Ward rating system reduces MRSA cases

Infection control nurses at Newcastle Upon Tyne NHS Foundation Trust introduced the ‘ward accreditation tool’ in April last year, after identifying variations in infection control rates across the trust.

The trust – which has more than 1,600 beds – had 59 recorded cases of MRSA bacteraemia in 2007–2008. Following implementation of the tool, the number of cases dropped by 35% to just 38 recorded cases between April 2008 and March 2009.

Under the new system, a ward sister completes a 12-section questionnaire once a month, which covers compliance with protocols on hand hygiene, dress, waste disposal, and infection control training for staff.

It also includes a knowledge test in which staff are observed carrying out infection control high-impact interventions, such as the insertion and care of peripheral cannulas and aseptic technique.

The results are sent to the trust’s nurse specialist for patient safety, and each ward is given a rating for each section of the questionnaire – green for 100% compliance, amber for 80% to 99% compliance, or red where urgent action is required.

When all questionnaire sections achieve a ‘green’ rating, the ward can apply for accreditation status. It then completes such an assessment once a quarter – subject to random spot checks.

So far, 20 wards out of 100 at the trust have achieved accreditation. The average ward score across the trust has also gone from 82% compliance with all 12 sections in April 2008 to 99% in March 2009.

Joanna Coward, nurse specialist for patient safety at the trust, said: ‘Although we had some pockets of excellence, we were concerned because there was inconsistency in practice across the trust.

‘The tool has enabled us to target areas of weakness which needed improvement, and each of the charge nurses and sisters has had the opportunity to have local ownership of this data.

‘The data has also shown some excellence in practice which we have sustained throughout the trust,’ she told delegates last month at the Patient Safety Congress in Birmingham, hosted jointly by Nursing Times and Health Service Journal.

The Newcastle ward tool is based on the Department of Health’s EPIC II guidance, published in 2007, and ‘saving lives’ tools, published in 2005. The results provide further evidence that directly measuring the quality of nursing care – as outlined in the NHS Next Stage Review – leads to improved outcomes.

As Nursing Times revealed in January, NHS North West has seen a 26% drop in the number of falls in its hospitals since it introduced a falls assessment quality indicator in July.

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