Releasing Time to Care Community Hospitals: NHS Lanarkshire

Situation

NHS Lanarkshire has 4 GP community Hospitals, 3 in Clydesdale and 1 in Kilsyth. It has agreed that all 4 hospitals will eventually undertake Releasing time to Care (RT2C). To date only 1 GP hospital has embarked on RT2C – LockhartHospital (30 bedded hospital) in Lanark. Work commenced in LockhartHospital in July 2009. This paper will highlight some of the work and achievements made to date. 6 Staff have attended the Modular Implementation Training

Background

NHS Lanarkshire is using RT2C as a means to embed Leading Better Care – the role framework for Senior Charge Nurses and the Clinical Quality indicators. Additionally it is using the RT2C programme to assist staff in making connections to and embedding other local and national work programme – eg SPSP, FFN. Tissue viability, 18 week RTT, strategic Lean to name a few.NHS Lanarkshire plans to roll out RT2C to all 110 inpatient areas, including CommunityHospitals and Mental Health by March 2011.

Practice Development Facilitators work the senior charge nurse and their teams to examine practices, challenge existing practices, identify areas to improve and assist in seeking and implementing solutions. The Practice development facilitators work 3 days a week with the ward team for the first 6 weeks then 1 – 2 days for the following 6 week. The aim of this is to assist in empowering the team to take ownership of the new ways of working. After the 12 week period the clinical area is supported by facilitated action learning sets, where there is the opportunity to network, share experiences and develop further work.

LockhartHospital is the fist GP community hospital to commence and continue to work through the programme (a combination of RT2C general and CommunityHospitals). This work commenced in July 2009 and the facilitated phase ended in September. Since then staff have developed further, implemented more improvements to practice and continue to attend action learning sets / support sessions.

Achievements

  • All 3 foundation modules (Well Organised Ward/ managing stock, Knowing How you are Doing, Patient Status at a glance) have been completed
  • Handovers Module has been completed
  • Patient Observations has been completed
  • Mealtimes has been completed
  • Multidisciplinary team working
  • Managing Drug Administration is in progress

Results

Well Organised Ward / managing stock –

  • New shelving introduced
  • Storage box facility introduced within general and clinical areas
  • Discussion with store / procurement lead to improved procurement process for nursing staff
  • Introduction of a Top Up system leading to a 90% reduction of nursing time on stores ordering process.
  • Time released for nursing staff from the procurement process back to direct care delivery.
  • Keypad entry place on stock room to assist better stock management (previously there had been issues with the Out of Hours community nursing team using the ward stock and not replacing what they used)
  • 10 – 20% reduction in stores costs achieved and sustained

Patient Status at a glance

  • Examined existing patient name board
  • Debated the development of a further PSAG board but staff felt that the current board met their needs however this is subject to ongoing review
  • Have developed and displayed a Mission statement about the ethos and care within the Hospital environment. This has been well received by both the staff, multidisciplinary ream and patients / relatives and carers.

Knowing how we are doing

  • Introduced the CQI’s within the clinical area which have been well received by the ward staff. These continue to be reviewed on a monthly basis.
  • Have managed to get access to data with regards to bed statistics, occupancy etc which previously was unavailable to ward staff.. This can be accessed through the organisations intranet site.
  • There is a perceived improvement in the use of the bed within the Hospital as demonstrated by the graph below

Staff Handovers Module

  • Review of handover practice highlighted areas for improvement
  • Staff developed a Standard Operating Procedure for Handovers which is adhered to
  • At Night to Day shift handovers it has been agreed that 1 day shift nurse will not receive handover and remain on the ward to help the remaining night staff to start getting patients prepared for breakfast.
  • Staff report that they are getting off duty on time more regularly than before

Patient observation Module

  • Review of practice highlighted areas for improvement
  • Introduction of Standard Operating Procedure in relation to patient observations.
  • Introduction of MEWS documentation and Monitoring & Observation CQI ( will eventually transfer to SPSP when that reached primary care)
  • Staff report a reduction in patients being readmitted to the Acute Division hospital sites as deterioration is picked up at an early stage and acted on appropriately.

Mealtimes Module

  • Mealtimes are given more of a focus.
  • Protected Mealtimes introduced. Patient / carer information introduced and given to all on admission to ward.
  • Preparation for mealtimes introduced
  • More staff available during mealtimes has improved the quality of patient experience.
  • FFN CQI being used to monitor progress.
  • Work still needs further review to capture improvements and develop the ward further.

Multidisciplinary team working

  • Involvement of the OT, Physio and dietician in the work of Releasing Time to Care has improved relationships across the Multidisciplinary team.
  • Improved engagement with AHP’s has increased the rehabilitation focus and potential for patients.
  • Discharge process has also been enhanced to support patients discharge with other service involvement
  • Nursing staff were concerned about the amount of time they were spending on GP ward rounds which appeared not to contribute much value to patient care. This happened on a daily basis and were lengthy. This was reviewed.
  • In agreement with the GP service ward rounds now happen on 2 main days with the facility for staff to contact the GP team if they have concerns regarding patients in the interim. Not only has this released nursing time back to direct patient care it has also release GP time back to the delivery of patient care in their practice.

Managing Drug Administration

  • Commenced this Module and is ongoing
  • Review of drug storage and usage continues
  • Discussion with the Out of Hours team regarding access to medicines, prescriptions and getting prescriptions changed.

Miscellaneous

  • Staff also looking at non traditional learning and development opportunities thus enabling learning at work through work.
  • Raised awareness of the Academy 10 package( e learning package available on organisations intranet)
  • Ward staff currently considering being a pilot site for some the COPE (Care of the Older Person Education) distance learning Package which has been developed by the Practice Development Practitioner for Older Adults with others in the Practice Development team.
  • Senior Charge Nurse feels she is working within the Leading Better Care role framework and is able to evidence this using a variety of measures.

1