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LNWH NHS TRUST
DAILY SAFETY BRIEF WARD TO BOARD
Mitchell Fernandez Head of Quality for Nursing, Midwifery & AHP
QUESTIONS: • How do we manage wards resources on a daily
basis including escalation process?
• What real time data available to make informed decision?
• Who are the decision makers in assessing ward/unit as safe in relation to staffing, patient acuity & dependency and other indicators?
LNWH DAILY SAFETY BRIEF:
• Development
• Challenges
• Flow Chart (Process & Escalation)
• Improved Experience and Better Outcomes
• Positive Consequences - Cultural Change
• Way Forward
TEMPLATE DEVELOPMENT
• Developed by corporate nursing team in collaboration with the Matrons and IT support
• Piloted in different wards and specialties for a month and feedback incorporated
• Ensure user friendly (mostly drop downs) and captures requirements in one template (CHPPD, A&D, fill rates & 1:1 specialling)
• Trust wide launch supported by the Chief Nurse (in house training and drop in sessions provided)
• Flow chart and guidelines developed for staff guidance
DAILY SAFETY BRIEF TEMPLATE
CHALLENGES
• Initial staff feedback - additional template to complete • Incorporated other checklists onto one template (electronic)
• User friendly and easy to complete (mostly drop downs)
• Safety brief – another handover • Engage staff in development
o Includes important issue for staff
o Start with things that matter to them
• Acknowledgement of good practices (100 days since last incident)
• Open and transparent – shared information available to frontline staff (inquisitive on what other specialties and sites were doing)
• IT support – staff training and shared drive created
DAILY SAFETY BRIEF ZONING & ESCALATION
PROCESS
DAILY SAFETY BRIEF ZONE SUMMARY
Completed
By
AM nikki grant 100% 100%
PM Evelyn Mc Caffrey100% 100%
AM Eugenia A B 133% 133%
PM Marvijoy M 133% 133%
AM Trisha 89% 100%
PM grace 89% 100%
AM reginam mankefor100% 100%
PM 0 100% 100%
AM HELEN ECIRU 100% 100%
PM HELEN ECIRU 100% 100%
AM v. fom 100% 100%
PM v.fom 100% 100%
AM M Lewis 100% 100%
PM M Lewis 100% 100%
AM Rose MKane 100% 100%
PM Mini Manoharan100% 100%
AM Clarissa Valencia91% 100%
PM C Carasig 91% 100%
AM Fiona Naughton 100% 100%
PM Fiona Naughton 100% 100%
AM Jhonarie Rinon 88% 100%
PM Anne Manuel 88% 100%
95% 95%
95% 95%
95% 95%
Total/Average AM
Total/Average PM
Zone Average
Gladstone 1
Gladstone 2
Gladstone 3
CCU
Defoe
Gaskell
Wards Name
RAG Score
Nigh
t
Month: March
Day
Zone/Site: Zone 2-NPH-
Medicines
Year 2017
Medical HDU
RRU
James
Jenner
Kingsley
ZONES QUICK GUIDE
BETTER EXPERIENCE AND OUTCOMES (2016-17)
• Identification of patient (Trust wide on daily basis) o1:1 specialling
oDOLS – daily average, LD (passport)
oCCP (Confusion Care Pathway) and carer’s passport
oRed trays (support)
oNEWS above 5 outside critical care
• 50% reduction in patient falls resulting to harm (SIs)
• 50% decrease in HAPU (grade 3 &4)
• Decrease in agency usage to cover staffing shortfall
POSITIVE CONSEQUENCES:
• Positive feedback on having real time information available to front line staff
• Wards’ ownership on assessing ward as safe for the day
• Cultural shift (below 100% fill rate not necessarily means unsafe)
• Informed decisions based on: • Staffing fill rate, patient A&D, occupancy rate/activity • Safety (specialling, risk of absconding , falls, PU, NEWS)
• Promote sharing of resources within the Zone (team work)
• Staffing shortfalls are now usually resolved within the Zone
• An opportunity where short updates are cascaded, best practice shared and issues highlighted for learning
ADVANTAGES:
• Bespoke template and programme developed locally with the frontline staff – FREE and staff buy in (ownership)
• Enable modification with no additional cost
• Promote transparency and working together
• Allow staff and senior managers to make informed decisions based on real time information
Daily Safety Brief – wards/units to board report
• Daily safety brief reported to the Trust Board through the monthly Nursing, Midwifery & AHP Safer Staffing Report presented by the Chief Nurse
• Report includes the following: o Staffing levels
fill rates, CHPPD, vacancies, sickness, etc.
o Patients’ A&D, case loads o Incidents reported o Patient experience (complaints, FFT) o Finance – temporary staffing usage
(bank & agency, 1:1 specialling RMN)
WAY FORWARD:
• District Nursing (DN) safety brief template roll-out
(staffing level, case loads ratio, patients allocation/units, safety incidents) by locality
• AHP template development o currently in placed on bedded units
oCommunity services to follow
• Incorporate nursing, AHP and medical staffing
DAILY SAFETY BRIEF DISTRICT NURSING SERVICE
DD_Z1SM London North West Healthcare
NHS Trust
Date 24 Year 2017 Time:
To be completed daily (8:30am)
ACUITY & DEPENDENCY SCORE
Number of patients on caseload (planned) 10
Number of patients seen (actual) 10
>120%
1 7.5 4.5 11.5 7.5 0 1 Day <75%
7.5 4.5 11.5 7.5 0 0 Night 76%-89%
1 0 0 0 1 90%-120%
Permanent Bank Hours Agency Permenant Bank AgencyTOTAL
STAFF
Early 1 7.5 0 0 0 0 0 1 Planned Actual
Late 0 0 0 0 0 0 0 20.0 20.0 Therapist
Long Day 0 0 0 0 0 0 0 20.0 20.0 Support Worker
Night 0 0 0 0 0 0 0 All staff
No. of MDT meetings attended 0 No. of complex caseload (Physical) 4 No of complex caseload (Social) 4
PATIENT'S DEPENDENCY
MDF Nov 2015
100%
Support Worker 0%
PLANNED STAFFING
SHIFTS EarlyNo of
HoursLate
No of
Hours
Long
Day
No of
HoursNight No of Hours
All Staff
Total
Staff
0.00
SITE: Northwick Park Hospital NHS
LOCALITY: CoE (Care Of Elderly)
COMPLETED BY: CHRISTOPHER THINAGAR Month June 8:30 AM
In-patient Template - Allied Healthcare Professionals
Management
Clinical Hours
STAFFING
Staffing RAG Score
Therapists
Therapist
TOTAL
ACTUAL STAFFING NUMBERS
Therapist
SHIFTS
Patient to Staff
ratio
Support WorkerCare Hours per Pt.
per day
0.75
Students -
Supernumerary
0.75
BACK TO TOP
DAILY SAFETY BRIEF AHP
Questions?
Breakout 2
Foyer area:
• Improvement cinema
• Q networking lounge
Nursing and AHP-led
improvement
• Bishopsgate 2
Co-production
• Bishopsgate 1
Creating a culture of
high performance
• Broadgate 2
World café
• London Wall
Involving board
members in QI
• Broadgate 1