Nursing & Midwifery Nursing & Midwifery Overview 2007/08Overview 2007/08

Marie-Noelle Orzel, OBEMarie-Noelle Orzel, OBE

Director of Nursing & Patient CareDirector of Nursing & Patient Care

CoG Meeting 16 January 2008 CoG Meeting 16 January 2008

(Agenda item 7)(Agenda item 7)

OverviewOverview

Reducing Health Care Acquired Reducing Health Care Acquired Infections (HCAIs)Infections (HCAIs)

Improving Patient Safety InitiativeImproving Patient Safety Initiative

Reducing HCAI’sReducing HCAI’s £220K from SHA£220K from SHA

Ward based PharmacistsWard based Pharmacists

New commodes and electronic bedsNew commodes and electronic beds

Patient hoists and slidesPatient hoists and slides

IV nursing teamsIV nursing teams

MRSA screeningMRSA screening

Raising awarenessRaising awareness

Matron's RoleMatron's Role

• Monthly audit *• Ward reports *• Green scrubs• Uniform and Dress Code Policy• Visitors Policy/leaflet• E-learning *• IC educator role

HCAI

Environment

Infection Control Policy

Isolation ward

Surveillance

Handwashing

Leadership

Equipment

Estates

Housekeeping

Prescribing Policy

Systems

• Daily bed meetings• Daily email• Outbreak meetings• Rapid testing *• Torridge policy• Aide memoire card• Antibiotic and ward-based • pharmacist *

Education

• PEAT scores *• Equipment audit *• Housekeeping audit *• Inpatient survey *• PALS/complaints *

Human FactorsNaked forearms

IMPROVEMENT DRIVERSSECONDARY DRIVERSPRIMARY DRIVERSTARGET

** measurable outcomes

Working with Visitors

Uniform and Dress Code Uniform and Dress Code PolicyPolicy

– New uniform/dress code New uniform/dress code Principles apply whether Principles apply whether

uniformed or notuniformed or not

Bare from elbow to Bare from elbow to fingertipfingertip

Removal of tiesRemoval of ties

– ‘‘Scrub style uniforms’Scrub style uniforms’ More uniforms allocated More uniforms allocated

= clean uniform daily= clean uniform daily

Doctors also in uniformDoctors also in uniform

The Matron’s roleThe Matron’s role

Senior matrons carry our regular ‘walk arounds’ on the wards to check cleanliness.

When they see a shortfall they take action immediately and check it again on their next visit.

The eWhiteboardThe eWhiteboard

eWhiteboardeWhiteboard

What the ward team seesWhat the ward team sees

Caring for Caring for Acutely Ill Acutely Ill patients – Early patients – Early Warning ScoreWarning Score

Resuscitation/Resuscitation/Emergency trolleyEmergency trolley

Were not Were not standardised in each standardised in each ward areaward area

New standardised New standardised defibrillators & defibrillators & Resuscitation Trolleys Resuscitation Trolleys now purchasednow purchased

Standardised and Standardised and simplified equipmentsimplified equipment

Equipment stored the Equipment stored the same way on every same way on every wardward

Snap lock system Snap lock system

Releasing time to care Releasing time to care projectproject

National ProjectNational Project

Aim is to release Aim is to release time for clinical time for clinical staff to spend staff to spend with patients with patients

Being piloted in Being piloted in 6 areas6 areas

Concentrating on the HOW, not the WHAT

Project AimsProject Aims

Organise wards so that they Organise wards so that they work more efficientlywork more efficiently

Understand how and what Understand how and what we are doing nowwe are doing now

Develop skills in service Develop skills in service improvementimprovement

Measure our progress and Measure our progress and changeschanges

Increase from 40% to 60% Increase from 40% to 60% the time a nurse spends in the time a nurse spends in direct caredirect care

Wards own their action plansWards own their action plans

Delivering Delivering higher higher quality quality care for care for patients patients with no with no extra extra resourceresource

Wards are stocked with linen Wards are stocked with linen delivered on trolleysdelivered on trolleys

Also a supplementary linen cupboard, which Also a supplementary linen cupboard, which requires feeding from the main linen trolley, requires feeding from the main linen trolley, which if it weren’t for the door could fit in which if it weren’t for the door could fit in this cupboard..this cupboard..

All of this represents staff time in moving linen around (time not looking after patients).

Staff don’t use either system to get linen to the beds they use another trolley.

Direct Care Time

Motion Admin Discussion Handovers InformationRoles

Opportunity to increase safety and reliability of

care

Rol

e T

ime

(e.g

. n

urse

)

Total Time

“Everything I need to do my job is

conveniently located”

‘The paperwork is easy to understand

and quick to complete’I am not interrupted by

people requesting information or looking

for things

‘’Handovers are concise, timely and

provide all the information I need”

‘It is clear to everyone who is

responsible for what”

‘We have the information we need

to solve our own problems, and find out if we were successful”

…and it releases time to care

The OpportunityThe Opportunity

So what do we do with opportunity?

Design safer care processes e.g. uninterrupted drug rounds

Design more reliable care processes

Patients who get more direct care time, safer care and more reliable care will have a reduced length of stay

Any Any

QuestionsQuestions