Patients First Always Care Assurance and Accreditation System Acute Standards Launch Rosslyn Crocket MBE Board Nurse Director Wednesday 22nd July 2015 “Let whoever is in charge keep this simple question in her head not, “how can I always do this right thing myself but “How can I provide for “this right thing to be always done?” Florence Nightingale 1859 Adult Acute CAAS Standards Care Assurance and Accreditation System (CAAS) Why? “Provide Person Centred Care for every Patient Every Time” The CAAS Standards developed with staff and patients approval will for the first time allow us to evidence the standard of care we deliver. How? Implement a system which effectively measures and assures the standard of patient care within NHSGGC Implement the care standards that were developed in consultation with staff that meet the requirements of patients and national regulators Develop and Implement an assurance system to ensure the agreed care standards are consistently applied for all patients every time across NHSGGC. CAAS Adult Acute Standards Implementation When? Acute Standards presented to Clinical and Managerial teams July 2015 SCN’s and Lead Nurses will present and discuss the CAAS Standards with their teams including multidisciplinary teams SCN’s, Nurse Leaders and Management commence the process of identifying what requires to be in place to support frontline staff implement the standards All acute wards in NHSGGC will implement the CAAS Standards in September 2015 CAAS: Benefits The content is not new, its just a new way of delivery and assessment Supports the multi-professional team understand how they deliver care, identify what works well, and replicate to spread improvement Provides teams with clear expectations of the care that is required within a supportive framework. Reduce duplication of audits and inspections Increase the quality of patient and staff experience Reliable assurance of quality from point of care to the Board, our national regulators and increases transparency with the public. 13 Adult Acute Standards Pressure Area Care Working Effectively with the MDT Effectively Managing resources & staff Governance End of life care Falls CAUTI Deteriorating patient Adult Acute CAAS Standards Person centred care Medicines management Older People in Acute Care & Adult Protection FFN Infection Prevention and Control Pain Control CAAS Progress : Staff Support CAAS is a framework that supports staff to achieve, develop and identify gaps in capacity and capability always with a view to service improvement. In consultation with staff NHSGGC is supporting clinical teams implement CAAS in the following ways. CAAS Progress : Staff Support Salford Visits - key staff have experienced the softer touches of CAAS with a view to replicating in their area i.e. Patient experience/compliments, staff pride in the care they deliver CAAS Web Information - can be found in the nursing and midwifery section on NHSGGC website. Sited here for easy access for all staff as well as providing the public with information on the service improvement program 4 Test Site Wards – Set up, to test the language and content of the standards support was provided by PD, L&E and OD in order to identify the needs of the teams and also to further inform the board wide implementation plan. Team Dynamics: “How good is the Team” benchmarking supported by OD was undertaken in the 4 test sites. All wards found this a useful exercise on which to build on NHS GGC CAAS Website link: http://www.nhsggc.org.uk/our-performance/celebrating-nurses-midwives/ CAAS Progress : Staff Support Cont’d Staff Engagement Events Link Nurse/Midwife Framework Support for Link Nurse Lead Nurse/ Midwife Work plans Powerful Conversations SCN/M, Lead Nurse/M & Team Leader Network Communication Strategy Capacity for Improvement Group CAAS IT What Nursing Teams are Saying! As set of standards that provide the opportunity to get it right for our patients in an open and honest way. PD Nurse Happy to do make changes and do my bit to support the ward to help the patients Housekeeper Help us to regain patients confidence in our service SCN This is what we do anyway, however it will help us to deliver on what we need to in a more efficient way. Staff Nurse “Caring for patients” is everyone's job, delighted to hear that the wider AHP team will also be involved. SCN An ideal way of keeping up to date with a wide range of topics/issues. It’s what I have been needing Staff Nurse What Senior Management Teams are Saying! Will help identify areas of Improvement. CSM Hugely positive, it will change the ethos of how everyone works. CSM CAAS will provide reliable assurance across all our wards and community teams. CSM CAAS will provide a positive framework and structure for SCN/M’s & their teams, but also support management to understand requirements. GM CAAS will allow for more consistency across all areas for direct care and management work plans. Both are inconsistent at the moment and CAAS will provide a framework for ALL to follow. CSM What the Corporate Nursing Team are Saying! I visited the CAAS test wards - to hear the experiences of the SCN’s & teams on what it's like to test the CAAS standards, their feedback was invaluable & I loved their enthusiasm! It was great hear what we can achieve together. N Director THE FUTURE Exciting Putting Patient First Support Staff Everyone’s Responsibility Celebrate Success Be Proud Patients First Always Care Assurance and Accreditation System Test Site Ward Experiences John Stuart CAAS Adult Acute Lead/ Chief Nurse North Sector 22nd July 2015 CAAS Working at Various Levels Patients – receive safe, effective personal care every time. Ward Teams – ownership of improvement work and enhanced job satisfaction. Directorates/Sectors – reliably assess nursing provision in their areas. can care NHS Board – demonstrate the quality of nursing care in the whole organisation and provide assurance CAAS: Test Site Ward Experiences Progress supported and monitored through a CAAS Acute Operational Steering Group. Four Adult Acute Wards tested the standards Ward 2 Inverclyde Ward 6 VOL Ward 43 GRI Ward 45 GRI These wards were asked to participate, chosen for their diversity to ensure the test was spread as broadly as possible across adult acute service. Test wards have provided vital feedback Allowed for collaborative strategic planning for staff support and the CAAS Implementation framework Helped identify areas of current strengths within nursing, beneficial has prevented duplication of support Clearly identified some gaps which are receiving a focus for improvement. CAAS :Link Role Framework Testing Definition: Link Role A link nurse/person is a “nurse/midwife/ person that is, or is moving towards being a subject specific champion, a resource, improvement and monitoring person for an identified topic of practice or care” The 4 wards have been vital in testing the link role framework Allowed for the testing of efficiency support mechanisms for the learning and development of staff in relation to their allocated standard. Testing of mechanisms to ensure CNS support capacity is spread across the teams Allowed for the testing of the CAAS resource folders Burns Unit Situated in Glasgow Royal Infirmary The Burns Unit is a specialist regional 13 bedded facility with the capacity to Care for 3 high dependency patients and is part of a Managed Clinical Network. (Care of Burns Injury in Scotland) What was good about CAAS? Link persons having shared goals and knowing what was expected of them. Ensuring high standards of care through evidence based practice. Shared learning, support and education involvement of our Lead Nurse and Practice Development Nurse for Burns and Plastic Surgery, also networking within GG&C. Staff ownership and increased professional and clinical responsibility through link role framework and sharing of ideas for clinical improvement. Jacqui Bellew Senior Charge Nurse Burns Unit Cont’d What was challenging/requires further development? Initial staff buy in for their photographs to be used on Bed boards. Allocation of protected time within current establishment; organisation of link role when there is staff movement; SCN time for meetings at the initial implementation. Further work required on the assessment tool and what evidence is required for the portfolio. Jacqui Bellew Senior Charge Nurse Ward 6 Situated in The Vale Of Leven a Small District Hospital. A short stay Elective Surgery (Minor and Intermediate) 10 bedded plus 4 trolley ward. We are a Multi-Specialty surgical facility for: General, Orthopedic, Gynecology, Ophthalmology and Urology surgery. What was good about CAAS? A great opportunity as a team to review our practices in line with the standards and reassure ourselves we are providing the best A vehicle to re-establish our public and self confidence A way to demonstrate our continued improvements allowed us to see where we need focus. Elizabeth Fettes Senior Charge Nurse Ward 6 cont’d What was challenging/requires further development? Identifying the link person - some volunteers, some link roles not popular, a little persuasion required. Collection of Evidence: Clarification on what evidence will be required. Some standards don’t fit our area: (e.g. End of life care - we have adapted the evidence we will provide to ensure it is meaningful and will guarantee a patient centered focus – i.e. team will attend Sage and Thyme communication workshops in order to ensure we have a strong focus on support - as we are often in the position of being with patients when bad news about test results are delivered.) Elizabeth Fettes Senior Charge Nurse Ward 43 Situated in Glasgow Royal Infirmary A large cardiology ward within the Jubilee building in GRI (40 beds which include acute receiving and step down beds) What was good about CAAS? Empowering link nurses to take the lead in improving nursing care/standards. Increased staff knowledge of evidenced based care. Improved team work within ward, including AHP's etc Encouraged 'good ideas' approach from all staff Excellent support from some of the CNS's Focus on quality of patient care Liz Campbell / John Murtagh Senior Charge Nurse Ward 43 cont’d What was challenging/requires further development? Time resource within a busy cardiology ward. Protected time issues for link nurses. Workload commitments from each link nurse and SCNs Support issues for some of the standards from CNS's. Clarity around evidence requirement and the adopted assessment tool. Liz Campbell / John Murtagh Senior Charge Nurse Ward 2 Situated in Inverclyde Royal Hospital A medicine for the Elderly Care Ward within Inverclyde Royal in Clyde Sector. This ward caters for the assessment and rehabilitation of the elderly. What was good about CAAS? Staff satisfaction has increased with their increased knowledge of the standards. Link nurses feel empowered with their remit and their increased knowledge. Staff generally feel care has improved particularly in relation to PURA and as a result of active care. Julie Bruce Senior Charge Nurse Ward 2 cont’d What was challenging/requires further development? Mainly challenged with capacity to free up time for staff to undertake learning, and staff to be available for link nurse to cascade their knowledge with fellow team members. Other wards currently not working to the standards has impacted on ward 2 when patients have been transferred. Julie Bruce Senior Charge Nurse Patients First Always Care Assurance and Accreditation System CAAS Implementation Framework Elaine Love Chief Nurse for Governance and Regulation 22nd July 2015 CAAS : Tri – Board Assurance Process The Tri- Board Assurance process is in development, it’s anticipated the principles will be the same across the boards with provision incorporated for flexible local implementation, as each board has different structures and support mechanisms The Tri-board collaborative will continue to support each other as the standards are implemented and each board moves towards their assurance phase. CAAS : NHS GGC Assurance Process Adult Acute Clinical teams will have time to familiarising themselves with the content of the CAAS standards from July 2015 prior to implementation. CAAS : NHS GGC Assurance Process Wards first unannounced Lead Nurse Assurance Visit will determine a wards baseline The Chief Nurse Governance & Regulations team will plan a GGC Adult Acute schedule of assurance Visits over a 10-12 week period Practice Development will take the lead for forming and developing a team to undertake the unannounced visits Lead Nurses will participate within their clinical sessions in areas out with their responsibility The emphasis of these visits is on identifying where improvement support is required CAAS : NHS GGC Assurance Process Benefits to this approach This will: Provide a consistent process in support of identifying a baseline Provide the opportunity to develop LN capacity for undertaking future assurance visits Shadow opportunities for all LN’s and for Chief N’s/M Identify what further development/support may be required by Lead Nurses in undertaking the role of assurer Allow us to establish bespoke support for wards. Critically we must ensure ownership is maintained at a local level with wrap around support measures being in place. Under starter Orders on the Road to Success This is nothing new, just a new way of working. CAAS is not a quick fix, the journey is for the long term and its everyones responsibility, from point of care to the Board. CAAS : Time Lines CAAS Component Time Scale Responsible Person CAAS Standards Launch July 2015 Nurse Director CAAS Standards Introduced to Clinical & AHP Teams July 2015 Senior Charge Nurse/Lead Nurses/ Chief Nurses CAAS Standards Implementation September 2015 Senior Charge Nurse & Multidisciplinary Team CAAS Ward Self Assessments July - October 2015 Senior Charge Nurse CAAS Ward Unannounced Improvement Assurance Visits October 2015 - January 2016 Lead Nurse Improvement Support February 2016 Chief Nurse Governance/Regulation CAAS & NMC Revalidation The Tri- Board Collaborative considered the NMC Nursing & Midwifery Revalidation plans when developing the CAAS Framework CAAS aims and objects support the 4 domains of the new NMC Code. CAAS will support Nurses & Midwives in their reflective evidence & PDP development for Revalidation. Questions Patients First Always Care Assurance and Accreditation System Closing Remarks Robert Calderwood Chief Executive 22nd July 2015 Acute Adult Standards Launch Its great to be launching this new approach to improving care for our patients in this fabulous building. As you know the standards have been developed in collaboration with our neighbouring health boards of NHS Lanarkshire and Ayrshire & Arran. Congratulations to all our staff who have been involved and contributed to their development. • We must be clear the quality of care delivered to patients is everyone’s business – Directors Managers, all clinicians & all support staff – WE ARE ALL HERE TO WORK TOGETHER. • CAAS will be crucial in assuring the quality of care our patients receive which must be safe effective and person centred. • Its vital everyone no matter what their role feels empowered, motivated and supported to deliver on the CAAS standards. NHS GGC Board & Senior Management Message We ask that you engage and work with us as we progress this approach to improvement for our patients. On behalf of the Board I would like to thank you for all your hard work and assure you of our full support in carrying out your crucial role implementing CAAS Acute Care Standards within NHS GGC. Good luck with taking this exciting approach forward and I wish you all every success. In the Lecture Room Beside Aroma Cafe