clinical safecare live: standard operating procedure · 2017-10-31 · clinical . safecare live:...

Clinical

SafeCare Live: Standard Operating Procedure

Document Control Summary

Status: New – replaces Safe Staffing Escalation SOP

Version: V1.0 Date: February 2017

Author/Title: Owner/Title:

Dean King - Project Coordinator Kenny Laing – Deputy Director of Nursing

Approved by: Policy and Procedures Committee Date: 23 March 2017

Ratified: Policy and Procedures Committee Date: 23 March 2017

Related Trust Strategy and/or Strategic Aims

Clinical Strategy

Implementation Date: March 2017

Review Date: March 2018

Key Words: Safe Staffing SafeCare Live Establishment

Associated Policy or Standard Operating Procedures

Safe Staffing Policy Establishment Review SOP

Contents

1. Introduction .......................................................................................................................... 3

2. Purpose ................................................................................................................................... 3

3. Scope .................................................................................................................................... 4

4. Shift by Shift Census Process ..................................................................................................... 5

4.1 SafeCare Live Census Update .................................................................................................. 5

5. Shift by Shift Escalation Process .............................................................................................. 11

6. Process For Monitoring Compliance And Effectiveness ............................................................ 12

7. References ............................................................................................................................ 12

Appendix 1 – Mental Health Dependency Levels ......................................................................... 13

Appendix 2 – Tasks to be recorded within the census on SafeCare system ................................... 14

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Change Control – Amendment History

Version Dates Amendments

0.1 28/02/17 KL review of original SOP draft

0.2 01/03/17 KL amendments following meeting with internal audit team

0.3 02/03/17 DK amendments following conversation with KL

1.0 08/03/17 Minor drafting prior to submission to PPC

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1. Introduction Nursing, midwifery and care staff, working as part of wider multidisciplinary teams, play a critical role in securing high quality care and excellent outcomes for patients. There are established and evidenced links between patient outcomes and whether organisations have the right people, with the right skills, in the right place at the right time. The National Nursing Strategy ‘Compassion in Practice’ emphasised the importance of getting this right, and the publication of the report of the Mid-Staffordshire NHS Foundation Trust Public Inquiry and reviews by Professor Sir Bruce Keogh into 14 trusts with elevated mortality rates, Don Berwick’s review into patient safety, also highlighted the risks to patients of not taking this issue seriously. South Staffordshire & Shropshire Healthcare NHS Foundation Trust (The Trust) is committed to ensuring that service users receive the highest quality care whilst in receipt of services. To ensure that this is achievable there must be sufficient numbers of staff who have the right levels of skills and training who can be deployed responsively to meet service user needs. We take the care of our service users very seriously and already have a number of mechanisms in place to ensure that our wards are safely staffed, including displaying boards for patients and visitors in all of our wards that shows the planned and actual staffing available at the start of every shift. In 2014, a national mandate from the NHS Chief Nursing Officer England and the Care Quality Commission entitled ‘Hard Truths’ outlined 5 commitment which Trusts are required to have in place. The fifth commitment was as follows: “The Trust: • Reviews the actual versus planned staffing on a shift by shift basis • Responds to address gaps or shortages where these are identified • Uses systems and processes such as e-rostering and escalation and contingency plans to make the most of resources and optimise care”. This SOP outlined how the Trust meets that commitment. 2. Purpose

This SOP is intended to describe a set of procedures which enable staff members to understand the steps which are required to ensure that there is adequate staff working on each shift to meet patients’ needs. Also, when the usual staffing levels are not in place and/or that the usual staffing levels are insufficient to meet patient needs due to increased demand that staff are clear about how to escalate this for support to senior nurses and managers to identify and redeploy human resources to maintain safety as and when necessary.

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3. Scope This SOP applies to all qualified nursing staff who are working in or have responsibility or accountability for clinical inpatient services. There are specific accountabilities for the following staff members: Nurse in charge of each shift

• During the shift and prior to handover, consideration should be given to the dependency level of each of the patients on the ward.

• The Census on SafeCare Live must be updated during each shift. This can be done at any time, but might show as ‘Predicted’. This input must be made ‘Actual’ UP TO 90 MINUTES before the start of the Census period. The Census period timings are visible on the system pages, and explained below in 4.1.2. This means the Nurse in Charge is giving due consideration to the staffing requirements for the oncoming shift.

• Makes decisions about real time management of staff and escalates concerns as necessary. SafeCare Live can be updated at any time to reflect real time situation. This would then show a ‘Predicted’ figure for the oncoming shift which would need to be made ‘Actual’.

Ward Managers

• Responsible for ensuring that all registered nurses within their area of responsibility are trained in the use of SafeCare Live and are undertaking their Census activity as required as part of routine supervision.

• Notify E-Rostering and Supplementary Nurse Staffing team when any changes to bed numbers are made.

Site Managers (St Georges and Redwoods Centre)

• Reviews the adequacy of staffing across each site on a shift by shift basis • Redeploys staff across the wards as necessary based on demands relating to patient

dependency and actual staffing as indicated by the SafeCare system. • Oversees compliance with census recording across all wards and contacts nurse in

charge where census has not been completed

Matrons

• Respond to staffing issues escalated by wards and or site managers, making decisions which require additional authority or resource to resolve specific staffing issues

• Monitor patterns of staffing across their areas of responsibility over time and ensure actions are taken to address any deficits identified

• Undertake occasional census reviews on wards to ensure consistency in scoring, addressing any deficits in staff knowledge and skills as necessary.

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• Escalate any staffing concerns which cannot be managed within the resources available on site to Deputy Director of Nursing/ Director of Nursing as necessary

On call Managers

• Respond to staffing issues escalated by wards and or site managers, making decisions which require additional authority or resource to resolve specific staffing issues when called upon to do so out of hours

4. Shift by Shift Census Process The diagram below indicates the steps to be undertaken and those responsible to ensure that staffing levels are managed on a shift by shift basis:

4.1 SafeCare Live Census Update

The following pages give a pictorial explanation as to how to update the census.

The following overarching guidelines should be used.

4.1.1. Census should be updated 3 times per day, AM, PM and NIGHT.

4.1.2. There is a 90 minute window before the Census period for making any ‘Predicted’ data into ‘Actual’.

Census Period Census Period Times Data inputted and made ACTUAL between:

AM 0730 - 1300 0600 - 0730

PM 1300 - 2030 1130 -1300

Ward Nurse in Charge

• Nurse in Charge updates SafeCare Live Census and makes 'Actual' up to 90 minutes before start of next shift.This gives an indication of satffing shortfalls or otherwise.

• Use instructions as at Section 4.1 of this SOP.

Nurse in Charge

• In the event of a staffing shortfall, Nurse in Charge resolves or escalates in line with local arrangements.

Site Manager

• On commencing each shift, review each ward's staffing status and census compliance to ensure safe staffing levels across the hospital site.

• Where census data has not been inputted, contact ward to ensure census is completed.

• Redeploy staff as neccessary to ensure safe staffing is maintained.

• Escalate unresloved clinical risk and issues followning the Shift by Shift Staffing Escalation Process

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NIGHT 2030 - 0730 1900 -2030

4.1.3. The system will predict staffing two shifts forward of the shift that you are inputting. This means that assuming dependency / acuity doesn’t change, all that would be required would be to make the ‘Predicted’ data ‘Actual’ by pressing SAVE.

4.1.4. The inputting of dependency levels for each patient on the ward during the census period are the method by which the SafeCare system calculates how many nurses and care staff are required to provide safe care for the next shift.

4.1.5. The dependency level descriptors are available in Appendix 1 of this SOP and provide guidance as to the presentation of patients in each Dependency Level.

4.2 Census Update – Aide Memoire (any queries or advice should be directed to the Trust E-Rostering and Supplementary Staffing Team)

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NOTE ; You can input actual data within 90 minutes of the upcoming shift. The system will then ‘predict’ that information for the following two shifts. This will need to be actualised by pressing ‘save’ as on the next page.

You will be presented with a page corresponding to your Ward / Unit.

Update Census by pressing ‘Update Census’

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For Task Types see Appendix 2

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Once ‘Save’ is pressed, the system updates the dependency page as above. It also shows excess hours or otherwise.

Figures in GREEN indicate a SAFE state, possibly excess hours.

Figures in RED indicate UNSAFE state, shortfall.

Figures in BLACK indicate staffing is within 10% either side of SAFE

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Staff Names Appear Here

Figure 5

On the same page, it is possible to scroll down to see Rostered staff, Unfilled duties, Next Shift Status and Unavailability.The BLUE arrows indicate more information can be accessed.

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5. Shift by Shift Escalation Process

NO YES

YES

NO YES

YES

Gap Identified on Ward:

No internal solution

Able to use inter ward swaps and remain safe?

Site Manager Informed

Flexible staffing shift requested Staff Moved. Update E-Roster / SafeCare Live

Gaps Filled?

Staff moved. Update E-Roster / Safe-Care Live. Complete Incident Form.

Unresolved significant risks remain

Site Manager to escalate to Matron / Manager on Call for resolution or additional authority to resource

Significant risks remain

If unable to resolve, escalate to executives, consider Business Continuity Plans and Major Incident Protocols.

NO

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6. Process For Monitoring Compliance And Effectiveness Compliance with this SOP will be monitored by lead site managers at the Redwoods Centre, Shrewsbury and St Georges, Stafford. This will be undertaken by reviewing Safe Care Live data and comparing with actual staffing levels on the wards on a daily basis.

7. References Department of Health (2014) Hard Truths The Journey to Putting Patients First; Online: 05.03.15

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/270368/34658_Cm_8777_Vol_1_accessible.pdf

Frances R (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, Online: 05.03.15

http://www.midstaffspublicinquiry.com/report

National Quality Board (2013) How to ensure the right people, with the right skills, are in the right place at the right time; A guide to nursing, midwifery and care staffing capacity and capability. NHS England. Online: 05.03.15

http://www.england.nhs.uk/wp-content/uploads/2013/11/nqb-how-to-guid.pdf

NHS England (2014) Safer Staffing: A Guide to Care Contact Time, NHS England, Online 05.03.15

http://www.england.nhs.uk/wp-content/uploads/2014/11/safer-staffing-guide-care-contact-time.pdf

Royal College of Nursing (2010) Guidance on safe nurse staffing levels in the UK, RCN Online: 05.03.15

http://www.rcn.org.uk/__data/assets/pdf_file/0005/353237/003860.pdf

Mental Health and learning Disability inpatient and community Staffing tools

http://wm.hee.nhs.uk/our-work/our-letcs/mental-health-institute-letc/%E2%80%A2mhi-letc-workforce-development-plan/safer-staffing/

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Appendix 1 – Mental Health Dependency Levels

Dependency- acuity C

ategory

Care Level Descriptors 1. General observations. Self-caring service users who are able to do most daily

living activities unaided. Core therapeutic interventions are provided.

2. General observations. More dependent on ward staff for his/her personal care needs. Requires more than base-level core interventions.

3. May be on intermittent observations. Heavily reliant on ward team for his/her safety and care.

4. May be on intermittent observations or 1-1 observations for part of the day. Dependent on the ward team for his/her safety and care. Requires high engagement and intervention.

5. Enhanced observations - requires 24 hours 1-1 observation and engagement



Note – where a patient presentation and/or observation levels change throughout the shift, then the dependency level which is correct for the longest period of time during the shift should be recorded.

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Appendix 2 – Tasks to be recorded within the census on SafeCare system

Tasks

Tasks are activities that take nursing staff off the ward for more than 30 minutes, but are not associated with a service user from that ward.

Tasks are set up with a minimum length of time that they were carried out for. They should be entered in blocks of the indicated times in brackets.

Task Types

ECT (X 4 hours)

Escorting Contractor (x 1hour)

Escorts for Another Ward (x 30 mins)

Patient Escorts External (x 1 hour)

Section 136 (x 4 hours)

Notes

In this section you can make any narrative comments to support your data entry.

clinical safecare live: standard operating procedure · 2017-10-31 · clinical . safecare live:...

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