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NHS boards recognise role of nursing in raising quality


More than half the measures chosen by hospital trusts to demonstrate their quality of care are nursing indicators, analysis by Nursing Times shows.

All trust boards had to publish quality accounts for the first time last month. These are meant to include trust boards’ top priorities for improvement and measures describing their quality of care.

Sometimes people see the word quality, but they think that really it is about finance. This demonstrates that it really is about care

Nursing Times analysed the quality accounts of 25 randomly selected acute trusts and found that 55 per cent of the measures of quality chosen by the trusts, and 47 per cent of the priorities, were strongly related to nursing. In total, the 25 trusts set out 133 priorities and 118 measures of quality.

The finding suggests the importance of nursing to quality improvement has seized the attention of trust boards.

Common examples of nurse-related areas included in the accounts as priorities and measures were: infection control and occurrence of healthcare associated infection; occurrence and prevention of falls; and incidence and prevention of pressure ulcers (see box).

Salford Royal Foundation Trust’s quality account was one of the most heavily nurse related.

Peter Murphy, assistant director of nursing for quality improvement at the trust, said: “We are focusing on improving quality of care on a daily basis and nurses are an integral part of that. The idea of bottom-up, shop floor clinical staff transforming care is part of the philosophy of the trust.”

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Jennie Hall, director of nursing and patient experience at South London Healthcare Trust, said the inclusion of nurse related priorities and measurements in her trust’s quality account would improve nurse visibility and her own personal accountability for quality improvement.

“Nurses’ role is vitally important. They provide 24 hour inpatient care alongside other clinicians and I sincerely hope that is understood,” she said.

Pennine Acute Hospitals Trust director of nursing Marian Carroll said opinion on what the trust’s quality account should cover was sought down to matron level.

She said she thought nurses would be pleased to see a number of nurse related indicators included.

“Sometimes people see the word quality, but they think that really it is about finance. This demonstrates that it really is about care,” she said.

“The quality accounts set out priorities and responsibilities for both teams and individuals, and it’s quite right that there should be clear accountability as a result.”

However, a number of trust quality accounts analysed by Nursing Times contained very few nurse related areas for improvement or measurement.

These included those of South Tyneside Foundation Trust. Executive director for nursing and patient safety David Shilton defended the choice measures in the account. He said: “Quality accounts are not intended to represent a comprehensive picture of all quality activity.

“A more comprehensive account of quality indicators, including a broader range of nurse sensitive indicators, is included in the [trust] annual report.”

Quality accounts - an idea piloted last year and retained by the coalition government - are intended to “enhance accountability to the public and engage the leaders of an organisation in their quality improvement agenda”, according to the Department of Health.

The accounts, currently required only for acute and mental health trusts, are due to be rolled out next year to community and primary care providers.

Earlier this year, Nursing Times revealed the first three national nursing outcome measurements - formerly known as metrics - that had been chosen for the NHS Indicators for Quality Improvement programme. These included the number of patient falls, the number of pressure ulcers and the number of patients with a continuous urinary catheter.

Quality indicators

Nurse related outcome measures commonly chosen by trusts for quality accounts

  • Falls - occurrence or prevention
  • Infection control and healthcare associated infection - occurrence
  • Incident numbers/reporting rates
  • Patient observations/deterioration prevention
  • Patient experience/satisfaction measures
  • Pressure ulcers - incidence or prevention

Readers' comments (5)

  • Richard White

    This is excellent news for nursing. In my field, tissue viability, we are making good progress in the key areas of pressure ulceration, leg ulcer healing rates and best practice, and wound infection. The promising start and enthusiastic uptake of the Quality Agenda is a credit to nursing. We must keep up the effort!

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  • Are they going to recognise our role in raising quality by way of better pay/working conditions/status/ influence as well? Nope? Didn't think so.

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  • In industry, increased product turnover, increased efficiency or improvement in quality brought about by shop floor input is usually rewarded by management in the form of increased status or remuneration, often as a productivity bonus.

    Skilled industrial front line staff i.e. production workers are normally valued employees and are encouraged to become involved in their product, work as teams whilst working within the constraints of their trades. Electricians, fitters, plumbers, pipe fitters, carpenters etc and are not expected to cross another trades area of expertise.

    In the more successful small/middle sized industrial concerns the management/ owners are often skilled men/women and have worked their way through the business and are as adept as the shop floor workers themselves.

    Unfortunately the modern NHS operates under another, more malignant managerial style. Incompetence, ignorance and bullying are now the predominant driving forces in the new look NHS.

    No amount of ‘Nursing Indicators’, ‘Quality Accounts’, or Trust Board Target Setting, Spin and Bulletins will halt the relentless spiral into the abyss which faces the NHS.

    The answer is more front line staff not inept managerial/administration tantrums, blame setting when unrealistic targets are not met and presenting dubious research findings.

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  • Here here, well said nursing are key to quality mainly because when a new quality target is set several managers get togther to discuss how we document and achieve it then hand it down to nurses to perform. As we are so patient focoused we often rise to the challenge. The reason medics are not key to quality is that they are to focused on thier own interest to even turn up for training. Would love to know average trust figures in the UK of how many consultants have attended ANTT, Resus and infection control training inthe last year (if ever) However they still perfom cannulation and blood taking and so on.

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  • Not just pretty faces are we?!

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