Providing safe care in the community

Clinical improvement project lead Jane Robinson on recent recommendations from NHS Improvement

Clinical improvement project lead Jane Robinson on recent recommendations from NHS Improvement

Picture: iStock

Shorter lengths of stay in hospital mean that community nurses are caring for patients with increasingly complex needs, often working without instant access to other members of the multidisciplinary team for advice as would be more readily available in a hospital setting.

The setting for community care is often in people’s homes and the area covered by an individual community nurse may be geographically large, remote and without internet access.

The complexity of patient need can also require care from other members of the multidisciplinary team and nurse managers may be managing staff other than nurses. Understanding their unique contribution is an important part of safe community care.

Safe and sustainable staffing

Where should we start in our approach to providing safe community care? The National Quality Board has published seven safe and sustainable staffing improvement resources since January 2018. They are all based on recent evidence and are combined with professional judgement to make a series of recommendations towards safe and sustainable staffing. They are all available on the NHS Improvement website.

The improvement resource for the district nursing service, provided by the largest group of community nurses in England, includes 12 recommendations, beginning with local organisations working together to define safety.

Queen’s Nursing Institute chief executive Crystal Oldman chaired the development group, which included 27 other experts from district nursing and academia. Front-line district nurses were also involved and asked patients and their families what they needed from their district nurse. We also used the King’s Fund’s nine characteristics of good quality care in district nursing. This framework can be used to help standardise a potentially complex definition of quality and identify relevant metrics to begin to assess quality and safety in this setting.

According to the evidence review that underpins the improvement resource, metrics should include those regarding patient outcomes, patient safety and patient or carer experience, staff experience and system-wide measures. A quality and safety dashboard should be reviewed by members of the board every month to inform local decision-making.

Reality of community nursing

I shadowed district nurses and talked with patients to find out more about district nursing, and I was surprised to see the acuity of patients being cared for in their own homes. The joys of working to the full potential of a role were evident.

The dangers of lone working were also explained to me. For example, one district nurse told me about a time when she had been locked in a patient’s house by a relative. He was worried about his relative who was being cared for at home and ‘just wanted someone to listen to them’.

'We need to show everyone the reality of community nursing'

I would not have appreciated the reality of community nursing without seeing and hearing about it for myself.

This leads me onto addressing how we raise the profile of community nursing services. We need to show everyone the reality of community nursing. This cannot be achieved by simply discussing data in a meeting room. Involve patients and their families. They gave us a perspective we would have otherwise missed. Patients and their families want to know what time their district nurse is visiting; carers want to be able to arrange their lives so that they can be there during a visit. This was their only complaint.

In conclusion, agree which outcomes will identify safety as you define it; monitor and discuss these outcomes as widely as possible; use the data to inform future services and identify risks. The model for improvement starts with an aim and the measures that will identify whether the aim is being achieved. You are the experts.

The resources available on the NHS Improvement website aim to support safe care across all parts of the service. However, unless they are used and continually added to, they are useless.

Please let us know what you think and add your own documents via the improvement hub discussion board.


NHS Improvement

About the author

Jane Robinson is clinical improvement project lead at NHS Improvement

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