The campaign group, led by Dr Foster, has today written to the Secretary of State for Health asking him to help implement a Present on Admission flag to give a clearer picture of both in-hospital care and social care.
Find more details here as well as how to join the campaign.
RE: Present on Admission flag
Dear Minister,
During the publication of the Dr Foster Hospital Guide 2011, a campaign was also launched to introduce a new code that gives a clearer picture of both the quality of social care and in-hospital care. The campaign has 16 hospital trusts already signed up as well as a range of other organisations and individuals. This simple and cheap solution is the Present on Admission flag (POA). It will allow clinicians to record if a fall, pressure sore or infection was present when a patient was admitted or if it developed whilst in hospital care – information we do not currently know.
The NAO report, ‘The Care Quality Commission: Regulating the quality and safety of health and adult social care’, (2 Dec 2011) specifically p.8 point 16 of the executive summary, states that good quality information for adult social care is not always available. A POA flag will provide an early warning system in adult social care by identifying from where patients are being admitted, how often and if their condition is an indicator of poor quality of care such as a pressure sore. The Care Quality Commission is signed up to the rapid introduction of a Present on Admission flag.
The NHS Information Centre (IC) is looking at introducing a POA flag which will require a re-engineering of the national information architecture, and we support this effort. However a system is needed in the interim that can provide this valuable information. Our system, developed in discussions with clinical coders, clinicians and academics, supported by the undersigned and outlined overleaf, is a quick and simple interim solution.
There is much evidence to the benefits of a POA flag, which is used in Medicare and Medicaid in the US, in Canada and in Australia and we propose the system is introduced here in the English NHS. We would ask that you instruct the IC to commission NHS Connecting for Health to introduce this interim system immediately until the full work of the IC on POS is ready.
Yours sincerely,
Cynthia Bower, Chief Executive, Care Quality Commission
Dr Peter Carter, Chief Executive and General Secretary, Royal College of Nursing
Rt. Hon. Margaret Hodge MP: Chair of the House of Commons’ Public Accounts Committee
Nick Smith MP: Member of the House of Commons’ Public Accounts Committee
Sue Eve-Jones, Director, Professional Association of Clinical Coders – UK
Roger Taylor, Director of Research, Dr Foster Intelligence
Mark Magrath, Deputy-Chief Executive, Basildon and Thurrock University Hospitals NHS Foundation Trust:
David Wise, Medical Director, Calderdale & Huddersfield NHS Foundation Trust
Ian Gell, Medical Director, Chesterfield Royal Hospital NHS Foundation Trust
Dr Robin P Bolton MA MD FRCP, Consultant Physician and Medical Director, Doncaster and Bassetlaw Hospitals NHS Foundation Trust
Julie Pearce, Chief Nurse, Director of Quality & Operations, East Kent Hospitals University NHS Foundation Trust
Catharina Schram, Medical Director, East Lancashire Hospitals NHS Trust
Dr Ann Keogh, Director of Medical Safety, Heart of England NHS Foundation Trust
Dr Mark Jackson, Associate Director of Quality, Liverpool Heart & Chest Hospital
Jacqueline McKenna MBE, Director of Nursing, Medway NHS Foundation Trust
Stanley Okolo, Medical Director, North Middlesex University Hospital NHS Trust
Anna Dugdale, Chief Executive, Norfolk and Norwich University Hospital
Dr Sonia Swart, Medical Director, Northampton General Hospital NHS Trust
Stephen Fowlie, Medical Director, Nottingham University Hospitals NHS Trust
Sir Robert Naylor, Chief Executive, University College London Hospitals NHS Foundation Trust
Cathy Geddes, Chief Executive, Whipps Cross University Hospital NHS Trust
Andrew Foster, Chief Executive, Wrightington, Wigan and Leigh NHS Foundation Trust
How to implement a low-cost, low-resource intensive POA flag
In order to reduce cost and speed the implementation of POAs we have developed, through consultation, a simple system. Code Y95 already exists to note where a condition is ‘Hospital Acquired’. We suggest NHS Connecting for Health develops a new code for ‘Present on Admission’ and mandates the use of either one or the other for the following ‘first round’ conditions. This list could be added to over time:
1. Stage III and IV Pressure Ulcers
2. Falls and Trauma
3. Manifestations of Poor Glycemic Control
4. Catheter-Associated Urinary Tract Infection (UTI)
5. Vascular Catheter-Associated Infection
6. Surgical Site Infection
7. Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE)
8. AMI
9. Stroke
10. Acute renal failure
11. GI bleeds
12. Cardiac/respiratory arrest
I note that emotional trauma is not included. Poor and or negligent treatment can and does cause considerable shock and emotional damage even if it doesn’t cause any physical damage. Apart from the unnecessary suffering of patients, one way or another, other NHS staff then have to deal with this hospital acquired injury, thus causing increased costs for the NHS.
Including it in your lists might well help hospital managers realise that trust is the fundamental basis of successful treatment, not clever public relations.