Recording Care – The
Challenge
PACE Pilot
January 2016
Recording [nursing and
midwifery] Care......
What’s the point?
What it is.....
Recording
Care
2011 2013
Outcomes
• Final report
• Standards for Nursing and
Midwifery Record Keeping Practice
• Regional person-centred nursing
assessment and plan of care
document
• Improved record keeping practice 30% increase in audit scores
Ongoing Work
• System of accountability to regionally monitor standards of nurse record
keeping practice
• Endoscopy Day Case Record
• Under 24 hour stay record
• Health Care Support Worker Practice
• Regional Abbreviations policy (sep project)
• Children’s Record & improvement cycles
• Learning Disabilities Record and improvement cycles
• Care planning
• Key Performance Indicator development
• Review of NOAT
• Review of web resources
• Review of Record Keeping Guidance
• Links to revalidation
AUDIT COMPLIANCE
November Agreement 2014 - audit, pilots, literature review
CARE PLANNING SUMMIT – January 2015
Presentation to EDoNs April 2015
Meetings June, July and August 2015
PACE FINALISED
Pilot August/ September 2015
Presented to CNO/ EDoNs
August/ September 2014 Pilots
Issues – repeated failure to:
• link identified need to plan of care
• record evaluations linked the plan of care
• record outcomes linked to the plan of care
and identified need
Literature Review
Findings:
• No new models
• Involvement of patients and families
• Reflection and review
• Multi-professional formats
• Organisational investment
• Core skills
Care Planning Summit
12th January 2015 and March WG Meeting
• Protocols/standard operating procedures should not be
used within plans of care
• Nursing standards for care processes which can be
referred to within each clinical setting
• Care Plans should represent a clear description of the
patient’s journey through a service
• Involvement of the patient should be clearly articulated
within the record
• Daily assessment should be evidenced against ADLs and
needs recorded as they arise – i.e. nurses should not be
recording potential needs but actual needs as they arise
• Recording care should be at the bedside of the patient or
as close to the point of care delivery
• Handover should be driven by the plans of care
• Evaluation should be set against care planned against
assessed need
• The goal of care is presented in the care planned
• The skills of nurses to engage in a new process should be
addressed along with a system of change management
PACE
P – PERSON CENTRED
A – ASSESSMENT
C – PLAN OF CARE
E – EVALUATION
Evaluation
AUDIT – USING NOAT
FOCUS GROUP
This exercise explored in the opinion of the champions:
• What worked well
• What didn’t work well
• The experience of implementing change – barriers and
enablers
• What future support might be required for a wider roll
out
Audit
Findings
40% improvement in care planning section of NOAT
Focus Groups
•
•
•
•
Evidence of person centred/ family centred approach
Increased contemporaneous record keeping
Increased effectiveness in communication
Clear picture of the person’s journey through a
service
• Accountability and professionalism increased
• Ownership
What next?
• Presented to CNO/EDoN meeting
• Agreement for formal pilot
• Agreement for facilitation to enable
• Evaluation – link to HEIs, IHI and Personcentred Practice framework
(McCormack and McCance, 2010)
Recording [nursing and
midwifery] Care......
What’s the point?
People at the Centre
Nothing about me without me.....
Worked Example: 10:30am –
11:15am
• Divide into groups – surgical, medical
and children’s
• Use the scenario to work up a nursing
plan of care using the PACE framework
• Note any challenges – appoint someone
to write and someone to speak!
COFFEE: 11:15 am
Barriers and Enablers
11:45 am
TIME
BARRIER
ENABLER
New approach – increase time Given adequate time from
to record
nurse leaders
Inadequate training
preparation
Adequate training preparation
COMMUNICATION
BARRIER
ENABLER
Lack of explanations of
change/expectations
Given adequate explanation
Lack of feedback to ward level
Facilitate feedback to ward
level. Ward champions.
Misunderstanding of PACE
Training Facilitators/ward
Champions
Reluctance from patient
Explanation
TRAINING
BARRIER
ENABLER
Lack of training/ preparation
at all levels
Support from NIPEC
Attendance at training
workshops.
CEC
Involvement of ward
champions to cascade
Resource pack.
Use of working examples
Some focus on writing skills –
concise/factual
Training audit tool
IMPACT OF CHANGE
BARRIER
ENABLER
Fear -not writing
enough/change of entire style
Training/on going support at
ward level
Fear of legal/professional
repercussions
Addressing these issues
Revalidation
Staff attitudes - sceptical
Communication / Discussion
Ward process – organisation
of care
Creative thinking to current
ward processes
DISSCUSSION
Evaluation Framework 12:05 pm
Exploring ways to evaluate robustly….
• Balanced scorecard
• Review and comment back • Scribe and Speaker
Resource Pack and Facilitation
Role of the Facilitators:
• Raise awareness of PACE – ward sessions,
supervision etc.
• Scope care environment and assist with
action plans to enable introduction of PACE
e.g. processes of care
• Facilitate change e.g. implementation plans
• Problem solving – solution focussed
• Evaluation – data collection (baseline
measurements.
Resource Pack and Facilitation
Resource Packs:
What else would be helpful in the packs?
Care planning section….