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.”
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.