THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST Agenda item A5(iii) PROVIDING CLINICAL ASSURANCE: CLINICAL ASSURANCE TOOLKIT (CAT), NURSE STAFFING, FRIENDS & FAMILY TEST (FFT) A SUMMARY REPORT EXECUTIVE SUMMARY This paper provides the regular monthly report on the nursing quality assurance, ie:- a. Clinical Assurance Toolkit (CAT), which provides assurance of the care given to patients. It is based upon self-assessment by the Ward Sister/Charge Nurse (or equivalent) and also environmental cleanliness checks by the Matrons (in the acute setting). All hand hygiene is peer reviewed and from October 2013 the Matron checks will be peer reviewed quarterly. b. Monitoring of nurse staff levels, including planned versus actual staff, and when shifts fall short of planned staffing levels. c. Friends & Family Test results and feedback, including response rates and the Net Promoter Score. d. As part of our commitment to transparency in safe care, all wards and departments are now displaying actual and planned staffing levels. This report is the first since the changes to the CAT questions in April 2014. The focus of this Board paper will vary each month for April, IPC practice is highlighted in line with the revised CAT Strategy. The escalation of red scores to Trust Board will occur at Month 2. RECOMMENDATION To (i) note the content of this report (ii) comment accordingly. Mrs Helen Lamont Nursing & Patient Services Director 16 th May 2014
THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST PROVIDING CLINICAL ASSURANCE: CLINICAL ASSURANCE TOOLKIT (CAT), NURSE STAFFING, FRIENDS & FAMILY TEST (FFT) A SUMMARY REPORT 1. INTRODUCTION This is the first monthly report since the updating of questions in the April 2014 Clinical Assurance Toolkit (CAT) survey. The Care Summary report pulls together a range of quality assurance and patient outcome measures into a visual format, and accompanies this report as an appendix. This Care Summary is available by Ward, Directorate and Matron. 2. CAT REPORT SUMMARY 2.1. Scores & Trends The overall score for the Trust decreased slightly from 97.3% in March to 96.8% in April. Questions changed in April as previously explained to the Board. The reduction in the number of questions asked has had an effect on the denominator used to calculate the scores fewer questions means that one wrong answer has a proportionally bigger impact on the scores. The revised tool has much more focus upon care quality and outcomes than process. 2.2 Focus on IPC Practice This section of the report takes a particular area of practice that is audited via CAT and looks at the findings at a Trust level. During April s CAT, all patients were isolated who needed to be at the time of the audit. Of the wards that had patients with suspected infectious diarrhoea, 96.15% had isolated the patients on their first episode of loose stool (in line with Trust policy) and 100% of wards had completed care pathways for these patients. Of the wards who had MRSA positive patients, 100% had undertaken a full MRSA screen on admission and 100% had a completed care pathways for these patients. The correct hand hygiene products were used before ANTT procedures in 99.79% of observations. During observations in theatre areas, 97.67% of the staff observed scrubbed for the appropriate length of time. Personal protective equipment (PPE) was disposed of appropriately following patient contact in 100% of observations. Next month the focus will be on nutrition. 1
3. NURSE STAFFING Ensuring staffing is safe within care environments is a very high priority. Every day across the Trust, key clinical leaders, such as Matrons and Ward Sisters, agree and manage staffing levels, including reacting to issues/shortfalls. Governance around staffing is high and frameworks are in place to support decision making. Monitoring planned and actual staffing and dependency levels across the Trust in real time is an aspiration and development which is underway. Planned and actual staffing levels are displayed on wards and departments, where appropriate, for public information and transparency. From April 2014, monitoring of this data as a trend will be incorporated into CAT. This means Sisters/Charge Nurses (or equivalent) recording planned and actual staff for one week in the month from the majority of clinical areas in the Trust. By planned staffing, we mean the number of nurses included on the roster for a particular shift (early, late and night). The actual staffing means the number of nurses who actually worked on the shift in question. The term nurses in this context means Registered Nurses & Midwives as well as support staff which may be, for example, Healthcare Assistants, Play Specialists, Housekeeper roles. The Nurse Staffing Report attached (Appendix 2) gives an overview of the data by Directorate across the Trust. The explanations for this report are below: Funded establishment this is the overall funded nursing establishment in whole time equivalents for each ward / department SNCT establishment this is the result of the Safer Nursing Care Tool which was collected for the first week in April. The multipliers have been applied providing the number of WTE required to care for the dependency / acuity of the patients on the ward at that time. Shifts actual did not meet planned this is the number of times over a period of a week (same week as SNCT data collection) that the actual staffing numbers per shift did not meet the planned Staff Turnover these are 12-month rolling figures identifying the percentage of nurses leaving the ward / department Sickness Absence nursing sickness absence rate Vacancy Rate this is the percentage of all grades of nursing vacancies for this month Band 5 Vacancy Rate this is the percentage of band 5 vacancies the ward has this month In April, 19% (205) inpatient shifts (including adult, paediatric and maternity) did not meet their planned staffing level (96 early shifts, 81 late shifts and 28 night shifts). There were a further 48 shifts from non-inpatient areas (day case and outpatients) where the numbers of shift did not meet the planned level. Critical Care areas across the Trust have a very robust system for monitoring planned and actual staffing data and levels of care every shift The Nurse Staffing Review team are scoping how this information will be centrally collated and reported to Trust Board. 2
At the time of reporting, April s data for sickness, vacancy rates and funded establishments were not available. Therefore, March s data was used for comparisons to the Safer Nursing Care Tool (SNCT) in the Nurse Staffing Report that accompanies this paper. This is an example of the information the team can provide to the Trust Board on a regular basis. The SNCT is a tool to calculate dependency levels of patients in adult in patient areas, and is one of the measures used to decide numbers of nurses. It must be emphasized that this is a new development and not yet fully tested or validated. This tool is under development in Emergency Department and Children s. 4. FRIENDS & FAMILY TEST 4.1 Overview of Results The Friends & Family Test is scored using the Net Promoter Score, which has previously been explained to the Board. The table below shows the level of achievement in acute areas of the Friends & Family Test for March and April 2014. Month Inpatient % Emergency Department % Net Promoter Score IP Net Promoter Score A&E Mar 41.7% 10.3% 81 67 Apr 82.4% 16.2% 81 70 The score for Inpatient Wards in the Trust has been relatively consistent across the published data since April 2013 (range 76-81). The score for the Emergency Department has varied more (58-78). The installation of a token box system for the Emergency Department in November 2013 has improved response rates. April has seen a large increase in the Inpatient response rate, with no large change in the score. From October 2013, the Friends and Family question was asked of Maternity patients, as part of the ongoing national rollout of the scheme. Patients are asked the question at four touch points in the maternity pathway: Antenatal Care, Birth, Postnatal Ward and Postnatal Community Provision. The Maternity scores are as follows: Month Antenatal Care Birth Return Rate Postnatal Ward Postnatal Community Provision Net Promoter Score Mar 7.3% 20.6% 33.2% 2.4% 85 Apr 6.9% 26.9% 42.9% 0% 81 3
4.2 March Data The Trust been advised by its Friends and Family third party supplier that there was a problem with the data received and reported to Board, and uploaded to NHS England in April (relating to the March return), and 219 responses were not included. The impact this would have made to Inpatient results is: 1 st Returned Corrected Difference Number of cards 1945 2164 219 % response 41.6 46.3 4.7 NPS 81.9 81-0.9 The advice from NHS England is that they do not revise data if the difference between the revised and original data is not considered substantial and therefore the data will remain as submitted. The third party provider have investigated the incident which occurred due to human error and have advised that additional controls have been put in place to prevent this occurring in the future. 5. ACKNOWLEDGING HARM-FREE CARE As part of the Trust s commitment to harm-free care, wards who achieve 200 days without any patients developing a pressure ulcer or moisture lesion will now receive a letter of recognition from the Trust. The first ward to achieve this was Ward 32 FH. Wards who achieve their own target also receive cookies as a celebration. This scheme has been very positively received. 6. RISKS AND RISK MITIGATION One of the key reasons for undertaking the CAT each month is the mitigation of patient safety risks. Any immediate risks are highlighted to staff at the time (for example, performing a procedure without washing hands) as well as being marked negatively on the CAT audit. In addition to identifying risks at the time of the audit, the CAT scores are also instrumental in highlighting areas where a number of minor factors have combined to produce a red score overall. 6.1 Escalation of red areas April 2014 marks the first month of the new escalation process, where wards will only be required to submit an action plan on the second month of red scores. This means that only areas where issues have been ongoing for more than a month will be reported to Board. The first time this will be reported is in June 2014, relating to May s data. 4
7. SUMMARY The CAT continues to be viewed as a positive assurance method; the addition of staffing further strengthens this. The feedback from Ward Sisters/Charge Nurses about the new questions and Care Summary is very positive. The How we are doing boards are the Trust s method of communicating CAT scores, harm-free care and infection control information to both members of staff on the wards and the public, visible at ward level. The boards are updated monthly with new information and there are explanations for members of the public on what the information means to them. Staffing information is now included. The Trust continues to perform well on the Friends and Family Test and is making good progress in relation to response rates, despite the A&E response rate being lower than usual in March. 8. RECOMMENDATION To receive and note the contents of this report and comment accordingly. 9. KEY Main CAT Measures Less than 91% Between 91% and 97.9% 98% or more Staff Absence More than 3% 3% or less Turnover More than 9% 9% or less Pay Over/Underspend Overspend Underspend Mrs Helen Lamont Nursing & Patient Services Director 16 th May 2014 5