Recording Care – The Challenge PACE Pilot January 2016

Recording [nursing and midwifery] Care What’s the point?

What it is.....

Recording Care

Final report Standards for Nursing and Midwifery Record Keeping Practice Regional person-centred nursing assessment and plan of care document Improved record keeping practice - 30% increase in audit scores Outcomes

Ongoing Work System of accountability to regionally monitor standards of nurse record keeping practice Endoscopy Day Case Record Under 24 hour stay record Health Care Support Worker Practice Regional Abbreviations policy (sep project) Children’s Record & improvement cycles Learning Disabilities Record and improvement cycles Care planning Key Performance Indicator development Review of NOAT Review of web resources Review of Record Keeping Guidance Links to revalidation

AUDIT COMPLIANCE November Agreement audit, pilots, literature review CARE PLANNING SUMMIT – January 2015 Presentation to EDoNs April 2015 Meetings June, July and August 2015 PACE FINALISED Pilot August/ September 2015 Presented to CNO/ EDoNs

August/ September 2014 Pilots Issues – repeated failure to: link identified need to plan of care record evaluations linked the plan of care record outcomes linked to the plan of care and identified need

Literature Review Findings: No new models Involvement of patients and families Reflection and review Multi-professional formats Organisational investment Core skills

Care Planning Summit 12 th January 2015 and March WG Meeting Protocols/standard operating procedures should not be used within plans of care Nursing standards for care processes which can be referred to within each clinical setting Care Plans should represent a clear description of the patient’s journey through a service Involvement of the patient should be clearly articulated within the record

Daily assessment should be evidenced against ADLs and needs recorded as they arise – i.e. nurses should not be recording potential needs but actual needs as they arise Recording care should be at the bedside of the patient or as close to the point of care delivery Handover should be driven by the plans of care Evaluation should be set against care planned against assessed need The goal of care is presented in the care planned The skills of nurses to engage in a new process should be addressed along with a system of change management

PACE P – PERSON CENTRED A – ASSESSMENT C – PLAN OF CARE E – EVALUATION

Evaluation AUDIT – USING NOAT FOCUS GROUP This exercise explored in the opinion of the champions: What worked well What didn’t work well The experience of implementing change – barriers and enablers What future support might be required for a wider roll out

Findings Audit 40% improvement in care planning section of NOAT Focus Groups Evidence of person centred/ family centred approach Increased contemporaneous record keeping Increased effectiveness in communication Clear picture of the person’s journey through a service Accountability and professionalism increased Ownership

What next? Presented to CNO/EDoN meeting Agreement for formal pilot Agreement for facilitation to enable Evaluation – link to HEIs, IHI and Person- centred Practice framework (McCormack and McCance, 2010)

Recording [nursing and midwifery] Care What’s the point?

People at the Centre Nothing about me without me.....

Worked Example: 10:30am – 11:15am Divide into groups – surgical, medical and children’s Use the scenario to work up a nursing plan of care using the PACE framework Note any challenges – appoint someone to write and someone to speak!

COFFEE: 11:15 am

Barriers and Enablers 11:45 am

TIME BARRIERENABLER New approach – increase time to record Given adequate time from nurse leaders Inadequate training preparation Adequate training preparation

COMMUNICATION BARRIERENABLER Lack of explanations of change/expectations Given adequate explanation Lack of feedback to ward levelFacilitate feedback to ward level. Ward champions. Misunderstanding of PACETraining Facilitators/ward Champions Reluctance from patientExplanation

TRAINING BARRIERENABLER Lack of training/ preparation at all levels Support from NIPEC Attendance at training workshops. CEC Involvement of ward champions to cascade Resource pack. Use of working examples Some focus on writing skills – concise/factual Training audit tool

IMPACT OF CHANGE BARRIERENABLER Fear -not writing enough/change of entire style Training/on going support at ward level Fear of legal/professional repercussions Addressing these issues Revalidation Staff attitudes - scepticalCommunication / Discussion Ward process – organisation of care Creative thinking to current ward processes

DISSCUSSION

Evaluation Framework 12:05 pm Exploring ways to evaluate robustly…. Balanced scorecard Review and comment back - Scribe and Speaker

Resource Pack and Facilitation Role of the Facilitators: Raise awareness of PACE – ward sessions, supervision etc. Scope care environment and assist with action plans to enable introduction of PACE e.g. processes of care Facilitate change e.g. implementation plans Problem solving – solution focussed Evaluation – data collection (baseline measurements.

Resource Pack and Facilitation Resource Packs: What else would be helpful in the packs?

Care planning section….