Throughout 2015, the nursing and support team continued to provide holistic health and social care of a personal, individualised and measurable quality to all our residents and patients. Strengthening quality and safety systems was a key priority in our aim to deliver the highest standards of care.
An internal and external recruitment campaign enabled us to provide for the expansion of our rehabilitation bed numbers and strengthen our nurse management structure in order to provide for clinical quality risk and patient safety management.
We continue to actively manage risk both clinical and non-clinical and facilitate patient and resident safety by promoting a culture of proactively monitoring and analysing information from incident reporting, incident reviews, satisfaction surveys, risk registers and clinical audit. Key performance indicators in relation to incident management and reporting are monitored monthly and targets for compliance set.
Health and safety issues are managed by the hospital’s Health and Safety Group. We commenced self-evaluation against the National Standards for Safer Better Healthcare which will result in an action plan for implementation on completion.
EDUCATION AND TRAINING
Undergraduate student nursing placement continued with BSc student nurses carrying out their placement for Care of the Older Person. The team also hosted international students. Clinical practice updates and in-service training was provided in medication management, end of life care, pressure ulcer prevention & wound management, nutrition & swallowing. Staff received training in areas such as health and safety, abuse awareness, infection control, hand hygiene and fire training.
Nursing staff attended the International Association of Gerontology and Geriatrics (IAGG) Conference in April. The RHD submitted two research papers which were accepted for poster presentation.
A number of patient engagement and education projects have been completed throughout the year. The team led by the Nursing Quality Manager developed information leaflets on falls prevention and pressure ulcer prevention for patients, residents, carers and relatives. Information from audits and quality initiatives are shared with patients, relatives and staff on information boards on each unit.
CLINICAL QUALITY IMPROVEMENT IN 2015
There has been strong emphasis on quality improvement throughout the hospital with a number of successful projects taking place. All of these projects are multidisciplinary in nature. We continued to implement the FallSafe quality improvement project introduced in 2014. This project led by our Nursing Quality Manager involves educating and supporting staff to reliably deliver falls prevention, interventions and assessments through care bundles.
Throughout the year, we collected nursing metric data which enabled us to identify areas of good practice and also areas which fell below standards and where improvements were required. Nursing metrics collected and analysed captured compliance with nursing documentation, medication management, mandatory training, falls compliance with care bundles and post fall assessments. The analysed data was communicated to relevant departments and to the hospital management team. The care bundle is evidence based in that individual elements have been used in successful studies of multifactorial interventions to reduce inpatient falls. Another dimension of the falls prevention involves the RHD hospital-wide multidisciplinary team post fall assessment. The number of falls in the RHD has fallen by 36% since commencement of the project.
The RHD is a partner with the National Quality Improvement Programme in the Pressure Ulcer to Zero Collaborative. The RHD nursing and clinical teams have introduced components of the SSKIN Care Bundle. The components of the bundle are Surface, Skin inspection; Keep moving/repositioning, Incontinence & moisture and Nutrition & hydration. Reliably delivering all elements of the care bundle at every care opportunity will improve the pressure area care that a person receives. This will have an impact on improving care outcomes. The introduction of the Pressure Ulcer Safety Cross has raised awareness within each ward regarding how many pressure ulcers are acquired. The aim of this is to influence the team to think about what changes are needed to result in an improvement.
Throughout 2015, service user experience surveys were carried out across all rehabilitation units. The surveys are used by heads of departments and teams to inform quality improvements, where appropriate.
Our complaints process provided our residents and patients with the opportunity to express their concerns when their experiences have not been optimal. In collaboration with the Speech and Language Therapy department, a simplified and aphasia friendly complaints form was produced providing residents and patients with an opportunity to feedback their experience.
The clinical audit programme continued throughout 2015. Priority one audits were completed in areas of medication management, nursing documentation, hand hygiene audit and incident reporting documentation.
As end of life care is central to the mission of the hospital, staff attended training on “what matters to me”. This is a workshop facilitated by the Hospitals Friendly Hospitals programme to improve end-of-life care in residential care settings by enhancing communication skills so staff at all levels are better able to engage in discussions with residents about what is really important to them.
The hospital also hosted a pilot workshop, facilitated by the Irish Hospice Foundation, for families and relatives on “supporting families” and topics included “thinking ahead and decision making in end of life care”. The feedback to the workshop was very positive overall.
Interim Director of Nursing