Accident and emergency departments should assess whether their nurse staffing levels match actual workload requirements, as part of a new checklist comprising 50 key quality standards.
The Royal College of Emergency Medicine’s checklist, which covers all aspects of emergency care, also urges clinicians to assess whether staff feel valued and are routinely able to take breaks.
“Sometimes staff feel they are forced to compromise on the quality of service being provided”
The best practice standards cover everything from the physical environment in A&E – such as whether all areas are clean and clinical areas are arranged to preserve patients’ dignity and privacy – to the treatment of specific groups, such as older patients, children and those with complex needs.
The standards are defined as either “fundamental” – ones that should be applied by everyone at all times, with “zero tolerance of breaches” – or “developmental” standards – requirements seen as “over and above” the basics.
“EDs are encouraged to regularly analyse their practice using this document,” said the college’s recently-published Best Practice Guideline.
“Achieving these standards requires commitment and support,” it said. “Where a standard cannot be met, this should be escalated to people who can take appropriate action.”
When it comes to staffing, the guidance said it was essential that staffing levels met the ratios and requirements recommended by the Royal College of Nursing, including those for children’s nurses.
“This will offer clarification of what best practice looks like”
The RCEM told Nursing Times that emergency teams should use the Baseline Emergency Staffing Tool (BEST), developed by the RCN, which is based on assessing the dependency of patients to determine nursing workload and staffing requirements.
The RCEM’s checklist document also stated it was vital that staff should feel valued, asking whether there was support for staff in stressful situations and systems in place to prevent burnout.
Ideally, there should be regular joint handovers involving both doctors and nurses, stated the checklist.
On the topic of staff training and education, it said the concept of “care” should be integral to A&E induction processes and part of ongoing teaching. It recommended that all staff should have received training in “customer care” and “compassionate care”.
Meanwhile, A&E staff should be encouraged to report concerns about care and know what to do if they do not feel they are being listened to.
RCEM president Dr Taj Hassan said emergency care nurses and doctors could sometimes feel the quality of care they were able to offer suffered due to the pressures on services.
“In the hectic, often overcrowded environment of the ED, sometimes staff feel they are forced to compromise on the quality of service being provided, in their desire to safely tackle the sheer quantity of patients requiring treatment in order to hit their targets,” he said.
“While meeting targets is important, it is vital that our primary focus should be on ensuring patients receive the highest possible quality of care,” he said.
“Our guide provides a 50-point checklist for ED staff to ensure that delivering safe, compassionate care is central to what they do and placed above all other aims,” noted Dr Hassan.
He stressed that the fundamental points highlighted in the guide should already be in place in departments across the country.
“This will offer clarification of what best practice looks like and be a timely reminder of the paramount need to ensure quality care ahead of the traditionally difficult winter season,” he said.
“We have also suggested some initiatives and ideas for departments to develop for patients, that we hope will add just that little bit extra to patient experience,” he added.