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DRAFT MINUTE of MEETING of the AREA NURSING & MIDWIFERY COMMITTEE
Board Room, Assynt House, Inverness /13 NOVEMBER 2007–11.05 am
Present: / Peter Cartwright (In the Chair)Helen Bryers
Mary Burnside
Lynn Chalmers
Katrina Flannigan
Nigel Hobson
Chrissie Lane (from 12.15 pm)
Marie Law
Jennifer Lobban
Stephen Loch
Alison MacLean
Gill MacNeill
Caroline Matheson
Heidi May (from 12.40 pm)
Judith McKelvie (Item 12)
Liz McClurg
Muriel McNab (Item 12)
Mairi Milne
Patricia Morrison
Joan Philip
Fiona Sharples (from 1.15 pm)
Linda Sinclair
Amanda Smith
Hazel Smith
Heather Smith
Helen Tissington
Pat Tyrrell
Margaret Walker
Elizabeth Watson
Mhairi Will
Eric Wiseman
Catherine Zawalnyski
In Attendance: / Brian Mitchell, Board Committee Administrator
1 / WELCOME AND APOLOGIES
Apologies werereceived fromAlanCaswell, Lorraine Coe, Pam Garbe, Jonathan Gray, Laura Greenshields, Hilda Hope, Trish Kelly, Veronica Kennedy, Elaine Lang, Prue Lennox, Paula McCormack, Iona McGauran, Sarah McLeod, Ruth Miller, Rachel Soplantila, Joanne Thorpe, Angie Watt,Eric Wiseman, Isobel Woods, and Sandie Young.
2 / MINUTE OF MEETING OF 9 OCTOBER2007
The Committee Approved the Minute of meeting held on 9 October 2007 subject to the following amendment:
- Page 8, Item 13, Line 7 – remove “impatient” and replace with “inpatient”.
3 / MATTERS ARISING
3.1Adult Survivors of Childhood Sexual Abuse – Nomination to Short Life Working Group
Mr Cartwright emphasised the need for nominations to the Working Group.
The Committee so Noted.
4 / ARGYLL AND BUTERESPIRATORY NURSING SERVICE
Katrina Flannigan gave a presentation to the Committee on the role of the Respiratory Nurse Specialist for the Oban Lorn and the Isles Locality, to reduce the winter pressure on acute bed provision, provide early supported discharge, and improve communication between primary and secondary care. This included a Hospital at Home service in order to avoid a revolving door series of admissions. The role covered aspects across the acute/ primary care setting, with a view to winning the hearts and minds of patients, and included support for Social Work services. An example of the work undertaken was the working with GPs to identify those patients not presenting to Hospital, this allowing closer monitoring of relevant patients and allowed for greater contact with the primary care setting. To date one of the local impacts had been the reduction in bed days used since the introduction of the role, and it was advised that the Pulmonary Rehabilitation project was also showing results. Katrina advised that patient education for those with COPD was very important and that this involved arranging meetings on outlying islands and the holding of clinics. Moving forward challenges for the future included the promotion of respiratory care throughout Argyll and Bute CHP, facilitation of the development and provision of Pulmonary Rehabilitation, and the empowerment of those with COPD to self manage their conditions with the utilisation of new technology.
Margaret Walker raised the subject of Pulmonary Rehabilitation and was advised that patients were classified as “functionally disabled”, were subject to assessment and then given an 8 week personally tailored exercise plan and education session. A comprehensive range of exercise was included and after the 8 week period the patient was re-assessed. Research data had been collected on this scheme although this had yet to be collated meaningfully. Pat Tyrrell stated that the model in operation had the potential to make a substantial difference in the Argyll and Bute CHP area and Katrina stated that the use of Single Shared Assessments had been extremely helpful. To date there had been no “expert patients” recruited although this would also be beneficial.
After discussion the Committee Noted the position.
5 / HEART FAILURE NURSING
Amanda Smith gave a presentation to the Committee, advising that for the whole of the UK approximately 63,000 new cases presented each year with approximately 85,000 people living with heart failure, representing 1-2 % of the population (10-20 % of the elderly) and accounting for 2-5 % of NHS expenditure. It was stated that 33% of patients were readmitted to hospital within 12 months of discharge, that the prognosis was worse than for most cancers, and that overall provided for a poor quality of life for sufferers. The Heart Failure Service in Highland was established in November 2006, in partnership with the British Heart Foundation (BHF), and 3 wte nurses had been appointed to cover the NHS Highland area, excluding Argyll and Bute CHP where progress was being made and funding was being pursued with BHF. The aims of the service were to provide a consistent and systematic approach to the treatment of chronic heart failure, to provide individual care and management packages for heart failure patients and carers, to reduce hospital readmission rates, and improve quality of life at home. Referral criteria for the service involved hospital admission with heart failure, documented evidence of Left Ventricular Stenotic Disorder, and a willingness on behalf of the patient to participate, a typical example of which was outlined. The key components of the service were the improvement of patient knowledge of condition and medication, titration variation of drug therapy in accordance with guidelines, encouragement of compliance, the monitoring of blood chemistry and patient condition, and communication with GPs and other community staff involved. The achievements of the service to date were outlined and future plans included building on relationships with Community Teams and others, assisting in the development of Community Nurses with specific interest, Educational sessions, Patient Forum and Newsletter production, and ongoing research and development.
On the point raised it was confirmed that the service had been welcomed wherever it had been introduced and that one of themain factors of consideration was in relation to remote and rural area aspects. This led to staff being innovative with their time management and, as the service itself was only in operation for just one year, lessons were being learnt in this area. The Committee was advised that the Highland incident rate had yet to be benchmarked against the rest of Scotland and that extended prescribing training would be carried out in due course.
After discussion, the Committee Noted the position.
Amanda Smith left the meeting at 11.50 am.
6 / NATONAL PATIENT SAFETY ALLIANCE
Maryanne Gillies gave a presentation to the Committee in relation to the Scottish Patient Safety programme and advised that the Chief Executive and Director of Pharmacy from NHS Highland were members of the national Steering Group. The Programme was led by the Institute for Healthcare Improvement and Scotland was the first to introduce this on a national basis. It was advised that Interventions in NHS Tayside had been successful and overall the programme was process, rather than target, driven. The aims of the Scottish Patient Safety Programme were to build on similar developments in other international healthcare systems and widening the focus of the Safer Patients Initiative from saving lives to improving quality through reducing harm, deploying details of tested and evidence-based Interventions that had been demonstrated to make a difference, to develop a quality improvement and patient safety culture in NHS Highland hospitals, and incorporate long term sustainability and capability thereby taking this approach to higher levels. The objectives were to improve the organisation and leadership on safety, reduce healthcare associated infections (HAI), reduce adverse surgical incidents, reduce adverse drug events, and improve critical care outcomes. These objectives were underpinned by a series of 12 planned interventions within a two year period and there was to be an event to launch and highlight the Programme. Nationally there would be the formal establishment of the Scottish Patient Safety Alliance, development of governance and reporting arrangements including a national advisory board, publication of further information regarding implementation arrangements, ongoing discussion with NHS Scotland, Royal Colleges, and professional bodies regarding developing support measures for specific safety changes in acute care, and the appointment of expert technical advisors to work with NHS QIS.
For NHS Highland, the initial work required would be to form a Senior Leadership Team, form Work Stream Teams in Raigmore, Caithness General, Belford, and Lorn and IslesHospitals, and the formation of a Patient Safety Implementation Group. In addition there was a requirement to collect relevant baseline data, make preparations for the first Learning Session, and establish appropriate communications networks. The membership and role of the Senior Leadership team was outlined and associated measurable examples of leadership activities included prominent placement of safety issues on senior staff and NHS Board meeting agendas, the visiting of staff and asking about safety issues, implementation of Safety Briefings, regular scheduling of presentations from staff working on patient safety issues, connecting executive performance to improvements in patient safety, and the inclusion of patient safety measures within the Balanced Scorecard. The five Work Stream Teams, and their membership, in relation to RaigmoreHospital were outlined as were the three Teams relevant to Rural General Hospitals. These front line Work Stream Teams would be acting as improvement teams to test and implement changes, and would choose pilot sites and target interventions; the aim being to have all sites and all interventions implemented within the two year programme. As an example of the kind of interventions involved there was reference to Ventilator Associated Pneumonia and the introduction of a ‘bundle’ of interventions that would include elevation of the Head of the bed, daily sedation vaccinations and assessment of readiness to extubate, Peptic Ulcer Disease prophylaxis, and Deep Venous Thrombosis Prophylaxis.
As part of the Programme there was to be a Collaborative Learning Process that would include a series of learning sessions in January, May and November involving the gathering of new information on strategies to improve safety, the sharing of information and learning from other hospitals, and the development of detailed improvement plans. There would also be Action Periods involving working within hospitals toward major breakthrough improvements. Moving forward the measures of success would be a reduction in mortality, a reduction in adverse events, a reduction in crash halls, a reduction in infection rates, regular leadership walkrounds being in place, and patient safety items appearing on meeting agendas. The benefits of the Programme would be an improvement in patient safety, reductions in length of stay, cost benefits, reduction in numbers of complaints and increased patient satisfaction, and increased improvement capability among staff. During discussion and on the points raised it was advised that evaluation would be conducted through data transfer and include all NHS Boards, that there would be no additional funding arrangements, and that details in relation to the January Workshop would be issued to relevant staff.
The CommitteeNoted the position.
Maryanne Gillies left the meeting at 12.10 pm.
The Committee agreed to consider the following Items at this point in the meeting.
12 / RECOMMENDATION FOR TRAINING NURSING ASSISTANTS
Mr Hobson spoke to the circulated report setting out the strategic direction for the future training of Nursing Assistants within NHS Highland in respect of which the Scottish Executive required that there be achievement of Level 2 Scottish Vocational Qualification (SVQ) or equivalent. NHS Highland utilised two training programmes, namely the National Incremental Competences in Health Education (NiCHE) devised by CaledonianUniversity, and SVQ in Care at levels 2 and 3. The decision to follow a NiCHE or SVQ course had until recently been based on historic practice as per the decision of the previous Trusts to use one or other programme. It was stated that both programmes were not mutually exclusive, with each having their respective strengths as outlined, and to ensure effective planning and targeting of resources it had been concluded that a clear and consistent direction as to which programme Nursing Assistants should pursue was required. It was stated that well trained Nursing Assistants were the cornerstone of an effective nursing team and providing them with a career ladder to formal nurse training enhanced both their morale and motivation. The recommendation to follow a particular programme was driven by a range of variables as follows:
- The desirability of a national standard qualification that was portable across a range of employment settings.
- The availability of an infrastructure to support the work-based mentorship and assessments.
- The type of training undertaken by other members of the multi-disciplinary/ agency team, and the degree to which a common training programme supported better teamwork.
- The degree of specificity required for clinical competencies.
- Market demand.
Ms McKelvie advised the Committee that such training requirement would be outlined in staff KSF Outlines and as such resources required to be identified to enable this to be undertaken. The key aspect was to ensure that in terms of training the right programme was adopted and Ms McKelvie stated that the SVQ system was now more flexible than was previously the case and that if this was delivered in-house would be more cost effective. During discussion it was confirmed that staff appeared to prefer the NiCHE programme although this was more hospital-based in nature than was perhaps required and Muriel advised that as part of the training requirements areas of competences were being assessed although one issue would be that staff were not all working at the same level. Pat Tyrrell expressed concern at the utilisation of a training programme that was not accredited although acknowledged that this had proved to be more appropriate for staff. In this regard Mr Hobson stated that whilst there was no formal accreditation the programme had been scrutinised by the Scottish Qualifications Authority and considered to be equivalent to SVQ Level 2 and Muriel added that the letter of confirmation received form NiCHE had been accepted as evidence of competence elsewhere. Helen Tissington stated that the NiCHE programme was KSF aligned and met the requirements of the organisation and queried as to the interest shown in this from GP practices to which Muriel advised that there had been some shown, mostly from Broadford, Isle of Skye. She added that the enhanced programme had been assessed as equivalent to SVQ level 3.
Mr Loch stated that what was required was an analysis as to the relevant costings/ timescales involved and Ms McKelvie confirmed that such comparison would be useful and that the input of Lead Nurses would be welcome. Ms Burnside suggested that it would also be of benefit to obtain feedback from those having completed the programmes. Mr Hobson suggested that Lead Nurses nominate a representative to work in association with Judith and Muriel produce a definitive guide as to the appropriate approach to training the needs for which required to be outlined and planned accordingly. Chrissie Lane expressed an interest in being involved in this process in order that Palliative Care needs be identified and considered as appropriate and Caroline Matheson recommended that AHP colleagues be invited to participate also.