acuity, alerts and escalation - nhs confederation/media/confederation...•bank/agency/overtime to...
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Acuity, alerts and escalationJune 2014
Sue Smith, Executive Chief NurseUHMB NHS FT
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Background
• Changing demographics – ageing, dementia, technology
• Care closer to home – impact on community and hospital services
• Changes to out-of-hours provision
• Expectations of patients and families
• Francis recommendations
• Hard Truths staffing data
Sue Smith, Aaron Cummins, UHMB NHS FT
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Acuity
[Example footer text: (Page 1/8) – Management briefings: October 2013]Sue Smith, Aaron Cummins, UHMB NHS FT
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Acuity/dependency
• Monitored 2 times a year and additionally if:
– Things don’t ‘feel’ right
– Nurse sensitive indicators start to deteriorate
– If there is any organisational change
• Twice yearly reports to the Board of Directors
– Hard Truths data to be published monthly
Sue Smith, Aaron Cummins, UHMB NHS FT
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Sue Smith, Executive Chief Nurse, UHMB NHS FT
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Triggers for alerts
Sue Smith, Aaron Cummins, UHMB NHS FT
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Case study 1 - orthopaedics
• 2 wards; 1 matron; 56-beds; 60/40 RN skill mix. NBR appeared sensible
• Some restructuring of day case and inpatient/trauma work
• Safer Nursing Care Tool used and reviewed alongside other data/intelligence including complaints data/trends
Sue Smith, Aaron Cummins, UHMB NHS FT
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Findings
• Nurse sensitive indicators, complaints, incidents had been rising
• 8 level 1 beds funded, however changes in acuity had been significant
• 8 additional staff required
• Paper to executive team and staffing agreed
Sue Smith, Aaron Cummins, UHMB NHS FT
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Results
Sue Smith, Aaron Cummins, UHMB NHS FT
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Case study 2 – medical ward
• 50 beds
• 8 specialties
• Funded establishment appropriate
• 8 vacancies plus 3 maternity leave (gap of 11)
• Staff tired and demotivated
• Bank/agency/overtime to cover shifts
• Outcomes poor
Sue Smith, Aaron Cummins, UHMB NHS FT
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Actions
• Proactive recruitment
• Increased skill mix
• Leadership development and support
• Daily teleconference
• Regular senior support
Sue Smith, Aaron Cummins, UHMB NHS FT
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Results
Sue Smith, Aaron Cummins, UHMB NHS FT
Outcome 2013 2014
Sickness 14.33 % (January) 4.78% (January)
Falls 47% reduction(Dec/Jan 13 Vs Dec/Jan 14)
Pressure ulcers 50% reduction(Dec/Jan 13 Vs Dec/Jan 14)
Medication errors
68% reduction(Nov-Jan 13 Vs Nov-Jan 14)
-£715k over 1-year
-£540k over 1-year
-£150k over 1-year
-£1.4m over 1-year
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Key challenges
Sue Smith, Aaron Cummins, UHMB NHS FT
• Out of hours services
• 7-day working
• New commissioning landscape
• Funding – using evidence to support decisions
• Negative media coverage
• Feeding the beast…..