Crisis Nursing & Midwifery Model of Care Western Health April - PowerPoint PPT Presentation

Crisis Nursing & Midwifery Model of Care Western Health April 2020

Situation & rationale for change • There is a need to establish workforce models that will be able to respond to both the anticipated increase in the number of inpatients and the associated increase in personal leave directly due to COVID-19 • A crisis nursing/midwifery model of care and staffing profile for each surge level at WH is being developed to provide safe patient care and to ensure that staff workloads are controlled as much as possible Footer Text 2

Details of the change The introduction of the model may not be a whole of health service determination, but will likely evolve on a ward/department basis – dependent upon the volume & nature of any surge in demand/activity & the levels of personal leave (PL) from nurses/midwives. Surge 1 - PL rate <10% & additional beds open are within available resources Surge 2 - PL rate 10% - 20% &/or clinical demand/activity dictates that additional beds are needed beyond what can be achieved through business as usual processes. Surge 3 - PL rate >20% &/or clinical demand/activity dictates that additional beds are needed substantially beyond what can be achieved through business as usual processes. Footer Text 3

Surge Staffing Models Surge 1 Maintenance of Safe Patient Care Act staffing requirements through business as usual processes. Personal leave is less than 10%, acuity is manageable & replacement of personal leave is achievable with either bank, pool or agency staff. Surge 2 Personal leave is greater than 10%. The level of personal leave, together with increased demand & clinical acuity may mean that very limited nurses/midwives are available to meet demand. WH would be forced to implement measures to ensure that patients continue to receive care. Footer Text 4

Rosters and shifts: • Night duty will convert to 12 hour shifts • An equal number equivalent of AM shifts to night duty shifts will convert to 12 hour shifts • AM eight hour shift shifts will commence at 06:00 • Afternoon eight hour shifts will commence at 14:30. • All other areas with consistent shift staffing requirements ICU, Emergency, Delivery Suite will move to a full 12 hour roster; no 8 hour shifts • These changes decrease the overlap time for double staffing therefore minimising staff exposure to COVID-19, increases the hours of direct care reducing pressure on night duty staff & maintains same nursing/midwifery ratios for day and nights Footer Text 5

Surge 3 • Personal leave of >20% or when demand for vacancy replacement outstrips the ability to replace with nursing and midwifery staff. • Some WH wards/departments may need to move to a night duty level roster for all registered nurses, midwives & enrolled nurses. • To support the nursing staff a pool of over 600 COVID-19 Support Staff roles (tier 3 worker) will be deployed under a team based staffing model. Footer Text 6

• Non-clinical nurses/midwives would be reassigned to clinical roles where possible. • COVID-19 Support Staff roles to fill vacant nursing/midwifery shifts (including RUSON, RUSOM & PCA roles in wards, & ward nurses in ICU) in a team based staffing model. Education: • To support this, education programs have commenced in: o Delegation and supervision o ICU refresher/induction o Ward refresher/induction o HDU programs for assigned wards Footer Text 7

Registered Nurses role Working at top of scope within the multidisciplinary team:  Registered Nurses and Midwives delegate and supervise COVID-19 Support Staff roles in accordance with the NMBA Registered Nurse standards for practice (2016), NMBA Registered Midwife standards for practice (2018) and Decision-making framework for nursing and midwifery (2020)  Registered Nurses and Midwives can only delegate aspects of care to a COVID-19 Support Staff role, which are consistent with the educational preparation, skill level and assessed competencies of the person being delegated the task.  RUSONs/RUSOMs/PCAs and any other ‘COVID-19 Support Staff’ roles are not to be given sole allocation of patients Footer Text 8

Working at Top of Scope of Practice • Registered Nurses/Midwives in all areas practice at top of scope • Move to a team model that is under the delegation and supervision of the Registered Nurse/Midwife or Specialist Nurse o Position descriptions developed for new roles o Activity lists developed as a guidance for safe and appropriate delegation. Resources will be on the COVID-19 microsite Footer Text 9

COVID-19 Support Examples of COVID-19 Support Staff Role Activity List: Staff roles Area of care Activity • Hygiene Assist with oral hygiene – brushing teeth, dentures, mouth wash/toilet • Assist with simple eye care – eye toilet • Includes: • Toileting Change incontinence pads or aids o Staff previously without currency of • Empty, record and provide urinary bottle • Empty and record urinary catheter bag practice that have undertaken basic drainage training packages. • Manual handling & Assist with patient transfers, sitting patients o Nurses reassigned to a specialty Mobility out of bed/on toilet/commode • Assist with provision of pressure area care (eg ICU) without formal training or • Nutrition Assist with safe meal set up, cut up food, qualifications in that specialty. adjusting table and opening packages o Registered Undergraduate Student • Environment Ensure falls prevention strategies are in place – call bell, phone, bedside table in of Nursing (RUSON) reach, bed lowered, trip hazards removed o Registered Undergraduate Student Communication • Reporting and/or escalating all care and of Midwifery (RUSOM), and concerns to supervising registered nurse/s • Clerical answering and transferring o Personal care assistants (PCA) calls/intercom Documentation • Complete fluid balance chart: Oral input and urine output and report to RN • Undertake activities that have been • Maintenance Cleaning and putting away equipment delegated & supervised by a registered between use i.e. – infusion pumps, bed frames nurse • Other duties Assist in the care of the deceased patient Footer Text 10 • Packing and unpacking patient belongings

Surge 3 Move to a team model that is under the delegation and supervision of the Expert Nurse and/or Midwife Key characteristics of expert RNs and RMs Expert Possess in-depth clinical knowledge and experience • Demonstrate deep understanding Ward Nurse of complex situations • Base decisions on clinical reasoning and expert intuition COVID-19 Support Staff Role • Address patients’ needs proactively and holistically • Function as leaders among bedside RNs, RMs & COVID-19 Support Staff 2019 Advisory Board roles Footer Text 11

Activity Lists Activity lists have been prepared for: • Medical wards • Surgical wards • Rehabilitation wards • Palliative Care • ICU • ED • CCU • Dialysis • Day Oncology These are designed to support staff delegation and supervision. Footer Text 12

ICU – Surge 1 WWH - [13 beds / PL 20%] – 1:1 ratio Footscray The ‘Future State Escalation 2a Model identified there would be insufficient ICU staff to maintain 1:1 ratio with the above bed configuration, as demonstrated in displayed graphs. WSH - [12 beds / PL 20%] – 1:1 ratio Sunshine Page 6

ICU – Surge 1 staffing impact WWH - [13 beds / PL 20%] – ICU nurse (1:2 ratio) + RN non ICU (1:2 ratio) WSH - [12 beds / PL 20%] – ICU nurse (1:2 ratio) + RN non ICU (1:2 ratio) The ‘Future State Escalation 2b Model includes 1 ICU nurse + 1 RN to two patient ratio, therefore decreasing the reliance on ICU staff. Footscray Sunshine Hospital Department Unit Budget EFT Hospital Department Unit Budget EFT Western Health ICU WSH 12 Beds ANUM $812,811 6.05 Western Health ICU WWH 13 Beds - ANUM $835,412.7 5.99 12 Beds ICU staff [1:2] $3,990,360 35.98 13 Beds ICU staff [1:2] $4,758,217.1 41.76 12 Beds RN Staff [1:2] $4,368,480 36.58 13 Beds RN staff [1:2] $4,368,479.8 36.58 NUM $137,694 1.1 NUM $136,432.7 1.1 Totals - - $9,309,345 79.72 Totals - - $10,098,542.2 85.43 Current State - Future State Future State Current State - Department Unit 12hr Roster- Escalation 2b- Escalation 2b- EFT Variance $ Variance 12hr Roster-$ EFT EFT $ ICU WSH 12 Beds ANUM 6.05 $812,811 -6.05 -$812,811 12 Beds ICU staff [1:2] 35.98 $3,990,360 -35.98 -$3,990,360 12 Beds RN Staff [1:2] 36.58 $4,368,480 -36.58 -$4,368,480 Access Nurse 5.23 $650,916 5.23 $650,916 ANUM 5.26 $696,586 5.26 $696,586 Clinical 47.81 $5,436,405 47.81 $5,436,405 Equipment Nurse 1.1 $115,079 1.1 $115,079 NUM 1.1 $137,694 1.1 $137,694 ICU WWH 13 Beds - ANUM 5.99 $835,413 -5.99 -$835,413 13 Beds ICU staff [1:2] 41.76 $4,758,217 -41.76 -$4,758,217 13 Beds RN staff [1:2] 36.58 $4,368,480 -36.58 -$4,368,480 Access Nurse 5.18 $604,147 5.18 $604,147 ANUM 5.19 $696,501 5.19 $696,501 Clinical Nurse Roster 12Hr 46.65 $5,440,739 46.65 $5,440,739 Heart Failure CNC 0.84 $101,494 0.84 $101,494 NUM 1.1 $136,433 1.1 $136,433 - - 119.47 $14,015,993 165.15 $19,407,887 -45.67 -$5,391,894 Additional 45.67 EFT required Page 7