The CNO for Wales Jean White explains how initiatives are helping to improve safety and quality of care
We are fortunate to live in an age where finding something out is easy, thanks partly to people like Sir Tim Berners-Lee, the inventor of the world wide web. Healthcare organisations and the practitioners who work in them need information to function effectively.
Whether the information is a patient story, a result of the national Fundamentals of Care (FOC) audit or observations on a patient’s chart, it is not the act of gathering and recording that is important but what we do with this data when we get it.
In the case of the annual FOC audit, which is conducted on every inpatient area in Wales and reported to the Welsh Government, evaluation of the findings has led to a number of national work programmes to improve care. These include: the development of an oral health and hygiene toolkit and changes to mouth-care packs; revision of nursing documentation; and work on improving continence care.
In Wales, a number of initiatives have been introduced to improve the safety and quality of care. The 1000 Lives Plus national improvement programme methodology (www.1000livesplus.wales.nhs.uk) asks: “How you will know if a change has made an improvement?” So, for example, it is not enough to introduce a care bundle to prevent pressure ulcer formation - you must also record the outcome. On wards throughout Wales, the introduction of the SKIN (Surface, Keep Moving, Incontinence, Nutrition) bundle reduced pressure dramatically. Some areas report hundreds of days without an incident - essentially an eradication of a common problem.
“By changing handover and positioning of staff - neither of which cost any money - care was improved”
Displaying data in public has the double benefit of motivating staff as they see the positive outcomes of their efforts and, importantly, telling the public about the care setting they are entering.
When an incident does occur, it should trigger a local investigation. The object of data collection is not making graphs and statistical returns but information on which to make decisions.
I visited a ward recently where they reported a big reduction in falls. The staff had recorded the number of falls and seeing it was high had asked some key questions, such as “when during the day do falls most commonly occur?” and “what part of the ward do they happen in?” The answers showed it was during handover and in the part of the ward furthest from the nurses’ station. By changing handover and positioning of staff - neither of which cost any money - care was improved.
In early January, the prime minister called for nurses in England to do hourly rounds of their patients and raised the importance of staff being released from bureaucracy to spend more time with patients. Both of these are tenets of the Transforming Care initiative that began in Wales in 2009, and is being rolled out to every ward in Wales.
The concept of intentional rounding is causing some debate, with some nurses questioning its value. The evidence from Wales shows its impact on the patient experience. For example, in one ward I visited, an audit showed patient call bell frequency fell from 23 per hour before implementation to eight per hour afterwards. In the same period, the incidence of falls reduced markedly and both patient and staff satisfaction with care increased.
This need for useful data to inform local and national decisions is driving another major initiative in Wales - an IT-based module that collects ward-based care metrics and feeds them into a national nursing dashboard. This will go live in April 2012 and will give real-time information on performance, which will help give staff and organisations the information they need to improve care even more.
Jean White is chief nursing officer for Wales