FACING THE CARE CHALLENGE IN PRACTICE

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FACING THE CARE CHALLENGE IN PRACTICE

• Reflections of a Chief Nurse
• Mandie Sunderland

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WELCOME TO MY WORLD!

• 5,000 Nurses Midwives / 10,000 staff
• 3 hospital sites
• Breach of authorisation with Monitor removed
  August 2010
• 3 conditions with CQC Registration
• Staffing
• Safeguarding
• Appraisal
• Rule 43 (Coroner)
• All have nursing involvement
• Reputation re standards of nursing care
• Same commissioners as Mid Staffs

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NURSING OUR PROFESSION

• Adverse media stories
• Inquiries / Investigations / Reports
• Public perception
• Fit for Purpose debate
• NMC Consultation
• Media coverage too posh to wash!
• Personal experiences
• SUIs
• Coroners Verdicts
• Complaints
• Disciplinaries
• NMC Referrals

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THEMES OF QUALIFIED NURSES MIDWIVES
DISCIPLINARY CASES 2008/10

• Professional conduct medicines
• - failure to follow policy (inc several
  fatalities
• theft
• Professional conduct patient observations
• failure to escalate (inc several fatalities)
• failure to document
• Professional conduct personal
• - attitude / behaviour
• communication
• internet abuse
• Professional conduct other
• documentation
• confidentiality

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ISSUES

• Recruitment
• quality of applicants
• Medicines Managements
• numeracy
• standards / policy for medicines administration
• basic knowledge of safe practice
• Provision of fundamental care
• knowledge of basics
• appetite for basics
• inability to plan care
• Knowledge of accountability both professional /
  personal
• aware of NMC but no in depth knowledge
• someone elses fault

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HEFT SOLUTIONS

• Pre interview tests re drug calculations for all
  RNs
• original pass mark 100 (achieved by 10)
• given calculator and formula card
• no time restraints imposed
• Pass rate revised Oct 2099
• pass rate between 60 80 can proceed to
  appointment if interview exceptional
• Manager to develop PDP to ensure completion of
  medicine administration competency
• Score of 60 not employed
• Assessments for adults / paediatrics / neonates

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EXAMPLES OF QUESTIONS OF MEDICINES ASSESSMENT

• Patient A requires 30mg of oral Prednisolone you
  have a stock of 5mg tablets. How many tablets do
  you need to give?
• Convert 400 micrograms into milligrams
• If there is 80 mg of Gentamicin in 2 mls how much
  Gentamicin is in 0.5ml?
• You need to administer 40 mg the vial contains
  50mg in 2 mls. How many mls do you need?
• You need to give 100 mls of Metronidazole over 20
  mins. What is the hourly rate in mls?
• Your patient weighs 65 kg the drug prescribed on
  7mg per kg. How many mg are required?

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MEASURING FUNDAMENTALS OF CARE

• Development of Nursing Patient Experience
  Metrics
• Originally 8 indicators
• Medicines administration
• Falls
• Nutrition
• Tissue Viability
• Infection Prevention
• Patient Observations
• Pain Management
• Continence Management
• Electronic real time reporting
• Peer review Back to the Floor
• Assurance process in place
• Consequence to poor performance / celebration of
  good practice

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Progress October 2010

• Trust remains GREEN overall and has stayed at 90
• 1 RED ward October 2010 (2 RED wards
  September 2010)
• 3 wards slipped from GREEN to AMBER
• GHH slipped from GREEN to AMBER overall
• Pilot of Metrics 2 commencing November 2010 -
  Additional indicators for Diabetes Management
  Discharge Checklists and Assurance

Bar chart to demonstrate Red Wards Green
Wards January 2010 October 2010
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METRICS RESULTS OCTOBER 2010
Critical Care
Theatres
Neonates
Paediatrics
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QUESTION
Do we have a fundamental problem with the
knowledge base of our nursing workforce?
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VITAL

• Virtual interactive teaching and learning
  Education tool to acquire knowledge and skills
  that confirm core standards for safe practice
• Profession / role specific modules in development
• VITAL for nursing
• E learning foundation module related to
  fundamental safe practice
• Integrated training needs analysis and learning
  intervention

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VITAL - premise

• Registered nurses first
• MS to write to every nurse
• HEFT Context around professionalism promoted
• Core safety - linked to metrics
• Linked to other trusts
• Probably badged
• Life span patient journey focused
• VLE user support

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ACCESS

• Access via HEFT Faculty website (www.)
• Platform MOODLE on-line virtual learning
  environment
• Trust specific reports produced
• Will inform national research project on current
  state of nursing knowledge led by HEFT Faculty
  in collaboration with participating partners

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INDICATIVE NURSING CONTENT TBC
Medication Storage Custody inc numeracy
End of Life
Patient Observations inc MEWS /PEWS elements of SBAR and Sepsis
Pain Management
Tissue Viability
Nutritional Assessment
Falls Assessment
Continence Assessment
Privacy Dignity/elements of Communication SBAR
Diabetes
Blood transfusion
Mentor update
Safeguarding children/adults
Discharge planning
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Further face to face education and training
modules as required
STEP OFF / OR
VITAL for nurses Programme Framework
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VITAL Proposed Assessment Scheme
- Congratulations -Successfully passed VITAL
Module
Possible Outcome ongoing performance support.
Glossary Module on MOODLE called VITAL VITAL
contains Units of learning e.g Safeguarding
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VITAL-Ready to go
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NEXT STEPS

• Inclusion of Midwifery 2011
• Development of Trust badge to epitomise HEFT
  Nurse/Midwife
• Utilisation of VITAL pre recruitment?
• Allow access from home to all nurses and midwives
• Assurance to Trust Board, Regulators, patients
  and public that our nurses are knowledgeable and
  competent

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THOUGHTS FOR THE FUTURE

• Move to graduate status excellent news!
• Fit for purpose debate continues
• Yet another review of pre reg curriculum??
• Explore potential to enable mandatory training
  and competency mania.
• Public confidence jury remains out!
• Recent events
• Recommendation 4
• The Trust, in conjunction with the Royal
  Colleges, the Deanery and the nursing
  school at Staffordshire University, should
• review its training programmes for
  all staff to ensure that
• high-quality professional training
  and development is
• provided at all levels and that
  high-quality service is
• recognised and valued.
• The Mid Staffordshire NHS Foundation Trust
  Inquiry

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BLASPHEMOUS THOUGHTS!

• No pilot of P2K
• Concerns over pre-reg practice experience/assessme
  nt of clinical skills/progression to registration
• HEFT Faculty of Nursing Midwifery
• Pilot of 30 students (pre-reg training)
• External evaluation of end product
• Total ownership of whole experience
• Work with academic partner
• Academic credit given to practice
• Ownership and commitment from practice
• Value for money
• Fits with new policy direction
• Logistics becoming easier e.g. amalgamation with
  community nursing
• Appetite from patients / public / practitioners

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• 4.32 Each year several billion pounds are
  spent on central funding of education and
  training for NHS staff through the
  Multi-Professional Education Training levy, in
  addition to investment by NHS organisations in
  their own staff. A top-down management approach
  led by the DOH does not allow accountability for
  decisions affecting workforce supply and demand
  to sit in the right place. It is time to give
  employers greater autonomy and accountability for
  planning and developing the workforce, alongside
  greater professional ownership of the quality of
  education and training

• Healthcare employers and their staff will agree
  plans and funding for workforce development and
  training their decisions will determine
  education plans.
• Education commissioning will be led locally and
  nationally by the healthcare professions .
  Mechanisms will be put in place for nurses and
  midwives and allied health professionals.
• The professions will have a leading role in
  deciding the structure and content of training
  and quality standards.
• All providers of healthcare services will pay to
  meet the costs of educatioin and training.
  Transparent funding flows for education and
  training will support the level playing field
  between providers.

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EQUITY AND EXCELLENCE LIBERATING THE NHS JULY
2010