The government’s focus on quality indicators means hours are spent collecting data. But nurses are employed to care for patients, not shuffle paper and numbers, says Julie Stevens
I am concerned we spend so much time collecting data to demonstrate that we are giving high quality care that there is no time left to actually provide that care itself.
Department of Health initiatives published over the past year have identified a stream of national care quality indicators for nursing, high impact actions for nursing and midwifery and nursing metrics, which trusts have to report on and benchmark against each other. Issues related to tissue viability and associated specialties form a high percentage of the data requested.
Pressure ulcer incidence, wound infection, pain control, wound management, venous ulcer healing rates and managing the open abdomen are just a few of the types of tissue viability data now required by government bodies such as NICE and NHS London.
The DH suggests nurses achieve the goal of demonstrating effectiveness by improving the quality of services we offer, increasing productivity being innovative and using preventive measures.
While I accept it is reasonable to expect nurses to be able to prove we provide quality care, these requests come from a variety of institutions that have not specified the manner in which we are to collect this data, who will input and analyse it, and how we will fund the time and resources to do it. In many cases the method is uncoordinated and left to individual trusts to collect this information in whatever way they can.
A good example occurred in December 2009, when NHS London asked trusts to start collecting healing rates of venous leg ulcers so they could be benchmarked against each other. However, trusts were offered no guidance on how they were to achieve this.
Some tissue viability nurses accepted an offer from the RCN to use its website to collate the data, while other trusts have been trying to use their community RiO sites (a type of care record system) to gather this information. However, there is no standardisation across the UK so how accurate will the findings be? It must be remembered that healing is not always the sole outcome measure for venous ulcers - improvements in pain control, reduction in exudate levels and increased mobility are just as important.
“As I open my emails today there are numerous requests for data which will take me hours to respond to”
One way of meeting the challenges of the next few years within current budgets and reducing clinical staffing levels would be to employ a health economist as part of the clinical audit team. These professionals are skilled at calculating efficiency savings of new innovations and productivity. Business managers are poor at providing this information and often expect clinicians to pluck the data out of the air at a moment’s notice.
We need different healthcare bodies to take a more coordinated approach so we are not bombarded with simultaneous requests for data. Alternatively, a national institute should be set up specifically to look at quality and patient outcomes, especially related to tissue viability. A national institute funded by the government could develop standardised databases on a variety of subjects. This standardisation could be effective in reducing poor practice and litigation costs.
As I open my emails today there are numerous requests for data which will take me hours to respond to. But we are employed to care for our patients, not shuffle paper and numbers. I also have 10 new referrals but am not sure when I will be able to leave my desk to see them. I will just have to wait for the computer to go off line, which will give me an excuse to use my expertise to do what I do best - heal patients with wounds.
JULIE STEVENS is consultant/lead nurse, tissue viability service, West Middlesex University Hospital and Hounslow and Richmond Community Healthcare