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