leading better care vicky thompson national programme leader – senior charge nurse role, clinical...
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Leading Better Care
Vicky Thompson
National Programme Leader – Senior Charge Nurse Role, Clinical Quality Indicators & Releasing Time to
Care
NHS Scotland
SCN ROLE
Role Framework
Exemplar Job Description & KSF Outline
Activity Analysis
Development Needs Analysis
Educational Framework
Workforce Planning
Releasing Time to
Care
Links
CQIs
Policy Context
• Senior Charge Nurses in hospital settings will be working in the context of the revised role
• The majority of in-patient areas to have Clinical Quality Indicators in place
• The SCN will be the visible embodiment of clinical leadership in NHS settings, coordinating patient care, and inspiring the nursing/midwifery team
By the end of 2010…
Delivering Care
Enabling Health
Advanced Practice
Recruitment & Retention
Workload & Workforce Planning
SCN & CQI
Mod
erni
sing
Nursing
Careers
HCSW
Nurse Bank
Improving Patient Care at the Bedside
• Clearly define this key role and ensure that SCNs are visible and accessible to patients and their carers.
• LBC establishes a national framework for SCNs working in hospital settings across NHS Scotland.
• Empowers Senior Charge Nurses to be clinical leaders and guardians of safety and quality in their area.
• Developed through extensive stakeholder involvement including patient / client input.
• Four key dimensions for the Senior Charge Nurse role:Ensuring safe and effective clinical practiceEnhancing the patient experienceManaging and developing their teamsContributing to the delivery of organisational objectives
• Supported by Clinical Quality Indicators (Falls, Pressure Ulcer Prevention & Food, Fluid & Nutrition)
• The revised SCN role is applicable to nurses and midwives working in hospitals in all clinical specialities, and is supported by the NES Education and Development framework, a National Programme Leader and a Board-level facilitator network.
• Significant and essential links to the Releasing Time to Care initiative
The vision from Leading Better Care
‘We will have strong clinical leadership delivered by empowered Senior Charge Nurses who are the guardians of quality
and clinical standards for the patients under their care.’
Paul Martin
Chief Nursing Officer
Why Change?
‘If you always do what you’ve always done, you will always get what you always had’
Albert Einstein
Do we all see the same thing?
Supporting Frameworkand Tools for Implementation
Framework for Implementation
Educational Framework
Implementation of Senior Charge Nurse Role
Safe and Effective Clinical Practice
Enhance Patient Experience
Manage and DevelopPerformance of the Team
Effective contribution To
Organisational Objectives
Workload and Workforce Planning Tools
e QIPSCQIs
Release Time to Care Productive Ward
SCN Role FrameworkTo Ensure Safe and Effective Practice
Clinical Leadership & Teamwork
Evidence Based, Clinically Effective Practice
Continuous Quality Improvement
Patient Safety
To Enhance the Patients Experience
Clinical Expertise
Co-ordination of Patients Journey
Promote Culture of Patient Centred Care
To Manage and Develop the Performance of the Team
Role Model
Facilitate Learning & Development
Managing the Practice Setting
To Contribute to Organisations Objectives
Networking
Service Development
Political & Strategic Awareness
Supporting Framework
• Competencies and KSF outlined
• Working Document
• For current SCNs and their managers
• ‘Talent Spotting’ – use as framework for development
Implementation of the new role• Crucial in leading and delivering the high quality care
that our patients and the public expect.
• Transition of SCNs to the revised role is a phased process that has Executive level support from NHS Board Nurse Directors across Scotland and is overseen by a national steering group.
• The work of NHS Boards is supported by a funding package provided by Scottish Government Health Directorates. Board-level Clinical Facilitation, plus the delivery of education and development packages and one to one facilitation for Senior Charge Nurses will provide additional support
• Many Boards are also offering action learning for their SCNs. In addition, educational and developmental initiatives are supported by the NHS Education for Scotland (NES) Educational Framework and resources.
• Cohorts of SCNs are already developing into these roles across NHS Scotland and the initiative targets the implementation of this role for all SCNs working in hospitals by the end of 2010.
• From recent information provided by NHS Boards we know that there are around 2000 SCNs in Scotland. Of them, around 1545 will be included in the revised role and around 700 are already undergoing development or working to the outline.
Clinical Quality Indicators - CQIs
Why did we need Clinical Quality Indicators?
• Audit Scotland (2002) reported on limited availability of information on impact of nursing on quality
• Audit Scotland (2007) – acknowledged progress but challenges for national quality indicators
• Identify nurse specific measures that have impact on quality of care and patient experience
CQI Progress
• Three CQIs developed:– Falls– Food, Fluid and Nutrition– Pressure Area Care Prevention
• Data capture and reporting systems being developed locally & nationally
• Further CQIs in discussion for specialist areas, eg midwifery, mental health, etc
Clinical Quality Indicators
• Change of culture
• Data collection and analysis skills
• Quality improvement skills
Data, data and more data…
• Expect poor results initially
• Use it as a tool to engage staff and improve care
• If it’s not documented where is the evidence of care delivered?
Quality Indicator : Food Fluid and Nutrition
Inclusion Criterion: Patients who have been admitted for longer than 24 hours
Clinical Quality Statement:
Element Compliance target Exclusion
100%
100%
100%
100%
100%
100%
100%
100%
Patient not identified as at medium / high risk
100%
Patient not identified as at medium / high risk
100%meals are not provided e.g. ICU
100%meals are not provided e.g. ICU
100%meals are not provided e.g. ICU
100%meals are not provided e.g. ICU
References
1 NHS Quality Improvement Scotland (2003) Food Fluid and Nutritional Care in Hospitals. (www.nhshealthquality.org)2 BAPEN (2003) The 'MUST' Explanatory Booklet. A Guide to the 'Malnutrition Universal Screening Tool' ('MUST') for Adults. (www.bapen.org.uk)
Patients who require support with eating and drinking are identified and are given help with eating & drinking as necessary.
Assessment
Food allergies are recorded at the intial assessment of the patient.
The screening and assessment processes helps identify under nutrition and factors that may prevent patients from eating and drinking adequately. Screening should be recorded within 24 hours and repeated in accordance to clinical need. This shall include assessing and recording height and weight; eating and drinking likes / dislikes; food allergies and the need for therapeutic diet; cultural / ethnic / religious requirements; social/environmental meal time requirements; physical difficulties with eating and drinking and the need for equipment to help with
eating and drinking1,2.
Patients drinking preferences are recorded at initial assessment.
Management
This section refers to an observation of meal times within the ward/department.
The intervention identified within the plan of care relates to the level of risk identified through assessment.
There is evidence of repeat assessments relevant to the level of idenfied risk.
There is documented evidence that nutritional information has been shared with the patient and / or relevant others.
Criterion
Patients have a nutritional risk assessment documented. Within 24 hours of admission using a validated risk assessment tool as agreed by your organisation.
Patients dietary needs / preferences are recorded at intitial assessment e.g Cultural, Religious and / or ethnic dietary preferences.
Patients eating preferences are recorded at initial assessment.
Structures and processes
Nursing staff ensure the effective delivery of food and fluid and contribute to the provision of patients' high quality nutritional care
Mealtimes are protected to minimise disruption to the patient over this time.
Patients receive the correct choice of meals/dishes.
Meals/dishes are delivered at a temperature acceptable to the patient.
Definition of terms
NHS QIS Standards Food, Fluid and Nutritional Care in Hospital (2003) state that this will include the outcomes of the initial assessment; outcomes of the screening for risk of under nutrition; frequency / dates for repeat screening and actions taken as a consequence of repeat screenings. Ideally, this shall be developed in conjunction with the patient or carer. Patients food and fluid intake should be monitored and necessary action
taken if this is inadequate1. NHS QIS Standards Food, Fluid and Nutritional Care in Hospitals (2003) recommend that the discharge plan shall include information about the patients nutritional status; special dietary requirements; and that the arrangements made for any follow-up on nutritional issues.
Inflexible hospital routines, clinical procedures and ward rounds can disrupt mealtimes and thus reduce patients nutritional
intake1. All non - essential staff activity is stopped during mealtimes; there is adequate numbers of staff available to provide food and fluid to patients and where necessary, to provide individual assistance with eating and drinking. There is a protocol for the provision of therapeutic diets, supplements, high
energy and high protein food and fluid1. There is provision of any
requirement outwith the planned menu e.g. vegan meals1.
There is evidence that the discharge plan contains nutritional information.
Ward / Department Date
Element Criterion patient 1 patient 2 patient 3 patient 4 patient 5% compliance
Section % compliance
Patients have a nutritional risk assessment documented. Within 24 hours of admission using a recognised risk assessment tool as agreed by your organisation. 0.00%Food allergies are recorded at the intial assessment of the patient. 0.00%Patients dietary needs / preferences are recorded at intitial assessment e.g Cultural, Religious and / or ethnic dietary preferences. 0.00%Patients eating preferences are recorded at initial assessment. 0.00%Patients drinking preferences are recorded at initial assessment. 0.00% 0.00%The intervention identified within the plan of care relates to the level of risk identified through assessment. 0.00%There is evidence of repeat assessments relevant to the level of idenfied risk. 0.00%There is documented evidence that nutritional information has been shared with the patient and / or relevant others. 0.00%There is evidence that the discharge plan contains nutritional information.
0.00% 0.00%
Breakfast Lunch Evening Meal
% compliance
Section % compliance
Mealtimes are protected to minimise disruption to the patient over this time.
0.00%Patients receive the correct choice of meals / dishes.
0.00%Meals / dishes are delivered at a temperature acceptable to the patient.
0.00%Patients who require support with eating and drinking are identified and are given help with eating & drinking as necessary. 0.00% 0.00%
Overall Compliance 0.00%
Exclusions: Patients admitted less than 24 hours and meals are not provided in high dependency areas such as ITUs.NB Definitions of high, medium and low risk relate to the definitions identified in MUST. ( Bapen 2003)
Actions relating to levels of risk have been identified through MUST.( Bapen 2003)References1 NHS Quality Improvement Scotland (2003) Food Fluid and Nutritional Care in Hospitals. (www.nhshealthquality.org)2 BAPEN (2003) The 'MUST' Explanatory Booklet. A Guide to the 'Malnutrition Universal Screening Tool' ('MUST') for Adults. (www.bapen.org.uk)
Assessment
This section refers to an observation of meal times within the ward/department. Please observe practices that relate to the whole ward/department over a breakfast, lunch and evening meal
Structures and Processes
Management
PDSA Template Every goal will require multiple smaller tests of change
AIM
Describe your first (or next) test of change: Person responsible When to be done Where to be done
PLAN
List the tasks needed to set up this test of change Person responsible When to be done Where to be done
.
Predict what will happen when the test is carried out Measures to determine if prediction succeeds
DODescribe what actually happened when you ran the test
STUDYDescribe the measured results and how they compared to the predictions
ACTDescribe what modifications to the plan will be made for the next cycle from what you learned
Impact on Quality
Compliance with CQI with Revised SCN Role (Cycle 5)
0
20
40
60
80
100
Baseline Cycle 2 Cycle 3 Cycle 4 Cycle 5
%
Food, Fluid and Nutrition
Pressure Area Care
Monitoring and Observations
Falls
Implemented revised SCN Role
CQI Compliance trends
0%10%20%30%40%50%60%70%80%90%
100%
FFN PAC MO Falls Avecompliance
baseline
after work
Synergies with other national programmes
FallsProgramme
Leading Better Care
Healthcare AcquiredInfections
Better Together/ Patient experience
programme
National Nursing / Midwifery
Workforce & Workload
Programme
Joanna Briggs
Institution initiative
Scottish Patient Safety
Programme
Tissue Viability
Programme
Improving Nutritional
Care programme
Patient Experience
Supporting Development
Supporting Development
• National Programme Leader
• Network of Clinical Facilitators
• Steering group chaired by Executive Nurse Director
• Commitment from Scottish Government, QIS and NES
Leading Better Care Clinical
Facilitator Network
eQIPS / CQI Development
Group
Releasing Time to Care
Facilitator Network
Leading Better Care Implementation Group
Scotland’s Executive Nurse Director’s Group (SEND)
Leading Better Care
N
1. NHS Ayrshire & ArranSusan HannahPractice Development Lead, 01294 323457
2. NHS BordersKim SmithPractice Development Leadership coordinator, 01896 827651
3. NHS Dumfries & GallowayMaureen McCraeUnit manager, specialist palliative care,01387 241986
4. NHS FifeLynn BarkerProgramme Lead Leading Better Care,01592 743505
10. NHS LothianFiona Bonnar & Linda Conway
Lead Clinical Facilitators, 01506 434274 / 07813 579660
9. NHS LanarkshireMargot Russell, Practice Development Specialist Clinical Leadership and Quality,01698 723205
8. NHS HighlandJenny LobbanProject Manager / Facilitator,01463 704715
7. NHS Greater Glasgow & ClydeKate Cocozza, Lead Nurse Practice Development,0141 201 1695
6. NHS GrampianFiona Gray, Programme Manager / Facilitator,01224 555064
5. NHS Forth ValleyMay FallonSenior Nurse, Practice Development,01324 678528
14. NHS western islesMary McElligot, Professional Practice Development Manager , 01851 708057
13. NHS TaysideDebbie Baldie, Senior Practice Development Nurse,01382 660111
11. NHS ShetlandAndrea Ridealgh, Senior Charge Nurse,01595 743357
12. NHS OrkneyMoira Sinclair, Charge Nurse, 01856 888244
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Please note that this diagram is for internal use only and should NOT be used in any publications
Special Health Boards
Golden Jubilee National Hospital – Irene McGachy,Clinical Facilitator, 0141 951 5050
The State Hospital - Sandra Steele
National Programme Leader – Leading Better Care
Vicky Thompson, 07920 765343
Leading Better Care Facilitators
How do we know if we’ve succeeded in implementation?
By the end of 2010…
Clinical Quality Indicators will provide us with:
– Data used for quality improvement as part of day-to-day work
– Quality improvement methodology known and used regularly by all nurses
By the end of 2010…
Senior Charge Nurses will be:
– Empowered clinical leaders
– Guardians of quality and clinical standards
– Visible, approachable and authoritative
Contact Details
Vicky ThompsonNational Programme Leader –
Senior Charge Nurse, Clinical
Quality Indicators & Releasing
Time to Care
07920 765343