NPPC Meeting
23 June 2010
Agenda Item: 10/25
RCN Patient Safety Workstream
1.
Purpose
1.1
To provide an overview of the RCN’s direction, workstream and deliverables on
patient safety as a basis for endorsement and or revision by NPPC.
Additionally, to identify gaps that needs to be addressed through task and finish
groups.
2.
Background
2.1
Patient Safety, along with clinical effectiveness and the patient experience is
one of the three key components of quality in healthcare across the UK. High
profile cases have served to focus, and to maintain attention on the role of
safety in the provision of quality care underlining its importance. The President
has championed patient safety at a European and U.K. level. The RCN is
represented within national patient safety programmes and ongoing campaigns
including the 1000 Lives plus in Wales, the Scottish Patient Safety alliance, the
Patient Safety First campaign in England. Appendix 1 identifies the RCN links
to external agencies.
2.2
The report from Mid-Staffordshire NHS Foundation Trust highlighted issues
around organisational culture; the impact this can have on staffs’ ability to raise
concerns effectively, and the effect it has on morale stating that the “lack of
band seven nurses was a considerable risk that could result in poor standards
of care” (CQC, 2009: 47) and that “there was a worrying deficit of senior
nurses” (HCQ, 2009: 47). Furthermore the investigation revealed that “there
had been little training and development of nurses…[and] the leadership of
nurses had been poor” (CQC, 2009: 58).
2.3
Patient safety strategies in all four countries1 accentuate the link between
quality, and productivity, together and emphasise the need to review, reorganise and evaluate ways of working and best use of resources so as to
achieve increased outputs with better outcomes.
2.4
There is increasing interest across the UK in working locally to identify and
address factors which may lead to the major failures in patient safety. However,
the current economic climate raises serious concerns that any future change
will be driven predominantly by the need to cut public sector spending which
may have an adverse effect on nursing staff levels and skill mix leading to
further potential compromises in the delivery of safe care to patients.
1
Department of Health (2006) Safety first: a report for patients, clinicians and healthcare managers.
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_062848
Scottish Patient Safety Programme (2008) http://www.nhshealthquality.org/nhsqis/5191.html
Welsh Assembly Government (2005) Designed for Life - a world class health service for Wales
http://www.wales.nhs.uk/documents/designed-for-life-e.pdf
Department of Health, Social Services and Public Safety (2006) The quality standards for health and social care
http://www.skillsforhealth.org.uk/~/media/Resource-Library/PDF/qpi_quality_standards_for_health___social_care.ashx
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RCN Background
2.5
2.6
The RCN argues that patient safety is embedded in all aspects of
nursing practice and is an essential aspect of quality ( See NPPC June 2010
Quality Update linking quality to safety).
.
The RCN has had a clear and consistent voice on patient safety since the
successful campaigns around needle stick injuries (2001; 2008); followed by
the ‘Wipe it Out’ campaign (2005); and ‘Nutrition Now’ (2008).These
campaigns, have been well received by members and parliamentarians alike,
have provided a focal point for activity and key messages on infection
prevention and patient safety in order to support both RCN members and
patients in the delivery of safe care.
2.7
Work on safety culture and context has focused on the development and
testing of The Safety Climate Assessment Tool (SCAT) which has been used
with a number of acute and mental health organisations as well as residential
homes to assess their safety climate. This tool, recently endorsed by European
Union Network for Patient Safety2 provided baseline data pre and post workbased learning initiatives with practitioners in the RCN’s Derby Project and also
evaluation of projects through RCN practice development and leadership
programmes.
2.8.
The public facing patient safety resource was launched last May. The website
and the patient safety area on the Learning Zone have been viewed 8,428 and
9,166 times respectively between May 2009 and May 2010.
2.9. Recently the RCN has established a Quality, Standards and Innovation unit
within the Learning & Development Institute to enable the co-ordination of all
RCN activity around quality, standards and innovation around 8 workstreams
monitored through the Quality Steering Group and in turn accountable to NPPC
(Figure 1).
2
European Union Network for Patient Safety (2010) Use of patient safety culture instruments and recommendations.
http://90plan.ovh.net/~extranetn/images/EUNetPaS_Publications/eunetpas-report-use-of-psci-and-recommandations-april-8-2010.pdf
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Figure 1: RCN Work Streams
1.
Standards,
guidelines &
evidence
2.
Measuring
nursing
quality
5.
6.
Incentives and
Board Reporting
Accreditation
2.10
3.
Implementing
&
Improving
4.
Patient
safety
7.
Innovation in
Practice
8.
Integrated
on-line
resources
The RCN’s quality and safety work is framed by UK-wide nursing
practice principles, developed by the RCN and shortly to be launched across
the UK, supported by all key UK stakeholders (Appendix 2). These principles
make explicit what can be expected of nursing in any setting regardless of
who the provider of care is. The principle specifically addressing patient
safety is:
“Nurses and nursing staff manage risk, are vigilant and help to keep
everyone safe in the health care setting.”
This principle provides the basis for developing key messages about patient
safety and ways of measuring nursing care.
2.11. Following discussion at the previous NPPC a paper outlining current
patient safety work being undertaken within the RCN was requested.
The work of the patient safety workstream is now described with current
challenges and areas for development identified.
3.
Detail
Patient safety workstream
3.1.
The purpose and objectives of the workstream are outlined in Box 1. The
workstream brings together all activity around patient safety consistent with
the QSI unit’s role as a knowledge broker, bringing together key stakeholders
across the UK with the expertise of members and staff to this end. This
includes collating and appraising evidence around a small number of focused
projects to support the RCN’s operational plan and strategic and policy
priorities. There is also a key role in signposting resources for both members
and staff.
3.2.
The QSI unit provides an explicit public face and profile to the RCN’s quality
and standards work including patient safety. However, to achieve its purpose
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will require integrated working across many areas of the RCN so that the
workstream can both benefit from and inform the work of others.
Box 1 : Purpose & objectives of the Patient Safety Workstream
Purpose
To coordinate RCN-wide patient safety activity and intelligence so as to;

support RCN members to provide safe care to patients

enable the RCN to influence the patient safety context and policy
Objectives:

Help strengthen the nursing voice around patient safety so that patients receive safe care

Develop relevant resources for nurses to implement and evaluate patient safety

Gather and analyse data and intelligence around the safety context e.g. Raising Concerns,
Raising Standards initiative
3.3. Specific projects planned for 2010-2011 bring together work undertaken by a
number of RCN Departments and include an ongoing focus on cultural and
contextual assessment; health care infections; nutrition; needle stick injuries;
the measurement agenda around a number of practice focused projects and
resources for members:
Culture and Context:
 Evaluation and review of Safety Climate Assessment tool and its future
 MISSCARE Tool project brief being developed for approval by the Quality
Steering Group (Appendix 3 describes the framework for this tool to
illustrate how it could provide information around factors influencing patient
safety outcomes).
 Development and rollout of a cascade system to the RCN’s Quality
Improvement Network and RCN nursing forums to facilitate more effective
feedback from members
Campaigns:
 Wipe it Out: Health Care infection. The objective of the campaign, is
currently undergoing a transitional period to enhance engagement and
awareness of members and is the key focal point for communicating and
gaining a greater awareness of issues that impact on the ability of staff to
provide safe care.
 Needle stick campaign. A European Directive on the Prevention of Sharps
injuries in the hospital and healthcare sector was published on 1st June
2010. Member states have three years to transpose this into national
legislation. The Directive requires employers to carry out risk
assessments and put measures in place to prevent injuries including the
provision of safer needle devices and a ban on recapping. The RCN was
a key player in the development of the European framework agreement
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on sharps injuries (which led to the formation of the Directive) by providing
both technical and negotiating expertise to the discussions. The RCN is
working with key stakeholders to ensure transposition is effective.
Nutrition Now Campaign; resources from this campaign are being placed
on the RCNs website where they will continue to be updated. The RCN is
currently working with the CQC to develop an observation tool for
regulators to use in judging whether nutrition and hydration outcomes are
being met.
Measurement and Intelligence collection:
 Data gathering and intelligence around patient safety captured through
the Raising Concerns Raising Standards database which builds on the
analysis of Ombudsmen reports UK-wide.
 The measurement workstream includes a number of patient safety related
projects being undertaken across the RCN, led by different teams e.g. the
project promoting venous thromboembolism prophylaxis (Appendix 4).
Integration and Implementation:
Developing better integration of patient safety activity with activist support, the
role of RCN Safety representatives; leadership and learning and development
programmes; regional and country-wide activity, is being achieved through
country-wide mapping against the QSI workstreams, and through the West
Midlands Project led by Geraldine Cunningham and Tom Sandford.
Resources for Members:
 RCN patient safety web pages launched at Congress 2009
 Infection prevention and control website launched at Congress 2010
 Patient safety stories to be launched summer 2010
 Launch of a range of resources linked with quality and safety including
staffing and skill mix during 2010-2011.
3.4
The patient safety workstream is closely linked to the measurement
workstream which aims to co-ordinate, develop and refine a programme of
measurement, data capture and audit in relation to nursing standards and
patient safety, in collaboration with key internal and external stakeholders.
3.5
Inter-departmental collaboration is the basis for delivering all the quality and
patient safety workstreams. RCN Safety Representatives are a key resource
to patient safety work. Leadership of projects therefore varies according to the
topic and focus, drawing on the RCN’s wealth of expertise. This can be
illustrated in relation to:
 Infection prevention and control - led by Nursing Department and involving
L&D Institute with the measurement agenda
 Pressure ulcers and tissue viability which is integrating a range of projects
involving different departments -Nursing Department, Policy Unit and L&D
Institute.
 Submission of evidence and representation on the advisory board to the
Boorman review into health and wellbeing of the NHS workforce;
leadership courses and competences. This involved Employment
Relations Department and the L&D Institute. The final report made an
implicit connection between patient safety and staff health and wellbeing.
ERD ops plan around improving the nurses’ working environment
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Leadership and management - focusing on how executive nurses
influence Trust Boards on quality and patient safety led by the Nursing
Department and supported by the L&D Institute.
3.6
The RCN’s infection prevention network includes both members and nonmembers including those affiliated with external organisations. This provides
informal but valuable opportunities for networking and collaboration on projects
providing feedback from different perspectives.
3.7
The key nursing issues arising from this agenda relate to how the RCN can:






3.8
Other areas for development in patient safety activity relate to:





3.9
4.
ensure that nursing is a key driver in maximising the relationship between
the safety and the quality agenda
maximise the nursing voice in future developments and decisions about
patient safety
support and develop nursing staff through the development,
implementation and evaluation of a range of resources and tools aimed at
learning around patient safety.
support the role of executive, advanced and specialist nurses in improving
the quality and safety of patient care
strengthen the message that the quality and safety of patient care
fundamentally requires agreed staffing levels and skill mix
support members to identify and manage risk
impact of nurse attitudes and behaviours in relation to safety;
ways the RCN can actively involve patients and the public in determining
the future patient safety and quality agenda;
an emphasis in the Mid-Staffordshire investigation report around nurse’s
lack of observation skills, low knowledge around ability to read cardiac
monitors and failure to recognise deterioration
further improving collaborative working between RCN Department’s on
patient safety
Developing a set of clear messages around patient safety
Next steps relate to strengthening the patient safety workstream with a
number of projects that address the areas for development identified above
guided by NPPC’s discussion around this paper.
Resources, costs and implications
4.1 The cost of co-ordinating the patient safety workstream and a number of
small projects related to the RCNs operational plan is included in the L&D
Institute budget. Other related projects feeding into the workstream are
funded by other RCN departments or through the Forum bidding process.
5.
Risks
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5.1
Reputational risk may arise from the perception that the RCN is not actively
pursuing an explicit programme of work about an issue of critical importance to
the public, practitioners and policy makers.
6.
Diversity
6.1
Diversity and equality issues are considered within projects and workstreams
7.
UK-wide/Four country perspective
7.1
This work is UK wide and includes consideration of specific country specific
perspectives as appropriate
8.
Strategic plan
8.1
This workstream supports strategic objective 3.5 that the RCN “be recognised
as a leading authority on the setting of professional standards and
accreditation.”
9.
Recommendations
NPPC is asked to:


Endorse the objectives and focus of the patient safety and related
measurement workstreams
Identify areas where a task and finish group needs to be established
June 2010
Originators: Geraldine Cunningham; Kim Manley; Linda Watterson
Input from: Geraldine Cunningham; Kim Manley; Rose Gallagher; Kim Sunley; Josie
Irwin; Ross Scrivener; Martin Semple; Rita Devlin Clare Mayo.
Linked information:
June 2010 Quality Update to NPPC
References
Care Quality Commission (2009) Investigation into Mid-Staffordshire NHS
Foundation Trust. London. CQC.
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Appendix 1
Person
(alphabetical
Order)
Maura
Buchanan
Rita Devlin
Ron Elvins
Rose Gallagher
Jenny Gordon
Kim Manley
Clare Mayo
Mathew
Rice/Dee
Holbrook
Martin Semple
Sophie
Staniszeweska
Kim Sunley
Linda
Watterson
Role in relation to
patient safety
External Links
President
National Patient Safety Forum
Royal Colleges
Northern Ireland Safety Forum
RCN Northern
Ireland Quality and
Patient Link
Representing &
Influencing Link
with RCN Safety
Reps Learning and
Development
RCN Advisor
Infection Control
Links to Nursing
Department
Advisors
Workstream lead:
Standards,
evidence and
guidelines
Quality and
Standards Lead
for RCN
RCN Scotland
Quality and Patient
Link
Enhancing
Practice &
Influencing- links
to RCN
Consultancy and
leadership/quality
programmes
European network for Infection prevention
and control
NPSA
Quality lead RCN
Wales
Strategic Alliance
Warwick
Patient Public
Engagement
Research
Patient Safety
ERD
Lead Patient
Safety and
Measurement
Workstreams
1000 Lives Plus campaign
NICE, SIGN
HQIP, CQC,
Scottish Patient Safety Programme
Scottish Patient Safety Alliance
NPSA
CQC
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Appendix 2
Eight principles of nursing practice
The principles of nursing practice tell us what ALL people can expect from nursing practice,
be they colleagues, patients, their families or carers.
Nursing is provided by nursing staff, be they ward managers (in hospitals) or team members
(in the community), specialist nurses, community nurses, health care assistants or student
nurses.
or, more simply...
The principles of nursing practice describe what EVERYONE can expect from nursing.
Stem statement: Nurses and nursing staff…
Principle A
- treat everyone in their care with dignity and humanity, understanding their individual needs,
showing compassion and sensitivity, and caring in a way that respects all people equally.
Principle B
- take responsibility for the care they provide, answering for their own judgments and actions,
and performing these in a way that is expected of them by patients, their families and carers,
and required of them by their professional bodies and the law.
Principle C
- manage risk, are vigilant and help to keep everyone safe in the health care setting.
Principle D
- provide and promote care that is person centred, involving patients, users, their families and
carers in decisions and helping them make informed choices about their treatment and care.
Principle E
- are pivotal communicators: they assess, record and report on treatment and care; they
handle information sensitively and confidentially; they deal effectively with complaints; and
they report conscientiously the things they are concerned about.
Principle F
- have up to date knowledge and skills, and use these with intelligence, insight and
understanding according to the needs of each individual in their care.
Principle G
- work closely with their own team and other professionals, ensuring patients’ experience of
care and treatment is seamless, of a high standard and has the best possible outcome.
Principle H
- lead by example, developing themselves and other staff, and influencing the way care is
given in a manner that is open and responds to individual needs.
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Appendix 3
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Appendix 4
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