Nursing

1
Nursing Midwifery Overview 2008/09

• Marie-Noelle Orzel, OBE
• Director of Nursing Patient Care
• 14 January 2009
• Item 8
• Relates to Domains 4, 5 6

2
QUALITY Patient Experience The National Agenda

• Darzi, Framing the Nursing Contribution
• Confidence in Caring
• Nurses in Society
• Chief Nursing Officer Metrics for Nursing
• RCN Dignity in Care Campaign

Compassion, Dignity, Respect, Experience, Cleanlin
ess, Safety, Infection rates, Clinical outcomes
3
A calm, clean, safe environment
Good team working and good relationships
A positive friendly culture
Patients have confidence in care
Organisational / clinical / area / unit
Team
Individual
Skills and will
Ways
Means
Well managed Care with efficient delivery
Personalised care for and about Every patient
Staff are caring with confidence
4
QUALITY Releasing time to care project

• National Project
• Aim is to release time for clinical staff to
  spend with patients
• Organise wards/departments so that they work more
  efficiently
• Develop skills in service improvement
• Measure our progress and changes
• Increase from 40 to 60 the time a nurse spends
  in direct care

Concentrating on the HOW, not the WHAT
5
QUALITY Releasing Time to Care
The paperwork is easy to understand and quick to
complete
Everything I need to do my job is conveniently
located
We have the information we need to solve our own
problems, and find out if we were successful
I am not interrupted by people requesting
information or looking for things
It is clear to everyone who is responsible for
what
Handovers are concise, timely and provide all
the information I need
Opportunity to increase safety and reliability of
care
Role Time (e.g. nurse)
Direct Care Time
Motion
Admin
Discussion
Handovers
Information
Roles
Total Time
6
QUALITY Releasing Time to Care EMU
100
6.3
Opportunity to increase safety and reliability of
care
5.8
25.6
Role Time (e.g. nurse)
7.7
14.8
8.8
28
Direct Care Time
Motion
Admin
Discussion
Handovers
other
Medicines
Total Time
7
QUALITY Releasing Time to Care, EMU
Opportunity to increase safety and reliability of
care
100
10.3
4.7
14.5
4.9
2.4
10.2
Role Time (e.g. nurse)
48
Direct Care Time
Motion
Admin
Discussion
Handovers
Other
Medicines
Total Time
8
QUALITY Releasing Time to Care, Okement Ward

• Before
• Cluttered
• Nurses at desk not bedside
• Confusing for visitors/relatives

9
QUALITY Releasing Time to Care, Okement Ward

• After
• Clear Reception area manned by receptionist
• Nurses at bedside
• Quiet working area for Doctors
• Easier for patient Movement

10
QUALITY Patient Experience - Putting
Patient/Customer Care First

• Lead Nurses attended development day November 08
• 68 Senior Matrons / Matrons attended the Patient
  Experience event in October 08.
• 39 Ward Sisters attended the Patient First
  course in December 08
• Ward clerks to be trained in Feb 09

11
QUALITY Nursing Quality Assessment Tool

• Utilises handheld tablet computers
• Incorporates RCN observations of care
• Evaluates 11 Essence of Care benchmarks
• Includes real time patient survey

12
QUALITY Nursing Quality Assessment Tool
Nursing Core Standard Respect and dignity. Standard Every patient has their privacy and dignity respected at all times. Nursing Core Standard Respect and dignity. Standard Every patient has their privacy and dignity respected at all times. Nursing Core Standard Respect and dignity. Standard Every patient has their privacy and dignity respected at all times. Nursing Core Standard Respect and dignity. Standard Every patient has their privacy and dignity respected at all times. Nursing Core Standard Respect and dignity. Standard Every patient has their privacy and dignity respected at all times.
Element Environment Source Yes No Instruction
Patient privacy is maintained by the use of curtains and appropriate clothing. Ask patient Observe Ask 6 patients. All 6 must report compliance.
Permission is obtained by staff before entering any private area i.e. curtains, bathrooms, side rooms. Ask patient Observe Ask 6 patients. All 6 must report compliance.
Element Care
Dignity and modesty is maintained for those patients moving between care settings. Ask patient Observe Ask 6 patients / observe
Patients are called by their preferred name. Ask patient Ask 6 patients / observe
Do all the call bell systems work? Observe Ask staff Ask 3 staff. All must be aware
Element Leadership
Do staff know how to contact the interpreting / translation service? Ask staff Ask 3. All must be aware
Do all staff adhere to the uniform policy Observe Look for jewellery, watches and hair length
Do staff treat patients with dignity and respect? Observe General feel over time on ward
13
QUALITY Patient Experience
Question 2007 National Survey results 15 wards Summer 2008 Outcome
B16. Not received enough help to eat meals 10 6 4 improvement
B13. Food was fair / poor 34 23 11 improvement
B7/8. Bothered by noise at night 28 40 12 decrease
E2. Not involved enough in decisions about care and treatment 45 38 7 improvement
E11. Waiting more than 5 minutes to answer call button 7 3 4 improvement
E1. Staff contradicting each other 36 25 11 improvement
E4. Not enough opportunity for family to speak to a Doctor 31 22 9 improvement
E3. Not enough information provided about their care treatment 19 12 7 improvement
E6. Not always enough privacy when discussing condition / treatment 26 17 9 improvement
C3. Doctors talked in front of as though they were not there 23 13 10 improvement
D3. Nurses talked in front of as though they were not there 22 12 10 improvement
D6. Nurses did not always wash / clean hands before touching patients 20 9 11 improvement
Always met expectations - 55 -
14
QUALITY Patient Safety - Englands National
Safety Campaign
The campaign cause is To make the safety of
patients everyones highest priority The
campaign aim is to achieve No avoidable death,
and no avoidable harm
15
QUALITY Patient Safety RDE

• Deteriorating patients ?
• CVC Lines ?
• Surgery checklist ?
• Falls ?

16
QUALITY Patient Safety Deteriorating Patients
Caring for Acutely Ill patients Early Warning
Score
17
QUALITY Patient Safety Deteriorating Patients

• EWS Graded Response Strategy

• Green , amber, red based on acuity.
• Defined response by team
• To appear on physical and Electronic ward
  Whiteboard.
• Provides Trust wide acuity reporting

18
EWS- Aide memoir
QUALITY Patient Safety Deteriorating Patients

• Issued to all staff on induction.
• EWS plus phlebitis score.
• Plans to link to self assessment and ESR

19
QUALITY Patient Safety CVC Lines
MEET THE VASCULAR ACCESS TEAM!

• Assess and facilitate appropriate vascular
  access device for adult patients to reduce IV
  related complications
• Support clinical teams to troubleshoot and be an
  educational resource
• To ensure appropriate audits on compliance with
  National and local policies on IV Therapy are
  undertaken.

20
QUALITY Patient Safety CVC Lines
VASCULAR ACCESS TEAM ACTIVITY LINE INSERTION
21
Early Evidence
QUALITY Patient Safety CVC Lines

• PEOC
• Reduced length of stay
• Antibiotics on time
• Discharged home with PICC
• Community hospitals with PICC
• Respiratory
• 2 weeks IVABs inpatient
• Now discharged with Midline after 24 hrs for Home
  IVs
• Cardiology
• 6 weeks IVABs inpatient
• Now discharged with PICC visiting Community
  hospital

22
Evidence
QUALITY Patient Safety CVC Lines

• Reduced IV related complications
• Consultant feedback
• Patient Feedback
• Verbal feedback from staff patients

23
Intentional Rounding
QUALITY Patient Safety Falls

• Targeted falls education
• Intentional round every hour for patients with
  falls risk score gt 30
• Checklist with key quality questions
• Verbal feedback from staff patients

24
QUALITY Patient Safety Falls
FALLS OBSERVATIONAL CHECKLIST
For patients with a falls risk score of gt20,
please enter either A achieved or V
variance in columns. Record reason for variance
and action taken overleaf. THIS PATIENT REQUIRES
OBSERVATION EVERY . MINUTES
DATE   TIME   TIME   TIME   TIME   TIME   TIME   TIME
1. CONTINENCE Do you need to go to the toilet? 1. CONTINENCE Do you need to go to the toilet?
2. PAIN Do you have any pain? 2. PAIN Do you have any pain?
3. ORIENTATION Fully alert FA Mildly confused/disorientated MC Severe confusion/disorientation SC Asleep A 3. ORIENTATION Fully alert FA Mildly confused/disorientated MC Severe confusion/disorientation SC Asleep A
4. POSITION / COMFORT Are you comfortable? 4. POSITION / COMFORT Are you comfortable?
5. DRINK / MOUTHCARE Would you like a drink? 5. DRINK / MOUTHCARE Would you like a drink?
6. CALL BELL WITHIN REACH If you need me, press this button 6. CALL BELL WITHIN REACH If you need me, press this button
7. BED RAILS DOWN 7. BED RAILS DOWN
8. BED TO FLOOR 8. BED TO FLOOR
9. IS THERE ANYTHING ELSE I CAN DO? Because Ive got the time 9. IS THERE ANYTHING ELSE I CAN DO? Because Ive got the time
INITIALS INITIALS

25
QUALITY Patient Safety Falls
26
QUALITY Breastfeeding

• Current breastfeeding rate is 76
• Target breastfeeding rate is 90
• Signed up to the UNICEF Baby Friendly initiative
• Sets key standards that ensure a higher quality
  of care given to support to breastfeeding women