Abstract
Descriptor
NHS Forth Valley, acute services identified an 122% increase in demand for patients to receive enhanced observations during 2023-2024. The attached chart demonstrates the staff bank requests over the 12 months evidencing the 2 sharp rises during April 23 and November 23.
Methodology
- Weekly reviews of patients placed on enhanced observation with bedside teaching
- Education programme for nurse leaders (CNM&SCN), nursing workforce and carers
- Ensuring activities are available and accessible
- Scope initiatives being used in other health boards which have proven to reduce demand of enhanced observation
- Gain feedback from patients, staff and carers on improvement ideas
Aims/Objectives
To reduce the requirement of enhanced observations by 50% by May 2025.
A sample review during a two week whole system response to acute site pressures provided intelligence that multiple patients were receiving enhanced observations but there was a lack of adherence to the current NHS Forth Valley Policy1. This highlighted patients were not appropriately risk assessed or regularly reviewed and there was also a lack of evidence that the least restrictive options had been explored. The review also demonstrated patients were not engaged in meaningful activity, cognitive rehabilitation or stimulation, which therefore provided an absence of evidence of the benefit to patient, highlighted a risk of a prolonged length of stay, risk of exacerbating stress and distress and potential increase of physical harm. In addition, enhanced observation has a significant financial impact due to of supplementary staffing use.
The focus of the improvement work will be to ensure enhanced observations are used appropriately, is the least restrictive option, promotes recovery and benefits the patients in line with national drivers, local guidance and legislation1,2,3.
Results/Outcomes
From the project starting in March 2024 and looking at December 2024 the data confirms a 94% reduction in supplementary hours and staffing requests through the staff bank and an 86% reduction of patient identified on safecare as requiring enhanced observations, see charts attached. Qualitative measures with application of the local policy and the quality of person centred care planning has improved. These improvements combined have lead to no adverse events or complaints raised in relation to appropriate use of enhanced observations. Furthermore, the project has contributed to significant cost reduction in NHS FV nurse staffing.
References
1.NHS Forth Valley, 2022. Nursing Observations and Interventions. NHS Forth Valley. Available at: scottish.sharepoint.com/sites/FV-Guidelines/Guidelines/Forms/AllItems.aspx?id=%2Fsites%2FFV-Guidelines%2FGuidelines%2FEnhanced Nursing Observations%2Epdf&parent=%2Fsites%2FFV-Guidelines%2FGuidelines (Accessed 18 March 2025)
2.NHS Scotland, 2024. Ageing & Frailty Standards in Scotland. NHS Scotland. Available at: https://www.nhsinform.scot (Accessed 18 March 2025)
3.Scottish Government, 2000. Adults with Incapacity (Scotland) Act 2000. Available at:https://www.legislation.gov.uk/asp/2000/4/contents (Accessed 18 March 2025)