THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST

Board Paper - Cover Sheet

Meeting Date 26.10.2016

Report Title Nursing and Midwifery Practice Development Report 2017/18

Agenda Item A5(iv)

Lead Director Report Author

Helen Lamont, Nursing and Patient Services Director Elaine Coghill Trust Lead NMAHP Research, Education and Practice Development, Suzanne Medows, Senior Nurse (Practice Development Corporate)

Classification NHS Unclassified / NHS Protect / NHS Confidential

Purpose (Tick one only)

Approval Discussion

For Information √

Links to Strategic Objectives

Practice Development is an important facet in the delivery of high standards of care, which focuses on safety and quality and in this respect is clearly aligned to the Strategic Goals of the Trust. It is aligned to the Nursing & Midwifery Strategy (2016-2019)

Links to CQC Domains/ Fundamental Standard(s)

This paper reflects the domains of the Nursing & Midwifery Strategy (2016-2019) which is itself aligned to the CQC Domains.

Identified Risk? (If yes, risk reference)

No

Resource Implications

No

Legal implications and equality and diversity assessment

No

Benefit to patients and the public

Yes

Report History

Previous report to Board in October 2016

Next steps

To continue to monitor progress and report back to the Trust Board.

THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST

NURSING AND MIDWIFERY PRACTICE DEVELOPMENT REPORT 2016/17 EXECUTIVE SUMMARY Practice Development is an important factor in the delivery of high standards of care, which focuses on safety and quality and, in this respect, is clearly aligned to the Strategic Goals of the Trust. The Practice Development function within the Corporate Nursing team is led by the Trust Lead for Nursing, Midwifery and Allied Health Professional Research, Education and Practice Development and supported by the Senior Nurse Practice Development on behalf of the Nursing and Patient Services Director. This paper provides an overview of the Trust’s position with its identified 2016/17 Nursing and Midwifery Practice Development priorities. The priorities have been aligned with the Nursing & Midwifery Strategy (2016-2019). The report aims to provide assurance to the Board of ongoing progress to enhance the patient experience and deliver high quality care. RECOMMENDATION To i) note progress to date and ii) support ongoing work.

Helen Lamont Nursing & Patient Services Director

Elaine Coghill

Trust Lead for Nursing, Midwifery and Allied Health Professionals, Research Education and Practice

Development

Suzanne Medows Senior Nurse (Practice Development Corporate)

17th October 2016

Agenda item A5(iv)

THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST

NURSING PRACTICE DEVELOPMENT

“Practice development is a continuous process of improvement towards increased effectiveness in patient centred care. This is brought about by helping healthcare teams to develop their knowledge and skills to transform the culture and context of care. It is enabled and supported by facilitators committed to systematic, rigorous continuous processes of emancipatory change that reflect the perspectives of service users”.

Garbett R and McCormack B (2002)

1. INTRODUCTION Practice Development is an important factor in the delivery of high standards of care, which focuses on safety and quality and, in this respect, is clearly aligned to the Strategic Goals of the Trust. As new initiatives from Government and other National bodies (e.g. NMC, NICE) arise, careful thought in terms of their impact and application is required before a way of implementing them within the Trust can be determined. Within the Trust, issues arising from complements, complaints and incidents may be thematic and require a change or development in practice and the recommendations from serious untoward incidents and inquests may also require urgent consideration and changes in practice. Alongside such emergent issues is the necessity to continually review and revise current practice to ensure it, and the documentation which supports this, remain relevant, evidence based, and continue to support staff to deliver the high quality care which patients both expect and deserve. The Practice Development function within the Corporate Nursing Team is led by the Trust Lead for Nursing, Midwifery and Allied Health Professional Research, Education and Practice Development and supported by the Senior Nurse (Practice Development Corporate) on behalf of the Nursing and Patient Services Director. To support this work, a Practice Development Group is established, which consists of directorate based Clinical Educators, community based Specialist Practice Teachers and Nurses from the central Nursing team who have an education remit such as the Practice Placement Facilitators (who ensure the quality of the learning environment for Student Nurses and Allied Health Professionals). The initiatives described within this report have been aligned with the Nursing & Midwifery Strategy (2016-2019). The initiatives were identified following consultation with Nurses and Midwives at Nursing forums and Directorate meetings and the Head of Patient Experience. A calendar of Practice Development (appendix 1) has been developed to focus the education surrounding some of these initiatives.

Agenda item A5(iv)

2. QUALITY OF CARE & PATIENT EXPERIENCE 2.1. How we are doing boards ‘How we are Doing’ (HWAD) Boards were established on all wards in 2012/13, these boards currently display information regarding cleanliness and hand hygiene compliance, Harm Free care data and results of monthly CAT audits and Friends and Family test. In 2015, following feedback from patients and staff, a more user friendly format was developed and in January 2016 this was piloted on inpatient wards in NCCC. In October and November 2016 the Senior Nurse (Practice Development Corporate) and a group of Clinical Educators, attended three patient groups to seek their views on the existing and the pilot boards and to determine if any further changes should be made. In December 2016 the Community Advisory Panel views were also sought and feedback from earlier groups was shared with them. This led to the final versions of two boards, one for inpatient areas and the other for outpatient areas (appendix 2) which are currently on order and will be installed in October 2017. 2.2. Shortlisted for Healthcare People Management Association (HPMA) Awards Following the implementation of Revalidation for all Nurses and Midwives, by the Nursing and Midwifery Council (NMC), the Trust was one of the first in the country to use the functionality in the Electronic Staff Record (ESR) as a method of monitoring progress of staff during their three year revalidation cycle. The Trust, represented by the Senior Nurse (Practice Development Corporate) and the HR Workforce Information Manager were shortlisted, although not the eventual winners, by the Healthcare People Management Association (HPMA) for an award in the category ‘Best use of Your ESR’. 2.3. Nursing & Midwifery Strategy November 2016 saw the launch of the Nursing and Midwifery Strategy 2016 – 2019, ‘Proud of Nursing and Midwifery in Newcastle: Growing our future together’. Since this date Directorates are now presenting their annual reports using the strategy template and we have an ongoing and evolving strategy implementation group whose role is to ensure that the strategy remains a live document which accurately reflects developments in Nursing and Midwifery. We have planned a Nursing and Midwifery Strategy ‘one year on’ event to take place in November 2017. The Intranet has been updated to reflect the strategy and its evolution. 2.4. Measuring the impact – Volunteers The number of volunteers in the Trust has increased and we wish to measure the impact that volunteers have on improving patients’ experience and well-being. Funding has been used from an existing vacancy and a member of staff will be released from her role as an Occupational Therapist one day per week to work with the Volunteer Services/Personal Touch Co-ordinator to evaluate the role of the ward support volunteer (16-18 year old working 4pm-8pm). A National review

has already been undertaken and this study will use a similar methodology within the Trust. The secondee will commence in October 2017 working one day per week for six months.

2.5. ‘Pyjama Paralysis’ As part of our developing understanding of Practice Development throughout the Trust, the Senior Nurse (Practice Development Corporate) has been engaging with Matrons and Sisters/Charge Nurses at Directorate meetings. At one such meeting in Surgical services, two Sisters discussed a phenomenon known as ‘Pyjama Paralysis’ It is bases on the premise that we should get more hospital inpatients out of nightwear, out of bed, and into their day clothes to speed their recovery and help minimise harms from prolonged immobility. Evidence tells us that for every 10 days of bed-rest in hospital, the equivalent of 10 years of muscle ageing occurs in people over 80-years old, and building this muscle strength back up takes twice as long as it does to deteriorate. One week of bedrest equates to 10% loss in strength, and for an older person who is at threshold strength for climbing the stairs at home, getting out of bed or even standing up from the toilet, a 10% loss of strength may make the difference between dependence and independence. The staff on ward 8, Freeman Hospital and ward 44, RVI have decided to be more proactive in encouraging patients to get up and get dressed following surgery, accordingly, they have designed a poster for each bedspace and will verbally communicate the benefits of getting up and getting dressed. The sisters are keen to understand if this has any impact on length of stay and will work with one of the Consultants to understand this better. This is a very good example of a Practice Development initiative which starts with staff in one area and has the potential to become more widespread. 2.6. Step into our Journey at Newcastle Hospitals “A mile in my shoes” Campaign was launched by the Health Foundation in June 2016 at the NHS Confederation annual conference in England. Since then it has been taken out and about – from the House of Lords to NHS Events. They teamed up with the Empathy Museum to develop a collection of stories from people with a range of roles in the NHS, including frontline jobs such as a pharmacists or doctor, to some less visible positions such as Finance Manager, HR Manager and Porter. The Trust Lead for Nursing, Midwifery and Allied Health Professionals (NMAHP) Research, Education & Practice Development and the Head of Patient Experience after reviewing this initiative from the Health Foundation agreed that this was a concept that could be developed locally at Newcastle Hospitals. Therefore a Task and Finish group has been established to develop a local concept based around the National Initiative “A Mile in My Shoes”. The main objective is to empower clinical staff, patients, visitors and the public to gain a new insight into the person’s situation, understand their perspective and provide care that meets patients’ needs.

It is anticipated that this concept will be launched in 2018. 2.7. Carers

In March 2017 the Equality and Diversity Lead carried out a survey of Carers and Young Carers to understand their experience when the person they care for is in hospital and also to determine if the Trust was meeting the requirements of the Care Act 2014. In response to the results of the survey, a Carers Working Group has been established and an action plan commenced. As part of this action plan, the Senior Nurse (Practice Development Corporate) and the Clinical Educators in conjunction with the Dementia Team will be raising awareness of the important messages in wards using mobile Education 4 You boards (see section 3.1).

3. NURSING AND MIDWIFERY EXCELLENCE 3.1. Education 4 You During 2016, the Clinical Educators developed an intranet page using the brand ‘Education 4 You’. The webpage contains information for nurses and midwives and those in associated roles regarding education opportunities and local training programmes provided by each of the Clinical Educators. In order to ensure that important education messages are delivered to key areas, and being mindful of the difficulties of releasing staff from busy ward environments in order to attend training, we also developed the concept of mobile education using the same ‘Education 4 You’ brand. Two trolleys were purchased for each of the Freeman and RVI sites and are used to deliver short educational messages lasting up to 15 minutes to staff in their own clinical environment (appendix 2). To date, since April 2017, these trolleys have been used to deliver education in wards and departments;

April – Clinical Supervision

May – Dementia

May – Safe Supervision/Levels of Care

July – Revalidation and registration

September – Antimicrobial management

September – ‘Your ticket home’ (discharge) An evaluation of the impact of these trolleys and the Education 4 You brand will take place in autumn 2017 however, it is clear that there is great interest in using this format to deliver education as the microbiologists requested permission to use the trolleys and their feedback has been very positive; “I went out for the first time yesterday – really good reception, delighted with how it went” 3.2. Clinical Supervision In 2012 the Trust developed a Clinical Supervision policy in response to recommendations made by a CQC inspection during that year. An evaluation of Clinical Supervision, undertaken in 2014 found that Clinical Supervision was

viewed positively by participating staff however, an Internal Audit report published in 2015 demonstrated that not all staff were actively engaging with the process. Building on work begun as part of a development programme during 2015/16, a group of Clinical Educators have implemented an action plan to promote the use of Clinical Supervision in the Trust;

‘Clinical Supervision Awareness Month was held in April 2017 and included displays at key locations across the Trust and roadshows using Education 4 You boards (taking the message to staff in wards and departments).

Training sessions for Clinical Supervisors have been refreshed and delivered in acute and community settings.

Guidance has been provided for staff and managers to promote the recording of Clinical Supervision using ESR.

3.3. Nursing and Midwifery Revalidation

A system of Revalidation for all registered Nurses and Midwives was introduced by the NMC in October 2015 with the first registrants to renew their registration using this system from April 2016. Although the revalidation process is now embedded, a small number of staff still require support which is offered by the Senior Nurse (Practice Development Corporate) and the Clinical Educators. A review of lapsed registrations in July 2017 revealed that in comparison to 2014/15, prior to the introduction of revalidation, the number of lapsed registrations has reduced (see table below) however the registered nursing time lost to the Trust remained the same due to procedural changes at the NMC which means those whose registrations unintentionally lapse have to go through a formal process to apply for reinstatement. Scrutiny into the nine cases during the current year shows that in only two cases was this related to the revalidation process and the other seven cases related to a failure to pay the annual retention fee.

2014/15 2016/17

No. of Lapses of Registration 20 9

Total days 75 75

Average Days 3.8 8.3

In response to this, during July 2017, a programme of focussed education was delivered using the Education 4 You boards, information on the Trust Intranet and attendance at Trustwide and Directorate meetings. 3.4. Practice updates for Clinical Educators The Clinical Educators are a group of nurses and midwives based in Directorates, whose responsibility is the education and support of others.

In order to ensure that they have the most up to date skills and knowledge, speakers with expert knowledge are invited to attend Clinical Educator meetings and the discussion and debate that takes place shapes the training that the Clinical Educators develop. In the next year, it is anticipated that those educators new to post, will be offered the opportunity to develop their education planning and teaching skills through an in-house programme which is accredited through the City and Guilds. 3.5. Nursing & Midwifery Newsletter The Senior Nurse (Practice Development Corporate) produces a quarterly newsletter for nurses and midwives in which there are opportunities to share important messages and celebrate success. 3.6. Interprofessional Preparation of Supervisors Pilot In September 2017 an interprofessional pilot programme ‘introduction to Supervision’ was held. Initiated by the Director of Medical Education, the session aims were to enable clinical staff who are, or who wish to become a Supervisor (Clinical or Educational) to gain further information on what Supervision entails and information regarding their role as supervisor. Initial evaluation from the pilot demonstrated that all participants enjoyed the opportunities presented by sharing their learning with other disciplines of staff and it is anticipated that this programme will be repeated. 3.7. Clinical Practice – Skills Workbook Clinical Educators are currently developing a skills workbook for new registrants. The inspiration for this came from a conversation about how to ensure consistency of information and training for clinical skills across all disciplines and Directorates in the Trust. Due to the variable levels of knowledge and previous experience demonstrated by practitioners Clinical Educators felt that a theory based workbook with sections for each clinical skill would offer new registrants / learners a standard level of information to support their competency based training. It was also apparent that there is some inequality of supporting information provided for individuals without access to a clinical educator or where no supplementary information is available. The Royal College of Nursing (RCN) document ‘Standards for infusion therapy’ (2016) has informed the content of the workbook for those clinical skills involving intravenous care e.g. venepuncture and cannulation and intravenous drug administration. Other relevant documents and expert professional best practice advice are also essential to the content. The intention is to provide participants with self-learning opportunities for key areas of knowledge required before competency can be achieved.

4. WORKING IN PARTNERSHIP

4.1. Keeping Patients Hydrated in Hospital

In December 2013, the National Institute for Health and Care Excellence (NICE) published guideline 174 ‘Intravenous fluid therapy in adults in hospital’. This

guideline covered the general principles for managing intravenous (IV) fluid therapy in hospital inpatients of 16 and over and with a range of conditions.

Under the guideline, recommendations were made about the general principles for managing intravenous fluids. 5 key priorities for implementation were identified:

Principles and protocols for intravenous fluid therapy

Assessment and monitoring

IV fluid resuscitation

IV fluids for routine maintenance

Training and education for all healthcare professionals Since publication of the NICE guideline, Clinical Educators have delivered education to nurses and midwives across the organisation however, an audit of fluid balance chart completion which was carried out in February 2017 showed compliance with completion of all required data was only 54% with the most commonly missed field being previous days total and positive or negative balance. Working with the medical staff, a new design of fluid balance chart was piloted in Assessment Suite, RVI. Work as a consequence of this is ongoing and this will also involve the members of the nutritional steering group to ensure there is a streamlined plan for the monitoring of all aspects of hydration in patients. Further audit will be undertaken once documentation changes take effect.

4.2. Peer Observation The value of the work of Clinical Educators is well recognised and illustrated by the investment the Trust makes in these posts. The Trust has aspirations to make the wide and varied multi-professional education offer a high quality learning experience with robust quality assurance and shared values across all streams of activity including Teaching Fellows and those involved in mentoring and supervision. The Ofsted Handbook 2016 identifies that when outstanding teaching is taking place;

Learners are engaged in and contributing to the learning activity

Learners are making progress

Assessment is rigorous

There is a high level of subject and vocational expertise

Well managed, lively debate where all learners are involved and ask questions

There is a clear link to previous and future sessions/lessons

Frequent and thorough checking of understanding

Lessons are consistently good

In order to provide evidence that the teaching provided by Clinical Educators is at this high standard. a planned implementation of informal peer observation starting with ‘Come teach with me’ which is an invitation to colleagues to observe an activity or session which they would like to showcase. The focus is on sharing of best practice and the celebration of sound teaching, learning and assessment. All Clinical Educators are asked to invite observation of their teaching at least twice per year and a record of this is kept by the Workforce Development Manager. 4.3. Medicines Education Programme for Assistant Practitioners The role of Assistant Practitioner was developed in the Trust in 2012. The Assistant Practitioner works under the indirect supervision of a registered nurse

providing care and treatment to patients. A suite of competencies has been developed which include administration of medicines relating to cannulation & catheterisation. Following requests by ward sisters, a proposal that Assistant Practitioners be allowed to performing a second check of medication supporting the registered nurse has been approved and has the full support of Medicines Management and Governance Committee ( April 2017) who agreed;

‘’Where a second checker is required a competency assessed Assistant Practitioner (Nursing) may check (but not administer) intravenous fluids (excluding blood and blood products), intravenous medicines and controlled drugs; the only exceptions being insulin, drugs requiring complex calculations and chemotherapy.’’

Led by the Nursing and Midwifery Practice Development Group, a workbook and education programme have been developed to support the acquisition of the necessary skills and competence. The programme will commence in Autumn 2017/Spring 2018. 4.4. Making Every Contact Count Making Every Contact Count (MECC) is defined as an approach to behaviour change that utilises the day to day interactions that organisations and individuals have with other people to support them in making positive changes to their physical and mental health (Health Education England 2016). The Trust Lead for Nursing, Midwifery and Allied Health Professionals, Research, Education and Practice Development is a member of the MECC task and finish group and is supporting the delivery of an implementation action plan that includes;

Development of an intranet page for staff to provide information and resources

Support for staff education as required

Development of a local evaluation plan which will be based on national evaluation documentation.

5. Safe and Effective Harm Free Care

5.1. eRescue

The roll-out of the electronic patient tracking boards (Phase 1) is now complete, and is live across the Trust on 69 Wards including Adult, Maternity and Paediatric areas. Staff feedback throughout the roll-out has been really positive especially around how easy the boards are to use. The project team will continue to build on this enthusiasm to move forward to the next phase of the Project which will be development and rollout of electronic observations. 5.2. Competency Assessment Documents Competency assessment ensures that staff have the appropriate skills, knowledge, attitude and experience to undertake specific tasks safely and effectively without the need for direct supervision. In 2013 the Nursing and

Midwifery Practice Development Group developed guidelines and a template for Competency Assessment documents and this has provided a framework which allows staff across the Trust to be assessed using the same measures of knowledge, performance and professional approach. In the last 12 months, members of the Nursing and Midwifery Practice Development Group have commented on 37 competency assessment documents (21 of these being new), some of these are approved by the group, others, where the practitioner is not prepared by their pre-registration training to undertake the skill, are agreed in the Clinical Role Development Group which is a multiprofessional (non-medical) group, Chaired by the Nursing and Patient Services Director. This work provides assurance in relation to patient safety and efficient and effective use of resources by ensuring that staff have access to an agreed competency framework for the development of skills outside of their ‘traditional’ core roles. 5.3. Clinical Assurance Tool and ACE Awards The Clinical Assurance Toolkit (CAT) is completed by Clinical Leaders in 180 areas across the Trust. The Acknowledging Continuous Excellence (ACE) Awards are a way of recognising those who achieve high scores in the CAT and were formally endorsed by Trust Board in November 2014. There are five categories for the ACE awards;

Environmental Cleanliness – Matrons monthly cleanliness checks

Patient Experience – Patient satisfaction, harm free care, nursing complaints

Measure of Patient Quality – MRSA screening, risk assessments

Measure of Clinical Quality – Saving lives documentation

Staff Knowledge – Infection Prevention and Control, risk assessments, hand hygiene

Matrons nominate their areas based on their constant high standards and once an area is nominated in all five categories a Governor is invited to visit the area and review, with a Senior Nurse, whether this recognition should be awarded. To date 95 areas across the Trust have achieved success in 2- 4 categories and 19 further areas have achieved all five categories and received their new awards during the year. Further assessments are due to take place during October and November 2017. In those areas where an award has not yet been achieved, the Senior Nurse (Practice Development Corporate) is working closely with relevant Matrons to understand the reasons and to support the achievement of the award. 5.4. Focus on Safety Following the publication of the Staff Survey in which a significant number of nurses and midwives agreed they had witnessed incidents which could have hurt staff/patients or service users, work is being developed in collaboration with the Clinical Governance and Risk Department to raise the profile of safety and measures in place to keep people safe. It is anticipated that safety information will

be taken to wards and departments using the Education 4 You trolleys in December 2017.

7. CONCLUSION 2017/18 has seen work completed which builds on many of the developments from the previous year and also a number of ongoing and new initiatives. Positive engagement with staff through directorate meetings also identifies that practice development is not necessarily led from the senior team as ward sisters identify and develop their own initiatives e.g. Pyjama paralysis. Through this collaborative approach we look forward to the development of new initiatives in the year ahead.

8. RECOMMENDATION To i) note progress to date and ii) support ongoing work.

Helen Lamont Nursing & Patient Services Director

Elaine Coghill

Trust Lead for Nursing, Midwifery and Allied Health Professionals, Research, Education and Practice

Development

Suzanne Medows Senior Nurse (Practice Development Corporate)

Appendix 1

APRIL 2017

Clinical Supervision

MAY 2017

Dementia

JUNE 2017

#Add value Today

JULY 2017

Revalidation & Registration

AUGUST 2017

ANTT

SEPTEMBER 2017

Antimicrobial management

and ‘Home First – 2017 Year of

Discharge’

OCTOBER 2017

MECC

NOVEMBER 2017

N&M Strategy 1 year on

DECEMBER 2017

Safety

JANUARY 2018

Delirium

FEBRUARY 2018

tbc

MARCH 2018

tbc

Design 1 – Inpatient areas

Design 2 – Outpatient areas