Proactive Rounding – Actively Caring

1. Proactive Rounding – Actively Caring Trudy Reid & Mary Burke Southern HSC Trust WSCNTL 2014, Kings Hall Leading Care, Leading Teams - Innovating and Supporting Person-Centred Care

2. Actively Caring Southern Health and Social Care Trust Trudy Reid & Mary Burke

3. Organisation of Care The aim of this project is to review and address how nursing / midwifery care is organised and delivered in acute wards / departments, identify areas of best practice and to recognise opportunities to deliver patient safety and improve the patient experience.

4. Phased approach Two acute Hospital sites • Base Line 12 hour Observations of practice • Phase 1 – 11 pilot wards • Phase 2 - 19 wards across both sites • Evaluation included repeat Observations of practice

5. Safe Administration of Medicines Aim • To support individual nurses and midwives achieve safe administration of medicines and reduce inappropriate omitted and delayed medicines Methodology/Implementation • Observation of medicines assessment tool • Self-assessment • Reflective learning • Work shop for band 6-7 (39 sisters attended) Evaluation • Observation of practice • Audit • Reduction in all medication incidents (although incidents may increase initially as awareness heightened) • 53% completed self evaluation programme This work was shared with Nurse Consultant, Clinical Education Centre, who will integrate the elements of this work stream

6. Medicines Self Assessment

9. Shift Handover Aim • To review how shift handover currently takes place • To review the literature on shift handover • To provide a standardised approach to shift handover Methodology/Implementation • Use SBAR guidance and template or adapt current templates Evaluation • Observation of practice • Audit of handover process Outcome • The principles of the SBAR model of communication for handover are now implemented in all wards, most areas now generated electronically • Shift handover observed to be effective – reduction in time of handover - 45 mins – 25mins in MAU and 30mins-15 mins in Surgical admission ward, with only applicable and relevant information communicated

10. Hand Over Template

11. Customer Care Aims • To ensure all staff are aware of their responsibility to inspire public confidence in all aspects of delivery of care Methodology /Implementation • Delivery of PowerPoint presentation • Nursing supervision • Engaging with staff Evaluation • Evaluation from participants • Observation of practice • Improve patient/client experience • Reduction in complaints Outcome • Overall total- 764 staff attended (58%) • Extended to other areas and disciplines – outpatients/community midwives/AHPs/medical staff (approx. 100)

12. Proactive Rounding Aim • To ensure that all patients have face to face contact with nursing staff minimum of two hourly Methodology • Use of proactive rounding tool Evaluation • Observation of practice • Patient rounding audit too Outcomes Falls reduction by 25% * ‘At first I thought intentional rounding was nothing more than a paper exercise, now I feel it is really beneficial to patient care as now I hardly ever hear a buzzer and all patients are able to tell exactly who their nurse is..’

14. Proactive Rounding Audit Tool

15. Other elements of organisation of care • Model of care • Prevention of Health Care Associated Infection • Roles and Responsibilities

16. Rotational Programme • Induction Programme • Competency based Programme • Named preceptors • Rotational programme • ED/MAU • 6 months ED 6 months in MAU • Trauma/orthopaedics • Clinical supervision

17. Lunch & Learn • MDT Learning together • Sharing the learning • New Initiatives • Examples of good practice and areas for development • NIPEC Educational Audit

18. Patient Safety Briefings • Weekly meeting at ward level • New guidance, policies, procedures and best practice • Audit feed back including NQI • Sharing the learning from complements, complaints, incidents, RCA and SAI • Feed back from weekly sisters meetings • Correspondence

19. Actively Care