Quality and Nursing Staffing Report

Transcription

1 Trust Board Northern Devon Healthcare NHS Trust Incorporating Community Services in Exeter, East and Mid Devon 1. Purpose 1.1. The purpose of this report is to report to the Trust Board safer staffing data for the months of March and April The report will also provide assurance that nursing sensitive indicators are being monitored against the reduction in temporary staffing throughout the organisation. 2. Background 2.1. The Corporate Nursing Team regularly review staffing levels in triangulation with acuity data provided by wards and departments through the safer staffing application provided by allocate software. Monthly reports are uploaded to NHS improvement Carter (February 216) recommended organisations to start reporting on CHPPD (care hours per patient per day) as of April 216. Following initial piloting of this calculation across several organisations, May 216 will be the first reportable month for CHPPD. This is reported via a Unify template and uploaded to NHS improvement It has been recognised that reporting on whole time equivalents, skill mix or staff to patient ratios may not reflect varying staff allocation across the day. Reporting on CHPPD should resolve this. However, caution should be used as this calculation will not highlight acuity of patients and flexible needs of a ward team. All points of measurement should be triangulated and reviewed collectively The nursing teams across the organisation have worked successfully to reduce agency spend to align within the agency cap rates; however, it is important that quality is not affected. The Corporate Nursing Team have been monitoring nursing sensitive indicators, mainly falls and pressure damage, to ensure that the quality of care to patients has not been affected. Engagement with staff during the reduction in agency spend has been key in continuing to deliver on the quality agenda The new divisional structure has given the Corporate Nursing Team assurance that a visible Senior Nurse is sited on any immediate staffing or clinical safety concerns. 3. Reduction in Nursing Variable Pay V Quality 3.1. Diagram 1, shows the reduction in nursing variable pay across the organisation, excluding the community nursing setting. This has been triangulated with falls and pressure damage. Corporate Nursing Page 1 of 5

2 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Trust Board Northern Devon Healthcare NHS Trust Incorporating Community Services in Exeter, East and Mid Devon Temporary staff spend Falls Pressure damage Linear (Temporary staff spend) Linear (Falls ) Linear (Pressure damage) Diagram 1-demonstration of reduction in variable pay and trends in NSI s 4. Falls 4.1. The number of falls in the acute site has fallen, but risen in the community hospitals during March 216. The Trust falls rate has fluctuated over the last twelve months and is on a rising trajectory. Although the number of falls has reduced, so too have the number of beds available, hence the rise in the rate. 5. Pressure Damage 5.1. There has been a marginal increase in incidence of pressure damage harm events in March 216, but over the previous two years this is still lower than previously recorded. The overall trajectory across the organisation is static, and there is an action plan to address the on -going concern around pressure damage. The acute pressure ulcer reporting is rising which may be reflective of an increased awareness, in particular early signs of pressure damage grade 1.

3 APPROVED v Hours per Patient per Day (HPPD) - Acute & Northern Community Hospitals, March and April Average of Actual HPPD Average of Required HPPD Diagram 2, HPPD Acute and Northern Community Hospitals 6.1. Hours per patient day have been calculated by examining the three times a day acuity data and measuring this against actual. The blue bar chart shows the average of actual staff present on shift, the red bar shows the average of nursing hours required according to patient acuity and dependency. Eight out of the 12 wards had on average staffing levels above their requirements throughout March and April 215. Four out of the 12 wards had on average below the staffing levels required for March and April 216, out of these wards none were more than 1 hour per day short, with the exception of Capener Ward, which was 1.5 hours short on average across both months.

4 APPROVED v Hours per Patient per Day (HPPD) Eastern Community Hospitals Average of Actual HPPD Average of Required HPPD 1 Diagram 3, HPPD Eastern Community Hospitals 7.1. For Eastern locality hospitals, one area (Ottery St Mary Hospital) had staffing above their requirement, according to their acuity data. Exeter Budlake ward was 15 minutes under their requirement. Honiton Ward was 3 minutes under their requirement. All other areas were no more than 1 hour under their requirements per day, according to the census reports. 8. Monitoring of HPPD and Introduction of CHPPD 8.1. It is important to note that both diagrams 2 and 3 report on a combination of registered and healthcare assistant staff groups Using HPPD or CHPPD should not be used in isolation to determine safety in ward areas, it is a point in time assessment that can enable benchmarking.

5 APPROVED v Use of Temporary Staffing 9.1. Use of the safer staffing application and the divisional restructuring has allowed the clinical matrons to become more responsive to patient needs and requirements moving staff in real time. There is still a reliance on temporary staffing to ensure adequate cover within the wards and departments of the organisation Across the acute inpatient wards there are currently 29 registered nursing vacancies which is 16% of total registered whole time equivalent In the community hospital setting northern locality there are 2.55 registered nursing vacancies which is 8% of total registered whole time equivalent In the community hospital setting eastern locality there are 1.55 registered nursing vacancies which is 11.9% of total registered whole time equivalent 1. Conclusion and Recommendations 1.1. To conclude, there has been a considerable reduction in the use of temporary staffing across the organisation. Using less temporary staff has not increased the incidence of harm events. Registered Nurse vacancies remain a particular concern especially across acute and Eastern inpatient areas. Acuity census data collected by inpatient areas suggests that most patients are receiving care hours by nursing staff reflective of what is required according to acuity and dependency. The trend line for falls continues to decrease. The trend line for pressure damage remains static To start reporting on CHPPD from the end of May 216 in line with national directive To start considering how CHPPD can be reported on inclusive of allied health professionals which will be the second phase of CHPPD reporting, this will in turn recognise the multidisciplinary approach NDHCT has to patient centred care To continue with proactive recruitment of nurses and healthcare support workers to continue reduction in agency usage.