LNWH NHS TRUST

DAILY SAFETY BRIEF WARD TO BOARD

Mitchell Fernandez Head of Quality for Nursing, Midwifery & AHP

QUESTIONS: • How do we manage wards resources on a daily

basis including escalation process?

• What real time data available to make informed decision?

• Who are the decision makers in assessing ward/unit as safe in relation to staffing, patient acuity & dependency and other indicators?

LNWH DAILY SAFETY BRIEF:

• Development

• Challenges

• Flow Chart (Process & Escalation)

• Improved Experience and Better Outcomes

• Positive Consequences - Cultural Change

• Way Forward

TEMPLATE DEVELOPMENT

• Developed by corporate nursing team in collaboration with the Matrons and IT support

• Piloted in different wards and specialties for a month and feedback incorporated

• Ensure user friendly (mostly drop downs) and captures requirements in one template (CHPPD, A&D, fill rates & 1:1 specialling)

• Trust wide launch supported by the Chief Nurse (in house training and drop in sessions provided)

• Flow chart and guidelines developed for staff guidance

DAILY SAFETY BRIEF TEMPLATE

CHALLENGES

• Initial staff feedback - additional template to complete • Incorporated other checklists onto one template (electronic)

• User friendly and easy to complete (mostly drop downs)

• Safety brief – another handover • Engage staff in development

o Includes important issue for staff

o Start with things that matter to them

• Acknowledgement of good practices (100 days since last incident)

• Open and transparent – shared information available to frontline staff (inquisitive on what other specialties and sites were doing)

• IT support – staff training and shared drive created

DAILY SAFETY BRIEF ZONING & ESCALATION

PROCESS

DAILY SAFETY BRIEF ZONE SUMMARY

Completed

By

AM nikki grant 100% 100%

PM Evelyn Mc Caffrey100% 100%

AM Eugenia A B 133% 133%

PM Marvijoy M 133% 133%

AM Trisha 89% 100%

PM grace 89% 100%

AM reginam mankefor100% 100%

PM 0 100% 100%

AM HELEN ECIRU 100% 100%

PM HELEN ECIRU 100% 100%

AM v. fom 100% 100%

PM v.fom 100% 100%

AM M Lewis 100% 100%

PM M Lewis 100% 100%

AM Rose MKane 100% 100%

PM Mini Manoharan100% 100%

AM Clarissa Valencia91% 100%

PM C Carasig 91% 100%

AM Fiona Naughton 100% 100%

PM Fiona Naughton 100% 100%

AM Jhonarie Rinon 88% 100%

PM Anne Manuel 88% 100%

95% 95%

95% 95%

95% 95%

Total/Average AM

Total/Average PM

Zone Average

Gladstone 1

Gladstone 2

Gladstone 3

CCU

Defoe

Gaskell

Wards Name

RAG Score

Nigh

t

Month: March

Day

Zone/Site: Zone 2-NPH-

Medicines

Year 2017

Medical HDU

RRU

James

Jenner

Kingsley

ZONES QUICK GUIDE

BETTER EXPERIENCE AND OUTCOMES (2016-17)

• Identification of patient (Trust wide on daily basis) o1:1 specialling

oDOLS – daily average, LD (passport)

oCCP (Confusion Care Pathway) and carer’s passport

oRed trays (support)

oNEWS above 5 outside critical care

• 50% reduction in patient falls resulting to harm (SIs)

• 50% decrease in HAPU (grade 3 &4)

• Decrease in agency usage to cover staffing shortfall

POSITIVE CONSEQUENCES:

• Positive feedback on having real time information available to front line staff

• Wards’ ownership on assessing ward as safe for the day

• Cultural shift (below 100% fill rate not necessarily means unsafe)

• Informed decisions based on: • Staffing fill rate, patient A&D, occupancy rate/activity • Safety (specialling, risk of absconding , falls, PU, NEWS)

• Promote sharing of resources within the Zone (team work)

• Staffing shortfalls are now usually resolved within the Zone

• An opportunity where short updates are cascaded, best practice shared and issues highlighted for learning

ADVANTAGES:

• Bespoke template and programme developed locally with the frontline staff – FREE and staff buy in (ownership)

• Enable modification with no additional cost

• Promote transparency and working together

• Allow staff and senior managers to make informed decisions based on real time information

Daily Safety Brief – wards/units to board report

• Daily safety brief reported to the Trust Board through the monthly Nursing, Midwifery & AHP Safer Staffing Report presented by the Chief Nurse

• Report includes the following: o Staffing levels

fill rates, CHPPD, vacancies, sickness, etc.

o Patients’ A&D, case loads o Incidents reported o Patient experience (complaints, FFT) o Finance – temporary staffing usage

(bank & agency, 1:1 specialling RMN)

WAY FORWARD:

• District Nursing (DN) safety brief template roll-out

(staffing level, case loads ratio, patients allocation/units, safety incidents) by locality

• AHP template development o currently in placed on bedded units

oCommunity services to follow

• Incorporate nursing, AHP and medical staffing

DAILY SAFETY BRIEF DISTRICT NURSING SERVICE

DD_Z1SM London North West Healthcare

NHS Trust

Date 24 Year 2017 Time:

To be completed daily (8:30am)

ACUITY & DEPENDENCY SCORE

Number of patients on caseload (planned) 10

Number of patients seen (actual) 10

>120%

1 7.5 4.5 11.5 7.5 0 1 Day <75%

7.5 4.5 11.5 7.5 0 0 Night 76%-89%

1 0 0 0 1 90%-120%

Permanent Bank Hours Agency Permenant Bank AgencyTOTAL

STAFF

Early 1 7.5 0 0 0 0 0 1 Planned Actual

Late 0 0 0 0 0 0 0 20.0 20.0 Therapist

Long Day 0 0 0 0 0 0 0 20.0 20.0 Support Worker

Night 0 0 0 0 0 0 0 All staff

No. of MDT meetings attended 0 No. of complex caseload (Physical) 4 No of complex caseload (Social) 4

PATIENT'S DEPENDENCY

MDF Nov 2015

100%

Support Worker 0%

PLANNED STAFFING

SHIFTS EarlyNo of

HoursLate

No of

Hours

Long

Day

No of

HoursNight No of Hours

All Staff

Total

Staff

0.00

SITE: Northwick Park Hospital NHS

LOCALITY: CoE (Care Of Elderly)

COMPLETED BY: CHRISTOPHER THINAGAR Month June 8:30 AM

In-patient Template - Allied Healthcare Professionals

Management

Clinical Hours

STAFFING

Staffing RAG Score

Therapists

Therapist

TOTAL

ACTUAL STAFFING NUMBERS

Therapist

SHIFTS

Patient to Staff

ratio

Support WorkerCare Hours per Pt.

per day

0.75

Students -

Supernumerary

0.75

BACK TO TOP

DAILY SAFETY BRIEF AHP

Questions?

Breakout 2

Foyer area:

• Improvement cinema

• Q networking lounge

Nursing and AHP-led

improvement

• Bishopsgate 2

Co-production

• Bishopsgate 1

Creating a culture of

high performance

• Broadgate 2

World café

• London Wall

Involving board

members in QI

• Broadgate 1