we are here for you

Document Sample
we are here for you Powered By Docstoc
					Using existing tools to support nursing
   quality and improved outcomes:
           Progress to date
                    Agenda
• Re-launching Essence of Care across an
  organisation, enhancing and improving scoring
  and comparison processes

• Developing an integrated approach with the
  Productive Ward Programme

• Using quality indicators and visual tools to
  monitor progress on the work in Nottingham
 Nottingham University Hospitals
Merged – City Hospital with Queen‟s
Medical Centre
      Different cultures
      Different ways of working

 One of the largest NHS Teaching
Trusts in the country

 92 wards

 12,000 staff in total with 4,000 nurses

 Turnover of £722m… and in balance!
  What is the quality and
productivity agenda about?
         •    NHS funding has risen from 37 billion
             in 2001 to 109 billion
         •    Overall staff numbers have increased
             but the number of patients treated has
             not risen proportionately
         •    This does not suggest people are not
             working as hard (or harder)
         •    Complaints, readmissions, HAIs, and
             errors remain unacceptably high
             although inpatient satisfaction is
             relatively high
         •    The quality/productivity agenda is
             about more effective use of existing
             inputs to produce more outputs (people
             treated) but with better outcomes
             (↑health status, ↓complication rates and
             errors).
         Nurses Are Pivotal……

“We know that nursing and midwifery are fundamental to high
                     quality healthcare….
   There is hardly an intervention, treatment or healthcare
    programme in which we do not play a significant part.
   This means we are in a powerful position to improve the
   quality of care across the NHS and play a major role in
                  improving health outcomes”

           Dame Christine Beasley CNO (2008)
              High Impact
                Actions




Productive                     Essence
Ward                           of Care




             Staff & Patient
              Experience
High Impact Actions


            Staying safe -     Protection from
            preventing falls      infection

              Keeping            Promoting
              Nourished         normal birth

             Fit and well        Important
                to care           Choices

            Ready to go –        Your skin
             no delays            matters
                Safety & Quality


 Productive
                                   Essence
Ward & High
                                    of Care
   Impact
                                   provides
Actions looks
                                   evidence
    at the
                                     of the
processes &
                                    quality
 outcomes
                                    of care
   of care
Engaging and Involving Staff &
          Patients
Essence of Care
Streamlined and Objective Approach
The Essence of Care Year
         2010
Example of Benchmark Tool
          Improving Practice
                          January 2009               May/June 2010
                    64 Areas Submitted Scores   73 Areas Submitted Scores
                           •    0 Gold                 •    8 Gold
                           •    5 Green                •    16 Green
                           •    56 Amber               •    49 Amber
                           •    3 Red                  •    0 Red


NUTRITION BENCHMARK 2009           Red                             NUTRITION BENCHMARK 2010    Red
                                   Gold                                                        Gold
                                   Green                                      0%               Green
              5%   0%                                                                11%
                        8%
                                   Amber                                                       Amber

                                                                                              22%




                                                          67%

  87%
“Both Productive Ward (Meals
Module) and Essence of Care has
helped us to review and make
changes to how we serve our
meals. Instead of the patient
getting all 3 courses served
together – they now have each
course served separately, which
means they are not overwhelmed
by the quantity of food and
courses stay warmer longer”

(Sister Medical Ward)
  “As a results of scoring the
 nutrition benchmark we have
  changed how we serve how
 meals – we now leave those
patients who need help to last,
so their meals are always still
    hot when they are fed.”

     (Sister Medical Ward)
Productive Ward
         The Productive Ward




Modular Structure:
• 608 modules in
  progress (Jul 2010)                       Numbers of Specif ic Modules Completed - July 2010
                                                     (Excluding Foundation Modules)




• 82 wards (Sept 2010)   70

                         60

                         50

                         40




                                                                                                                           Nursing Procedures
                                                                                                         Patient Hygiene
                         30




                                                                                                                                                Ward Rounds
                              Patient Obs


                                                Admissions




                                                                         Handovers
                                                             Discharge




                                                                                             Medicines
                         20




                                                                                     Meals
                         10

                         0
    Knowing How We Are Doing

• 4 Main areas focused on:
   – Patient Safety & Reliability of Care, Patient
     Experience, Efficiency of Care, Staff
     Wellbeing
• Improvement not possible without knowing
  performance.
• Improvements driven by local team.
Performance Board
                  Safety Measures

• Standard                               • Variants
   – Falls                                  – CVL Incidents
   – Pressure Ulcers                        – VIPS Scoring
   – MRSA (incl.                            – Staff moves
                         Staff look at
     Bacteraemia)        incidents to help  – Peritoneal Dialysis
   – C. Diff.            inform safety        infections
                         measures
   – Observations                           – Skin integrity
   – LOS (Target = ELOS)                    – Night time discharges
   – Patient Satisfaction                   – Missing chemotherapy
   – Staff Sickness                           cards
   – Drug incidents
   Knowing How We Are Doing
                 continued..
• Roles &
  Responsibilities
• Visualisation                                        Focus


• Weekly meetings                                      Off
                                                       target


• Focus              WARD FOCUS

                     Date:
                                                       On
                                                       target



• Action Plans       Issue:

                     Action plan:


                     Person responsible for actions:


                     Signed

                     Resolved
                     Signed:
                     Date:
The sluice was
extremely cluttered.
Ward staff spent a day
looking at what
needed to be in the
sluice and how we
could reduce the time
nurses spent in the
sluice.
                                                             5s work in the sluice ….
                     reduced the distance travelled to collect commodes and dispose waste on return
                     reduced time spent in fetching commode as they are now ‘ready to go’
                     saved time equates to 8 12 hour shifts per year to reinvest time to patient care


          Cupboard   Cupboard   Cupboard              Sink
                                                                                      Cupboard   Cupboard     Cupboard                      Sink




           Commode




           Commode



                                     Domestic Waste                                                                Domestic Waste
Shelves




                                                                            Shelves
           Commode




                                   Clinical Waste                                                                Clinical Waste
           Commode




                                    Sluice                                                                        Sluice

                                                                 Collect                                                                                Collect
                                                                Commode                                                                                Commode

                                                                 Return                                                                                 Return
                                                                Commode                                                                                Commode


                                                                                                                                                    Wipes near
                                                                                                            Commode               Commode
                                                                                                                                                   sluice puts all
                                                                                                                                                   needed items
                                                                                                                                                      together
                                                                                                                                  Commode
                                                                                                            Commode




                                Original Layout                                                             Revised Layout
     „High Quality Care For All‟
         Changing Cultures

"We can only be sure to improve what we
         can actually measure"

                     Lord Darzi, June 2008
Productive Ward and Essence of Care
 Cycle of Continuous Improvements

                  Clinical staff feel
                   empowered to
                   make changes                 Impact on staff
                                                  satisfaction
 Objective
 measures
   driving
performance                                            Staff are able to
                                                   correct issues – getting
                       Patients feel                   it right, first time
  There is less
     waste in        safer and happier
   the system
                             Problems are
                           identified earlier

				
DOCUMENT INFO