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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