Scottish Inpatient Experience Survey 2016 Volume 1: National Results

Results - Patient Safety

Summary

The survey found that one in five people ( 20 per cent) felt that they had experienced problems during their hospital stay such as infections, bed sores, reactions to medications, or falls.

Eight per cent of people felt that they had experienced clinical errors during their stay in hospital, the most common being 'delayed or incorrect test results'. The survey results further suggested that where clinical errors occurred, they were not always dealt with to patients' satisfaction. In over a third of instances ( 35 per cent) people reported that staff did not discuss the error with them and in 41 per cent of cases patients were not satisfied with how the errors were dealt with.

There was also a specific question relating to drips and needles in patients' veins. This found that one in 12 people felt that either: their drip was not checked regularly enough; their drip was not changed when required; or their drip was not removed quickly enough.

Introduction

The Scottish Patient Safety Programme ^{[ 10]} was launched in 2008 to improve the safety and reliability of healthcare and reduce harm, whenever care is delivered whether in acute or community settings. Within adult acute care, the programme is now organised into nine priority areas for improvement ^{[ 11]} which includes reducing:

• mortality and harm from sepsis
• falls
• pressure ulcers
• medicine errors
• catheter associated infections

Whilst in hospital it is not unknown for a patient's condition to deteriorate for various reasons. It is important that patients are appropriately monitored and that they get an effective, timely response. The SIGN recommendations on Care of deteriorating patients ^{[ 12]} set out the essential elements for prompt and reliable recognition of and appropriate response to deteriorating patients in Scotland's acute health care settings.

Response to worsening of patients' condition.

Almost a quarter of people responding to the survey ( 23 per cent) reported that they had experienced a worsening of their condition whilst in hospital.

In situations where people felt that their condition had worsened, over one in ten people ( 11 per cent) felt that the staff did not respond quickly. Whilst this does mean that in the vast majority of instances ( 89 per cent) staff did respond quickly, a figure of over one in ten suggests that there is scope for improvement from the patient's perspective.

Some caution would be advised in interpreting these results. These figures relate to patients' own assessment of their condition and the survey does not provide information on how serious the deterioration was, nor whether the situation experienced by the patient would constitute a deterioration in condition as judged by a health professional.

Peripheral cannulas

Peripheral venous cannulas [ PVCs] are widely used in a hospital setting: it has been estimated that as many as one in three hospital patients has one at any given time ^{[ 13]}. PVCs are associated with potential medical complications, such as bloodstream infections, which can have serious consequences. ^{[ 14]}

Observation and monitoring are crucial to identifying complications at an early stage. Both the Royal College of Nursing and Health Protection Scotland recommend that PVC sites are checked at least on a daily basis ^{[ 15]}. It is further recommended that the site is checked during injection of drugs, when IV fluid bags are changed and when drip flow rates are checked. PVCs should be removed as soon as they become clinically unnecessary.

In order to assess how well patients felt that their PVCs were maintained, Patients who had a PVC were asked whether it was checked regularly enough, whether it was changed when required, and whether it was removed quickly enough (Table 3):

• almost nine out of ten ( 92 per cent) who had PVCs had no concerns with how they were maintained

• the remaining 8 per cent felt that their PVCs were not being maintained appropriately

• the most common failing reported ( seven per cent) was that patients felt that their drip was not checked regularly enough

Table 3 Summary of peripheral venous cannulas [ PVCs] maintenance (%)

Statement	%
Not checked regularly enough	7
Not changed when required	4
Not removed quickly enough	5
At least one of the above	8

Harm or injuries to patients

People were asked for their views regarding problems that may have arisen during, or as a result of, their hospital stay. People were asked to indicate whether they had experienced any of the following:

• Infection ( e.g. urinary tract infection, surgical wound infection, MRSA, C.Diff etc.)
• Blood poisoning/sepsis
• Blood clot ( e.g. Deep Vein Thrombosis [ DVT], Embolism)
• Bed sore (pressure sore)
• Injury from falling over
• Bad reaction to medication
• Complication from surgery
• Any other problems

One in five people ( 20 per cent) had experienced at least one of the problems listed. By far the most common was an infection, with seven per cent of patients experiencing an infection during their inpatient stay (Table 4).

Four per cent of respondents selected the option 'any other problems' . As a result it is not clear what problem they will have been considering when responding to this question.

Table 4 Summary of harm or injuries experienced during hospital stay (%)

Harm or injuries	%	Change from 2014
Infection	7	-1
Blood poisoning/sepsis	1	0
Blood clot	1	0
Bed sore (pressure sore)	2	0
Injury from falling over	1	0
Bad reaction to medication	4	0
Complication from surgery	3	0
Any other problems	4	0
At least one of the above	20	1

The Patient Rights Act 2011 includes the principle that "no avoidable harm or injury is to be caused to the patient by the healthcare provided" ^{[ 16]}. The question of whether any harm was avoidable is complex and needs to be considered in local review on an individual basis. The above information does not distinguish harms that might have been avoidable.

Clinical errors

People were also asked whether they had experienced any of five listed clinical errors:

• Incorrect diagnosis
• Wrong treatment
• Incorrect medicines
• Incorrect doses of medicines
• Delayed or incorrect test results

Eight per cent of people responding to the survey felt that they had experienced at least one of the clinical errors listed. The most common of these was 'delayed or incorrect test results', which was experienced by three per cent of patients (Table 5).

Table 5 Summary of clinical errors experienced during hospital stay (%)

Clinical error	%	Change from 2014
Incorrect diagnosis	2	0
Wrong treatment	1	0
Incorrect medicines	2	0
Incorrect doses of medicines	1	-1
Delayed or incorrect test results	3	0
At least one of the above	8	1

Responding to clinical errors

An important aspect of reducing and managing risk is to ensure that when mistakes do occur they are acknowledged and dealt with. The Learning from adverse events through reporting and review: A national framework for NHSScotland approach ^{[ 17]} stressed that the needs of the patient and their family should be addressed as a priority when something has gone wrong. This includes being open and honest about what has happened and communicating about any reviews or improvement plans.

Where patients felt that any of the five clinical errors above occurred during their care, they were asked whether staff had discussed the error with them (Figure 20):

• over one in three people ( 35 per cent) reported that staff did not discuss the error with them

• 44 per cent had the event discussed with them 'to some extent'

• 21 per cent had the issue discussed with them 'completely'

These results suggest that, when mistakes do errors do occur, more could be done to discuss the situation with the patient.

People were also asked whether they were satisfied with how the events had been dealt with (Figure 20):

• around two in five ( 41 per cent) indicating that they were not satisfied

• 32 per cent indicated that they were satisfied 'to some extent'

• 27 per cent were 'completely' satisfied, a rise of two percentage points from 2014

Figure 20 Summary of how satisfied patients were with how clinical errors were dealt with (%)