Respond Deliver & Enable 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

Respond Deliver & Enable 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

Respond Deliver & Enable A positive friendly culture A calm, clean, safe environment Well managed Care with efficient delivery Personalised care for and about Every patient Good team working and good relationships Organisational / clinical / area / unit Team Individual Skills and will Ways Means

Respond Deliver & Enable 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

Respond Deliver & Enable Direct Care Time MotionAdminDiscussionHandoversInformationRoles Opportunity to increase safety and reliability of care Role Time (e.g. nurse) Total Time “Everything I need to do my job is conveniently located” ‘The paperwork is easy to understand and quick to complete’ I am not interrupted by people requesting information or looking for things ‘’Handovers are concise, timely and provide all the information I need” ‘It is clear to everyone who is responsible for what” ‘We have the information we need to solve our own problems, and find out if we were successful” QUALITY: Releasing Time to Care

Respond Deliver & Enable 100% 25.6% 6.3% 5.8% 7.7% 14.8% 28% Direct Care Time MotionAdminDiscussionHandoversotherMedicines Opportunity to increase safety and reliability of care Role Time (e.g. nurse) Total Time QUALITY: Releasing Time to Care EMU 8.8%

Respond Deliver & Enable 100% 4.9% 10.3% 4.7% 14.5% % 48% Direct Care Time MotionAdminDiscussionHandoversOtherMedicines Role Time (e.g. nurse) Total Time QUALITY: Releasing Time to Care, EMU Opportunity to increase safety and reliability of care

Respond Deliver & Enable QUALITY: Releasing Time to Care, Okement Ward Before: Cluttered Nurses at desk not bedside Confusing for visitors/relatives

Respond Deliver & Enable 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

Respond Deliver & Enable QUALITY: Patient Experience - Putting Patient/Customer Care First Lead Nurses attended development day November Senior Matrons / Matrons attended the ‘Patient Experience’ event in October Ward Sisters attended the ‘Patient First’ course in December 08 Ward clerks to be trained in Feb 09

Respond Deliver & Enable 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

Respond Deliver & Enable Nursing Core Standard: Respect and dignity. Standard: Every patient has their privacy and dignity respected at all times. Element: EnvironmentSourceYesNoInstruction 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 patientAsk 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 staffAsk 3. All must be aware Do all staff adhere to the uniform policyObserve Look for jewellery, watches and hair length Do staff treat patients with dignity and respect?Observe General feel over time on ward QUALITY: Nursing Quality Assessment Tool

Respond Deliver & Enable QUALITY: Patient Experience Question 2007 National Survey results 15 wards Summer 2008 Outcome B16. Not received enough help to eat meals10%6% 4% improvement B13. Food was fair / poor34%23% 11% improvement B7/8. Bothered by noise at night28%40% 12% decrease E2. Not involved enough in decisions about care and treatment45%38% 7% improvement E11. Waiting more than 5 minutes to answer call button7%3% 4% improvement E1. Staff contradicting each other36%25% 11% improvement E4. Not enough opportunity for family to speak to a Doctor31%22% 9% improvement E3. Not enough information provided about their care & treatment19%12% 7% improvement E6. Not always enough privacy when discussing condition / treatment26%17% 9% improvement C3. Doctors talked in front of as though they were not there23%13% 10% improvement D3. Nurses talked in front of as though they were not there22%12% 10% improvement D6. Nurses did not always wash / clean hands before touching patients20%9% 11% improvement Always met expectations-55%-

Respond Deliver & Enable 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

Respond Deliver & Enable QUALITY: Patient Safety – RD&E –Deteriorating patients  –CVC Lines  –Surgery checklist  –Falls 

Respond Deliver & Enable Caring for Acutely Ill patients – Early Warning Score QUALITY: Patient Safety – Deteriorating Patients

Respond Deliver & Enable 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

Respond Deliver & Enable EWS- Aide memoir Issued to all staff on induction. EWS plus phlebitis score. Plans to link to self assessment and ESR QUALITY: Patient Safety – Deteriorating Patients

Respond Deliver & Enable MEET THE VASCULAR ACCESS TEAM! QUALITY: Patient Safety – CVC Lines 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.

Respond Deliver & Enable VASCULAR ACCESS TEAM ACTIVITY – LINE INSERTION QUALITY: Patient Safety – CVC Lines

Respond Deliver & Enable 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 QUALITY: Patient Safety – CVC Lines

Respond Deliver & Enable Evidence Reduced IV related complications Consultant feedback Patient Feedback Verbal feedback from staff & patients QUALITY: Patient Safety – CVC Lines

Respond Deliver & Enable Intentional Rounding Targeted falls education Intentional round every hour for patients with falls risk score > 30 Checklist with key quality questions Verbal feedback from staff & patients QUALITY: Patient Safety – Falls

Respond Deliver & Enable 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 DATE: TIME 1. CONTINENCE – Do you need to go to the toilet? 2. PAIN – Do you have any pain? 3. ORIENTATION – Fully alert = FA; Mildly confused/disorientated = MC; Severe confusion/disorientation = SC; Asleep = A 4. POSITION / COMFORT – Are you comfortable? 5. DRINK / MOUTHCARE – Would you like a drink? 6. CALL BELL WITHIN REACH – If you need me, press this button 7. BED RAILS DOWN 8. BED TO FLOOR 9. IS THERE ANYTHING ELSE I CAN DO? Because I’ve got the time INITIALS

Respond Deliver & Enable QUALITY: Patient Safety – Falls

Respond Deliver & Enable 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