This paper chronicles the Isle Of Wights' journey from special measures to a CQC rating of good

When Medical Audits and Isle of Wight NHS Trust were introduced in mid 2018, the Trust was in special measures and were struggling with a burdensome paper based audit programme that was collecting hundreds of data points but wasn’t providing the information required to help identify areas for improvement or enable benchmarking across the Trusts wide range of services.

Then began the journey to standardised auditing and quality assurance across the Trust.

Helped by Medical Audits, they began to review the data required for compliance with CQC and developed an audit process for the Trust to encompass the needs of CQC and Trust Board for evidence of compliance.

It was essential that at the same time they could reduce the burden of audit on clinical staff and release time to care.

speech Fundamentally, the Medical Audits system was established within the Trust to ensure that clinicians could complete mandatory audits, without utilising all of their time speech

Maggie Oldham,
CEO,
Board Report, 2018/2019

Medical Audits chosen as the audit software system

The Isle of Wight NHS Trust is the only integrated acute, community, mental health and ambulance health care provider in England.

Established in April 2012, the trust provides acute, community, mental health, ambulance and urgent care services to a population of 140,000 people living on the Isle of Wight.

The Trust was placed in special measures in 2018.

Medical Audits was chosen as the audit software system to help the organisation review their audit processes, standardise and simplify the audits across the Trust and quality assure the information provided for governance and oversight of standards.

speech Not only have we got the Medical Audits platform with its pre developed audits, but also working with Medical Audits we developed our own hospital risk assessments and added those to the same platform and they all work together to provide our board with lots of assurance speech .

Rob Jubb, Head of Health & Safety and Security

Special Measures (now called Recovery Support Programme)

In serious cases where hospitals are not providing good and safe care to patients, and the management cannot fix the problems by themselves, action is taken to improve the hospitals. The term used for this is "special measures".

Special measures involve action by three organisations:

  • Care Quality Commission
  • Monitor
  • NHS Trust Development Authority.

At the end of each year the Chief Inspector of Hospitals inspects and judges whether improvements have been made to the management of the hospital and if it is delivering good enough care to exit special measures.

A hospital will only come out of special measures if it has made the required improvements. The average time to exit special measures is 17 months although some Trusts are in special measures for 4 years or more.

Isle of Wight NHS Trust is proud to be now rated as Good

CQC Ratings from NHSProviders factsheets
speech Of the 41 trusts that have been in special measures, only six are now rated as 'good' overall by CQC.

Isle of Wight NHS is proud to be rated as good speech
speech Medical Audits dramatically reduces the time spent auditing and enables our staff across acute, community, mental health and learning disability and ambulance services to invest their time in our patients speech

Mary Aubrey, Interim Chief Nurse and Quality Improvement Advisor to the CEO, IOW, NHS Trust 2020/2021
Support for the Medical Audits system
has been Trust wide
- From Board to Ward
Increased auditing identifies risks and areas for improvement.

As Practice improves care improves for our patients.

The charts below demonstrate the improvements in performance and practice.
Fluid Chart compliance
2019
40%
2020
90%
2021
98%
DNA CPR compliance
2019
50%
2020
90%
2021
98%
NEWS2 compliance
2019
75%
2020
95%
2021
97.6%

Aims of the Project

Fundamentally, the Medical Audits system was established within the Trust to :

  • Release Time to Care
  • Standardise and simplify audit processes across the trust
  • Quality Assure the information provided for governance and oversight of standards

These aims have been achieved with ease using Medical Audits Software

speech With Medical Audits its so much easier, all the information is available to everybody in real-time; so people aren’t constantly chasing us for copies of reports they’ve misfiled speech .

Karen Robinson, Head Of Infection Prevention and Control, Isle of Wight, NHS Trust

speech Before we had Medical Audits it was really really difficult … now its streamlined and much better and so much easier to use speech .

Ward Manager, Isle of Wight NHS Trust

Implementing Medical Audits Software and Standardising Auditing across the Trust

The Medical Audit’s software is really easy to use and has a detailed, inbuilt auditing guidance, helping ensure the different grades and specialities of staff in the Trust can audit in a standardised, consistent way.

Medical Audit’s audit software enables faster, more efficient auditing with auto-generated reports to help improve practice.

Seamless implementation and complete staff usage

speech Really reliable, no technical problems..
Staff and trust board find it really user friendly and easy to access results...
Recommend other trusts to use Medical Audits - really improves patients outcomes...
Medical Audits company have been tremendous in supporting the trust...
speech .

Mary Aubrey, Interim Chief Nurse and Quality Improvement Advisor to the CEO, IOW, NHS Trust 2020/2021

Clear, detailed Information about what needs to be done to be compliant

Tracking of Non-Compliances

Auto-generated reports with tracking of issues and actions required are clearly visible to staff across the Trust.

Action plans are easily accessible on every computer, making it so easy to know what’s needed to meet standards.

speech We can see the actions that are needed and support the whole department to ensure these actions are put into place speech .

A&E Department Manager, Isle of Wight NHS Trust

Laura Bail, Quality and Assurance Lead, Isle of Wight, NHS Trust
speech The company have been really supportive - no question was too difficult or too stupid speech

Simple to use interface and Standardised Audit Content

Across the Trust, the system has been embraced by staff who love its ease of use and clear, detailed standardised information.

speech Revolutionised the way we audit...
Intuitive, easy to use, well laid out...
Wondrously holistic system...
Auditing has been standardised for you [removing inconsistency]...
speech

Ben Davis, Health & Safety Compliance Officer, Isle of Wight, NHS Trust

Support From Medical Audits During Implementation and since has been tremendous

Standardised Auditing and Quality Assurance Across the Isle of Wight

Initially implemented across acute nursing services, cleaning and health and safety, the audit software was then extended to community, mental health and learning disability and ambulance services across the Isle of Wight.

Laura Bail, Quality Assurance and Accreditation Lead, Isle of Wight, NHS Trust

Individual Accountability and Ownership of Audit and Quality Assurance process

As staff became accustomed to actionable intelligent information that was clear and simple to understand their participation in the audits increased.

Audits completed by specialist teams are available immediately to review and close issues raised against their individual departments.

This promotes a sense of ownership among ward staff and serves to increase interaction with the audit and quality improvement process.

speechThe Medical Audits have really helped us with our Quality Assurance speech .

Out Patient Department Manager, Isle of Wight NHS Trust

speech We use the audit system to measure our performance and quality assure the standards of care we provide speech.

End of Life Ward Manager, Isle of Wight NHS Trust

speech Use of Medical Audits has shown a visible and consistently improved compliance with the completion of audit activity and allows for actions to be documented when non-compliance with required clinical practice is found speech

Maggie Oldham
Chief Executive


Isle of Wight NHS Trust Annual Quality Report 2020

Medical Audits software has been rapidly expanded across the trust into specialist areas including Learning Disability, Mental Health and Ambulance Services etc. due to the successful results experienced at each stage.

Audit Observations Completed

2019
9685
2020
26386
2021
39085

Increased numbers of audits with reducing numbers of non-conformances raised tells the story of a successful journey to good

Improved compliance, Improved care standards

INCIDENT/COMPLIANTS 2019 2020 2021
Sub optimal care of deteriorating patient 17 13 6
Dementia care related compliants 12 9 5
Medication Incident Related Harm 13 3 0

Improved compliance, Improved care standards

INDICATOR 2019 2020 2021
NEWS2 Compliance 75% 95.20% 97.60%
Sepsis 2 Compliance 85% 89.90% 93.60%
Fluid Chart Compliance 40% 95.20% 98.40%
DNA/CPR Compliance 50% 89.90% 93.60%
Hand Hygiene Compliance 92% 95.20% 98%

Disordered paperwork to streamlined systematic dashboards

speech A succinct way of gathering data , displayed on one self explanatory Trust wide dashboard speech .

Laura Bail, Quality and Assurance Lead, Isle of Wight, NHS Trust

Medical Audits embedded and utilised across the whole trust

speech We moved out of special measures and are now classified as good..

Medical Audits helped prove to CQC... all contributed to getting to good
speech .

Rob Jubb, Head of Health & Safety and Security

Medical Audits is now embedded across Isle of Wight NHS Trust and is used by staff throughout acute, community, ambulance services and mental health and disability services to gather audit data for quality assurance.

CQC Inspection Ratings

2018 2019 2021
Safe Inadequate Requires Improvement Good
Effective Requires Improvement Requires Improvement Good
Caring Good Good Good
Responsive Requires Improvement Requires Improvement Good
Well-Led Inadequate Requires Improvement Good
OVER ALL Inadequate Requires Improvement Good

In Conclusion

Mary Aubrey, Interim Chief Nurse and Quality Improvement Advisor to the CEO, IOW, NHS Trust

Staff at all levels have embedded excellent audit practices using the Medical Audits software (and enjoy it!) and have seen the Quality Improvements their work has brought.

The Isle of Wight Trust and the people at the heart of their services are proud to be rated as Good.

We at Medical Audits are proud to have played a part in the journey.


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