Re: risk assessment for staff shortage

[Guest guest]

The indicators from acute care are sentinel events which shouldn't

happen at all under ideal circumstances. Like pressure sores, it's

debatable whether any level is tolerable.

In terms of health visiting, I did try and think through similar

events a few years back, but since health visiting isn't one of those

instrumental trades which can be cosidered to be in control of the

care and the environment of care, attribution of causes is trickier.

But knowing Senate colleagues, they'll have suggestions for these -

here are my vague ideas:

Late identification of developmental delays which should've been

apparent at an earlier age;

Early weaning;

Postnatal depression diagnosed later than 3 months postnatally;

Failure to thrive without a referral;

Delayed immunisation without appropriate reason;

Growth of less than 3rd centile at any time in first year of life.

They'd need much clearer specification & the confounding problems

clearing up. Not easy.

From: Cowley <sarahcowley183@...>

Date sent: Fri, 30 Mar 2012 14:25:49 +0100

Subject: risk assessment for staff shortage

Send reply to:

We are all hoping for great improvements in staff numbers soon and

the interim workforce figures from the NHS Information Centre for

Health and Social Care record a very small rise in health visitors

(from 7941 in September 2011 to 8065 inDecember) and an even smaller

rise for school nurses (from 1165 to 1170). The rise for health

visitors is particularly significant, because up to now, there have

been consistent falls in the numbers, so that trends has been halted

and reversed, butI would not expect this to be sustained ahead of

the large cohort of health visitor students qualifying in September.

I have been asked, though, 'what do we do in the mean time?'Does

anyone have a system for assessing risk from the shortage of staff?

The question has come to me a couple of times from people who are

used to well established risk assessment tools used in acute care,

where measures of things like deaths, falls, infections etc, can give

a clear indication

[Guest guest]

Many thanks for your thoughts . I think this is a useful list of 'quality markers,' but guess the challenge is to sell them (or failure to achieve positive progress on them) as a 'risk,' largely because of that attribution issue. I think a few - late identification of developmental delay, failure to thrive without a referral (possibly needs a timeline?), failure to identify PND (although I thought it sometimes manifested itself later?) - could clearly be viewed as having immediate risk and cost consequences, so have a great deal of promise. I wonder if anyone has actually worked this through - perhaps when arguing for more staff or more money or anything else or for a change of practice anywhere?Certainly, I am unaware of any substantial research on the matter, which I think is a big gap. Coincidentally, a colleague in the NNRU at King's forwarded to me yesterday an email message from a Designated Nurse/safeguarding children, responding to their most recent circular, which read:"Is it time to set minimum nurse staffing levels in English hospitals? Increasing economic pressures on healthcare systems raise concerns about how workforce cuts and reconfigurations may affect quality [1]. Currently there are no centrally set minimum staffing levels for National Health Service organisations; providers are responsible for determining staffing requirements locally. In this Policy+ we look at the impact mandated minimum Registered Nurse (RN) staffing levels have had in other countries and consider current guidelines and recommendations. http://www.kcl.ac.uk/nursing/research/nnru/Policy/Currentissue/index.aspx " The Designated Nurse/correspondent acknowledged the recent scandals in acute, particularly elderly care, but wanted to draw attention to the issue for health visitors and school nurses, because of their inability to provide the early interventions needed to prevent children and families tipping into child protection. best wishesOn 30 Mar 2012, at 18:03, hwood@... wrote: The indicators from acute care are sentinel events which shouldn't happen at all under ideal circumstances. Like pressure sores, it's debatable whether any level is tolerable. In terms of health visiting, I did try and think through similar events a few years back, but since health visiting isn't one of those instrumental trades which can be cosidered to be in control of the care and the environment of care, attribution of causes is trickier. But knowing Senate colleagues, they'll have suggestions for these - here are my vague ideas: Late identification of developmental delays which should've been apparent at an earlier age; Early weaning; Postnatal depression diagnosed later than 3 months postnatally; Failure to thrive without a referral; Delayed immunisation without appropriate reason; Growth of less than 3rd centile at any time in first year of life. They'd need much clearer specification & the confounding problems clearing up. Not easy. To: From: Cowley <sarahcowley183@...> Date sent: Fri, 30 Mar 2012 14:25:49 +0100 Subject: risk assessment for staff shortage Send reply to: We are all hoping for great improvements in staff numbers soon and the interim workforce figures from the NHS Information Centre for Health and Social Care record a very small rise in health visitors (from 7941 in September 2011 to 8065 inDecember) and an even smaller rise for school nurses (from 1165 to 1170). The rise for health visitors is particularly significant, because up to now, there have been consistent falls in the numbers, so that trends has been halted and reversed, butI would not expect this to be sustained ahead of the large cohort of health visitor students qualifying in September. I have been asked, though, 'what do we do in the mean time?'Does anyone have a system for assessing risk from the shortage of staff? The question has come to me a couple of times from people who are used to well established risk assessment tools used in acute care, where measures of things like deaths, falls, infections etc, can give a clear indication Cowleysarahcowley183@...http://myprofile.cos.com/S124021COn

[Guest guest]

http://www.kcl.ac.uk/nursing/research/nnru/Policy/Currentissue/PolicyIssue34.pdf http://www.hpm.org/Downloads/Symposium_2009/Conis_Filling_the_Gaps.pdf From: [mailto: ] On Behalf Of CowleySent: 31 March 2012 09:18 Subject: Re: risk assessment for staff shortage Many thanks for your thoughts . I think this is a useful list of 'quality markers,' but guess the challenge is to sell them (or failure to achieve positive progress on them) as a 'risk,' largely because of that attribution issue. I think a few - late identification of developmental delay, failure to thrive without a referral (possibly needs a timeline?), failure to identify PND (although I thought it sometimes manifested itself later?) - could clearly be viewed as having immediate risk and cost consequences, so have a great deal of promise. I wonder if anyone has actually worked this through - perhaps when arguing for more staff or more money or anything else or for a change of practice anywhere? Certainly, I am unaware of any substantial research on the matter, which I think is a big gap. Coincidentally, a colleague in the NNRU at King's forwarded to me yesterday an email message from a Designated Nurse/safeguarding children, responding to their most recent circular, which read: " Is it time to set minimum nurse staffing levels in English hospitals? Increasing economic pressures on healthcare systems raise concerns about how workforce cuts and reconfigurations may affect quality [1]. Currently there are no centrally set minimum staffing levels for National Health Service organisations; providers are responsible for determining staffing requirements locally. In this Policy+ we look at the impact mandated minimum Registered Nurse (RN) staffing levels have had in other countries and consider current guidelines and recommendations. http://www.kcl.ac.uk/nursing/research/nnru/Policy/Currentissue/index.aspx " The Designated Nurse/correspondent acknowledged the recent scandals in acute, particularly elderly care, but wanted to draw attention to the issue for health visitors and school nurses, because of their inability to provide the early interventions needed to prevent children and families tipping into child protection. best wishes On 30 Mar 2012, at 18:03, hwood@... wrote: The indicators from acute care are sentinel events which shouldn't happen at all under ideal circumstances. Like pressure sores, it's debatable whether any level is tolerable.In terms of health visiting, I did try and think through similar events a few years back, but since health visiting isn't one of those instrumental trades which can be cosidered to be in control of the care and the environment of care, attribution of causes is trickier. But knowing Senate colleagues, they'll have suggestions for these - here are my vague ideas:Late identification of developmental delays which should've been apparent at an earlier age;Early weaning;Postnatal depression diagnosed later than 3 months postnatally;Failure to thrive without a referral;Delayed immunisation without appropriate reason;Growth of less than 3rd centile at any time in first year of life.They'd need much clearer specification & the confounding problems clearing up. Not easy. From: Cowley <sarahcowley183@...>Date sent: Fri, 30 Mar 2012 14:25:49 +0100Subject: risk assessment for staff shortageSend reply to: We are all hoping for great improvements in staff numbers soon and the interim workforce figures from the NHS Information Centre for Health and Social Care record a very small rise in health visitors (from 7941 in September 2011 to 8065 inDecember) and an even smaller rise for school nurses (from 1165 to 1170). The rise for health visitors is particularly significant, because up to now, there have been consistent falls in the numbers, so that trends has been halted and reversed, butI would not expect this to be sustained ahead of the large cohort of health visitor students qualifying in September. I have been asked, though, 'what do we do in the mean time?'Does anyone have a system for assessing risk from the shortage of staff? The question has come to me a couple of times from people who are used to well established risk assessment tools used in acute care, where measures of things like deaths, falls, infections etc, can give a clear indication Cowleysarahcowley183@...http://myprofile.cos.com/S124021COn University Campus Suffolk is the trading name of University Campus Suffolk Ltd. Registered in England and Wales, company number: 05078498.

Registered Address: Waterfront Building, Neptune Quay, Ipswich, IP4 1QJ

[Guest guest]

http://www.rcn.org.uk/__data/assets/pdf_file/0009/439578/03.12_Mandatory_nurse_staffing_levels_v2_FINAL.pdf http://www.arnbc.ca/blog/tag/primary-care/feed/ From: [mailto: ] On Behalf Of CowleySent: 31 March 2012 09:18 Subject: Re: risk assessment for staff shortage Many thanks for your thoughts . I think this is a useful list of 'quality markers,' but guess the challenge is to sell them (or failure to achieve positive progress on them) as a 'risk,' largely because of that attribution issue. I think a few - late identification of developmental delay, failure to thrive without a referral (possibly needs a timeline?), failure to identify PND (although I thought it sometimes manifested itself later?) - could clearly be viewed as having immediate risk and cost consequences, so have a great deal of promise. I wonder if anyone has actually worked this through - perhaps when arguing for more staff or more money or anything else or for a change of practice anywhere? Certainly, I am unaware of any substantial research on the matter, which I think is a big gap. Coincidentally, a colleague in the NNRU at King's forwarded to me yesterday an email message from a Designated Nurse/safeguarding children, responding to their most recent circular, which read: " Is it time to set minimum nurse staffing levels in English hospitals? Increasing economic pressures on healthcare systems raise concerns about how workforce cuts and reconfigurations may affect quality [1]. Currently there are no centrally set minimum staffing levels for National Health Service organisations; providers are responsible for determining staffing requirements locally. In this Policy+ we look at the impact mandated minimum Registered Nurse (RN) staffing levels have had in other countries and consider current guidelines and recommendations. http://www.kcl.ac.uk/nursing/research/nnru/Policy/Currentissue/index.aspx " The Designated Nurse/correspondent acknowledged the recent scandals in acute, particularly elderly care, but wanted to draw attention to the issue for health visitors and school nurses, because of their inability to provide the early interventions needed to prevent children and families tipping into child protection. best wishes On 30 Mar 2012, at 18:03, hwood@... wrote: The indicators from acute care are sentinel events which shouldn't happen at all under ideal circumstances. Like pressure sores, it's debatable whether any level is tolerable.In terms of health visiting, I did try and think through similar events a few years back, but since health visiting isn't one of those instrumental trades which can be cosidered to be in control of the care and the environment of care, attribution of causes is trickier. But knowing Senate colleagues, they'll have suggestions for these - here are my vague ideas:Late identification of developmental delays which should've been apparent at an earlier age;Early weaning;Postnatal depression diagnosed later than 3 months postnatally;Failure to thrive without a referral;Delayed immunisation without appropriate reason;Growth of less than 3rd centile at any time in first year of life.They'd need much clearer specification & the confounding problems clearing up. Not easy. From: Cowley <sarahcowley183@...>Date sent: Fri, 30 Mar 2012 14:25:49 +0100Subject: risk assessment for staff shortageSend reply to: We are all hoping for great improvements in staff numbers soon and the interim workforce figures from the NHS Information Centre for Health and Social Care record a very small rise in health visitors (from 7941 in September 2011 to 8065 inDecember) and an even smaller rise for school nurses (from 1165 to 1170). The rise for health visitors is particularly significant, because up to now, there have been consistent falls in the numbers, so that trends has been halted and reversed, butI would not expect this to be sustained ahead of the large cohort of health visitor students qualifying in September. I have been asked, though, 'what do we do in the mean time?'Does anyone have a system for assessing risk from the shortage of staff? The question has come to me a couple of times from people who are used to well established risk assessment tools used in acute care, where measures of things like deaths, falls, infections etc, can give a clear indication Cowleysarahcowley183@...http://myprofile.cos.com/S124021COn University Campus Suffolk is the trading name of University Campus Suffolk Ltd. Registered in England and Wales, company number: 05078498.

Registered Address: Waterfront Building, Neptune Quay, Ipswich, IP4 1QJ

[Guest guest]

Thanks , these are useful links for anyone wanting to follow up the need to improve staffing levels in hospitals. I didn't see any reference to risk assessments for health visiting or school nursing work, unless I missed it?best wishesOn 31 Mar 2012, at 19:52, Fogarty wrote: http://www.rcn.org.uk/__data/assets/pdf_file/0009/439578/03.12_Mandatory_nurse_staffing_levels_v2_FINAL.pdf http://www.arnbc.ca/blog/tag/primary-care/feed/ From: [mailto: ] On Behalf Of CowleySent: 31 March 2012 09:18 Subject: Re: risk assessment for staff shortage Many thanks for your thoughts . I think this is a useful list of 'quality markers,' but guess the challenge is to sell them (or failure to achieve positive progress on them) as a 'risk,' largely because of that attribution issue. I think a few - late identification of developmental delay, failure to thrive without a referral (possibly needs a timeline?), failure to identify PND (although I thought it sometimes manifested itself later?) - could clearly be viewed as having immediate risk and cost consequences, so have a great deal of promise. I wonder if anyone has actually worked this through - perhaps when arguing for more staff or more money or anything else or for a change of practice anywhere? Certainly, I am unaware of any substantial research on the matter, which I think is a big gap. Coincidentally, a colleague in the NNRU at King's forwarded to me yesterday an email message from a Designated Nurse/safeguarding children, responding to their most recent circular, which read: "Is it time to set minimum nurse staffing levels in English hospitals? Increasing economic pressures on healthcare systems raise concerns about how workforce cuts and reconfigurations may affect quality [1]. Currently there are no centrally set minimum staffing levels for National Health Service organisations; providers are responsible for determining staffing requirements locally. In this Policy+ we look at the impact mandated minimum Registered Nurse (RN) staffing levels have had in other countries and consider current guidelines and recommendations. http://www.kcl.ac.uk/nursing/research/nnru/Policy/Currentissue/index.aspx " The Designated Nurse/correspondent acknowledged the recent scandals in acute, particularly elderly care, but wanted to draw attention to the issue for health visitors and school nurses, because of their inability to provide the early interventions needed to prevent children and families tipping into child protection. best wishes On 30 Mar 2012, at 18:03, hwood@... wrote: The indicators from acute care are sentinel events which shouldn't happen at all under ideal circumstances. Like pressure sores, it's debatable whether any level is tolerable.In terms of health visiting, I did try and think through similar events a few years back, but since health visiting isn't one of those instrumental trades which can be cosidered to be in control of the care and the environment of care, attribution of causes is trickier. But knowing Senate colleagues, they'll have suggestions for these - here are my vague ideas:Late identification of developmental delays which should've been apparent at an earlier age;Early weaning;Postnatal depression diagnosed later than 3 months postnatally;Failure to thrive without a referral;Delayed immunisation without appropriate reason;Growth of less than 3rd centile at any time in first year of life.They'd need much clearer specification & the confounding problems clearing up. Not easy. From: Cowley <sarahcowley183@...>Date sent: Fri, 30 Mar 2012 14:25:49 +0100Subject: risk assessment for staff shortageSend reply to: We are all hoping for great improvements in staff numbers soon and the interim workforce figures from the NHS Information Centre for Health and Social Care record a very small rise in health visitors (from 7941 in September 2011 to 8065 inDecember) and an even smaller rise for school nurses (from 1165 to 1170). The rise for health visitors is particularly significant, because up to now, there have been consistent falls in the numbers, so that trends has been halted and reversed, butI would not expect this to be sustained ahead of the large cohort of health visitor students qualifying in September. I have been asked, though, 'what do we do in the mean time?'Does anyone have a system for assessing risk from the shortage of staff? The question has come to me a couple of times from people who are used to well established risk assessment tools used in acute care, where measures of things like deaths, falls, infections etc, can give a clear indication Cowleysarahcowley183@...http://myprofile.cos.com/S124021COn University Campus Suffolk is the trading name of University Campus Suffolk Ltd. Registered in England and Wales, company number: 05078498. Registered Address: Waterfront Building, Neptune Quay, Ipswich, IP4 1QJ Cowleysarahcowley183@...http://myprofile.cos.com/S124021COn