1. Nursing & Midwifery Overview 2007/08 Marie-Noelle Orzel, OBE Director of Nursing & Patient Care CoG Meeting 16 January 2008 (Agenda item 7)

2. Overview Reducing Health Care Acquired Infections (HCAIs) Reducing Health Care Acquired Infections (HCAIs) Improving Patient Safety Initiative Improving Patient Safety Initiative

3. Reducing HCAI’s £220K from SHA £220K from SHA Ward based Pharmacists Ward based Pharmacists New commodes and electronic beds New commodes and electronic beds Patient hoists and slides Patient hoists and slides IV nursing teams IV nursing teams MRSA screening MRSA screening Raising awareness Raising awareness Matron's Role Matron's Role

4. Monthly audit * Ward reports * Green scrubs Uniform and Dress Code Policy Visitors Policy/leaflet E-learning * IC educator role  HCAI Environment Infection Control Policy Isolation ward Surveillance Handwashing Leadership Equipment Estates Housekeeping Prescribing Policy Systems Daily bed meetings Daily email Outbreak meetings Rapid testing * Torridge policy Aide memoire card Antibiotic and ward-based pharmacist * Education PEAT scores * Equipment audit * Housekeeping audit * Inpatient survey * PALS/complaints * Human Factors Naked forearms IMPROVEMENT DRIVERSSECONDARY DRIVERSPRIMARY DRIVERS TARGET * * measurable outcomes

5. Working with Visitors

6. Uniform and Dress Code Policy –New uniform/dress code Principles apply whether uniformed or not Principles apply whether uniformed or not Bare from elbow to fingertip Bare from elbow to fingertip Removal of ties Removal of ties –‘Scrub style uniforms’ More uniforms allocated = clean uniform daily More uniforms allocated = clean uniform daily Doctors also in uniform Doctors also in uniform

7. The Matron’s role Senior matrons carry our regular ‘walk arounds’ on the wards to check cleanliness. When they see a shortfall they take action immediately and check it again on their next visit.

8. The eWhiteboard

9. eWhiteboard

10. What the ward team sees

13. Caring for Acutely Ill patients – Early Warning Score

14. Resuscitation/ Emergency trolley Were not standardised in each ward area Were not standardised in each ward area New standardised defibrillators & Resuscitation Trolleys now purchased New standardised defibrillators & Resuscitation Trolleys now purchased Standardised and simplified equipment Standardised and simplified equipment Equipment stored the same way on every ward Equipment stored the same way on every ward Snap lock system Snap lock system

15. Releasing time to care project National Project National Project Aim is to release time for clinical staff to spend with patients Aim is to release time for clinical staff to spend with patients Being piloted in 6 areas Being piloted in 6 areas Concentrating on the HOW, not the WHAT

16. Project Aims Organise wards so that they work more efficiently Organise wards so that they work more efficiently Understand how and what we are doing now Understand how and what we are doing now Develop skills in service improvement Develop skills in service improvement Measure our progress and changes Measure our progress and changes Increase from 40% to 60% the time a nurse spends in direct care Increase from 40% to 60% the time a nurse spends in direct care Wards own their action plans Wards own their action plans Delivering higher quality care for patients with no extra resource

17. Wards are stocked with linen delivered on trolleys

18. Also a supplementary linen cupboard, which requires feeding from the main linen trolley, which if it weren’t for the door could fit in this cupboard..

19. All of this represents staff time in moving linen around (time not looking after patients). Staff don’t use either system to get linen to the beds they use another trolley.

20. Direct Care Time MotionAdminDiscussionHandoversInformationRoles Opportunity to increase safety and reliability of care Role Time (e.g. nurse) Total Time “Everything I need to do my job is conveniently located” ‘The paperwork is easy to understand and quick to complete’ I am not interrupted by people requesting information or looking for things ‘’Handovers are concise, timely and provide all the information I need” ‘It is clear to everyone who is responsible for what” ‘We have the information we need to solve our own problems, and find out if we were successful” …and it releases time to care

21. The Opportunity So what do we do with opportunity?  Design safer care processes e.g. uninterrupted drug rounds  Design more reliable care processes Patients who get more direct care time, safer care and more reliable care will have a reduced length of stay

22. Any Questions