Dumfries and Galloway Alice Wilson

Transcription

1 NHS Board Contact Dumfries and Galloway Alice Wilson Title Category Background/ context Senior Charge Nurse Supervisory Status Workforce The role of the Senior Change Nurse (SCN) is: to ensure safe and effective clinical practice to enhance the patients experience to manage and develop the performance of the team to ensure effective contribution to the delivery of the organisation s objectives There is clear evidence that activity and acuity levels within the general wards have increased significantly over recent years. As a result the main focus of the SCN role has been to deliver hands on care to patients. Implementing this proposal will ensure on-going management of risk for the organisation whilst also continuing to improve quality and performance outcomes, reflected by an improvement in: patient experience, outcomes and safety health and wellbeing of staff increased productivity delivery of key performance indicators Problem As a clinical leader, patient advocate and the person responsible and accountable for the standards of care in the ward or department, the SCN shoulders a burden of expectation unparalleled on the front line of the NHS. All aspects of care delivery, people and financial management of the ward or

2 department rests squarely with the SCN. In NHS Dumfries and Galloway SCNs are almost fully clinical case holding which puts an added burden as they have little dedicated time to deliver on all that is expected from them It would be easy to argue, on the grounds of this alone, that the nature of this role demands supervisory status, however it is important to outline some of the anticipated benefits, to the organisation, in supporting this test of change. Aim To test the impact and benefit of introducing supervisory status for the Senior Charge Nurse (SCN) role for the purpose of maintaining and improving quality and consistency of care experienced by patients, along with supporting the delivery of key performance indicators. In order to fulfil the supervisory role there will be the requirement for the SCN to be additional to the funded nursing establishment, increasing from the current one day per week to five. The project will run in two ward areas in DGRI for until the end of and will be used to quantify the potential benefits of the supervisory Summary of Key Performance Indicators reduction in complaints patient safety indicators consistently at appropriate compliance Clinical Quality Indicators consistently at 95 per cent compliance full completion of all documentation (audit) evidence of reduction in adverse events and demonstration of learning Reduction in delayed discharges Reduction in sickness/absence (1 per cent) mandatory training and annual development reviews (ADR) consistently up to date full implementation of quality rostering policy and

3 erostering system implementation and sustainment of change in practice Action taken Results Two SCNs were given an additional 30 hours supervisory time per week to test whether this would impact on the quality of patient care. Given that this is a very different model for NHS Dumfries and Galloway both SCNs were given external coaching and regular support from their Nurse Manager and Associate Nurse Director Regular measurement of KPIs was carried out as well as audit of practice and outcomes in one another s areas in conjunction with the Nurse Manager. Key Performance Indicators Complaints: There has been a clear reduction in the number of complaints: Jan-May complaints Jan-May complaints In addition to the number of complaints there has been a change in the types of complaints received with very few now commenting on staff attitude or poor nursing care experience. Patient Safety Indicators: There are three Clinical Quality Indictors: Falls Pressure Ulcers Food, Fluid and Nutrition Both areas have achieved and maintained a consistent score of 95 per cent or above for all three Clinical Quality Indicators. This covers elements of assessment, prevention and management of risk.

4 Whilst it is relatively simple to reach 95% in the Clinical Quality Indicators it is, like many other areas, difficult to maintain and the opportunity presented in the pilot allows the SCN to get underneath the scoring and look at what influences compliance. This has allowed them to work with staff, challenging and supporting them to deliver. Completion of all documentation: There has been a steady improvement in the compliance with completion of documentation: specifically Active Patient Care documentation shows a steady improvement, over a seven month period till March 2014: Sept 74 per cent Oct 80 per cent Nov 73 per cent Dec 91 per cent Jan 98 per cent Feb 95 per cent Mar 100 per cent Reduction in adverse events: Responding to the majority adverse incidents sits with the SCN, only the most significant ward based events are expected to be led by a wider team, which will include the SCN. Keeping on top of incidents, including slips, trips and falls and ensuring outcomes and learning are shared with staff is a difficult task. This is evident in the time taken to close incidents prior to the pilot. Ward 16 SCN has managed to reduce the length of time to closure of incidents from average 18 days to an average of eight days. The type and severity of incidents has also change as evidenced in the table below; demonstrating a clear reduction in incidents.

5 Ward 16 Jan Oct 2013 Nov May 2014 Allanbank Thornhill 3 1 Castle Douglas 2 6 Kirkcudbright 2 1 Moffat 2 2 Ward 16 1 October 2012 to 31 May October 2013 to 31 May 2014 Category A 13 Category A 12 Category B 69 Category B 4 Category C 29 Category C 5 Category D 19 Category D 4 Category E 16 Category E 11 Category F 41 Category F 5 Category G No incidents Category G None closed, 1 outstanding Category H No incidents Category H No incidents Category I No incidents Category I No incidents Delayed discharges: Delayed discharges are complex and multifactonal and there have been specific issues in relation to cottage hospital beds and of carers in the community which has had a knock-on effect on Dumfries and Galloway Royal Infirmary (DGRI). However, there has been an overall reduction in delayed discharges with the notable exception of discharges to Annan Hospital and to a lesser extent Castle Douglas Hospital. Ward 9 Jan Oct 2013 Nov May 2014 Allanbank 6 5 Castle Douglas 3 2 Moffat 2 2 Annan 3 4 Lochmaben 1 2 Awaiting a Care 6 2 Package Transfer to NHS 1 England Total 21 18

6 Efficiency savings and productive gains Sustainability Lessons learned These have been set out in the results above. The Board is continuing with the pilot at present and will make a decision on the long term direction regarding the status of the supervisory charge nurse in due course. Essential to have a clear idea of metrics at the outset in order to be clear about the impact of the project before and after.