Nurses often feel they are overburdened with audits, and need quick and easy ways to share best practice. A trust developed a booklet to help them share advice
Ann Gibbins, PGCert, BSc, RN, is cardiac matron, Brighton and Sussex University Hospitals Trust; Jane Butler, MSc, BSc, RM, RGN, is currently on secondment to South East Coast Strategic Health Authority from her post of deputy chief nurse, Brighton and Sussex University Hospitals Trust.
Gibbins A, Butler J (2010) How a booklet was developed to share best practice in rolling out Essence of Care benchmarks. Nursing Times; 106: 12, early online publication.
The Essence of Care initiative helps practitioners to take a structured approach to comparing practice. This article outlines how nurses in Brighton and Sussex University Hospitals Trust developed an Essence of Care booklet for staff to support them in raising standards of care. It discusses how Essence of Care is being used in practice and the benefits of introducing the booklet.
Keywords Essence of Care, Benchmarking, Quality of care
- This article has been double-blind peer reviewed
Nurses involved in rolling out Essence of Care should:
- Ensure senior nurse leadership of the project and that benchmarking results contribute to the monitoring of patient experience at local and strategic level;
- Ensure all staff understand their role and contribution to Essence of Care;
- Develop a strategy for rolling out the benchmarks and ensure clear goals;
- Be proactive about engaging staff and use every opportunity such as induction and appraisal to show how they can contribute;
- Draw on practitioners’ clinical interests so they can contribute their expertise;
- Help staff to develop confidence through teaching sessions and providing information and resources.
Nurses need to be able to self assess local care against best practice standards. The Department of Health (2001), therefore, launched Essence of Care to enable trusts to develop clinical benchmarks for nursing care.
The self assessment can take the form of direct observation or feedback from staff and patients as well as audit of records. The initiative aims to emphasise the importance of the fundamentals of care for patients. To date, 11 benchmarks have been launched, with a consultation on a proposed new one on pain management/”>management last year (DH, 2009). Trusts are already working on this benchmark.
Since the launch of the initiative, some concerns and barriers have been identified. Ellis (2006) reported inconsistent application because of the emphasis on quantitative data rather than qualitative measures. A Nursing Times poll found 25% of staff questioned felt Essence of Care was purely a management initiative (Oxtoby, 2004).
Despite these issues, patients still consider the fundamentals of care to be extremely important, and the NHS next stage review placed quality of care at the heart of its vision (DH, 2008).
Brighton and Sussex University Hospitals Trust have been using the benchmarks since Essence of Care was first launched. A steering group chaired by the deputy chief nurse was established to provide senior nurse leadership, and each benchmark has been rolled out across all clinical areas simultaneously using locally modified data collection tools. An Essence of Care project coordinator supported the rollout by providing training on benchmarking and action planning.
While a reporting system was in place, it became clear there was no means of sharing best practice across the trust. This meant different groups of staff were often dealing with similar issues in isolation, rather than being able to draw on expertise within the trust.
In December 2007, steering group members decided to collate examples of good practice into one single resource that would enable staff to share their ideas. These were recorded in a booklet entitled Top Tips, covering each benchmark. For example, in the area of pressure damage, the booklet describes how to report pressure ulcers to the trust’s hotline, and explains where to find patient information.
Many of the supporting resources, produced in addition to the booklet, are available on the trust’s Essence of Care website for staff to download, such as signs and teaching aids. This saves time as they can quickly access pre-prepared resources and modify them for their own area.
National Patient Safety Agency alerts have also been highlighted under the appropriate benchmark sections in the booklet. For example, the section on oral hygiene includes advice on checking the security of pink sponges for mouth care before use.
The medical photography department arranged printing of the booklet, which was launched at the trust’s annual nursing and midwifery conference in 2008. Every clinical area received a copy and every new nurse or midwife also receives one as part of their induction. The booklet is updated via the Essence of Care steering group.
Case study: Using Essence of Care in the cardiac unit
The fundamentals of Essence of Care have had a positive impact on standards of care across all clinical areas in the Sussex Cardiac Centre at Brighton and Sussex University Hospitals Trust. Every month, mandatory audits covering many aspects of clinical care, environment and health and safety are carried out. The results show there have been improvements in areas such as nutrition, continence care, pain assessment and pressure damage monitoring.
While it has been extremely rewarding to see these improvements, they have not been achieved without significant challenges. The trust has an excellent system where link nurses in clinical areas lead on certain aspects of patient care and regularly update information boards/folders and disseminate relevant information at ward meetings. This approach is successful in terms of information giving, but this places responsibility for individual areas of care onto one or two nurses. The Top Tips booklet helped all nurses to see how they could use resources to improve patient care.
In addition, keeping Essence of Care at the forefront of nursing practice when there are so many competing demands has been a particular challenge. Developing a tool on admission and risk assessment, which incorporates both generic admission data and patient risk assessments, has helped to overcome this. Nursing staff work through the document as part of the admission process, ensuring they obtain key risk assessment data on areas covered in Essence of Care and specific cardiac risk assessments.
Nursing staff feel the Top Tips booklet has provided effective resources that help to support standardised care across the trust. It has also provided a powerful tool with which nurses can challenge individuals and systems when the minimum standard of care is not delivered.
The booklet has helped to establish a culture of “can do” and “will do” in clinical areas, which in turn has had extremely positive effects on staff morale. One junior qualified nurse recently commented: “I really feel that I make a difference to patients when I am at work.” The nurse went on to explain that using Top Tips meant patients were waiting less time, for example, for wound care reviews. The booklet has a section on pressure damage that gives staff information, such as how to refer, where to find the assessment tool and how to order specialist equipment. In addition, the booklet has empowered nurses to be more self directed, rather than waiting for specialist input.
The aim in developing Top Tips was to engage nurses at all levels in taking responsibility for delivering all aspects of care in line with best practice. We also wanted to ensure robust feedback systems were in place, both up and down the clinical and management teams. To achieve this, a series of actions/goals were set (Table 1). This provided a robust structure on which to roll out the initiative.
Within the Essence of Care steering group, the patient representative was vital in supporting the booklet’s development. In the cardiac centre, our future plans involve asking the cardiac patient involvement group to review key documents related to Essence of Care and to consider how best to feed back audit results to the group to ensure service users’ input is integral to future developments.
The audit of the Top Tips booklet in the cardiac department demonstrates how care standards have improved and how staff have been engaged and energised in providing fundamentals of care.
The booklet collates best practice ideas from across the trust and offers advice that nurses can use immediately to make a difference today.
- Essence of Care is a clinical benchmarking initiative designed to help nurses improve the fundamentals of patient care through self assessment and action planning. Benchmarks are based on what matters to patients.
- Nurses have expressed concerns that they are overburdened with audits and would welcome the opportunity to share best practice and practical tips.
Department of Health (2009) Essence of Care: A Consultation on a New Benchmark on Pain. London: DH.
Department of Health (2008) High Quality Care for All: NHS Next Stage Review Final Report. London: DH.
Department of Health (2001) The Essence of Care: Patient-focused Benchmarking for Health Care Practitioners. London: DH.
Ellis J (2006) All inclusive benchmarking. Journal of Nursing Management; 14: 5, 377-383.
Oxtoby K (2004) Is Essence of Care making a difference? Nursing Times; 100: 18, 18-21.