COMMUNITY HOSPITAL CASE STUDY

Releasing Time to Care – realising the benefits

The ward began implementing Releasing Time to Care (RTC) in March 2010.

1 year on, the team have implemented the three foundation modules, meals and medicines and are in the process of implementing the handovers module.

Increasing Direct Care Time

Our baseline direct care time has risen from 27% in July 2010 to 30% in April 2011 and will be repeated in October 2011.

The total number of interruptions has also increased, but interruptions for location of equipment have reduced from 16% to 2% since implementing Well Organised Ward.

Improving patient safety & reliability of care

Before implementation of RTC medicine rounds were at 08.00, 10.00, 12.00, 14.00, 18.00 and 22.00 (6 rounds). Night staff did the rounds at both 22.00 and 08.00. The number of medicine rounds between 08.00 and 14.00 meant that one staff nurse was occupied with drugs completely for most of the morning. The number of drug errors were high especially the 08.00 round. There were also many interruptions during the rounds.

By working through the medicines module of releasing time to care the team have reduced the medicine rounds to four at 08.00, 14.00, 18.00 and 22.00. The day staff now do the 08.00 round (immediately after the handover), so the night staff only do a medicine round at 22.00. By promoting a culture of the staff nurse doing the medicine round being more proactive in preventing interruptions has made a substantial improvement in drug errors. These improvements have reduced the number of drug errors from 12(November & December) to 8 (January, February & March)

Improvingefficiency of care

The time released has contributed towards improved clinical care for patients. Following implementation of the Meals module compliance score with the Food, Fluid and Nutrition clinical quality indicator (CQI) has consistently remained within the target zone of 95 - 100%.

In the same period compliance score with the Falls CQI has not been consistent. During the period of December 2010 to March2011 there were high levels of staff sickness, including the Senior Charge Nurse who was absent for most of that time. Compliance has improved recently, which may be due to the return of the Senior Charge Nurse, although staff members are responsible for maintaining standards even when the Senior Charge Nurse is not there.

Improving patient experience

We attempted to complete a patient satisfaction survey in 2010, but found obtaining enough completed data challenging due to the type of patients and length of stay. Following assistance form the Clinical Governance and Risk Assessment team we are planning to repeat this exercise starting in May 2011using a different process. We also plan to use ‘you said, we did’ boards to inform patients and their relatives of the results and improvements.

Improving staff well being

We completed a staff satisfaction survey over 4 months in 2010 in which staff were asked whether their shift had been good, bad or ok. Results were variable, but the final survey was only completed by 4 staff members, which makes the result unreliable. One of the challenges was persuading the staff of the benefits in completing the survey. Now that RTC is embedded into normal working practice we will be repeating this survey over the next 4 months to compare results.

After we started implementing RTC we did a comparison of short term sickness between April to July 2010 and the same period in 2009. This showed an improvement from 43% to 20% as percentage of days lost per month.

We are currently collecting the data to compare the same period for 2011.

The resulting cost saving was £4,275 in bank usage

We have recently implemented a dashboard for reporting RTC and CQI data on a monthly basis. This should make our data collection more robust and improve our processes for identifying challenges.

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