Embed Size (px)
Citation preview
Nursing & Midwifery News
Nursing Together in Newcastle
February 2014
The need to keep our patients ‘harm free’ is a key message in the opening
remarks of this edition of the Nursing and Midwifery Newsletter. The Safety
Thermometer was developed nationally as a point of care survey tool to
provide a ‘temperature check’ on the quality of care offered to our patients.
The data provided by the Safety Thermometer is used alongside other data
to measure improvement, however delivering ‘harm free’ care is more than
measuring the care given on one day (on Safety Thermometer day) but is
the demonstration of improvement that can be and is sustained and
embedded in our care.
I am aware that not everyone likes the term “harm free care”, however it is currently recognised
terminology and, regardless of how we describe it, I am sure we are all in agreement that patients
should always be kept safe, and with risks avoided. The published results of the Safety Thermometer
demonstrate how well the Trust currently performs in this respect www.safetythermometer.nhs.uk/
The concept of “harm free care” has been applied to pressure ulcers and is a good example of
changing practice and attitudes. Pressure ulcers are no longer considered inevitable in the very sick
patient and are mostly avoidable with simple skills as implementing strict repositioning regimes and
adherence to the skin care guidance. In recent months we have all signed up to a zero tolerance to
the development of pressure ulcers to patients in our care, from Ward to Board.
I am very aware that signing up to zero tolerance is only a first step and the reality of ensuring that
pressure ulcers do not develop on our watch remains a challenge for some clinical areas. However,
many wards have achieved 60 days or 100 days pressure ulcer free days. Their achievements are
based on hard work, team building, good leadership and a changed attitude to harm free care.
My congratulations go to:
Ward 19 FH (100 days); Ward 52 RVI (60 days); Ward 16 RVI (100 days), Ward 46 RVI (100 days);
Ward 12 FH (100 days); Ward 5 FH (100 days); Ward 13 (192 days);
Ward 23 RVI (60 days; Ward 42 RVI (100 days); Ward 44 (60
days); Ward 6 FH (100 days); Ward 5 RVI (100 days) and
finally Ward 32 FH (150 days).
Thanks to you all for your continued hard work Helen Lamont Nursing and Patient Services Director
February 2014 2
The Adult Speech and Language Therapy Service will be providing 6 training sessions focused on improving awareness of swallowing difficulties for patients in acute and rehabilitation settings. The aim of the sessions are to increase knowledge and recognition of dysphagia, to increase awareness of how to help people with dysphagia, and to be aware of your role in look-ing after patients with dysphagia. Staff who are involved in the management of patients with dysphagia e.g. ward housekeepers, healthcare assistants and qualified staff are strongly encouraged to attend. If you have any queries about the course content or would like to book a place for yourself or any of your staff on one of the sessions below, please email [email protected]
or contact (0191) 2824324 (24324 if dialling internally).
Monday 3rd
March – FH Level 7 Seminar Room (1.15 – 2.30pm)
Wednesday 16th
April – Radiology Meeting Room, Level 3, New Victo-
ria Wing, RVI (1:15-2:30pm)
Monday 9th
June – FH General Medical Seminar Room Level 6 (1.45 –
3.00pm)
Wednesday 16th
July – Radiology Meeting Room, Level 3, New Victo-
ria Wing, RVI (1:15-2:30pm)
Wednesday 24th
September – FH General Medical Seminar Room
(1.15-2.30pm)
Wednesday 5th
November – Neurology Clinical Meeting Room, Level
5, New Victoria Wing, RVI (1:15-2:30pm)
Dysphagia Awareness Training for Housekeepers, HCA’s and Registered Nurses
February 2014 3
Dear SR ANTT, I am confused as to who can actually assess staff as competent in ANTT. Can you help? There has been some confusion re ANTT competency assessment lately, so I am happy to explain the process. When ANTT first came into the Trust nearly 3 years ago, all clinically active staff who undertook any type of intervention which breached the patient’s skin/gums, accessed an IV device or inserted and accessed a urinary catheter were required to be assessed as competent in ANTT. An expansive series of ‘ANTT explained’ sessions were run to introduce the concept, followed by many ‘Cascade Trainer’ sessions, which were designed to ensure that every clinical area had someone who was trained to assess others as competent in ANTT. Cascade trainers were advised to train a core group of at least 50% of their staff on the wards. Once trained, these newly-assessed staff members could then safely assess their colleagues in clinical practice too, through a Peer-to-Peer process. This is no different to the way we currently competency-assess people in practice for a wide range of skill assessments, in many different areas. Assessment documents can be found on the Trust ‘Saving Lives’ welcome page. The Asepsis page is accessed by clicking on the Asepsis ‘bubble’. Just scroll down and print off the ANTT Competency Tool. Please note: the ‘DOP’ tools are for medical staff only. Once assessed as competent, a record should be held at ward level of who has passed their competency. The original competency document should remain with the person who passed it, so they can show it if required. Cascade trainers were issued with an online format with which to maintain records of assessment, but if any line manager would like this for their own area, just email me on [email protected] and I am happy to oblige! If you have no cascade trainer for your area, then please keep an eye out for new Cascade Trainer sessions which will be advertised in the next month. If you have a staff member who was a cascade trainer elsewhere, they can continue in the role in your area too. Do clinical staff have to be competency-assessed for both Standard and Surgical ANTT? Staff can be assessed as competent in either or both! The ANTT competency looks to assess the principles underpinning the application the ANTT approach whilst protecting the key parts and key sites from contamination at all times no matter what the procedure!. Therefore, staff assessed as competent in Standard ANTT should be competent to apply the same principles to Surgical ANTT too. That being said….there is nothing wrong in being assessed as competent in both! Lastly…..if relevant to your role, are you and your colleagues ANTT competent? By now, all clinically active staff should be! I am always happy to offer advice, so do sent me an email or telephone me on my DECT on
48414!
The ANTT Column
February 2014 4
When the environment is wrong it
can lead to ………….
Increased incidence of slips, trips and falls Behaviour which challenges e.g. walk-ing a lot, withdrawal from noise in-creased anxiety. Frustration and anger Boredom Loss of independence
How can we help? By thinking about the environment and plan-ning in advance, and using the principles of good design for dementia we can;
Reduce over-stimulation Provide orientation, particularly in
place and time Improve socialisation and interaction Promote independence and enhance wellbeing Maintain personal dignity. Reduce falls
We need to consider Sensory changes; i.e. deteriorating hearing and vision. Colour and con-trast become more important (contrasting seats on toilets, handrails etc) Familiarity; objects that look familiar or even domestic in nature e.g. clocks that are analogue rather than digital. Wayfinding; personal objects at a bed-side can help patients locate their bed, clear signage can help someone locate a toilet and maintain their independ-ence and dignity.
The Dementia Environment Group has
undertaken a lot of work designed to
make improvements to the environment in
which we care for people with Dementia.
Perhaps unsurprisingly, most of this work
has focussed on wards at the Freeman
Hospital and CAV where a high proportion
of people may have Dementia.
Many of these changes could also be
applied in other wards or departments
and in October 2013 we had ‘roadshows’
at Medicinema RVI and the restaurant,
at Freeman hospital which attracted a lot
of attention (perhaps it was the sight of
two toilets standing at the top of the
escalator at RVI or just inside the
restaurant!!).
Soon we hope to have a directory of
‘dementia friendly’ equipment which you
will be able to find on the Intranet under
‘D’ for dementia.
Suzanne Medows
Senior Nurse Practice Development
Improving the environment for Dementia Care
February 2014 5
The Nurse Staffing Review
NEW - Forum for Bands 2 - 4 clinical staff Some dates have been planned for a new forum for bands 2—4 Clinical staff
working in roles which will include, Nursing Healthcare Assistants, Therapy
Assistants, Assistant Practitioners, Housekeepers, (Staff in other roles are
welcome to attend). Please note the following dates for your diaries;
Tuesday 1st April, 1 – 3pm, Lecture Theatre, IOT, Freeman Hospital
Thursday 26th June, 1 – 3pm, Function Room 137, Freeman Hospital
Friday 28th November, 1 – 3pm, Lecture Theatre Sir James Spence, RVI
If you work in one of these roles please come along, you will have the oppor-
tunity to shape the agenda for future meetings. I look forward to seeing you.
Suzanne Medows
Senior Nurse Practice Development
The Nurse Staffing Review is progressing well across the Trust.
Key achievements include:
A review of inpatient nurse staffing numbers & skill mix in close collaboration with ward sister and Matrons. Introduction of Safer Nursing Care Tool (SNCT) on adult inpatient wards. Inclusion in national work to develop SNCT for ED, Children's and Midwifery areas. Inclusion of staffing data and nurse sensitive indicators incorporated into CAT from April 2014 in a new ‘Care summary’ page. Review and development of job descriptions. On-going work to identify ‘supervisory ‘ time for ward sisters & charge nurses . Development of a Nursing & Midwifery Staffing Strategy – to be published soon. Development of ‘strengths based recruitment ‘ for ward sisters/charge nurses, to be rolled out to other bands/roles. Significant investment into new nursing posts. Development of new roles, including Assistant Practitioner ( nursing). Development of a Nursing & midwifery recruitment & retention Group- the picture above shows the team at a Recruitment Event in Glasgow. Monitoring of recruitment timelines.
For any further information, please speak to your Matron or Karen Coles/Fiona Thompson, joint NSR leads or Liz Harris head of Nursing RVI
February 2014 6
Jilly Goodfellow and Janine Gradwell are the nurse colposcopists’ in the Women’s Health Unit at the
RVI. After a discussion with the learning disabilities nurse for the Trust we realised there was not
an information leaflet for women attending for colposcopy examination who have a learning disability.
The National Health Service Cervical Screening Programme (NHSCSP) has an information leaflet for
these women who require cervical screening (smear test) but not for the colposcopy visit so we de-
cided to develop our own innovative leaflet. There are a number of studies that recognize that this
vulnerable group of women has an increased likelihood of not attending for screening and therefore
colposcopy examination due to a fear of the actual examination because of a lack of understanding,
this puts them at a significant increased risk of developing a potential cervical cancer in the future.
We wanted to ensure these women had information about their colposcopy clinic appointment or
treatment in an easy read / understandable format and therefore not marginalizing them from
screening. We would hope after reading / looking at the leaflet on their own or with their advocate /
practice nurse this would encourage attendance at colposcopy and be less anxiety provoking.
We wanted to show this information in a pictorial way with a short amount of text. The leaflet ex-
plains the colposcopy examination, the environment and the staff the women would meet. We staged
and took the photographs ourselves using a member of staff as the patient and the advocate. None
attendance for colposcopy is the biggest risk factor in the development of cervical cancer (NHSCSP
2012) so hopefully the leaflet will allay women’s fears and encourage attendance. The draft leaflet
was taken to a patient focus discussion group to ensure the wording was correct and the women could
understand the information we were trying to convey. The Trust has now ratified the leaflets and
they are available on the Trust website in the easy read information section. We were extremely
proud to win the poster presentation at the Newcastle Nursing and Midwifery conference in June. If
any GP’s or practice nurses would like to download the information from the RVI website then please
click on the links below or contact me on 0191 2825670 or [email protected]
http://www.newcastle-hospitals.org.uk/downloads/Womens%20Services/
Colposcopy_Clinic_what_happens_here_-_easy_read.pdf
http://www.newcastle-hospitals.org.uk/downloads/Womens%20Services/
Practice Education Conference - Tuesday 8th April 2014
A day of sharing contemporary methods
and views around Practice Education.
Keynote Speakers to include:
Karen Giles, Health Education North
East.
Workshop sessions to include:
The Failing Student
Innovative Teaching
Multi-Professional Learning
And more to be confirmed.
Open to all Nurses and Allied Health
Professionals from The Newcastle upon
Tyne NHS Trust
Full Program to follow
To register your interest early, or for
more information, please contact:
Sorcha McLaughlin
Preceptorship Co-ordinator
Ext 39533
Barbara Foggo
Practice Placement Facilitator
Ext 38082
Women’s Services: A new and innovative easy read information leaflet for
women attending for colposcopy examination who have learning disabilities.
February 2014 7
New Competency Assessment Tools
All of these Clinical Competencies can be found on the following intranet page http://nuth-vintranet1/cms/SupportServices/PatientServices/ClinicalCompetencies.aspx
Name of Competency Assessment Document Date Published Where Published
Urethral catheter insertion (Adult) Competency as-sessment document
September 2013 Patient Services Webpage
AMT nasal tube retaining device (often called ‘nasal bridle’) insertion & management - compe-tency assessment document
October 2013 Patient Services Webpage
Patient-Controlled Analgesia (PCA) Competency assessment document
October 2013 Patient Services Webpage
Physiological Observations: Competency and As-sessment of Assistant Practitioners (Nursing)
October 2013 Patient Services Webpage
Assistant Practitioner - Administration of enemas and suppositories
October 2013 Patient Services Webpage
Assistant Practitioner - Intravenous cannulation October 2013 Patient Services Webpage
Assistant Practitioner - Urinary Catheterisation October 2013 Patient Services Webpage
Clinical Supervision
Master Class Sessions for Clinical Supervisors
5.3.14 1400 1600 Seminar Room 2, Sir James
Spence Centre, RVI
24.3.14 1400 1600 Classroom 2, Education Centre,
FH
25.4.14 1400 1600 Classroom 2, Education Centre,
FH
15.5.14 1400 1600 Seminar Room 1, Sir James
Spence Centre, RVI
25.6.14 1400 1600 Function Room 138
Education Centre, FH
10.07.14 1400 1600 Seminar Room 1, Sir James
Spence Centre, RVI
To book a place please contact- Carol Gilhespy or Sorcha McLaughlin
Preceptorship Co-ordinators
Room 88D, Freeman Hospital,
Telephone ext– 39533/48054
email: [email protected] or [email protected]
February 2014 INFECTION PREVENTION AND CONTROL
Diarrhoea and C. difficile Care Pathway Compliance Audit
Infectious diarrhoea such as C.difficile can be readily transmitted between patients causing increased morbidity and mortality. Outbreaks of norovirus can have a significant effect on the functioning of healthcare organisations and the healthcare economy. It is therefore essential that patients who develop diarrhoea are assessed and managed appropriately to reduce the impact to patients, staff and visitors as well as the hospital as a whole. Integrated Care Pathways (ICP’s) enhance delivery of high quality patient care ensuring consistency across all disciplines. ICP’s are tools which incorporate local policies, manage clinical risk and meet the requirements of clinical governance
1.
The findings of the audit demonstrated that 86% of patients were isolated after the first episode of diarrhoea as per Trust policy, and the care pathway was commenced in 97% of cases. Reassuringly 100% of care pathways were commenced for C.difficile although occasionally they were incomplete. The Isolation Policy states that the cubicle door must be kept closed unless an assessment dictates otherwise. Compliance with the door being closed at the time of the audit was 59%. Of the 41% of doors left open only 15% had documented why the door was open. There are several sections of the pathway which must be completed to document that the patient has been managed correctly. The findings demonstrated that of the 32 care pathways audited, the stool chart was completed in 81% (26) of cases, a medical review had been documented as undertaken in 66% (21) of cases,
the section on isolation had been completed in 61% (19) of cases and the reason for isolation being discussed with the patient in 41% (13) of the cases. Unless clinically indicated a specimen should be sent for testing on the second episode of diarrhoea of unknown cause in 24 hours unless clinically indicated however these occurred in only 60% of cases. In 63% of the cases where information was documented only 25% had sent a specimen on the second episode of diarrhoea as per Trust policy.
25% sent specimens after 3 episodes, 5% sent specimens after 4 episodes and 10% sent specimens after more than 10 episodes of diarrhoea (the reason for the latter is unknown however these were C. difficile negative patients). 35% had sent specimens for testing after only one
episode of diarrhoea, however in all of these cases there was a clinical indication for doing so. Recommendations
Circulate and present the findings to all appropriate staff groups
Set up a multidisciplinary working group to review these pathways, to ensure they are in line with current national guidance and Trust policy,
and are easy for staff to understand and complete.
Continue education on the use of the pathways through IPC mandatory training programmes, Enhanced Induction, the Healthcare Assistant Academy, ward based staff education during IPCN visits and dissemination of lessons learned during investigations such as RCAs and Serious Investigation
Meetings
Re-audit compliance in 6-8 months
February 2014 9
Hand Hygiene Awareness Day
The Hand Hygiene Awareness Day on 23rd
January 2014 welcomed Julie Storr and Claire
Kilpatrick, two experts in the field of Infection
Prevention and Control and advisers to the World
Health Organisation.
They held two workshops;
THINK HAND HYGIENE:
CHANGING BEHAVIOURS
one at the RVI and one at Freeman on the
understanding and implementation of the 5
moments for hand hygiene, giving new
perspectives on the importance and practical
application of this key practice. Thank-you to those
who attended, many of whom left having gained
much from the event to take back to their areas to
improve hand hygiene.
The day also included stands at the main entrances
to increase public awareness of hand hygiene and
information for staff on the new hand hygiene
products, effective hand care tips and the new hand
hygiene posters.
February 2014 Infection Prevention and ControlInfection Prevention and Control
Preventing Norovirus - what you can do?
Gel your hands when entering and leaving ward and depts. Contact your IPCN if you have 2 or more patients with diarrhoea/vomiting Isolate all patients with diarrhoea of unknown cause as soon as pos-sible Wash hands with antiseptic soap and water when caring for symp-tomatic patients Refrain from work for 48 hours
after your symptoms have stopped
Fit testing – you must be fit tested ONLY if:
You may be involved in aerosol gen-erating procedures on patients with pulmonary TB or influenza. These include: Suctioning
√ cough inducing procedures
√ use of high speed devices in sur-gery
Your ward/dept. needs a fit tester to complete fit testing
You must have a supply of FSM16 Easimasks – order details:
FSM Easimask, BTP059, 30 per box.
IPC Education Forum for Nurses
Nursing focused topics and discussions 2-3pm on the following dates:
√ Tuesday 11th February Lecture Theatre, Sir James Spence Education Centre, RVI
√ Wednesday 16th April Rm 138, FH
√ Tuesday 17th June Lec Th. RVI
√ Monday 13th October Lec Th. IoT, FH
Topics for 11th February:
√ How to complete care pathways
√ How to access results
√ Looking up alerts on eRecord
√ How to correctly administer eradication
therapy
√ IPC BINGO—with prizes!
ALL WELCOME
IPC Education Forum – for all staff Topics for 11th March:
12.45-13.45
√ HCAI update and lessons learnt
√ Trust-wide antibiotic point preva-lence audit results
√ MDR organisms – newer treat-ments
Cannula
√ Use non-ported cannula in wards
√ Always attach extension sets to non-ported cannula
√ Check for signs of infection, con-dition of dressing on every shift
√ Document insertion details and observations
√ Don’t use safeflow valves on can-
nula – use an extension set
Have you completed your mandatory training? Which programme should you do?
√ Non-clinical staff– IPC for non-clinical staff
√ All clinical staff – IPC level 1
√ Registered nurses and midwives - level 1 & 2
√ Community staff – IPC for community staff (not level 1 or 2)
√ Dental staff – IPC for Dental staff (not level 1 or 2)
ANTT Ensure you are competent Competency tool can be found on the Saving Lives web page under ‘Asepsis’
Call for articles
If you would like to write an article for the newsletter to celebrate a team or per-
sonal achievement, or to tell colleagues about an innovation or change in your area
then please contact Suzanne Medows who will be delighted to discuss this with you.
Suzanne can be contacted by email on [email protected]
February 2014 Recent Staff Publications
What is perinatal well-being? A concept analysis and review of the literature.
Citation: Journal of Reproductive & Infant Psychology, 01 September 2013, vol./is. 31/4(381-398).
Author(s): Carly Allan, Debbie Carrick-Sen, Colin R Martin.
Communicating with haematology patients: a reflective account.
Citation: Nursing Standard, 25 September 2013, vol./is. 28/4(37-43).
Author: Melanie Savage.
Cardiac tamponade following heart surgery
Citation: British Journal of Cardiac Nursing, Oct 2013, vol. 8, no. 10, p. 504-510, 1749-6403
(October 2013).
Author: Sandra Laidler.
Parental decisions on children participating in research.
Citation: Nursing Children & Young People, 01 October 2013, vol./is. 25/8(16-21).
Author(s): Mohammed Elemraid; Kerry Pollard; Mathew Thomas; Clare Simmister; David Spen-
cer; Stephen Rushton; Andrew Gennery and Julia Clark.
A newly elected BACCN Chair.
Citation: Nursing in Critical Care, 01 November 2013, vol./is. 18/6(319-319).
Author(s): Annette Richardson.
A review of instruments to measure health-related quality of life and well-being among preg-
nant women.
Citation: Journal of Reproductive & Infant Psychology, 01 November 2013, vol./is. 31/5(512-530).
Author(s): C. J. Morrell; A Cantrell; K Evans.; D.M. Carrick-Sen.
Influenza: an outbreak in a UK respiratory centre.
Citation: British Journal of Nursing, 28 November 2013, vol./is. 22/21(1206-1206), 09660461
Author(s): A. Aujayeb, A, Russell,; K. Walton.; J Samuel; S. Waugh; M. Valappil; R. Fagg; S.
Gray; S. West, and G. Meachery.
Person-centred care.
Citation: Nursing Older People, 01 December 2013, vol./is. 25/10(14-14), 14720795
Author(s): Clare Abley, Clare and Rachael Thompson.
Exploring risk, prevention and educational approaches for the non-diabetic offspring of patients
with type 2 diabetes - a qualitative study.
Citation: Journal of Advanced Nursing, 01 December 2013, vol./is. 69/12(2726-2737).
Author(s): Charlotte Gordon; Mark Walker and Debbie Carrick-Sen.
February 2014 12
A PAT ON THE BACK
Quarter 3 Individual winners:
Karen Wallace, Ward
13, Care of the Elderly,
Freeman Hospital.
Donna Sill, Midwife
Sonographer, RVI
Hospital.
Congratulations to you both on your
success and well done to everyone who was nominated.
_____________________
Congratulations to Dr Clare Abley on
gaining an NIHR Post Doctoral Fellowship
Award. During the award, Clare will focus
on the important topic of Dementia at
both a local and national
level.
This prestigious award is
one of only a handful
given out at a national
level and we congratulate
Clare on this success and look forward to
hearing about her work as it progresses.
Congratulations to all the nurses and
midwives who reached the final shortlist
for the Nursing Times Achievement
Awards:
Helen Smith - Infant Feed Lead
Alison Forsythe - Learning Disabilities
Leanne Cromwell—A & E Staff Nurse
Amanda Baverstock—A & E Sister
Julie Guest - CYP Stem Cell Transplant
Nurse Practitioner
Rashmi Bhardwaj - Senior Nurse
Researcher
Senior Nurse Researcher Rashmi
Bhardwaj also enjoyed tea at Clarence
House with HRH Prince Charles to
celebrate her success in being short-
listed for the Cardio-vascular category in
the Nursing Times Achievement Awards.
SAVE THE DATE………………….
16th Annual Nursing and Midwifery Conference
When: Friday 13th June 2014
Where: Centre for Life, Newcastle
