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Plenty of room for improvement, suggest early nurse metric results

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Ward sisters should be prepared for initial disappointment over compliance with nursing indicators, suggest early results from trusts that have just started using them.

As part of a plan first revealed in January, Heart of England NHS Foundation Trust in Birmingham has been introducing a system of nursing metrics over the past six months to measure ward performance.

The trust, one of the largest in the country, has now gathered sufficient baseline data for six wards – three medical and three surgical – to show nursing teams how they are performing.

The indicators cover seven clinical areas – falls assessment, medicine prescribing and administration, food and nutrition, pressure area care, pain management, patient observations and infection prevention and control (see box).

The baseline data for April and May has allowed the trust to start building a picture of strengths and weaknesses on compliance with best practice in these areas. 

Jo Richmond, a corporate nurse at the trust, who along with chief nurse Mandie Sunderland has rolled out the programme, said: ‘We have shown this data to the ward sisters who are quite depressed because it does not show high compliance in a lot of areas. But that is something we expected at the outset.

‘We have also been able to use it already to start to spread good practice,’ she told Nursing Times.

The metrics – intended to be rolled out across the whole trust within the next year – are also set to be linked with the trust’s data on patient experience.

Additionally, as reported by Nursing Times in April, from the start of the financial year 2010, the trust will have part of its annual funding from Birmingham East and North PCT decided by how well its nurses are performing against the indicators.

Last month the government published a set of 232 national quality indicators which trusts can choose to use to measure the performance of its clinical teams, including nurses.

Nursing Times understands that a more tailored set of indicators for nurses and midwives are being developed by the chief nursing officer for England, Dame Christine Beasley.


Examples of indicators being introduced:

* Confirming that all risk assessment documentation provides details of patients names and hospital numbers;

* That all patients receive a falls risk assessment on admission to the trust if they are over 65 or have a history of falls;

* A daily skin inspection has been recorded for patients if identified at risk;

* Hand hygiene audits have been completed during the previous month;

* The patient has been weighed on admission or since admission to the ward.

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