community nurses measure up did v heather strachan nmahp ehealth lead scottish government

Community Nurses Measure Up DIDV

Heather Strachan

NMAHP eHealth Lead

Scottish Government


Electronic Patient Record

Need for standardised information for sharing patient information

and secondary uses

Lack of other information sources about Community Nursing, e.g. Practice Team Information (PTI) and ISD 29/30 ceased

AHP Census, September 2005 - Provided previously unknown information across Scotland, e.g.

Number of patients on caseload

Most common interventions

Most common conditions

Background


24th April 2008 – National, One Day Census

Web Based System

Focussing on the Community Nursing Teams-

District Nursing

School Nursing

Health Visiting

Treatment Room Nursing

Family Health Nursing

How?


1. Support development of the Electronic Patient Record for use by Community Nurses: Establish Minimum Nursing Dataset Identify standard terminology

2. Provide information and intelligence to support service redesign, workload management and policy decisions:

Diversity of Health problems Variation in nursing practice, roles, location Provide national nursing baseline

Benefits

3. Communication with Community Nurses through workshops and training sessions

raised awareness of need for standardising information in clinical recordsGained insight into the power of information Gained insight into the complexity of their day to day work once they tried to describe it demonstrated the motivation and drive of community nurses to work together to make themselves heard


Communication and Engagement

Communication through Community Health Partnership Leads and Directors of Nursing

User Reference Groups- Scenarios

Awareness Sessions

Website and publicity material e.g newsletters

Pilots

Training Sessions

Help desk


The Census Dataset

About the Nurse: Registered/ unregistered with SPQ/ SVQ Caseload holder / caseload size Non-patient related activity

About the care: Nursing Problem / Intervention(s) Aim of Care Medical diagnosis Intensity (Child Health) Planned frequency of care

About the patient: Age, ethnic group, gender

About the patient contact: Individual/ group/ clinic Face to face, telephone, etc Location Planned/ unplanned Reason for more than 1 staff member


• A National Community Nursing Team Census took place on 24th April 2008.

• First fully electronic, national data collection initiative for community nurses

• 74% of staff working on census day completed a census return.

• This amounts to 3,385 completed returns.

• Report published on ISD website 25th November 2008.

Outcome


Analytical Tables

Reported at Scotland Level Only

Participation and Contacts

Participation numbers and percentage

Skill Mix – Registered and non-Registered

Number of Patients seen – by service

Number of Contacts, Proportion of Planned Contacts – by service

Non-Patient Activity – by service type


Reported at Scotland Level Only

Clinical Analysis

Aim of Care for Individual and Groups/ Clinics by service type

Intensity of Care by service type (Child Health)

Nursing Problems High Level Categories by service type

Nursing Interventions High Level Categories by service type

Medical Diagnosis High Level Categories by service type

Analytical Tables (2)

Analysis by Patient

Age and Gender by Service type

Ethnicity


• The majority of patients were seen individually by District Nursing, with Health Visitors doing more clinics. School Nurses have more patient contacts in the Group setting.

• Most patients had a single contact, 23 patients being seen more than 3 times on the same day.

• Treatment room nurses most unplanned contacts (1 in 4) with

Health Visitors next.

Contacts


• Caseload figures indicative only. • Lack of consensus among School Nurses re definition of

caseload. • Some staff managing multiple caseloads or covering for another

caseload holder or Corporate caseload model in use.

Caseloads


• The highest non-patient activity for all disciplines was “other.”

• Anecdotally “Other” was may have been used to record other types of patient activity like writing prescriptions and reports for children’s hearings;

• For Treatment Room Nursing and District Nursing there was a high proportion of supply ordering. For Health Visiting and School Nursing there was a high proportion of attending professional meetings.

Non-Patient Activity


• Overall, the highest numbers (almost one third) of individual contacts were for Maintenance care. Prevention is the overall most common care aim for groups and clinics.

• Highest aim for District Nurses were Curative and Maintenance - The Health Visitors’ most common care aim was Supportive, Followed by Assessment and Enabling.

Aim of Care


• Intensity of care derived from Hall 4, was identified for health visitors, school nurses and family health nurses. The highest was additional followed by core and intense.

• It should be noted that Health Board protocols may vary, for example the specific length of time which a family with a new baby is considered to be at the additional level of care.

Intensity of Care


• Individuals, groups and clinics could be assigned a main, second and third nursing problem.

• Health visiting teams had issues in allocating “a Problem” where they were carrying out a Health Promotion Activity.

• For this report the problems and interventions were grouped into high level categories, it is these categories which are being reported on. A more detailed breakdown of these categories can be reported on in subsequent reports.

Problems and Interventions


• Skin / wound care was the highest reported problem category overall. District Nursing and Treatment Room Nursing reporting the highest proportions of problems in this area.

• The second most recorded problem overall was Long Term Conditions Management.

• Almost half of the problems reported by Treatment Room Nursing were for procedures.

• Infant / Child development was the main problem reported for Health Visiting

• Health promotion main issue for School Nursing. • Bladder and bowel management, medication management and

procedures were common problems.

Problems and Interventions


• High numbers of Treatment Room Nurses, Health Visitors and School Nurses did not record a diagnosis. Health Visitors and School Nurses in particular, “Not Available” in 80% of the cases compared with 17% for all the other disciplines combined.

• Circulatory System Disease was the highest reported diagnosis category overall.

• Second Endocrine, Nutritional Metabolic and Immunity Disorders, supporting Long term conditions

• Mental Disorders was the main diagnosis reported for Health Visiting and School Nursing.

• For Family Health Nursing the main Diagnosis was Neoplasms.

Diagnosis


• 62% were women and 38% were men.

• Extremes for Health Visiting and District Nursing age profiles. Family Health Nurses both ends of spectrum. Treatment room nurses worked across all ages.

• The ethnicity profile of the patients close to the profile for Scotland obtained from the General Register office for Scotland statistics.

Patient’s age, sex and ethnicity


What’s Next? National Report Published 25th November

www.isdscotland.org/data_development

• Local Reports distributed to All Boards February 2009

• Meetings with Boards DNS to identify from the data support local analysis and interpretation of this in its local context and identify further questions or data collection issues

• Review practicalities of data collection at patient level from Electronic Health Records (ie MiDIS)

• Develop Scottish Community Nursing Catologue as part of International Classification of Nursing Practice (an ICN product supported by WHO)

• Further recommendations from these activities will identify usefulness of information, any refinements to data set, links with workload project to review definitions and values ie caseload, planned and unplanned care, non patient related activity.


•What skill levels for each service type is associated with particular nursing interventions? •What range of nursing interventions were carried out for patients or clients seen as individuals, groups or in clinics?.• What nursing problems do patients have who had 2 contacts from the same member of staff for each service type?• What nursing problems and interventions were undertaken for patients across each service type who had an unplanned contact?.• Which non patient related activity was undertaken by each skill levels for each service type?• What nursing problems are associated with a particular care aim?

Further Question


• What care aims are associated with particular medical diagnosis?

• What care aims are associated with particular contact types? • Is there any relationship between care aim and intended

frequency of future visit?• What different types of nursing problems and interventions are

offered to families with children who require additional and intense levels of care intensity?

• What nursing problems arise from specific medical diagnosis?• Where no medical diagnosis exists, what interventions are

being carried out and why (nursing problem)?• What interventions are associated with particular nursing

problems? • What nursing interventions are undertaken by different skill

levels in each service type?

Further Question


Terminology Mapping (1)

Scenarios PTI Existing Systems

Categorisedlists

Categorisedlists

NANDANICNOC

NANDANICNOC

OmahaOmaha

HomeHealthcareClassification

HomeHealthcareClassification

ICNPICNP

•Flexible

•Comprehensive •Adaptable

•Transferable

•Comparable Census


Terminology Mapping (2)

Categorisedlists

Categorisedlists

Additional problems &Interventions fromCensus comments

ICN ICN

ICNPICNP

Scottishterms

Scottishterms

TerminologyMapping

Tool

TerminologyMapping

Tool

Scottish Catalogue of

Community Nursing

Scottish Catalogue of

Community Nursing


Questions?

community nurses measure up did v heather strachan nmahp ehealth lead scottish government

Documents

patient information

nursing practice

nursing problem interventions

community health partnership

service typeintensity

service redesign

service typeethnicity

community nurses74