Nursing & Midwifery Performance - Sam Foster

Nursing & Midwifery Performance - Sam Foster - Deputy Chief Nurse

Transcript

1. Our Journey to self regulation
2. Good Hope
3. WHO ARE HoEFT?  Foundation Trust  3 main sites – 1,700 beds − Birmingham Heartlands − Solihull (Acute Merger in 1996 – Care Trust Partnership 2011) − Good Hope (First Acquisition in NHS.)  TCS – Solihull Community Services April 2011  11,500 staff  £700 million turnover
4. Challenges for Nursing  Build public trust and confidence in the nursing profession particularly in light of national adverse media coverage  Robust Board Assurance – lots of data not much info  Professional concerns re nursing practice  Nursing largest workforce − Biggest pay bill − Patient contact 24/7  Efficiency challenge
5. We can mix these up…… Proposition that is taken for granted as if it were known to be true Comfort, faith A declaration to inspire full Confidence, freedom from doubt, based on evidence Assume Assure Reassure
6. Knowing how we are doing - Where did we start? Review of what we had Multiple audit tools reports, shared drives, Evidence base, NICE guidelines, NPSA, RCN…. Implementation of the NW Indicators using an in house developed IT solution, with a back to the floor approach. Falls Assessment Nutrition Pain Management Pressure Area Care Medicine Administration Observations Infection Prevention Added: Continence Diabetes
7. Developments at HoEFT  Development of new metrics − Maternity − Community − Neonates − Paediatrics − Theatres − Outpatients − A&E − Endoscopy
9. ASSURANCE Target not achieved - Unsatisfactory progress with action plan? Any extenuating circumstances? Has it been flagged? e.g. Auditor competence, Staffing issue, Dependency Special measures – Month 1 Inform Chief Nurse Head Nurse: Set up meeting with Senior Sister, CD, Matron, General Manager create an Action Plan Action Plan agreed Monitored monthly via Head Nurse Chief Nurse updated on progress at NMB Achieved – back to monthly monitoring Not achieved Special Measures Month 2 Report to Nursing and Midwifery Board Diagnostics – performance dashboard etc. ‘Confirm and Challenge’ meeting with Chief Nurse Continue monthly monitoring of results Two months’ poor performance: Special Measures • Weekly Monitoring • Senior Nurse Support • New Leadership Result: Improvement
10. Nursing Care Indicator 2010-2013 0 10 20 30 40 50 60 70 80 90 100 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb 2010 2011 2012 2013 45 36 21 14 9 13 8 1 4 2 3 9 8 2 2 1 5 7 5 4 3 5 4 2 4 3 5 1 1 1 2 2 4 6 5 2 1 6 16 19 28 28 20 21 12 23 24 18 27 17 25 11 18 16 42 41 40 25 32 30 29 32 25 27 35 19 25 25 33 25 24 20 20 28 34 7 12 13 11 16 24 35 43 39 34 40 24 45 43 57 56 60 38 42 45 64 49 60 49 57 58 66 57 70 61 64 61 58 55 56 52 58 55 Number of wards Metrics: Nursing Care Indicators Number of Wards Audited 2010-2013 Scoring: 0-79% 80-89% 90-100% 0-84% 85-94% 95-100%
11. HOWEVER… We recognised that we were measuring process which had its limitations What else could we triangulate? What would we do with all of this information?
12. Nursing and Midwifery performance committee Co-Chair – Deputy Director of Finance and Performance TOR adapted form Finance and Performance committee Monthly meet with head nurses Forward planner for suite of indicators/Triangulated scorecards Exception reports Performance notices Real sense of business like accountability
13. The data is wrong DENIAL It does not apply to me ANGER I will get the correct data BARGAINING There is nothing I can do about it DEPRESSION Acceptance and action RESOLUTION Adapted from Elisabeth Kübler-Ross 5 stage model (Though more modern grief theories such as that of John Bowlby described as ‘ebb and flow of processes such as shock and numbness, yearning and searching, disorganization and despair, and reorganization’ have some attraction) Culture: The five stages of grief
17. Nursing and Midwifery Metrics Metrics results by ward- The monthly nursing and midwifery metrics provide a good early indicator of compliance with process. An agreed escalation process in place for wards who do not meet compliance. Trust wide there is an increased focus on compliance with accurate fluid balance.
19. Pressure Ulcers Your skin matters scorecard: “Your skin matters” is a National High Impact Action concerned with reduction of pressure ulcers. The score card correlates all internal information relating to skin integrity and is monitored by the Nursing and Midwifery Performance Committee. Since Q3 All head nurses lead a monthly RCA forum and review all pressure ulcers, including a review of the avoidability of all pressure ulcers. The trust is on track with its CQUIN trajectory of no more than 24 avoidable grade 3/4 pressure ulcers over Q3/4.
21. Daily Harm Alerts Daily Harm Alert Email: Dear Sisters/Charge Nurses, Over the past 72 hours (weekend) there have been 12 pressure sores reported. Please note that one of these is a Grade 3. There are no injurous falls to report. REMINDER: RCA’s MUST BE COMPLETED WITHIN 7 DAYS In detail: Ward Grade Date 21 2 19/04/2013 Beech 2 19/04/2013 3 2 20/04/2013 24 2 20/04/2013 ITU 2 20/04/2013 Rowan 2 21/04/2013 A&E 2 21/04/2013 28 2 21/04/2013 12 3 21/04/2013 ITU 2 x 2 22/04/2013
25. Q4 Look forward Removal of “amber rating” from metrics Focused review of injurious falls Focused review of pressure ulcer reductions Re- launch of catheter passport and monitoring via safety thermometer. Focused improvement on ADT completion – (Launch PMS 2 in May) Focused improvement on sickness absence Agree 2013/14 CQUINS
26. Thank you for listening