genomic revolution, building on the Genomic Medicine Centre and seeking to become a Genomics Central Laboratory Hub for the region • Develop our clinical informatics ability to ensure that we can take advantage of new information available for the benefit of patients 6 Preventative care. We will: • Continue to expand our screening programmes as national policy and commissioning intentions develop • Take every opportunity to further support and improve the health of our staff • Ensure that our clinical translational research programme, much of which is directly relevant to health promotion, accelerates translation of research into benefit for the local population 7 Discovery. We will: • Develop a detailed plan to continue increasing the number of UHS patients who are offered access to clinical trials and maximise the impact of the research we undertake • Work with the University of Southampton to submit a strong bid for the next round of Biomedical Research Centre / Biomedical Research Unit funding opportunities • Support the University of Southampton to create an international centre for cancer immunology to accelerate the development of new immune therapies to treat cancer 8 All stages of life. We will: • Continue to expand our paediatric services in partnership with community and local acute paediatrics and develop the physical infrastructure of a modern children’s hospital as quickly as finances allow • Continue to improve transition and the care of teenagers and young adults • Develop elderly care services that are integrated across the acute and community sectors • Continue to develop our end of life care 14 OVERVIEW AND PERFORMANCE REPORT Key issues and risks 1 Failure to deliver national access targets, which impacts patient experience and patient safety. Whilst we are meeting some of the national constitutional standards in waiting times, we are not meeting them all. A number of actions have been taken in relation to improving responsiveness and working with local health and social care partners to reduce delayed transfers of care. The Trust will continue to work to reduce delayed transfers of care, as well as reviewing the efficiency of discharge processes during 2019/20. 2 Capacity and occupancy, which impacts on patient flow and the quality and timeliness of care. Operational risks have been identified across a number of services/specialties linking to issues around increasing referrals, system capacity and delayed transfers of care. We have mitigated this by implementing daily reviews to assess system capacity and escalation requirements aligning capacity plans with the wider system, developing plans to reduce length of stay with strong clinical leadership and oversight and working with local health and social care partners to reduce delayed transfers of care. 3 Staffing, both in terms of recruitment and retention. To mitigate this risk we will continue to focus on making UHS an attractive employer by: • developing band four posts and apprentices • leveraging the ‘Think UHS’ recruitment brand • continuing to recruit within Europe and further afield • working with universities to increase student nurses • enhancing medical overseas fellows posts • reviewing all junior doctor rotas in light of the new contract • using flexible and temporary staff when needed • creating different roles linked to our research agenda • reviewing training and education to enhance retention. 15 OVERVIEW AND PERFORMANCE REPORT Performance report Going concern disclosure After making enquiries, the directors have a reasonable expectation that the Trust has adequate resources to continue in operational existence for the foreseeable future. For this reason, they continue to adopt the going concern basis in preparing the accounts. Reporting structure As a large NHS university hospital foundation trust, UHS monitors performance within individual teams throughout the year with feedback processes in place to escalate issues to more senior management teams. At a corporate level we have an established executive reporting structure. Monthly Trust Board Public meeting where executive directors present high level summary to chairman and non-executive directors. For further information see page 31. Audit and risk committee Strategy and finance committee Quality committee Trust executive committee (TEC) Review performance/issues/risks in greater depth For further detail on role of these committees please refer to the annual governance statement section on page 70. Trust Board study sessions Trust Board members meet to focus on a specific issue. Performance meetings Operational management team (led by chief operating officer) and division and care group management teams focus on individual patient and service pathways to develop improvement plans. 16 OVERVIEW AND PERFORMANCE REPORT Key performance indicators (KPIs) The Trust publishes a monthly integrated KPI Board report on our website which provides both the Board and the public with an overview of our performance. This report is constantly evolving as new areas of monitoring are developed and new areas of national focus become apparent. For 2018/19 the format of the monthly report followed the five key Care Quality Commission (CQC) questions: • Are we safe? • Are we effective? • Are we caring? • Are we responsive? • Are we well-led? The monthly report features the following sections: • Overview – Aggregation of commentary supporting all sections of the report • Safe • Effective • Caring • Activity • Emergency access • Referral to treatment and diagnostics • Cancer waiting times • Flow • Staffing • Research and development • Estates • Digital This report also includes summary versions of quarterly reports submitted to the Trust executive committee, which go into greater detail about patient experience, patient safety, clinical effectiveness outcomes, and infection prevention. In addition, a separate finance Board report is submitted to Trust Board on a monthly basis. The Emergency Access, Activity and Flow section have several KPI’s that are relevant to the key risk of delivering the national access target. Some of the KPI’s are: • Number of attendances • Time to initial assessment • Hospital red/black alerts • Delayed transfers of care • Non-elective length of stay The Activity and Flow section have several KPI’s that are relevant to the key risk of capacity and occupancy. Some of the KPI’s are: • Length of stay • New referrals • Number of attendances • Bed occupancy • Hospital red/black alerts The Staffing (HR) section has several KPI’s that are relevant to the key risk of Staffing. Some of the KPI’s are: • Staff turnover • Nursing vacancies • Friends and Family Test – percentage of staff who recommend UHS as a place to work You can see full copies of the monthly report by visiting www.uhs.nhs.uk 17 OVERVIEW AND PERFORMANCE REPORT How we monitor performance In addition to reviewing the data submitted to the Trust Board in these papers, we have a suite of tools available to compare UHS performance to that of comparable trusts around the country. Depending on the measures being monitored, UHS has a number of peer groups to benchmark against including other local providers, major trauma centres and university hospital teaching trusts. Each NHS trust will service a different size and type of population and will offer a slightly different range of services so it is important to understand that this benchmarking provides an initial indication of performance rather than an absolute guide to our position nationally. In 2018/19 we continue to review the National Model Hospital data as it is published from NHS Improvement. The data and ability to compare our performance has helped to highlight areas of excellent practice and areas where there is potential to improve. The Trust is engaging with the model hospital team and has a member of staff on the ‘model hospital ambassador program’, as well as reviewing areas highlighted as having potential opportunities alongside finance and operational teams. Detailed analysis and explanation of the development and performance of UHS Activity, capacity and occupancy Over the past three years we have seen significant increases in all types of activity. This is linked to demographic growth, new specialist techniques and services transferring from other providers, including vascular services from Portsmouth. In addition, UHS now has responsibility for surgical services at Lymington. The graph and table below demonstrate this increase in activity. UHS growth in activity – 2016/17 to 2018/19 800,000 700,000 600,000 500,000 400,000 300,000 200,000 100,000 0 Inpatient spells (inc. day cases) 2013/14 2016/17 Outpatient appointments 2017/18 2018/19 ED attendances (type one) Referrals (excl March) Inpatient spells (inc. day cases Outpatient appointments ED attendances (type one) Referrals (excl March) 2016/17 160,000 630,045 99,273 189,194 2017/18 157,993 658,147 104,616 197,522 2018/19 168,791 695,343 110,771 207,209 Increase 2016/17 to 2018/19 5.5% 10.4% 11.6% 9.5% 18 OVERVIEW AND PERFORMANCE REPORT Hospital alert status The hospital alert status is decided by the operations centre after assessing the bed and staffing position, and is recorded twice daily at the Trust bed meetings (though the status may change at any time). Black alert is the highest level of alert and is issued when there are no empty beds available across the Trust with no expected discharges, the emergency department is full, and if actions are not taken several ambulances are likely to be delayed for long periods of time, stopping them from responding to 999 calls (this is based on a national definition of escalation). Red alert is when the majority of the hospital is under significant operational pressure and is likely to include a mismatch between supply and demand of beds and/or there are no beds available, with patients waiting more than three hours in the emergency department, and patients with a clinical decision for admission but no bed identified for them to move to. The Trust will undertake a wide range of actions in response to this, including the opening of additional overnight beds (usually within day wards), the redistribution of staff or bed capacity to support areas under most pressure, Trust-wide communication to request a focus on actions which will enable patients to be discharged or the admission avoided and the potential review of less urgent elective operations to maintain bed availability for patients with more urgent needs. In 2015/16 a black alert was recorded seven times at the twice daily bed meetings. In 2016/17 this was increased to eleven, in 2017/18 this increased to twenty, however in 2018/19 there were no black alerts. The chart below shows red alerts logged during 2018/19. Red alerts 2018/19 60 Number of AM and PM alerts 45 30 15 0 4/1/18 6/1/18 8/1/18 10/1/18 12/1/18 2/1/19 Contributing to this change has been an increase in day cases and an increase in length of stay (LoS) for elective patients linked to a more complex case mix. UHS delayed transfers of care 2018/19 The chart below shows the total bed days attributable to delayed transfers of care at UHS in 2018/19. 3,600 Percentage of bed days lost 3,200 2,800 2,400 2,000 April 2018 June 2018 August 2018 October 2018 December 2018 February 2019 19 OVERVIEW AND PERFORMANCE REPORT Referral to treatment (18 weeks) performance National target: 92% of all patients on 18 week pathway and not yet treated should have waited 18 weeks or less at the end of the month (incomplete pathways target). How did we do? UHS did not meet the target this year. Achievement of this target in 2018/19 should be set against a rise in patient referrals, which highlights the increased demands being placed on the Trust. The Trust has finished the financial year with no patients waiting greater than 52 weeks, and a total referral to treatment waiting list lower than in March 2018. Emergency department (ED) performance There are three types of emergency departments: Type Type Type ONE TWO THREE 3 24 hour with full resuscitation facilities 3 Consultant-led 3 Designated accommodation for patients admitted via ED 3 Single specialty emergencies (eye or dental) 3 Consultant-led 3 Designated accommodation 3 Minor injuries/walk-in centres 3 Doctor or nurse-led 3 Can be routinely accessed without appointment 3 May be co-located within an ED or sited in the community We run all three types of departments and all three types are subject to the national target and are therefore reflected in our figures. National target: The constitutional standard states that 95% of patients should be treated and either admitted or discharged within fours of arrival into ED. However, NHS Improvement set local targets for all NHS organisations with an ambition that the NHS would return to meet the 95% target by March 2019. The local targets set by quarter (to allow for seasonal variations) for UHS were: Quarter 1 - 90% Quarter 2 - 91.4% Quarter 3 - 90% Quarter 4 - 90-95% How did we do? 2018/19 was another challenging year for emergency patients for the whole Hampshire and Isle of Wight area. Whilst we had a positive start to the year achieving quarter 1 and 2 targets, we did not meet quarter 3 or 4 targets. We did, however, meet out local delivery system targets. 20 OVERVIEW AND PERFORMANCE REPORT The graph below shows our performance against the four hour target over the last year (including all UHS types and Lymington). National 4 hour access target – UHS performance 100% 95% 90% 87.1% 85% 80% 82.1% 82.3% 87.4% 87.4% 93.0% 90.5% 84.7% 82.9% 85.7% 90.7% 88.9% 84.8% 77.9% 81.1% 75% Jan 2018 Feb 2018 Mar 2018 Apr 2018 May 2018 June 2018 July 2018 Aug 2018 Sep 2018 Oct 2018 Nov 2018 Dec 2018 Jan 2019 Feb 2019 Mar 2019 The graph below shows our local delivery system performance against the four hour target over the last year (including all SGH types, Lymington and Southampton Treatment Centre). National 4 hour access target – Local delivery system 100% 95% 91.0% 90% 91.1% 95.1% 92.8% 88.7% 87.1% 89.2% 91.5% 85% 92.9% 88.4% 83.3% 85.9% 80% 75% Apr 2018 May 2018 June 2018 July 2018 Aug 2018 Sep 2018 Oct 2018 Nov 2018 Dec 2018 Jan 2019 Feb 2019 Mar 2019 21 OVERVIEW AND PERFORMANCE REPORT Cancer waiting times There are nine separate cancer waiting times standards (below), each of which can then be split into tumour site specific performance groups. Measures Urgent GP referrals seen in two weeks Breast symptoms referral seen in two weeks Treatment started within 62 days of urgent GP referral Treatment started within 62 days of referral (breast, cervical and bowel screening) 62 day consultant upgrades Treatment started within 31 days of decision to treat Second or subsequent treatment (surgery) started within 31 days of decision to treat Second or subsequent treatment (anti-cancer drugs) started within 31 days of decision to treat Second or subsequent treatment (radiotherapy) started within 31 days of decision to treat Target > 93% > 93% > 85% > 90% > 86% > 96% > 94% > 98% > 98% 18/19 YTD (up to and including Feb 19) 86% 50% 74% 80% Achieved 8 8 8 8 86% 3 93% 8 85% 8 100% 3 100% 3 The number of patients referred under the two week wait urgent suspected cancer protocol seen within two weeks of their referral, rose by 7.7% in 2018/19. The chart below shows the rise in demand for UHS cancer services over the past three years UHS growth in cancer actvity – 2016/17 to 2018/19 (up to and including month 11) 18,000 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0 Two week waits 2016/17 up to and incl Feb 62 day target patients 31 day target patients 2017/18 up to and incl Feb 2018/19 up to and incl Feb For staffing performance, please refer to page 58. For financial performance please see page 177. Paula Head, chief executive officer 28 May 2019 22 OVERVIEW AND PERFORMANCE REPORT Regulatory body ratings Single Oversight Framework NHS Improvement’s Single Oversight Framework provides the framework for overseeing providers and identifying potential support needs. The framework looks at five themes: 1. Quality of care 2. Finance and use of resources 3. Operational performance 4. Strategic change 5. Leadership and improvement capability (well-led) Based on information from these themes, providers are segmented from one to four where ‘4’ reflects providers receiving the most support, and ‘1’ reflects providers with maximum autonomy. A foundation trust will only be in segments three or four where it has been found to be in breach or suspected breach of its licence. Segmentation During 2018/19 the Trust was confirmed as being placed within segment ‘2’. This segmentation information is the Trust’s position as at 31 March 2019. Current segmentation information for NHS trusts and foundation trusts is published on the NHS Improvement website. Finance and use of resources The finance and use of resources theme is based on the scoring of five measures from ‘1’ to ‘4’, where ‘1’ reflects the strongest performance. These scores are then weighted to give an overall score. Given that finance and use of resources is only one of the five themes feeding into the Single Oversight Framework, the segmentation of the Trust disclosed above might not be the same as the overall finance score here. Area Financial sustainability Financial sustainability Financial sustainability Overall scoring Care Quality Commission ratings: Metric Capital service cover Liquidity Income and expenditure margin Distance from financial plan Agency spend Q1 Q2 Q3 Q4 2 2 1 1 1 1 1 1 1 1 1 1 1 2 2 1 1 1 1 1 1 1 1 1 Overall rating for this trust Are services at this trust safe? Are services at this trust effective? Are services at this trust caring? Are services at this trust responsive? Are services at this trust well-led? Good Requires improvement Outstanding Good Requires improvement Good 23 OVERVIEW AND PERFORMANCE REPORT In December 2018, the CQC inspected four core services; urgent and emergency care, medicine, maternity and outpatients. It also looked at management and leadership, and effective and efficient use of resources. The CQC report (published on the 17 April 2019) rated the Trust as ‘good’ overall and ‘outstanding’ for providing effective services. “Our inspectors found a strong patient-centred culture with staff committed to keeping their people safe, and encouraging them to be independent. Patients’ needs came first and staff worked hard to deliver the best possible care with compassion and respect. Inspectors saw many areas of outstanding practice, with care delivered by compassionate and knowledgeable staff. Several teams led by example with a continuous focus on quality improvement. The Trust did face some challenges especially with the ageing estates. Some patient environments were showing significant signs of wear and tear – but again staff were doing their utmost to deliver compassionate care”. Dr Nigel Acheson Deputy chief inspector of hospitals (South) Environmental matters We recognise that the Trust’s business has an impact on the environment. As a large hospital we undertake a wide range of activities and use a large amount of resources, for example: • The Trust generates approximately 3,000 tonnes of waste yearly, half of which is clinical waste. If not properly treated this huge amount of waste can cause soil, water and air pollution depending on the disposal route. • Due to the large number of visitors and deliveries we attract every day, traffic congestion is regularly experienced on and around the site, which impacts the air quality around the hospital. We are committed to environmental sustainability and consider it as part of the business culture. We acknowledge that reducing waste and minimising the consumption of scarce resources is consistent with financial sustainability. Our sustainability disclosure section on page 80 provides greater detail on the steps we are taking to reduce our activities’ impact on the environment. 24 OVERVIEW AND PERFORMANCE REPORT Social, community, anti-bribery and human rights issues We recognise our responsibilities under the European Convention on Human Rights (included in the Human Rights Act 1998 in the UK), which are relevant to health and social care. These rights include the: • right to life • right not to be subjected to torture, inhuman or degrading treatment or punishment • right to liberty • right to respect for private and family life The Trust is committed to ensuring it fully takes into account all aspects of human rights in our work. At University Hospital Southampton we value our reputation for top quality care and financial probity and conduct our business in an ethical manner. The Bribery Act 2010 was introduced to make it easier to tackle the issue of bribery which is a damaging practice. Bribery can be defined as ‘giving someone a financial or other advantage to encourage them to perform their duties improperly or reward them for having done so’. To limit our exposure to bribery we have in place an Anti-Fraud, Bribery and Corruption Policy, a Standards of Business Conduct Policy and a Freedom to Speak Up (formerly Raising Concerns) Policy. These apply to all staff and to individuals and organisations who act on behalf of UHS. We also employ a local counter fraud specialist who will investigate, as appropriate, any allegations of fraud, bribery or corruption. The success of our anti-bribery approach depends on our staff playing their part in helping to detect and eradicate bribery. Therefore, we encourage staff, service users and others associated with UHS to report any suspicions of bribery and we will rigorously investigate any allegations. In addition, we hold a register of interest for directors, staff, and governors and ask staff not to accept gifts or hospitality that will compromise them or the Trust. The Board of Directors carries out its business in an open and transparent way. We are committed to the prevention of bribery as well as to combating fraud and expect the organisations we work with to do the same. Doing business in this way enables us to reassure our patients, members and stakeholders that public funds are properly safeguarded. There are no important events since the year end affecting the foundation trust. No political donations have been made. The Trust has no overseas branches. 25 FR STAND BODY ACCOUNTABILITY REPORT Members of the Trust Board Board member Name Title Paula Head Chief executive officer David French Deputy chief executive officer and chief financial officer Gail Byrne Director of nursing and organisational development Jane Hayward Director of transformation and improvement Biography Declarations Paula joined the Trust as chief executive in September 2018, having been chief executive at the Royal Surrey County NHS Foundation Trust in Guildford and before that at Sussex Community NHS Foundation Trust. She began her career as a pharmacist working in the community, hospitals and at health authorities before moving into general management and her first board position at Kingston Hospital. Since then she has spent time on the boards of commissioners and providers, including director of transformation at Frimley Park Hospital NHS FT. Paula lives in Hampshire and has a daughter studying medicine at the University of Southampton. Daughter is a medical student at University of Southampton; Member of Hampshire & Isle of Wight Sustainability and Transformation Partnership Executive Delivery Group David joined the Trust in February 2016 and led on finance, procurement, estates and commercial development until March 2018, when he became interim chief executive officer. He read Economics and Social Policy at the University of London before joining ICI plc, where he qualified as a chartered management accountant. David has extensive healthcare experience from the pharmaceutical industry, mostly Eli Lilly and Company where he held many commercial and financial roles in the UK and overseas. He joined the NHS in 2010 as chief financial officer of Hampshire Hospitals NHS Foundation Trust. He also serves as a non-executive director for Vivid Housing Limited, a social housing provider across Hampshire and the Solent. Non-executive director and chair of audit and risk committee, Vivid Housing Limited; Director, UHS Estates Limited, a wholly-owned subsidiary of UHSFT; Director, Southampton Commercial Estates Development Partnership (CEDP) Project Company Limited, a whollyowned subsidiary of UHSFT; Member of Solent Acute Alliance; Member of Hampshire & Isle of Wight Counter Fraud Board; Member of Hampshire & Isle of Wight Sustainability and Transformation Partnership Capital Planning Panel (from May 2018) Gail joined the Trust in 2010 as deputy director of nursing and head of patient safety. Prior to this, she has worked at the Strategic Health Authority as head of patient safety, and director of clinical services at Portsmouth Hospital. Gail has also worked in Brisbane, Australia as a hospital Macmillan nurse, and as general manager of a special purpose vehicle company for the private finance initiative at South Manchester Hospitals. Husband is a consultant surgeon in the Trust; Daughter is a midwife at UHS (from March 2019) Jane joined the Trust in 2000 as a clinical services manager for the cardiothoracic directorate after spending two years in Hertfordshire as director of performance and 11 years at Barts and the London Hospitals in various roles including planning, finance and commissioning. Jane has led on human resources, information management and technology, improvement and modernisation and has been chief operating officer. Jane joined the Trust Board in February 2008 and became director of transformation and improvement in January 2014. Director, UHS Estates Limited, a wholly-owned subsidiary of UHSFT; Father and mother are UHSFT simulated patients (voluntary position) Dr Derek Medical Sandeman director Dr Caroline Marshall Chief operating officer Derek was appointed to the Trust as a consultant physician in 1993 and went on to develop a regional endocrine service. Throughout his career he has had extensive clinical leadership experience, most recently serving eight years as clinical director. Derek’s leadership roles have also included programme director for postgraduate education and the Wessex Endocrine Royal College representative. He has a strong history of wider system engagement, working collaboratively with partners to improve systems resilience and pathways. Caroline joined the Trust in 1997 as a consultant hepatobiliary and neuroanaesthetist. She has held the posts of college tutor for the Royal College of Anaesthetists and UHS mentoring and coaching lead. In 2008, she became clinical service director for critical care, and then divisional clinical director for division A between 2010 and 2013. Caroline served as interim chief operating officer between January to December 2014, and was then appointed to the substantive post. Her portfolio includes the executive lead for cancer and the executive lead for major trauma. Director of UHS Pharmacy Limited, a wholly-owned subsidiary of UHSFT; Member of Hampshire & Isle of Wight Sustainability and Transformation Partnership Clinical Executive Group Daughter is employed within the emergency department at UHS (from 1 August 2018) 27 ACCOUNTABILITY REPORT Non-executive directors Name Title Peter Hollins Chair Simon Porter Senior independent director and deputy chair Dr Mike Non-executive Sadler director Biography Declarations Peter graduated in chemistry from Hertford College, Oxford. Joining Imperial Chemical Industries in 1973, he undertook a series of increasingly senior roles in marketing and then general management. Following three years in the Netherlands as general manager of ICI Resins BV, he was appointed in 1992 as chief operating officer of EVC in Brussels – a joint venture between ICI and Enichem of Italy. He played a key role in the flotation of the company in 1994, returning in 1998 to the UK as chief executive officer of
Url: /Media/UHS-website-2019/Docs/About-the-Trust/Annual-reports-and-quality-accounts/annual-report-2018-19.pdf

Stress echocardiogram - patient information

Description: This factsheet provides information about having a stress echocardiogram.
Url: /Media/UHS-website-2019/Patientinformation/Heartandlungs/Stress-echocardiogram-636-PIL.pdf

InP-Cisplatin-Fluorouracil

Description: Chemotherapy Protocol HEAD AND NECK CANCER CISPLATIN-FLUOROURACIL In-Patient Regimen Regimen • Head and Neck Cancer – InP-Cisplatin-Fluorouracil Indication • Neoadjuvant and palliative treatment of squamous cell carcinoma of the head and neck Toxicity Drug Cisplatin Fluorouracil Adverse Effect Neuropathy, nephrotoxicity, ototoxicity Diarrhoea, stomatitis The adverse effects listed are not exhaustive. Please refer to the relevant Summary of Product Characteristics for full details. Monitoring Drugs • FBC, LFTs and U&Es prior to each cycle • Patients with complete or partial dihydropyrimidine dehydrogenase (DPD) deficiency are at increased risk of severe and fatal toxicity during treatment with fluorouracil. All patients should be tested for DPD deficiency before initiation (cycle 1) to minimise the risk of these reactions Dose Modifications The dose modifications listed are for haematological, liver and renal function and drug specific toxicities only. Dose adjustments may be necessary for other toxicities as well. In principle all dose reductions due to adverse drug reactions should not be re-escalated in subsequent cycles without consultant approval. It is also a general rule for chemotherapy that if a third dose reduction is necessary treatment should be stopped. Please discuss all dose reductions / delays with the relevant consultant before prescribing, if appropriate. The approach may be different depending on the clinical circumstances. Version 1.2 (November 2020) Page 1 of 6 Head and Neck – InP-Cisplatin-Fluorouracil Haematological Consider blood transfusion if patient symptomatic of anaemia or has a haemoglobin of less than 8g/dL. Criteria Neutrophils Platelets Eligible Level 1.5x109/L or greater 100x109/L or greater Defer treatment for 7 days if the neutrophil count is less than 1.5x109/L and / or the platelet count is less than 100x109/L. If the counts have recovered to these levels at 7 days resume treatment. Consider using a 75% dose reduction. If the counts do not recover delay a further seven days. If they are satisfactory at 14 days treatment can be re-started using a 50% dose reduction. Hepatic Impairment Drug Cisplatin Fluorouracil Bilirubin (μmol/L) N/A less than 85 more than 85 AST/ALT units N/A less than 180 more than 180 Dose No dose reduction necessary 100% Contra-indicated Renal Impairment Drug Cisplatin Fluorouracil Creatinine Clearance (ml/min) more than 60 45-59 less than 45 Dose (% of original dose) 100 75 consider carboplatin Consider dose reduction in severe renal impairment only Other Dose reductions or interruptions in therapy are not necessary for those toxicities that are considered unlikely to be serious or life threatening. For example, alopecia, altered taste or nail changes. A cycle of chemotherapy should be delayed for up to two weeks to allow for a reduction in the severity of toxic events of NCI-CTC grade 3 or more to a severity of NCI-CTC grade 1 or less (with the exception of alopecia, fatigue, malaise, and nail changes). Delays beyond two weeks required discontinuation of chemotherapy Version 1.2 (November 2020) Page 2 of 6 Head and Neck – InP-Cisplatin-Fluorouracil Cisplatin Modifications in the dose of cisplatin are necessary for peripheral sensory and motor neurotoxicity, ototoxicity, or nephrotoxicity. Consider stopping treatment for patients with neurotoxicity or ototoxicity of NCI-CTC grade 3 or more. Fluorouracil Modifications in the dose of fluorouracil are necessary for mucositis and diarrhoea. Regimen 21 day cycle Neo-adjuvant – 2-3 cycles prior to radiotherapy (3 cycles will be set in Aria) Palliative – 6 cycles 6 cycles will be set in Aria Drug Cisplatin Fluorouracil Dose 100mg/m2 1000mg/m2 Days 1 1, 2, 3, 4 Administration Intravenous infusion in 1000ml sodium chloride 0.9% with 20mmol potassium chloride at a maximum rate of 1mg cisplatin/min (minimum time 120 minutes) Intravenous infusion in 1000ml sodium chloride 0.9% over 24 hours Dose Information • Cisplatin will be dose banded in accordance with the national dose bands (1mg/ml) • Fluorouracil will be dose banded in accordance with the national dose bands (50mg/ml) Administration Information Extravasation • Cisplatin – exfoliant • Fluorouracil - inflamitant Other • The fluorouracil is given as a continuous infusion over 24 hours. A central or PICC line is recommended for treatment to commence and continue. Version 1.2 (November 2020) Page 3 of 6 Head and Neck – InP-Cisplatin-Fluorouracil Additional Therapy • Antiemetics 15-30 minutes prior to chemotherapy - aprepitant 125mg oral day 1 - aprepitant 80mg oral days 2, 3 - dexamethasone 4mg once a day oral - ondansetron 8mg twice a day oral for 5 days - metoclopramide 10mg three times a day when required oral • Cisplatin pre and post hydration as follows; Pre Furosemide 40mg oral or intravenous 1000ml sodium chloride 0.9% with 20mmol potassium chloride and 16mmol magnesium sulphate over 60 minutes Post 1000ml sodium chloride 0.9% with 20mmol potassium chloride and 16mmol magnesium sulphate over 60 minutes Patients should be advised to drink at least 3 litres of fluid in the 24 hours after administration of cisplatin. • • Oral loperamide 4mg after the first loose stool then 2-4mg four times a day when required for the relief of diarrhoea (maximum 16mg/24 hours). • Mouthwashes as per local or national guidelines • Gastric protection with a proton pump inhibitor or a H2 antagonist may be considered in patients considered at high risk of GI ulceration or bleed References 1. Vermorken JB et al. EORTC 24971/TAX 323 Study Group. Cisplatin, fluorouracil and docetaxel in unresectable head and neck cancer. N Engl J Med 2007; 25: 357 (17): 1695-1704. Version 1.2 (November 2020) Page 4 of 6 Head and Neck – InP-Cisplatin-Fluorouracil REGIMEN SUMMARY InP-Cisplatin-Fluorouracil Day 1 1. Warning – Check supportive medication prescribed Administration instructions 1. Aprepitant 125mg oral day 1 2. Aprepitant 80mg oral days 2, 3 3. Dexamethasone 4mg once a day, days 1, 2, 3, 4, 5 oral or intravenous 4. Metoclopramide 10mg three times a day as required oral or intravenous 5. Ondansetron 8mg twice a day, days 1, 2, 3, 4, 5 oral or intravenous 6. Consider gastric protection 7. Consider mouthwashes 2. Furosemide 40mg oral or intravenous bolus 3. 1000ml sodium chloride 0.9% with 20mmol potassium chloride and 16mmol magnesium sulphate over 60 minutes 4. Cisplatin 100mg/m2 intravenous infusion in 1000ml sodium chloride 0.9% with 20mmol potassium chloride at a maximum rate of 1mg cisplatin/minute (minimum time 120 minutes) 5. 1000ml sodium chloride 0.9% with 20mmol potassium chloride and 16mmol magnesium sulphate over 60 minutes 6. Fluorouracil 1000mg/m2 intravenous infusion in 1000ml sodium chloride 0.9% over 24 hours Day 2, 3, 4 Warning – Check supportive medication prescribed Administration instructions 1. Aprepitant 125mg oral day 1 2. Aprepitant 80mg oral days 2, 3 3. Dexamethasone 4mg once a day, days 1, 2, 3, 4, 5 oral or intravenous 4. Metoclopramide 10mg three times a day as required oral or intravenous 5. Ondansetron 8mg twice a day, days 1, 2, 3, 4, 5 oral or intravenous 6. Consider gastric protection 7. Consider mouthwashes 7. Fluorouracil 1000mg/m2 intravenous infusion in 1000ml sodium chloride 0.9% over 24 hours Version 1.2 (November 2020) Page 5 of 6 Head and Neck – InP-Cisplatin-Fluorouracil DOCUMENT CONTROL Version Date Amendment Updated monitoring with DPD 1.2 Nov 2020 testing Dose banding updated Coding removed Ondansetron and 1.1 Jan 2015 dexamethasone duration changed to five days to match support treatments 1 Dec 2014 None Written By Donna Kimber Pharmacy Technician Donna Kimber Pharmacy Technician Dr Deborah Wright Pharmacist Approved By Rebecca Wills Pharmacist Dr Deborah Wright Pharmacist Dr S Ramkumar Consultant Clinical Oncologist This chemotherapy protocol has been developed as part of the chemotherapy electronic prescribing project. This was and remains a collaborative project that originated from the former CSCCN. These documents have been approved on behalf of the following Trusts; Hampshire Hospitals NHS Foundation Trust NHS Isle of Wight Portsmouth Hospitals NHS Trust Salisbury NHS Foundation Trust University Hospital Southampton NHS Foundation Trust Western Sussex Hospitals NHS Trust All actions have been taken to ensure these protocols are correct. However, it remains the responsibility of the prescriber to ensure the correct drugs and doses are prescribed for patients. Version 1.2 (November 2020) Page 6 of 6 Head and Neck – InP-Cisplatin-Fluorouracil
Url: /Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Headandneckcancer/InP-Cisplatin-Fluorouracil.pdf

Cisplatin-Fluorouracil

Description: Chemotherapy Protocol HEAD AND NECK CANCER CISPLATIN-FLUOROURACIL Regimen • Head and Neck Cancer – Cisplatin-Fluorouracil Indication • Neoadjuvant and palliative treatment of squamous cell carcinoma of the head and neck Toxicity Drug Cisplatin Fluorouracil Adverse Effect Neuropathy, nephrotoxicity, ototoxicity Diarrhoea, stomatitis The adverse effects listed are not exhaustive. Please refer to the relevant Summary of Product Characteristics for full details. Monitoring Drugs • FBC, LFTs and U&Es prior to each cycle • Patients with complete or partial dihydropyrimidine dehydrogenase (DPD) deficiency are at increased risk of severe and fatal toxicity during treatment with fluorouracil. All patients should be tested for DPD deficiency before initiation (cycle 1) to minimise the risk of these reactions Dose Modifications The dose modifications listed are for haematological, liver and renal function and drug specific toxicities only. Dose adjustments may be necessary for other toxicities as well. In principle all dose reductions due to adverse drug reactions should not be re-escalated in subsequent cycles without consultant approval. It is also a general rule for chemotherapy that if a third dose reduction is necessary treatment should be stopped. Please discuss all dose reductions / delays with the relevant consultant before prescribing, if appropriate. The approach may be different depending on the clinical circumstances. Version 1.1 (November 2020) Page 1 of 6 Head and Neck – Cisplatin-Fluorouracil Haematological Consider blood transfusion if patient symptomatic of anaemia or has a haemoglobin of less than 8g/dL. Criteria Neutrophils Platelets Eligible Level 1.5x109/L or greater 100x109/L or greater Defer treatment for 7 days if the neutrophil count is less than 1.5x109/L and / or the platelet count is less than 100x109/L. If the counts have recovered to these levels at 7 days resume treatment. Consider using a 75% dose reduction. If the counts do not recover delay a further seven days. If they are satisfactory at 14 days treatment can be re-started using a 50% dose reduction. Hepatic Impairment Drug Cisplatin Fluorouracil Bilirubin (μmol/L) N/A less than 85 more than 85 AST/ALT units N/A less than 180 more than 180 Dose No dose reduction necessary 100% Contra-indicated Renal Impairment Drug Creatinine Clearance (ml/min) Dose (% of original dose) Cisplatin Fluorouracil more than 60 45-59 less than 45 100 75 consider carboplatin Consider dose reduction in severe renal impairment only Other Dose reductions or interruptions in therapy are not necessary for those toxicities that are considered unlikely to be serious or life threatening. For example, alopecia, altered taste or nail changes. A cycle of chemotherapy should be delayed for up to two weeks to allow for a reduction in the severity of toxic events of NCI-CTC grade 3 or more to a severity of NCI-CTC grade 1 or less (with the exception of alopecia, fatigue, malaise, and nail changes). Delays beyond two weeks required discontinuation of chemotherapy Version 1.1 (November 2020) Page 2 of 6 Head and Neck – Cisplatin-Fluorouracil Cisplatin Modifications in the dose of cisplatin are necessary for peripheral sensory and motor neurotoxicity, ototoxicity, or nephrotoxicity. Consider stopping treatment for patients with neurotoxicity or ototoxicity of NCI-CTC grade 3 or more. Fluorouracil Modifications in the dose of fluorouracil are necessary for mucositis and diarrhoea. Regimen 21 day cycle Neo-adjuvant – 2 cycles prior to radiotherapy Palliative – 6 cycles 6 cycles will be set in Aria Drug Cisplatin Fluorouracil Dose 100mg/m2 4000mg/m2 Days 1 1 Administration Intravenous infusion in 1000ml sodium chloride 0.9% with 20mmol potassium chloride at a maximum rate of 1mg cisplatin/min (minimum time 120 minutes) Intravenous infusion over 96 hours Dose Information • Cisplatin will be dose banded in accordance with the national dose bands (1mg/ml) • Fluorouracil will be dose banded in accordance with the national dose bands (50mg/ml) Administration Information Extravasation • Cisplatin – exfoliant • Fluorouracil - inflamitant Other • The fluorouracil is given as a continuous infusion over 96 hours. A central or PICC line is recommended for treatment to commence and continue. Version 1.1 (November 2020) Page 3 of 6 Head and Neck – Cisplatin-Fluorouracil Additional Therapy • Antiemetics 15-30 minutes prior to chemotherapy - aprepitant 125mg oral day 1 - aprepitant 80mg oral days 2, 3 - dexamethasone 4mg once a day oral - ondansetron 8mg twice a day oral for 3 days - metoclopramide 10mg three times a day when required oral As take home medication - aprepitant 80mg once a day for two days starting on day two of the cycle ora - dexamethasone 4mg once a day for three days starting on day two of the cycle oral - ondansetron 8mg twice a day for three days starting on the evening of day one of the cycle - metoclopramide 10mg three times a day when required oral • Cisplatin pre and post hydration as follows; Pre Furosemide 40mg oral or intravenous 1000ml sodium chloride 0.9% with 20mmol potassium chloride and 16mmol magnesium sulphate over 60 minutes Post 1000ml sodium chloride 0.9% with 20mmol potassium chloride and 16mmol magnesium sulphate over 60 minutes Patients should be advised to drink at least 3 litres of fluid in the 24 hours after administration of cisplatin. • Oral loperamide 4mg after the first loose stool then 2-4mg four times a day when required for the relief of diarrhoea (maximum 16mg/24 hours). • Mouthwashes as per local or national guidelines • Gastric protection with a proton pump inhibitor or a H2 antagonist may be considered in patients considered at high risk of GI ulceration or bleed References 1. Vermorken JB et al. EORTC 24971/TAX 323 Study Group. Cisplatin, fluorouracil and docetaxel in unresectable head and neck cancer. N Engl J Med 2007; 25: 357 (17): 1695-1704. Version 1.1 (November 2020) Page 4 of 6 Head and Neck – Cisplatin-Fluorouracil REGIMEN SUMMARY Cisplatin-Fluorouracil Day 1 1. Aprepitant 125mg oral 2. Dexamethasone 4mg oral or intravenous or equivalent dose 3. Ondansetron 8mg oral or intravenous 4. Furosemide 40mg oral or intravenous 5. 1000ml sodium chloride 0.9% with 20mmol potassium chloride and 16mmol magnesium sulphate over 60 minutes 6. Cisplatin 100mg/m2 intravenous infusion in 1000ml sodium chloride 0.9% with 20mmol potassium chloride at a maximum rate of 1mg cisplatin/minute (minimum time 120 minutes) 7. 1000ml sodium chloride 0.9% with 20mmol potassium chloride and 16mmol magnesium sulphate over 60 minutes 8. Fluorouracil 4000mg/m2 over 96 hours intravenous infusion Take Home Medicines 1. Aprepitant 80mg once a day for two days starting on day two of the cycle oral 2. Dexamethasone 4mg once a day for three days starting on day two of the cycle oral 3. Ondansetron 8mg twice a day for three days starting on the evening of day one of the cycle 4. Metoclopramide 10mg three times a day when required oral Version 1.1 (November 2020) Page 5 of 6 Head and Neck – Cisplatin-Fluorouracil DOCUMENT CONTROL Version Date Amendment Updated monitoring with DPD 1.1 Nov 2020 testing Dose banding updated Coding removed 1 Dec 2013 None Written By Donna Kimber Pharmacy Technician Dr Deborah Wright Pharmacist Approved By Rebecca Wills Pharmacist Dr C Baughan Consultant Clinical Oncologist This chemotherapy protocol has been developed as part of the chemotherapy electronic prescribing project. This was and remains a collaborative project that originated from the former CSCCN. These documents have been approved on behalf of the following Trusts; Hampshire Hospitals NHS Foundation Trust NHS Isle of Wight Portsmouth Hospitals NHS Trust Salisbury NHS Foundation Trust University Hospital Southampton NHS Foundation Trust Western Sussex Hospitals NHS Trust All actions have been taken to ensure these protocols are correct. However, it remains the responsibility of the prescriber to ensure the correct drugs and doses are prescribed for patients. Version 1.1 (November 2020) Page 6 of 6 Head and Neck – Cisplatin-Fluorouracil
Url: /Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Headandneckcancer/Cisplatin-Fluorouracil.pdf

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