There is evidence that attaching financial penalties to nursing quality targets improves patient care.
The trust was set a CQUIN target to increase the number of patients on the Liverpool Care Pathway, where a decision is made not to resuscitate a patient and only provide supportive interventions to keep them comfortable and free of pain.
Last year, only 15 per cent of terminally ill patients at Walsall were on the Liverpool Care Pathway, which involves patients and families discussing end of life care with clinicians and nurses. This meant that during the final days of their life patients might still have endured interventions that were focused on trying to prolong life.
After setting the target, staff systematically introduced the pathway for more patients. The trust reports that 53 per cent of eligible patients are now on the pathway - more than treble the proportion last year.
Kathryn Halford, associate director of nursing and paediatric professional lead, said this had improved staff confidence in talking to patients and families about death. She said: “It gives them a framework to approach the subject.”
Improving end of life care was used as a CQUIN 44 times in the 94 acute trusts investigated by Nursing Times and in many cases the Liverpool Care Pathway was the method used to achieve this.
Sharon Cullen, associate director of nursing at the Princess Alexandra Hospital Trust in Essex, agreed CQUINs helped clinical staff focus on priorities.
She said: “The value is to the patient and when we receive the financial element we can use that to enhance care.”
Ms Cullen said her trust - one of two with the highest number of nurse-centred indicators - had used the targets to make the hospital safer for patients.
After being set a CQUIN target to reduce falls, the trust is now appointing a registered nurse as a falls coordinator to assess risks and ensure that vulnerable patients are correctly referred for treatment.
“It was an area we wanted to address. Our population is ageing so we were very aware our client group has the potential to be vulnerable to falls,” Ms Cullen said.