The Fabbest of the Fab (Part 1)

The overall 2015 FabNHSStuff Award Winner

The Safe Staffing App:  Nottingham University Hospitals

This simple, quick to use tool allows the trust to see an accurate, live staffing position from ward to board. The app is pre-programmed with agreed planned staffing for each shift for every ward. At  handover the nurse in charge inputs actual staffing numbers into one of the ward's mobile devices, including how many Trust, bank and agency staff are on duty for both registered nurses and HCA’s.

The app then reports fill rate (we only count staff directly delivering care excluding any supervisory/supernumerary staff), skill mix and highlights if a ward has high numbers of bank and/or agency staff for both both registered nurses and HCA’s. The nurse in charge is then ask to assess if, in their opinion, the ward is staffed safely. If the nurse answers no, the app prompts the nurse to complete a red flag alert. The nurse is able to report a red flag even if all indicators are green.

At any time during the shift the nurse in charge can update the staffing app meaning that the system can show a live staffing position. The app also recognises if a ward has not updated their staffing levels within the agreed timeframe and flags this, prompting a senior nurse review. The system is then able to report fill rates, % trust staff on duty, skill mix and number of wards assessed as safe or prompted to report a red flag at Trust, site, divisional, directorate and ward level so that it is quick and easy to use for all levels of staff who need to review staffing levels.

The reports generated by the app allow rapid assessment of staffing across wards, easily highlighting any wards that need urgent support. The app is supported by a standard operating procedure and a red flag escalation process which guide staff on actions needed to facilitate safe staffing across all our wards.

The app is currently being rolled out across all NUH wards.

For further information contact Ann Marie Riley:

Email: ann-marie.riley@nuh.nhs.uk

Twitter @AnnMarieRiley10

Caron Swinscoe:

Email: caron.swinscoe@nuh.nhs.uk

Twitter: @SwinnyNUH

The Piccalilley Award

'The Singing Sensations' 'Because they want to', 'Nutrition assistants - making a difference', and the 'Wellbeing library' Projects: Northumbria Healthcare NHS Foundation Trust

Annie Laverty explains The Singing Sensations

As a student I can remember being amazed when I first met someone who, due to stroke, was unable to share her name or speak a sentence, and yet could sing an entire song.  I observed how music could act as a powerful bridge to communication allowing carers to reach their loved ones when they are no longer able to use words.

We know that music is a wonderful medium for reminiscing with those with memory loss. While they may not recall every detail from events in the past, certain songs and types of music can stimulate the brain to recall some of the emotions and memories of days past. A powerful and important connection to our sense of self.

The simple act of singing has some physical benefits too, such as improving the flow of oxygen in the body, which can lead to improved alertness, motor control and coordination. We can perhaps all recall a time when music has nurtured the spirit – it can calm and comfort someone in distress, and nursing research has illustrated the part music can play in reducing pain.

All of the above felt like great reasons to warmly welcome the Singing Sensations into our hospital. Joyce and Elaine are two amazing women who are bringing joy and music to ward 23 for the benefit of patients and staff.  Singing groups are held in the day room – a chance to make some noise and reminisce over special songs and cake.

A gentleman arrived at our first singing session feeling very apprehensive.  Joyce noticed his lips moving but no sound was coming out.  Joyce sat next to him for a while until he shared that he didn’t like singing out loud. He could still recall a time at school when his teacher had told him he couldn’t sing and threatened him with punishment if she heard him again.  The special environment created on the ward that day made the gentleman feel safe enough to sing out loud for the first time in over 60 years.

• This is fantastic.  It makes everyone feel happy
•  I loved it. Can I come again?
• This is what it’s all about….seeing people happy
• The day room is a great place to hold the singing – you feel at ease·
•  Loved it.  I’ll come back every time
• It’s lovely for patients – they  come out the day room smiling
• You can hear the music and the singing throughout the ward.  Even patients who aren’t in the day room can hear the music

Elaine and Joyce, we salute you for the time you give to making our NHS a happier place. As Ella Fitzgerald would remind us ‘The only thing better than singing is more singing …’

Because they want to

Annie Laverty outlines the project

My role brings with it the privilege of listening to and acting upon the feedback that we receive from thousands of patients and families every year. I feel very grateful when people take the time to get in touch and to work with us – we know that all feedback, whether good or bad, helps to make us better.

Over time, I’ve learned a lot about the power of stories and the creative use of film and photography in improvement. I’ve witnessed when the emotion they convey hits home, lands hard and silences the room. I’ve also noticed how this information is retained to remind us later to pay attention to the important things. It’s why for me, the soft stuff is never soft. Stories of care at the frontline have taught me about the everyday heroes and the incredible kindness that exists in the NHS despite the pressure, noise and complexity of delivering healthcare.

I wanted to share one of those stories. A gentleman was critically ill in one of our hospitals – he had let the team caring for him know that he wanted to die at home, but they knew his condition meant that he would never survive the journey. Rather than just accept this as a sad fact, staff decided to act swiftly, holding the gentleman’s wishes in mind. Quietly, without fuss, they closed the curtains of all the neighbouring wards that overlooked a small contained garden courtyard – they didn’t seek permission, or do a risk assessment, but they did ensure complete privacy before moving the gentleman outside. Twenty minutes later he didn’t die in hospital, he died in the garden, aware of the summer breeze on his skin, with his wife in his arms.

I want this website to celebrate NHS staff like this. Those – the many – who make decisions every day to do what’s right and to care wholeheartedly by holding the individual in mind – not because they have to but because they want to. It’s who they are. Aren’t they fab and worth shouting about ?

Nutrition assistants - making a difference

Our Nutrition and Dietetic department at Northumbria Healthcare has always promoted good nutrition & hydration for all patients, staff and visitors. Our Nutrition Nurses regularly train staff on the importance of and correct use of the MUST tool and carry out environment audits at mealtimes to give a baseline of good practice within the trust.

In 2011, based on best evidence, our Hip fracture quality improvement programme (HIP QIP) introduced the use of nutrition assistants to successfully improve mortality and patient experience. We wanted to see if this approach would have a similarly powerful effect on medical care of the elderly wards.

Through our Shared Purpose programme, funded by The Health Foundation, we recruited three fantastic individuals – Malcolm, Marc and Michael – whose sole purpose is to promote nutrition, encourage increased intake in an environment where care is personalised and eating and socialising promoted.

Here are just some of improvements they have been part of:

• Ensuring hot, cooked breakfasts, with fresh fruit salad and juice for mid-morning snack
• ‘Come dine with me’ for patients and their families
• Less reliance on alternative nutrition such as ensure drinks
• More reminiscence sessions, tea parties and films over cake
• Preparing packs for our most vulnerable patients over the weekend
• Increased liaison with family members
• More info resources on dementia and delirium available for families
• More active use of the day room
• Weekly snack clubs where families are invited to join in

Feedback has been hugely positive from patients, families and ward staff:

“He’s made such a difference …..it has meant my patients spend time with the same person on a daily basis who can focus on nutrition and give them extra snacks… the patients are cheerful and look forward to seeing his face”

“the ability to eat is not purely about the physical ability or the quality of food, it is about a sense of wellbeing and hope… what seemed like a little kindness in filling mum’s chocolate box was so significant, and she ate them because (you) had given them to her)… thank you for the positive impact you have had on mum’s health”

As well as the improvements to patients’ experience, we’re on target to see our patients receive an extra million calories this year. In a short space of time we have already seen statistically significant improvements – on a ward with a nutritional assistant patients are more likely to gain weight during their hospital stay (p=0.01). The reverse was true prior to the nutrition assistants being recruited.

There is also an exciting trend towards a positive reduction in length of stay, which would indicate that patients are becoming well enough to leave hospital quicker and would more than secure the return on investment.

Further analysis on greater numbers is required to ensure sufficient power behind these early findings relating to length of stay but we remain hopeful and very excited!

Thank you to our nutrition assistants, for all that you are doing and the difference you are making. You’re fab

The Wellbeing Library

Wellness is not a ‘medical fix’ but a way of living – a lifestyle sensitive and responsive to all the dimensions of body, mind, and spirit, an approach to life we each design to achieve our highest potential for well-being now and forever.

When we look at the patients in our wards it’s not unusual to see people who not only medically unwell but feel emotionally unwell too. But when we start to look at the bigger picture we can see why hospital stays occasionally have grown longer and why some patients overall wellbeing has taken a downward turn. This is not the result of poor care, but the fact that we could be doing more to meet the full needs of our patients.

Our teams have continued to find ways where we could be doing more to make a difference to the our patients overall experience. This is where the idea for the wellbeing library began, to create a library within a large hospital to provide the tools and resources needed to really ensure we are looking after our patients, above and beyond what has become the norm.

From using iPads to educate and empower our patients to use apps or to listen to their favourite music to the more low-tech idea of using reminiscence boxes to evoke our patients most cherished memories from the past.

Even though activities have always been available to patients on our wards, we knew we needed to deliver this to staff and patients with a fresh approach. This began by giving our wards a “Fun box” which is full of interactive items which patients and staff can use to engage. The items can be used around their bedside or together in our patients day rooms. Since the very recent rollout, we have received great feedback from staff and patients : –

• This is very important work. We need to embrace and make good use of this service
• Even though the fun box is fairly new to our ward it has already been proven to have a positive impact
• It gives me something to do and it passes time. I like it

We are fully aware that the impact of the resources available will depend on the appropriate delivery and enthusiasm of one to one or group session’s. The project already has the support of senior ward staff and the POAS liaison team.

Our items that are available in the wellbeing library will come with facilitation guides as well as the option of personal assistance when delivering to patients. As this is a relatively new resource in our hospital we are constantly striving to improve the service and will be using QI framework to not only evaluate the current offering but to gain inspiration for further resources.

Resources have up to now been provided by our hospital HVS charitable funds who have kindly offered their full support in future plans or developments. Our vision is to build on what we currently have. The wellbeing library is already very popular amongst our teams and we aim for the use of the resources available to become an integral part of a patients hospital stay.

We believe the vision of the wellbeing library will help to bring our wards together, to create a community within our hospitals and to help us build a caring future. “Smile and the ward smiles with you”