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Contact: (0191) 223 1407 - Ms Elaine Coghill, Senior Nurse, Service Improvement
There are three new initiatives currently in progress to improve patient care throughout the Trust. The first is the Productive Ward Programme that helps staff organize their ward using improvement techniques from industry. The main tasks are then redesigned to ensure they are patient-focused and easier for staff. This then links in to the second initiative “Being with Patients” that shifts staff attitudes and behaviours and gets them to consider ‘how we are’ is as important as ‘what we do’. Central to this work succeeding is having effective nurse leaders, i.e. the ward Sister/Charge nurses. Work is already being undertaken to strengthen their role.
The Productive Ward
The Releasing Time to Care: Productive Ward Programme has been developed by the NHS Institute for Innovation and Improvement (NHS II&I) to show nurses how to apply improvement techniques to their work on wards. The basis of this work shows that ward based nurses spend less than 40% of their time on direct patient care with the rest spent on activities such as paper work and administration, handovers, discussion with other staff and seeking equipment.
Project Plan
The project plan was extremely ambitious with 7 to 10 new wards being added every month. A total of 55 wards will have undertaken the programme within 6 months. The wards selected to be part of this intense 6 month programme can be seen in appendix one. Wards soon to move into new ward environments, critical care areas, theatres and outpatient areas have been omitted from the 6 month programme plan.
Ward Processes
The NHS II&I have in four pilot sites, on one ward examined various ward processes including patient observations, admissions and discharge management, shift handovers, meals and medicines over a six month period. This Trust aims to examine patient observations and meal rounds in all fifty seven wards over the six month period. The 5 "s" lean technique (Sort, Set in order, Shine, Standardize and Sustain) will also be applied on each ward.
Measuring success
Specific key measures will be examined as a baseline, throughout the six month period and after the six month roll out has completed. These include: MRSA/Clostridium Difficile infections, pressure sores, falls, absenteeism, patient satisfaction, staff satisfaction, bank and agency spend, ward cost/patient spell and length of stay.
Being with Patients
Being with Patients utilises a whole range of teaching and learning techniques in order to change and enhance practice. The programme is delivered by Trust facilitators and an action learning company. The programme uses patient’s experiences of care:
- To positively influence understanding of what it means to be a patient
- To reflect on practice and feel valued for caring behaviours
- To acquire practical strategies to enhance patients’ experiences of care
The Trust has already undertaken 4 awareness days and 2 enhanced skills programmes and feedback has been very positive. Formal evaluation has also been undertaken.
Click here to find out more about our development programmes.
Strengthening the role of the Sister/Charge Nurse
The Sister/Charge nurse role has been described as 'the guardian of care' yet many feel that new management responsibilities has diverted their attention away from clinical quality. This evolution of the role over the years has raised problems of workload capacity, which has in turn affected their recruitment and retention. Moreover, the responsibility of twenty four hour accountability discourages less junior nurses from applying for these senior roles. Within the Trust work has already begun to examine the Sister/Charge nurse role and initiatives have been implemented to strengthen this role, including an induction portfolio.
Learning Disabilities News
Nearly ten years ago two main National Reports for learning disabilities, “Signposts For Success” (DH 1998) and “Once a Day" (DH 1999) identified basic changes that secondary care and General Practitioners practices needed to make to improve services for people with learning disabilities. This included early detection of illness and fair and equal access to treatment. This was again reinforced in 2001 in the Valuing People Report (DH 2001) which also identified that there was a lack of clear, accessible plans and support systems for people with learning disabilities to navigate through the health system. Over the last two years there have been many publications to suggest that the health service is still not meeting people’s needs that have learning disabilities. More recommendations have been published in light of reports of poor practice which the Newcastle Hospitals have reviewed and examined recommendations.
A review of the number of patients admitted to the trust with learning disabilities was undertaken from January 2007 until the 22nd February 2008. Conditions incorporated as being associated with learning disability were included after consulting the MENCAP definition. These included the following conditions: cerebral palsy, downs syndrome, attention deficit, autism, fragile X and asperger’s. Dyspraxia, dyslexia, epilepsy, Rett Syndrome and fetal alcohol were not included. A total of 1288 patients were admitted to the Trust with a recognised learning disability. Of these 727 were elective and 561 non-elective patients with 52% under the age of 21 years.
Treat me right (Mencap 2004) called for more learning disability training for all staff. One particular initiative within the Trust is a learning disabilities guide that has “Ten Top Tips” to assist nurses when caring for patients with learning disabilities (appendix three). This has been developed in collaboration with the local learning disability partnership in Newcastle and includes a website address offering education and links that staff can access regarding learning disabilities and information on where staff in the Trust can get support and advice. The website is currently being developed and to access go to : http://www.easyhealth.org.uk/
