Download monthly report - Wye Valley NHS Trust

Report to:
Date of Meeting:
Title of Report:
Trust Board Meeting “in public”
Agenda item: 11
3 November 2015
Exception Report for Expected and Actual Staffing for
Nursing, Midwifery and Care Staffing (Ward Areas)
Status of report:
Information
(decision and approval, position statement,
information, confidential discussion)
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 September 2015
Appendix B – Nurse Sensitive Indicators September 2015
1. Purpose of the report
To inform the Trust Board of the ward areas that didn’t meet the expected staffing requirements in August 2015.
This relates to Board Assurance Risk Number 417. Risk to recruitment of new staff and retaining current staff.
2. Recommendations
The Trust Board are asked to note the content of the report.
3. Summary of Key Issues for discussion
The majority of shift fill rates were between 90 and 100%. There were however a number of overfill shifts
predominantly within the HCA workforce; with variability between 110% - 157.5%. Again the main reason for
overfill was to cover the shortfall in RGNs in those areas but also due to an increased need for high dependency
care largely due to confused patients. Wye ward in particular had a high usage of HCAs on nights to support both
high dependency patients and vacancies.
Fill rates in some clinical areas for registered staff have been below 90 % although this is down on last month (8
occasions last month and 6 occasions this month). This is mainly due to vacancies and high sickness rates and the
inability to provide bank and agency back fill. Lugg ward reported a fill rate below 80% mainly due to unfilled
agency shifts. Teme report an under fill of 42.5% for HCAs at night due to reduced activity and capacity. Their
HCAs were redeployed to other areas.
A review from the Director of Nursing and Quality, in relation to Hillside and Leominster Community Hospitals,
has identified that both have now successfully recruited band 5 nurses (Leominster 2 WTE and Hillside 1 WTE)
and are starting within the next month. This leaves no band 5 vacancies at Hillside and 1.44 WTE vacancies at
Leominster.
Nurse sensitive Indicators (NSI)
This month’s NSIs has seen an increase in a number of indicators including complaints and slips, trips and falls, C
diff and Drug errors. These results coincide with an exceptionally high agency usage rate for the month of
September, coupled with periods of high intensity patient flow which therefore may have impacted on the
results. The Trust continues to be MRSA free.
Pressure Ulcers
There has been no reported incidence of level 3 and 4 pressure ulcers this month.
Slips Trips and Falls.
There has been a significant increase in slips, trips and falls this month with the majority of inpatient areas
reporting an increase in the number of incidents. The exceptions to this are Redbrook ward, Ross Community
Hospital and Bromyard Community hospital which have seen a reduction by 3, 1 and 1 respectively.
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. Some of the falls occurred to patients who were
not deemed to be high risk with most involving incidents in the bathroom when patients were having their
morning wash. Going forward, staff will be instructed to ensure patients are safe to leave on their own and that
there are no hazards in the environment such as a wet floor. It is also important to note that challenging staffing
requirements may have also contributed to the increased incidents across the Trust.
In August’s Safer Staffing report the Nursing Director informed the committee that they had asked for the data
collection tool used on datix to be updated to capture more details about incidents of falls which will include
location, if a risk assessment was undertaken, what measures have been put in place including specialing and
intentional rounding . This is now in place.
Drug Errors
There has been an increase in reported drug errors (+5) on the previous month. On further investigation the
report shows that all County Hospital inpatient areas have reported drug errors with either 1 or 2 errors
occurring on each ward. Both Lugg ward and Frome ward have shown a slight decrease in errors. Wye ward and
Leominster Community Hospital reporting 1 each. 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 EDC. None of the drug errors resulted in significant harm to the patients
involved.
Infection Control
There has been 1 reportable clostridium difficle case in September.
Friends and Family test
The majority of clinical areas are in the green percentile in the response rate to the Friends and Family test.
Over 97% and 99% of respondents for inpatient and community hospitals respectively would recommend us to
their friends and family which is an improvement on last month.
NSI for Neighbourhood Teams, School Nursing and Health Visiting
The DONQ agreed to submit NSI for Neighbourhood Teams, School Nursing and Health Visiting on a quarterly
basis. The data for September shows the majority of indicators are green across all areas; however there has
been 2 drug errors within the neighbourhood teams along with 1 slip, trip and fall and 1 grade 3&4 pressure
Ulcer.
Additional Information
There are new agency rules from the TDA and Monitor. From the 19th October Trusts are restricted in the type of
nurse agencies they can use and a cap has been implemented on ceilings of agency spend. This significantly
impacts on the Trusts use of off framework agencies (i.eThornbury) and also our maximum monthly agency
spend (reduced agency spend by over £200,000 a month to meet the new 10% cap). The Trust has applied for a
3 month extension on the use of off framework agencies, but to date we have not received a reply.
In the meantime the Trust is required to retrospectively submit a Board approved monthly report and evidence
based action plan to reduce usage and spend to the TDA. The DONQ in conjunction with the DOF and the DOPD
has set up a task and finish group to develop and implement an action plan to reduce agency over the next 3 to 6
months.
4. For further information or any enquires relating to this report please contact:
Michelle Clarke, Director of Nursing & Quality, [email protected]
Or
Paul Hooton, Deputy Director of Nursing [email protected]
5. 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