REPORT TO: STAFFORDSHIRE AND STOKE ON TRENT PARTNERSHIP NHS TRUST BOARD MEETING. TO BE HELD ON: WEDNESDAY 29 October 2014

Transcription

1 REPORT TO: STAFFORDSHIRE AND STOKE ON TRENT PARTNERSHIP NHS TRUST BOARD MEETING TO BE HELD ON: WEDNESDAY 29 October 2014 Enclosure: 06 Subject: Safe Nursing Staffing Strategic Goal: (tick as applicable) We w ill provide high quality and safe services w hich provide an excellent experience and best possible outcomes We w ill w ork w ith users and carers to deliver integrated services, simply and effectively Our organisation w ill develop and deliver sustainable, innovative services that support independence Our w orkforce w ill be empow ered and supported to deliver care in a w ay that is consistent w ith our values Director Lead: We w ill make excellent use of our resources and improve levels of efficiency across our services Siobhan Heafield, Director of Nursing & Quality (Report to be presented by Rose Goodwin, Associate Director of Professional Leadership) Recommendation: For Approval & Assurance X For Discussion X For Information PURPOSE OF THE REPORT: This paper provides an overview of safe nurse staffing levels in the 5 Community Hospitals of the Partnership Trust during September KEY POINTS: Staffing Pressures Concerns Staffing pressures within in-patient services in the community hospitals reached a peak at the latter part of September Concerns were raised by the matrons and escalated to the Community Hospital Manager who alerted the Acting Director of Operations. The concerns were escalated to the Executive Management Team meeting on the 22 September and the Board received a verbal update on the 24 September from the Acting Director of Operations outlining the need to give consideration to the closure of some beds. The concerns raised indicated that where staffing challenges had been manageable until that point the matrons expressed concern that mitigations were no longer sustainable. The key factors were the increased number of vacancies, ratio of temporary staff to substantive staff and the failure of temporary staff fulfilling booked shifts. Matrons also raised concerns about patient safety issues. They felt that there were more patients falling despite the subsequent evidence that there were a reduced number of falls in September Page 1 of 4

2 than August. The matrons reported an increase in patient acuity amongst patients transferred from acute services. All these factors impacted on the sustainability of the measures in place to staff the wards across all five hospitals safely. Due consideration was given to the concerns and it was agreed following discussion at EMT that in order to assure safe staffing levels across wards, one ward should be closed temporarily and the staff redeployed. It was agreed on the basis of patient safety that the ward to close should be Smithchild Ward. It should be noted that the layout of Smithchild Ward means that observation of patients is a significant challenge requiring additional nursing staff to maintain patient safety. Using the staff in other ward areas allow more beds to be kept open and staffed safely across all of the hospitals. It should be noted that during the period of the Community Hospitals refurbishment programme ward staff had been redeployed, to other community hospitals. Therefore the plans to redeploy staff to other wards gave consideration to where staff had previously worked during the refurbishment programme. Staffing Monitoring During September there were 15 red professional judgment shifts identified of which 7 of these relate to shifts where there was only 1 Registered Nurse on duty. Additional actions were undertaken to ensure patient safety including flexing working patterns and practices and additional hours being worked for part of these shifts. Grange Ward reported 8 of these 15 red shifts during the month and the pressures experienced by this ward was included in the concerns raised by matrons Grange Ward reported a fall resulting in a patient sustaining a fractured neck of femur. A RCA is being undertaken to determine whether staffing was a causative factor in the incident. A lunchtime drug round for half the patients on Grange ward was missed to due to staff dealing with a deteriorating patient. A medical review was undertaken on all patients and not harm was associated with the incident. All patients involved were spoken to by the matron and relatives of all patients (without capacity) were seen by the matron. Leek Moorlands Hospital had only 1 RN on duty for two wards on the 12 September. This was due to short notice sickness and a failure of temporary staff reporting for duty. Measures were instituted to ensure patient needs were met by staff on the previous late shift. Prior to the ward closure a patient from Smithchild Ward was able to leave the ward unsupervised resulting in a Serious Incident report being made. Staffing levels and limited ability to observe patients effectively due to ward lay out were thought to have contributed to the event. The patient was returned safely to the ward in a timely manner and did not suffer any harm. It was noted that falls had been high during both August and September for Oak Ward. The summary report (attached) includes slips, trips and falls under the heading of falls regardless of injury. During September there have been 2 patients on Oak Ward who are at high risk of falls. They are both nursed on high/low beds with protective matting around the bed perimeter. 1 to 1 nursing observation is also in place for these individuals however whenever they roll off the low bed onto the matting this is recorded as a slip, trip or fall and the high number of falls noted relate to this activity. Assurance has been obtained from both the Hospital Matron and Ward Sister that safe processes are in place to support rehabilitation, individual choice and personal safety for these and the remaining patients. Page 2 of 4

3 Staff sickness remains high with; RN 6.4 WTE and HCSW WTE off sick. Ward Sisters and senior operational managers are working closely with HR colleagues to manage sickness absence. A number of staff who have transferred from Longton Cottage Hospital have reported themselves as sick following the move. Referrals to Team Prevent (occupational health) and HR reviews are underway to support early return. Recruitment Vacancies for September remained high with 29.83WTE RN s and 5.0WTE HCSW posts vacant compared to 22.74WTE (RN) and 3.37 (HCSW) posts in August. There are 8.6WTE RN s appointed and not yet started. A recruitment / interview day is scheduled on the 18 October 2014 for Community Hospital services. There are 28 individuals being interviewed for registered nurse posts and 15 for care worker posts. Posts were offered for 12 Band 5 nurses, 4 band 6 nurses and 9 HCSW. Further Scrutiny Further scrutiny of staffing has been instigated through a weekly conference call between the Professional Head of Nursing, the Performance Team and the hospital Matrons to maintain close review of safe staffing levels and issues influencing them. This is in addition to the communication between the ward teams, Matrons and Professional Head of Nursing. INTER DEPENDENCIES: Legal and/or Risk It is a requirement of NHS England to provide monthly updates on safe staffing levels. Failure to comply will risk reputational damage with the public. Clinical Financial HR Staff and Trade Union involvement actions undertaken/planned The link between safe nurse staffing levels is clear. Ensuring that the right staff are on duty to deliver care in a timely manner is a priority for the Partnership Trust There are no financial implications associated with this paper. On-going recruitment and management of staff sickness is reliant upon HR support. The Staffing Establishment has been approved by and supported by the Board Support from staff side colleagues is essential in managing staff absence and supporting safe recruitment practices. Social Care Patient & Public Involvement Equality Impact Information exempt from Disclosure Requirement for further review This paper relates to safe nurse staffing levels in Community Hospitals only. There has been no direct involvement of public groups in the development of this paper. Safe staffing information is available to the wider public through NHS Choices and the organisations website. Safe nurse staffing levels has an impact on all users of service regardless of culture or ethnicity. This paper describes how a safe staffing profile is monitored and this is available to the public via the organisations website. None. This paper will be published on the Partnership Trust website to allow public scrutiny. Safe nurse staffing levels will continue to be monitored on a monthly basis Page 3 of 4

4 RECOMMENDATIONS / ACTION REQUIRED: The Trust Board is requested to note the report content and be assured that the organisation is compliant with safe nurse staffing level guidance and a rigorous monitoring process in place. Page 4 of 4

5 Safe Staffing (Community Hospitals) Sep-14 Staffing Hospital Ward Professional Judgement - Green Professional Judgement - Amber Professional Judgement - Red Rate (Day) - RN Rate (Day) - HCSW Rate (Night) - RN Rate (Night) - HCSW Average RN to Patient Ratio (Day) Average RN to Patient Ratio (Night) below Agreed Staffing - RN below Agreed Staffing - HCSW Vacancies - RN Vacancies - HCSW Posts appointed to but not yet started Maternity Leave Sickness Professional Assurance Statement Bennion % 95.0% 100.0% 99.9% 1:8 1: B B B7-1.0 B5-1.0 B staff absence (vacancy and sickness). Bradwell Oak % 100.2% 100.0% 96.5% 1:8 1: B Oak Ward reported 1 Red shift during September which relates to one night shift with 1RN on duty. The number of falls increased during July and has remained high during September. The high humber of slips, trips & falls relate to 2 patients nursed on low rise beds who frequently roll off these beds onto safety matting; although not a fall as such they remain reportable incidents. Sycamore % 99.6% 100.0% 100.0% 1:7 1: B B5-1.0 B5-0.8 B2-1.8 staff absence (vacancy and sickness) Total % 98.2% 100.0% 98.8% 1:8 1: Cheadle Ward One % 93.4% 100.4% 91.5% 1:10 1: B B5-1.0 B Ward Two % 94.8% 98.7% 98.5% 1:9 1: B B5-3.0 B2-2.0 B RN vacancies. There was one night shift reported where only 1RN was on duty as a result of short notice sickness. There has been increased pressure in the system due to staff vacancies and patient acuity. Total % 94.1% 99.4% 94.7% 1:10 1: Aynsley Ward Closed Longton Smithchild % 99.2% 100.0% 118.0% 1:8 1: B Safe staffing maintained but some pressure on staffing due to patient acuity. 1 patient left the ward unsupervised resulting in a SI being raised, no harm occurred to the individual concerned. Total % 99.2% 100.0% 118.0% 1:8 1: Leek Cottage % 101.5% 100.0% 100.0% 1:8 1: B B Saddler % 100.4% 97.9% 100.0% 1:8 1: B B short term staff sickness resulting in 1 Red shift (1RN). Safe staffing maintained but some pressure on staffing due to patient acuity. There were 2 occassions where there was only 1 RN on night duty due to short notice sickness and failure of tempory staff to arrive for duty. One of these shifts co-incided with a Red shift on Cottage Ward where there was only 1 RN on duty. Staff flexibility and alternative work patterns ensured patient safety. Total % 101.0% 99.0% 100.0% 1:8 1: Broadfield % 94.5% 100.0% 94.7% 1:9 1: B B Safe staffing maintained but some pressure on staffing due to patient acuity Chatterley % 101.1% 97.0% 93.7% 1:10 1: B B5-0.8 B B5-1.0 B staff absence (vacancy and sickness). There were 2 Red shifts reported relatingto 1RN on night duty as a result of short notice sickness. Additional support from adjacent ward teams sought as well as flexible working from ward staff to ensure safety. Haywood Grange % 96.6% 86.6% 107.3% 1:8 1: B B5-1.0 B2-1.0 B2-4.1 Jackfield % 90.8% 98.6% 92.5% 1:9 1: B B B2-3.5 Scotia % 100.0% 98.6% 106.8% 1:4 1: B Safe staffing has been compromised due to patient acuity and staff absence (vacancy & sickness). 8 Red shifts were reported due to poor RN to patient ratios and patient acuity needs. There was 1 fall resulting in a fracture during September and although stafing was 1 staff member below the required staffing figures for the shift, RCA investigation has not concluded that this was a contributing factor in the event. During september there has also been an increase in overall incidents reported for the ward, including medication incidents. No harm occurred as a result. Safe staffing maintained with support from other clinical areas to address patient acuity needs and staff absence. Safe staffing maintained. The team have been able to support other ward areas to maintain overal ward/patient safety. Sneyd % 95.1% 98.5% 95.4% 1:8 1: B7-1.0 B B6-1.0 B6-0.8 B2-1.8 Safe staffing maintained but staff absence (vacancy and sickness) has increased pressure on staafing resillience. The SI reported relates to a patient collapse requiring CPR. Total % 95.9% 95.5% 96.9% 1:8 1: Overall % 96.8% 97.6% 98.4% 1:8 1:

6 Safe Staffing (Community Hospitals) Sep-14 Quality Measures Hospital Ward Pressure Ulcers - New Pressure Ulcers - Transferred In Falls Complaints Serious Incidents Healthcare Acquired Infections % New Harms (Safety Thermometer) Patient Experience Score Bennion % Bradwell Oak % Sycamore % Total % Cheadle Ward One % Ward Two % Total % Longton Aynsley Ward Closed Smithchild % Total % Leek Cottage % Saddler % Total % Broadfield % Chatterley % Haywood Grange % Jackfield % Scotia % Sneyd % Total % Overall %