Date of Meeting: / 27th November 2015
Title of Report: / Exception Report for Expected and Actual Staffing for Nursing, Midwifery and Care Staffing (Ward Areas)
Status of report:
(decision and approval, position statement, information, confidential discussion) / Information
Lead Executive Director: / Michelle Clarke, Director of Nursing & Quality
Author: / Paul Hooton, Deputy Director of Nursing
Appendices: / Appendix A - Fill Rate Indicator Return Staffing: Nursing, midwifery and care staff –October 2015
Appendix B – Nurse Sensitive Indicators October2015
- Purpose of the report
To inform the Trust Boardof the ward areas that did not meet the expected staffing requirements in October2015. This relates to Board Assurance Risk Number 417 - Risk to recruitment of new staff and retaining current staff.
- Recommendations
The Quality Committee areasked to note the content of the report.
- Summary of Key Issues for discussion
The majority of shift fill rates are over 90%. Howevera significantproportion of fill rates are over 100% with a near equal split between Registered General Nurses (RGN)and Health Care Assistant (HCA)staff. A number of these shifts can be accounted for through use of specials to support high dependency patients.Some wards (Lugg, Acute Admissions Unit (AAU) and Hillside) struggled to fill RGN shifts this month and increased their number of HCA`s to support the nursing workload.The Director of Nursing & Quality (DNQ) has asked the Deputy Director Of Nursing (DDON) and the Head Of Nursing (HON) to review the fill rates and agency use for this month and produce a plan to manage this more effectively.
Fill rates in some clinical areas for registered staff have been below 90%. This is slightly up on last month (10 occasionslast month and 11 occasions this month). This is mainly due to vacancies and high sickness rates and inability to provide bank and agency back fill.Lugg Ward reported a fill rate below 80% mainly due to unfilled agency shifts. Teme Ward reportan under fill of 67.7% for HCAs atnight again due to reduced activity and capacity.
The GilwernAssessment Unit is due to open on the 14th of December. Following a series of meetings between the DDON and the HON for Urgent Care, a plan has been developed to support the staffing requirements for the new unit. This includes redeploying staff to that area, recruiting HCA`s, block booking of agency staff and a contingency if required to close some beds on AAU to support the workforce need in the short term.
Bromyard as of 7th December will have 1.56 WTE Band 5 vacancy to an improvement from a vacancy factor of 3.27 WTE in May 2015.
There is no maternity leave, in May there was 1.8 WTE and there is no long term sickness in May there was 1.8 WTE Band 5.
Nurse sensitive Indicators(NSI)
This month’s NSI`s has seen a decrease in all our NSI with the exception of complaints. This is against a back drop of a very busy period of high levels of activity in the Emergency Department. The Trust continues to be MRSAfree.
Pressure Ulcers
There has been no reported incidence of level 3and 4 pressure ulcers this month.
Slips Trips and Falls.
There has been a significant decrease inslips, trips and falls this month with the majority of inpatient areas reporting a reduced number of incidents. The exceptions to this are Wye Ward,Monnow Ward, Day Case, Bromyard Community Hospital and Teme Ward who have seen a slight increase over the last month. On further investigation a number were repeat falls and also a high percentage of the incidents were patients who were identified as high risk due to confusion and had all the relevant precautions in place, although in some incidents one to one care was limited due to staff shortages. Teme Ward increase was due to rehabilitation of elective joint replacement surgery, as patients become more confident or when the patient chooses to ignore the advice and written instructions. Ward staff do their best to monitor and supervise the recovery and are looking at how they can improve this process and find another way to prevent this type of incident.
The Trust has revived the Trust Falls Group lead by the HON for Urgent Care and also following the six month safer staffing review, the DNQ has asked the lead nurse for Urgent Care to undertake a review of slips, trips and falls management within the Trust.
Drug Errors
There has also been a decreasein reported drug errors(-3) on the previousmonth. The majority of inpatient areashave seen an improvement or no change. This improved position coincides with anew section being added to medication errors on the incident reporting system which enables staff to complete their reflective practice electronically. To date, for medication incidents that have been reported in October 2015, 68% have completed the reflective section. However some areas have seen a slight increase in drug errors. Frome Ward, Redbrook Ward, Ross and Leominster CommunityHospitals have all seen a slightincrease. All drug errors have been investigated and all staff involved has been requested to write a reflective practice log and the matrix will not be signed off until the reflective practice is complete and returned to the Education & Development Centre.None of the drug errors resulted in significant harm to the patients involved.
Infection Control
There has been 1reportable clostridium difficle case in October at Bromyard CommunityHospital.
Friends and Family test
The majority of clinicalareas are in the green percentile in the response rate to the Friends and Family test with over 97.5% of respondents for inpatient and Community Hospitalsrespectively recommending us to their friends and family. A small number of areas (Arrow Ward, Children’s Ward, Day Case and Women’s Health have a low response rate. The DNQ is addressing this with the individual areas.
- For further information or any enquires relating to this report please contact:
Michelle Clarke, Director of Nursing & Quality,
Or
Paul Hooton Deputy Director of Nursing
- Please confirm, by ticking the box, that you have included or considered the following items in developing your report:
Background
Care Quality Commission Implications
Legal / NHS Constitution considerations
Analysis of Risk including link to the Board Assurance Framework and Risk Register
Resource Implications (staffing & financial)
Adult and Child Safeguarding
Patient, Public and Stakeholder involvement