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Can a district nurse caseload review tool improve patient management?

As a way of reviewing district nurse caseloads, one trust in Staffordshire trialled a new tool to improve patient care

As a way of reviewing district nurse caseloads, one trust in Staffordshire trialled a new tool to benefit patient care 

District nurses at Staffordshire and Stoke on Trent NHS Partnership Trust (SSOTP) are benefiting from the introduction of a district nurse caseload review tool.


QNI conference (left to right): Paula Wood, Helen Wheeler, Celine Grundy,
Pamela Davenport and Professor Alison White, QNI fellow.

Before the tool was introduced, the trust’s district nurses had no standardised way to review their caseloads. In addition, they were finding caseloads were becoming more difficult to manage due to unpredictability and increased demands for patient care.

1.1 million

The number of people the Staffordshire and Stoke on Trent NHS Partnership Trust serves

As a result, outcomes and actions were not always documented and challenges over treatments and care were not standardised. There was also an inability to discuss specific caseloads with other primary care professionals such as GPs and practice nurses.

In October 2016, a number of key stakeholders including senior management, specialist community practice educators in district nursing, and district nurses came together to establish how they wanted the caseload review tool to work, and what they needed from it.

With support from the trust’s information management and technology team, a basic version of the tool was piloted in February 2017. The tool was piloted with the trust’s 35 district nursing teams across a 12 month period before it was introduced on an ongoing basis.

‘With the increasing future demand and the Five Year Forward View projections, we felt we needed to be as robust as we possible with district nursing,’ says the trust’s service improvement manager Celine Grundy, who was part of the project team that developed the tool.

‘Over the 12 month period, we tested the caseload review process four times with all 35 district nursing teams, led by our community practice educators. We are now at the stage where we feel the tool is as good as it can be. We now carry out the caseload review process twice a year.’

Efficient, safe management

The tool is helping to ensure that district nursing caseloads are effectively, efficiently and safely managed.

‘We felt we had got it right during the pilot stage so the content of the tool has not changed a great deal,’ says the trust’s professional lead for adult nursing, Paula Wood.

‘We have made additions to prevent the district nursing teams having to access separate systems such as when the new Commissioning for Quality and Innovation (CQUIN) wound assessment for 2017/2018 was launched.

2041

the year it is estimated that life expectancy will be 86.2 years for women and 83.4 years for men

(Source: Office for National Statistics)

The tool has embedded really well and the most important thing for us is that it has been accepted by the staff. They like it because they feel they know what is going on with their caseload. They can use the tool to view by patient condition or GP practice or however they want to do it.

The tool enables the district nursing teams to see what is going on in all of the different caseloads and it helps to identify any issues arising. It provides that complete knowledge of the caseloads.’

Outcomes

Since the introduction of the tool, the district nursing teams have seen a number of improvements. These include a reduction in the number of rescheduled visits within their caseloads, multiple treatments have been merged to the same day and visits in residential care have been altered to the same day to avoid daily visits. This has led to improved efficiency of the trust’s district nursing service.

The value of time

‘Our district nurses have said they value the time they spend with a senior nurse to go through their caseloads,’ says Ms Grundy.

‘It enables them to be sure and feel confident that they are providing the right treatments to their patients. The district nurses and their community practice educators (CPEs) are given that time to work through the caseload review process.

'Our organisation respects this and reviews are planned in the team’s diary. It is proving to be an effective learning tool as the district nurse and their CPE can pick up on any aspects that may need to be corrected and they can sit down and talk through those actions. For example, more training may be needed or certain documentation may need to be implemented.

'The tool is an excellent all-rounder with regards to delivery of care.’

 

District nurse feedback has been overwhelmingly positive with many commenting on how user-friendly the tool is. The teams have also said that the tool provides ample learning opportunities.

‘We have built questions in the tool to provide assurance to the district nurses,’ says Ms Wood.

2017

The year the district nurse caseload review tool was awarded first prize at the QNI’s Annual Conference

‘These feature as prompts, like a checklist, to guide the district nurses through their caseload reviews. For example, have you tried a different treatment or have you considered referring the patient? All patients are having the same caseload review process undertaken and the district nurses tell us they find the prompts particularly useful.’

Award recognition

The tool was awarded first prize and praised for its innovative approach at the QNI’s Annual Conference in October 2017.

The trust is already looking to the next stage and how they can use the tool in other areas of the organisation. Ms Grundy feels it may work well with other trust services that have large caseloads.

‘It is an exceptional piece of work which is truly making a difference to our district nurses and importantly their patients,’ says the trust’s director of nursing and quality, Rose Goodwin.

‘We cannot imagine not having the tool’

‘The tool is quite pictorial-led and simple to use,’ says one of the trust’s community practice educators in district nursing, Rob Ratcliffe.

‘When a patient is being reviewed in the tool, there will be a little symbol next to their name which will notify the district nurse as to whether they have been reviewed recently. A smiley face icon illustrates to the user that the patient has been reviewed.

'If a district nurse has a patient that is relatively new to their caseload that has a lower limb wound, for example, the tool would highlight if the patient has not had a doppler or that this has not been recorded. The tool can be used to see if something is missing and this can be added on straightaway.

'All aspects of a patient’s care are able to be viewed quickly and easily with the tool. We can look at what exactly is going on with a patient’s care to ensure nothing is missed.

'We cannot imagine not having the tool now. It helps to ensure we are delivering safe, effective patient care and that is the biggest value of the tool for us as clinicians.'

 

Find out more

For more information on the district nurse caseload review tool, contact the trust’s professional lead for adult nursing, Paula Wood via email paula.wood@ssotp.nhs.uk.

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