Safety tools, approaches and insights

• Implementing the aSSKINg pressure ulcer care bundle – a blog by Susan Martins
• Nurse-led use of technology to enable better care - Homerton University Hospital Action Card App
• Yellow kits - an innovation to reduce the risk of falls in Accident and Emergency departments
• Friends of African Nursing: Training perioperative nurses across Africa
• Measuring standards of care, not negative outcomes
• Nobody left behind: Improving the health of people with learning disabilities and reducing inequalities across primary care
• Tackling antibiotic underdosing: Interview with Ruth Dando, Head of Nursing for Theatres, Critical Care and Anaesthetics at BHRUHT
• Insights from a reducing falls project at the University Hospital Southampton
• How a catheter removal project improved care for patients while saving money and carbon emissions

Safety culture

• How a simple newsletter can improve culture and communication within teams
• It’s time to look beyond perceived barriers to Family Integrated Care in the NICU and create a culture for change
• Safety Incident Supporting Our Staff (SISOS)
• Safety Chats

Interviews with nurses

In our series of Patient Safety Spotlight interviews, we talk to different people about their role and what motivates them to make health and social care safer.

• Martin Hogan, Lead Professional Nurse Advocate at Central London Community Healthcare NHS Trust
• Kathy Nabbie, Theatre Scrub Nurse Practitioner and Non-medical Surgical First Assistant  
• Angela Hayes and Caroline Morris, Palliative Care Nurse Specialists at The Christie NHS Foundation Trust

In an episode of our Speaking up for patient safety interview series, we spoke to Rebecca Wight, a nurse consultant practitioner. Rebecca talks about what happened to her when she tried to raise patient safety concerns about a colleague. 

• Speaking up for patient safety: Rebecca Wight in conversation with Peter Duffy and Helen Hughes

Could you share for safety?

Are you a nurse with a passion for patient safety? Do you have insights, projects or practical tools and resources that could be shared for wider benefit? Perhaps you’d like to feature in one of our Spotlight interviews?

You can get in touch with our hub editorial team by emailing us at content@pslhub.org

• From 2010/11 to 2017/18, the number of full-time equivalent (FTE) nurses in the NHS barely changed, even as NHS hospital and community sector activity levels increased by 26%. Since 2017/18, nurse numbers have increased, with the number of FTE nurses and health visitors in the NHS rising by 4.8% in the year to June 2020.
• Disparities between service areas continue to widen. The number of FTE nurses working in adult hospital nursing grew by 5.5% in the year to June 2020, while the number working in community nursing grew only by 1.6%, and by 3.8% in mental health. Over the past 10 years, only adult nursing and children’s nursing have seen increases in FTE nurse numbers, while the numbers in community nursing, mental health nursing and learning disability nursing are all lower than they were in June 2010.
• Vacancy rates are one measure of staff shortages as they highlight posts that the NHS is funding but cannot fill. Across all staff groups, the NHS had 83,591 FTE vacancies in June 2020. Registered nurse FTE vacancies accounted for close to 38,000 (45%) of these. A quarter of all nursing vacancies are in mental health. This is particularly concerning as Covid-19 is likely to lead to further demand for mental health services.
• The overall skill mix of the NHS nursing workforce continues to become more diluted. The number of FTE nursing support staff increased at over twice the rate of growth in registered nurse numbers in the year to June 2020.
• The main ‘supply’ of new nurses to the NHS comes from undergraduate university degree courses. In 2020 there was a 23% increase in the number of students accepted onto nursing degree courses in England (relative to 2019) – the highest annual number of acceptances since 2011.
• The UK ranks below the average of high-income OECD countries in terms of the number of practising nurses and the annual number of new nurse graduates relative to its population. On both counts, the UK reports lower ratios than comparable countries such as Germany, the USA and Australia.
• To achieve the required increase in the number of new graduate nurses from domestic education, the UK needs to find solutions to the long-term bottleneck that makes expanding the numbers in training challenging. These solutions could include increasing the use of simulation-based clinical experience, or reducing the total clinical hours required to be on a par with undergraduate nursing courses in the USA and Australia.
• The UK has been highly reliant on recruiting nurses trained outside the UK. About 15% of registered nurses in the UK are trained outside the UK – more than double the OECD average.
• Our analysis shows that achieving the government’s target of employing 50,000 NHS nurses by the end of the parliament will only be possible with sustained investment and policy action on domestic supply, including a marked improvement in retention of the current nurse workforce. Coordinated, ethical and effective international recruitment will also be required. To meet the 50,000 target the government will need an average of 5,000 international recruits a year up to 2024/25.
• But the 50,000 target will be insufficient to meet increased demand. As such it represents a political attempt to galvanise a system drifting from one reactive measure to the next. We argue there needs to be a shift in focus, away from a sigle top-down target to a more sustainable, long-term approach. This should start with robust, independent projections of the future demand for and potential supply of nurses.

• More training places will be offered through degree apprenticeships so staff can “earn while they learn”. 
• Nursing students could take up jobs as soon as they graduate, rather than waiting until September. 
• The plan asks the NMC to consider greater use of simulated learning in order to reduce clinical placement hours for nursing degree students.  
• Investment in occupational health and wellbeing services for staff. 
• Flexible working options will be considered for every job.  
• An intention to reduce reliance on international recruitment from nearly a quarter of staff to about 10% of the workforce. 
• Reform the NHS pension from this year to make it easier to partially retire or return to work. 
• A potential ban on substantive staff working agency shifts. 

Nightingale Frontline will provide remote, small group sessions offered to:

• Executive Directors of Nursing
• Senior Leaders
• Ward Managers/Team Leaders
• Newly Registered Nurses/Midwives
• Nurses/midwives: Redeployed or Returning to practice following retirement or non-clinical roles
• Nurses/midwives managing caseloads remotely
• Windrush and BAME Leaders

The leadership support will be facilitated by our expert FNF Associate Facilitators and our senior nurse and midwife alumni network who are highly experienced and skilled in a method of Action Learning known as Co-consulting. This approach combines the benefits of coaching with peer learning in an environment underpinned by psychological safety.

Book your free leadership support session. Sessions will be released monthly. If you have any questions, please email: academy@florence-nightingale-foundation.org.uk

My background is in tissue viability and I retain the clinical and leadership role with tissue viability as part of this role. I have been in tissue viability for 17 years and developed and continue to lead the service at Ashford and St Peter's Hospital NHS Foundation Trust. During this time I was seconded into the post of Acting Assistant Chief Nurse 0.5WTE for 1 year. Previous to this, I worked as a Deputy Head of Practice Development and a Ward Sister.

You are the first harms prevention nurse consultant in the UK. How did the role come about?

The Trust Chief Nurse had the vision to look at hospital associated harms as a whole and how this needs to be managed in a strategic way across the Trust. The role ties in with the NHS Patient Safety Strategy 2019.

Where does your role sit within the governance structure?

The role sits within the corporate division and has close ties and associations with all of the divisions and their governance structures. The post reports into the Trust Safety and Quality Committee.

How long have you been in post?

This is the start of my fourth week.

What are the main purposes of the role?

My role includes:

• Leading and developing the Harms Free Care Service across the Trust.
• Developing the Trust Harm Free Care Strategy and monitor its effectiveness.
• Leading on the Harms Free Care Strategy within the Trust, working with the teams to deliver a sustained reduction in pressure damage, avoidable falls, the absence of a new venous thromboembolism (VTE), harm associated with poor nutrition and the absence of catheter associated urine infection.
• Being expected to develop and influence strategies and frameworks to ensure that all healthcare staff adhere to Trust policies relating to Harm Free Care, through developing practice linked to the clinical governance and performance frameworks and Trust corporate objectives.
• Supporting the Trust to develop and implement systems for performance monitoring and performance improvement programmes for pressure ulcers, VTE, falls, nutrition and catheter associated urinary tract infection.

Talk us through a typical day.

It's a little early to talk about a typical day yet. I still have a clinical role in tissue viability 2 days per week as part of my role and so these days are spent assessing and planning care for patients with complex wound needs, providing education and training. The rest of my time is filled with planning for the role of Harms Free Care, looking at our present data and analysis, meeting with the harms leads, such as the VTE prevention lead nurse and the nutrition lead.

Have you had a chance to see what impact the role has had on patient safety?

It’s too early to look at impacts, but feedback has been positive that harms must be seen together and not separately. Meaning that we should not concentrate on the reduction of one harm at the potential cost of a rise in another, the harms are interrelated and need to be focused on as such. One of the key parts of the role will be ensuring our metrics in relation to harm are relevant and meaningful to both staff and patients.

How are you measuring the impact of the role?

There will be multiple measures which will be benchmarked against improvement targets for the reduction of harms. This will include data such as numbers of harms as well as other data such as patient feedback.

How do you engage staff and patients in patient safety?

We engage staff via various means: education, bulletins, focus days such as Worldwide Stop the Pressure Day, focus weeks such as Nutrition and Hydration Week. We are working towards engagement strategies as part of the NHS Patient Safety Strategy.

How do you see this role developing?

I would like to see this role being adopted by other Trusts as we have a concerted focus across the NHS to reduce patient harms.