Promoting “Elder-Friendly” care in the acute setting – development of a Quality Mark for wards

Why Quality Mark? Hospital admission can lead to negative outcomes for older people: – loss of cognitive ability – loss of mobility – loss of skills in daily living activities, affecting independence – loss of continence, newly acquired or exacerbated by admission – development of pressure sores or HAIs – malnutrition and dehydration

Aim of the Quality Mark Recognise achievement of “elder-friendly” wards Support and encourage wards to improve quality of care provided Encourage focus on continuous improvement cycle through publicising membership of the scheme and ward level findings and feedback

Premise for QM The hospital/senior management team: – Identifies the particular needs of older people in the acute hospital setting and the risks of admission – Understands basic care requirements and acknowledges that high quality care for this group of patients is a pre- requisite for achieving a good standard of care overall – Supports, enables and equips ward managers to create a care environment that can meet the needs of frail older people. The ward manager leads, motivates and enables the ward staff team to deliver high quality care to frail older people. The behaviours and actions of the ward staff result in high quality care. Patients and carers perceive that all of the above come together into a positive experience of care

The challenge of assessing dignity in care (2008) Picker Institute Personal Hygiene Practical Assistance / Personal Care Privacy Social Inclusion Autonomy Communication Eating and Nutrition End-Of-Life Care Pain

Data required Prospective collection of data – Information will be collected via 5 different assessment tools: – A hospital/senior management team questionnaire – A ward questionnaire (including environmental checklist) – Staff questionnaires – Patient questionnaires – Observation tool. Use of existing data sources as performance indicators, e.g. – PEAT – CQC Quality and Risk Profile – Indicators from National Audit

Feedback from Staff The ward nursing team: has sufficient numbers (in terms of overall number and of number of qualified nurses) to provide good quality essential care on every shift; has high morale, works as a team and reports being well led; is well managed with respect to supervision, appraisal and staff development (with an emphasis on the provision of training in the values, attitudes and skills required to meet the particular needs of frail, older people).

Staff Questionnaire sections Support for staff, in terms of time for care inputs and leadership provided Accessing support from other professionals Self assessment of skills/ knowledge for care Supporting autonomy for patients Information and communication on the ward Social inclusion

Other data related to support available for staff Off duty Staffing Rota Training Matrix Access to services on the ward (completed by e,g Occupational Therapy)

Access to services 1 Occupational Therapy is available on this ward between the hours of: Monday______-______No access  Tuesday______-______No access  Wednesday______ -______No access  Thursday______ -______No access  Friday______-______No access  Saturday______-______No access  Sunday______-______No access  In an out-of-hours emergency the ward can gain access to this service.... ImmediatelyWithin an hourWithin 1-3 hours Within 3-6 hours Other__________________

Access to services 2 Registration Referral procedures Waiting times Continuity Ward support for service Communication between ward/ service Limitations/ contstraints on service provision Hospital Policy and impacts

Off duty staffing record: WEEK ONEWEEK TWOWEEK THREEWEEK FOUR MTWTFSSMTWTFSSMTWTFSSMTWTFSS Ward Manager Charge Nurse 1 Charge Nurse 2 Charge Nurse 3 Charge Nurse 4 Staff Nurse 1 Staff Nurse 2 Staff Nurse 3 Staff Nurse 4 Staff Nurse 5 Staff Nurse 6 Staff Nurse 7 Staff Nurse 8 Staff Nurse 9 Staff Nurse 10 TOTAL

Questions to be addressed Content of staff questionnaire – applicable and feasible Timing and frequency – will it be affected by turnover in staff, change of ward manager? Should other ways of collecting staff feedback be considered? Looking for opportunities to run tests on all tools prior to full pilot