Good Practice

The challenge of addressing Working Time Directive 2009 is being tackled in a number of ways across different organisations.

In preparation for the Transforming Care Delivery conference in April Skills for Health - Workforce Projects Team asked delegates if their organisations wanted to submit a poster for display at the conference, the outcome was a number of displays that highlighted best practice, areas of innovation and adopted working methods introduced to handle the approaching issue of WTD compliance.

All conference posters can be accessed via the healthcare workforce portal.

Details of two of the poster submissions:

Clinical support nurse – South Devon Healthcare Trust

To address the reduction in working hours for trainee doctors, brought about by the Working Time Directive andthe move to full shift working for compliance with the NewDeal contract, the trust looked at the H@N model. We hoped this would assist not only in achieving compliance with thenew legislation but also in ensuring that patients receive justas good care out of hours as they do within the core hours. Historically, the trust had floating night sisters, one covering surgical and one covering medicine, overseen by a night manager. These very experienced nurses often had to doportering, cleaning, covering breaks and their skills were not being fully utilised. An audit was carried out, which bar coded and analysed all tasksperformed by the night sisters. This helped identify work thatcould be easily transferred to an NVQ3, healthcare assistant role,to release the night sisters for a new role in the H@N team.The night sisters did not consider themselves to bepractitioners and wanted a name to suit their role and choseclinical support nurse.To become a clinical support nurse they underwent anassessment of their clinical skills and the nurse consultant incritical care worked with them to develop a clinical package in order for them to update and extend their skills. The trust implemented the multi-disciplinary night team in July2004, which has gone from strength to strength with the roleof the clinical support nurse very much at the forefront of itssuccess. They are now competently undertaking workpreviously performed by trainee doctors such as assessment, planning diagnostics and patient management.The trust is now considering broadening the principles ofH@N to weekends and twilight cover – and eventually 24/7. For further information please contact yvonne.linley-shaw@nhs.net

Implementation of Hospital at Night (H@N) – Royal Liverpool and Broadgreen University Hospital Trust(RLBUHT)

The reduction in hours required to meet the 2004 requirementswas achieved by remodelling the out of hours team, and thecreation of new ways of working.Team workingH@N was implemented which gave:

• improved communication
• a co-ordinated response
• teaching/learning opportunities for Drs and nurse practitioners
• team building
• a breakthrough of traditional medical/nursing divides

Benefits of H@N

• Marked reduction in PRHO workload
• Prompt response by appropriate multi-disciplinary team member

Cost Implications

Most of the personnel required to achieve WTD are already employed within the trust and with the implementation ofappropriate training and education along with rota change andskill mix review it is hoped that WTD 2009 can be implemented with little or no increase in costs.

Towards 2009 – a 48 hour week

RLBUHT proposes to reduce the junior doctors working week by:

• Workload assessment and audit leading to rota and skill mix changes
• Expansion of roles for non-medical staff
• Extending the scope and use of Patient Group Directives (PGD’s)
• Increase the No. of nurse prescribers
• Further handover sessions throughout 24hr period
• Expansion of out of-hours cover by senior doctors
• The introduction of a Medical Emergency team (MET) which will provide 24/7 expert intervention & advice. A MET can be simply described as a cardiac arrest team with a changed calling criteria

For further information please contact patrick.chu@rlbuht.nhs.uk

We need your examples of best practice

Are you working on a project that is having a real impact on your organisation’s WTD 2009 compliance? Is it something that could be shared more widely across the service?

We are in the process of gathering together a wide range ofcase studies in order to share learning and best practice. It maybe a scheme that has worked well across your trust or just in oneparticular specialty, it might be something that has seen thedevelopment of new roles or the introduction of new technology.

Whatever the work is, there could be other organisations whowould benefit from knowing about it. The aim is to create asearchable database that can be used in a number of ways –from looking at similar trust types and size to speciality andtype of development. If you have an example that you’d like to share, please contact claire.blankley@skillsforhealth.org.uk in the first instance. Skills for Health - Workforce Projects Team staff will work with you on the final content before it is published but the aim is to build an excellent body of best practice from across the service that can be used by everyone in the build up to 2009.