We are using technology to ensure the nursing resource matches the clinical requirements for every ward, says Steve Jessop
In the wake of the Mid Staffs scandal and Keogh report, many healthcare organisations have had to address safe staffing levels. In his report, Sir Bruce Keogh suggested that the data on workforce levels at the 14 trusts investigated did not accurately represent the actual numbers of staff on wards on any given shift.
Any nurse will tell you patient safety is intrinsically linked to staffing levels. The increasing requirement to record patient information and statuses while delivering care creates a paradox - information is needed to improve care but collecting this increases administration demands. You have to question whether nurses’ skills are being used correctly in caring for patients.
A major issue in the way the NHS manages nurses is the lack of up-to-date information for making decisions on safe ward staffing. Staffing levels are predicted using a ratio of the number and condition of patients. This ratio, called patient acuity, is typically analysed by trusts just two or three times per year.
“I am leading a project to measure real-time patient acuity to support around 3,000 nurses in 52 wards at Hull and East Yorkshire Hospitals Trust and their patients - and I believe we are the first trust to take such an approach”
Consider the administration effort associated with the process - every day a paper form is completed on every patient, recording their acuity rating. Once this data is recorded and input to an IT system over a period of time, it is possible to calculate using various tools or spreadsheets how much nursing resource is required for the forthcoming months.
A lot of hospitals use the Safer Nursing Care Tool or similar tools that are derived from the critical care classification of patients; however, these are used more as evidenced-based tools for benchmarking than for determining the number of nurses you need per shift. The data burden on trusts is huge and this method of number crunching remains a slow and awkward process for senior managers.
Imagine, then, if patient acuity was easy to record, easy to manage and easy to analyse. Better still - imagine if the analysis was accessible in real time. If the technology to deliver all this was in place, nurses would have the information to hand to say “we’re understaffed” - a voice backed by hard, live evidence that could not be ignored.
This vision is why I am leading a project to measure real-time patient acuity to support around 3,000 nurses in 52 wards at Hull and East Yorkshire Hospitals Trust and their patients - and I believe we are the first trust to take such an approach.
We have invested in technology by Cayder that shows nurses where patients are. With each of the 45 wards using large electronic whiteboards, patient flow technology allows nurses to manage patient admissions more safely. We are extending the software to include management of patient acuity, allowing us to ensure that the nursing resource matches the clinical requirements for every ward on every shift.
This could be a game changer for safety briefings. We are developing a reporting tool and, when it is complete, we will be able to assess areas of high acuity and move resources, whether from medical, surgical, oncology or haematology wards.
The initial reaction from nurses is extremely encouraging: 95% of wards now measure acuity as part of their daily routine and, thanks to the technology being in place, there is no additional paperwork.
We are aiming to answer common questions such as “is the ward able to support patients with a high acuity?” or “have I got enough resources?”, removing any uncertainty and ensuring staffing levels are as safe as possible at all times.
One of my main aims as chief nursing information officer is to spread the use of technology to support clinical staff and empower them to focus on the essential: caring for their patients.
Steve Jessop is is chief nursing information officer at Hull and East Yorkshire Hospitals Trust