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Safety fears prompt calls for more nurse led care plans


Nurses are being told to take more responsibility for developing personalised care plans in response to fresh evidence that the safety and welfare of NHS patients is being compromised.

Nurse leaders have told Nursing Times that better care plans would prevent accidents such as patient falls, which continue to account for more than a third of all incidents reported to the National Patient Safety Agency.

Latest figures for each trust in England, published last week, reveal 31 per cent of the 506,317 incidents reported to the NPSA between April and September 2009 were due to “patient accidents”, such as slips, trips and falls.

This shows little improvement on the previous reporting period in October 2008 and March 2009, when 32 per cent of all incidents were recorded as “patient accidents”. In the previous six months the figure was 33 per cent.

In November 2009, chief nursing officer for England Dame Christine Beasley highlighted falls prevention as one of eight “high impact actions” that should be implemented across the NHS to improve patient care and save NHS costs.

Royal Bolton Hospital Foundation Trust director of nursing Lesley Doherty said the answer was “assessment, risk rating, knowing your patient and having individualised care plans”.

She said: “It’s not only an improvement on reducing the number of falls, but reducing length of stay in hospital. It is something that really does need to be addressed and something that every nurse should have accountability for.”

NPSA head of medical specialties Francis Healy said too much emphasis has been placed on trying to predict who is at risk from falls, rather than what should be done to help them.

“Assessments have taken precedence over interventions, but it is the individualised intervention, or care plan, that is most important,” she said.

Many of the issues around falls prevention “overlap” with those of nutrition, hydration and skin care, all of which should be addressed using a personalised care plan, said Ms Healy.

She said: “This is about the essential nursing practice of treating every patient as an individual.”

Under Lord Darzi’s next stage review, trusts were given a deadline of this year to ensure all 15.4m people with long term conditions have received a personalised care plan.

The aim is to give people more control over which treatments and services they receive and help them to self care more effectively.

For an elderly person with heart disease, this might involve a discussion about their health and wellbeing goals and what to do if the condition worsens.

But assessments published last week by the Care Quality Commission as part of a tough new registration system have revealed personalised care is not always being provided.

The assessments highlighted problems at 10 trusts, seven of which have been told to improve the care and welfare of patients - the second most common problem after levels of staff support.

Inspectors found risk assessments and care plans in some trusts were of “variable quality” and patients needed to be more involved.

Unless trusts address these issues urgently, they face large fines and even closure.

CQC national clinical advisor and former nurse Ann Close said: “Care plans make sure you’re looking at what care needs do patients have, what are they particularly at risk of, and what nursing interventions are needed.”

She said developing care plans was part of “the role of the registered nurse”, but “we’re not doing it that well”. This was often due to staff shortages and skill gaps, she said.



Readers' comments (12)

  • Once again I find this article appalling. What exactly is it that Registered nurses are there to do if not to assess and plan care for patients. What are the Universities doing, what are they being taught?. Who else is supposed to assess and plan care (perhaps they leave that to the Health care worker along with everything else. Has anyone ever heard of the Regulator of Nurses The Nursing and Midwifery Council. Have they said anything, or are they silent on this matter too?

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  • By the time you've filled in Falls Risk Assessment tools, Manual Handling Risk
    Asssessments, Malnutrition Risk Assesssment, Pressure Sore risk assessments tools, Incident Report Forms, Mini mental scores and care plans, there isn't much time left for the patient.

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  • I think it is easy to put the blame on nurses, if more time was allocated for nurses to spend on individual care plans and approaches and less time having to fill in triplicated paperwork delegated by management then I am sure this reduction in incidents would happen. As another nursing times article mentions, there has been a huge increase in employing mangers which obviously is going to limit the staff on the shop floor which will in turn reduce the safety of patients. In these cash strapped times is that really the way forward for the crumbling NHS?

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  • Judith ASllen I really don't think you know what you are talking about, either that or you have missed the point of the article entirely. And as for the article, it appalls me too, but for very different reasons.

    It all boils down to this.

    Nurses CAN and DO assess and plan care for patients.

    The multitude of care plans, FRAT scores, risk assesments, etc are ridiculously high for each patient.

    The majority of Nurses time is taken up with paperwork.

    There are far too many patients and far too few Nurses.

    So, unlike this moronic article suggests (apart from a little caveat right at the end), Nurses are NOT failing in their duty at all, we just cannot do everything. Unless the staff numbers are doubled and there is a protected Nurse/patient ratio (I would suggest no more than 6 patients to one staff nurse and one HCA) then these idiot managers are going to have to choose, do they want all their nice little forms filled in neatly? Or do they want us to care for patients? They can't have it both ways!

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  • Seriously Judith. You need to try and be the lone qualified nurse for 30 patients with only 2 auxillarie to help for 12 hours. You cannot complete care planning under those conditions if your life depended on it. You won't ahve 5 seconds free of multiple interruptions that only a qualified nurse can handle.

    I am getting real sick and tired of older nurses who are away from the current situation at the bedside making attempts to try and form intelligent opinions about what is going on.

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  • Oh and Judith even when you are forced to leave the bulk of the basic care to the care assistants you are still going to be utterly and completely overwhelmed with a heavier workload than what the HCA's carry.

    Come to my ward and give it a try for a shift and see what you can accomplish.

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  • Dear Anonymous. Yes there are too many forms and no doubt too many patients, but the fact remains that Registered nurses are employed and paid to care for patients. Instead of having a go at me, perhaps you should take your grievances about staffing levels to your Ward manager, or your line manager, if this achieves nothing take it the your professional organisation and if that achieves nothing take it to the NMC the people you pay your fees to. I have no problem with putting my name to anything, but I was'nt aware my age was there too.

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  • Judith, again you are missing the point. Yes we are paid to look after patients, no doubt many of us would have the instinct to even if it wasn't our job, but when we are alone on a ward looking after 12, 16, 18 even 24 patients with no help, then guess what, their care will suffer. That has nothing to do with our training or competence, it is simple numbers.

    And there have been a plethora of studies and reports stating that staffing levels are often unsafe, just look at the recent work by the CQF, but the managers and the government DO NOT LISTEN, as they simply repeat the condescending 'there's no money in the pot!' And many of us do complain constantly to our managers, I myself fill in incident forms every single shift we are shorthanded, it does nothing.

    I am 'having a go at you' however because you seem to have taken the simplistic and frankly insulting stance of many people and simply blaming Nurses for all this, specifically Nurse training and those going through it, and that is a view that I simply am sick and tired of.

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  • Greetings to all the discruntled members responding to this article.

    I am proud to be a nurse but like everyone else, very tired.

    On paper my ward is covered appropriately every day - staff are willing to provide bank cover to work shifts whenever our area has a shortfall. However when there is appropriate staffing there is always movement to cover other areas that are short staffed. As a result there is a reduced morale of an area that has historical good retention.

    Where are you RCN and NMC??

    I read about these issues daily on this website...PLEASE don't say you aren't aware of what is going on.

    Nurses are scared to stand up & be counted - STOP questioning their fear & investiate WHY.

    Where is the evidence of a NATIONWIDE NHS dependancy scoring system so that nurses can begin to quantify the needs of their patients & team?

    As qualified nurses we entered this profession to give the best care possible - we are trying to do so with all the many tools provided, but there just aren't enough hands to provide basic nursing care & to fulfill all the paperwork & IT exacting requirements of the 21st century.

    To some of the previous commenters - I am a professional nurse & ashamed of your bitching. Stop fighting each other & get together to discuss and hi-light the issues that directly effect patient care.

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  • As a recent NHS patient it seems my Care Plan was superb, however, the nurses writing it had no time to deliver the care or at least not to me.

    As an agency nurse care plans are a nightmare as it is not possible to discover from reams of irrelevant nonsense what is actually happening to the patient. If one had hours to read each file it would be different but...
    We need a grown up discussion on relevant coherent records of nursing care that is provided for the patient not over-zealous pen pushers

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