Nursing and Midwifery Annual Report

Nursing and Midwifery Annual Report 2013-2014 Katherine Fenton OBE Chief Nurse UCLH Chief nurses award: Cliona Curran Ward Sister Jubilee Ward

Contents Welcome and introduction 3 Our Key Facts and Strategy Summary 4 Page 1. Nursing and Midwifery Strategy: We know that care and outcomes for patients are of a high quality 6 2. Nursing and Midwifery Strategy: Nurses and midwives are always caring thoughtful and intelligent 8 3. Nursing and Midwifery Strategy: Patients and their families feel confident in their care, and have the best experience possible throughout 9 4. Nursing and Midwifery Strategy: Nurses and midwives are stewards of the NHS purse 10 5. Nursing and Midwifery Strategy: Nurses and midwives have a structured, coherent clinical and/or academic post graduate pathway 11 6. Nursing and Midwifery Strategy: Research is alive in practice 12 7. Nursing and Midwifery Strategy: Matrons are influential and exemplify inspirational leadership at all levels 13 8. Nursing and Midwifery Strategy: The sister and charge nurse is a high profile, valued and effective role 14 Patient Experience: Making a Difference 15 Excellence in Education 16 Our Priorities for 2014-15 17 Celebrating Success 18 2 Nursing and Midwifery Annual Report 2013-2014

Welcome and introduction A message from Katherine Fenton OBE, Chief Nurse I am delighted to present my third nursing and midwifery annual report. 2013-14 was a phenomenally busy year for our nurses and midwives. We started the year with some challenging objectives to continue delivering our 2012-15 strategy. The publication of the Francis and other key reports saw us expand these objectives to ensure we could incorporate the valuable learning reflected in the recommendations from these papers. In August we launched the 100 Days to Demonstrate Excellence campaign. This accelerated the delivery of our objectives in readiness for our CQC inspection. 14 key priorities outlined in this campaign led to progress in all of the elements of our strategy. The successes achieved are testament to the hard work and commitment of UCLH nurses and midwives. We had a number of successes in 2012-13. Notably these included national recognition for our Strengths Based Recruitment work. Our CQC inspection found excellent compassionate care delivered by our nurses and midwives. It also recommended areas for improvement. These were documentation, security of patient records, NEWS, DNAR and dementia care. 2014-15 will be a challenging year as we meet these CQC recommendations and complete the delivery of the aims we set out in our three year strategy. It will be a year of challenge and consolidation for us as professionals but I remain confident in my belief that the care provided at UCLH is outstanding, and will be the best in the United Kingdom. 3

2013-14 Nursing and Midwifery: Key Facts and Figures 3,290 (WTE) Nurses, Midwives and Assistants The largest single staff group in the Trust Over 350 Student Nurses and Midwives in training Annual Budget of over 150 Million Pounds 4 Nursing and Midwifery Annual Report 2013-2014

The Nursing and Midwifery Strategy 2012-15: Overview and Successes The N&M strategy was launched in summer 2012 comprising of eight key strategic aims which link to UCLH s mission statement to provide top quality patient care, excellent education and world class research. 1. We know that care and outcomes for patients are of a high quality 2. Nurses and midwives are always caring thoughtful and intelligent 3. Patients and their families feel confident in their care, and have the best experience possible throughout 4. Nurses and midwives are stewards of the NHS purse 5. Nurses and midwives have a structured, coherent clinical and/or academic post graduate pathway 6. Research is alive in practice 7. Matrons are influential and exemplify inspirational leadership at all levels 8. The sister and charge nurse is a high profile, valued and effective role Key Achievements: Patient Safety The N&M contribution to the Trusts Patient Safety agenda in 2013-14 was significant. Of note was the significant reduction in hospital acquired pressure ulcers, and maintenance of low levels of falls with harm. The Matrons group had successes in year through the introduction of Quality Boards Quality Huddles and Harm Free Care focused Matrons Rounds. Key Achievements: Patient Experience The four Always Actions were developed and rolled out to all nursing and midwifery staff across UCLH. Since their launch in August 2013, over 30,000 inpatient welcome packs have been given to out patients across sites. The project has received national recognition as runner up in the Access to Information category at the 2013 Patient Experience Network National Awards. Key Achievements: Research & Workforce 2013-14 saw the launch of the N&M Research strategy. Strengths Based Recruitment was implemented and has become a nationally funded piece of work. Acuity & Dependency auditing has become fully embedded an practice supporting our annual cycle of establishment setting. 5

1. Nursing and Midwifery Strategy: We know that care and outcomes for patients are of a high quality Harm Free Care (HFC): Measurement of HFC using the National Safety Thermometer has developed further this year, with monthly feedback to Boards on individual ward performance. Overall Trust performance has improved in-year and has consistently been above 96% of patients receiving harm free care. UCLH clinicians have been involved in the next-steps of Safety Thermometer Development, notably the Medicines Safety module. Care thermometer launched: The Care thermometer was launched in July 2013. 12 key measures of ward performance are reported in the care thermometer. These reflect staffing, reliability of care, outcomes and patient experience. The thermometer continues to be developed and is one of the foundations for the UCLH model of ward accreditation which will be delivered in 2014-15. Deteriorating Patients: 2013-14 saw a reduction in cardiac arrests by 50%. The deteriorating patient work was recognised in the HSJ awards. A National Early Warning Score (NEWS) chart was developed using a Plan Do Study Act approach and was launched in March 2014. Dose Omissions: Some improvement in performance in year, but still much to do in order to achieve our overall target of no more than 1.5% dose omissions. The dose omissions group has made gains in raising awareness and understanding of this issue, raising the profile of dose omissions throughout the Trust. UCLH dose omission work has been internationally recognised, with a paper accepted for presentation at the IHI European Patient Safety Congress in Paris 2014. 6 Nursing and Midwifery Annual Report 2013-2014

Nutrition and Hydration strategy: Implementation of the strategy included a move to Steamplicity with 6% increase in food ratings on Meridien. Other improvements were the introduction of a new Nutrition Screening Tool with increased screening compliance to over 80%. Hospital Acquired Pressure Ulcer (HAPU) Reduction: The SSKIN quality improvement project was re-launched in 2013-14. The programme is linked with UCLP and Community colleagues and is supported by UCLH s first Darzi Nurse. To date rates of HAPU are at historically low levels for the Trust. UCLH ranks third for the Trusts with the lowest rates of HAPU in the Shelford group. Despite our successes, we have significant work to do in this arena, and are working in close collaboration with Shelford and Salford Royal colleagues to reduce rates of pressure damage further. Hospital acquired pressure ulcers 2013-14 NUMBER OF PRESSURE ULCERS 70 60 50 40 30 20 10 0 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2012 2013 QUARTER 7

2. Nursing and Midwifery Strategy: Nurses and midwives are always caring thoughtful and intelligent We are committed to delivering top-quality patient care, excellent education and world class research Safety Kindness Teamwork Improving Strengths Based Recruitment: We are recruiting to key nursing posts using this approach which ensures that people are not only competent to undertake the role and are aligned to the values of the organisation, but who have the innate strengths to make them highly successful. Appraising to Trust Values: The new appraisal system is now firmly embedded and based upon the Trust values. In 2013-14 Nurse appraisal rates were amongst the highest in the Trust. Mentoring to Trust Values: A new pre-registration strategy was launched in 2013-14. The purpose of the strategy is to standardise the approach to recruiting and mentoring students in placement at the Trust. Valuing our staff: Last year, many of our nurses and midwives were recognised for their contribution to the Trusts objectives at the Celebrating Excellence awards ceremony. Recruit 500 Has set the bar for excellence in selecting, assessing and recruiting the best staff available. Recruitment is centralised and based upon competency and values. The Chief Nurse and Director of Workforce are leading a campaign to reduce the vacancy rate and attract the highest calibre staff to work with us. We have recruited over 500 nurses, midwives and nursing assistants since the campaign commenced and subsequently reduced the vacancy rate by 4%. 8 Nursing and Midwifery Annual Report 2013-2014

3. Nursing and Midwifery Strategy: Patients and their families feel confident in their care, and have the best experience possible throughout Name Boards Were launched in 2013-14. Since their introduction in August 2013, we have observed improvement in several inpatient survey questions via Meridian. Confidence at every step of the pathway 2013-14 saw the development and roll out of the Always actions across the Trust. These are 4 pledges to our patients that will improve the experience they have whilst in our care. One of these initiatives was the introduction of patient headboards so every patient knows exactly who is accountable for their care. As demonstrated in the graph, our survey results show that patients do have confidence and trust in the nurses treating them where we continue to score above the 90% benchmark. Meridian Results: Confidence and Trust Meridian Inpatient Survey Results for the Question: Did you have confidence and trust in the nurses treating you? 95 85 75 Apr13 Jun13 Aug13 Oct13 Dec13 Feb13 Benchmark Trust 9

4. Nursing and Midwifery Strategy: Nurses and midwives are stewards of the NHS purse Ward Efficiency Measures The ward efficiency group continues to make improvements, notably in improving TTO prescribing (on tablet devices), increasing the Discharge Lounge usage by over 50 per cent (in the Tower) and improving ward-levelmetrics with a interactive ward-level guide to ward efficiency updated on a weekly basis. This work will continue at pace into 2014-15. Evidence Based Staffing The Francis report highlighted the need for evidence based approaches to setting safe staffing levels. A large amount of work has been undertaken this year to make sure that not only are there the right number of nurses in the establishment to match the acuity and dependency on the wards, but that recruitment, rostering and escalation processes ensure that there are the right number of people on each shift. Two reports on nurse staffing have been presented at board. QEP & CQUIN Savings Nurses and midwives have played a central role in supporting the Trust achieve its QEP efficiency and CQUIN targets. In both cases improving the quality of care whilst providing best value for money. Specifically, nurses played a central role in pressure ulcer reduction via the CQUIN scheme. This initiative secured significant revenue for the organisation, whilst improving safety and service provision for our patients. E-Roster: Work to fully implement e-rostering has continued throughout this year. All ward areas are now using e-rostering and staff are having their extra hours & enhancements paid via the system. Work continues to roll out to non rostered areas alongside the development of an interface between the nurse bank ipoint system and e-rostering. 2014 will see further work to develop real time acuity and dependency assessment so that staffing can be matched to acuity on a shift by shift basis. 10 Nursing and Midwifery Annual Report 2013-2014

5. Nursing and Midwifery Strategy: Nurses and midwives have a structured, coherent clinical and/or academic post graduate pathway UCLH Nursing and Midwifery representatives have participated in a variety of key stakeholder events and focus groups Within our LETB to shape the design of a number of clinical & academic post graduate pathways including community nurses through integrated care models and emergency nurse practitioners. In addition, two bespoke pathways for trainee nurse & midwife consultants have been designed to support the development of our workforce to become clinical experts and leaders of the future. It is planned that these pathways will be implemented in 2014-15. North Central and East London 11

6. Nursing and Midwifery Strategy: Research is alive in practice Centre for Nurse & Midwife LED Research conference The 3rd Annual Centre for Nurse & Midwife LED Research (CNMR) conference launched the UCLH Nurse and Midwife Research Strategy to enable UCLH to lead the way in Developing the Role of the Clinical Academic Researcher in the Nursing and Midwifery Professions and increase our capacity to deliver world-class research to improve patient care. Theme leads have been appointed for each of the research themes: Women s Health Cancer Infection & Infection Control Clinical Leadership & Quality and Integrated Care. Research theme leads will : Support the development of bodies of nurse and midwife led research in the five themes Develop the role of Research Nurses and Midwives Raise the profile of research and audit Support and facilitate grant applications Identify funding for protected research sessions Work towards employing a full time Nurse and Midwife researcher within each of the five themes. 12 Nursing and Midwifery Annual Report 2013-2014

7. Nursing and Midwifery Strategy: Matrons are influential and exemplify inspirational leadership at all levels UCLH Matrons have had a successful year culminating in a major presentation of their achievements at a King s Fund event in September 2013. The group goes from strength to strength, developing as a cohesive body of senior leaders who are the custodians of clinical standards Trust-wide. As part of their Kings Fund development programme Matrons have led and established four major projects this year. These were: The King s Fund development programme will continue with specific objectives into 2014-15. The matrons will host an International Nurses Day Conference Confident in our Care: Every time focusing on how as nurses and midwives we ensure UCLH continues on its journey from good to great. Quality Boards Quality Rounds Patient Experience of bedside handover I-Matron: Raising their clinical leadership profile 13

8. Nursing and Midwifery Strategy: The sister and charge nurse is a high profile, valued and effective role Capable, inquisitive and confident nurse and midwifery leaders at ward/ departmental level are crucial to success in everything we do at UCLH... We will be the best nursing and midwifery workforce in the NHS. Strengths Based Recruitment In 2013 a strengths profile for Ward Sisters was developed with Shelford partners. This work has been published in the Health Service Journal and further developments to profile other nurses are being sponsored by Jane Cummings Chief Nursing Officer for England. We are recruiting to key nursing posts using Strengths Based Recruitment which ensures that people are not only competent to undertake the role and are aligned to the values of the organisation, but who have the innate strengths to make them highly successful. Midwifery Leadership. Throughout 2013-14 there have been a number of initiatives and development opportunities for senior midwives and midwifery sisters to enhance and support their roles. A bespoke leadership programme, focusing on self awareness and accountability has been completed by all midwives at band 7 and above. The senior midwifery team has been restructured to ensure visible clinical leadership in all areas. 14 Nursing and Midwifery Annual Report 2013-2014

A Focus on Patient Experience: Making a Difference Quality Boards: Have been introduced on each inpatient ward to provide a snapshot view of performance. Sisters and charge nurses are responsible for updating the data, which includes pressure ulcers, patient falls, complaints and FFT scores. There is also space to write individual patient feedback and the actions being taken to resolve any issues identified. The boards are visible to patients, visitors and other members of the MDT and so encourage staff to be open and transparent about their successes and areas for improvement. It is hoped that this will also keep staff motivated in ensuring they deliver harm free care 100% of the time. Inpatient Welcome Packs: It was identified in the national inpatient survey that nearly two thirds of our patients did not feel they had received enough information about ward routines. Nationally, this questions tends to score poorly but we decided to drill deeper into the problem and address it. This resulted in the development of a welcome pack, which contains information about the ward as well as items to help keep patients safe and comfortable (including an eye mask and ear plugs to help them sleep). Since their introduction in August 2013, we have observed improvement in several inpatient survey questions via Meridian, the highest being a sustained 15-20% improvement on the question did you receive information about how to complain? Feedback from patients and staff alike has been very positive. One patient commented: The welcome pack made my stay so much more comfortable... Made us feel like we were on first class BA. 15

Excellence in Nursing and Midwifery Education This section gives a short summary of some of the nursing and midwifery education activities at the Trust in 2012-13. UCLH Undergraduate & Post Graduate Pre-Registration Strategy This year we implemented the undergraduate and post-graduate pre-registration strategy developed in 2012-13. The strategy focuses on strengthening the student experience and mentorship support. UCLH welcomed 120 adult nurses starting their training in 2013, 31 Child Branch students, Midwifery 23 from LSBU/KCL/City University. Support & Mentorship UCLH held its first Mentor conference,the conference launched the Lead mentor role this will be rolled out across the Trust in 2014. UCLH pioneered work with academic partners to develop a pan London Adult and Child practice assessment document. Student Retention into Newly Qualified Posts In 2013 recruit 500 campaign supported UCLH student only day which saw 42 students into Newly qualified nurse post across the Trust. A Focus on our Nursing and Midwifery Assistants UCLH has long recognised the importance of its Nursing and Midwifery Assistants. A summary of initiatives this year: Clinical Health Apprenticeships are now entering their 3rd cohort The third UCLH/RCN Nursing Assistants Conference is planned for May 2014 Five pre-nursing NA s have been employed within the Trust as part of the HEE scheme to provide budding student nurses with healthcare experience. 16 Nursing and Midwifery Annual Report 2013-2014

Nursing and Midwifery 2014-2015: Building on Our Successes Building on our successes: Nursing and Midwifery strategic objectives are aligned to the Trusts Top Ten objectives* (click link below) and feature, where applicable, a direct link to the relevant Francis Report recommendations. Progress will be monitored through the Nursing and Midwifery Leadership Group and Nursing and Midwifery Board. Summary of 2014-15 Nursing and Midwifery Objectives 1. High Quality Outcomes: harm free care, nutrition, medicine dose omissions, cardiac arrests and ward accreditation Launch and embed Confident in our Care N&M Clinical Fridays and Monthly Big Quality Huddles. Implement standardised documentation. 2. Caring Thoughtful & Intelligent: strengths based recruitment, always actions, named nurse, focus on older people Dementia care. 3. Patients & Families can be confident: embed intentional rounding, improve patient experience scores. 4. Stewards of the NHS purse: reduce N&M vacancy levels to 5%, ensure acuity/ establishments reviewed, implement ward efficiency programme. 5. Clinical/Academic career pathways: develop C/A pathway, evaluate pre-reg strategy, design revalidation programme, hold 3rd N&M conference. 6. Research is alive in practice: Implement 5 N&M programmes from research strategy, publish number of researchers & projects, appoint a director of CNMR. 7/8. Matrons & Sisters Development: Implement matrons rounds, recruit sisters to strengths based profile, deliver ward sisters development programme. Summary of 2014-15 Midwifery Specific Objectives 1. High Quality Outcomes: Reduce CS and operative vaginal birth rates, launch & embed the Better Birth Campaign. 2. Caring Thoughtful & Intelligent: develop & pilot midwifery practitioner, introduce revalidation. 3. Patients & Families can be confident: improve performance on the national maternity survey. Transform womens experience of postnatal care. 4. Stewards of the NHS purse: develop a model for real time acuity and dependency monitoring for midwifery. 5. Clinical/Academic career pathways: Become centre of excellence for Simmom. Implement consultant midwife pathway and pre-registration strategy. 6. Research is alive in practice: Increase the number of midwifery led projects to 10. 17

Celebrating Success in the Nursing and Midwifery Workforce The 2013-14 Celebrating Excellence Awards Nurses and midwives do not work in isolation, and either form part of, or lead multi- professional teams. This leadership and teamwork was evident at the recent UCLH Excellence Awards in which nurses and midwives were amongst those honoured for their contribution to the success of the Trust across a number of categories. Chief nurses award: Cliona Curran Ward Sister Jubilee Ward Nurse Mentor of the year: Michaela Musial Top Quality Patient Care: Gwyneth Griffiths Award: Darren Barnes and Yogini Jani Nurse Assistant of the Year: Beatrriz Quigley Newly Qualified Nurse of the year: Kate Boulter Chief Executive s Outstanding Leadership Award: Julie Hogg 18 Nursing and Midwifery Annual Report 2013-2014

Whether it be Nursing and Midwifery research or clinical practice UCLH nurses and midwives lead the way, and are being recognised for such through winning a large number of national and international research, practice and leadership scholarships. These awards inform and drive innovation and clinical excellence for our patients across the UCLH sites. National Institute for Health Research Yana Richens - NIHR Clinical Academic Fellowship Bernie Porter - MBE Michelle Hope - Darzi Fellowship Belinda Green - Florence Nightingale travel award 19

20 Nursing and Midwifery Annual Report 2013-2014