Nursing Glimpse of Brilliance

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1 November 2017 This newsletter will be prepared and sent to you on a bi-monthly basis, providing you with a snapshot of useful information including new developments and key new roles within the Trust. New Appointments Congratulations to Theresa Marsden who has been appointed as the Data Quality and Audit Midwife. Well done to Gaynor Daw who has commenced a twelve month secondment as Deputy Governance Midwife. Sarah Brennan has been appointed as substantive labour ward leader, congratulations. Congratulations to Hifza Quraishi who has commenced in post as Band 7 in theatres at Pinderfields. Well done to Jane Stockill who has been appointed as the band 7 for PACU. Tracey Spacey has been appointed as Critical Care Unit Manager, congratulations. Congratulations to Karen Benstead on her substantive appointment to Assistant Director of Nursing for Care Closer to Home. In an amendment to the last edition it has been confirmed Annette Critchley was appointed as Community Vascular Outreach Nurse. Congratulations to Matron Scott Fenwick who has commenced in post as Head of Patient Flow for 3 months. Farewells Good luck to Gill Pownall (Head of Midwifery) who has left the Trust to commence a 12 month secondment with NHS England. Congratulations to Fiona Gregory (Assistant Director of Nursing for the Division of Surgery) who has recently retired. Enjoy your retirement. The Community Team bid a fond farewell to Janet Watson-Ellis (Network 6 Team Leader) who will be retiring in November Celebrating Success Congratulations to Kirsty McMullan who received the Leading the change to speaking up becoming business as usual category at the recent Freedom to Speak up Awards Kirsty was also runner up in the category Freedom to Speak Up Guardian or network of the year. In total the Trust were nominated for three different categories and shortlisted for two. Well Done Welcome to Kirsty Stead who has joined the Division of Medicine as the Associate Deputy Director of Operation. The Division have also welcomed Elena Gelsthorpe-Hill as trainee PSM Acute Medicine

2 Changing practice and culture in adopting a patient centred approach With an ever increasing demand upon services at Mid Yorkshire Hospitals NHS Trust and a recent trust reconfiguration, ways of working for our patients are being addressed to ensure a positive patient experience. This has been approached by looking at ways to reduce length of stay, increase discharges which in turn impacts on risk of falls, infection rates and a reduction in deconditioning. What was the solution? Embed the SAFER care bundle as an MDT approach to care through ownership and accountability The Mid Yorkshire Hospitals NHS Trust looked at an approach to standardise ward approaches to admission and discharge Adopting and rolling out a trust wide Red2Green process Project of change to be led by senior nurse to ensure approach has credibility and is sustainable Continuous improvement of practice through Red2Green Promote SAFER through multiple methods of communication The Board rounds identified 10 patients to report at 10am to the operations centre into the flow team SAFER is a practical tool to reduce delays for patients in adult inpatient wards (excluding maternity). The SAFER bundle blends five elements of best practice. It s important to implement all five elements together to achieve cumulative benefits. It works particularly well when it is used in conjunction with the Red and Green Days approach. When followed consistently, length of stay reduces and patient flow and safety improves. The SAFER patient flow bundle S - Senior Review. All patients will have a senior review before midday by a clinician able to make management and discharge decisions. A All patients will have an Expected Discharge Date (EDD) and Clinical Criteria for Discharge (CCD), set by assuming ideal recovery and assuming no unnecessary waiting. F - Flow of patients to commence at the earliest opportunity from assessment units to inpatient wards. Wards routinely receiving patients from assessment units will ensure the first patient arrives on the ward by 10am. E Early discharge. 33% of patients will be discharged from base inpatient wards before midday. R Review. A systematic multi-disciplinary team (MDT) review of patients with extended lengths of stay (>7 days also known as stranded patients ) with a clear home first mind set. S - Senior Review. All patients should have a senior review before midday. What were the results? Over a 6 month period within 3 medical elderly wards over 300 extra patients were discharged. The median length of Stay for this cohort group across the three wards dropped by days. Red2Green processes have addressed some ward areas of delay Use of the discharge lounge increased The median length of stay within an area of surgery fell by 2.5 days. Wards that adopted the SAFER care bundle have seen an increase in discharges. The trust adopting a change in culture to ensure this practice continues and is seen as valuable for our patients and staff alike. For further information please contact Mike Williams, Matron/Urgent Care project manager Michael.williams2@midyorks.nhs.uk

3 Pictured below is Nicola Lawford, Ward Manager of Ward 15 at Dewsbury. The ward doubled their discharge rate in the first week of implementing SAFER. Graduate Nurse Programme The Practice Learning Development Facilitator team have been working hard to support the Mid Yorkshire School of Nursing in partnership with Bradford University. Student nurses nearing qualification in their final semester at University are invited to a Graduate Nurse Recruitment Open Day. The Graduate Nurse Programme is evidence based and is designed around Health Education England s 2015 preceptorship guidance. It is aimed at helping new nurses develop their knowledge and skills in a safe and supportive environment. As part of this programme the students attend workshops prior to qualifying which are developed to empower new nurses to encourage them to step up and take accountability on their journey towards autonomous practice. NEWS - Improvements Following the recent CQC inspection concerns were raised with regards to poor monitoring, escalation, review and documentation of the deteriorating patient in relation to high NEWS scores within medicine at DDH. There have been significant improvements made at DDH on the medical wards. All DDH wards are now in the top half of the league table on the Vitalpac dashboard. Well done. It has been acknowledged by the Deteriorating patient group that this is a remarkable achievement and the group would like to recognise this. Congratulations to Ward 15 at DDH who have demonstrated an improvement in performance. New nurses at the Trust are called Freshers and are recognised as having a blue sticker on their name badge. Following qualification, fresher nurses attend nine education days delivered by the Clinical Educators from the Professional Development and Education Team. Freshers are assigned a named mentor and receive a high level of support as they are inducted in to their new role. There is also a Rapid Process Improvement Workshop (RPIW) planned for the deteriorating patient on the DDH medical wards in November 2017.

4 Gold Standards Framework The Gold Standards Framework (GSF) is a model that enables good practice to be available to all people nearing the end of their lives, irrespective of diagnosis. It is a way of raising the level of care with the help of advanced care planning. Through GSF, palliative care skills for cancer patients can now be used to meet the needs of people with other life-limiting conditions. The GSF provides a framework for a planned system of care in consultation with the patient and family. It promotes better coordination and collaboration between healthcare professionals. The tool helps to optimise out-of-hours care and can prevent crises and inappropriate hospital admissions. Its aim is to provide patient centred care allowing patients and carers to have the care in the right place at the right time. The implementation of the framework will take place over a two year period leading to accreditation at the end of this time. Initially it is being introduced to 15 wards across the Trust with a view to implementing the framework Trust wide. Sarah Oldroyd been appointed as the Trusts Gold Standards Facilitator This post is initially for a year and Sarah will be available for support and advice in relation to the Gold Standards Framework. Sarah is contactable through the Specialist Palliative Care Team or via . Macmillan Fast Track Facilitator Justin Trewren has been appointed as the Macmillan Fast Track Facilitator My role is a two year project funded by Macmillan. Its aim is to achieve the discharge of the dying patient to their preferred place of care, reduce length of stay and reduce readmission of patients on the end of life care plan at Pinderfields Hospital. I ve been in post since 04 September 2017; much of my activity during the first two months has been around the preparation for a Rapid Process Improvement Workshop regarding Fast Track discharge. The project has seen the development of a Rapid Discharge Pathway. The pathway aims to give clear guidance and time frames improving the time, quality and safety of discharges for our patients at the end of life. Many improvements were made to the Fast Track process during the workshop week. At the moment the project is focussed on Gate 43, but I look forward to implementing it across the Trust in the future. I know together we can increase the number of patients achieving their preferred place of care and death. I ve been involved with around 45 Fast Track discharges since in post, for advice and support please send a referral to the Macmillan Specialist Palliative Care Team stating that your referral is regarding Fast Track Discharge Planning for End of Life Care.

5 React to Red The React to Red skin campaign is being led by our Tissue Viability Nurses (TVNs) to raise awareness of pressure ulcer prevention. Below: Alison Murphy (Lead TVN) on Ward 6 at Dewsbury promoting React to Red It is aimed at patients, families and carers with the message that by reacting to red skin and asking for help and advice from a healthcare professional, red skin can be prevented from becoming a serious wound. As part of the campaign React to Red awareness stands were held on 16 November in the atrium at Pinderfields and near the main entrance to the Ridings Building at Dewsbury. The TVNs were highlighting the React to Red training tool designed to help staff, patients and carers recognise the early warning signs so they can react and ensure preventative measures are in place. The TVNs will also be visiting wards and community teams. The main messages are: 1. Regularly check skin is not sore or discoloured in anyway. 2. It s really important to keep patients moving while in bed or on a chair. Change position as much as possible when appropriate. 3. Ensure that skin is clean and dry or ask for help. 4. Eat a well-balanced diet and drink plenty of fluids. 5. Special equipment is available for those at risk of developing pressure ulcers. MUST Training A MUST workshop will be occurring on the 11 December 2017 at 14:30 in Trust HQ. This will be run by a lead dietician, Quality Improvement Lead and VitalPac trainers and will endeavor to unpick some of the issues around staff difficulties to complete MUST as well as educating staff on the importance of accurate and timely nutrition assessments. All staff that complete MUST assessments are welcome. To book a place please contact: Steve.Friel@midyorks.nhs.uk. Quality Improvement Lead ( ) More information is available on the React to Red intranet page or contact the TVN Team Tweet Tweet Keeping you up to date has been recognised as an essential need by the deputy chief nurses who now have a twitter account. This will provide information on key matters within the Trust. Please join and comment