Meeting title Report title TEC Sub-Committee Meeting date 16 December 2015 Lead director Report author FOI status Report summary Nursing & Midwifery Establishment Compliance - November 2015 Charlotte Hall, Chief Nurse Carole Webster Deputy Chief Nurse Disclosable This paper details the actual hours used matched with the hours planned for nursing and midwifery staff for inpatient areas and includes the Unify data return. The paper provides some key nursing metrics that are used as national measures of key performance for staff measured against staffing. Purpose Recommendation Corporate objective links CQC standard Identified risks and risk management actions Resource implications Legal implications Equality impact assessment Report history Considered by other committees Appendices Information The Trust Executive Committee is asked to note the Report Our patients, our services, our people, our finances Safe, effective, caring responsive, well led Safe staffing levels will minimise adverse clinical incidents and ensure our patients are cared for in a safe environment. It is essential to have safe staffing levels at all times, which currently necessitates using temporary staffing Monthly report to TEC and to trust board - NMC Appendix 1 Full Staffing UNIFY Data Great care to every patient, every day 1
EPSOM AND ST HELIER UNIVERSITY HOSPITALS NHS TRUST NURSING & MIDWIFERY ESTABLISHMENT COMPLIANCE TEC SUB-COMMITTEE: 16 th DECEMBER 2015 1. INTRODUCTION 1.1 This paper details the each ward s percentage of rostered nursing / midwifery hours (planned) expected to be delivered compared to the percentage of hours that were delivered (actual) throughout the month of November. 1.2 The Trust also follows NICE guidance in supporting the benchmark of 1 registered nurse to 8 patients in the day and 1 registered nurse to 11 patients during the night. It is important to note that the matrons and CSM s also use professional judgement to determine staffing levels on a shift by shift basis. 2.0 Planned versus actual staffing: 2.1 In November, there were no general adult areas which fell below the 80% actual nursing hours provided. There was one paediatric ward and this was: QM2 at STH- HCA day shift 345 planned, 253 actual (73.3%) 2.2 There were three wards recorded with over 130% actual nursing hours: A3 (Orthopaedics) HCA Night Duty 690 planned, 920 actual (133%) C3 (Stroke) HCA Night Duty 690 planned, 484 actual (135.6%) Casey (paediatrics Epsom)- HCA day duty 403 planned, 652 actual (161.8%) 2.3 QM2 was due to sickness. A3 and C3 used a higher number of HCA shifts than planned because the shifts could not be filled by registered nurses. Casey had a patient who required two nurses to manage them 24 hours a day for 3 weeks. 3.0 Ward Manager Supervisory days 3.1 The ward manager supervisory days are recognised as being essential to providing optimum levels of high quality care. They enable ward managers to supervise care, monitor standards, work alongside staff and undertake staff development as well as speak to patients and visitors and generally be clinically visible across the Trust. The graph below is encouraging as it demonstrates an upward trend in the number of ward managers who are spending 50% or more of their time supervising practice. 30 25 20 15 10 5 0 Number of ward managers taking 50% or more supervisory days 2
Falls per 1000 occupied bed days 3.2 Red Flags In November there were 64 red flags datix reports across the Trust, this is an increase from October with the greatest number being reported in the following areas: Alexandra ward, Epsom (8) There are no clear trends apart from short notice staff absence Epsom Emergency Department five in Adult and four in paediatrics. These relate to the department working with less than their established numbers of nursing staff due to vacancy and short notice absence. 4 Vacancies 53 Registered Nurses and 3 Midwives started in November. 24 were from overseas recruitment. The post of Lead Nurse for Retention and Progression has been appointed and the output from this will be reported through the People and Organization Committee. 5 Nursing metrics 5.1 In order to monitor safety and effectiveness a range of national nursing indicators are used that support the successful delivery of high quality care. From January 2016 this information will be reported by individual wards in a dashboard. Falls This performance report details numbers of falls per 1000 OBD. The Falls Safety Group reports to the PSQC and details more in depth analysis and actions of the management of falls. The number of falls has remained fairly static. There is variation in the rate of harm between same specialities across sites and this is being investigated by the falls team. falls per 1000 bed days Sep 2014 - November 2015 10.00 0.00 Sep Oct Nov Dec Jan Feb Mar Apr May June July Aug Sep Oct Nov Month reported Physiological observations and management of the acutely unwell patient The % of breached or late observations by ward is monitored weekly, it can also be viewed in real time. The data is used as one indicator of how wards manage the observation of patients and detect a deteriorating patient who needs intervention. For the purposes of this report both sites are shown as a % of breached observations however we also monitor it by ward. There is an improving picture in how nurses are monitoring patient s vital signs, overall the trust has moved from 28% down to 12%. The next step is to review the response to a deteriorating patient and this can be done via Vitalpac software land inked back to individual nursing and medical staff. 3
12/10/2014 19/10/2014 26/10/2014 02/11/2014 09/11/2014 16/11/2014 23/11/2014 30/11/2014 07/12/2014 14/12/2014 21/12/2014 28/12/2014 04/01/2015 11/01/2015 18/01/2015 25/01/2015 01/02/2015 08/02/2015 15/02/2015 22/02/2015 01/03/2015 08/03/2015 15/03/2015 22/03/2015 29/03/2015 05/04/2015 12/04/2015 19/04/2015 26/04/2015 03/05/2015 10/05/2015 17/05/2015 24/05/2015 31/05/2015 07/06/2015 14/06/2015 21/06/2015 28/06/2015 05/07/2015 12/07/2015 19/07/2015 26/07/2015 02/08/2015 09/08/2015 16/08/2015 23/08/2015 30/08/2015 06/09/2015 13/09/2015 20/09/2015 27/09/2015 04/10/2015 11/10/2015 18/10/2015 25/10/2015 01/11/2015 08/11/2015 15/11/2015 12/10/2014 19/10/2014 26/10/2014 02/11/2014 09/11/2014 16/11/2014 23/11/2014 30/11/2014 07/12/2014 14/12/2014 21/12/2014 28/12/2014 04/01/2015 11/01/2015 18/01/2015 25/01/2015 01/02/2015 08/02/2015 15/02/2015 22/02/2015 01/03/2015 08/03/2015 15/03/2015 22/03/2015 29/03/2015 05/04/2015 12/04/2015 19/04/2015 26/04/2015 03/05/2015 10/05/2015 17/05/2015 24/05/2015 31/05/2015 07/06/2015 14/06/2015 21/06/2015 28/06/2015 05/07/2015 12/07/2015 19/07/2015 26/07/2015 02/08/2015 09/08/2015 16/08/2015 23/08/2015 30/08/2015 06/09/2015 13/09/2015 20/09/2015 27/09/2015 04/10/2015 11/10/2015 18/10/2015 25/10/2015 01/11/2015 08/11/2015 15/11/2015 24% 22% 20% 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% Percentage of Breached Observations by Ward - St Helier - week ending from 12/10/2014 to Percentage of Breached Observations by Ward - St Helier - week ending from 12/10/2014 to 4 per. Mov. Avg. (Percentage of Breached Observations by Ward - St Helier - week ending from 12/10/2014 to ) 36% 34% 32% 30% 28% 26% 24% 22% 20% 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% Percentage of Breached Observations by Ward - Epsom - week ending from 12/10/2014 to Percentage of Breached Observations by Ward - Epsom - week ending from 12/10/2014 to 4 per. Mov. Avg. (Percentage of Breached Observations by Ward - Epsom - week ending from 12/10/2014 to ) Hospital Acquired Pressure Ulcers (HAPU) Nurses have improved how skin integrity is managed with significant reduction in the numbers of grade 3 and 4 HAPUs over 2 years, some wards reporting no grade 3 or 4 ulcers for 18 months. However the incidence of grade 2 skin damage or pressure ulcers has risen and this is now our focus for management. Each hospital acquired grade 2 ulcer will now have a modified root cause analysis presented by the ward staff and causation determined. The practice of intentional rounding is now subject to review and is to be formally monitored as part of clinical Tuesdays and the matron s quality round. 4
25 Hospital acquired pressure ulcers Grade 2-4 Number 20 15 10 5 Grade 2 Grade 3 Grade 4 0 April May June July Aug Sept 2015/16 Oct Nov Dec Jan Feb March A review of all ward foam mattresses in October highlighted a number were no longer fit for purpose many were stained and with fluid ingress. This presents an infection control risk and reduces the efficacy of the mattress to off load pressure on patient s pressure points increasing their risk of grade 2 skin damage. The trust is undertaking a replacement mattress programme following the mattress audit as new mattresses have been purchased. 6.0 Recommendations The TEC Sub-Committee is asked to note the report. 5
November 2015 Staffing: Nursing, Midwifery and Care Staff Data Collection - Epsom & St Helier DataSheet Hospital Site name Ward name Registered Midwives/Nurses planned actual staff staff hours hours Day planned staff hours Care Staff actual staff hours Registered Midwives/Nurses planned actual staff staff hours hours planned staff hours actual staff hours St Helier Hospital - RVR05 A3 (A3) 1506 1414 1035 1161 1035 996 690 920 93.9% 112.2% 96.2% 133.3% St Helier Hospital - RVR05 A5 (A5) 1380 1329 690 684 1305 908 690 690 96.3% 99.1% 69.6% 100.0% St Helier Hospital - RVR05 A6 (A6) 1380 1307 690 684 1035 931 690 725 94.7% 99.1% 90.0% 105.1% St Helier Hospital - RVR05 AMUS (AMU) 2415 2381 1035 1038 2415 2496 690 690 98.6% 100.3% 103.4% 100.0% St Helier Hospital - RVR05 B1 (Whitfield Unit) 1215 1157 525 525 690 679 345 345 95.2% 100.0% 98.4% 100.0% St Helier Hospital - RVR05 B3 (B3) 1035 960 525 572 690 690 345 357 92.8% 109.0% 100.0% 103.5% St Helier Hospital - RVR05 B5S (B5 Surgical) 1905 1754 870 934 1380 1322 690 817 92.1% 107.4% 95.8% 118.4% St Helier Hospital - RVR05 B6SS (B6 Medical Short Stay) 1035 1031 690 667 1035 965 345 345 99.6% 96.7% 93.2% 100.0% St Helier Hospital - RVR05 BEA1 (Beacon) 1035 984 345 316 690 598 345 334 95.1% 91.6% 86.7% 96.7% St Helier Hospital - RVR05 C3 (C3 Stroke Unit) 1725 1690 870 892 1035 1082 690 920 98.0% 102.5% 104.5% 133.3% St Helier Hospital - RVR05 C4 (C4) 1380 1255 690 713 1035 919 345 380 90.9% 103.3% 88.8% 110.1% St Helier Hospital - RVR05 C5 (C5) 1035 933 345 339 690 690 345 345 90.1% 98.3% 100.0% 100.0% St Helier Hospital - RVR06 C6 (C6) 1380 1288 870 848 1035 1001 690 748 93.3% 97.5% 96.7% 108.4% St Helier Hospital - RVR05 FDW (Frank Deas) 1725 1643 690 679 1035 1058 690 702 95.2% 98.4% 102.2% 101.7% St Helier Hospital - RVR05 HS (Harry Secombe) 1380 1324 345 345 1035 932 0 0 95.9% 100.0% 90.0% St Helier Hospital - RVR05 M2 (M2) 932 820 575 575 690 690 345 345 87.9% 100.0% 100.0% 100.0% St Helier Hospital - RVR05 MAT (Maternity Ward) 3848 3618 1071 1079 3737 3657 977 920 94.0% 100.7% 97.9% 94.2% St Helier Hospital - RVR05 NNU (Neonatal Unit) 1471 1471 292 292 1449 1449 126 126 100.0% 100.0% 100.0% 100.0% St Helier Hospital - RVR05 QM2 (QM2) 1674 1375 345 253 1288 1173 0 161 82.1% 73.3% 91.1% St Helier Hospital - RVR05 RB (Richard Bright) 1380 1305 345 317 1035 966 0 12 94.6% 91.7% 93.3% St Helier Hospital - RVR05 SCCU (Coronary Care Unit) 690 690 690 667 100.0% 96.7% St Helier Hospital - RVR05 SITU (ITU/HDU) 3830 3600 3657 3634 94.0% 99.4% Epsom Hospital - RVR50 ALE (Alexandra) 1380 1271 1345 1218 1035 1024 1308 1228 92.1% 90.6% 98.9% 93.9% Epsom Hospital - RVR50 AMUC (Chuter Ede AMU) 2978 2651 1552 1420 2622 2484 1196 1093 89.0% 91.5% 94.7% 91.4% Epsom Hospital - RVR50 BRI (Britten) 1380 1227 988 953 1035 1000 736 736 88.9% 96.5% 96.6% 100.0% Epsom Hospital - RVR50 BUC (Buckley) 1948 1857 1615 1506 1552 1426 1242 1173 95.3% 93.3% 91.9% 94.4% Epsom Hospital - RVR50 CSY (Casey) 1387 1249 403 652 1001 1001 0 403 90.1% 161.8% 100.0% Epsom Hospital - RVR50 ECCU (Coronary Care Unit) 1380 1158 345 328 1058 1035 0 0 83.9% 95.1% 97.8% Epsom Hospital - RVR50 EITU (Intensive Therapy Unit (inc. HDU)) 1691 1587 1610 1587 93.8% 98.6% Epsom Hospital - RVR50 EMAT (Maternity Unit) 2848 2716 1035 957 2415 2369 1011 927 95.4% 92.5% 98.1% 91.7% Epsom Hospital - RVR50 GLO (Gloucester) 1380 1239 690 690 1035 1035 0 0 89.8% 100.0% 100.0% Epsom Hospital - RVR50 NOR (Northey) 1380 1198 690 684 1035 886 690 690 86.8% 99.1% 85.6% 100.0% Epsom Hospital - RVR50 SCBU (Special Care Baby Unit) 714 714 129 129 690 690 0 0 100.0% 100.0% 100.0% Epsom Hospital - RVR50 SWIF (Swift Ward) 1918 1761 690 684 931 908 103 103 91.8% 99.1% 97.5% 100.0% South West London Elective OrthoDERB (Derby) 1806 1650 912 822 1068 1032 372 372 91.4% 90.1% 96.6% 100.0% South West London Elective OrthoOAKS (Oaks) 1806 1650 912 834 1068 1032 372 408 91.4% 91.4% 96.6% 109.7% South West London Elective OrthoPACU (EOC PACU - Recovery) 2022 1999 426 426 1159 1159 0 0 98.9% 100.0% 100.0% Night Care Staff rate - registered nurses / midwives (%) rate - care staff (%) 61,374 57,255 24,575 24,216 48,000 46,171 16,068 17,015 93% 99% 96% 106% Day rate - registered nurses / midwives (%) rate - care staff (%) Night