DSC Notice: 08/2001* Date of Issue: March 2001 Subject:
Inclusion of Nurse Activity in Admitted Patient Care CDSs/HES.
NHS Information Standards
Board
Implementation date: 01 April 2002 DATA SET CHANGE CONTROL PROCEDURE
This paper gives notification of changes to be included in the NHS Data Dictionary, the NHS Data Manual and the NHS CDS Manual in due course.
Summary of change:
The collection of nurse activity in admitted patient care CDSs and HES.
Summary of impact:
The recording of codes indicating registered nurse responsibility for admitted patient care episodes.
Change Proposal Reference No: 04/01
The NHS Information Standards Board (ISB), established by the NHS Information Authority, is responsible for approving information standards. The NHS ISB is supported by the Management Information Standards Board, Clinical Data Standards and Technical Standards sub-boards.
*The DSCN Number Format has been changed to denote the new arrangements as follows: sequence
number/year of issue (ccyy). The service identifier and service sequence number are redundant owing to changes in practice and have been removed.
The packaging of standards documentation is under review. Any changes will be notified in due course.
Please address enquiries about this DSCN to the Data Standards Team, NHS Information Authority, Aqueous II, Aston Cross, Rocky Lane, Birmingham, B6 5RQ Tel: 0121 333 0237 or to the nominated enquiry point.
Data Set Change Notices are located on the Internet in the Electronic Library at
http://www.standards.nhsia.nhs.uk/library/index.htm and on the NHSnet at http://nww.standards.nhsia.nhs.uk/library/index.htm
DATA SET CHANGE NOTICE 08/2001 Reference: CP 04/01 version 1.1
Subject: Inclusion of Nurse Activity in the Admitted Patient Care Commissioning Data Sets/HES.
Type of Change : Introduction of default codes: Nurse: N9999998 Specialty Function Code and Consultant Specialty Function Code: 950
Reason for Change: Requirement to reflect the Nurse, where appropriate, as the clinician wholly responsible for the episode of care.
Effective Date: Mandatory from 1 April 2002
Effect on Central Returns: Inclusion of “nurse” Admitted Patient Care CDSs in Hospital Episode Statistics (HES).
Introduction:
1. In response to concerns over a possible data gap due to the creation of nurse consultants, and the increase in their number following the NHS Plan, this DSCN mandates the inclusion of nurse activity in the Admitted Patient Care Commissioning Data Sets/HES. Background:
2. The role of Nurse Consultant was introduced following consultation in 1998 to fulfil two aims, the first being to enable career development in nursing whereby a nurse, even at a senior level, can continue to treat patients. The second aim is to help provide better outcomes for patients by improving health services and their quality.
3. Posts are approved by Ministers on the recommendations of Regional Offices, who scrutinise proposals received from Trusts and other organisations.
4. Details of the new posts were set out in HSC 1999/158 Making a difference:
Strengthening the Nursing, Midwifery and Health Visiting Contribution to Health and Health care (www.doh.gov.uk/coinh.htm).
5. Detailed guidance about establishing posts, and invitations to the NHS to submit
proposals, was set out in HSC1999/217, Nurse Midwife and Health Visitor Consultants:
Establishing posts and Making appointments (www.doh.gov.uk/coinh.htm).
6. The first wave of 141 nurse consultant posts was announced in January 2000, and 232 posts have been approved to date. Over a third of these posts are in critical care and will be in a key position to develop critical care nursing, following the government's
7. The key concept relating to Nurse Consultants is that they are registered nurses. The fact
that they may undertake duties that have in the past been undertaken by doctors does not alter this fact. The Data Definitions Group, who discussed the issue at their September meeting, endorsed this, and urged that existing constructs for nurse-lead activity be used. The Role of a Nurse Consultant:
8. The following points have been extracted from HSC 1999/217 to help identify the range/scope of activities undertaken by a nurse consultant.
a. Objectives of post:
• to provide better outcomes for patients by improving services and quality; • to strengthen leadership;
• to provide a new career opportunity to help retain experienced and expert nurses, midwives and health visitors in practice. (para 5)
b. Scope of work:
• Posts can be established in any service or specialty where it is clear that doing so meets these objectives. Some are likely to involve complex cross-boundary and inter-agency working but all will have nursing, midwifery or health visiting practice at their core. (para 5)
• All posts must…. involve working directly with patients, clients or communities for at least 50% of the time available. (para 7)
• Where it is appropriate to the service or specialty, it is expected that nurse, midwife or health visitor consultants will make and receive
referrals…(para 9) Identifying a Nurse Consultant:
9. The HSC 1999/217 guidance for professional accreditation states that:
the nurse, midwife and health visitor consultants must hold current
registration with the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) on a part of the register relevant to the field of practice in which the appointment is being sought, and be able to provide evidence of significant post-registration development in the relevant field. Currently there is no single form of professional recognition denoting post-registration experience and learning matching that is considered necessary for appointment to a consultant practitioner post (para 19).
10. This would indicate that there is currently no way to distinguish someone in a nurse consultant post purely on the basis of a UKCC registration number. However the UKCC number could be used as a unique identification similar to a GMC number to identify individual nurses. There is no way of generically identifying nurse consultants; each job
description could be different. Note that individual midwives are not currently identified in the CDSs; a single default code is used for all midwives.
11. Owing to the current inability to identify nurses acting as consultants, the existing constructs in the NHS Data Dictionary to support nurse-lead activity, such as Nursing Episodes for admitted patients or Nurse Clinics, have been used for nurse consultants as for any other nurse. In order to determine whether the increased responsibility of nurses affects the care of patients in hospital, nurse activity should be included in CDS/HES using dummy codes. However, Nurse Episodes must only be created where the Nurse is in overall charge of the patient. A “Nurse” Admitted Patient Care CDS must not be created if the consultant is in charge of the patient. Concurrent/duplicate CDSs must not
be generated by systems.
Specific Consultant/midwife/GP details currently carried in the CDSs:
12. Consultant or midwife details are currently carried in CDS/HES in the following data items:
Consultant Code
Specialty Function Code
Consultant Specialty Function Code
13. The Consultant Code is the identifier for the responsible doctor, identifying the individual, or a default code to show that the responsible professional is a midwife. The code N9999998 should be assigned to indicate that a nurse is responsible for the patient’s care. The Specialty Function Code is the main specialty of the Consultant. The Consultant Specialty Function Code is the specialty under which the patient is treated. The default code 950 for Specialty Function Code and Consultant Specialty Function Code could be used to aggregate nurse activity where required. However, it should not be confused with the specialty codes of the Royal Colleges.
Note: The nurse may or may not be appointed to a nurse consultant post. Augmented Care Periods:
14. Augmented Care Periods do not carry details of consultants or medical staff. They do, however, carry Specialty Function Code (Augmented Period) to define the main specialty of the Consultant clinically managing one or more Augmented Care Periods. Default nurse codes should not be used in this area. Whilst augmented care requires specialised, intensive nursing, the overall clinical responsibility will be with a medical consultant. As with current definitions in the NHS Data Dictionary, nurse responsibility is only recorded where the nurse has sole responsibility for the management of the patient.
15. Questions and Answers:
15.1 Will the appointment of nurse consultants reduce the numbers of Consultant Episodes?
As a nurse consultant is only expected to spend 50% of their time in actual contact with patients (the rest being taken up with training, etc.) it would appear unlikely that they would assume total responsibility for a large number of Nursing Episodes. The mention made of 'cross-boundary and inter-agency working' would tend to suggest that they would work as part of the consultant team. Currently, details of a consultant team are not recorded.
15.2 Does the nurse consultant carry the same degree of clinical responsibility as a consultant?
The Chief Nurses’ office replied as follows:
The question about being clinically responsible is problematic. Without wishing to be obtuse, it depends what you mean! All nurses are 'clinically responsible' for the patients in their care. Nurse consultants are first and foremost registered nurses, accountable for their acts and omissions as registered professionals.
15.3 Can the Out-Patient CDS be used to exchange Nurse Attendances?
The NHS Data Dictionary and NHS Data Manual defines Out-Patient Attendance commissioning data flows for Consultants, but not other professionals. Several of the data items are only applicable to medical staff. Therefore, Nurse Attendances are not mandated to be included in the national out-patient commissioning data set flows.
It is anticipated that a flow of nurse out-patient attendances will be requested at some future date.
15.4 Can nurse activity be carried in the Accident and Emergency Attendance CDSs ?
Carrying details of nurses in the Accident and Emergency Attendance CDS would not be possible in the current CDS, because A+E: Staff Member Code is a locally defined three character code.
15.5 How should a transfer from a Consultant to a Nurse, or a transfer from a Nurse to a Consultant be recorded?
The Nursing Episode will form part of a Hospital Provider Spell. This starts when a Consultant, Nurse or Midwife assumes responsibility for care
following the decision to admit the Patient. The transfer of responsibility from a consultant to a Nurse is recorded by closing the Consultant Episode and opening a Nursing Episode. All transfers with the Spell are recorded as
15.6 Inclusion in Service and Financial Framework Returns (SaFFRs) ? It is up to the Department of Health/Ministers to decide what to include or exclude in Central Returns. Collection of data via HES would, however, provide evidence as to the numbers of episodes involved.
Future Development:
16. The need to identify individual nurses by the use of a UKCC code will be kept under review, feedback shows that this information is already collected for Mental Health Care purposes. Meanwhile, the use of a default code will enable nurse activity to be captured. Conclusions:
17. This DSCN mandates a mechanism for the identification of episodes where a nurse is responsible for the total care of the patient. Nurse Activity should be included in the Admitted Patient Care Commissioning Data Sets/HES and the following default codes should be used:
Nurse: N9999998
Specialty Function Code and Consultant Specialty Function Code: 950 Additional Information:
For further information please contact: Data Standards Programme
NHS Information Authority Aqueous II Aston Cross Rocky Lane Birmingham B6 5RQ Tel: 0121 333 0237 Fax: 0121 333 0334
