1. Community Nurses Measure Up DID V Heather Strachan NMAHP eHealth Lead Scottish Government

2. 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 ceased  AHP Census, September 2005 - Provided previously unknown information across Scotland, e.g. Number of patients on caseload Most common interventions Most common conditions Background

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

4. 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 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 once they tried to describe it  demonstrated the motivation and drive of community nurses to work together to make themselves heard

5. 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

6. 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

7. Community Nurses Measure Up DID V A National Community Nursing Team Census took place on 24th April 2008. First fully electronic, national data collection initiative for community nurses 74% of staff working on census day completed a census return. This amounts to 3,385 completed returns. Report published on ISD website 25 th November 2008. Outcome

8. 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

9. 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

10. Community Nurses Measure Up DID V The majority of patients were seen individually by District Nursing, with Health Visitors doing more clinics. School Nurses have more patient contacts in the Group setting. Most patients had a single contact, 23 patients being seen more than 3 times on the same day. Treatment room nurses most unplanned contacts (1 in 4) with Health Visitors next. Contacts

11. Community Nurses Measure Up DID V Caseload figures indicative only. Lack of consensus among School Nurses re definition of caseload. Some staff managing multiple caseloads or covering for another caseload holder or Corporate caseload model in use. Caseloads

12. Community Nurses Measure Up DID V The highest non-patient activity for all disciplines was “other.” Anecdotally “Other” was may have been used to record other types of patient activity like writing prescriptions and reports for children’s hearings; For Treatment Room Nursing and District Nursing there was a high proportion of supply ordering. For Health Visiting and School Nursing there was a high proportion of attending professional meetings. Non-Patient Activity

13. Community Nurses Measure Up DID V Overall, the highest numbers (almost one third) of individual contacts were for Maintenance care. Prevention is the overall most common care aim for groups and clinics. Highest aim for District Nurses were Curative and Maintenance - The Health Visitors’ most common care aim was Supportive, Followed by Assessment and Enabling. Aim of Care

14. Community Nurses Measure Up DID V Intensity of care derived from Hall 4, was identified for health visitors, school nurses and family health nurses. The highest was additional followed by core and intense. It should be noted that Health Board protocols may vary, for example the specific length of time which a family with a new baby is considered to be at the additional level of care. Intensity of Care

15. Community Nurses Measure Up DID V Individuals, groups and clinics could be assigned a main, second and third nursing problem. Health visiting teams had issues in allocating “a Problem” where they were carrying out a Health Promotion Activity. For this report the problems and interventions were grouped into high level categories, it is these categories which are being reported on. A more detailed breakdown of these categories can be reported on in subsequent reports. Problems and Interventions

16. Community Nurses Measure Up DID V Skin / wound care was the highest reported problem category overall. District Nursing and Treatment Room Nursing reporting the highest proportions of problems in this area. The second most recorded problem overall was Long Term Conditions Management. Almost half of the problems reported by Treatment Room Nursing were for procedures. Infant / Child development was the main problem reported for Health Visiting Health promotion main issue for School Nursing. Bladder and bowel management, medication management and procedures were common problems. Problems and Interventions

17. Community Nurses Measure Up DID V High numbers of Treatment Room Nurses, Health Visitors and School Nurses did not record a diagnosis. Health Visitors and School Nurses in particular, “Not Available” in 80% of the cases compared with 17% for all the other disciplines combined. Circulatory System Disease was the highest reported diagnosis category overall. Second Endocrine, Nutritional Metabolic and Immunity Disorders, supporting Long term conditions Mental Disorders was the main diagnosis reported for Health Visiting and School Nursing. For Family Health Nursing the main Diagnosis was Neoplasms. Diagnosis

18. Community Nurses Measure Up DID V 62% were women and 38% were men. Extremes for Health Visiting and District Nursing age profiles. Family Health Nurses both ends of spectrum. Treatment room nurses worked across all ages. The ethnicity profile of the patients close to the profile for Scotland obtained from the General Register office for Scotland statistics. Patient’s age, sex and ethnicity

19. Community Nurses Measure Up DID V What’s Next?  National Report Published 25th November www.isdscotland.org/data_development www.isdscotland.org/data_development Local Reports distributed to All Boards February 2009 Meetings with Boards DNS to identify from the data support local analysis and interpretation of this in its local context and identify further questions or data collection issues Review practicalities of data collection at patient level from Electronic Health Records (ie MiDIS) Develop Scottish Community Nursing Catologue as part of International Classification of Nursing Practice (an ICN product supported by WHO) Further recommendations from these activities will identify usefulness of information, any refinements to data set, links with workload project to review definitions and values ie caseload, planned and unplanned care, non patient related activity.

20. Community Nurses Measure Up DID V What skill levels for each service type is associated with particular nursing interventions? 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? Further Question

21. Community Nurses Measure Up DID V 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 (nursing problem)? What interventions are associated with particular nursing problems? What nursing interventions are undertaken by different skill levels in each service type? Further Question

22. 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

23. 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

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26. Community Nurses Measure Up DID V Questions?