FACING THE CARE CHALLENGE
IN PRACTICE
- Reflections of a Chief Nurse
Mandie Sunderland
WELCOME TO MY WORLD!
- 5,000 Nurses & Midwives / 10,000 staff
- 3 hospital sites
- Breach of authorisation with Monitor – removed August
2010
- 3 conditions with CQC Registration
• Staffing
• Safeguarding
• Appraisal
- Rule 43 (Coroner)
• All have nursing involvement
- Reputation re standards of nursing care
- Same commissioners as Mid Staffs
NURSING – OUR PROFESSION
-
Adverse media stories
Inquiries / Investigations / Reports
Public perception
‘Fit for Purpose’ debate
- NMC Consultation
- Media coverage ‘too posh to wash’!
- Personal experiences
• SUI’s
• Coroners Verdicts
• Complaints
• Disciplinaries
• NMC Referrals
THEMES OF QUALIFIED NURSES &
MIDWIVES DISCIPLINARY CASES 2008/10
1.
Professional conduct – medicines
- failure to follow policy (inc several fatalities
- theft
2. Professional conduct – patient observations
- failure to escalate (inc several fatalities)
- failure to document
3. Professional conduct – personal
- attitude / behaviour
- communication
- internet abuse
4. Professional conduct – other
- documentation
- confidentiality
ISSUES
• Recruitment
- quality of applicants
• Medicines Managements
- numeracy
- standards / policy for medicines administration
- basic knowledge of safe practice
• Provision of fundamental care
- knowledge of ‘basics’
- appetite for ‘basics’
- inability to plan care
• Knowledge of accountability both professional / personal
- aware of NMC but no in depth knowledge
- ‘someone else’s fault’
HEFT SOLUTIONS
• Pre interview tests re drug calculations for all RN’s
– original pass mark 100% (achieved by 10%)
– given calculator and formula card
– no time restraints imposed
• Pass rate revised Oct 2099
– pass rate between 60 – 80% can proceed to appointment
if interview exceptional
– Manager to develop PDP to ensure completion of
medicine administration competency
– Score of 60% not employed
– Assessments for adults / paediatrics / neonates
EXAMPLES OF QUESTIONS OF
MEDICINES ASSESSMENT
• Patient A requires 30mg of oral Prednisolone; you have a
stock of 5mg tablets. How many tablets do you need to give?
• Convert 400 micrograms into milligrams
• If there is 80 mg of Gentamicin in 2 mls how much
Gentamicin is in 0.5ml?
• You need to administer 40 mg the vial contains 50mg in 2
mls. How many mls do you need?
• You need to give 100 mls of Metronidazole over 20 mins.
What is the hourly rate in mls?
• Your patient weighs 65 kg the drug prescribed on 7mg per kg.
How many mg are required?
MEASURING FUNDAMENTALS
OF CARE
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Development of Nursing & Patient Experience Metrics
Originally 8 indicators
– Medicines administration
– Falls
– Nutrition
– Tissue Viability
– Infection Prevention
– Patient Observations
– Pain Management
– Continence Management
Electronic real time reporting
Peer review – ‘Back to the Floor’
Assurance process in place
Consequence to poor performance / celebration of good practice
Progress – October 2010
Metrics results 2010
40
35
Number of wards
• Trust remains GREEN overall
and has stayed at 90%
• 1 ‘RED’ ward October 2010 (2
‘RED’ wards September 2010)
• 3 wards slipped from ‘GREEN’
to ‘AMBER’
• GHH slipped from ‘GREEN’ to
‘AMBER’ overall
• Pilot of Metrics 2 commencing
November 2010 - Additional
indicators for Diabetes
Management; Discharge
Checklists and Assurance
30
25
20
15
90% +
10
< 80%
5
0
Jan Feb Mar Apr May Jun
Jul Aug Sep Oct
Month
Bar chart to demonstrate
Red Wards : Green Wards
January 2010 – October 2010
METRICS
RESULTS
OCTOBER
2010
Critical Care
Paediatrics
Theatres
Neonates
QUESTION
Do we have a fundamental problem
with the knowledge base of our
nursing workforce?
?
VITAL
• Virtual interactive teaching and learning Education tool to
acquire knowledge and skills that confirm core standards for
safe practice
• Profession / role specific modules in development
VITAL for nursing
• E learning foundation module related to fundamental safe
practice
• Integrated training needs analysis and learning intervention
VITAL - premise
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Registered nurses first
MS to write to every nurse
HEFT Context around professionalism promoted
Core safety - linked to metrics
Linked to other trusts
Probably badged
Life span – patient journey focused
VLE user support
ACCESS
• Access via HEFT Faculty website (www.)
• Platform: MOODLE on-line virtual learning
environment
• Trust specific reports produced
• Will inform national research project on
current state of nursing knowledge led by
HEFT Faculty in collaboration with
participating partners
INDICATIVE NURSING CONTENT TBC
Medication Storage & Custody inc numeracy
End of Life
Patient Observations inc MEWS /PEWS elements of SBAR and
Sepsis
Pain Management
Tissue Viability
Nutritional Assessment
Falls Assessment
Continence Assessment
Privacy & Dignity/elements of Communication SBAR
Diabetes
Blood transfusion
Mentor update
Safeguarding children/adults
Discharge planning
STEP OFF
/ OR
VITAL for nurses
Programme
Framework
Further face to face
education and training
modules as required
VITAL – Proposed Assessment
Scheme
Possible Outcome
- Congratulations Successfully passed
VITAL Module
Green =100% – PASS.
Multiple attempts
within specified time
3/12. Individual
performance
Monitor through
grade centre.
ongoing performance
support.
Amber = 80 99%/Red = <80% Post
3/12. Repeat failed
units within further
1/12. (+/- learner
support).
Glossary
Module on MOODLE called VITAL
VITAL contains Units of learning e.g Safeguarding
Remain Amber/Red – TNA
highlight specific deficits
(TNA) Ongoing incremental
learning period focusing of
specific issues eg: face to
face , access portfolio of
learner support materials ,
shared learning, role of Prof
Ed team, one to one;
support for Dyslexia or
discalculate learner.
VITAL-Ready to go
MOODLE
PILOT
Mid October
2010
VITAL
VITAL
1st phase
2nd phase
Self
assessment
Dec 2010
Summative
assessment
Jan 2011
NEXT STEPS
• Inclusion of Midwifery 2011
• Development of Trust badge to epitomise
‘HEFT’ Nurse/Midwife
• Utilisation of VITAL pre recruitment?
• Allow access from home to all nurses and
midwives
• Assurance to Trust Board, Regulators, patients
and public that our nurses are knowledgeable
and competent
THOUGHTS FOR THE FUTURE
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Move to graduate status – excellent news!
Fit for purpose debate continues
Yet another review of pre reg curriculum??
Explore potential to enable mandatory training and competency
‘mania.’
Public confidence – jury remains out!
Recent events
Recommendation 4
“The Trust, in conjunction with the Royal Colleges, the Deanery
and the nursing school at Staffordshire University, should
review its training programmes for all staff to ensure that
high-quality professional training and development is
provided at all levels and that high-quality service is
recognised and valued.”
The Mid Staffordshire NHS Foundation Trust Inquiry
BLASPHEMOUS THOUGHTS!
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No pilot of P2K
Concerns over pre-reg practice experience/assessment of clinical
skills/progression to registration
HEFT Faculty of Nursing & Midwifery
- Pilot of 30 students (pre-reg training)
- External evaluation of end product
- Total ownership of whole experience
- Work with academic partner
- Academic credit given to practice
- Ownership and commitment from practice
- Value for money
- Fits with new policy direction
- Logistics becoming easier e.g. amalgamation with community
nursing
- Appetite from patients / public / practitioners
• 4.32 – ‘Each year several billion pounds are spent on central funding of education
and training for NHS staff through the Multi-Professional Education & Training levy, in
addition to investment by NHS organisations in their own staff. A top-down
management approach led by the DOH does not allow accountability for decisions
affecting workforce supply and demand to sit in the right place. It is time to give
employers greater autonomy and accountability for planning and developing the
workforce, alongside greater professional ownership of the quality of education and
training
………………. - Healthcare employers and their staff will agree plans and funding
.
for workforce development and training; their decisions will
determine education plans.
- Education commissioning will be led locally and nationally by the
healthcare professions ………. Mechanisms will be put in place for
nurses and midwives and allied health professionals.
- The professions will have a leading role in deciding the structure
and content of training and quality standards.
- All providers of healthcare services will pay to meet the costs of
educatioin and training. Transparent funding flows for education
and training will support the level playing field between providers.’
‘EQUITY AND EXCELLENCE – LIBERATING THE NHS’ JULY 2010