Community Nurses Measure Up DID V Alison Wallis: Nursing Clinical Advisor, Data Intelligence Group Lee Davies: Project Manager, Data Development

Community Nurses Measure Up DID V Agenda Background Benefits Communication and Engagement The Dataset Outcome Reporting Terminology Mapping What’s next?

Community Nurses Measure Up DID V  Electronic Patient Record  Need for standardised information for sharing patient information and secondary uses  Lack of other information sources about Community Nursing, e.g. Practice Team Information (PTI) and ISD 29/30 incomplete  AHP Census, September Provided previously unknown information across Scotland, e.g. Number of patients on caseload Most common interventions Most common conditions Background

Community Nurses Measure Up DID V  24 th April 2008 – National, One Day  Web Based System  Focussing on Community Nursing Teams - District Nursing School Nursing Health Visiting Treatment Room Nursing Family Health Nursing The Census

Community Nurses Measure Up DID V 1. Support development of the Electronic Patient Record for use by Community Nurses:  Establish Minimum Nursing Dataset  Identify standard terminology and national data standards 2. Provide information and intelligence to support service redesign, workload management and policy decisions:  Diversity of Health problems  Variation in nursing practice, roles, location  Provide national nursing baseline Benefits 3. Communication with Community Nurses through workshops and training sessions  raised awareness of need for standardising information in clinical records  gained insight into the power of information  gained insight into the complexity of their day to day work using their terms to describe it  demonstrated the motivation and drive of community nurses to work together to make themselves heard

Community Nurses Measure Up DID V Communication and Engagement  Communication through Community Health Partnership Leads and Directors of Nursing  User Reference Groups - Scenarios  Awareness Sessions  Website and publicity material e.g. newsletters  Pilots  Training Sessions  Help desk

Community Nurses Measure Up DID V The Scenarios 1.General Development Programme 2.Elderly Gent, Lives alone 3.Educating carer in procedure 4.Reduced Fluid Intake 5.Check Environment 6.Behavioural Temper Tantrum

Community Nurses Measure Up DID V Nursing: Problems, Interventions Bladder/Bowel Care Care Management Carers Pregnancy Postnatal Infant/Child Development Family Care Emotional/Psychological Issues Equipment Health Promotion Long Term Condition Management Medication Mobility Nutrition / Fluids Personal Care Risk Management Social Circumstances Symptom Management Teaching Procedures Skin/Wound Care

Community Nurses Measure Up DID V 1.General Development Programme (I) Infant/Child Development 2.Elderly Gent, Lives alone (P) Social Circumstance(s) 3.Educating carer in procedure (I) Teaching 4.Check Environment (I) Risk Management 5.Reduced Fluid Intake (P) Symptom Management 6.Behavioural Temper Tantrum (P) Infant/Child Development

Community Nurses Measure Up DID V The Census Dataset  About the Nurse: Registered/ unregistered with SPQ/ SVQ Caseload holder / caseload size Non-patient related activity  About the care: Nursing Problem / Intervention(s) Aim of Care Medical diagnosis Intensity (Child Health) Planned frequency of care  About the patient: Age, ethnic group, gender  About the patient contact: Individual/ group/ clinic Face to face, telephone, etc Location Planned/ unplanned Reason for more than 1 staff member

Community Nurses Measure Up DID V The Census Experience IT Issues – ISD and Local Access Helpdesk IT Awareness Communication

Community Nurses Measure Up DID V Outcome Staff 3385 (74%) staff working on Census Day completed the census form First fully electronic, national data collection initiative for community nursing

Community Nurses Measure Up DID V District Nurse: North Lanarkshire CHP Registered Without SPQ Made individual contacts only Also did some practice development work Saw 3 patients: Male 91Problems:Skin/Wound Care – Leg Ulcer Interventions:Skin/Wound Care – Leg Ulcer Care Medical Diagnosis:Circulatory System Disease – Peripheral Vascular Disease Care:Planned Curative, Face to Face in patients home occurring once a week. Female 72Problems:Skin/Wound Care – Wound Care Interventions:Skin/Wound Care – Surgical Wound Care Medical Diagnosis:Injury – Fracture of Tibia and Fibula Care:Planned Resolution, Face to Face in patients home occurring twice a week. Female 38Problems:Bladder/Bowel – Urinary Catheter in Situ Medications – Unable to take Med’s Skin/Wound Care – At risk of Pressure Sore Interventions:Bladder/Bowel – Catheter Care Medication – Administration Skin/wound Care – Pressure Ulcer Prevention Medical Diagnosis:Paraplegia Care:Planned Stabilisation, Face to Face visit in patients home, is occurring once a day.

Community Nurses Measure Up DID V Analytical Tables Reported at Scotland Level Only  Participation and Contacts Participation numbers and percentage Skill Mix – Registered and non-Registered Number of Patients seen – by service Number of Contacts, Proportion of Planned Contacts – by service Non-Patient Activity – by service type

Community Nurses Measure Up DID V Reported at Scotland Level Only  Clinical Analysis Aim of Care for Individual and Groups/ Clinics by service type Intensity of Care by service type (Child Health) Nursing Problems High Level Categories by service type Nursing Interventions High Level Categories by service type Medical Diagnosis High Level Categories by service type Analytical Tables (2)  Analysis by Patient Age and Gender by Service type Ethnicity

Community Nurses Measure Up DID V What’s Next? Report Identify local champions to assist with information dissemination Work with key stakeholders to identify and answer further questions from the data Distribute local data to their respective boards and support local analysis and interpretation of this in its local context

Community Nurses Measure Up DID V What skill levels for each service type is associated with particular nursing interventions? What is the difference in caseload numbers for different skill levels for each service type? What range of nursing interventions were carried out for patients or clients seen as individuals, groups or in clinics?. What nursing problems do patients have who had 2 contacts from the same member of staff for each service type? What nursing problems and interventions were undertaken for patients across each service type who had an unplanned contact?. Which non patient related activity was undertaken by each skill levels for each service type? What nursing problems are associated with a particular care aim? What care aims are associated with particular medical diagnosis? What care aims are associated with particular contact types. Is there any relationship between care aim and intended frequency of future visit? What different types of nursing problems and interventions are offered to families with children who require additional and intense levels of care intensity? What nursing problems arise from specific medical diagnosis? Where no medical diagnosis exists, what interventions are being carried out and why? What interventions are associated with particular nursing problems? What nursing interventions are undertaken by different skill levels in each service type? What interventions were undertaken by each service type where no medical diagnosis was identified? Possible Further Questions

Community Nurses Measure Up DID V Refine Review the Dataset to further support other nursing initiatives i.e. NMWWPP Review the definitions i.e. Planned/Un-planned Care, Caseload Enhance pick list values to ensure they fully reflect the nature of nursing team activities. Explore concept of nursing diagnosis to better identify nursing problems Revise categories of non-patient activity Progress the development of the International Classification of Nursing Practice Catalogue in partnership with the International Council for Nurses

Community Nurses Measure Up DID V Terminology Mapping (1) Scenarios PTI Existing Systems Categorised lists Categorised lists NANDA NIC NOC Omaha Home Healthcare Classification ICNP Flexible Comprehensive Adaptable Transferable Comparable Census

Community Nurses Measure Up DID V Terminology Mapping (2) Categorised lists Categorised lists Additional problems & Interventions from Census comments ICN ICNP Scottish terms Scottish terms Terminology Mapping Tool Terminology Mapping Tool Scottish Catalogue of Community Nursing Scottish Catalogue of Community Nursing

Community Nurses Measure Up DID V Repeat Refine the web based data capture system and develop a process to make it available for more frequent application or for the use of specific staff groups Identify sponsors and resources for any future local or national census initiatives

Community Nurses Measure Up DID V Report Published 25th November 2008 Provide us with your address and we will send you the link to access the report