Development of the ‘Safety Huddle’ in the community setting

In June 2016 a member of my team and I picked up a piece of work given to the Sefton locality by our deputy director of nursing, Jenny Hurst.

She was with Liverpool Community Health (LCH) on a secondment from secondary care and wanted a ‘Safety Huddle’ to be designed for use by all District Nurses, to ensure all key harms were addressed on a daily basis and to ensure patient and staff safety was formally documented.

Aims

The Safety Huddle’s main aim was to improve and document all clinical handovers within individual teams across the locality. Together we devised the template for the Safety Huddle, as although daily handovers were taking place within teams, they were not formally documented and so it was recognized by senior management that a more formalised handover was needed in order for us to evidence handovers.

As Debbie was developing her leadership skills, we decided to use this opportunity to develop the Safety Huddle template as part of her leadership project, as we both felt this was something which was needed within the locality.

The key principles of the Safety Huddle are to ensure that all priority patients are discussed on a daily basis. We currently use a priority board; which is a useful aid and lists all patients where daily visits are essential to ensure their needs are met; for example people with diabetes on insulin, post–operative Dalteparin injections, bowel care patients, daily wound dressings, palliative patients on syringe drivers, etc.

The huddle also addresses new pressure ulcers; these patients are reviewed by a caseload holder or team leader within 48 hours of identification. Other areas included in the huddle are palliative patients, new or complex patients, any senior reviews needed. High risk patients, including patients who may require double up visits are discussed; this could be patients who should not be recatheterised in the community setting, or patients where the health & safety team are involved and appear on the Trust’s High Risk Patient Register. Discussing these patients ensures increased levels of communication in the team.

Implementation

Staff who are returning from sick or annual leave come directly into work on their first day back and do not visit patients on their way in. This ensures they receive an up to date handover of these patients prior to visiting. The Safety Huddle is also used to ensure important information is shared with staff and we are also asking if lone worker devices are fully charged and working.

The Standard Operating Procedure (SOP) was additionally produced by us and then rolled out along with the Safety Huddle template, to other teams within the locality / organisation in order to support the delivery of the Safety Huddle.Within our team we audited the Safety Huddle Template along with the Standard Operating Procedure we wrote. This demonstrated improved outcomes in clinical care / patient and staff safety. We made some changes to the template as a direct result of feedback obtained.

The Safety Huddle was then rolled out across the locality; once this was piloted it was then rolled out to the other localities within the trust and is now standardised across the trust. It has also been adapted and used in children’s services and with allied health professionals. It is now a mandatory requirement for all District Nurses across the organisation to complete the Safety Huddle daily and in Sefton for all teams within adult and children’s services it has become a mandatory process by the clinical lead.

We have presented the Safety Huddle at pressure ulcer workshops, quality events as well as presenting to other services within our organisation.

Progress and results

As the NHS continues to go through so many changes, we thought that staff may have been resistant to the use of the Safety Huddle template, but since its launch in July 2016 as a pilot within our team, an audit has demonstrated that the number of grade 3 and 4 pressure ulcers has reduced and also the number of grade 2 pressure ulcers has also greatly reduced, which shows that the Safety Huddle has had a positive effect upon patients developing pressure ulcers.

Linking effective leadership and team effectiveness yields a valuable opportunity to align team members around shared objectives and strategies. It maintains team confidence, supports team members, enabling us to appreciate each other’s contribution and collectively seeks to improve patient care and outcomes.

The Safety Huddle has reduced unnecessary hospital admissions following complications from patients with complex needs. It has improved MDT communication within teams.

Ongoing audit and review is planned, as the Safety Huddle is implemented across the organisation. Part of our recent CQC report highlighted patient and staff safety, and we will be completing the Safety Huddle with the CQC present in April 2017 in order to show how effective it has become within our teams.

Skill development

We believe we have developed numerous leadership skills as a result of designing the Safety Huddle and also following the completion of the SOP. We have taken the lead in delivering daily handovers and the completion of the template has allowed us to identify how this has improved patient care and minimised risks of patient care being compromised. This daily handover has also allowed staff to input any concerns they may have regarding patients and as this template is also used to discuss any other business this enables all staff to speak up. We believe it has ultimately improved the level of communication within teams and also with senior management. Investigating Officers completing RCAs can also request a copy of the Safety Huddle as part of their investigation.

All members of the team have become more confident in delivering handovers on a daily basis. Ultimately practices have been improved and patients are less likely to miss visits, which has ultimately promoted patient safety. The completion of the daily Safety Huddle is structured and staff are now actively engaging in the clinical handover process.

We were successfully nominated for the LCH star award for the development of the Safety Huddle and received our award in November 2016 by the Interim Chief Executive. Our Deputy Director of Nursing is continually promoting our Safety Huddle, which has a really positive effect on us both and the team.

You can download copies of the safety huddle documents below: