Report title Nursing & Midwifery Establishment Compliance - October 2015 Meeting date 27th November 2015

Transcription

1 Meeting title Trust Board Report title Nursing & Midwifery Establishment Compliance - October 2015 Meeting date 27th November 2015 Lead director Report author FOI status Report summary Charlotte Hall Chief Nurse Carole Webster Deputy Chief Nurse Disclosable The National Quality Board (NQB) published guidance for nursing, midwifery and care staffing capacity and capability in November Purpose Recommendation Corporate objective links CQC standard Identified risks and risk management actions Resource implications This paper details the actual hours used matched with the hours planned for nursing and midwifery staff for each inpatient area in October, actions taken to maintain safe staffing levels and evaluates this against key nursing and midwifery metrics drawn from the Nursing Scorecard. Information The Trust Executive Committee is asked to note the Report Our patients, our services, our people, our finances Safe, effective, caring responsive, well led Safe staffing levels will minimise adverse clinical incidents and ensure our patients are cared for in a safe environment. It is essential to have safe staffing levels at all times, which currently necessitates using temporary staffing Legal implications Equality impact assessment Report history Considered by other committees Monthly report to TEC and to trust board Nursing and Midwifery Committee Trust Executive Committee Patient Safety and Quality Committee Appendices Appendix 1 Full Staffing UNIFY Data Great care to every patient, every day 1

2 INTRODUCTION EPSOM AND ST HELIER UNIVERSITY HOSPITALS NHS TRUST NURSING & MIDWIFERY ESTABLISHMENT COMPLIANCE TRUST BOARD MEETING: 27 TH NOVEMBER The Trust is required to make submissions of planned staffing compared with actual staffing in response to one of the requirements from the National Quality Board (NQB) report. (2012). 1.2 This paper details the each ward s percentage of rostered nursing / midwifery hours (planned) expected to be delivered compared to the percentage of hours that were delivered (actual) throughout the month of October. The purpose of this is to identify areas of staffing concern; where wards report less than 80% or more than 130% actual staffing are required to provide exception reports to the chief nurse. This data is submitted to Unify. 1.3 NICE guidance stipulates every Trust must complete a recommended acuity/ dependency tool. The trust completes this three times a year in February, June and October following recommendations through the Shelford Group. 1.4 The Trust also follows NICE guidance in supporting the benchmark of 1 registered nurse to 8 patients in the day and 1 registered nurse to 11 patients during the night. It is important to note that the matrons and CSM s also use professional judgement to determine staffing levels on a shift by shift basis. ANALYSIS 2.0 Planned versus actual staffing: 2.1 In October, there were there was one general adult area which fell below the 80% actual nursing hours provided and this was: CCU at Epsom HCA Day shift 379 planned, 236 actual (62.3%) 2.2 There were two wards recorded with over 130% actual nursing hours: A3 HCA Night Duty 713 planned, 1024 actual (143%) C6 HCA Night Duty 357 planned, 484 actual (135.6%) 2.3 CCU continues to be monitored closely by the Ward Manager and Matron to ensure that patient care or experience is not compromised. The two areas, A3 and C6 had to use a higher number of HCA shifts than planned because the shifts could not be filled by registered nurses so professional judgement was used to manage the shift appropriately. 2

3 3.0 Ward Management Supervisory days 3.1 The ward manager supervisory days are recognised as being essential to providing optimum levels of high quality care. They enable ward managers to supervise care, monitor standards, work alongside staff and undertake staff development as well as speak to patients and visitors and generally are clinically visible across the Trust. The supervisory status has been introduced through a phased approach. Currently 59% wards are fully funded to be supervisory (five shifts allocated per week). The remaining 41% have a minimum of three days allocated per week and all will be fully compliant from April The challenge for staff has been to free the time to work in a supervisory capacity instead of working clinically caring for a group of patients. As vacancies fill this is becoming easier. It is good that the number of supervisory days taken across the trust is continuing to increase. The graph below is encouraging as it demonstrates a downward trend in the number of ward managers who are achieving less than 50% supervisory practice whilst on duty Staff continue to record red flags through the trust Datix system, these are monitored closely by the specific directorate Matron and Head of Nursing. "Red flag events" include lack of patient checks, omissions in providing medications and delays in issuing pain relief, which will act as a trigger for considering increasing staff numbers. Another warning sign will be if there are fewer than two registered nurses on a ward during a shift. 3.4 In October there were 39 red flags Datix reports across the Trust with the greatest number, five, being reported in Epsom Emergency Department. These relate to the department working with less than their established numbers of nursing staff due to vacancy and short notice absence on a shift. 4. Vacancies 4.1 In total 61 new nurses and midwives started working in the Trust in October. Of these, 31 were from overseas recruitment and the rest by routine recruitment processes. The number of vacancies in ED, paediatrics and theatres remains a concern. Work is underway to advertise 3

4 these in a specialist magazine for ex -military service staff, as well as advertising on TRAC and NHS jobs 4.2 The implementation of the new TRAC system in October has gone well, and combined with the new factual references processes, has already made a positive impact on the time to hire resulting in nurses starting work more quickly. 4.3 The Head of Nursing and Midwifery recruitment, head of education and one of the Trusts Clinical practice Educators attended Kingston University in October to talk to 3 rd year student nurses about working for the Trust. A supportive recruitment plan has been developed for the students, including support with application forms and programme of interview practice sessions. 4.4 The following departments have band 7 vacancies; Epsom Emergency Department and Neonatal unit at STH. Both these areas are closely supported by their Matrons and are trying to recruit. 4.5 The Head of Midwifery has reviewed the establishment on M2 (gynaecological ward) as currently there is no band 7 ward manager. It has been agreed that the vacant post should cover both the ward and outpatients; this post is currently being recruited to. 4.6 SAU (surgical) has had only one part time ward manager vacancy since July. This is currently being reviewed and will be advertised in the near future. 5.0 Nursing metrics 5.1 The nursing metrics that demonstrate the value of nursing are being reviewed and will be available for next month s report. These will include individual ward date: No falls per 1000 occupied bed days Grade 2,3,4 hospital acquired pressure ulcers FFT score and response rate Number of cases of C.Diff % of late observations breached % of harm free care expresses through the Safety Thermometer Number of wards without a substantive ward manager at band Recommendations 6.1 The Board is asked to note the report. 4

5 Staffing: Nursing, Midwifery and Care Staff Data Collection - Epsom & St Helier DataSheet October 2015 Hospital Site name Ward name Registered Midwives/Nurses planned actual staff staff hours hours Day planned staff hours Care Staff actual staff hours Registered Midwives/Nurses planned actual staff staff hours hours planned staff hours actual staff hours rate - registered nurses / midwives (%) St Helier Hospital - RVR05 A3 (A3) % 105.5% 82.8% 143.6% St Helier Hospital - RVR05 A5 (A5) % 98.2% 82.8% 101.7% St Helier Hospital - RVR05 A6 (A6) % 96.9% 82.8% 101.7% St Helier Hospital - RVR05 AMUS (AMU) % 102.0% 94.5% 100.1% St Helier Hospital - RVR05 B1 (Whitfield Unit) % 103.1% 101.7% 109.8% St Helier Hospital - RVR05 B3 (B3) % 106.4% 100.0% 103.4% St Helier Hospital - RVR05 B5S (B5 Surgical) % 103.3% 91.1% 113.0% St Helier Hospital - RVR05 B6SS (B6 Medical Short Stay) % 98.5% 89.3% 103.4% St Helier Hospital - RVR05 BEA1 (Beacon) % 96.6% 94.6% 100.0% St Helier Hospital - RVR05 C2 (C2) % 113.2% 92.5% 113.2% St Helier Hospital - RVR05 C3 (C3 Stroke Unit) % 105.6% 86.5% 112.9% St Helier Hospital - RVR05 C4 (C4) % 95.2% 92.5% 100.0% St Helier Hospital - RVR06 C5 (C5) % 100.0% 100.0% 100.0% St Helier Hospital - RVR05 C6 (C6) % 103.4% 83.9% 135.6% St Helier Hospital - RVR05 FDW (Frank Deas) % 107.3% 96.8% 106.5% St Helier Hospital - RVR05 HS (Harry Secombe) % 96.6% 86.0% St Helier Hospital - RVR05 M2 (M2) % 98.1% 100.0% 96.8% St Helier Hospital - RVR05 MAT (Maternity Ward) % 102.5% 93.3% 75.7% St Helier Hospital - RVR05 NNU (Neonatal Unit) % 100.0% 100.0% 100.0% St Helier Hospital - RVR05 QM2 (QM2) % 109.5% 100.0% St Helier Hospital - RVR05 RB (Richard Bright) % 96.6% 95.6% St Helier Hospital - RVR05 SITU (ITU/HDU) % 99.7% Epsom Hospital - RVR50 ALE (Alexandra) % 89.9% 98.9% 96.7% Epsom Hospital - RVR50 AMUC (Chuter Ede AMU) % 85.8% 96.1% 99.0% Epsom Hospital - RVR50 BRI (Britten) % 99.5% 94.7% 100.0% Epsom Hospital - RVR50 BUC (Buckley) % 93.6% 96.0% 99.5% Epsom Hospital - RVR50 CSY (Casey) % 80.2% 95.4% Epsom Hospital - RVR50 ECCU (Coronary Care Unit) % 62.3% 100.0% Epsom Hospital - RVR50 EITU (Intensive Therapy Unit (inc. HDU)) % 96.1% Epsom Hospital - RVR50 EMAT (Maternity Unit) % 90.5% 97.2% 87.5% Epsom Hospital - RVR50 GLO (Gloucester) % 96.1% 100.0% 100.0% Epsom Hospital - RVR50 NOR (Northey) % 90.8% 84.8% 98.5% Epsom Hospital - RVR50 SCBU (Special Care Baby Unit) % 100.0% 100.0% Epsom Hospital - RVR50 SWIF (Swift Ward) % 100.0% 95.2% 100.0% South West London Elective OrthoDERB (Derby) % 96.8% 100.0% 100.0% South West London Elective OrthoOAKS (Oaks) % 96.9% 97.8% 100.0% South West London Elective OrthoPACU (EOC PACU - Recovery) % 90.1% 99.1% Night Care Staff rate - care staff (%) 61,371 56,698 25,343 24,635 49,612 46,983 16,875 17,412 92% 97% 95% 103% Day rate - registered nurses / midwives (%) rate - care staff (%) Night