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All trusts told to use new nurse-led checklist to ‘ensure the safety of emergency patients’

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The regulator NHS Improvement has today launched a patient safety checklist for accident and emergency departments that is designed to improve efficiency and outcomes this winter.

A spokeswoman for NHS Improvement said the tool was nursing led and developed by clinical staff at University Hospitals Bristol NHS Foundation Trust.

“We are asking all trusts to implement this checklist”

Mark Radford

She told Nursing Times that the regulator was asking all NHS trusts in England to implement the use of the Emergency Department Patient Safety Checklist this winter.

She noted that it was designed to help clinical staff complete time-based tasks, which will help improve the delivery of basic care in A&Es and improve the safety and clinical outcomes for patients.

It is a “simple framework” of nursing and medical tasks, which “systemises” the observations, tests and treatments that are required by patients in a time-based sequence, said the regulator.

The resource comprises a two-page form (see attached document) that sets out the various tasks that should be performed – such as vital signs checks and pain assessment – each hour over a 12-hour period.

“We recognise that this winter could very busy across the healthcare system”

Mark Radford

By systemising the basic care tasks, required by A&E patients, the checklist allows all staff, even those not as familiar with the department to provide the right care, quickly, said NHS Improvement.

It stated that the evidence base for using the new checklist was “strong and compelling”.

University Hospitals Bristol has reported, that since the checklist’s introduction, outcomes have improved for patients and risk within the department has reduced.

Among the improvements are an increase of over 5% in the number of CT scans performed within one hour of a patient arriving in A&E, as well as a fall in the overall length of A&E patient stays.

There has also been a mean increase of 25% in hourly observations and early warning score calculations being recorded.

“Having a safety toolkit such as this will be vital to help staff to maintain focus”

Taj Hassan

Meanwhile, no clinical incidents relating to failure of staff to recognise a deteriorating patient or delays in the delivery of care have been reported, according to the trust.

In addition, staff at Bristol are said to feel more supported and able to cope with a busy department.

The checklist has been implemented at a number of trusts across the South West and its use is “growing quickly”, said NHS Improvement in a statement.

All NHS trusts will be encouraged to implement the checklist, or show they have something similar in place to ensure the safety of patients during “the busy winter period”, said the regulator.

The coming winter is expected to be especially busy, with analysists reporting this year that trusts are increasingly not seeing the significantly slower months that once helped then cope with demand.

In addition, NHS leaders have recently predicted a bad winter based on warning signs from the southern hemisphere’s experiences so far this year.

Australia and New Zealand have had a “heavy flu season”, which saw hospitals in those countries “struggling to cope”, said NHS England chief executive Simon Stevens in September.

Mark Radford, associate nurse director at NHS Improvement, said: “We have been working with frontline clinicians and system leaders to develop a package of support designed to ensure trusts can continue to deliver safe, effective care, even during times of high demand.

NHS Improvement

Senior nurses appointed by national regulator

Mark Radford

“As pressure on emergency care continues, we recognise that this winter could very busy across the healthcare system,” said Mr Radford.

“We are asking all trusts to implement this checklist, as evidence from the organisations who have already implemented it, shows that it improves patient outcomes and the safety of the emergency department,” he added.

The checklist has been endorsed NHS England, the Royal College of Emergency Medicine, the Royal College of Nursing and the Care Quality Commission.

Taj Hassan, president of the Royal College of Emergency medicine, said: “Delivering consistent safer care in the emergency department lies at the very heart of good emergency care.

“We know that when our departments become crowded it becomes more difficult to maintain consistency,” he said.

Taj hassan

Taj hassan

Taj Hassan

“Having a safety toolkit such as this will be vital to help staff to maintain focus on what is utterly vital in the patient’s journey,” he added.

Earlier this month, it was announced that free flu jabs were to be extended to all care home staff in England, while trusts were also been told to “ramp up” efforts to ensure nurses and other workers received the vaccine.

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Readers' comments (2)

  • I think it speaks volumes that we are planning a checklist for a twelve hour stay in the Accident and Emergency Department !! as if this is now somehow acceptable.
    I will support and implement anything that makes the patient experience better, and if I'm honest my life (and that of my colleagues) a little better, however, another tick list is not the answer, E;G the form asks if the obs have been done,but there is no evidence that they have been acted upon how is this safer for the patient? How does this form make the staff feel more supported? more just something else that they have not done.
    Surely our focus should be on improving patient care and experience, I am not sure that producing another checklist achieves this.

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  • I agree with your comments 12.13. It is just a tool and if the staffing levels are poor or the skill mix isn’t right it will not lead to better care. In fact it is likely to create the circumstances for poor care. If however staffing levels are good & skill mix is right care can be good. This is simply an aid, and in the wrong hands could be dangerous, because it can lull people into a false sense of security that things have been done when they haven’t.

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