Making a DifferenceManagement Programme for Staff Nurses and Staff Midwives

“The hand that touches the patient, makes a difference.”

Dr. Margaret Maher McGuire

Care Assurance Standards

&

Excellence in Care

Why do we need an Assurance

System?

Care Assurance Standards

1. Tissue viability (PUDRA)

2. Falls

3. CAUTI

4. Deteriorating patient

5. Medicines Management

6. Pain control

7. Standard Infection Prevention & control

8. Food, fluid & nutrition

9. Person centred care

10. Older adult

11. End of life care Effective management of resources & staff governance

12. Working effectively in the Multi-disciplinary team

OPAH

HAI

CARE ASSURANCE

SPSP

Person Centred

Excellence in Care

Deteriorating Patient

The Older Person

Falls

Patient centredcare

Pressure ulcers

Quality care delivery

Patient centredcare

Guiding Principles Of Excellence

in Care (EiC)• Listen & hear both practitioners

• Reduce data burden

• Develop EiC in collaborative & co-production

manner

• Support the Nursing & Midwifery workforce to

flourish

• Mobilise the use of information technology

• Have consistency across NHSGGC &

Scotland

• Build on a culture of continuous improvement

Quality of Care Review Framework

SafetyPreserve Safety

Working within the levels of

competence to deliver safe care

GovernanceThe nursing narrative describes

the formal and informal

governance mechanisms for

monitoring nursing standards

and delivery of person centred,

safe, effective nursing care .

WorkforceEnsuring the nursing workforce

is composed of the right

numbers with the right skills in

the right place

Quality ImprovementThe nursing narrative describes current

nursing quality improvement interventions

and mechanisms to identify areas where

the standards are not being met and can

describe how improvement will be

undertaken and measured.

Excellence in Care Framework

CultureThe nursing culture advocates values

and behaviours that promote

psychological safety and learning.

SustainabilityThe nursing narrative describes

how information is used to

demonstrate sustainable

improvement and to anticipate

problems and prepare to

prevent recurrence.

Person CentredPrioritise People

People who receive nursing care and

services are treated with dignity and

respect. What matters to them is put

first.LeadershipPromote

Professionalism and Trust

To explore, identify and or

develop

indicators/measures that

can be used to demonstrate

honesty, integrity and

leadership that inspire

confidence.EffectivenessPractice Effectively

Assess and deliver care and

treatment based on best

evidence and practice.

SafetyPreserve Safety

• NEWS Rate

• Development of a

nursing/midwifery HAI measure

• Medication administration

OMMISSION rate (across most

fields of N&M)

EffectivenessPractise Effectively

• Pressure Ulcers Rate

• Falls Rate

• CAUTI –for further review

• Test compliance with Nutritional

Care Assessment bundle

• Test a Record Keeping Bundle

Person CentredPrioritise People

• 5 must do’s with me

• Percentage of PDPR’s/EKSF

Narrative describes other Board

initiatives such as

•You said, we did

• This is me

LeadershipPromote Professionalism and Trust

• Number of Upheld Nursing

Complaints

• Quality of the learning

environment = QMPLE score

• Explore development of a measure

for caring/professionalism

GovernanceThe Board level Nursing narrative

describes the formal and informal

governance mechanisms for

monitoring nursing standards and

delivery of person centred, safe,

effective nursing care .

Workforce• Sickness Absence Rate

• Nursing Vacancy Rate

• Safe staffing levels - use of

workforce tools and actual

establishment

• Supplementary Staffing use and

costs

Quality ImprovementThe Board level nursing narrative describes

current nursing quality improvement

interventions and mechanisms to identify

areas where the standards are not being met

and can describe how improvement will be

undertaken and measured.

• Number of N/M QI leadership

qualification

Excellence in Care Framework

Adult In-Patient

Culture• iMatter – EEI above 67

The Nurse Director can describe any high

level themes and associated actions.

Patient Opinion Data

The Nurse Director can describe how

nursing feedback is sourced and used

SustainabilityThe narrative also describes how

the information is used to

demonstrate sustainable

improvement and to anticipate

problems and prepare to prevent

recurrence.

SafetyPreserve Safety

• NEWS Rate

• Development of a

nursing/midwifery HAI measure

• Medication administration

OMMISSION rate

EffectivenessPractice Effectively • Each Nursing and midwifery family to

identify key indicators

Person CentredPrioritise People

• 5 must do’s with me

• Percentage of PDPR’s/EKSF

Narrative describes other Board

initiatives such as

•You said, we did

• This is me

LeadershipPromote Professionalism and Trust

• Number of Upheld Nursing

Complaints

• Quality of the learning

environment = QMPLE score

• Explore development of a measure

for caring/Professionalism

GovernanceThe Board level Nursing narrative

describes the formal and informal

governance mechanisms for

monitoring nursing standards and

delivery of person centred, safe,

effective nursing care .

Workforce• Sickness Absence Rate

• Nursing Vacancy Rate

• Safe staffing levels - use of

workforce tools and actual

establishment

• Supplementary Staffing use and

costs

Quality ImprovementThe Board level nursing narrative describes

current nursing quality improvement

interventions and mechanisms to identify

areas where the standards are not being met

and can describe how improvement will be

undertaken and measured.

• Number of N/M QI leadership

qualification

Excellence in Care Framework

Generic

Culture• iMatter – EEI above 67

The Nurse Director can describe any high

level themes and associated actions.

Patient Opinion Data

The Nurse Director can describe how

nursing feedback is sourced and used

SustainabilityThe narrative also describes how

the information is used to

demonstrate sustainable

improvement and to anticipate

problems and prepare to prevent

recurrence.

Excellence in Care

Hub

National Team

eHealth Lead

EIC Leads

National Imp

Programme reps

Group three Indicators

Nutrition and hydration

QMPLE

Workforce

Qi Qualification

Person-centred care

Professionalism

Healthcare Acquired infection

Medicines omissions

Nursing and Midwifery Families

Indicators

Children and Young

People

Paediatrics

Midwifery

Community nursing

Adult in patients

Learning disability

Mental Health

Specialist Dementia

NHS 24

Design and

develop measures

Design based on Quality of Care Review process

Measures to integrate across all improvement areas

Identify measures for all N&Mand build

dashboard by 2019

Identify NHS

Board Leads

Clearly identify leads at AND/CN and Senior

nurse levels for all N&MFamilies

Develop and support networks

who will drive development and implementation

of EIC

Build capacity

and capability

Nursing and midwifery capacity and capability required to develop and deliver Excellence in Care and to drive improvement

Expert

Coach

&

Practitioner

Measures

will be the

quality

indicators for

Safe staffing

All measures

and

approach

to EIC to

be co-

produced Capacity

should be

the

square

root of

the

workforce

How do we Measure the quality

of the Standards Currently

• Falls safety cross (datix)

• Pressure ulcers safety cross (datix)

• NEWS compliance (SPSP excel sheet)

• Patient carer feedback (cards, patient

opinion, complaints)

• Hand hygiene

Why is

Quality

Improvement

really

important?

Making a Difference• Aimed band 5 nurses/midwives

• 2 day programme (delegates must attend in

same month)

• Content Quality improvement, learning

environment, professional issues

• Only staff nominated for that month should

attend

• Information emailed to delegate prior to

course

• E-evaluation link sent out post course and

upon completion they receive a certificate for

revalidation purposes

Making a Difference• Approximately 25 places South sector

per month (dates planned until June

2018 apart from January

• Opportunity for staff to meet Chief,

Associate chief nurses from their

sectors/directorates

• Builds capacity in terms of have QI

knowledge within the clinical

environment

• Good preparation for link nurse role

A&A BOR D&G FIFE FV GR GGC HL

49 15 21 43 33 62 172 36

AIM TO HAVE 172 NURSES IN

NHSGGC AS QUALITY

IMPROVEMENT LEADER

If the 690 lead level practitioners were spread

proportionately across Scotland’s health boards the

numbers would look like those above.

How do you improve Quality of

care within your clinical area at

the moment?

• Work harder??

• Put it down to being short staffed?

• Ignore it?

• Think its some-else’s job?

• Pray......?

• Don't know were to start?

Quality Improvement• Who can do it ......ANYONE

• It can be simple or complex dependent on

your improvement.....but keep it simple

• Taking an idea and test it to improve care

• Something your a passionate about

• Keep testing small scale

• Think about & engage your team

• Communicate it to everyone

• Sell your improvement

• Measure your impact

• Celebrate & Share

Care Assurance Improvement

Resource (CAIR)• NHSGGC dashboard (under

development/testing)

• Will be able to demonstrate the

assurance of care in the ward

environment (e.g pressure ulcers,

NEWS compliance, Falls etc)

• Will pull information from existing

systems like STSS, Datix etc

• Overall aim to be utilised across

NHSGGC acute by late 2017

Care Assurance Improvement

Resource (CAIR)• NHSGGC dashboard

• Will be able to pull information from

existing systems like STSS, Datix etc

• Ability data entry (next phase of

development)

• Testing in May 2017 (to gain feedback)

• 10 wards in each of the sectors

• Testing: PUs outcome measures, Falls

outcome measure, Hand hygiene,

SCIPs, Workforce