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NICE Clinical Guideline Acutely ill patients in hospital

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NICE Clinical Guideline Acutely ill patients in hospital Powered By Docstoc
					Quality Matters Programme
          (QMP)
           Christine Davidson
 Senior Nurse – Corporate Nursing Team
   Part of a set of tools

                         Ward Staffing
  QMP                    Establishments


            Leadership

Ward                      Productive
Dashboard                   Ward
                       Why QMP
• Quality of nursing care - How
  do you know?
• EoC Patient-focused
  benchmarks for clinical
  governance (2001)
• EoC uptake patchy – some
  good attempts; some none
  existent; using locally-
  developed tools
• External and internal
  monitoring/reporting
• Needed to look at a smarter
  way to enable busy nurses,
  midwives and others to
  become interested in this
  important audit work
            Commenced 2007
                              1.  Medicines Management
                              2.  Communication
• 11 original standards       3.  Record Keeping
• Added to and combined       4.  Bowel and Bladder Care
  others over the years       5.  Discharge Planning
• Now 15 with one other       6.  Patient Safety in environment
  coming on line this         7.  Infection Control
  coming year                 8.  Nutrition and Hydration
                              9.  Personal Hygiene
• 122 clinical                10. Pressure Ulcer Prevention
  wards/departments           11. Self Care
  covered                     12. Privacy and Dignity
• 1,178 audits completed in   13. Promoting Health
  first year                  14. Safeguarding Adults and
                                  Children
• >6,000 completed to date    15. Uniform
                              16. Pain Management (new)
                      Process
• Audit Tool and Auditors scripts
• Easy to use ‘tick box’/Yes or No responses
• Overall score as percentage of applicable
  elements
• Led by local ward team
• ‘External’ assessor on every team – otherwise
  invalid
• Covers, e.g.
  –   Awareness of policies
  –   Observations of practice/documentation
  –   Establishes views of patients
  –   Reviews state of the environment
                Scoring System
             2007/8                            2010/11
        Score           Rating      Score              Rating
Below 45%               Red      Below 80% Red
45 - 84.9%              Amber 80 - 89.9%       Amber
85 - 94.9%              Green    90 - 94.9%    Green
95% +                   Blue     95% +         Blue

Under 80% = Red – Re-audit cycle 3 monthly
2 reds in a row – Meeting with DoN, Head of Nursing, Matron and
                  Charge Nurse
80-89.9% =        Amber – 6 monthly re-audit
90-94.9% =        Green – 9 monthly re-audit
95%+      =       Blue – Excellence Award
            Reporting of results
• Monthly ‘master’ spreadsheet
• Annual report
• Six monthly updates to Trust Board
   – Ward to Board
   – Exception reporting on areas of concern (Mid-Staffs)
• Published at Senior Nurse and Midwifery Study Days
• Other:
   – Business Units include QMP results quarterly in integrated
     governance reports
   – All results available on Trust Web pages and published
     throughout the Trust
   – Forms part of monthly quality contact monitoring meetings with
     commissioners
                                        QIP - Trust Highest, Lowest, Average and Score Ranges, by standard, as at 30th November 2010


                                        100



                                         90



                                         80



                                         70
High, Low and Average Scores




                                         60


                                                                                                                                                                  Highest Score
                                         50
                                                                                                                                                                  Low est Score
                                                                                                                                                                  Trust Average
                                         40



                                         30



                                         20



                                         10



                                          0
                                               Admini Comm Recor Bladde Discha Patient Inf ecti Nutritio Person Pressu Principl Privac Promot Saf eg    Unif or
                                               stratio unicati   d     r &     rge   Saf ety   on     n&     al &  re   es of     y &    ing   uardin     m
                                                n of     on    Keepin Bow el Plannin   in    Control Hydrati Oral Ulcer  Self   Dignity Health   g      Policy

                               Highest Score    100    100     100    100    100     100    100     100      100    100    100    100    100    100      100
                               Low est Score    72      66     43     67.0    39     67.1    50     70.7     62.3   61.1   60.7   78.5   78     54        92
                               Trust Average    90.2   94.4    88.2   91.7   87.5    92.8    89     94.4     92.4   92.5   92.7   94.2   91.3   86.6     98.2
                                                                                                  Standard
   Examples of issues identified
• Drugs: improved practice, security, reduction in incidents
• Privacy & Dignity: improved awareness amongst staff
• Nutrition: Improved nutritional assessments, greater dietetic
  involvement
• Communication: raising awareness of things to communicate with
  patients about
• Documentation: Trust-wide review, new documentation,
  improvements in assessments and care planning
• Tissue Viability: Improved assessments and documentation
• Slips Trips and Falls: improved falls risks assessments
• Discharge planning: originally improved but dipping slightly
• Uniform: significant improvement in image/compliance
• Other: change in last offices policy, review of bereavement services
• Significant local ownership of issues
                  Cont.
• Sets professional agenda more
  clearly/specifically
• Use in PDR’s and objective setting
• More structured approach for junior staff
• Results correlating with areas of concern
• Overseen by Trust’s Heads of Nursing and
  Corporate Nursing Team
• Working on electronic solution
                      Summary
• Systematic benchmarking info. across whole organisation –
  helps CEO/NED’s
• Has initiated many changes/improvements
• Evidence profile
• Multi-disciplinary involvement (AHP’s Pharmacists,
  Radiographers, Dietitions)
• Doctors even interested now!
• Introduced healthy competition between wards/depts.
• ‘Driving test’ analogy
• Needs to be managed
• Fundamental part of performance monitoring
• ….also won Y&H Health & Social Care Award for ‘Safety in
  Care’ 2008
• National interest (CQC, Audit Commission, other providers)
  Thank You


Any questions?

				
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posted:9/13/2012
language:English
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