RAG Key Core Service Key Number ED MD - MED SD - SUR IA .
Shrewsbury and Telford Hospital NHS TrustRAG KeyDeliveredOn Track to deliverSome issuesNot on rviceCore Service KeyUrgent & Emergency ServicesMedical CareSurgical CareCritical CareMaternity & GynaecologyEnd of Life CareChildren's ServicesTrustSiteExec SponsorResponsibleLeadNumberMD - Must DoSD - Should DoIA - Immediate ActionThis MonthStatusNov-17Lockdown 23/11/17The Trust Action plan focuses on any action defined as must do, should do, compliance or immediate. Please refer to individual plans for any additional actionsImplementerAgreed actionsDeadlineAssurance required, embedded andThis month's progress against timescaletestedStatusImmediate Actions following announced inspectionContinually review medical staffing templatesRecruitment and retention paper for medicsReduction of locum use for medicsCompliance action - Regulation 18We were concerned to see high staffing vacancies in someareas and the reliance on medical locums and temporaryIA001nursing staff to keep services safe. It was noted that in someareas the nurse staffing templates had not been reviewedagainst increasing patient dependency.Continually review nursing staffing data at executiverapid review meetingsTRUBothVictoria MaherAlex BrettWorkforce teamRecruitment and retention paper for nursingStrengthen governance and escalation of risk ofworkforce issues from ward to board1EoLCPRHNeil NisbetSURRSHNeil NisbetDebbie JonesSheila FryerCarolynne ScottSCG HoNVM/EB - Care groups producing medical workforce plans to be presentedat Execs in Sept 17. As at 17/11 Awaiting a date for care group medicaldirectors to present their plans to ExecsOct-17The Care groups are working to align recruitment plans to workforceplans and also develop new roles to address shortages. Recruitmentremains a particular issue due to local complexities in some areas andnational shortages. Plans are aligned to business and financial plans thatarticulate the needs from now and define 1, 3 and 5 years. As aboveDec-17All locums are now booked through direct engagement. Locums arespecifically covering vacancies and difficult to recruit to posts. Caregroup workforce plans and associated recruitment plans outline moresustainable solutions not withstanding significant medical gaps and hardto recruit to posts1. Reviewed templates2. Evidence of review and action inJul-17 minutes of meetings3. Monthly paper to Workforcecommittee and Quality & SafetySep-17 (Q&S)4. Included on Trust Board agenda5. Finance confirmation regardingApr-18 budgetsMonthly safer staffing paper to Q&S.Six monthly nurse establishment review at board (last undertaken Aug17)Roll out of safe careSome issuesDiscussed at Trust board - further discussions to agree long termstrategy at execsWorkforce committee reports risk escalation to board and undertakes adeep dive into care groups at every meeting; workforce issues alsodiscussed at confirm and challenge with each care group monthlySep-17The Care groups are working to align recruitment plans to workforceplans and also develop new roles to address shortages. Recruitmentremains a particular issue due to local complexities in some areas andnational shortages. Plans are aligned to business and financial plans thatarticulate the needs from now and define 1, 3 and 5 years.Cease reliance on off framework agency registerednurses and strengthen bank and substantive staffutilisationDec-17Agency T&F group have a comprehensive action plan. NHSI support inplace. Tier 5 reliance has stopped and use of tier 1&2. Bank campaignlaunched. Recruitment process streamlined and TRACS Systemimplemented. Recruitment events for nurses and midwives in placeInclusion within SSP programmeAug-17Yes - care group workforce plans aligned to finance in place definingworkforce needs and development at 1, 3 and 5 yearsDeep dive of the mortuary at PRH1. CQC review during unannouncedDec-16 revisit of area2. Capital planning meeting minutesCompleteH&S - Mortuary included in regular audit schedule and first oneSeptember 17DeliveredDeep dive to address actionsDec-161. CQC review during unannouncedrevisit of areaCQC revisited and noted replaced ceiling tiles had water marks on them.See SUR action plan for tx action AA001DeliveredIdentify long term recruitment and retention strategyCompliance action - Regulation 15The mortuary at the Princess Royal site is in a poor state ofIA002 repair, we found consumables considerably out of date, thedepartment was unsecure (unlocked) and in need of a deepclean.The theatre storage facilities at Royal Shrewsbury were also ina poor state. There were no cleaning schedules, and theceiling had broken or missing tiles and there were stainsIA003suggesting water damage. Ceiling tiles were also missing fromalong the corridor patient pass through on their way totheatre.Oct-17Trust CQC Action Plan 2017 v1.0 Nov 2017 Update
Shrewsbury and Telford Hospital NHS TrustRAG KeyDeliveredOn Track to deliverSome issuesNot on trackEDMEDSURCCMGYEoLCCHITRUCore Service KeyUrgent & Emergency ServicesMedical CareSurgical CareCritical CareMaternity & GynaecologyEnd of Life CareChildren's ServicesTrustNumberMD - Must DoSD - Should DoIA - Immediate ActionThis MonthStatusThe Trust Action plan focuses on any action defined as must do, should do, compliance or immediate. Please refer to individual plans for any additional actionsNoRecommendationCoreServiceSiteExec SponsorResponsibleLeadImplementerIA004The mortuary at the Princess Royal site - A hoist needed to liftdeceased patients had been broken since October.EoLCPRHNeil NisbetDebbie JonesSheila FryerEDRSHDebbie KadumColin OvingtonMatronMust do actionsAll patients brought in by ambulance are promptly assessedand triaged by a registered nurse. A suitably qualified memberMD001of staff (DR/ANP/RN) triages all patients, face to face, on theirarrival in ED.Compliance action - Regulation 18There are sufficient nursing staff on duty to provide safe careMD002 for patients. A patient acuity tool should be used to assess thestaffing numbers required for the dependency of the patients.Agreed actionsDeep dive of the mortuary at PRHReview processImplement changesTRUBothDeirdre FowlerHelen JenkinsonCeri AdamsonKath PreeceLynn AtkinAssurance required, embedded andThis month's progress against timescaletestedBroken hoist – One of the 2 hoists available requires replacementwheels. This was reported promptly and would have been fixed (prior tothe inspection) except that the wrong sized wheels had been ordered. In1. CQC review during unannouncedSep-17the meantime, the standby hoist is being used whilst the repair to therevisit of areaother hoist is expedited. The new wheels were fitted in early January2017DeadlineStreaming process now in place.Oct-17 1. Roster review and sign offAmbulance H/O trial commenced 11th October, now implemented2. Observation and testing of processNov-171 minute brief to be circulated regarding changesTRUBothVictoria MaherEdwin BormanAlex BrettBothVictoria MaherMary BealesMary BealesReview at a granular level within each care groupMar-18 1. Job planning review completeRevised SSU targets agreed by September 2017Workforce Committee and Trust Board based oncurrent programmesNov-17Paper drafted and submitted to October Workforce Committee andapproved for onward transmission to Trust Board on 30/11/2017.Deadline revised from Sep-17 to Nov -171. Board papers approvedJan-18 2. Risk Mgmt Matrix approved byboth Committees3. Notes of Confirm and Challengemeetings demonstrate SSUCare Group SSU improvement actions formulated andOct-17 monitoring and result and Care Groupmonitored at Confirm and Challengeactions result in Trust targets metNon-attendance rates (wasted places) at SSU to be4. Reduction of avoidable nonrecorded by Corporate Education and reported toattendance figuresCare Group HRBPs monthly for follow up withNov-17operational Managers with the aim of reducingavoidable wasted placesReview feasibility of protection of study leave duringpeak activity2DeliveredSpecific work is being undertaken at a granular level in each care groupto review the medical workforce requirements across all services- this isbeing done by the Care Groups, led by the medical directors and workOn Track toshould be reaching fruition in the next week (Sept) to share with thedeliverCEO, Execs and the Medical Director. Care group plans will be scrutinisedat Confirm and Challenge and the Care Group Boards. E-job planningcommissioned as a tool to enable full review of all job plans.Risk Mgmt training matrix revised and approved byEducation Sub-Committee and Workforce CommitteeTRUDeliveredDec-17 1. Check and audit SafecareImplement Safecare electronic systemof initially reviewing the templates. This action relates to the ongoing review)MD004 All staff are up to date with mandatory trainingStatusTrial of 4 wards commences in September. Training programme beingOn Track todelivered. Roll out to general wards due to be complete by enddeliverDecember 2017IA001 addressed the issue of reviewing the templates and initial implementation ofSafecare (see action for detail)Compliance action - Regulation 18MD003 Review its medical staffing to ensure sufficient cover isprovided to keep patients safe at all times. IA001 addressed the issueNov-17Lockdown 23/11/17Oct-17Trust CQC Action Plan 2017 v1.0 Nov 2017 UpdateRevision of Trust Matrix in progress. Operational pressures may delayresponses from clinical areas but targeted for submission to January2018 Education Sub-Committee and Workforce CommitteeDeadline revised from Nov-17 to Jan-18Confirm and Challenge meetings held monthly – ongoing focus on SSU Some issuescomplianceMonthly report of non-attendance developed and added to November2017 Workforce Assurance reports. Monitoring of trends commencing.Trust entering increased activity period and attempts are being made byoperational managers to relocate staff from study days and the DeputyDirector of Nursing has had to intervene to keep on track
Shrewsbury and Telford Hospital NHS TrustRAG KeyDeliveredOn Track to deliverSome issuesNot on rviceCore Service KeyUrgent & Emergency ServicesMedical CareSurgical CareCritical CareMaternity & GynaecologyEnd of Life CareChildren's ServicesTrustSiteExec SponsorResponsibleLeadNumberMD - Must DoSD - Should DoIA - Immediate ActionThis MonthStatusThe Trust Action plan focuses on any action defined as must do, should do, compliance or immediate. Please refer to individual plans for any additional actionsImplementerEdwin BormanTracey LloydBrenda MaxtonAgreed actionsFormal communication (global email/1 minutebrief/message of the week) reminding staff of theirrequirements relating to mental capacity actInclude a refresh on consent/MCA in FY1/FY2teaching session by patient safety teamEnsure nurses attend various forums:Helen Coleman Band 6 Masterclass (oct-17)3 yearly update (Dec-17)Helen VennHelen Hampson Stat training (receive update in CPR section regardingTracey LloydDNAR - Sep-17)Shared learning presented at NMF (Tracey)Compliance Action Regulation 11All staff have an understanding of how to assess mentalcapacity under the Mental Capacity Act 2005 and thatMD005 assessments are completed, when required- Mental capacity documentation had not been alwayscompleted for defined ceiling of treatment decisions- Nurses understanding of the Act was inconsistentTRUBothEdwin BormanGraeme MitchellRobin LongBrenda MaxtonUpdate doctors at medical/surgical clinicalgovernance meeting on DNR'sEdwin BormanOrganise CPD event for MCA/DoL’s training forDoctors and Nurses/Midwives*Helen HampsonSafeguarding intranet page will signpost toMCA/DoL's appJulie LloydAngela HughesJules LewisJules LewisReview RaTE self-assessment question to ascertainknowledge & understanding following trainingCheck understanding & knowledge as part ofExemplar ProgrammeVMI methodology to review EoLC documentation(streamlined)EoLC/Palliative care team to meet with Hospital @Night team and design a training pack which willinclude EoLC plan and out of hours supportDeadlineAssurance required, embedded andThis month's progress against timescaletestedSep-17Email to be sent by end of Sept 17Nov-17FY1's completed Sep-17FY2's have DoL's in Nov-17 which covers MCA. TL has done an RCA withemphasis on mental capacity which has been approved. V Redmond istrying to organise the next wave of training for permanent staff with theTrust Solicitors.Dec-17Band 6 masterclass scheduled for OctoberResus lesson plans for medical & registered staff updated to include MCACorporate Education lead to review feasibility of including within 3 yearlyupdate for RN’sNov-17Chair of Medical Governance will provide updates - scheduled forOct/Nov 2017. USCG rescheduled for December CGE due to timeconstraints. Patient Safety Advisor to include in Safer Times which iscirculated to all governance groups in Scheduled Care.Deadline revised from Nov-17 to Dec-17 (on the agenda for December)1. Improvement in Audit resultsApr-18 2. Lesson plans reviewed3. Evidence of review and action inminutes of meetingsDec-17Sally AllenAngela HughesTRUBothDeirdre FowlerHelen JenkinsonWork in progressQuestion on Mental Capacity addedOct-17Added to list of requirements for next version update. Incorporated intothe next version updateFeb-18Workshop has taken place and documentation streamlinedJan-18As at Nov update, EoLC Facilitator is meeting with Hospital @ night teamDecember 2017Audit compliance relating to completion ofSep-17documentationReview results of audit at CGE and create appropriateEdwin BormanDec-17action planAudit compliance relating to complete of MCA andSally AllenMay-18DoL’s formStrengthen the governance of CGE and Quality &Safety committee to challenge and monitor progressof all the above actions via Trust CQC action planMar-18Communicate need for compliance at NMFSep-17Trust CQC Action Plan 2017 v1.0 Nov 2017 UpdateStatusTrust solicitors, Hill Dickinson have offered to deliver the training.Awaiting confirmation of dateOn Track to*To maximise attendance training to be scheduled outside of winterdelivermonthsSep-17Audit complete, Lead Resus officer due to present results at CGE Oct-17Sally AllenUp to date safety thermometer information is displayed on allMD006wards3Nov-17Lockdown 23/11/17Communicated at NMF Sept-171. Improved complianceOn Track todeliver
Shrewsbury and Telford Hospital NHS TrustRAG KeyDeliveredOn Track to deliverSome issuesNot on rviceCore Service KeyUrgent & Emergency ServicesMedical CareSurgical CareCritical CareMaternity & GynaecologyEnd of Life CareChildren's ServicesTrustSiteExec SponsorResponsibleLeadNumberMD - Must DoSD - Should DoIA - Immediate ActionThis MonthStatusThe Trust Action plan focuses on any action defined as must do, should do, compliance or immediate. Please refer to individual plans for any additional actionsImplementerUp to date safety thermometer information is displayed on allwardsTRUBothDeirdre FowlerHelen JenkinsonTRUBothEdwin BormanBruce McElroyOct-17Janette PritchardInclude within IPC Quality Ward Walks (QWW)Sep-17CeriAdamson/KathPreece/Lynn AtkinMatrons perform spot checks and review RaTEinformationDec-17Communicated at NMF Sept-17Act upon results of pharmacy audits and reinforceconsequence of non-compliance (ward manager,matrons & governance meetings)Dec-17To be included and reviewed as part of HoN preparation for confirm &challenge meetings. Included on NMF agenda Sept-17W&C - spot checks undertaken, TRAKKA cupboards installed & medicinesstored appropriatelyPharmacy audit action plans in place and monitoredDec-17To be included and reviewed as part of HoN preparation for confirm &challenge meetingsSep-17All results currently being collated and will be provided to Care GroupNursing Teams, Matrons, Ward Managers, Nursing and Midwifery forumand the Patient Safety Team in September 2017 to robustly implementany actions required.4RSHEdwin BormanBruce McElroy1. Improved complianceRolling program for Ward and clinical Areas Storageand Security Audits, established with an extendedseries on monthly audits concerning the security andstorage of medicines.Ruth DudgeonVicky JeffersonQuarterly updates from pharmacy to NMF regardingissues of compliance scheduledSep-17Ward ManagersAdd agenda item to monthly ward meeting templateSep-17Updated template, communicated at NMF (Sept) and updated tointranetCeri AdamsonSCG HoNLynn AtkinSara JamiesonReview RaTE for medicines management complianceand identify issuesDec-17Communicated at NMF Sept-17Ruth DudgeonVicki JeffersonMedicines management - Exemplar StandardAll wards and clinical areas storing medicines will beaudited to ensure they have suitable equipment,appropriate records and are aware of exceptionreporting and actions if out of range.If not in place calibrated dual areas thermometerswill be provided, along with register and traininginformation1. Improved complianceAug-17First presentation by pharmacy Sept-17On Track todeliverWards must scores 100% on last quarterly CD audit and Score 100% onat least 1 of the last 3 rolling monthly medicine management audits*with no more than 1 failed question on each of the remaining auditsto gain the minimum of Silver awardSep-17Extended monthly audit program finalised and in place by the end ofAugust 2017. All wards and clinical areas have completed additionalaudits reviewing both room and fridge temperature monitoring andrecording. All results currently being collated and will be provided toCare Group Nursing Teams, Matrons, Ward Managers, Nursing andMidwifery forum and the Patient Safety Team in September 2017 torobustly implement any actions required.Oct-17 1. Improved complianceThermometers procured and delivered to ward and clinical areasSeptember 17. All areas identified in the audit as requiring calibratedthermometers have been provided them along with recordingdocumentation and escalation guidance. In newly identified areas andareas undergoing a change of use medicine storage will be assessed forsuitability by pharmacy and provided thermometers where requiredTrust CQC Action Plan 2017 v1.0 Nov 2017 UpdateStatusExemplar v2.4 updated to include Safety ThermometerOn Track toQWW include a question to check safety thermometer is being displayeddeliver(areas checked 4 times a year/some twice)Ruth DudgeonVicky JeffersonRuth DudgeonMEDAssurance required, embedded andThis month's progress against timescaletestedInclude additional check within ExemplarAngela HughesAngela HughesMedication refrigerator temperatures are recorded daily andMD008 appropriate action is taken when temperatures fall outsideaccepted parametersDeadlineSep-17Ceri AdamsonKath PreeceLynn AtkinSara JamiesonCompliance Action Regulation 12Ensure medicines are securely and appropriately stored at allMD007 times (PRH ED 'we saw missed temperature checks ofrefrigerators used for the storage of temperature sensitivemedicines in the resuscitation room' added as a x Trust action)Agreed actionsReview existing question on RaTE self-assessment tospecifically mention safety thermometerJulie LloydMD006Nov-17Lockdown 23/11/17On Track todeliver
Shrewsbury and Telford Hospital NHS TrustRAG KeyDeliveredOn Track to deliverSome issuesNot on trackMedication refrigerator temperatures are recorded daily andMD008 appropriate action is taken when temperatures fall outsideaccepted RUCoreServiceCore Service KeyNumberUrgent & Emergency ServicesMD - Must DoMedical CareSD - Should DoIA - Immediate ActionSurgical CareCritical CareThis MonthNov-17Maternity & GynaecologyStatusLockdown 23/11/17End of Life CareChildren's ServicesRSH Edwin Borman Bruce McElroyImprovedcomplianceor immediate. Please refer to individual plans for any additional actionsThe Trust Action plan focuses on any action defined as must do, 1.shoulddo, complianceTrustSiteExec SponsorResponsibleLeadImplementerAngela HughesCeri Ad
As at 17/11 Awaiting a date for care group medical directors to present their plans to Execs Recruitment and retention paper for medics Oct-17 The Care groups are working to align recruitment plans to workforce plans and also develop new roles to address shortages. Recruitment remains a particular issue due to local complexities in some areas and
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RAG around 400. Alice Gast, the president of Imperial, who wrote a short introduction for the magazine, said today: "This year's RAG Magazine is a discredit to RAG's legacy and to the College". "I find the mean spirited approach to targeting of individuals within the magazine disgusting and am sorry that I agreed to provide a note
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December 2007 Tiger Rag Newsletter of the Tiger Moth Club of New Zealand Inc. TIGER RAG Patron: Simon Spencer-Bower President: Jim Lawson Secretary-treasurer-newsletter editor: John King DECEMBER 2007 Secretarial address: PO Box 66-041, Beach Haven, AUCKLAND 0749 Phone/fax 09 483 6318, Mobile 027 482 3584, email king.jdm@xtra.co.nz 1
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STEP 3 - Purge the refrigerant lines and indoor coil with dry nitrogen. STEP 4 - Wrap a wet rag around the valve body to avoid heat damage and continue the dry nitro-gen purge. Braze the refrigerant lines to the service valves. Continue the dry nitrogen purge. Do not remove the wet rag until all brazing is completed.
your subs for 2014 please do so now using the renewal form enclosed in this issue of the Tiger Rag. Key dates to keep in mind are Taumarunui - 17th -19th October and the clubs AGM at Kaikohe - 6 -8th March, 2015. Scholarship recipient Susan Scott looks like she is loving adding some DH60G time to her logbook Photo Jerry Chisum .
