CNO Bulletin May 2022

 

A message from the CNO - Tracey Brigstock

Welcome to May’s issue of the CNO Bulletin.

This month is a special month as it ties in with celebrations for nurses and midwives all over the world.

International Day of the Midwife and Nurses’ Day 2022 (previously known as International Nurses’ Day) have been an opportunity for us to take real pride in our professions, celebrating our wonderful colleagues, and shout about the fantastic work which goes on in each and every department across the Trust.

To mark this special occasion, you can also ready a 'Year in Review' for our coveted DAISY Award.

But this month’s CNO Bulletin isn’t just about our week-long celebrations. Cardiac Nurse Practitioner Nina Jaspal shares her journey of undergoing the national Mary Seacole programme, while Ward Manager Jane Parker explains her volunteering journey with the charity Balsall Common Lions.

We’re also sharing updates from our Infection Prevention, Tissue Viability, and Delirium teams, plus much more.

 

In This Issue

 

The Mary Seacole programme, NHS Leadership Academy

This month Nina Jaspal, Cardiac Nurse Practitioner, tells us about her experience of undertaking the national Mary Seacole programme under NHS Leadership Academy.

My name is Nina Jaspal and I am a Cardiac Nurse Practitioner at UHCW. My nursing experiences have motivated me to become an autonomous practitioner, being able to carry out evidence based practise to benefit my patients, and having that strong academic foundation to build my skills upon. Throughout my career I have taken mentorship from inspirational colleagues who have advised me on many different paths that are now available in nursing. This is the key message that I want to share with you all. The opportunities for NHS staff are greater than they have ever been before to improve clinically, academically and to build upon your leadership skills, with courses being offered internally and externally through the NHS Leadership Academy and the Florence Nightingale foundation and many more.

https://www.leadershipacademy.nhs.uk/

Coaching has helped me previously to set time specific goals and enabled me to think differently about how these can be achieved. It’s given me the confidence to apply for other positions and be successful. I feel empowered knowing I am in control of my own career development and the opportunity coaching has given to me challenge my own barriers. Through the below link you can access mentoring or coaching, which is free for all NHS staff.

Leadership Lifelong Learning Midlands

This year I have been fortunate to have undertaken the Aspirant BAME leadership programme which is the first cohort that has been piloted in the Midlands that offers two leadership courses within a year to staff from a black and ethnic minority background. The NHS has identified the lack of BAME staff at senior levels within the NHS and the effects this has on the care we give. I am of the belief that a diverse team brings many different perspectives, through culture, backgrounds, and lived experience, through inclusion of diversity we are more likely to be able to think broadly and be more innovate and provide even greater care to all those that we serve.

Through this opportunity I have completed the Mary Seacole Programme which is a 6 month leadership development programme which is focused on developing your knowledge and skills in leadership and management. The opportunity to undertake this course has enabled me to really understand my value as a leader and my leadership style. It’s increased my awareness of the impact that anyone can have if you truly understand your strengths and weaknesses and learning the methodologies behind the fundamental modules and having access to the tools that can lead to implementing change.

Through the past 8 months my confidence levels have grown and I have been able to engage with senior leaders within and external to the trust, to listen to my perspective and really make meaningful change and inspire the junior work force and nurses from a BAME background. I have spoken out about my experiences as a nurse and on being accepted on this programme and the opportunities this has created on multiple platforms, and I hope to continue to encourage others to take opportunities when they present themselves.

With Nurses’ Day 2022 being celebrated on May 12th with the theme of ‘A Voice To Lead’ my take home message is this;

‘Were there none who were discontented with what they have, the world would never reach anything better.’- Florence Nightingale        

Thank you to all my incredible colleagues for the difference you make to patients on a daily basis, I am proud to work alongside you. Happy Nurses’ Day 2022!

 

International Day of the Midwife and Nurses’ Day 2022

The week of 5th-12th May saw us mark the celebration and recognition of the nursing and midwifery staff at UHCW for all their continuous hard work with the International Day of the Midwife and Nurses' Day 2022.

Elaine Clarke, Deputy Chief Nursing Office, opened the celebration event on May 12th by reflecting on the incredible achievement and contributions of our nursing and midwifery staff across the Trust despite the challenges of the last year.

This celebration introduced a number of inspirational Nursing & Midwifery leaders presenting on a range of topics including “Nursing and Research” and “The Midwifery Journey”.  Following these presentations, staff had the opportunity to meet with a variety of teams from across Nursing and Midwifery and to ask those questions at their stands highlighting education and excellence.

These celebrations also saw the re-introduction of the prestigious Florence Nightingale Award to Michelle Hartanto for the development of her leadership style and embodiment of the role of Shared Decision Making Council Chair.

This award is an excellent example of the theme of this year’s Nurses Day, “A Voice to Lead”, and was presented by Elaine Clarke and Vicky Williams.

The prize for the best Celebration Wall was also awarded to Ward 53 for their creativity and originality of content highlighting the amazing work performed across the trust every day.

The Pathway to Excellence team also introduced a “Pathway to Excellence Board” competition with exciting prizes to be won. This competition is about involving and engaging teams with the Pathway to Excellence framework, that encourages positive practice environments and contributions from leaders at all levels.

Please send your entries to PathwayToExcellenceUHCW@uhcw.nhs.uk by the 20th May 2022. We look forward to involving you all in the Pathway to Excellence survey activities in the upcoming months.

 

Pathway to Excellence® Update - May 2022

Following the submission of our Pathway to Excellence® Document of evidence last month we are looking ahead to the next milestone in our application process – the ‘Pathway Survey’ which will be launched later this summer.

As part of our preparations for the Pathway Survey we will be launching new info-graphics over the coming weeks centred on each of the six Pathway to Excellence® standards.  Please look out for these info-graphics in addition to lots of upcoming activities and ways in which you will be able to get involved in your areas in preparing for the survey.

On the 25th May we will also be hosting the ‘Pathway to Excellence® Roadmap to Survey’ event, 1:00pm-3:30pm in the CSB.

This event will provide support, guidance and opportunity for collaboration and shared learning regarding survey preparation, and to provide tools and guidance for those who will be supporting staff to complete the Pathway to Excellence® survey in their areas.

To book a place please email PathwayToExcellenceUHCW@uhcw.nhs.uk

 

Volunteer Spotlight: Jane Parker

I began my nursing career when I was 18 years old and since that time have worked in most acute specialties! Since 2012 I have been in post as a Ward Manager on AMU-1, the Acute Medical Admissions Unit. I share this role with my colleague Barbara Nyamariwata; this job share enables us to provide rotational cover across all shifts (days and nights) and to provide clinical leadership support to our staff in managing the acuity of patients on the unit and providing high quality, safe nursing care to our patients.

Volunteering role

I volunteer for the Balsall Common Lions; a local, national, and international charity who work for the community – our motto is “We Serve”.

We undertake a wide variety of activities including fundraising and awarding of charity grants, collections for four local food banks and support for our elderly community members, including transport to and from healthcare appointments.

We also work closely to support International appeals and disaster funds, and are currently aiding refugee efforts related to the recent conflict in Ukraine. We have recently funded and supplied a number of out-of-hospital birth bags (specialist suitcases) each containing all of the emergency supplies necessary for the safe delivery of a baby in the circumstances they find themselves in: birthing in bomb shelters, metros, and evacuating hospitals.

What do you enjoy most about your Volunteering work?

Most of all I enjoy the opportunity to meet other people outside of work – I love to be busy and we are a large group of like-minded people. Because of this volunteering with the charity provides the prefect flexibility for me to be able balance community commitments with my work schedule.

There are also a wide variety of training and development opportunities available to the volunteers, and I love the sense of achievement in helping others through the work we do.

 

Getting it Right first time - Back to Basics Infection Prevention and Control

Infection Prevention is core to the excellent work that we do all do at UHCW.

The most frequent activity, achievable and familiar to all, is hand hygiene. Every time we clean our hands, or provide patients with the means to do so, we achieve our aim in providing excellence in care; caring for ourselves, our colleagues, and fundamentally, our patients.  May has seen Glove Awareness Week, which also includes World Hand Hygiene Day, both of which encourage us to reflect of how well we achieve essential aspects of care, and how we model this excellence to those around us; colleagues, patients, and the increasing number of visitors we are able to welcome back thanks to a huge combined effort to ensure continued, safe restoration.

The challenge we face as a Trust is achieving sustained excellence in infection prevention activities; how can we all make sure we do the right thing, first time, every time?

Providing the right information, in the right place

  • We’ve moved towards a streamlined approach to infection prevention signage, using the doors to clinical areas to display relevant information for both staff and patients, and asking area staff to follow a “Perfect Poster Pack” approach, removing old versions of posters, and considering where posters are displayed for maximum effectiveness.
  • We use Isolation Hand signage, visual indicators for staff to wear specific PPE, whilst maintaining patient confidentiality. Recently we built on the usefulness of this system by introducing an additional isolation hand (purple), for suspected/confirmed respiratory patients.

Role Modelling

  • All UHCW staff are provided with role-appropriate training and guidance regarding the need for hand hygiene and mask wearing; by following this, we can be role models for our peers, and also reassure our patients and their visitors that we have everyone’s best interests at heart. 
  • Where asked, we should feel comfortable to explain to our patients and visitors why we clean our hands, or wear masks, and encourage them to follow the guidance provided for them. 
  • Hand hygiene provides an ideal opportunity to display our openness, pride, and sense of partnership – we can encourage patients and peers to ask or remind us to clean our hands, knowing this is a safe and reassuring environment in which to build improvement.

Asking for feedback

  • We all want to achieve excellence in care for our patients; however it can be hard to measure this. 
  • To work towards achieving excellence in the eyes of our patients, we have developed a “Confidence in Care” survey, which gathers feedback from patients across four key infection prevention domains; environmental cleanliness, hand hygiene, Covid signage, and Covid information.  We also ask whether, overall, the patient felt safe and secure during their hospital experience.

 

Tissue Viability – Doing the Basics Brilliantly

Making sure we get the essential elements of care right is fundamental to ensuring our patients safety. This is particularly important when maintaining skin integrity. The Tissue Viability team have been providing teaching sessions on pressure ulcer prevention and wound assessment with some fun interactive activities thrown it to get our staff focussed on doing basics brilliantly!

Using Amy as our patient (she’s a good sport!) staff have been getting involved in assessing skin, selecting appropriate pressure relieving equipment, effective repositioning, assessing continence and formulating plans about nutrition. These elements fall into our ASKIN bundle and are all essential aspects of good care.

You may have seen us out and about with our roving board; we are working our way across all clinical areas of UH and Rugby St Cross delivering categorisation training with the help of a big inflatable dice! So if categorisation drives you crazy and you see us out and about with our board come on over and join in for some bite sized training (you never know you may even get a little prize).

 

Medicines Safety

The theme of “Doing the Basics Brilliantly” continued for April’s Medicines Safety Day which focused on reminding all registered staff involved in the administration of medicines that the following process and checks must always be followed:

  • The prescription is legal (legible, signature and GMC/PIN number of prescriber is present, dated, the route, time, dose and frequency is written) and the allergy status of the patient is known
  • The patient is correctly identified - this must include checking the patient’s wrist band against the medication chart ensuring the Hospital number, name, D.O.B and allergies are aligned and correct. The patient should also be asked to confirm their name, D.O.B and any allergies if able.

For administration of an injectable medicine (including insulin) two nurses must perform this check together at the patient’s bedside prior to administration.

After confirming that the medication has been taken and/or administered, the medicines chart must be initialled in the appropriate column by the competent practitioner(s).

 

Falls Prevention

There will be a new Falls, Handling and Moving Lead starting in the Trust in July.               

The prevention of falls in all clinical areas remains a priority for staff. Ensuring risk assessments and the falls prevention booklet are completed are crucial in helping staff identify if a patient is at risk of a fall. It is often the simplest of actions that can make a big difference in reducing a patient’s risk of falling. For example:

  • Can the patient reach the call bell?
  • Can the patient reach their bedside table for their water?
  • Does the patient need their glasses/hearing aid?
  • Is the patient wearing suitable non slip footwear eg. Slippers/non slip socks
  • Does the patient require a falls alarm?

If a fall occurs staff should always ensure the Post Fall/ Group Reflection after a Fall documentation is completed. These documents support staff in ensuring all actions regarding the patient’s safety are completed and assist in the learning following the incident.

 

The Development and Implementation of the Delirium Care Bundle

Background

The National Audit of Dementia (NAD) (2019) and National Audit for Inpatient Falls (NAIF) (2017) highlighted a poor national picture for the management of inpatients with delirium, and called for urgent improvement within all inpatient care settings.  In response to these audit findings, Advanced Nurse Practitioner Marie Lawrence led a Quality Improvement proposal to develop and implement a bundle of tools in order to facilitate a standardised approach to delirium prevention, detection and management, with the overall goal to reduce poor outcomes for these patients (increased complication rates, length of stay and mortality rates). This proposal was approved at Care of the Elderly QIPS Forum in 2018, and a pilot was successfully undertaken within the Care of the Elderly  speciality at the Hospital of St Cross between Sept 2020 and Nov 2020.

The results of the pilot were accepted for oral presentation at the European Delirium Association Congress in Nov 2021 where Advanced Nurse Practitioner Marie Lawrence and Lead Nurse for Medicine Jo Crinigan presented the findings of the pilot and received great peer feedback from delegates.

The most recent audit results from the NAD & NAIF (2021) reiterated this national urgent call for improvement and these sentiments were also echoed in the Care of the Elderly Getting It Right First Time (GIRFT) report, which specifically calls for inpatient organisations to develop a delirium pathway, including the screening tool which has been included in our delirium care bundle. 

Evidence Base For The Delirium Bundle

The Delirium bundle was developed locally in response the national audit recommendations. The bundle, comprising the 4AT screening tool, TIME Bundle and a Nursing Prevention and Management Care Plan were tested alongside the Abbey Pain Scale.

4AT Screening Tool

A significant amount of research was undertaken into the most appropriate delirium screening tools to utilise within the bundle, including a peer visit to Salford Royal NHS Foundation Trust who were in the midst of completing a Delirium and Dementia project, which showed successful outcomes when implementing the 4AT screening tool (improved patient outcomes and experience, reduced length of stay and high-level cost savings). 

The 4AT Screening Tool for Delirium is a rapid assessment tool which takes less than two minutes to perform and does not require any formal training, therefore enabling all members of staff to utilise.  It also allows for the assessment of patients who may usually be ‘untestable’ as they are unable to verbalise or are excessively drowsy (MacLullich et al 2019).  The 4AT not only performs well in studies, but can be successfully implemented in electronic care records, as evidenced by the Salford Royal project. The 4AT is also recommended in the GIRFT Action Plan.

TIME Bundle

Health Improvement Scotland developed a Delirium Toolkit (2019) which was first published in 2016, which also incorporates the 4AT screening tool and promotes the use of the TIME (Triggers, Investigations, Management, Engage and Explore) Bundle for the management of delirium.  The Toolkit also provided the starting point for design of the Delirium Pathway and Care plan.

Abbey Pain Scale

The Abbey Pain Scale was included within the bundle to meet the national recommendation which calls for assurance that structured pain assessments are used and properly recorded for people with a diagnosis or current history of dementia.   It is an effective movement assessment tool for pain that should be used for patients who cannot verbalise; which facilitates the assessment of patients who are excessively confused or drowsy. 

Implementation of the Delirium Bundle

As part of the implementation of the bundle, the team developed a delirium patient information leaflet to further improve patient experience, this is available on the e-library.

In recognition of the national audit results and the actions required the Dementia Steering Group have been tasked with leading this vital large-scale piece of work towards trust-wide implementation. A task and finish group was established with support from the Project Management Office for the duration of this project and has already made progress as detailed below: 

  • Several engagement events including a key stakeholder event have been held to review the proposed bundle of tools and confirm the approach to take towards implementation, which includes aspirations and plans to develop a shared standardised approach to Delirium within the Integrated Care System and across the region.
  • Engagement has commenced with clinical education leads to support the education elements of the implementation process and recruitment has commenced for Delirium Link Staff, to support cascade training in all wards/departments. 
  • The managing challenging behaviour e-learning has been promoted as a pre-requisite to the implementation in each area.
  • Arrangements have been made to include Delirium in Standard 3 of the Ward Accreditation scheme, with potential to start in the summer once implementation commences.  This will focus on bundle compliance, staff knowledge and the environment.
  • Engagement has commenced with EPR workstreams to ensure that the bundle is included and the new EPR supports the tools that are required in this standardised process.
  • Care of the Elderly GIRFT Action Plan received – engagement with clinical audit.
  • Engagement with community partners towards the development of a community pathway and spread of this vital work.  A steering group is to be established.
  • Implementation planning including data collections/evaluation, communication strategy.     

Subject to final approvals the Delirium Bundle will be submitted to Health Records Committee for approval and Equality Impact Assessment prior its full implementation.

For any further information please contact Marie Lawrence.

 

WORLD CLASS WARD/DEPT. ACCREDITATION ASSESSMENTS 2022

The annual Accreditation assessments for 2022 are well under way. This round of assessments includes the 3 Essential standards that must be met for a ward to achieve higher than a White award. These are:

  • Standard 11: Pressure Ulcer Prevention
  • Standard 12 :Falls Prevention
  • Standard 13 : Infection, Prevention & Control

The 3 Essential standards will support clinical areas in a continuing focus on patient safety and reducing the incidences of harms occurrences.  It has been really positive to see so many wards making improvements following their last assessment and engaging with the Accreditation Framework. Some of the elements where improvements have been made across a number of wards include embedding clinical bedside handover, consistent use of Production/Focus boards and improvements in staff knowledge supporting them to deliver high standards of care.

Some of the themes identified for continued improvement include ensuring pressure ulcer and falls documentation is completed to clearly identify patients at risk and making sure actions are promptly implemented to reduce the risk of harm occurring.

Congratulations to all those wards who have demonstrated improvement following their last assessment and in particular Ward 10 and Ward 23 Head &Neck who have achieved a Silver award! Good luck to those wards yet to be assessed this year.

 

Criteria Led Discharge

At the beginning of April we commenced a secondment to lead the roll out of Criteria Led Discharge within the Trust. Each working 0.5WTE within the CLD role we bring a wide network of contacts and discharge pathway knowledge as well as daily first hand clinical experience of the patient journey at UHCW.

Our Backgrounds

Emma Brangwin: More than 15 years’ experience as a Physiotherapist both at St. Cross and at UHCW and Therapy Team Leader within Trauma and Orthopaedics for the last 9 years.

Lucy Edge: 10 years working as an Occupational Therapist, primarily in Liverpool, and for the last 4 years at UHCW. Currently Team Leader within the Integrated Discharge Team.

What is CLD?

Criteria Led Discharge is essentially a process of empowering competent members of the MDT (e.g. junior doctor, ANP, registered nurse or therapist) to discharge a patient when they meet pre-agreed clinical criteria for discharge, set by a consultant/lead-clinician.

It is not a new phenomenon, although until more recently, was previously referred to as nurse-led discharge and many other Trusts across the country and region have been and are indeed using it with a renewed focus in 2022.

CLD is 1 of 3 focused programmes of work identified by NHS England & NHS Improvement (NHSE/I)- Midlands Region relating to Nurse/AHP led acute hospital discharge in order to improve hospital flow and ultimately improve patients experience of their journey through the system.

We have the huge benefit here at UHCW of the extensive research and implementation knowledge of CLD from Associate Professor of Nursing Liz Lees-Deutsch who joined the Trust in October 2021 and works both in the Centre for Clinical Excellence at UHCW and Centre for Healthcare Research at Coventry University.

Liz has led national research on Criteria Led Discharge (nurse and therapy) through innovations in practice and qualitative enquiry. During 2020, Liz commenced protocol testing for Criteria Led Discharge after developing a standard operating procedure (Lees-Deutsch et al, 2019) evidenced through her systematic review (Lees-Deutsch and Robinson, 2018). In 2021, she produced the first national implementation guidance in collaboration with NHS England. In 2022, NHS England and NHS Improvement agreed the very first match funded PhD to support a programme of research into CLD, with Liz as lead supervisor. In April, Liz developed a process to support data collection to understand the prevalence and characteristics of patients who might be suitable for CLD at UHCW.

Liz is currently bringing her wealth of pragmatic academic and clinical expertise to guide us and UHCW in the implementation of Criteria Led Discharge supported by evidence.

She recently delivered a very informative, evidence-based and pragmatic presentation as part of the ECIST webinar series on Criteria-Led Discharge which can be viewed here: https://youtu.be/74fuX_0pn3w

The Project

The aim of our role is to explore what opportunities can be created with CLD across the Trust with a focus on empowering designated nursing and AHP staff to facilitate discharges effectively and safely. With an overall aim to reduce length of stay, increase morning and weekend discharges and improve patient and staff experience.

Our early work has been spent meeting and engaging with various specialities to determine where CLD could be implemented, creating a SOP and subsequent forms to guide the process and collecting baseline data to evaluate the effectiveness of implementation.

Looking forward, we are exploring further engagement with clinicians and AHPs to establish a working group and identify pilot areas for roll-out.

By the end of September the aim is to have a solid foundation of CLD implementation across a number of specialities in the trust with a focus on the PDSA cycle to ensure growth, momentum and sustainability.

If you would like to know more or would be interested in working with us on the project please do get in touch.

 

DAISY Award – A Year in Review

May marks a very exciting month as we celebrated International Nurses Day and International Day of the Midwife.  This was a fantastic opportunity to showcase all of our fabulous Nurses and Midwives who have become DAISY honourees over the last year.

During the last 12 months, we have received a staggering 362 nominations from grateful patients and their families who have received care at UHCW NHS Trust, narrating their stories and experiences and wanting to recognise and celebrate the skilful, compassionate care our nurses and midwives provide. 

And we had 23 new DAISY honourees who proudly received their prestigious awards from our Chief Nursing Officer in ceremonies attended by their colleagues and peers.

A massive congratulations to all our honourees and to everyone who has received a nomination in these last 12 months.

DAISY Award Honourees June 2021-May 2022

  • Daisy Knapp – Registered Nurse, Ward 43 UH
  • Lisa Archer – Registered Nurse, Day Surgery Unit, Rugby St. Cross
  • Claudia Anghel  - Registered Midwife, Labour Ward UH
  • Gail Hobley – Registered Nurse, Cedar Ward, Rugby St. Cross
  • Amber Long – Registered Nurse, Ward 15 UH
  • Michelle Huggins – Registered Nurse, Ward 32 Gastro UH
  • Lauren Deegan – Registered Nurse, Catheter Lab UH
  • Louise Riddell – Registered Nurse, Ward 10 UH
  • Mary Grogan – Registered Midwife, Ward 24 UH
  • Sunita Mahay – Registered Nurse, Plastics Clinic Ward 52 UH
  • Amanda Bayliss – Registered Nurse, Anti-Coagulation Clinic, Rugby St. Cross
  • Karen Sidgwick – Registered Nurse, Neonates UH
  • Amanda Kirkman – Registered Nurse, EPAC Ward 23 UH
  • Pamella Matsika – Registered Nurse, PAAC clinic 6 UH
  • Kerry Spencer – Registered Midwife, Ward 24 UH
  • Margo Day – Registered Nurse, Urology Specialist Nurse, UH
  • Caroline Duignan – Registered Nurse, Arden Centre UH
  • Ashleigh King – Registered Nurse, Day Surgery Unit Rugby St. Cross
  • Nicola Read – Registered Nurse, Ward 23 UH

We have brand-new posters for you to display in your areas to promote nominations for the DAISY Award.

You can download these here.

 

Extended Deadline for Nursing Times Awards 2022

The deadline for submissions the the Nursing Times Awards 2022 has been extended to Fridya, 27th May.

Staff are able to submit nominations in 25 different categories, including 21 'Organisation Awards' and four 'Individuals Awards'.

This year's awards ceremony return to their annual home, the Grosvenor House Hotel on Park Lane in London, on Wednesday, 26th October.

The awards bring together the nursing community to shine a light on the brightest talent in the profession and recognise those of you making nursing innovative, patient-focused and inclusive. It has never been more important to recognise the incredible contributions of you and your colleagues.

If you're considering making a nomination, click here.

 

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