Nursing & Midwifery Overview 2008/09

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, Cleanliness, 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’ ‘We have the information we need to solve our own problems, and find out if we were successful” “Everything I need to do my job is conveniently located” 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) Total Time Motion Admin Discussion Handovers Roles Information Direct Care 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% Total Time Motion Admin Discussion Handovers Medicines other Direct Care 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% Total Time Motion Admin Discussion Handovers Medicines Other Direct Care 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

13. QUALITY: Patient Experience

14. QUALITY: Patient Safety - England’s National Safety Campaign • The campaign cause is: • To make the safety of patients everyone’s highest priority • The campaign aim is to achieve: • No avoidable death, and no avoidable harm

15. QUALITY: Patient Safety – RD&E • Deteriorating patients  • CVC Lines  • Surgery checklist  • Falls 

16. QUALITY: Patient Safety – Deteriorating Patients Caring for Acutely Ill patients – Early Warning Score

17. 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 QUALITY: Patient Safety – Deteriorating Patients

18. QUALITY: Patient Safety – Deteriorating Patients EWS- Aide memoir • 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. QUALITY: Patient Safety – CVC Lines Early Evidence • PEOC Reduced length of stay Antibiotics on time Discharged home with PICC Community hospitals with PICC • Respiratory 2 weeks IVAB’s inpatient Now discharged with Midline after 24 hrs for Home IV’s • Cardiology 6 weeks IVAB’s 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 > 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 >20, please enter either ‘A’ = achieved or ‘V’ = variance in columns. Record reason for variance and action taken overleaf. THIS PATIENT REQUIRES OBSERVATION EVERY ……………. MINUTES

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