Nursing & Patient Services Annual Report

Transcription

1 Nursing & Patient Services Annual Report Helen Lamont, Nursing and Patient Services Director June 2015 Page 1 of 42

2 Contents Introduction... 4 Section 1: Patient Services Corporate Activity Developments and Projects... 5 i. Nursing and Midwifery Strategy... 5 ii. CQUIN Commissioning for Quality and Innovation... 6 iii. Standards and Professional Leadership... 6 iv. Staffing Developments... 7 v. International Recruitment... 7 vi. Bands 2 4 developments... 8 vii. Ebola Preparedness... 8 viii. Readmissions Projects... 8 a. Specialist Palliative Care Rapid Assessment Team... 9 b. Specialist Care Home Support Team... 9 ix. Implementation of IFIT x. NHS Safety Thermometer xi. Annual Nursing and Midwifery Achievement Awards Section 2: Services and Departments Practice Education Team Practice Development The Newcastle Specialist Continence Service Nutrition Tissue Viability Falls Prevention Nurse Consultant for Vulnerable Older Adults Nurse Consultant Critical Care Infection Prevention and Control Equality and Diversity Outpatients Occupational Health & Wellbeing Service Staff Bank Hospital at Night Nurse Practitioners Patient Services Coordinators (PSC) Urgent Care Page 2 of 42

3 17. Chaplaincy Patient Carer and Public Involvement Patient Relations Department End of Life Care Team Corporate Cancer Services Specialist Palliative Care Service Safeguarding Adults Therapy Services i. Paediatric Speech and Language Therapy ii. Adult Speech & Language Therapy iii. Occupational Therapy iv. Physiotherapy v. Podiatry vi. Psychology in Health Care vii. Newcastle Nutrition Appendix 1 Patient Services Staff (Headcount) Page 3 of 42

4 Introduction Many people equate Patient Services with Nursing leadership and do not fully understand the wide range and diversity of responsibilities shared between the wider Patient Services team. The responsibilities touch on the patient journey and experience from first contact with the Trust, to discharge and ongoing care. In addition, the team leads and supports a range of staff related functions to ensure their wellbeing and a steady supply of appropriately educated and competent staff, via the Staff Bank to support teams across the Trust. Of course, in addition there is a range of unseen advice and guidance which is not reported here, and which just keeps the show on the road. The following report illustrates much of what the team has achieved and sets out a number of priorities and challenges for the year ahead. It looks like 2015/16 will be just as busy as previous years, with the additional challenge of introducing Revalidation for the Trust s 4500 Nurses and Midwives. Helen Lamont Nursing and Patient Services Director 16 th June 2015 Page 4 of 42

5 Section 1: Patient Services Corporate Activity Developments and Projects i. Nursing and Midwifery Strategy During 2014/15 Patient Services have demonstrated achievement against the Trust Nursing and Midwifery strategy Proud of Nursing and Midwifery in Newcastle- Compassion, Quality and Excellence in all that we do which was launched in July The Strategy identifies five key themes: To put patients first in all that we do To deliver safe and effective Harm Free care To deliver high quality care To recognise, and maximise, our reputation for Nursing excellence To have an empowered and skilled workforce The aim of the Strategy is to articulate for all nurses and midwives in the Trust the key priorities for practice. Each theme is defined and then actions that will support and demonstrate achievement are outlined. Trust Board has been regularly updated on progress throughout 2014/15. Work is ongoing both corporately and in Directorates to deliver against these strategic priorities, achievements to date include; Enhanced patient feedback mechanisms through implementation of Friends and Family, across all Trust Services and development of analysis of all patient feedback in a combined report which is available to Directorates. Examples of service improvement based on patient feedback. Examples of personalised reasonable adjustments to meet the needs of individual patients. Increased numbers of patients experiencing Harm-Free care. Introduction of Open and Honest Care reporting to the public, demonstrating progress to reduce harms and actions taken in a wide variety of ways to improve the patient experience and quality of care. Work to support the Directorate based Clinical Educators in their role in the delivery of education in support of Corporate priorities and enhance their leadership and personal effectiveness Strengths Based Recruitment introduced for Band 7 Ward Sisters, an initiative developed with Shelford colleagues to ensure we recruit the best. This is now being developed for HCA s and band 5 Staff Nurses. Nurse staffing review of all adult in-patient wards with agreed establishments and robust monitoring arrangements in place. Development of Nursing and Midwifery Professional Advisory Council who have taken work forward to develop the Trusts definition of compassion within a Compassion Tree Page 5 of 42

6 Work is ongoing against all five themes to ensure that going forward Trust Nurses and Midwives, and all the staff who support them, can remain proud of all they achieve by delivering compassionate and excellent care. ii. CQUIN Commissioning for Quality and Innovation The Heads of Nursing and Head of Patient Services led work to secure improvements in quality of services and, better outcomes for patients, in line with Commissioning for Quality and Innovation (CQUIN) priorities. Significant work was undertaken relating to: Reduction in Pressure Damage incidence. Introduction of Alcohol screening and delivery of Brief Advice across several Patient Pathways. Ensure Dementia Screening and support for Dementia carers was in place. Roll out of Friends and Family and increase response rates across the Trust including community and Childrens services. Deteriorating Patients (NEWS). End of Life Care to maintain high quality care for palliative care patients with the withdrawal of the Liverpool care pathway. iii. Standards and Professional Leadership The professional leadership of all Nursing & Midwifery teams is the responsibility of the Nursing and Patient Services Director supported by Heads of Nursing and Patient Services as well as the Head of Midwifery. The Matrons are the guardians of professional standards at Directorate level and work very closely with Sisters/Charge Nurses, Nurses in Specialist Roles and the Corporate Nursing team to whom they are professionally accountable. This professional accountability framework provides the leadership and support which is essential to underpin safe and high quality care and that the Trust meets the requirements of the regulatory bodies and, indeed, the patients we care for. This responsibility is embedded into our Trust N&M strategy which provides the corporate Nursing work plans and success criteria. This responsibility and professional accountability is also in place to ensure safety. In all circumstances where appropriate standards, either capability or conduct, have not been met, a culture of fairness and consistency is applied particularly in recognizing human error. The most serious cases, which progress to formal process, are all overseen by the Nursing and Patient Services Director and her team. Whilst the most serious cases resulted in formal disciplinary action, a significant number were addressed in training and education or formal counseling. In 2014/15, the Senior Nursing team have contributed to Multi-Disciplinary Significant Event Reviews alongside the Clinical Directors for Patient Safety and Quality and Senior Staff within the Clinical Governance and Risk Department. They have ensured lessons learnt from these and other review processes have been shared by the successful and now well established monthly Patient Safety Briefings. Page 6 of 42

7 iv. Staffing Developments Nurse staffing remains high on the Trust agenda with continued National and local shortages of Registered Nurses. The Nurse Staffing Review Phase Two is complete, this included all areas which were not reviewed in Phase One (In Patient areas). This has been a huge undertaking covering 135 areas across the Trust. This led to a series of recommendations and actions for areas and Nurse staffing investment in Medicine, Care of the Elderly and Midwifery. There is now a regular review process in place which uses NICE endorsed toolkits such as the Safer Nursing Care Tool (SNCT) and the Professional Judgement of the Sisters, Matrons and the Nurse Staffing Review team. The reviews utilise Nurse Staffing data gathered from the Clinical Assurance Tool, SNCT, Nurse Day Count, Datix and workforce metrics. This data is also monitored by the Reporting and Monitoring Nurse Staffing Steering Group. Collaboration with IT and HR has led to the development of systems to monitor Nurse Staffing which provide a clearer understanding and puts us in a much better position to offer support where it is needed. The Trust Nursing and Midwifery Recruitment and Retention Group has continued its work, looking at ways of maximising the Trusts brand as a good place to work. The centralised recruitment process for band 5 Registered Nurses and Health Care Assistants (HCA) has been streamlined with greater collaboration with HR. Widening access continues through the Health Care Academy, Assistant Practitioner programme and for the first cohort of Pre- Registration HCA participants. Successful advertising campaigns, updated webpages and Careers Days have drawn new recruits to the Trust. Welcome days and a revised Preceptorship programme support new recruits which leads into continued professional development via Clinical Supervision and the appraisal system. Using Strengths Based Recruitment to appoint Band 7 Ward Sisters is to be rolled out to Staff Nurses and HCAs during the coming year. This process ensures the right staff with the right strengths are in the right posts providing a more engaged workforce which will lead to improved patient care. v. International Recruitment Due to ongoing national recruitment difficulties the Trust took the decision to recruit band 5 nurses from overseas. As the Trust already has a well established Filipino community, the decision was taken to recruit again from the Philippines and following a formal procurement process, a partner agency was identified to support recruitment. Senior Sister Allison Heathcote was appointed as the International Recruitment Nurse Lead and in February 2015 a team of 5 from the Trust travelled to the Philippines to carry out the interview process. This proved to be very successful and offers of employment were made to 53 nurses. A steering group specifically for International Recruitment was formed under the leadership of the Head of Nursing (RVI) to ensure the process is management effectively, with members of the group including colleagues from Human Resources, Staff Development and Finance. The first cohort of 7 nurses arrived in the Trust in April 2015 and they are currently completing an overseas nurses programme, working on the wards as pre-registered nurses until they have gained their NMC registration. Other nurses appointed in February are due to arrive during summer Page 7 of 42

8 vi. Bands 2 4 developments Building on the success of 2013/14, and in collaboration with colleagues in Staff Development, the Healthcare Academy which provides all new Healthcare Assistants with a two week induction programme, underpinned by national minimum training standards has continued. Since the first cohort in October 2013, 246 new Healthcare Assistants have attended this programme. Evaluation from both participants and managers is extremely positive. Leadership and responsibility for recruitment of Healthcare Assistants has recently been given to two Matrons who will also support the implementation of Strengths Based Recruitment for this staff group during Continuing the theme of developments for the non-professionally registered nursing workforce, the role of Assistant Practitioner has continued into its third year with recruitment recently completed for the fourth cohort of Trainee Assistant Practitioners. The success of this new role is noteworthy and has generated significant interest from both applicants and managers and during the recent interviews 27 candidates were appointed from a significant number of applicants. vii. Ebola Preparedness The Trust agreed to be one of four National surge centres during the Ebola epidemic in West Africa. This involved a great deal of preparation to provide safe facilities, train staff, source appropriate equipment, produce guidance, plan resilience and work in partnership with external agencies. The Nursing and Patient Services team has worked alongside many other colleagues to ensure a robust response. Staff safety was the priority in all preparations, therefore training was delivered to enable safe care of possible or confirmed cases whether they presented at walk-in centres, the emergency department or were brought directly to the ward 19 at the RVI. Training in the safe management of these patients has been delivered to over 230 staff, by the Infection Control Nursing team, including safe use of appropriate PPE (personal protective equipment). These included 11 staff from Scotland. Our processes and procedures have been tested and proved successful when staff safely managed suspected cases who presented to the Trust, and the repatriated of healthcare workers to the Infectious Diseases ward following exposure to Ebola while caring for patients in West Africa. The legacy of these preparations is that Newcastle will remain one of the four centres able to care for patients who require high level isolation as well as being the main centre to care for children with these diseases, due to our on-site paediatric service. To ensure readiness our processes and procedures will be tested regularly and a core group of staff trained in the management of these patients will be maintained. viii. Readmissions Projects Page 8 of 42

9 Following a very successful year all projects have been supported for a further year s funding with the expectation that these work streams will be embedded into business as usual. All project leads have been given the opportunity to share their success with the local commissioners. Monthly steering group meetings will continue chaired by Head of Patient Services with an emphasis, on where possible, amalgamating work streams. An update on each of the projects is as follows; a. Specialist Palliative Care Rapid Assessment Team As one of the Trust s re-admissions projects, a Specialist Palliative Care Rapid Assessment project went live in September Access to this service was initially 8.30am pm, 7 days a week including Bank Holidays. The project objectives were to provide a rapid (within 1 hour) Specialist Palliative Care assessment to those patients in their own homes, with identified complex, specialist palliative care needs that without such intervention might result in an admission to hospital. The Newcastle Community Specialist Palliative Care Team has led on this with the aim of improving patient care and enhancing the patient/carer experience whilst offering support to non-specialist palliative care colleagues. This assessment facilitates rapid intervention and management of the patients uncontrolled symptoms and other specialist palliative care needs, in order to: Prevent unnecessary admission to hospital. Trigger an appropriate time limited admission for specific treatment / investigation. For those patients who may require admission, the Specialist Palliative Care Team liaise with the receiving team (Assessment Suite at RVI) in order to facilitate timely intervention and either expedite rapid discharge home, or an appropriate time limited admission. KPI s at the end of year 1 demonstrated a quality improvement and net saving of 26,167 after receiving 126 referrals into the project with only 5 of these requiring a hospital admission. This is in addition to our existing service provision. As a result of this, negotiations have been successful with the CCG s in securing substantive funding to allow this rapid assessment element of the service to continue 7 days a week, and become integral within the existing Specialist Palliative Care Service. b. Specialist Care Home Support Team In April 2014 the Nursing Home Support Team and the Catheter Acquired Urinary Tract Infection Team combined to form the Specialist Care Home Support Team. The Specialist Care Home Support Team provides multidisciplinary assessment and support, into a number of Care Homes within the Newcastle upon Tyne area. This is undertaken by working in partnership with the Care Home staff and local GP s. The aim of the team is to prevent unnecessary hospital admissions, therefore improving the care and experience of residents within the Care Homes. Within the last year the team has avoided 467 hospital admissions. Page 9 of 42

10 ix. Implementation of IFIT The highly successful implementation of ifit was undertaken on the 28th February 2015 following extensive collaboration between numerous Trust departments. The success was measured by the exceptionally low call volume received by the IT Help Desk following the launch and the minimal impact experienced on day to day operations. Feed-back from all departments has been extremely positive with staff finding the system intuitive and user friendly. Tracking case notes using the Radio Frequency Identifier (RFID) tag has also proven to be very beneficial in locating misplaced notes, ascertaining if the case notes are still in the library and also tracking notes in transit. This greatly reduces the time required by staff to look for misplaced case notes and, most importantly ensures the increased availability of clinic notes. With the introduction of location based filing, WiFi enabled devices and search devices, the medical records team has been able to significantly reduce the amount of time required to pull, file and locate notes. This realisation in benefits will enable us to make significant CIP savings as outlined in the original business case, by March x. NHS Safety Thermometer The Department of Health published guidance to support the NHS in implementing the NHS Safety Thermometer in 2012 and data is collected on one day each month measuring four high volume patient safety issues. Pressure Ulcers Catheter Associated Urinary Tract Infections (CAUTI) Venous Thrombo-embolisms Falls Ward Sisters are responsible for the collection of this data however the co-ordination of data for validation and preparation for its submission rests with the Senior Nurse Practice Development. The leads for three of the four harms (Pressure Ulcers, CAUTI, Falls) also work within Patient Services and have developed and led initiatives which have seen an increase in the numbers of patients receiving Harm Free Care. xi. Annual Nursing and Midwifery Achievement Awards Each year and as part of the Annual Nursing & Midwifery Conference we hold an annual application process for all qualified Nurses and Midwives to submit an example of best practice for service improvement, innovation or research. The Hospital Trustees sponsor the awards and provide a 5000 award for innovation and excellence in practice, as well as a 5000 award for research. Awardees are expected to spend the award money on developments to further enhance the project. Short listed applicants are interviewed and provide further information about the project to a panel. In 2014 the winner was; Midwife Jane Linsley - The Birth Reflections Service. The service is an essential aspect of care for women and their families and allows the empowerment of women to take the opportunity to reflect and review their birth experience Page 10 of 42

11 and make a different to their lives and possible future births. The service extends beyond the discussion on the birth experience to how the women can embed a more positive effect on the bonding with the baby, supporting family relationships and ability to understand they life transition. In addition the service contributes to the patient feedback remit by listening and learning from patients experiences, auditing the themes and feedback through the risk management structures as appropriate. Results from the audit suggests that by having an informal mechanism, such as the birth reflection service, the women can meet, when they are ready to discuss their hopes and fears and has an impact on their decision to take their concerns through more formal routes. The uptake of this service is set to rise and by learning from and supporting these women to address their concern in this way will continue to contribute to the quality of the service provision. Highly commended by the panel were School Nurse Dawn Wilson, and Health Visitor Jacqui Smith for the Hello Goodbye: Supporting Children and families through key transition stages project. This project was undertaken as a new initiative with the vision of improving service delivery as part of a seamless 0-19 years children and young people s service in Newcastle upon Tyne. Page 11 of 42

12 Section 2: Services and Departments 1. Practice Education Team 5.0 WTE responsible for supporting Mentors from Nursing, Midwifery and Allied Health and providing support to new registrants. Contact: Suzanne Medows, Senior Nurse Practice Development Seamless support from novice to expert Review of the Preceptorship programme to reflect changing Trust priorities and the needs of new Registrants. Supported staff to ensure that standards for Clinical Supervision are maintained as per Trust policy. Implementation of Education Audit and further development of the electronic resource for learners on placement. Evaluated the use of the RCA tool used to identify common issues when students fail in practice, and elicited themes and trends to support students. Delivered two interprofessional Practice Education Conferences incorporating Practice Education Awards. HENE awarded the Trust a RAG rating of Green across all of the Education Quality in Practice (EQUIP) standards and eight areas were identified as good practice. What difference has your work made to patient care? The team is involved at all stages of practitioner development from student and new registrant to expert - Provide support and assist integration of overseas nurses within the Trust. - Practice Placement Facilitators to lead on the recruitment of personnel to the Pre-Registration Year of Care Pilot HCA posts - Managing change which emerges as a consequence of the Shape of Caring Review. - Managing transition of two new staff in the role of Practice Placement Facilitator. - Increasing numbers of commissioned students and maintenance of the mentor pool. - Increased demand for the delivery of the Preceptorship programme. - Raise the profile of the Trust Education Awards. practitioner. Providing support for practitioners throughout their careers the team promote the development of safe, autonomous professionals with the requisite skills and knowledge to deliver appropriate, high quality patient care. Statistical Information Preceptorship Programmes delivered = 4 (May 14, July 14, Nov 14 and January 15) 148 preceptees attended the programme and 74 submitted and achieved academic accreditation for this (20 credits at degree level). Mentors updated = 1,587. Practitioners supported to achieve mentor status = confirmed and audited new placements and 2 new placements in the early stages of development. Provided support to 303 placement areas. Case studies/best practice examples Practice Education conference held twice in the last 12 months, attended by staff from multidisciplinary backgrounds. Attendees shared best practice in education. Page 12 of 42

13 2. Practice Development 1.0 WTE Senior Nurse who works closely with the Trust s Clinical Educators, manages the Practice Education Team to support and develop practice. Contact: Suzanne Medows, Senior Nurse Practice Development Supporting staff and developing practice to improve patient care. Criteria for achievement of the Acknowledging Continuous Excellence (ACE) Award has been agreed and circulated. Several clinical areas have made progress in achieving one or more of the five standards required. Classic Safety Thermometer data continues to be collected monthly and pilots are now underway in respect to the Medication Safety Thermometer. Review of Clinical Educator role completed and a bespoke development programme to support these staff and help them meet the needs of the Trust is underway. and support; Supported the work of the Nursing and Midwifery o Handover Recruitment and Retention Group and led on a o number of key elements of the Action Plan in o relation to staff retention including; o Establishment of welcome documentation and meetings for new registrants taking up post in the Trust. o Review of Enhanced Induction and incorporation of this within Preceptorship to reduce time out of practice for new staff. Review of Patient Property policy in relation to NHS Protect Standards. Ongoing publication of the quarterly Nursing and Midwifery Newsletter What difference has your work made to patient care? The team supports continuous improvements which have a direct impact upon patient care. Development of policy, documentation and competency assessment tools ensure the nursing workforce use research and evidence as the foundation of their practice. - Work with Matrons to ensure that by the end of the year, every acute clinical area is on a pathway to receive the ACE Award. - Finalise agreement of the criteria for Community areas in respect to ACE Awards. - Explore options for measuring Harmfree Care using other versions of the Safety thermometer (Children and Young People, Maternity). - Explore options for using the electronic patient record to record Risk Assessment Care Planning - Support for the Nursing and Midwifery workforce of 4,500 registrants in respect to the introduction of Revalidation. - Development of core messages for Registrants new to the Trust including information for new staff and the core values for Nursing and Midwifery in the Trust. Page 13 of 42

14 3. The Newcastle Specialist Continence Service 4.0 WTE providing provide a specialist continence promotion service, across Newcastle to facilitate effective management of bladder and bowel dysfunction Contact: Jackie Rees Nurse Consultant Continence and Alyson Laws Nurse Specialist Continence (community) Continence: The 7C our focus this year has placed patients needs first by leading and supporting bladder and bowel health care. Implementing and developing best practice guidelines for urinary tract infection /catheter associated urinary tract infection across primary, secondary and tertiary care. Through local data collection UTI/CAUTI pathway of care developed. Implementation of a new service level agreement for containment products & succeeded in keeping within the financial control for this budget. Implementation of a continence assessment scoring tool within acute care and the Nursing care homes across Newcastle. Recognised for innovation in healthcare & received the BJN award continence nurse of the year Shortlisted as a finalist for the Nursing Times Awards & the General Practice Award & finalist for the Nursing & Midwifery Achievement Award for developing work with CAUTI/UTI. Training /education for all health care professionals. Represented the Trust at the Prostate survivorship events across the region. Our service is facing a number of challenges due to local and national changes in health care and the increasing clinical referrals and requests for training provision but our aims will be to: - Continue to achieve best practice for continence care, placing patient needs at the heart of what we do. - Promote continence and treatments to all our patients and staff rather than containment. - Achieve meaningful outcomes for CAUTI/UTI development. - Implement a new nurse led Patient Intermittent Catheter Clinic. - Maintain the containment product budget within financial control and launch a new catheter product formulary. - Drive a local continence campaign using the Trust Nursing and Midwifery Strategy. What difference has your work made to patient care? The continence service is a small team and we continue to promote bladder and bowel care, implementing best practice guidance and developing initiatives which help to assist improve the patient experience and their care. Statistical Information Patient referred into the continence service and received treatments: 1,596. Non face to face advice with specialist nurse (community): 617. Contacts with professionals and patients by continence admin staff: 9,762. Hours of staff training: 210. Best Practice BJN award for continence nurse of the year Finalist for - Nursing Times, the General Practice & Nursing & Midwifery Achievement Award for developing work with CAUTI/UTI. Prostate Patient Information & Healthy Bowel Information designed with direct patient involvement. 1st local Continence Study Day - which brought 83 delegates together to share new ways of working and best practice for Continence Care. Page 14 of 42

15 4. Nutrition 3.5 WTE who provide care, support and education to patients and staff across all areas of nutrition best practice Contact:Jo Ledger, Nurse Specialist Adult Clinical Nutrition High quality, personalised nutritional care which is free from harm for all our patients, with cutting edge provision for those with complex needs December 2014 Matrons Nutritional Audit showed that: 100% patients across the Trust received the support & assistance they needed to eat & drink. 95% of patients across the Trust were screened for malnutrition within 24 hours of admission, 97% of patients had the appropriate nutritional care plan in place and 96% of our wards have protected mealtimes in place. Review & improvement of individualised patient nutritional care plans, including food intake charts & the development of additional malnutrition screening (MUST) guidance for staff. A collaborative Food Analysis & Consumption Study at Freeman Hospital has resulted in the development of new menus for Older Adults with smaller portion meals with higher protein and energy values as well as additional snack menus in between meals. Growing Home Parenteral Nutrition (HPN) service showed 30% increase in regional referrals in 2014/15 from the previous year with the ongoing provision of specialist nurse support and training continued to be offered to this complex patient group. Ongoing low Catheter Blood Stream Infection (CBSI) infection rates in both hospital and home patient groups fed parenterally via central and midline venous catheters. This reflects the impact of the Nutrition Nurse Specialist s role in the provision and support of safe and effective patient care. - Ensuring high standards of care around nutrition & hydration practice are embedded, specifically; improving how well Trust staff record and monitor patients nutrition & hydration intake and plan of care. - On-going monitoring of nutritional care; through Clinical Assurance Tool, rolling audit of malnutrition screening and nutritional care and through the programme of Food Tastings as undertaken across the Trust involving Governors and Community Advisory Panel. - To demonstrate improvements in safe on-going care for patients with NG feeding tubes which will incorporate the development of a new risk checklist to assist staff in safe decision making for continued use of feeding tubes. - Ensuring safe and timely transition to the International Standardisation of equipment for enteral feeding systems across the Trust. - To continue to provide high quality, safe care for growing specialist nutritional services with increasing demands on time and resources What difference has your work made to patient care? The hard work and achievements around nutritional care enable our patients to receive high quality, personalised nutritional care that is free from harm, by well information, well-educated staff. Page 15 of 42

16 5. Tissue Viability 6.0 WTE who provide support, advice and education for all staff in relation to wound care. Contact: Fania Pagnamenta Nurse Consultant (Tissue Viability) Patients are becoming more elderly and vulnerable with subsequent increase in pressure damage. On the backdrop of a 42.6% increase in patients admitted with existing pressure ulcers, we were able to support a 24.24% reduction in pressure ulcers when data from April 2013 March 2014 to April 2014 March 2015 was compared. Clinically reviewed an increasing number of patients: o Acute - during the last financial year, over 4300 patients were seen by the acute team. o Community - over 1000 patients were seen by the community team. Offered a varied menu of education opportunities to colleagues including o Pressure ulcers. o Venous leg ulcers. o Methods of debridement. o Topical negative pressure training. o Compression training. o Dressings and wound assessment training. Further updated SystemOne to facilitate the documentation of care with regards to wound care to improve communication between settings. - The service is facing increasing challenges due to number of referrals; the demands for training and support by the directorates and the impact of national and local drivers to reduce pressure ulcers. - Pressure ulcers and moisture lesions are of a very complex aetiology and tissue viability has been continuously involved to ensure not only the data collected is robust, but that plans of care reflect the ever changing understanding of what preventive care works in clinical practice. Worked with the Pressure Ulcers Task Force to reduce pressure ulcers and continued to: o Undertake weekly audits to ascertain which wards have achieved their negotiated targets. o Validate all pressure ulcer and moisture lesions DATIX. o Validate monthly Safety Thermometer data. o Continued to develop the role of the link nurse across both settings. What difference has your work made to patient care? Improved the communication between acute and community settings with regards to wound care. Supported a 24% reduction in Trust acquired pressure damage. Almost all wards have now achieved 30 days of Pressure Ulcer Harm Free Care a tremendous achievement. Page 16 of 42

17 6. Falls Prevention 1.0 WTE who provides support, advice and education for all staff in relation patient falls prevention. Contact: Rachel Carter, Falls Prevention Co-ordinator Falls Prevention Initiatives Successfully Delivering Best Practice Standards Maintained a falls rate below the National Acute Trust average of 6.8 falls/1000 bed days. In relation to Safety Thermometer the Trust consistently reports a low rate of harm from falls. Root Cause Analyses for all falls causing serious harm analysed to show common themes and key learning. No Falls On My Patch campaign relaunched with new posters around the Trust, including Call Don t Fall posters at bed spaces and in toilets/bathrooms. Secured funding from the North East and Cumbria Academic Health Science Network (AHSN) to conduct a multicentre improvement project in relation to patient falls prevention. Reduced rate of harm from falls. What difference has your work made to patient care? Patient falls prevention significantly contributes to the delivery of Harm Free Care. Work continues to ensure that all staff are aware that it is their responsibility to minimise the incidence of patient falls and to reduce harm to patients. A key message to all staff is that falls are preventable and not inevitable. Through education of staff, audit of documentation and the continual RCA process, the Trust strives to achieve the implementation of best practice guidelines for falls prevention. Work will continue to ensure that this is delivered for all at risk patients so that we can ensure Harm Free Care is delivered. Statistical Information - Maintaining falls/1000 bed days rate will be a challenge due to an ageing population, increased acuity of patients and reductions in length of stay. These factors mean that the number of patients at risk will continue to rise as they have done in previous years. - A Trust priority will be to reduce harm from falls. This will be a challenge due to the high incidence of osteoporosis and increased acuity and dependency of the high risk patients. - A priority for the Trust will be to continue to work collaboratively with falls leads from the Shelford Group of Trusts to look at embedding best practice guidelines in a consistent manner. - A challenge in terms of the AHSN project will be to work consistently with the other centres involved in the project to ensure reliable and valid data. A recent review of RCA s conducted within Q3, identified positive results as: 93% of the patients had been assessed for their risk of falling within the required 12 hours from admission. 93% of the patients had a Falls Care Bundle in place to minimise their risk of falling. 93% of the patients had been identified as at risk of falling prior to this fall. 93% of patients had a call bell within reach. 93% of patients had been assessed for the appropriate use of bedrails. In 85% of the incidents, minimum staffing levels were in place. Page 17 of 42

18 7. Nurse Consultant for Vulnerable Older Adults 2.4 WTE leading work to provide the best care for people with dementia. Contact: Clare Abley, Nurse Consultant for Vulnerable Older Adults Providing the best possible care for patients with dementia and their families Continued leadership of the Trust Dementia Care Steering Group, including planning and delivering a very successful away day to develop a Trust Strategy for Dementia Care. Achieved the Health Education North East (HENE) Trust targets for education and training. Approximately 6,000 staff have now attended level 1 dementia training (dementia awareness) and 500 staff, level 2 training (for those who work with people with dementia on a regular basis). Commencement and successful completion of year one of NIHR post-doctoral fellowship: significant progress with systematic review of hospital care for older people with cognitive impairment and gaining all the necessary approvals to commence qualitative study following patients throughout their hospital stay, to determine what makes for both a positive and negative patient experience. Set up a series of focus groups for carers of patients on the wards who have dementia, to hear about their experiences and elicit their view/suggestions as to how things can be improved. The first focus group was held in November Development of and appointment to, two new posts both impacting positively on team capacity to support and develop excellence in the care of vulnerable older adults: o Fixed term part time post of - Ratification of the first Trust Strategy on Dementia Care and agreement of an action plan to facilitate its delivery across the Trust. - Further embed the best care possible for people with dementia and their carers across the organisation. - To sustain the numbers of staff receiving dementia related education and training. - To work with colleagues to further develop in house education and training for staff requiring a more in depth understanding of the needs of people with dementia and their carers, using the newly published Health Education England Framework. - To continue to make the necessary progress with both aspects of NIHR post-doctoral fellowship, i.e. complete systematic review of the literature on the non-pharmacological care and management of older people with cognitive impairment in general hospitals and work with a research assistant colleague, to undertake qualitative data collection focusing on the patient experience. - Continue to inspire and support nursing colleagues wishing to carry out research, particularly in relation to the care of older people. Associate Nurse Consultant for Vulnerable Older Adults (funded by NIHR research fellowship) o Nurse Specialist in Dementia Care post (permanent post funded by the Trust) Continued leadership of the multiagency, Safeguarding Adults Board, Improving Practice sub-group Page 18 of 42

19 8. Nurse Consultant Critical Care Contact: Annette Richardson Lead role for reduction and sustainment of central venous catheter blood stream infections in Critical Care and other areas Trust-wide. Lead role in the review of Pressure Ulcer Prevention across adult Critical Care. Developed, implemented and refined a new pressure ulcer risk assessment tool for critically ill adults. Tool called CALCULATE and accepted for publication in the journal Nursing in Critical Care. Reduced the number of pressure ulcers on all four critical care units. Lead role for improvements with Trust s Major Incident Plan. Delivered training, testing and designed improvement to enhance resilience and response. Fulfilled the role as Chair of the British Associated of Critical Care Nurses (BACCN). Co-investigator on a large national multi-centre critical care research study investigating Families reported experiences of critical care. - To sustain the low rates of CVC-BSIs Trust-wide. - To continue to reduce the rate of Pressure Ulcer incidence and moisture lesions in Critical Care in line with Trust measures and targets. - To continue to improve patient safety by reducing avoidable harm. What difference has your work made to patient care? Made improvements to patient safety. Maintained a low chance of patients acquiring infections associated with Central Venous Catheters Trust-wide in adult and paediatric areas. Provided all critically ill patients an appropriate pressure ulcer risk assessment, to inform the implementation of evidence based interventions such as turning regimes. Reduced the chance of critically ill patients acquiring a pressure ulcer. Made improvements to Major Incident preparedness, resilience and response. Statistical information Combined adult Critical Care CVC-BSI average rate 0.75/1,000 catheter days and national average 1.2/1,000 catheter days. PICU CVC-BSI average rate 2.7/1,000 catheter days and national average 2.89/1,000 catheter days. Total number of pressure ulcers (all categories and moisture lesions) reported in 2013/4 from four critical care units was 258. During 2014/5 this number was reduced to 165, a 36% reduction. Page 19 of 42

20 9. Infection Prevention and Control 18.5 WTE who provide guidance and support to staff, patients and carers promoting harm-free care to prevent healthcare-associated infection. Contact: Louise Hall, Matron Infection Prevention & Control Working across the patient journey to support staff to deliver safe, high-quality care IPC education programme delivered to all staff covering a range of topics via forums and wardbased sessions. These include two C.difficile campaigns, participation in the HCA Academy, induction programmes and other groups such as Student Nurses, Medical Students and Junior Doctors. Established of a multi-disciplinary IPC/eRecord Task and Finish Group to progress IPC developments on erecord. The Community IPC Link staff study day was held at Newcastle Falcons and was attended by 45 delegates. Shortlisted, with the Continence Team, for the Nursing Times Awards (Continence Promotion and Care) for the Re-admission Project: Reducing and preventing avoidable admissions of CAUTI/UTI in to secondary care. Responded to the international Ebola crisis in partnership with Infectious Diseases (ID) to become one of four surge centres in England, ensuring the Trust can safely manage any possible or confirmed Ebola cases. - Continue to promote best practice to reduce infection rates with a sustained focus on hand hygiene, CPE, C. difficile, MRSA, MSSA and E. coli bacteraemia. - Build on established regional networks and develop a new IPCN post to enhance collaborative working with the local CCGs, improving analysis and learning from HCAI across primary and secondary care. - Review Cleanliness and Environmental Strategy and establish integrated monitoring of the environment to support continuous improvement. - Employ an IV Nurse Specialist to improve IV device management and reduce MSSA bacteraemia. - Work with ID to establish a robust and on-going education and training programme for management of Ebola/VHF patients. What difference has your work made to patient care? IPCNs have implemented the Trust HCAI Prevention Strategy and Action Plan, promoting the ethos that infection prevention and control is everyone s responsibility. This has resulted in staff taking greater ownership for IPC issues in their wards and departments. 219 staff across acute and community services have undergone training in the management of potential/confirmed cases of Ebola. In addition, staff from Scottish ID units/a&e depts. have attended training in PPE-based high-level isolation and use of the Trexler Isolation Unit. Page 20 of 42

21 10. Equality and Diversity 0.8 WTE who assists staff to comply with equality legislation and helps remove barriers that could prevent patients getting the best from our services. Contact: Lucy Hall, Equality and Diversity Officer Putting patients at the heart of all we do through considering their protected characteristics Interpreting and translation services provided face to face and via telephone interpreting. Hearing Well in Hospital survey undertaken in older people s wards. Developed Putting patients at the heart of everything we do. Participated in Stonewall Health Care Index New guidance developed for staff to support them in asking questions about religion and belief. Development of a Clothing Bank for patients with no clothes on discharge. Robust Equality Analysis embedded in policy making and review. - Complying with changing equality legislation and Government guidance - Meeting the Equality Delivery System objectives - Meeting the needs of changing populations for example new migrant communities - Raising awareness of the needs and experience of Transgender People within the Trust - Raising awareness of the impact of loneliness and what we can do to prevent it - Training and embedding equality analysis into directorate plans What difference has your work made to patient care? Staff have a fold-out business card size information resource which identifies one key fact, one action to support patient care and one support agency that work to meet the needs of people with protected characteristics. Deaf patients can now text the Patient Advice and Liaison service to check a BSL Interpreter is booked for their appointment. We have become Stonewall Health Care Champions. Patients discharge is not delayed due to lack of clothing. Staff have some straight forward questions to help them find out about patients spiritual needs. Identified changes to policies that impact on patient care; for example linking lesbian, gay, bisexual and transgender people to support services in the Overdose and Poisoning policy. Statistical information Interpreting and translation services provided face to face and via telephone interpreting, consistently achieving fulfilment above 95%(Face to Face ) and 97% (Telephone interpreting) Page 21 of 42

22 11. Outpatients 192 WTE who provide all of the clinical and administrative functions for 300,000 Outpatients per year. Contact: Mr Gordon Elder, Outpatient and Medical Records Manager Providing flexible, timely Outpatient care closer to home Implementation of ifit records tracking system Increased usage of tertiary Outpatient centres to bring care closer to home. Both Main Outpatient Departments have achieved standards which form part of the ACE award. Customer Service Audits now adopted across all OPD s Trust Wide. Mr Stan Green, Receptionist at the RVI was part of the Team who won a Personal Touch award last year and were also voted Team of the Year. What difference has your work made to patient care? The implementation of ifit (to allow electronic notes location) was a major - Roll out of empty shelf filing within medical records. - Greater pairing of real time patient feedback with outpatient areas. - Implementation of electronic orders - Opening of our new Outpatient Healthcare and Diagnostic Centre in Cramlington. - Improved access for patients to the ambulance booking service. - Increased appointment availability and flexibility across the full week. - Off-Site letter printing project. - Self Service Check-in project. - Completion of 15 Step Challenge to be rolled out Trust wide. - Assist IT with the implementation of the Cerner PAS upgrade. project, which has reduced the number of missing clinic notes, ensuring as far as possible notes are available for care when required. Increased services in tertiary centres have enabled patients to receive care closer to home. Feedback from patients using tertiary centres is that they particularly like the personal care they receive and prefer to attend the tertiary centre than the main hospital site for care. Statistical Information 800,000 sets of case notes for Outpatient and Inpatient attendances. 750,000 encounters at our main reception desks. 300,000 Outpatient appointments. 150,000 telephone calls from patients and relatives. 2,500 families seen by our Bereavement Officers. Case Study A recent survey of the Arthroplasty services delivered at Benfield Park showed high levels of patient satisfaction with all questions regarding care, access and environment scoring excellent for over 90% of responses. Page 22 of 42

23 12. Occupational Health & Wellbeing Service 18 WTE who offer support to employees and managers in achieving a healthy, productive and effective workplace. Contact: Chris Wright - Clinical Lead Service Manager OH & WBS Newcastle OHS Supporting our staff to provide healthcare at its very best with a personal touch. Reaccreditation of Safe Effective Quality Occupational Health Service (SEQOHS) year one Newcastle OHS have maintained the National Gold Standard for Occupational Health Services Maintained improved KPI of 10 days to first appointment with increased referral rate. The service has had a 30% increase in referrals from managers seeking assistance with attendance management. Flu Uptake 65.7% flu uptake of front line staff compared to regional average of 57.5% Trust Public Health - Active membership of the Better health at work group (BH@WG) working towards the bronze award for the Trust. Support the health and wellbeing of staff Increased access to the Working on Wellbeing (WOW) programme which looks to improve and maintaining the resilience of staff. What difference has your work made to patient care? Newcastle OHS supports the health and wellbeing of Trust staff. Healthy staff directly results in better patient care. By maintaining easy and rapid access to OH support, keeps staff healthy at work and helps them return to work sooner which allows departments greater time to care for patients. Our work to integrate the occupational health delivery in the main sites of RVI and Freeman alongside telephone appointments mean staff needing our support require less time away from the ward to care for patients. This integrated Trust approach is estimated at approximately 3-4 thousand hours clinical time over the last year compared to having to receive support off site. Promoting healthy lifestyle options within the trust through the BH@WG, rehabilitation classes, resilience classes and self help support helps maintain a healthy work force Musculoskeletal support of staff through telephone advice line, back rehabilitation class and return to work class. NewcastleOHS referrals Apr May Jun Jul Sep Oct Nov Dec Jan Feb Mar NUTH total NUTH total NUTH total NewcastleOHS time to first appointment -days NUTH - To Build capacity and maximise efficiency o Consolidate staffing structure as agreed in o Integrate physiotherapy and psychology support for referrals to the service by managers. o Move to Regent Point - Promoting innovation - Working in collaboration with Trust key stake holder Lloyd s pharmacy in delivery of Flu campaign. - Working with HR to streamline recruitment process. - Promoting research Participate in national Skin Care Intervention Nurse (SCIN) research project - Targeted growth in small to medium sized enterprise Refresh the Newcastle OHS internet page to assist the public face of the service to help with external business generation. External Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Page 23 of 42

24 13. Staff Bank 8.5 WTE who support wards and departments with temporary staffing. Contact: Peter Savage, Staff Bank Manager Continuing to grow and support staffing across the wider organisation Upgraded to New Bank Staff Booking and Management System Bankstaff. Recruited and have gone live with Bank arrangements for Midwives and Physiotherapists. Aligned HCA recruitment with Trust procedures to include attendance at HCA Academy where appropriate. Admin and Clerical agency bookings now managed by Staff Bank. Fill Rate maintained at 88% despite increased demand for staff. Established process to communicate Department Bank fill rates through to the Nurse Staffing Activity Reports. In the year 2014/ ,789 shifts were covered amounting to 552,381 hours of work covered this demonstrates an increase of 12.6% on the previous year s activity and this has included engaging with local external agencies to supplement the staffing requirements. - Incorporating Strength Based Recruitment into Bank process. - To monitor and provide reports regarding the usage of Agency staff across the Trust. - NMC Revalidation of staff registered with the Bank. - For those who wish to do so, to streamline the process of recruitment to the Staff Bank following substantive appointment to the Trust. - To increase and maintain Staff Bank Mandatory training and Appraisal Compliance. - To ensure sufficient recruitment and Bank Nurse supply to remove reliance on Agency staffing. Statistical information Page 24 of 42

25 14. Hospital at Night Nurse Practitioners 15 WTE who triage calls from ward staff providing support and expert knowledge overnight. Contact: Brian Crosbie Lead Nurse Practitioner Patient safety maintained by ensuring that the patient is seen by the right person with the right skills at the right time. Hospital at Night now support 5 teams within the Trust o Surgery Freeman o Surgery RVI o Neurosurgery/Orthopaedics RVI o NCCC Block Freeman, and o Medicine RVI Each team has a lead Nurse Practitioner. 80% of Nurse Practitioners are Independent Prescribers. Looking after 970 in-patient beds. Phlebotomy provision to General Surgery Freeman. What difference has your work made to patient care? H@N provides a very effective and safe team structure to deliver care to patients in the out of hours period. The model supports collaboration, excellent communication and provides leadership to clinical staff overnight. Patients are prioritised based on clinical need. This year an additional team has been developed within Medicine at the RVI. A recent audit demonstrated H@N has improved workload, had a positive impact upon patient safety and significantly improved levels of support for junior doctors working on night shifts at the RVI. Statistical information - Audit of Hospital at Night Team staff perceptions and impact on patient care. - Continued support for staff undertaking independent nurse prescribing. - Development of Hospital at Night intranet pages. - Continuous support to development of NEWS monitoring. Key 1. Calls received each month 2. Jobs completed each month 3. Intravenous cannula inserted. 4. Litres of IV fluid prescribed. Page 25 of 42

26 15. Patient Services Coordinators (PSC) 17.2 WTE who provide site and bed management 24 hours a day and have key roles in a number of emergency response teams. Contact: Melanie Cunningham, Matron, Patient Services Consistency with flexibility to provide optimum care for all patients. Development of discharge care plans and transfer out of hospital documentation to improve quality and efficiency of discharge planning for frail older persons as part of CQUIN target. The addition of an extra nurse to improve discharge planning and co-ordination for medicine and elderly care has contributed to a reduction in patient length of stay of 3.2 days in comparison to quarter 1 of this year. Working in collaboration with community MDT, local authority, CCGs developed a step down from hospital model during winter pressures to prevent delayed discharges and improve patient experience. The team has supported the on call team through an unprecedented number of business continuity incidents as well as the continued support to create capacity. In collaboration with the Paediatric Directorate the patients are going to the right place the first time by increasing the numbers of patients attending the day patient ward. The newly appointed Matron and several new team members have energised the team through an extremely difficult winter. - A key challenge is to reduce the number of delayed transfer of care. In there were 526 delayed transfers of care with an average of 27 patients per day delayed. Through early identification of patients delayed, support can be targeted to resolve discharge issues. - Roll out discharge documentation to all ward areas. - Continue to work closely with neighbouring health and local authorities to develop shared pathways for discharge of out of area patients. - The key challenge is to ensure capacity and patient flow allows the admission of patients in a timely manner, reducing length of stay and preventing unnecessary admissions. What difference has your work made to patient care? The team supports continuous improvement in patient flow through development of policy, standardised care plans, improved communication, education and support for ward staff which has a direct impact on the quality of patients transfer out of hospital. Reduction in length of stay through early recognition, anticipation and progression/ resolution of discharge issues supports the reduction of hospital acquired complications for patients and improves the patient experience. Page 26 of 42

27 16. Urgent Care 2.0 WTE providing expertise relating to capacity and emergency care, ensuring that strategic objectives and patient flow improvements are focused and relevant standards achieved. Contact: Dot Kyle, Patient Services Manager Striving to ensure that every patient s Urgent Care experience meets their need, right care, right place, first time Performance monitoring of quality standards in relation to the Emergency Department including waiting times and quality standards to the Department of Health and Monitor. During the year work continued on the timely clinical handover of patients arriving by ambulance to the Emergency Department. There were minimal over 30 minute delays in handover; 54 in total, representing 0.1% of all ambulance arrivals. The number of ambulance arrivals remained consistently high, with a daily average of 100. Detailed operational resilience planning and funding. Despite challenging periods when there were significant surges in the number of emergency patients presenting, cancellation of elective activity was minimised. All staff working across the organisation responded in a positive and timely way to support a positive and safe patient experience. - Influence the continuing improvement work relating to Elective and Emergency Care. - Improve performance in relation to the waiting time standards for people attending the Emergency Departments. - Alongside Clinical Directorates support the implementation of the 8 High Impact interventions outlined in the NHS England Urgent & Emergency Care Review. - Influence and facilitate delivery of year round Resilience working with partner Health and Social Care organisations. - Support the development and delivery of the Newcastle and Gateshead CCG Urgent Care strategy. The allocation of Winter surge monies to fund the implementation of a GP in ED model. Patients who do not require an Emergency Department doctor can be seen by a GP in the department, allowing staff to concentrate on those who are most unwell. The Trust also trialled the use of a Step-down from hospital bed model. Beds were provided from two local care homes. Patients determined as suitable for interim care were cared for in the care home beds which facilitated their discharge outcome. What difference has your work made to patient care? The CQC national emergency department waiting time standard is 95%. Despite an increase of 3% in the number of patients attending the RVI Emergency department in comparison to the previous year, the Trust achieved 96% for the 12 month period ending March Statistical Information Attendances through the RVI Emergency Department (a Type 1 ED) increased by 3%, with the department seeing 10 more patients per day on average than in the previous 12 months. All Types attendances, which includes attendances at the RVI Emergency Department, Eye Casualty and the two Walk-in Centres based at Westgate and Molineux Street, increased by 2.25%. Page 27 of 42

28 17. Chaplaincy 5.8 WTE who provide spiritual, religious and pastoral support for patients, relatives and staff of all faiths and none. Contact: Nigel Goodfellow, Trust Head of Chaplaincy Chaplains: Supporting people through Dis-ease Work with the Jewish community culminated with the appointment of 4 Honorary Jewish Chaplains from the Newcastle and Gateshead Communities to support the Chaplaincy Team and Ward/Departmental Staff meet the Cultural, Religious and Spiritual Needs of Patients, Carers and Staff. Work with the Newcastle Marie Curie Centre has culminated with the signing of a Service Level Agreement for the provision of Chaplaincy by the Trust team at the Centre. This will build on existing relationships and support continuity of care for patients discharged to the Marie Curie Centre. - Building on the work with the Jewish community negotiating with other Faith and Belief Groups for the development of a Spiritual and Religious Care Group as an interface with local faith communities and the Trust. - Development of resources to support staff in identifying and meeting Spiritual, Religious and Cultural needs of Patients and Carers. The Annual Remembrance and Thanksgiving Services in Paediatrics, Paediatric Cardiology, Maternity, Critical care, Transplantation, Haematology and Motor Neurone Disease were held with each Service having an attendance of between 200 and 500 people. What difference has your work made to patient care? Chaplaincy enhances the patient experience by: Ensuring Religious, Spiritual and Cultural needs are taken seriously. Providing specialist care that enhances their sense of wellbeing and dignity of patients, their families and staff. Providing safe space (physically and emotionally) for patients/families/carers while they face the effects of illness, change and crisis on their lives and for staff as they support those patients/families and carers. Much of this work is done in terms of informal contacts on the wards, the corridors and in the Chaplaincy areas of the hospitals; however the department received an average of 300 specific patient referrals a month during the year. In a similar way much of the staff support goes unrecorded and is delivered on the wards and in the corridors; however the department followed up specific requests for more formal support on an average of 6 referrals a month. Case Study The role of Chaplaincy in supporting ward staff in delivering Gold Standard End of life care was highlighted by Katy Frances s involvement in arranging a wedding for a patient on the Assessment Suite at the RVI at very short notice, which won the Quarter 3 Team Personal Touch Award in Over the year Chaplains were involved in arranging 6 weddings, 6 relationship blessings, a Confirmation, and the visit of a dog and a cat to seriously ill or dying patients across the Trust. They also organised a clothing bank for patients with no clothes on discharge. Page 28 of 42

29 18. Patient Carer and Public Involvement 2.8 WTE who work in partnership with patients, the public, staff and third sector organisations to embed learning from patient experience across the Trust. Contact: Caroline McGarry, Patient Experience and Involvement Officer To help to understand and deliver Healthcare at its very best with a personal touch The new and updated Patient, Carer and Public Involvement Strategy was approved by the Trust Board in March 2015 Ongoing participation in the National Patient Survey Programme. In , this consisted of an Adult Inpatient Survey, Survey of Emergency Department Patients and a National Survey of Children and Young People. Continued support to the Community Advisory Panel who are now in their twelfth year of working with the Trust to improve the patient experience by offering the patient perceptive on various issues and working groups. Embedded the process for Friends and Family Test within inpatient settings and co-ordinated the roll-out into other services as directed by national guidance. Responding to reviews and ratings on public websites such as NHS Choices. Developed a system for analysing the thousands of free-text comments that we received via various mechanisms to ensure we understand the issues that patients wish to raise and use this to identify emerging themes for action. - To embed the process for the collection of Friends and Family Test data from all NHS patients as required from 1 April To instigate a range of public listening events within communities to go out to hear from the people who use our services. - To consistently use patient experience feedback to identify changes required and to ensure that any changes are reported back to patients. - To maintain support to the various mechanisms for patient involvement such as Patient Reported Outcome Measures (PROMs), Take 2 minutes cards and Friends and Family Test. - To support the amalgamation of existing workstreams into one Patient Experience Team to ensure a streamlined process for patients, public and the Trust. Trust is one of only five in the country to be shortlisted for CHKS Patient Experience Award which focuses on what patients think of their experience when they visit a hospital. What difference has your work made to patient care? The Trust has scored consistently high in the NHS Friends and Family Test with 98% of inpatients saying they would recommend this hospital to their friends or family. The Trust results from National Patient Surveys are historically very positive the 2014 results showing that we continue to improve on our good performance of previous years and compare very well to other Trust. Specific examples of You said we did are included in each Take 2 minutes newsletter to show improvements we have made as a result of patient feedback. A number of patient comments tell us that staff do not always introduce themselves. In response to this ongoing issue, the Trust signed up to the #Hello my name is campaign as we understand the difference that this can make to the patient experience. Page 29 of 42

30 19. Patient Relations Department 8.2 WTE who work as a Multidisciplinary Team addressing patient concerns and complaints. Contact: Paul Anderson Patient Relations Manager Dealing with queries and complaints in an open and transparent manner Meeting all targets for complaint acknowledgement and response (target 95%, met 98%) despite the number of complaints being up by 4% on previous year. Development of improved data analysis to allow clearer presentation and better informed reporting on complaints for the Board and Complaints Panel. Implementation of complainant satisfaction surveys and outcome surveys for Local Resolution Meetings to improve feedback on complaints handling. Continued development of Department using Complaints Action plan. Managing a further 42% increase in Freedom of Information requests made to the Trust. Responded to a range of national reports to ensure the Trust s compliance with every requirement relating to complaint management What difference has your work made to patient care? By acting as a one-step interface for patients who have experienced problems or difficulties with their care, so that this can be dealt with in the most appropriate way, in timely fashion, and with empathy. Statistical information - Maintaining high standards in respect of complaint handling and response targets and seeking to reduce referrals to PHSO, especially in view of increasing number of financial penalties being awarded by the Health Service Ombudsman, so as to reduce financial risk for the Trust. - Continuing to develop support for Directorate teams, including training and sharing good practice. - Restructuring of Patient Relations Department, Patient Experience and Equality into one integrated team. - On-going revision of Complaint Action Plan to identify and address further areas for improvement. - Developing and embedding a You said we did culture in the Trust to demonstrate learning from this source of patient feedback. Page 30 of 42

31 20. End of Life Care Team 2.0 WTE who lead and support the on-going development of End of Life Care services across the Trust. Contact: Brigid Purcell, Lead Nurse End of Life/Bereavement Care End of Life care is everybody s business, and we strive to get it right every time for every patient by providing on-going education and support Pilot of a new End of Life Support Worker Role which provides a dedicated careworker for any patient who is dying. Real time audits of the care of dying patients. Contribution to NHS NE Care for the Dying Patient Document. End of Life Care training mandated for all clinical staff from April Contribution to successful CQUIN for End of Life Care compliance which the trust signed up to in 2014/15 to build on the previous years work in relation to maintaining high quality care for palliative care patients with the withdrawal of the Liverpool care pathway. - Completion of National Care of the Dying Audit (Hospitals). - Continued education and dissemination of NHS NE care for the Dying patient document. - Business case submitted for substantive End of Life Care Lead Nurse. - Further development of the Support Worker role in partnership with Macmillan. What difference has your work made to patient care? Successful completion of National Audit for Dying patients. Guidance and support disseminated widely to clinical teams and areas to support best practice. Support Worker role has included: Sitting with patients who are dying alone, alerting staff to any discomfort or distress that is observed. Sitting with patients when relatives have been called due to a deterioration in the patient s condition. Supporting relatives with practical advice on carparking, offering refreshments and providing relatives the opportunity to attend to commitment s away from the patient s bedside. Page 31 of 42

32 21. Corporate Cancer Services 24.3 WTE who interpret national and local guidance and support the Trust to deliver key objectives around the Cancer Reform Strategy. Contact: Michelle Mangan Cancer Manager Providing cancer patients with the right care, in the right place at the right time - Sustaining the cancer targets. - Succession planning for Nurse Specialist posts - Improving cancer patient experience across all pathways. - Maintaining compliance with revised peer review standards - Securing substantive funding for the Macmillan One to One Team - Building on established relationships with the Clinical Commissioning Groups - Improving data completeness for the Cancer Outcomes and Services Dataset - Review of the administration functions of cancer Multi- Disciplinary Teams. Maintained Cancer Waiting Times Targets Delivery of the 4th Annual Trust Cancer Nursing Conference Launch of chemotherapy in the community Development of living well group to support those living with and beyond cancer Centralisation of the administration function of the Hepatobiliary Multi-disciplinary Team. Monthly data submissions to Public Health England in relation to the Cancer Outcomes and Services Dataset. Development of a form for Serious Diagnosis Notifications to be transferred electronically to GP s. What difference has your work made to patient care? Pro-active tracking of patients through their cancer pathway has ensured that investigations are performed in a timely way, improving the patient experience and supporting delivery of cancer targets. The advice and support provided to clinical teams by the Corporate Cancer Team ensure that quality standards are achieved using the best possible outcome and patient experience. Statistical information Results from the 2014 National Cancer Patient Experience Survey for the Trust illustrates that 93% of patients rated their overall care as excellent. Areas of good practice included, the care given to patients by Clinical Nurse Specialists, patients were treated with dignity and respect, and patients feel that their concerns and needs were listened to. Work is being undertaken to improve results in areas around access to written information with regards to procedures and access to financial support. Achieved the 62 day referral to treatment target for over 85% of patients. Case study 43 year old female with breast cancer, lives with husband and 2 small children. This lady felt that she was managing well after her treatment but on returning to work she struggled to move on from her diagnosis. The Macmillan One to One team became involved with this lady and supported her referral to psychology, exercise and the living well group. Her sessions with psychology have given her confidence to address her feelings and events that have arisen due to her breast cancer. She has now completed her exercise scheme and continues to swim and walk to keep up her activity. She has put the whole family on a healthy diet and is working hard on this and trying alternatives. She continues to work and now feels that she has the coping strategies to manage the concerns that she had during her recovery. Page 32 of 42

33 22. Specialist Palliative Care Service 24.5 WTE who support, inform and educate patients, carers and staff to achieve the best Palliative and End of Life Care. Contact: Michelle Muir, Lead Nurse Palliative Care An effective, highly responsive, multidisciplinary, integrated Specialist Palliative Care service, flexible to the needs of patients in all care settings Substantive funding of the rapid assessment 1 hour response 7/7 working project which has reduced inappropriate hospital admissions and occupied bed days bed days. Completion of Palliative Care strategy. Growth in non-cancer referrals and collaborative working. Presentations at national conferences and publications. Service developments, AHP team shortlisted for further national awards. - Completion and ratification of new Specialist Palliative Care Strategy. - Preparation for and successful outcome of planned CQC visit. - Rapidly growing activity in the service. - Taking part in the National Palliative Care funding Review and Minimum Data Set Pilots. - Working with EoL leads to roll out new Care for the Dying Patient Document. - Embed 7 day working. What difference has your work made to patient care? Thank you..helped relieve my anxiety and lift the depression that shrouded me - (Patient feedback). We have laughed and I have cried but always with support and care (Patient feedback). Huge differences in physical, psychological, social, spiritual care of patients and carers. This is done by giving direct patient care and empowering and educating staff and other providers. Due to substantive funding this is now possible 7 days a week in the community and on the RVI site. This is evidenced by staff, patient, and carer satisfaction and also by clinical outcome data which has been collected by the service for 17 years. This intervention allows high levels of discharge to patients preferred palace of care/death (1624 discharges 2014). The staff have been working across sites and boundaries to ensure the most appropriate care from the most appropriate clinician. Best Practice Statistical information Specialist Palliative Care Service has been selected as one of 10 national pilot sites to test the nest national minimum data set, and palliative care currency / 7/7 working in the community and RVI sites is reducing inappropriate hospital admissions and reducing inpatient bed days. CBT first aid training is core to the teams skill set. AHP team offer acupuncture and hypnosis for patients. All staff receive clinical supervision (1:1 and group) from a Consultant Clinical Psychologist. All nursing staff have regular clinical observation with Lead Nurse. Page 33 of 42

34 23. Safeguarding Adults 8 WTE who provide training and support staff to prevent and respond to adults at risk from abuse, harm and self-neglect. Contact: Val Murray Named Nurse Adult Safeguarding To ensure that Newcastle is an increasingly safer city for Vulnerable Adults at risk of Abuse Developed an elearning Level2 training package available from April 1st 2015 covering Adult Safeguarding, Learning Disabilities and Mental Capacity/Deprivation of Liberty safeguards Reviewed all Policies, training and materials to take account of Care Act (2014) implementation (April 1st 2015) Managed a huge increase in DoLs applications since the Cheshire West Supreme Court Ruling (March 2014) Undertaken a Mortality Review of patients with a Learning Disability who died in Trust care January to March 2015 Represented the Trust at large scale multi agency sexual exploitation reviews under Operation Sanctuary What difference has your work made to patient care? Safeguarding Adults/Mental Capacity/DoL/Learning Disability awareness is now embedded within the Trust with increased referrals and enquiries from Trust staff, this work directly supports patient safety within hospital and community settings. Statistical information 195 DoL applications (20-30 in previous years) a 550% increase 1103 Adult Safeguarding Cause for Concern forms responded to an 83% increase The Trust has participated in 8 Domestic Homicide Reviews Patients identified as having a Learning Disability have had; 756 Emergency Department attendances 3789 Out Patient attendances 623 spells of in-patient care received 205 day case attendances Case study - New Named Nurse takes up post May 2015 (Current Named Nurse retiring) - Establish a Link Consultant Post (current holder taking up a post elsewhere) - Manage Care Act changes such as potential increase in self neglect referrals - Continue to monitor impact of DoLs increases - Embed and build on learning from Learning Disability Mortality Review Investigations of a patient with welfare concerns at home revealed long standing domestic abuse. Capacity assessments were undertaken, A Deprivation of Liberty was applied for and referrals were made to Multi Agency Risk Assessment Conference (MARAC). When it came to discharge safety, risk assessments were undertaken and a multi-agency safe discharge plan made to a place of safety. Page 34 of 42

35 24. Therapy Services i. Paediatric Speech and Language Therapy 33.4 WTE working in multiagency community and acute settings to support children with speech, language and communication needs (SLCN) Contact: Jane Giles, Manager Paediatric Speech and Language Therapy Positive participation in ground breaking commissioning review Engagement in whole service commissioning review. Income generation and innovation - development of Language Enhancement Action Package for Schools bought in by 4 schools for 2015/2016. Development of a Speech and language Therapist role on the neonatal unit 7½ hours per week. Celebrated bite size training on communication provided to staff in educational settings. - Newcastle Council Family Services Review reduced commission for speech and language therapy in early years requiring change of priorities. - Joint local authority and NHS commissioning review. - Administration pressure to fulfil SystemOne requirements. - Minimal resources for increasingly complex in-patient referrals. What difference has your work made to patient care? Speech and language therapy established as essential to Newcastle Council s revised Sure Start offer Following SLT children become easier to understand and are able to socialise and learn Following SLT children are able to access the curriculum Case studies/best practice examples Tom attended the Busy Bees, early intervention group for 11 sessions with the aim of facilitating him to communicate his basic needs and feelings, and to accept more adult direction. His mum said Thank you to everyone at Busy Bees, since attending Tom has come on so much and it has helped me understand more about autism. 6 older children attended a summer group for stammering following which they told us they were able to speak better, were more confident, made new friends, were more relaxed and had fun. Page 35 of 42

36 ii. Adult Speech & Language Therapy 12.5 WTE who support management of disorders of speech, language, communication and swallowing. Contact: Jane Giles, Clinical Manager Adult Speech & Language Therapy Record increase in referrals Facilitated the stammering group to become a self-led group with reduced SLT support. Improved our prioritisation tool for acute referrals. Delivered again more intensive treatments for people with Parkinson s disease related voice problems. Delivered on winter pressures in the acute setting. - Referrals for in-patients increased further. - Referrals for community increased further. - Administration pressure to fulfil system one requirements. Recruited to the multi-centred RCT trial Cost effectiveness of aphasia computer treatment versus usual stimulation or attention control long term post stroke. James Faraday, specialist SLT, Freeman was one of only 15 AHP s and nurses in the Northern Region to be awarded Clinical Academic Internship, funding him 30 days to develop skills and expertise in aspects of clinical academic research. What difference has your work made to patient care? Life improving impact on Parkinson s Disease patients receiving intensive voice treatment Life improving impact on patients with Aphasia Life improving impact on patients with stammering In line with current national research findings we have contributed to the prevention of aspiration by rapid response to in-patient cases Statistical information Community referrals have risen from 338 to 656 per year between 2007/2008 and 2014/ 2015 In-patient referrals have risen from 1777 per year in 2010/2011 to 1936 per year in 2014/2015 Case Studies A patient who has Parkinson s disease received Lee Silverman Voice Treatment. After the four week course his speech volume increased from 58 decibels to 66 decibels. His voice handicap index (how handicapped he feels by his speech/ voice disorder) reduced from 34 to 13. His wife completed a Visual Analogue Scale which showed the % of time he was loud enough rose from 28% to 71% and the time he participated in conversations rose form 14% to 78% A patient who has aphasia following stroke received a 6-week block of 2x weekly individual therapy followed by computer assisted therapy fortnightly with an assistant and attended a conversation group once per week for 6 weeks. She saw improvement on the Communication Outcome Measure after Stroke from 35/80 to 60/80 following treatment. Verb naming improved from 16% to 68%. She reported more confidence as a result of intervention and has started going out independently. Page 36 of 42

37 iii. Occupational Therapy WTE. The OT service provides Assessment and Equipment to facilitate safe hospitals discharges. Contact: Odeth Richardson Head of Occupational Therapy Occupational therapy continues to put patients at the heart of therapy Successful integration of the community paediatric OT service with the mainstream service and the elimination of the waiting list. Restructuring of the department to ensure more consistent cover across all specialities covered. Joint working with Social Services to eliminate the paediatric adaptations waiting list. Upper limb prosthetics OT lead has completed training to enable appropriate assessment and provision of Myoelectric Prosthesis following the prescription guidelines. Contributing to the first OT and PT led Sarcoma networking event held on behalf of the north of England bone and soft tissue service. The development of the first Dementia champions within the department. Increasing the therapy input for stroke patients who are now receiving therapy within 72 hours of admission to the acute stroke unit if appropriate. What difference has your work made to patient care? - Managing the rising demands across the service. - Significant change and financial pressures within local authority which will impact equipment provision. - Explore options for the use of technology in delivering therapy. - Review and development of care pathways to ensure effectiveness and efficiencies. - Exploring options for a 7 day service. Rapid response and reduced waiting times for paediatric assessments and equity across the age group. Quality of care has been improved with patients having more access to therapy within stroke services. Maintaining activities in care homes to enable patients to keep active. By providing input, advice and support, the OT service enables patients to enjoy the occupations that are important to them to enable them to live their lives their way. Page 37 of 42

38 iv. Physiotherapy 248 WTE who treat patients of all ages with a wide range of physical problems and conditions caused by illness, injury, disability or ageing. Contact: Barbara Tait, Head of Physiotherapy We have continued to deliver excellent high quality, evidence based, innovative, individualised care over 7 days against challenging staffing levels and increasing work load pressures. Implemented 7 day working within respiratory, paediatrics, orthopaedics and stroke and developed non-traditional posts to support services eg Thursday Monday. The Extra Physiotherapy in Critical Care (EPIC) research portfolio study was the first UK study to directly assess the efficacy of standard physiotherapy rehabilitation intervention compared to enhanced rehabilitation whilst patients are still in the Critical Care environment. Clinical Specialist was nominated for and won a national award for the service they provide in haemophilia at the national Haemophilia Buddy Awards. Community Stroke Services won the Therapy services achievement award for their redesign of stroke pathway in conjunction with patients to provide a more responsive service and reduce length of stay in hospital. Trust achieved A rating for its Physiotherapy in Sentinel Stroke National Audit. What difference has your work made to patient care? Continuity of care in terms of same team provision for weekend service has led to improved patient outcomes The introduction of a removable rigid dressing has helped to reduce the number of falls following a below knee amputation on the vascular ward, it also help reduced the damage sustained as a result of a fall. - Ensuring seven day service delivery is fit for purpose, efficient and effective meeting the needs of the patients within the constraints of staffing levels, maternity leave and skill mix. To scope the demand for extended hours. - High referral numbers without increase in staffing levels for services on a Block contract - Domiciliary Physiotherapy, Community MSK and Community Stroke services leading to longer waiting times. - Ensuring adequate data collection and analysis to facilitate commissioning needs with appropriate IT infrastructure to support this especially across Community services. - Potential for fragmentation or loss of services being driven by increased competition and commissioning in the local health care environment. - Ensure adequate and dedicated treatment space, as continued lack of provision is creating problems to deliver therapy and progress new developments to improve the patient experience. Due to the redesign of patient pathway for Community Stroke Services, median length of stay for mild to moderate stroke patients was reduced from 8.5 to 2 days. Ventilated and/or neurologically impaired patients benefit physically and psychologically from hydrotherapy The further development and integration of service clinical pathways has improved evidence based patient care Case study A patient that fell on the vascular ward following a below knee amputation that was wearing a rigid dressing at the time has since been fitted for a prosthetic limb. If they had not worn the rigid dressing then they would have likely needed further surgery or had delayed fitting of a prosthetic limb. Page 38 of 42

39 v. Podiatry 28.8 WTE who provide podiatry services for people with clinical need across a range of inpatient and outpatient settings. Contact: Lesley McIntosh Clinical Operational Manager Patient focused foot care, enhanced by technology, clinical skills and training, effective team communication and best use of available resources. Skill mixed Old Age Medicine team Band 7/band 6 to support community service creating a structured team approach. Care home project to train carers and admin team support process, projects highlighted at the AHP conference. OAM staff followed rehab wards from the CAV site to Freeman, increasing amount of clinical time and support to Freeman wards. Foot pressure ulcer guidance agreed with the pressure ulcer task force, available on the tissue viability and podiatry intranet. Joint clinic with vascular/diabetes MDT, and once a month MDT case conference. - Increasing numbers of diabetic and nondiabetic referrals with no additional resource. - Increase in MSK referrals by 10%. - Need to reduce the DNA rate at Arthurs Hill Clinic. - Potential change to electronic patient record.(systemone). - Improved work with vascular team, but the placement is for Newcastle referrals only; to develop a business plan to place a podiatrist into the unit. What difference has your work made to patient care? Clinician in vascular team, one session a week has promoted the development of clear joined up supported discharge and admission pathways. Joint record implemented for Old Age Medicine team, reducing duplication of referrals assessments and visits. Reduce carbon footprint. Statistical information Community podiatry patients seen 19,136;1,386 in appliances;759 in Newcastle Diabetes centre. Total:21,281 with a 28.2% discharge rate. All using the same notes. Best practice examples Patient with diabetes ulceration referred into Newcastle Diabetes centre from community clinic. Admitted to hospital for vascular assessment, seen by advanced podiatrist from the NDC on the ward. Discharged from hospital to intermediate care, followed by Podiatrist using SystemOne notes and documentation which followed the whole patient journey meaning District Nurses were able to share care and records at the Nursing Home using the same care plan. Page 39 of 42

40 vi. Psychology in Health Care 94 WTE who provide services across the community in Newcastle around therapy and educational support classes for a wide range of mental health issues related to injury and illness. Contact: Stella Wilson, Head of Therapy Services Improving health outcomes by applying psychological theory and practice to reduce the impact of physical and mental health conditions. In house training courses have providing access to staff enabling the development of essential skills effectively and more cheaply. The team has made oral and poster presentations at National and International health conferences, and published papers in peer reviewed journals. The team has conducted audits of psychological wellbeing in adults and children with specific health conditions such as cleft lip and palate, diabetes and renal disease The development of a completely new pathway into Primary Care Mental Health Services incorporating telephone assessments. Based on the needs of staff in the Trust training in introductory and intermediate level - Key challenge for the health psychology team is to develop a service that enables greater parity of access to psychological services across all areas of child health. - Key challenge for the Primary care Mental Health Service involves service restructuring that will result in service integration with Newcastle Talking Therapies, providing a more integrated and accessible pathway for the people of Newcastle with mental health difficulties. - Maintaining quality and quantity of service provision during the period of a service review. knowledge and skills in communication skills and psychological and emotional care for staff delivering services to people with chronic illnesses. What difference has your work made to patient care? The health psychology team are enhancing adjustment to chronic conditions and enhancing psychological wellbeing for adults, children and families affected by these conditions. Patient audit has identified multiple areas where psychological treatment has benefitted their quality of life including; reduced symptoms of psychological distress, maintaining/ introducing an effective work/life balance or returning to work, confidence in appearance, Confidence in social situations/interactions, cognitive awareness, health benefits including cognitive and physical recovery, acceptance/positive adjustment. Statistical Information Patient evaluation questionnaires have highlighted satisfaction with quicker first contacts. Out of 464 people seen in March 19.4% were assessed with 5 days and 78.4% in 10 days. Detailed audit of pain management programme demonstrated significant improvement in symptomotology following a 6 week intervention. Page 40 of 42

41 vii. Newcastle Nutrition 58 WTE who assess, diagnose and treat nutritional problems using the most up-to-date clinical evidence expert knowledge and skill to provide care to patients. Contact: James Callaghan, Head of Newcastle Nutrition Trust a Dietitian (New campaign from the British Dietetic Association highlighting the value and work of Dietitians in the UK) Conducted a Regional Parenteral Nutrition audit (in conjunction with the Northern Nutrition Network) investigating the involvement of nutrition teams, line placements, incidence of line sepsis in conjunction with national guidelines & standards. Contract secured for a new Specialist Adult Weight Management Service (commencing April 2015) Funding awarded by CAHPR (Council for Allied Health Professions Research) for a study into The Barriers and Facilitators to adherence of the Mediterranean Diet in the North East of England. (NAFLD Clinic) Delivered Obesity Brief Intervention training for Trust Health Champions in partnership with the Better Health at Work Award. Implementation of a Paediatric Nutritional Screening tool (STAMP) across the Trust Developed a whole department approach to establishing a Dietetic Outcome Framework across Acute & Community settings Co-ordinated Awareness weeks for Nutrition & Hydration and Dietitians Awareness week across the Trust. - To continue to develop framework for measuring Dietetic Outcomes in all areas of the service - To negotiate a new contract for Home Enteral Feeding as part of the Northern Regional Consortium - To review and improve access to dietetic services and explore new ways of working What difference has your work made to patient care? The Trust s Nutrition & Dietetic services are delivered across Primary and Secondary care as well as Public Health. Dietitians are integral members of multidisciplinary teams / groups and therefore contribute to the high quality services delivered across the Trust. Dietetic services continue to receive a high level of positive feedback from service users through group evaluation and service user surveys. We continually seek to improve the way we deliver our services more efficiently whilst ensuring that the high quality of our service is maintained. Page 41 of 42