Ward Staffing Report January 2018

Transcription

1 Page 26 The following highlight report (in fulfilment of the National Quality Board (NQB) expectations on trust board awareness of safe staffing) focuses on any hotspot areas in which the board needs to be aware of in each Division after review of the overall staffing figures, daily staffing reports and staffing incident reports. The table below represents the high level summary of the planned and actual ward staffing levels reported for. This is the information which has been uploaded and will be for public display via NHS choices from early March Detailed ward by ward information is also included as part of this KPI report. From May 2016 Care Hours Per Patient Day (CHPPD) showing average care hours per patient for SGH, PAH and CMH has been included as part of the Model Hospital dashboard and is included in this report. Costs per ward have also been included in the model hospital dashboard since December Staffing position for Site Name SOUTHAMPTON GENERAL HOSPITAL COUNTESS MOUNTBATTEN HOUSE PRINCESS ANNE HOSPITAL Day Night Care Hours Per Patient Day (CHPPD) 1 Average fill rate - Total Average fill rate Average registered Average care - registered fill rate - nurses/ fill rate - Reg. hours nurses/ care staff Midwives care midwives/ Care per Midwives (%) (%) (%) staff (%) nurses Staff patient 83.0% 118.6% 93.1% 132.5% % 136.5% 94.3% 122.3% % 69.2% 101.6% 80.3% NB: Arrows indicate changes against the previous month and do not represent either a positive or negative performance position. Whilst it can be seen that we were not able to staff many clinical areas with our planned level of registered staff due to current vacancy levels, we maintained our staffing levels at or above minimum safety levels. This was achieved by using our nursing/midwifery bank and agency, through reviewing staffing on a daily basis across the Trust and deploying non-ward based staff to support. Hotspot areas for nursing/midwifery staffing in Key metrics show that staffing and capacity challenges continued to be extreme during periods in January. Acuity and dependency remained high across the trust and staff sickness impacted a number of areas. Exceptions by Division are detailed below: 1 CHPPD, split into registered nurses/midwives and health care support workers is calculated using this formula:- Actual hours worked_ Patient count at midnight

2 Page 27 Division A Surgery The surgical ward vacancies continued to improve slowly, with a conscious over-recruitment of support staff, but the wards continued to be challenged with staffing during January. Cancer Care Registered nursing vacancies at CMH continue to be a challenge but a targeted recruitment event has been successful with new starters now in the pipeline. The band 6 team are rotating around the care group to share practice and education and to improve engagement of staff in assisting other areas. AOS has not been used overnight during January and this has reduced the pressure at night. Critical Care All critical care areas have seen a rise in occupancy and flow throughout January. This has led to challenges to staffing the fluctuating levels of activity. The overall registered nurse vacancy has reduced to 8.8% 29 FTE) across the 4 units. Division B The Divisional registered nurse vacancy position remains significant at 24.1% (118 FTE) and has deteriorated during January. Focussed work continues on recruiting additional support staff to various areas of the division to support overall staffing levels. The division s daily staffing challenges have remained consistent in January with some shifts remaining at critical levels. Key mitigating actions and daily senior nurse focus have supported the ward teams to keep patients safe; golden key release is monitored carefully in order to ensure that high cost agency is only used for true break glass eventualities however January has seen a rise in the number of requests to maintain safety. Following consultation, all the divisions matrons are now providing a core hours, evening and weekend on site service and one element of their role is to lead safe staffing planning and decision making. ED and AMU - The registered vacancy position within the Emergency Care group remained stable in January at 12.5% (24 FTE). The trustwide capacity challenges have continued in January and have been particularly focussed on ED and AMU activity. This was reflected in the requests for high cost agency for break glass safety reasons. Urgent and Emergency Care (issued for consultation in November 2017). This has shown UHS to be broadly compliant with the recommendations and a consultation response has been returned. Emergency medicine wards & Medicine for Older People Registered nurse vacancies rose to 35% (92 FTE) and this was reflected in the need to use high cost agency for break-glass safety reasons and an increase in staff moving from across the hospital to support. This represents a concerning continued rise in registered vacancies in these areas and reflects the wider national picture of shortfalls in registered staff. Medicine continues to over-recruit unregistered staff which really supports the risk associated with the RN vacancy rate. Division C Child Health - RN vacancies across child health rose slightly to 15.6% (51 FTE) nurses. This has impacted on the ability to open the beds closed over the summer however there is an improved pipeline of starters expected from February. children and young people s inpatient wards in acute hospitals (issued for consultation in November 2017). This has shown UHS to be broadly compliant with the recommendations and a consultation response has been returned.

3 Page 28 Maternity & Neonates Vacancies for midwives have remained stable this month. Neonatal Care (issued for consultation in November 2017). This has shown UHS to be broadly compliant with the recommendations and a consultation response has been returned. Division D The overall Divisional registered nurse vacancy position increased to 22% (102 FTE) with a pipeline of 13 registered nurses to start in the next 3 months. Staffing of uncommissioned capacity to support the capacity challenges has resulted in an increased usage of high cost agency. T&O and Neurosciences remain areas of focus with registered nurse vacancies of 37.8% (48 FTE) and 26.3% (37 FTE) respectively, an increase for both areas in the month. High vacancies are being managed with staff doing bank shifts, over recruitment of band 3 and 4 s and deploying staff across wards Staff continue to reference the red flags identified in the NICE guidance on safe staffing when completing adverse event reports (AER) linked to staffing. These red flags highlight when patient care has potentially been impacted due to staffing shortfalls. These AERS are reviewed, actioned and mitigated in real-time to reduce the risks. They are also themed monthly and identified actions taken forward linked to the reporting on safe staffing and the trust risk register. Care group and divisional reports are also available to enable focus on trends in incidents being reported from each clinical area. In January there were 75 staffing incident reports in total covering 9 different staff groups. This is a significant decrease on the 110 incidents reported in December and brings the reporting back to normal levels. These incidents have been rated from near miss to moderate (6) impact. This also shows a significant fall on the number of incidents rated at moderate (18 in December) and brings reporting back to normal levels. Of these incidents, 52 were related to nurse staffing, a fall on the 88 reported in December. There were 2 Midwifery incidents reported for the month. Hotspot areas identified through the reporting are being closely reviewed by the divisions. In addition to the existing system, in August 2017 we introduced the capability to report red flag incidents in real-time on the safecare acuity/dependency system in healthroster. Following a rostering and safecare masterclass in January this facility has now been rolled out trustwide and the red flags will be reviewed at the daily staffing meetings The overall vacancy level for ward staffing (registered, unregistered and other support roles) was maintained in January and now stands at 409 FTE (12.9%). This however masks a worsening position for registered staff and an improved position for unregistered staff. The current vacancies are 395 FTE (18.9%) registered vacancies and -15 FTE (- 1.7%) unregistered vacancies as a result of conscious over-recruitment. It should also be noted that, with the arrival of the most recent cohort of nurses from overseas, an increased number of 61.5 FTE registered overseas nurses are currently working as unregistered nurses as they await the results of their English language testing (IELTS) requirements and competency requirements stipulated for NMC (Nursing and Midwifery Council) registration.

4 Page 29 Graph 1 below details the breakdown of temporary staffing cover across the last year. Overall use fell slightly in the month, however high cost agency usage rose by 1 FTE with 7 FTE (126 shifts) in for break glass safety reasons. This equates to 1.9% of the total temporary nursing staff usage. Shifts escalated to high cost agency remained unfilled in a number of cases and all measures were taken to manage staffing across the trust to ensure safety was maintained. The proportion of bank to agency usage continued to increase as planned with 29% of the temporary staff usage filled by agency compared to 38% 12 months ago. Daily escalation processes continue to support the most effective deployment of staff in real-time with the use of safecare acuity/dependency data embedded as part of the daily staffing reviews. Graph 1:

5 Page 30 Graph 2 Ward Staffing - Predicted vacancies