Quality and Safety
University Hospitals of North Midlands NHS Trust is committed to the prevention of avoidable healthcare associated infections. We have a comprehensive infection prevention programme that is aimed at reducing infections and ensuring the safety of our patients. As part of these measures we have an MRSA screening policy in line with national guidance. The policy is monitored through an assurance framework.
Since 2009 all patients attending our hospital for elective (planned) operations or other invasive procedures will be screened for MRSA. The screening will either be carried out in the pre-operative assessment clinic or when a patient is being admitted onto a ward prior to surgery, with the result being available before the surgery or procedure takes place. Patients being admitted onto our wards through Emergency areas as emergency admissions are similarly routinely screened for MRSA.
NHS England has begun the staged publication of mortality rates for individual hospital consultants in ten specialties, a major breakthrough in NHS transparency. This leads a push to give patients more information about their treatment, helping the NHS drive up and maintain the quality of care.
The data - covering around 3,500 consultants can be seen on the NHS Choices website. The data will initially be refreshed annually and publishing of data in this way will be mandatory from next year.
Safe Staffing Levels
Information on ward staffing levels for patients and service users
From April 2014 it became a national requirement, by NHS England, for all organisations with inpatient wards to publish their full nurse staffing data (by month and ward area) which would continue on a monthly basis. Hospitals are also required to display information on staffing data at ward level so that it is easily accessible to the public. This initiative is in response to the Francis Report which can be found here. To access the 'Hard Truths' document; the Government response to the public enquiry, click here.
On 1 November 2014 the University Hospital of Royal Stoke (formerly the University Hospital of North Staffordshire) and The County Hospital (formerly the Mid Staffs Foundation Trust) became the University Hospitals of the North Midlands (UHNM).
At UHNM we have worked hard to ensure our nurse staffing establishments have "the right people, with the right skills, in the right place, at the right time" (National Quality Board 19 November 2013) Click here to access the National Quality Board guidelines.
Hospitals have to submit their planned nursing hours for each ward on each shift for trained nurses and nursing assistants. Alongside this the actual hours worked against the planned hours are also submitted. Ideally the actual hours worked should be as close as possible to the planned hours.
UHNM submitted staffing data for the month of August 2019 achieving 89.3% of its planned hours for all shifts for both registered nurses and nursing assistants. The percentage for registered nurses 83.6% and for nursing assistants was 98%.
The Royal Stoke University Hospital achieved 92.4% of its planned hours for all shifts for both registered nurses and nursing assistants. The percentage for registered nurses was 87% and for nursing assistants was 101.5%
The County Hospital achieved 86.9% of its planned hours for all shifts for both registered nurses and nursing assistants. The percentage for registered nurses was 81.7% and for nursing assistants was 92.2%.
Factors that affect available hours include: sickness, maternity leave and nurse vacancy.
It is important that the planned hours for nurses are as close as possible to the actual hours worked. However, this measurement alone does not tell us if the planned hours were appropriate to deliver safe and effective care. In planning nurse staffing levels it is important to consider a number of other factors.
The amount and complexity of care required by patients can vary significantly from ward to ward and from specialty to specialty. UHNM uses the Safer Nursing Care Tool to measure patient dependency twice a year on every ward and this helps to inform the nurse staffing requirements for each area.
Senior nurses are experts in understanding the levels of care their patients need, they also understand the skills required and the number of nurses needed to deliver care safely. UHNM has recently taken part in the field testing conducted by the National Institute for Clinical Excellence (NICE) looking at how we use evidence to inform nurse staffing requirements.
How many patients are admitted and discharged throughout a 24hr period, the ward layout i.e. number of side rooms, how easy it is to observe patients, and distance travelled by nurses to deliver care and obtain the necessary resource and equipment are all important factors when considering the number of nurses required on each ward.
Research has demonstrated that staffing levels are linked to the safety of care and that fewer staff can increase the risk of patient safety incidents occurring. There is no national guidance on the number of registered nurses there should be on a ward due to the significant variation between wards and specialties, however it is recognised that patient care is improved with a higher proportion of registered nurses as part of the nursing establishment.
UHNM realises how important this is in the delivery of safe care and have invested in nurse staffing to make sure that every ward has nursing establishment to deliver a minimum one nurse to every eight patients.
Each day nurse staffing levels in all areas are reviewed on every ward on a shift-by-shift basis. Senior nurses take responsibility for this to make sure they are staffed safely. Nurse staffing numbers are RAG rated (red, amber green) to determine if they have met the required numbers. Any areas that fall short of the required numbers are rated as red and senior nurses document the reason why and the action is taken. This information is recorded electronically on our Staffing Assurance Dashboard and will be used to generate monthly reports to our Trust Board.
Ward quality reports
Each month a ward quality report is generated looking at our performance against a number of key factors that influence safe care. The report includes:
- Sickness and absence rates
- Numbers of bank and agency staff used
- Patient experience feedback
- Harm free care e.g. no. of pressure sores, no. of patients assessed against the risk of developing clots
- Documentation and clinical monitoring
- Continence care
- Pressure area care
- Infection prevention and control
- Administration of Medicines
- Proud to Care Standards
Results are shared with matrons and ward staff and are used to inform and improve the standards of care we deliver.
Each ward at UHNM has Staffing Display Boards. The boards give information on the nurse in charge for the day, the planned staffing numbers and whether the required nurse to patient ratio has been met. The Staffing Display Boards also indicate what actions have been taken to address any shortfalls.
Trust Boards take responsibility for the quality of care provided to patients by ensuring nursing and midwifery staffing levels are sufficient and capable to provide safe and effective care to our patients. To provide assurance on this the Trust Board receives:
Monthly exception reports, advising if staffing falls short of the required, the reason for the short fall and the actions taken to address the gap
Six monthly report of staffing capability involving the use of evidence based tools
Got a question about Staffing Levels?
For more information about staffing levels in our hospitals, please contact our Director of Nursing Workforce & Education, Helen Inwood on Helen.Inwood@uhnm.nhs.uk