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Framework for Safe Nurse Staffing and Skill Mix: Phase 1
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Phase 1 of the Framework is focused on safe nurse staffing and skill mix in general and specialist, medical and surgical care settings. This is the majority of care settings in acute care in Ireland. The Framework for Safe Nurse Staffing and Skill Mix in General and Specialist Medical and Surgical Care Settings in Ireland 2018 was published in April 2018. This document provides an overview of the approach to the development and testing of the Phase 1 of the Framework. It sets out the key information to guide services on how to determine safe nurse staffing and skill mix in general and specialist medical and surgical care settings using the Nursing Hours per patient day (NHpPD) model. NHpPD is a systematic method that is robustly tested internationally and is used to both measure and monitor the required direct care nursing hours to guide the most appropriate, safe, and effective nurse staffing level.
A number of supporting documents during the testing phase were published. The Evaluation of the ‘Pilot Implementation of the Framework for Safe Nurse Staffing and Skill-Mix’ Report 1 was published in February 2016. Report 1 set out the background, literature review, methods and findings in regard to the first stage of the evaluation – pre-intervention.
An Interim Report and Recommendations on Safe Nurse Staffing and Skill Mix in General and Specialist Medical and Surgical Acute Hospital settings was developed in January 2017 by the UCC Team led by Professor Jonathan Drennan.
Report 2 set out the detail from Report 1, alongside the comparison between the data from Time 1 (baseline pre-intervention) and Time 2 (following application of the Framework), including the findings from the Evaluation of the Pilot Implementation of the Framework for Safe Nurse Staffing and Skill-Mix Report and Recommendations on Safe Nurse Staffing and Skill Mix in General and Specialist Medical and Surgical Acute Hospital settings was published in June 2017.
Evaluation of the Pilot Implementation of the Framework for Safe Nurse Staffing and Skill-Mix in Emergency Care Settings Report 2
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Report 4 presents a further evaluation of the implementation of the recommendations in the Framework in six pilot wards and in 29 extension wards in a Model 4, Model 3 and Model 2 hospitals. Data are reported up to May 2019.
The Enhanced Care Model emerged as a solution to the problem of the 1:1 care demand evident during the implementation of the Framework for Safe Nurse Staffing and Skill Mix in General and Specialist Medical and Surgical Care Settings (Phase 1).
The Report outlines a model of care for patients in acute hospitals who need dedicated one to one care or ‘enhanced care’. What this means is that enhanced care will be delivered by a team of specially trained Health Care Assistants, supported by the nurses on the ward and senior nurses throughout the hospital.
Enhanced care is provided for patients who may be disoriented, have altered cognition or behaviour or a non-acute mental health illness. Preventing falls, confusion and agitation are the most common reasons that patients may require enhanced care.
A national workforce planning and workload management Information Technology (IT) system (TrendCare) has been introduced to assist in decisions on nurse staffing and skill mix. This system integrates with organisational level patient information management systems to enable the development of nursing intensity weight-based costing relative to patient Diagnostic Related Groups. TrendCare has been agreed as the national tool and is currently being introduced to Model 4 hospitals and will be introduced to Model 3 and Model 2 hospitals on a phased basis.