Safer Staffing The Right Staff, with the Right Skills, in the Right Place at the Right Time Sara Courtney – Head of Professions SEISD

Wider Policy Context

National Quality Board Guidance Available at: http://www.england.nhs.uk/wp-content/uploads/2013/11/nqb-how-to-guid.pdf

Acuity and Dependency Scoring Evidence Based Tool Professor Keith Hurst – advisor to NHS England Origins – No basis for historical staff establishments Patients on the wards becoming sicker Need to determine critical care capacity No simple consistent tool General managers accepted No tool that linked input with outcomes Allows benchmarking Staffing requirements = quality outcomes

Strengths and Weaknesses of the Tool itself Allows for most variables – discriminates between patients with differing needs Measures workload and patient acuity Measures throughput Quality measures included Easy to use and understand Weaknesses Measures actual – not predictive Requires validation of data to prevent ‘gaming’ Not suitable for use in small wards

Patient Dependency and Acuity Scoring Scores classify patients according to their reliance on ward staff for treatment or care Higher scores imply more dependent or more acute patients

Safer Nursing Care Tool Classifications Level Descriptor Patient requires hospitalisation Needs met by provision of normal ward cares. 1a Acutely ill patients requiring intervention or those who are UNSTABLE with a GREATER POTENTIAL to deteriorate. 1b Patients who are in a STABLE condition but are dependant on nursing care to meet most or all of the activities of daily living. 2 May be managed within clearly identified, designated beds, resources with the required expertise and staffing level OR may require transfer to a dedicated Level 2 facility / unit 3 Patients needing advanced respiratory support and / or therapeutic support of multiple organs.

What we need you to do… Starting on Monday 12th May Nurse in Charge will be required for 21 consecutive days to ‘score’ every inpatient bed Scoring the patient based on their previous 24hr period dependency and acuity Scoring should take place ideally during the morning at approx 1100hrs (pre lunchtime handover) If a bed is empty a score is not entered Weekly professional validation will take place to ensure consistent approach to scoring takes place

At the end of the 21 days… The scores should be entered onto a Ward Acuity and Dependency score sheet (will be sent to you electronically) This information will be analysed against National Benchmarked data sets and will form part of a new 12 monthly cycle of Acuity and Dependency Scoring which will inform Contracting and Budget setting and baseline establishments for the following financial year (as agreed at Strategic Workforce Committee) Scoring will take place 2 x year