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NHS South West: warning system for ward managers

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Nursing directors in the South West have developed a scoring system to highlight wards or clinical teams, which may be about to repeat the failings seen at Mid Staffordshire.

Ward sisters at most hospitals in the region have begun using the Early Warning Trigger Tool to assess their risk. It gives wards or teams a points score based on their answers to questions about common factors known to lead to problems.

These include whether there is a staff vacancy rate of more than 3%; whether unfilled shifts are more than 6%; sickness absence rates more than 3.5%; and whether hand hygiene and cleanliness audits are being performed.

If the score reaches the threshold of 12 points, it is considered an “early warning trigger” and “remedial action needs to be taken to prevent a later impact on the quality of care”, state notes on the system shared with Nursing Times.

NHS South West chief nurse and workforce director Liz Redfern has overseen development of the system, which was prompted by the scandal at Mid Staffordshire, where serious problems on particular wards went unchecked.

Ms Redfern said during the development of the tool over the past year several trusts had identified shortcomings. This has led them to, for example, put in place new permanent ward leaders and additional staff.

Ms Redfern said experienced nurse leaders already used the indicators in the tool on an intuitive, but informal basis, and could often spot a potential problem ward when they visited it.

But she added: “Any experienced nursing director can walk onto a ward and see things are not right, but they have got to back that up with some evidence.

“That intuition is very valuable but it gains more credibility when you have also got a consistent set of measures.”

Ms Redfern said the tool made it easier for a trust to be assured about quality. She said: “If a trust has nothing like this, then it is leaving itself very exposed.”

It is currently being adapted for community and mental services.

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