Community Nurses Measure Up DID

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Alison Wallis: Nursing Clinical Advisor,

Data Intelligence Group

Lee Davies: Project Manager,

Data Development

Community Nurses Measure Up DID

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Agenda

Background

Benefits

Communication and Engagement

The Dataset

Outcome

Reporting

Terminology Mapping

What’s next?

Community Nurses Measure Up DID

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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 incomplete

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

Number of patients on caseload

Most common interventions

Most common conditions

Background

Community Nurses Measure Up DID

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24th April 2008 – National, One Day

Web Based System

Focussing on Community Nursing Teams -

District Nursing

School Nursing

Health Visiting

Treatment Room Nursing

Family Health Nursing

The Census

Community Nurses Measure Up DID

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

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 records gained insight into the power of information gained insight into the complexity of their day to day work using their

terms to describe it demonstrated the motivation and drive of community nurses to work

together to make themselves heard

Community Nurses Measure Up DID

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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

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The Scenarios

1. General Development Programme

2. Elderly Gent, Lives alone

3. Educating carer in procedure

4. Reduced Fluid Intake

5. Check Environment

6. Behavioural Temper Tantrum

Community Nurses Measure Up DID

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Nursing: Problems, Interventions

• Bladder/Bowel Care• Care Management• Carers• Pregnancy Postnatal• Infant/Child Development• Family Care• Emotional/Psychological

Issues• Equipment• Health Promotion• Long Term Condition

Management

• Medication• Mobility• Nutrition / Fluids• Personal Care• Risk Management• Social Circumstances• Symptom Management• Teaching• Procedures• Skin/Wound Care

Community Nurses Measure Up DID

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1. General Development Programme (I)Infant/Child Development

2. Elderly Gent, Lives alone (P)Social Circumstance(s)

3. Educating carer in procedure (I)Teaching

4. Check Environment (I)Risk Management

5. Reduced Fluid Intake (P)Symptom Management

6. Behavioural Temper Tantrum (P)Infant/Child Development

Community Nurses Measure Up DID

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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

Community Nurses Measure Up DID

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The Census Experience

• IT Issues – ISD and Local

• Access

• Helpdesk

• IT Awareness

• Communication

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Outcome

Staff 3385 (74%) staff working on Census Day

completed the census form

First fully electronic, national data collection initiative for community nursing

Community Nurses Measure Up DID

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District Nurse:North Lanarkshire CHPRegistered Without SPQMade individual contacts onlyAlso did some practice development workSaw 3 patients:Male 91 Problems: Skin/Wound Care – Leg Ulcer

Interventions: Skin/Wound Care – Leg Ulcer CareMedical Diagnosis: Circulatory System Disease – Peripheral Vascular DiseaseCare: Planned Curative, Face to Face in patients home occurring once a

week.

Female 72 Problems: Skin/Wound Care – Wound CareInterventions: Skin/Wound Care – Surgical Wound CareMedical Diagnosis: Injury – Fracture of Tibia and FibulaCare: Planned Resolution, Face to Face in patients home occurring twice a week.

Female 38 Problems: Bladder/Bowel – Urinary Catheter in SituMedications – Unable to take Med’sSkin/Wound Care – At risk of Pressure Sore

Interventions: Bladder/Bowel – Catheter CareMedication – AdministrationSkin/wound Care – Pressure Ulcer Prevention

Medical Diagnosis: ParaplegiaCare: Planned Stabilisation, Face to Face visit in patients home, is

occurring once a day.

Community Nurses Measure Up DID

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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

Community Nurses Measure Up DID

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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

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What’s Next?

Report• Identify local champions to assist with information dissemination • Work with key stakeholders to identify and answer further questions from

the data• Distribute local data to their respective boards and support local analysis

and interpretation of this in its local context

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• What skill levels for each service type is associated with particular nursing interventions?• What is the difference in caseload numbers for different skill levels for each service type?• 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?• 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?• What interventions are associated with particular nursing problems? • What nursing interventions are undertaken by different skill levels in each service type?• What interventions were undertaken by each service type where no medical diagnosis was identified?

Possible Further Questions

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Refine• Review the Dataset to further support other nursing initiatives i.e. NMWWPP• Review the definitions i.e. Planned/Un-planned Care, Caseload• Enhance pick list values to ensure they fully reflect the nature of nursing team activities.• Explore concept of nursing diagnosis to better identify nursing problems • Revise categories of non-patient activity• Progress the development of the International Classification of Nursing Practice Catalogue in partnership with the International Council for

Nurses

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Terminology Mapping (1)

Scenarios PTI Existing Systems

Categorisedlists

Categorisedlists

NANDANICNOC

NANDANICNOC

OmahaOmaha

HomeHealthcareClassification

HomeHealthcareClassification

ICNPICNP

•Flexible

•Comprehensive •Adaptable

•Transferable

•Comparable Census

Community Nurses Measure Up DID

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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

Community Nurses Measure Up DID

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Repeat• Refine the web based data capture system and

develop a process to make it available for more frequent application or for the use of specific staff groups

• Identify sponsors and resources for any future local or national census initiatives

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www.isdscotland.org

Report Published 25th November 2008

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