Improving the dignity of older people in hospital: Aintree University Hospital NHS Foundation Trust
Dignity in care is a major theme of media concern, government action and regulatory attention. Aintree University Hospital NHS Foundation Trust has concentrated on working and engaging with its staff to provide simple but effective solutions to help improve the treatment, dignity and care of older people.
Aintree University Hospital NHS Foundation Trust serves 330,000 residents in north Merseyside and surrounding areas. These areas are some of the most socially deprived communities in the country and have highest rates for heart disease and cancer in the UK. .
The Trust noted that patient experience within the institution varied between health professionals, wards and departments. To improve quality throughout a staff survey was conducted to find out what stops nursing staff from delivering quality care. Key points identified were:
- An overwhelming volume of paper work.
- Newly developed IT systems requiring enhanced IT skills for nurses.
- Constant interruptions and demands from other staff – bed managers, discharge planners, matrons, managers and ward rounds.
- Early discharge drive.
- Hard to find time and energy to remedy poor performance.
In consultation with staff the following initiatives were undertaken.
1 ‘Nursing quality think tanks’. The Trust held a series of meetings with nursing staff which aimed to address why they chose to become nurses and what they hoped to achieve each day. Many nurses said achieving their hopes and daily ambitions were difficult due to challenges outlined above.
2 Working with the Picker Institute. The Trust worked with the patient engagement think tank the Picker Institute to help improve patient care and the information patients received. Initiatives included more patient information leaflets, frequent discussions between the ward pharmacists and patients to discuss medications that patients were receiving and finally, fridge magnets for patients with a contact number for any queries they may have about any medicines or side effects once discharged from the Trust.
3 Ward based solutions. Following these discussions the following mechanisms were introduced for the following problems.
|Challenge/problem as identified by staff||Solution|
‘We are swamped with paperwork, it takes us away from the bedside’
‘I want to be able to spend more time with my patients’
Switch to electronic patient records and discharge letters to GPs and patient.
Reduced nursing assessments using electronic systems (e.g. MUST tool) to capture information.
Improved information on patient discharge.
‘The ward is so busy, the phone rang 37 times in two hous'
'Where have the protected mealtimes gone?'
'Do we understand our patients?'
Training of 92 volunteers to help to feed patients.
Volunteer manning of ward phones.
One family member to ring the ward.
Nurses stations in bays with computers to help improve contact with patients
4 Valuing and celebrating staff. Critical to the achievement of change was engagement, valuing and integrating staff in solutions:
- A change in focus, away from complaints and towards compliments to celebrate across the Trust and up to Board level the exemplary practice often exhibited by Trust staff.
- Encouraging patients to complete Have I Made a Difference Cards about the care they received by healthcare staff. To date in excess of 700 cards have been completed and a quarterly prize is awarded. In December 2011 an annual winner was nominated and presented at the Trusts annual celebration ceremony.
- Recognition that it is “the coal face staff” who understand how things can be improved in clinical areas. Each ward now has a designated Patient Safety Officer who spends one day each week focussed entirely on enhancing the safety and quality of care.
- Redesign of the care and compassion strategy.
Lessons learnt and changes to practice
A clear theme from the focus groups was a desire to return to the essentials of nursing, and so a ‘Care and Compassion’ strategy was developed by the senior nursing team in conjunction with ward staff. This was subsequently launched at a quality conference, ‘Safe in Our Hands’ in March 2012. This was a joint venture with Edge Hill University and the invitations was extended to health professionals (nurses, doctors, allied health professionals) as well as students and lecturers from the university.
Business cards are issued to patients on discharge with the ward contact details should they require additional post discharge information/support.
The Trust has designed fridge magnets shaped like a medication capsule with key drug details; these are included in all pharmacy take home bags.
The Trust has seen a reduction in complaints in the department of elderly medicine. A subsequent unannounced CQC visit to two of these wards reported on many areas of excellence in providing dignity and respect to older patients.
Maintaining the high quality care that is provided at the Trust is one of constant vigilance and desire to improve. While the improvements have made a positive and noticeable difference which is supported by patient surveys the Trust realise that they are only as good as the experience of the last patient who was discharged from the hospital.
jill [dot] byrne [at] aintree [dot] nhs [dot] uk (Jill Byrne), Director of Nursing, Aintree University Hospitals NHS Foundation Trust.