Quality summary report: School Nursing CLCH Quality Report Jan Dec 2011 Service exact name School Nursing Address line 1 - Address line 2 - Town/city County Postcode No. beds Website London Greater London N/A www.clch.nhs.uk Main telephone Completed by Approval Sharon Hart Service Manager, Catriona Noble, Service Manager, Shelley Heffernan Professional Lead Service Manager Judith Barlow Associate Director
CLCH Quality Report 2011 Summary report for School Nursing Directorate Service area Children, Family, Health and Well-being, School Nursing Boroughs Barnet Kensington & Chelsea Hammersmith & Fulham Westminster CQC statement of purpose for this service The school health service is a screening, surveillance, education and support service with a strong holistic public health focus (prevention, early detection and management of poor health, as well as the development of child wellbeing). The service is available to all pupils from reception year until 19 years of age and their parents or carers, attending and staff employed by state schools within Central London Community Healthcare NHS Trust. The intention of the service is to monitor, improve and protect children and young people s health and to prevent illness either through the provision of direct nursing services or via health promotion. The primary objectives of the School Health Service are: To ensure optimal health and wellbeing for all children so that they may make healthier choices and achieve their maximum potential. Early identification of problems to allow planned interventions and timely referral to appropriate specialist services To provide general and, when required, tailored health information to support a healthy lifestyle To provide specified and agreed health interventions in response to identified health needs To ensure that children and young people do not have unmet health needs that restrict their access to the national curriculum To support pupils, parents and staff in the management of pupils in school with specific health conditions and those requiring medication, ensuring the existence of a joint care plan and providing information and support to individual students
To advise, train, and support school staff to be able to respond appropriately to student health conditions in terms of condition and medication management To meet the general as well as the more intensive clinical nursing needs of students attending special schools as specified in the individual health plans and personal education plans. To advise and lead on matters of health protection and prevention in relation to communicable and infectious diseases providing the school aged immunisation programme. To ensure children and young people are protected from harm through robust safeguarding procedures. Overall summary of quality performance and next steps The school nursing service achieved its key objectives from last year s quality report with two actions which have been carried forward, Development of CLCH web page providing information to young people and their parents re HPV vaccination and standardised vision training. The changes to the management structure have started to contribute to aligning the service across the 4 boroughs in CLCH and further work has commenced to standardise practice and improve outcomes for children and families. There are planned improvement initiatives for the coming year as per the actions in this report and the service is awaiting the DH guidance for School Nursing due to be launched in February 2012. There will be a service Quality group facilitated by the professional leads and the introduction of a project lead post which will support the standardisation of practice guidance and implementation of NICE Guidance. Safety Overview We aim to make our service as safe as possible at all times We encourage all staff to report any incidents on Datix.
A regular programme of appropriate training for all skill levels is undertaken. Key achievements this year We identified the following safety improvement actions in our 2010 Quality Report. This section outlines the progress we have made on each of them: 1) All school nurses have access to fully functioning lockable filing cabinets both in school and clinics. This action was to be completed by July 2011. All identified cabinets have been replaced. An audit will be carried out in summer term (April July 2012) as part of the records management audit. 2) A programme of archiving clinical records was carried out in Summer 2011 and will be continued in 2012 3) All staff must be trained and assessed as competent before carrying out any screening procedure. School Nurse Team leaders to keep staff training log. 4) Barnet Universal Services have participated in the centralised recruitment of student school nurses to support workforce development. 5) Immunisation and record management have been highlighted as areas for improvement through the incidences reported over the last year. This has been addressed through the development of a revised Immunisation Policy via the Immunisation Steering Group and the implementation of the EDMS project working on the centralisation and scanning of paper records. 6) An updated procedure for weighing and measuring was disseminated to all School nurse staff and resulted in additional training for staff in these areas. It has been more difficult to arrange training for vision and audiology screening across CLCH due to the availability of trainers. There has been some local provision of audiology and vision training. Competent staff have assessed new staff whilst a training programme is developed for CLCH. Vision screening needs to be standardised across the 4 areas as currently the screening procedure for vision is different in each area. A working party of school nurses, professional leads and an orthoptist will be set up to review competency based training, with a view to implementing a standard across the service. 7) All of the school health team across CLCH have received the appropriate
level of Safeguarding Children training at levels 2&3. Key results Total incidents Jan-Dec 2011 by category Total incidents Jan-Dec 2011 by severity Degree of harm Low Minor Medium High Catastrophic 20 46 10 1 0 Level of reporting: In this service, incidents are recorded in every case. Near misses are recorded
in every case. Themes arising The greatest number of Datix incidents are in the IT/Information category. These relate to access to Rio and network services. There are also some trends around medication which relate to immunisations and there continue to be recorded incidents about health records. Safety Actions Expected Named lead Improvement completion date Actions for 2012 Standardised vision screening across CLCH. July 2012 Clinical education Purchase appropriate equipment. facilitator To ensure appropriate training and updates for all school nursing staff is Service manager arranged and undertaken. Service manager and professional lead Plan to initiate archiving three times per July 2012 Joan year for the school health service across Downer CLCH. Launch of the weighing and measuring March 2012 Alison protocol Wright Participate in the Simplifying Referral April 2012 Pam Management Programme and the EDMS Biggs/Marcia record scanning pilot Pinnock Continue with development of the Clinical On-going Marcia
Practice Guidance Group (Barnet) Pinnock Effectiveness Overview The service has standardised health related questionnaires across the 4 boroughs in order to be able to capture standard information and allow for parental permission to share relevant health information with schools. The successful uptake of the NCMP programme by schools has encouraged a standardisation of practice across the 3 inner boroughs. Teams across CLCH have linked both informally and formally with GP practices providing details of service provision and a named school nurse as a point of contact. The uptake of HPV vaccination continues to increase year on year. Healthy Lifestyle nurse is currently conducting a PROM on the effectiveness of her interventions with young people to manage and maintain a healthy weight. The results will be available in May 2012. Key achievements this year We identified the following clinical effectiveness improvement actions in our 2010 Quality Report. This section outlines the progress we have made on each of them: 1) Ensure that school nurses engage with family and friends in offering information re risks and benefits of HPV vaccination. Target parents evenings. Send information in a timely manner. This has been completed again this year as part of the HPV programme. Our results for dose one of the HPV vaccination this year has increased and at month 3 we have achieved 79.8% which is just short of the final result submitted last year at month 12. 2) Individual practitioners evaluate content and delivery of their HPV health
promotion session with pupils and staff. Formal feedback is given on the delivery and content to ensure information provided to pupils is easily understood relevant, up to date and evidenced based. 3) Dedicated web page on CLCH web site specifically for HPV information. Interactive question and answer page. This action has not been achieved this year and will be carried forward as part of the improved communication strategy for CLCH. The reception health questionnaire has been standardised across CLCH and includes a question to gather information about any cultural needs which would affect accessing the school health service. The questionnaire also asks for permission from parents or carers to share screening information with the school staff. The National Child Measurement Programme (NCMP) has been reviewed across the three inner boroughs in order to standardise practice. The standard written feedback to parents currently provided in Westminster and Kensington and Chelsea to parents will be offered in Hammersmith and Fulham in 2012. Since the integrating of the inner boroughs and further integration with Barnet, it has become apparent that we need a consistent approach to clinical standards and the application of NICE guidance across CLCH. Some of the mapping of this work is being completed by the pathway leads but to improve this further we are appointing a project worker for a short period of time to map review and implement consistent clinical guideline, standards in accordance with NICE across the 4 boroughs. School Nurse Service has been involved with developing an Asthma Protocol for School in collaboration with Asthma UK, parents and pupils. This will be rolled out across the 4 boroughs to be implemented with other schools. Key results PROM Planned PROM for next year will be monitoring the enuresis service following the introduction of the enuresis pathway. Clinical audit
The School Nursing service took part in the trust wide record keeping audit. Paper and electronic records were audited as the service uses both forms of health records. All four boroughs were involved and audited the following number of records: Barnet 31 Kensington and Chelsea 99 Hammersmith and Fulham 11 Westminster 144 The service achieved a mean compliance rating of 68.73% NICE Compliance Standards: CG2/1 Infection control CG2/2 Hand hygiene Depression in children and young people CG28 CG43 Obesity Constipation in children and young people CG99 Nocturnal enuresis - the management of bedwetting in children and young people CG111 Tuberculosis CG117 Autism in children and young people CG128 PUBLIC HEALTH Prevention of sexually transmitted infections and under 18 PH3 conceptions School-based interventions on alcohol PH7 PH10 Smoking cessation services Promoting children s social and emotional wellbeing in primary PH12 education Preventing the uptake of smoking by children and young people PH14 TBC TBC TBC TB TBC C TBC G G G TB TBC C G TB TBC C TBC TBC TB TBC C TBC G G TBC TB C
Promoting physical activity, active play and sport for pre school and PH17 school-age children in family, pre-school, school and community settings TBC PH23 School-based interventions to prevent smoking G PH32 Skin cancer prevention: information, resources and environmental changes TB C G TB C Nice Guidance is sent to all staff for information but there is a gap in identifying specific actions required of the school nurse service to ensure compliance for all NICE guidance. This work will be a priority for the service and an action plan developed as part of the work developed with the project lead. We are compliant with hand washing guidance and have also promoted this with in schools. We promote sun awareness in schools, smoking cessation and are involved in promoting health lifestyles to combat obesity. The school nursing service will be implementing a new pathway for enuresis from March 2012 which ensures the service is NICE compliant. The School Nursing Service is awaiting the DH recommendations for the School Nursing Service which is due to be launched in February 2012. This document will form the foundation for service delivery and re-design over the next year. What the The advice was very helpful patients say about the outcomes of Very helpful service. their care and treatment Clinical Actions Expected Named lead Effectiveness completion improvement date actions To set up a dedicated area on CLCH web page July 2012 School Nurse for parents carers and young women to access Team Leads information in relation to the HPV vaccination. with IT and
Communicati on Team. To standardise the feedback letter across CLCH to parents following the measuring of children as part of the NCMP. July 2012 Prof leads /SM Participate in the implementation of the Emerging DoH School Nurse Development Plan e.g. recruitment Due to be launched Feb 2012 Service Managers, Professional Leads and Pathway Leads. Standardisation and NICE lead project worker to be appointed to review clinical standards, application of NICE across CLCH March 2012 Experience Overview Last year the service surveyed the heads of schools to identify their views and experience of the school nursing service. The key improvement measure identified was around communication. The service has addressed these issues by ensuring that the contact details of the school nurse and service manager are available to all staff in school. Individual school work plans are discussed and agreed with the schools for the academic year. The School Nursing service developed a school health profile tool in conjunction with school staff which has been implemented in H&F and will be rolled out across CLCH. To support this document a service level agreement is being developed with the schools.
Key achievements this year We identified the following patient experience improvement actions in our 2010 Quality Report. This section outlines the progress we have made on each of them: Ensure all schools have the contact details of their school nurse and also the contact details of the service manager. This was achieved during the year and information has also been communicated to the GP practices. The School Nurses met with their schools identified lead to ensure at the start of the academic year school nursing contact details were readily available to school staff and parents via the schools information services. Profile schools in partnership with head teachers to identify need and future provision in schools. In Hammersmith and Fulham the profiles have been completed with the schools and work plans identified for individual schools for this current academic year. Topics included health promotion initiatives re oral health and personal hygiene which included hand washing. The School Health Profile will be rolled out across CLCH in 2012 to inform the individual schools work plan for the next academic year. When there is long term sickness or maternity leave the school nursing service provides continuity with the same person for the duration of cover. This outcome has been difficult to achieve because of recruitment difficulties. As far as possible cover is provided by the same person where we have been able to secure long term bank staff. Ensure robust systems are in place for handover between school nurses to ensure continuity of care. Although handovers take place between professionals there is no formal procedure or documentation to assist this. Handover notes are written with in case notes of the clients but this does not give an over view of the caseload. A formal procedure and documentation needs to be developed. Ensure the school nursing service explains and confirms understanding of the safeguarding processes especially in relation to social services referral with parents/carers. This year the school health service has developed a PREM to be used with pupils in the high schools. This questionnaire was given to each pupil who attended a
school nurse drop in or a 1:1 appointment. Patient survey results Patient surveys (known as Patient Reported Experience Measures PREMs) Summary of results for core patient experience measures (Aug-Dec 2011) Question Result for this service Trust wide average % patients/carers rating overall experience good or excellent % patients saying they were definitely involved in planning their treatment % patients saying they were always treated with dignity & respect % patients saying they definitely understood explanation 87% 93% 42% 56% 90% 92% 84% 88% % patients satisfied with waiting time 71% 74% Borough Borough Number % Barnet 192 35 H&F 75 14 K&C 45 8 Westminster 15 3 Not recorded 219 40
Sex Sex Number % Male 38 7 Female 473 86 Not answered 35 6 Do you have a long-standing physical or mental health condition? Number % Yes 60 10 No 435 80 Not answered 51 9 Was it easy to contact the service to make an appointment? Number % Yes always 296 54 Yes sometimes 140 26 No 16 3 Not answered 94 17 Were you satisfied with the advice given by staff? Number % Yes completely 459 84 Yes to some extent 67 12 No 9 2 Not answered 11 2
Would you recommend the service to others? Number % Yes definitely 401 73 Yes probably 117 22 No 10 2 Not answered 18 3 Which school year are you currently in? No (0%) service users answered this question. Why did you visit the school nurse today? Number % Advice regarding Asthma 1 0.2 Advice regarding my general health 4 0.7 Advice regarding weight/nutrition 2 0.4 Other 3 0.5 Not answered 536 98 Interpretation of PREM results 100% of young people said their overall experience of the school nurse contact was good to excellent and felt that they were treated with respect and dignity. 39% of young people reported they did not feel they were involved with their treatment. The school nursing service offers advice and support and does not treat young people therefore this low result could be partially attributed to the language used in the PREM. The feedback from the School Nurses was that the questionnaire was difficult for young people to complete and in many instances they required help to understand it. 35% of young people who responded reported that they had some difficulty contacting their school nurse. An action for the service will be to
strengthen the liaison with school staff to ensure that the contact details of the school nurse are promoted and readily available to pupils. PREM methodology The following table summarises the number of patients that responded to a PREM this year. Young people who attended the school nurse drop in or had a 1:1 appointment were given the questionnaire. The service provided a posting box so that the responses remained confidential. The overall number of completed questionnaires is significantly more than reported below but there have been difficulties with scanning and posting to freedom for health which has resulted in a low number for the reported results. PREM volume targets Total (Aug-Dec 2011) Number of patients who responded to a PREM 546 Total new referrals 2336 % of new referrals who responded to a PREM 231% Target % of respondents 15% Target achieved? Yes Compliments and Complaints Compliments and Complaints Number of compliments Jan 2011 Dec 2011: 5 Number of complaints Jan 2011 Dec 2011: 1 We have received 5 compliments two of which were in relation to the delivery of a catch up MMR campaign in one of our high schools. The School Nursing Team had to organise a catch up session at very short notice in the school working closely with the Health Protection Unit, Public Health and School Staff. Compliments were received from the HPU and from the public health director. We received two compliments in regards to health promotion activities, one from public health for our support for healthy eating campaign in the white city area
and the other from Cambridge School. Dear Pat, I would just like to say a massive "THANKYOU" to you and all your team for your organisation and contribution to the Health Day today. All of the pupils and staff, as well as the parents, who came to school, have done nothing but praise the variety and quality of the sessions. It has been fantastic to see the pupils engaging so positively and learning so much about aspects of life that are so important for them in a relaxed and informal manner. Here s to next year s event!!! Head teacher, Cambridge School. Compliment was for the work achieved in the enuresis clinic. Dear Rebecca, Thank you for calling yesterday to check up on our progress with J staying dry through the night. As you've predicted, things are improving greatly. I wanted to thank you for your time and advice; it was very helpful to talk to you about this matter and in general. I especially appreciated your detailed information regarding keeping the kids sufficiently hydrated and the very practical tips on how to check that they are. I am so pleased that you are available for us at school; I think it is very important for parents to have such an efficient way of getting the health advice they need. I think it makes it more likely that any problems can be spotted in good time and that the parents will be well advised of how best to proceed. Thank you again Just wanted to place on record how impressed I was with the rapid response to the recent diagnosis of measles on the Traveller Site at Stable Way, by the Health Visitor Ann-Marie Curran and by Sharon Hart, Clinical Lead for School Nursing and by the school nurses themselves. On the morning of last Friday, 22 nd July, Ann Curran was informed that St Mary s hospital had confirmed that one child had measles. I understand that she immediately checked medical records for the children and young people, including five pregnant women living on the site and contacted Sharon Hart. At midday, Ann and Sharon came to the site with three school nurses. By 4.30 pm, 13 immunisations had been administered and advice had been given to the pregnant women and to mothers of young babies.
The School Nursing Service received one complaint. This was investigated and the allegation was not proven. Patient user groups and focus groups Other qualitative feedback What the patients say None N/A CJ mentioned how much he appreciated the School Nurse's help. This is one of the reasons he has managed to progress at William Morris School. CJ is particularly impressed that the nurse comes to all his review meetings. Thank you for calling yesterday to check up on our progress with J staying dry through the night. As you've predicted, things are improving greatly. I wanted to thank you for your time and advice; it was very helpful to talk to you about this matter and in general. I especially appreciated your detailed information regarding keeping the kids sufficiently hydrated and the very practical tips on how to check that they are. I am so pleased that you are available for us at school, I think it is very important for parents to have such an efficient way of getting the health advice they need. I think it makes it more likely that any problems can be spotted in good time and that the parents will be well advised of how best to proceed. Letter from Reading recovery teacher at Queenswell Infant and Nursery school I would like to thank you for the valuable work that you have undertaken at our school. Specifically the eye-sight screening programme for children in their first year of full time schooling. I was concerned about one of our pupil s eye sight and felt it was seriously affecting her progress. Her family were not aware of a problem. Once the issue was raised with you, all was excellently co-ordinated.. The screening had revealed that the child should be referred to the eye specialist. You
initiated all of this and the child was fast tracked for the first available appointment. She began wearing glasses to compensate for severely reduced vision in one of her eyes At Queenswell we are fortunate to have such dedicated health professional as part of our team. We hope that your screening work will continue and help to identify needs. Patient Action Expected Named lead experience completion Improvement date Actions Develop formal procedures for the handover of July 2012 Service cases between school nurses where there is on- managers going health support but not safeguarding needs. Develop an audit with safeguarding leads to ensure July 2012 Named the school health service has explained the nurses team safeguarding process to parents in relation to their leads referrals to social services. Develop a more explicit patient experience tool for July 2012 S Heffernan use in the service in order to capture relevant information from users for future service improvement. Develop involving the child/young person in there July 2012 Service care- to review the results of the prem. In more detail managers and devise an action plan prof lead