Acuity, alerts and escalationJune 2014

Sue Smith, Executive Chief NurseUHMB NHS FT

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

Acuity

[Example footer text: (Page 1/8) – Management briefings: October 2013]Sue Smith, Aaron Cummins, UHMB NHS FT

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

Sue Smith, Executive Chief Nurse, UHMB NHS FT

Triggers for alerts

Sue Smith, Aaron Cummins, UHMB NHS FT

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

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

Results

Sue Smith, Aaron Cummins, UHMB NHS FT

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

Actions

• Proactive recruitment

• Increased skill mix

• Leadership development and support

• Daily teleconference

• Regular senior support

Sue Smith, Aaron Cummins, UHMB NHS FT

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

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…..