LEADING BETTER CARE Sharing Good Practice
NHS BOARD: Fife
Ward: 32, Victoria Hospital, Kirkcaldy.
DETAILS OF IMPROVEMENT:
Nurse led Discharge
HOW WAS THIS IDENTIFIED?
Delay in discharging patients which led to bed shortages for admissions.
Patient interviews/ complaints – patients waiting most of the day for discharge medications, having to sit in sitting room.
Increased stress levels of staff.
WHAT WERE THE IMPLEMENTED IMPROVEMENTS?
1 nurse identified to work Tuesday to Friday 07:00 – 17:00 now completed nurse prescribing module to facilitate and improve patients’ timely discharge from ward.
WHAT IS THE SITUATION NOW?
Planned discharge of patients before 10:00 thus facilitating reduction in cancellation of surgery for others, increasing patient’s throughput with the ward without compromising patient care.
By implementing nurse-led discharge the nurse identifies patients with the medical team that is likely to be discharge the next day. The nurse completes the discharge letter and dispenses medication for ward stock of pre-pack medications or sends the scribe to pharmacy. Also the nurse is able to identify problems likely to cause delays in discharge – services to be recommenced, district nurses to be arranged, OT/ Physio input.
The day of discharge if the patients FEWS is 0 then the nurse will discharge the patient if FEWS is above 0 then the patient needs to be reviewed by the medical staff and they can review patient for discharge.
HOW IS THE CHANGE SUSTAINABLE?
By the ward staff driving this change on as the can clearly see the benefits for themselves and also improved patient care.
Ward staff and ward management can see increase ward capacity and the reduction in patient’s complaints at us as a team will sustain this.
MEASUREABLE OUTCOMES
WHAT ARE THE PATIENT BENEFITS?
Smoother transition between admission and discharge.
Patients no longer waiting all day to be discharged.
They have peace of mind that all the services are arranged.
Family aware of the likely time of discharge and therefore can arrange this better.
More patient centred. Patients involved more in discharge process. Post operative information given by 1 nurse therefore more consistent information given to patients. They are aware of what time they will be discharged home and can make arrangements. This is a more consistent service and leads to a smoother discharge. Happier patients with reduced waiting times for discharge.
WHAT ARE THE STAFF BENEFITS?
Other ward staff can concentrate on more acute patient care within the ward. Staff less stressed with patients requiring discharge and admission at the same time.
Reduced burden on other staff – especially with complex discharges.
WHAT ARE THE ORGANISATIONAL BENEFITS?
Increased bed capacity, without compromising patient care.
Reduction in patient complaints around delayed patient discharges.
HOW DID STAFF FEEL BEFORE THE IMPROVEMENT/ (a) DURING THE IMPROVEMENT AND (b) AFTER THE IMPROVEMENT?
(a) Staff felt stressed, they felt the patient care was compromised due to ward activity and there was an increase sickness absence levels with the ward.
(b) Staff less stressed and feel more able to cope with the increased pressures on the NHS at present without having to compromising patient care.
WHAT ARE THE LESSIONS LEARNT AND WHAT WOULD YOU DO DIFFERENTLY NEXT TIME?
Even areas that are seen to run effectively can make changes to improve patient care and staff wellbeing needs.
Tackle small issues first.
WHAT PLANS ARE THERE TO SPREAD THE IMPROVEMENTS?
For the discharge nurse/s to work 7 days a week.
LEADING BETTER CARE Sharing Good Practice
NHS BOARD: Fife
Ward : 32, Victoria Hospital, Kirkcaldy.
DETAILS OF IMPROVEMENT:
Gynae urgent referral clinic, held within the ward’s clinical area between 13:00-17:00 Monday to Friday
HOW WAS THIS IDENTIFIED:
The sheer number of non emergency patients seen within the ward and did not require urgent medical intervention but who GP’s wanted direct admission into the ward.
The majority of patients referred to gynae ward as emergency admissions from GP’s where reviewed, treated and then discharged with a plan of care.
WHAT WERE THE IMPLEMENTED IMPROVEMENTS?
Gynae urgent referral clinic held within the ward Mon-Friday 13:00-17:00 run by Reg and 1 nurse.
WHAT IS THE SITUATION NOW?
Patients are given appointment times thus reducing their wait to be seen and the need to be admitted to the ward for treatment.
Investigation that are required can be arranged before hand e.g. Ultrasound scanning.
1 nurse is responsible for the running of this clinic.
HOW IS THE CHANGE SUSTAINABLE?
By the ward staff driving this change on as the can clearly see the benefits for themselves and also improved patient care.
Ward staff and ward management can see increase ward capacity and the reduction in patient’s complaints at we as a team will sustain this.
MEASUREABLE OUTCOMES
WHAT ARE THE PATIENT BENEFITS?
Patient with urgent but not life threatening gynae issues are seen within a day of going to GP with this issue without having to be admitted to the ward or waiting for an outpatient appointment.
WHAT ARE THE STAFF BENEFITS?
Other ward staff can concentrate on more acute patient care within the ward therefore reducing their stress levels.
WHAT ARE THE ORGANISATIONAL BENEFITS?
Reducing the inappropriate admission to hospital. Increasing bed capacity for patients that really require inpatient care.
HOW DID STAFF FEEL BEFORE THE IMPROVEMENT/ (a) DURING THE IMPROVEMENT AND (b) AFTER THE IMPROVEMENT?
(a) Staff felt stressed, they felt the patient care was compromised due to ward activity and there was an increase sickness absence levels with the ward.
(b) Staff less stressed and feel more able to cope with the increased pressures on the NHS at present without having to compromising patient care.
WHAT ARE THE LESSIONS LEARNT AND WHAT WOULD YOU DO DIFFERENTLY NEXT TIME?
Even areas that are seen to run effectively can make changes to improve patient care and staff wellbeing needs.
To tackle small issues first as these maybe easier.
Sandra Fawns
Senior Charge Nurse,
Ward 32,
Victoria Hospital,
Kirkcaldy.
KY2 5AH
Ph 01592 643355