Board to Ward Assurance on Fundamental Nursing Care

UNIVERSITY HOSPITALS OF MORECAMBEBAY NHS TRUST

TRUST BOARD MEETING

To be held on 26 May 2010Agenda No 9a

Report of: / Jackie Holt, Director of Nursing
Paper Prepared by: / Jackie Holt
Date of Paper: / 19 May 2010
Subject: / Board to Ward Assurance on Fundamental Standards of Nursing and Midwifery Care
Care Quality Commission Standards: / Outcomes 1,2,4,5,6,7,9,10,11,12,16,21
Assurance Framework Link:
Auditors Local Evaluation (ALE) Link:
Background Papers: / Nursing & Midwifery Strategy 2009-2014
Item Considered at Earlier Committees
(pls detail mtgs): / Nursing & Midwifery Strategy Demonstration to Trust Board March 2010/Francis Report Discussions
Patient & Public Involvement:
In case of query, please contact: / Jackie Holt
Purpose of Paper:
To outline the Ward to Board assurance framework in relation to fundamental care standards.
The Board is asked to consider the prototype GURU ward dashboard in terms of assurance information for the Board.

AGENDA ITEM NO 9a

TRUST BOARD MEETING: 26 MAY 2010

Board to Ward Assurance on Fundamental Standards

ofNursing andMidwifery Care

1. Introduction

A significant milestone in the implementation of the Nursing and Midwifery Strategy has been the introduction of the Nursing and Midwifery Assessment Tools and the development of the ward dashboard which was demonstrated at the Board meeting in March 2010. This paper provides an overview of the Nursing andMidwifery Assurance framework and presents the first prototype of the GURU Ward dashboard for consideration by the Board.

1. Nursing/ Midwifery Quality Assurance Tool (NQAT/MQAT)

Thenursing tool was originally developed in Liverpool and Salford and was shared with Matrons and Ward Managers in UHMB. Since then we have taken the tool and adapted for Midwifery and Children’s services. It has been expanded to cover 15 essential aspects of care (appendix 1) and electronic versions of the tool areunder development.

The tools provide a way of checking performance against standards set and demonstrating continuous improvement in care and those elements of the service which matter most to patients. The aim of this approach is to ensure consistency in care standards, identifying best practice and to root out and eliminate unacceptable variations in care standards.

The tools enable practice to be benchmarked within the Trust and the sharing and learning of best practice.

The NQAT/MQAT is based on the original Essence of Care Standards (DoH 2007), the Confidence in Care document (DoH 2008)and is aligned to the Care Quality Commission, NHSLA, Saving Lives Campaign and Hygiene Code Standards.

The assessment tool measures care standards against fundamental aspects of care. It is designed to support and guide nurses in practice, to understand how they deliver care, identify good practice and where improvements are required. It provides for a RAG (Red, Amber, Green) rating against each of the standards and an overall score for each ward.

Areas of strength will be celebrated through the Trust’s system for learning lessons and those areas that require improvement will be reported via action plans through to the Divisional Governance Forums, Senior Divisional Nurses and Director of Nursing. The results will be displayed on GURU – the ward based dashboard.

The early versions were tested in selected areas of the Trust and the tools were launched at a cross Bay event on 18 May 2010.

1. GURU Dashboard

As part of the Productive Ward programme the Trust identified a series of measures to track monitor improvements. With this came the opportunity to exploit the potential of the LorenzoProgramme User Guide, GURU to develop a dashboard of key performance indicators to demonstrate ward performance in relation to essential aspects of safety, effectiveness and experience and general ward management and organisation. The GURU dashboard includes a series of measures to monitor overall performance. These measures provide evidence for the Nursing/Midwifery Assessments (NQAT/MQAT).

GURU provides information for Ward Managers at their fingertips. With just a few clicks of the mouse they are able to scrutinise the performance of their own and other wards in the Trust against a portfolio of quality indicators. The indicators provide evidence for the NQAT/MQAT.

GURU sits on all PCs within the Trust and is accessible to senior management and executives. There is also the facility to interrogate performance at Trust, Divisional and ward level.

GURU along with the NQAT/MQAT has enabled the Trust to establish a Board to Ward assurance framework of useful and meaningful performance data about the nursing and midwifery impact on quality. GURU has replaced a dated system of data collection for infection prevention and avoids the need to establish teams of auditors and the administrative industry this creates.

GURU allows staff to gain a historical picture of their departments’ performance in areas such as direct patient care, Infection prevention, staff sickness, patient/staff satisfaction, falls, complaints and compliments. Other options include the ability to peer review and mark a specific event that may impact on service provision and standards. Performance can be benchmarked against expected standards and thresholds. GURU indicators and threshold are attached at appendix 2.

UHMB staff believe that patients have a right to know how we are doing in relation to aspects of safety, experience and efficiency.

As part of reviewing how performance data is displayed and communicated to patients and the general public we have worked with patients and shadow governors to design the way in which the information is made available to them. The outcome has completely transformed the way we intend to communicate, publicise and share information about infection prevention and increased the quantity and quality of the information.

Future plans include the direct link and feed between GURU and other electronic databases such as the incident reporting system and the electronic record sickness data.

As we progress with the implementation of the electronic patient record these essential ward performance measures will be central to integrated care.

1. Prototype Board Report

Staff have been instrumental in the development of GURU and the enthusiasm generated from the Productive Ward programme has meant that this has ensured that GURU has been well received by staff who see it as theirs to own rather than an performance management tool that has been imposed. As wards come on line with the Productive Ward programme the GURU indicators are introduced.

We are now in a position to work with health informatics to develop the management reporting aspect of GURU. This means that performance at all levels ward to Board can be reported in the future.

The report in appendix 3 is the first attempt at generating a Board report against a number of the key indicators in GURU and drilled down to Divisional level.

1