#endPJparalysis the NUH story Ann-Marie Riley · Bit about NUH: • The health of people in...

#endPJparalysis – the NUH story

Ann-Marie Riley

Bit about NUH:

• The health of people in Nottingham

is generally worse than the England

average

• Life expectancy for both men and

women is lower than the England

average (approx. eight years)

• Serve a population of 2.5m with

general services and 3-4m with

specialist services

• Circa 15,000 staff of which around

4500 are RN/RMs

• Circa 1700 beds served across two

main inpatient sites

2

Magnet Principles

Magnet Designation is the highest international

distinction a healthcare organisation can receive

for nursing excellence and quality of care that is

delivered (ANCC 2013)

It provides a benchmark framework to an create

optional healthcare work environment that

achieves extraordinary workplace cultures,

delivers the highest standards of care and, most

importantly, achieves exemplary patient

outcomes

(ANCC 2013)

3

4

NUH focus

• Shared Governance (circa 55 councils)

• Chief Nurse Fellows

• Research and Education

• Clinical Academic Careers

• Magnet Programme

• Strong PPI collaboration

5

NUH focus

• Value patient time

• Prevent unnecessary delay

• Prevent patients leaving hospital

less able then when they entered it

6

#last1000days

How many of your last 1000 days would you want to spend in hospital?

7

•A Trust wide project focusing on reducing

internal and external delays for all of our

patients

•A 'red' day is when nothing positively

contributes to minimising a patient's

length of stay in hospital; inlcudes delays

over 24hrs

•A 'green' day gets patients closer to

being medically safe and going home or to

a more appropriate place of care

8

9

10

11

At NUH the primary focus was to reduce our internal red delays. Radiology department changed the way they prioritised emergency patients and also introduced a three times a day proactive management of their patients meeting resulting in a reducing trend of patients waiting for scans

0.0010.0020.0030.00

RG

Dat

e

02/05…

04/05…

06/05…

08/05…

10/05…

12/05…

14/05…

16/05…

18/05…

20/05…

22/05…

24/05…

26/05…

28/05…

30/05…

01/06…

03/06…

05/06…

07/06…

09/06…

11/06…

13/06…

15/06…

17/06…

19/06…

21/06…

23/06…

25/06…

27/06…

29/06…

01/07…

03/07…

05/07…

07/07…

09/07…

11/07…

13/07…

15/07…

17/07…

19/07…

21/07…

23/07…

25/07…

27/07…

29/07…

31/07…

Radiology delays

Number of Radiology delays Linear (Number of Radiology delays)

12

Deconditioning

Could this be happening in your area?

• Hospitalised older patients are 61 times more

likely to develop disability in ADLs than those not

hospitalised

• 17% of older medical patients who were walking

independently 2 weeks prior to admission needed

help to walk on discharge

• Patients spend up to 83% of their time in bed, 12%

in a chair

• For 60% of patients on bed rest there is nothing

documented to explain why13

14

• 50% of older patients experience

functional decline between

admission and discharge

• 50% of older patients become

incontinent within 24 hours of

admission to hospital

• Deconditioning contributed to

delayed discharge in more than

47% of older patients

• Once discharged only 30% of those

with a new or additional ADL

disability were back to baseline after

one year

15

Team responses:

• CNF review of neutropenic sepsis pathway –

reduced LOS, AB usage and cost (Cancer services)

• E+F supporting laundry service pilot (Stroke

services)

• Clothes banks (across 3 divisions)

• Continence focus –all areas

• Development of new harm free matron role

(Corporate)

• Enhanced supervision policy development (T+O)

• Nurse facilitated discharge

• Garden revamp for cancer patients

16

Team responses:

17

Organisational response:

• endPJparalysis included in NUH’s

quality priorities

• Also forms part of our patient safety

strategy

• Incorporated into new electronic

documentation

• Datix reporting

18

Patients:

• PPI involvement in every aspect of our

endPJparalysis work

• PPI led patient and carer information

sheet

• Agreement to follow the same three

principles across providers

• Where we can we engage public of

Nottingham

• Utilise opportunities to share work via

local radio, newspaper and TV

19