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1. How many single rooms are available to NHS patients at each of
your Trusts hospital sites?

1.1. Of these how many have: an ensuite toilet?
1.2. Of these how many have: an ensuite toilet and shower or
bath?

2. Please indicate which hospital sites within your trust operate an
accident and emergency unit:

3. How many specialist palliative care beds do you have available
at each of your hospital sites?

4. Does the trust treat private patients?
4.1. IF YES, do any of the following hospitals have a named
private unit/ service?

4.2. IF YES, What is the name of the private unit/ service?
4.3. How many beds are available within the private unit/ service?
5. How many single rooms are available within the private unit/
service?

5.1. how many have an ensuite toilet:
5.2. how many have an ensuite toilet and shower or bath:
6. Please provide the direct telephone number for the private
unit:

7. Do you have a system for recording the following adverse events?
operations resulted in a foreign body being left post surgery: what is your reporting system for a foreign body being left post surgery? operations were cancelled due to missing notes: operations were cancelled due to missing notes: operations resulted in wrong site surgery taking place: operations resulted in wrong site surgery taking place: 8 During the period 01 April 2010 - 31 March 2011, how many
operations resulted in a foreign body being left post surgery: operations were cancelled due to missing notes: operations resulted in wrong site surgery taking place: 9. How many incident investigations using a full Root Cause
Analysis did you carry out in 2010/11?

10. What percent of patient safety incidents resulting in severe
harm or death had a full RCA initiated/completed?

11. What percent of acute inpatients have a track and trigger
warning system in place for the duration of the admission?

12. What percent of patients are risk assessed for venous
thromboembolism on admission?

13. Are you compliant with all relevant NPSA safety alerts issues
in 2010/11 (you can find a full list of alerts issued at
http://www.nrls.npsa.nhs.uk/resources/?p=3).

15. Do the trust have a policy for providing educational
programmes on using and interpreting clinical indicators?
(training)

16. Does the trust have a designated member of staff who
supports teams in locating and analysing safety and quality data?
(support)

17. Is safety and quality data available on a central platform and
actively disseminated to users?

18. Does the trust employ an antibiotic pharmacist?
19. Does the trust operate a pre-admission assessment clinic or
equivalent system where patients are screened and results
returned in advance of the day of admission?

19.1. IF YES; which patient groups do you screen at the pre-op assessment clinic:
20 What method of MRSA screening do you use when screening at
admission:

21 On admission, do you begin immediate topical suppression?
22 Does the trust have at least one accident and emergency unit?
22.1 IF YES, do you screen:
23. Does the trust have a dedicated isolation ward?
23.1. IF YES, how many beds does it contain?
25. Does the trust have an isolation policy?
26. Where medically appropriate, are patients with C Diff isolated
in single rooms as a matter of priority?

27. Does the trust prescribe probiotics to any patient groups as a
prophylactic measure to reduce C.difficile infections?

28. Does the Trust have a policy to guide the use of
metronidazole and vancomycin for C.difficile infected patients

29. Does the trust routinely isolate all patients with diarrhoea
30. Does the trust have a specialist stroke unit or units?
31. IF YES, Please specify which hospitals have a specialist stroke
unit

31.1 What type of unit does the hospital have?
32. Please specify the number of beds in the unit
33 Is the Trust part of a stroke care network?
33.1 IF YES, please provide details:
34 How many emergency admissions with a primary diagnosis of
stroke (ICD10 codes I60 - I64) did the trust receive in the financial
year (period 01 April 2010 - 31 March 2011)?

34.1 OF THESE, please state the number of patients given a
Computerised Tomography (CT) scan within 24 hrs of admission?

35 Do you provide thrombolysis for stroke patients 24 hours per
day and 7 days a week

36 Do you have any formal arrangements with neighbouring
hospitals for the emergency transfer of stroke patients who would
benefit from thrombolytic treatment?

36.1 IF YES, please provide the name of the trust with whom you
have these arrangements

37 Does the trust offer a trauma service?
40 Does the trust have a dedicated trauma list available 24 hours
a day for the duration of the week, (Sunday to Sunday)?

38 Does the trust offer an orthopaedics service?
39 Do all the trust's orthopaedic ward/team have a linked geriatric
team with whom they have regular meetings at least once a
week?

41 Does the trust run a pre-operative patient education
session/class for patients to attend prior to Total Knee
Replacement (TKR) and Total Hip Replacement (THR)?

42 IF YES, what percentage of all patients attend the class prior to surgery? (please
answer appropriate option below)
43 Does the trust have a standardised anaesthetic protocol for
Total Knee Replacement (TKR) and Total Hip Replacement (THR)
patients?

44 IF YES, what is percentage compliance to this protocol?
We have audited this and in our last audit the figure was: We have not audited this but we estimate the figure to be: 45 What percentage of the trusts total knee replacement (TKR) and total hip
replacement (THR) patients walk within 24 hours of surgery?
We have audited this and in our last audit the figure was (%): We have not audited this but we estimate the figure to be (%): 46 Does the trust have a specialist orthopaedic physiotherapy
service which is available 7 days a week?

46.1 How many patients' discharge is delayed due to lack of physiotherapy services at
weekends?
We have audited this and in our last audit the figure was: We have not audited this but we estimate the figure to be: 47 Do you admit patients for total knee replacement (TKR) and
total hip replacement (THR) prior to the day of surgery?

48 IF YES, What is the principle reason for patients not being admitted on 49 Do you routinely record patient records using a specific multi-
disciplinary team THR/TKR pathway document?

49.1 IF YES, Is this data used to monitor compliance with the agreed 50 Do you use criteria-based discharge?
51 Do you routinely phone patients in the first 48 hours after
discharge to check on their progress?

52 Does the trust provide a paediatrics service?
52.1 IF YES, from which of your sites is the service offered?
53 Is the trust's elective paediatric surgery carried out only by
designated surgeons with at least six months training in a
specialist unit?

54 Do the trust's anaesthetists with responsibility for paediatric
anaesthesia participate in at least one paediatric list per week?

55 Does the trust make any of the following available 24 hours per day, 7 days per
At least two registered children's nurses on duty 24hours per day in each 56 Is there a designated facility on site for parents or guardians to
stay overnight?

57 Does the trust provide a palliative care service?
58 Please indicate how specialist palliative care is delivered at
your hospital:

59 Does the hospital's specialist palliative team include
60 Is the Trust’s specialist palliative care team available 24 hrs
a day seven days a week?

61 Are facilities provided to support relatives and carers who wish
to stay with a patient in hospital?

62 Does the trust routinely survey and evaluate the views of
patients and bereaved relatives and carers regarding the delivery
of care on the end of life programme?

65 Do all women have a choice about where they receive their
antenatal appointments (i.e. at hospital or local health centre)?

66 Are NHS antenatal classes available (e.g. Parentcraft)?
67 IF YES, please indicate when these are available:
68 Are all women routinely offered ultrasound scans:
69 IF YES, please indicate when these are available:
70 How many women gave birth in the unit during the year? (do
not include home births in this figure):

71 How many babies were born in the unit during the year? (do
not include home births in this figure):

72 How many women were booked for a home birth:
73 How many women had a home birth? (do not include births at
home by accident):

74 Please provide the number of beds and rooms available:
Antenatal Rooms:
Assessment area (for monitoring and / or induction):
Delivery rooms:
Postnatal Rooms:
Obstetric high dependency unit:
75 How many single rooms do you have that are used for both
delivery and postnatal care (labour, delivery, recovery and
postnatal, or LDRP, rooms)?

76 Amenity rooms; Are women able to book a single room in
advance of their birth:

77 If women can pay for a single room what is the average cost
per night (£):

78 Does the maternity unit have:
79 What sorts of security measures does the unit have:
80 What methods of pain relief are available for women?
81 Please state the total number of WTE midwives at the unit (Exclude non-clinical
managerial posts and staff in neonatal intensive care. Include community midwives if
applicable)
in your funded establishment, including vacant posts: as staff in post, including agency and bank staff: 82 Does the unit have the following staff available 24 hours a day, 7 days a week:
midwives available to provide one-to-one care: midwives trained and experienced in water birth: 83 What was the number of medical staff scheduled to be on site and on call on
Thursday March 24th 2011 at 22.00pm?
What was the number of medical staff scheduled to be on site and on call on Sunday
March 27th 2011 at 11.00am?
84. Do you have a designated care of the elderly (geriatric) ward
or wards:

84.1 IF YES, which hospitals have a designated care of the elderly
(geriatric) ward?

84.2 IF YES, What is the number of beds on the ward(s)?
84.3 IF YES, What was the number of staff nurses scheduled to be
on duty on Thursday March 24th 2011 at 22.00pm?

84.4 IF YES, What was the number of healthcare assistants
scheduled to be on duty on Thursday March 24th 2011 at
22.00pm?

84.5 What was the number of staff nurses scheduled to be on
duty on Sunday March 27th 2011 at 11.00am?

84.6 What was the number of healthcare assistants scheduled to
be on duty on Sunday March 27th 2011 at 11.00am?

Source: http://drfosterintelligence.co.uk/wp-content/uploads/2011/06/hg-2011-questionnaire-draft.pdf

University of wolverhampton

Note : The exercises provided on this sheet are for practice and so may not always represent the actual drugs or quantities which are administered in the Trust. A simple formula which can be used for drug dosage is: More technically stated Tablets Example: A patient is ordered 1 gram of Neomycin Sulphate. 500 milligram tablets are available. How many tablets will you give?

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