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#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
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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)
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NUH focus
• Shared Governance (circa 55 councils)
• Chief Nurse Fellows
• Research and Education
• Clinical Academic Careers
• Magnet Programme
• Strong PPI collaboration
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NUH focus
• Value patient time
• Prevent unnecessary delay
• Prevent patients leaving hospital
less able then when they entered it
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#last1000days
How many of your last 1000 days would you want to spend in hospital?
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•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
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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
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Radiology delays
Number of Radiology delays Linear (Number of Radiology delays)
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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
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• 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
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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
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Team responses:
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Organisational response:
• endPJparalysis included in NUH’s
quality priorities
• Also forms part of our patient safety
strategy
• Incorporated into new electronic
documentation
• Datix reporting
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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
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