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					CITY HOSPITALS SUNDERLAND NHS FOUNDATION TRUST DIRECTORATE OF NURSING AND QUALITY BOARD OF DIRECTORS PAPER JANUARY 2005 NURSING UPDATE

Executive Summary Introduction This paper provides Trust Board Directors with an update of progress and developments in the nursing service at City Hospitals in relation to: • • • • • • • • • • • • • • Matronship. Leadership development. Modern nursing project. Trained health care assistant. Essence of Care. Nursing and Midwifery Strategic Forum Competency ratification. Education Forum. Nursing and Quality Website. Nursing Conference Nurse Consultants The Nursing Practice Research Centre. Nursing information and record keeping. Recruitment and retention.

Whilst the paper provides a general overview of developments, more detailed information regarding each of the projects can be made available if required. Recommendations Directors are asked to note the content of the report.

Carol S Ringrow Executive Director of Nursing & Quality/ Divisional Director of Medicine

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CITY HOSPITALS SUNDERLAND NHS FOUNDATION TRUST DIRECTORATE OF NURSING AND QUALITY BOARD OF DIRECTORS PAPER NURSING UPDATE JANUARY 2005

Introduction This paper provides Trust Board Directors with information regarding progress and developments in the nursing service at City Hospitals. Whilst the paper provides a general overview of developments, more detailed information regarding each of the projects can be made available if required. Matronship Directors will recall the introduction of the Matron and Practice Development roles in May 2002. The matron role provides a clear focus for clinical leadership and a highly visible, accessible and authoritative figure upon whom patients can rely to ensure that the fundamentals of care are right. Since the last report there have been a number of changes to the matron areas of responsibility. • • • A separate matron post covers Emergency Medicine in the Division of Medicine. The Obstetrics and Gynaecology areas are now covered by one matron. The Head and Neck matron post now also covers all general outpatient departments.

Practice Development Nurses who lead modern nursing implementation in each of the Directorates support matrons in their work. Professional leadership for the matron team is provided through the Head of Nursing/Chief Matron. This post provides professional leadership and direction to directorate matrons and their staff, advises on nursing policy and professional nursing development, also leading the practice development team and managing the patient access team. An evaluation of the impact of the matron and practice development role was reported to Trust Board members during 2003 and a further evaluation is due to report in April 2005.

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Leadership Development Leadership development is essential for the empowerment of the ward and departmental sisters and charge nurses. City Hospitals has a rolling programme of the Leading Empowered Organisations (LEO) course for all ward managers and their deputies. The course is also now attended by colleagues in the Allied Health Professions. Modern Nursing The Modern Nursing project is a priority task for the Trust Modernisation Agenda and is delivering new roles for nurses in City Hospitals Sunderland to support the Chief Nursing Officers ten key competencies for nurses. Progress with nursing skills development in each of the Directorates is appended to this paper. Trained Health Care Assistant The rolling development programme for the Health Care Assistant to support modernisation of patient care delivery continues. This programme now consists of three phases. • • Phase one. Prior to appointment the selection process includes literacy and numeracy assessment. Phase two. All newly appointed HCA’s attend a one week preparatory programme prior to commencing duty on the ward. A clinical mentor is identified and the HCA undertakes a range of patient care competency based assessments during their first six months in post. These competencies are centred on the fundamental aspects of patient care. Phase three. Attendance at a further development programme which prepares the HCA to practice specific competencies that are relevant to their clinical area of practice.

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Essence of Care The domains are:

Communication Continence Hygiene

Nutrition Pressure Ulcers Privacy & Dignity

Record Keeping Safety Self Care.

All wards have audited the nine essence of care domains and action plans are now in place where required. A practice review is also currently underway on all wards. Future essence of care audits and practice review will be integrated into Directorate Clinical Governance Forward plans during 05/06. The Nursing and Midwifery Strategic Forum (NMSF) The Nursing and Midwifery Strategic Forum (NMSF), meets bi-monthly and is the forum through which national and local nursing and midwifery policy is debated.

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Education Forum The work of the Education Forum, ensures effective links with local Northumbria and Sunderland Universities. Forming strong partnerships enables CHS to contribute to shaping provision of appropriate education and training programmes to support modernisation of the NHS in line with the local and national nursing and midwifery agenda. Competency Ratification The Nursing and Midwifery Competency Ratification Board has continued to support the developing role of nurses and midwives through an appropriate framework, in line with pen portrait of the CHS modern nurse/midwife. The NMCRB have continued to work closely with Directorates to develop and implement appropriate roles to enhance service provision and career progression for nurses and midwives Trust wide. Nursing and Quality Website The Nursing and Quality website is now live on the CHS intranet and will continue to be developed to include, department information and contacts and ratified competency based assessments, with core competencies being available for use Trust wide thus reducing duplication of assessment within directorates. Nursing Conference The Ninth Annual Nursing Conference in collaboration with the Royal College of Nursing and the University of Sunderland this year welcomed the addition of Sunderland Teaching Primary Care Trust as a partner, reflecting the collaborative approach to healthcare in Sunderland. The October conference attracted over 150 local and national delegates with City Hospitals Sunderland staff and external speakers presenting concurrent sessions and workshops. Keynote speakers included Chief Nursing Officer for England, Professor Christine Beasley CBE, Baroness Julie Neuburger DBE and Laura Moffatt MP. Nurse Consultants The Trust has Nurse Consultants in Cardiology, Cancer Services, Ophthalmology, Critical Care, A&E and Renal Services. Examples of Nurse Consultant led service developments are: • Within Ophthalmology the number of patients diagnosed and treated by nurses in 2004 has increased by more than 33% representing approximately 27% of combined inpatient and outpatient attendances. • Further development of the nurse-led chest pain service. • Nurse Consultant led Rapid Access Chest Pain Clinic and the nurseconsultant led Cardio version service. • Support and evaluation the Critical Care Outreach Team. • Lead the care and treatment of stable chronic dialysis patients. • Nurse Consultant in A&E leading the nurse led minors service.

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Nursing Practice Research Centre The last six months has seen the replacement appointment of a Principal Lecturer/ Deputy Head of Nursing R&D in the Nursing Practice Research Centre. The former TRACE course has been reborn as the Trusts’ Research Appreciation course. The Research Fellow has been successful in submission to national and international journals. • Continuous Professional Development The NPRC continues to lead the nursing clinical skills course, running eight full-time and two part-time courses each year. The CPD Monitoring Group is now in existence. Further CPD activity centres on the development of a clinical practice degree in partnership with the University of Sunderland. It comprises of a core teaching element and practice placements, the current course having three strands, Ophthalmology, Head and Neck, and Emergency Care is due for validation in January 2005. • Research and Evaluation Conference and journal papers have been prepared and presented on the LEO project, the HCA preparedness work and the trial of fully automatic external defibrillators on B22 and CCU. A bid for the national evaluation of the extended nurse and pharmacy prescribing was made to the NHS Service, Delivery and Organisation programme – the results of which are awaited. • Patient Journey The four services within the current project are: Epilepsy, Paediatric Strabismus, Fertility and Lung Cancer Treatments. All of these projects will be completed by April 2005 and then move to service changes in the year following. Nursing Information and Record Keeping • Single Assessment Process (SAP) A key element of the NSF for Older People is the Single Assessment Process. A paper version has been in use within Sunderland since July 2002. This has had limited success and one of the main issues is that it is not sent out/returned with the patient and thus there is excessive duplication of effort from all parties. An electronic solution is available, and is currently being implemented across 10 elderly care wards, 10 key Social Service Teams and 4 District Nursing Teams. The CHS nurse trainers have produced an innovative and interactive training package, which incorporates change management, the importance
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of effective documentation between agencies and assessment tools in use as well as the functional aspects of the system. This was an exercise in partnership working along with Sunderland TPCT and Social Services staff and an in depth appreciation of how each organisation works was achieved. • Record Keeping The Record Keeping Group was established to modernise nursing documentation and the aim is to standardise record keeping, reduce the duplication of effort and variation of documents available. Achievements to date include: • Development of a standardised pack of observation charts. • Electronic Assessments developed and implemented i.e. Braden Score, Pilling Manual Handling assessment and Falls Risk Assessment. Electronic assessment tool for the MUST Nutritional Tool is currently being explored. • Bed Management The bed management screens and reports went live in August 2004. This enables nurses at ward level to input data detailing current and projected bed status at prescribed times throughout the day. The bed manager/ clerical support can then run a report and identify where beds are available and produce a projection for the coming hours. • Electronic Prescribing Electronic Prescribing (EP) is now live in all inpatient areas with the exception of ICCU, Neonatal Unit, Tyzack, the Children’s Unit at SEI and The Hume Unit. Feedback from nursing staff is positive regarding benefits to staff and patients. The advent of Medicines Management has also improved the discharge process. • GRASP The revalidation cycle for 2005-2006 has recently been circulated to Ward Managers, Matrons and Business Managers. Target dates have not been consistently achieved for this year largely due to service changes and ward moves. Utilisations for many areas have been unrealistically high this year. Workload data accuracy is largely dependant upon care plan accuracy and investigation has established a link between high utilisations and inaccurate care planning. Work has gone in to streamlining care plans and educating staff in how to use the revised plans. The utilisation figures will be monitored over the next few months to assess validity and correct usage.

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Conclusion This paper has provided a brief overview into some of the professional initiatives that are relevant to nursing and midwifery in City Hospitals. It has not included specific details regarding operational initiatives in each of the Directorates, as these will be included in the Directorate updates to the Board of Directors. More detailed information about each of the projects outlined in this paper is also available if required. Recommendation Directors are asked to note the contents of the report.

Carol S Ringrow Executive Director of Nursing and Quality/ Divisional Director of Medicine

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Appendix 1 Progress With Nursing Skills Development In Each Directorate EMERGENCY CARE Identified Skill The current numbers of staff competent and practicing . Venepuncture 177 Cannulation 177 I/V Administration 177 Clinical skills Order entry RGD’s ALS / ILS Critical care POP application Triage Thrombolysis 14 88 80 21 40 40 8

Total numbers of staff required to be competent and practicing for area 183 183 183 29 113 117 99 64 64 8

Percentage of staff.

96% 96% 96% 50% 78% 69% 21% 62.5% 62.5% 100%

GENERAL INTERNAL MEDICINE Identified Skill The current numbers of staff competent and practicing . Venepuncture 163 Cannulation 94 I/V Administration 132 Verification of expected death Insertion of FBNG tube Peg replacement Hickman line chemo Chemo via venflon Nurse led clinics HEAD & NECK Identified Skill 22 13 33 21 18 9

Total numbers of staff required to be competent and practicing for area 167 96 137 71 30 57 32 32 14

Percentage of staff.

97.6% 97.9% 96.3% 30.9% 43.3% 57.8% 65.6% 56% 64%

Venepuncture Cannulation I/V Administration

The current numbers of staff competent and practicing . 28 21 23

Total numbers of staff required to be competent and practicing for area 34 25 34
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Percentage of staff.

82% 84% 67%

Interpretation ECG Interpretation blood results Clinical skills Insertion FBNG tube Trachy management Aural care OBS & GYNAE Identified Skill

6 6 6 7 25 5

9 9 9 9 25 9

66% 66% 66% 77% 100% 55%

The current numbers of staff competent and practicing . Venepuncture 215 Cannulation 206 I/V Administration 213 Nurse led clinics 17 Clinical Skills 4 Pessary removal 4 & insertion Zoladex 4 administration Coil test / 2 removal Cytology 2 Swab taken 2 OPHTHALMOLOGY Identified Skill The current numbers of staff competent and practicing . Ophthalmic Dip 48 Critical care skills 1 Clinical skills 5 Venepuncture 55 Cannulation 50 IV Administration 33 Defibrillation Visual Acuity Tonopen Drop instillation RGDs Syringing of tear ducts Schimers test 10 55 67 34 0 33 20

Total numbers of staff required to be competent and practicing for area 230 226 225 17 10 4 4 2 2 2

Percentage of staff.

93.4% 91.1% 94.6% 100% 40% 100% 100% 100% 100% 100%

Total numbers of staff required to be competent and practicing for area 62 19 11 51 50 31 10 55 71 34 19 43 32
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Percentage of staff.

77% 5% 45% 107% 100% 106% 100% 100% 94% 100% 0% 76% 62.5%

Nurse led discharge Nurse assisted consent Nurse led Clinics Focimetry Conj swabs Guiding skills Biometry Instillation of drops Teaching and assessing ILS Applination tonometry Application of steristrips Removal of sutures Sub Conj injections Botulinum toxin injections Epilation of lashes Dacryocystogram s Adult Alerter trainer Ionising radiation training Recovery Scrubbing Monitoring of LA pt Anaesthetic Course

12 10 7 34 27 15 36 23 8 2 6 8 9 6 2 8 1 7 10 16 16 16 3

27 14 11 39 32 23 39 23 9 2 6 9 9 9 2 9 1 9 16 16 16 16 8

44% 71% 63% 87% 84% 65% 92% 100% 88% 100% 100% 88% 100% 66% 100% 88% 100% 77% 62.5% 100% 100% 100% 37.5%

ORTHOPAEDICS Identified Skill The current numbers of staff competent and practicing . Venepuncture 34 Cannulation 25 I/V Administration 44 Pinsite care Apply Splint 39 16

Total numbers of staff required to be competent and practicing for area 55 55 55 55 35
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Percentage of staff.

61% 45% 80% 70% 29%

Apply traction Male catheterisation PAEDIATRICS Identified Skill

30 14

55 55

55% 25%

Cannulation Venepuncture I/V Administration Radiology training Make referrals Nurse led discharge Resus & defib (apls) Physical assessment Chest auscultation Male/female catheterisation Urine microscopy App back slab Pin site care Splitting of plaster App Thomas splint

The current numbers of staff competent and practicing . 21 32 88 30 90 24 46 9 6 39 1 10 18 14 15

Total numbers of staff required to be competent and practicing for area 52 76 90 90 90 40 90 46 17 90 42 21 21 21 21

Percentage of staff.

40% 42% 97.8% 33.3% 100% 60% 51% 19.6% 35% 43.3% 2.4% 47% 85% 66% 71%

REHABILITATION & ELDERLY MEDICINE Identified Skill The current Total numbers of staff numbers of staff required to be competent and competent and practicing . practicing for area Venepuncture 177 185 Cannulation 171 177 I/V Administration 171 177 Critical care skills 15 177 Dysphagia level 1 55 163 NG tube rnsertion 11 169 Enteral tube care 37 169 / feed PEG replacement 21 169 Male 55 169 catheterisation Verification of 15 169 expected death Footcare 43 169
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Percentage of staff.

95.6% 96.6% 96.6% 8% 33.7% 6% 21% 12.4% 32% 9% 25.4%

SURGERY Identified Skill

The current numbers of staff competent and practicing . Venepuncture 73 Cannulation 73 I/V Administration 75 Interpret blood 4 results Nurse led 12 discharge Sound chest 1 Nurse led clinics 4 Clinical Skills 3 Palpate abdomen 1 Stoma care 40 ECG 7 interpretation Insert NG tube 37 Ionising radiation 4 skills Verification of 13 expected death Male 18 catheterisation Insertion supra 18 pubic catheter Intermittent 18 catheterisation Removal of 18 pollock tube Care & flushing 18 nephrosotmy tube Flushing ureteric 18 stents

Total numbers of staff required to be competent and practicing for area 78 78 78 78 64 5 4 6 5 44 78 56 11 21 18 18 18 18 18

Percentage of staff.

93.5% 93.5% 96.15% 5% 18.7% 20% 100% 50% 20% 90% 8% 66% 36% 61.9% 100% 100% 100% 100% 100%

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100%

THEATRES Identified Skill

Venepuncture Cannulation I/V Administration Recovery competency ILS

The current numbers of staff competent and practicing . 133 113 177 40 36

Total numbers of staff required to be competent and practicing for area 141 141 212 58 84
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Percentage of staff.

94% 80% 83% 68.9% 42%

ALS Foundation Critical Care CCSP Nurse led follow up ICCU skills Nurse led clinics

10 51 11 7 73 24

16 166 78 7 94 24

62.5% 30% 14% 100% 77% 100%

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