TrendCare Use Guidelines

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Purpose

These guidelines describe the operational use of TrendCare throughout Grey Hospital. Any request for a variation to these guidelines must first be discussed with the TrendCare coordinator and be approved via the TrendCare steering committee.

TrendCare Use

• All TrendCare users are required to record information into the system accurately and in

a timely manner

• Staff are responsible for predicting, actualising and updating information only on the patients allocated to them in the workload allocation screen. Staff must not enter data or change information on behalf of another staff member.

• If a Shift coordinator, Nurse Manager or Duty Manager does not agree with how another staff member has categorised a patient, they should discuss their concerns with the staff member involved. It should be the staff member that changes the rating if appropriate.

o Exception – In urgent circumstances or when the staff member cannot be contacted to have the discussion prior to the changes being made. However the discussion should occur as soon as possible after the rating change if a change is appropriate/necessary.

• All staff MUST maintain the security of their own logon and password. Data Integrity and System Maintenance

• Each ward should have a representative as their TrendCare Resource Nurse and they should have attended the Interpreter reliability workshop or have one on one training for IRR.

• Each area representative is to formulate an IRR plan with assistance from their TrendCare Coordinator

• Staff that do not achieve competence at IRR testing will have further TrendCare training and be retested to achieve the desired standard.

• Each area is to maintain Gold Standard Actualisation rates (100%) every month

• Any issues with staff list information including: department, role or demographics are to be sent to the TrendCare coordinator via email for problem identification and resolution.

• Patient types that consistently lie outside the benchmarked average hours (HPPD) when categorised, should be reported to the TrendCare coordinator for review

• Changes to Roster codes, leave codes, units, departments etc MUST be done by the TrendCare coordinator after discussion/approval from the TrendCare steering committee when appropriate.

TrendCare Use – Guidelines (Draft) Page 1 of 10 Document Owner: TrendCare Co-ordinator

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Minimum Staffing and Clinical Profile

• _{Minimum Profile} – A level which is used in Staff Allocate Inpatient Variance screen to highlight the need to staff to the minimum staffing profile. Useful in the event that the acuity requirement is less than the minimum requirement.

• _{Clinical Profile}– (also known as budgeted skill mix) The hours entered into this profile are those hours planned/budgeted for patient care. Each CNM should ensure these are correct and advise the TrendCare Co coordinator if they need changing.

Bed Management Admission

• The TrendCare system allows up to 9 patients to be admitted into any bed during a shift

• Patients should be entered into TrendCare via the IPM patient admission system, MANUAL entry should be avoided if at all possible, but if used ensure the correct date/time and patient details are captured.

• If MANUAL entry is used, patient details, DOB, time and date of admission must be recorded correctly to ensure the ‘episode of care ‘ number is assigned to the manual entry when iPM updates the patient admission

• When a patient has been entered manually or more than once in error, the ‘manual admission’ should be cancelled NOT discharged

• Ensure the correct ‘patient type’ has been assigned before predicting/actualising care Discharge

• All expected date of discharges must be flagged as soon as possible after admission

• Discharged patients must have their acuity updated/actualised before discharge

• Patients discharged between 0645-1515 must be discharged on the day shift inpatient screen in TrendCare

• The discharge shift entered must reflect the time entered by IPM (rounded to within 15mins) so this should occur simultaneously. IPM populates TrendCare BUT TrendCare DOES NOT inform IPM so discharge off IPM first if possible.

• Patients that were discharged on the previous shift but are still on TrendCare need to have “from previous shift” selected during the TrendCare discharge process.

Transfers between Departments

• All patients, once admitted to TrendCare, and moving within Grey Hospital, are to be transferred in by the receiving department during the transfer process, NOT discharged (Hannan excepted)

• The transfer in must not occur until the patient arrives at the receiving ward

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• Care time for transfers between departments is to be indicated in the patient

categorisation screen NOT the staff allocate screen unless it is a complicated lengthy transfer

• Sending ward must actualise care prior to the transfer if > 4hrs since start of shift On Leave

• Patients going on leave are required to be categorised and actualised prior to selecting ‘starting leave’ if > 4hrs since start of shift

• Patients returning from leave are required to be categorised on return and actualised following selection ‘end leave’

Inpatient Shift Data Patient Acuity

• _{‘Patient Type’} MUST be reviewed each shift to ensure it correctly reflects patient acuity

• Staff altering ‘Patient Type’ MUST also re predict shifts that the change in patient type effects

• If a patient is requiring complex medications or multiple observations – a high

dependency patient type might be more suitable Acuity Indicators

• It is not possible to have a Guideline specific to every acuity indicator because this is determined by patient type so staff MUST refer to the definitions to ensure accuracy when updating , by right clicking on the acuity indicator the definition will be visible.

• Staff must not add indicators (such as part special) for the sole purpose of increasing Hours per patient day (HPPD) OR to ‘fill’ their 8hrs, It must truly reflect patient acuity and NOT Nurse activity, and should be consistent between staff when a patient’s condition has not changed.

• Selection of patient acuity indicators must be consistent with care plans and clinical pathways, best practice guidelines and standards.

Actualisations

• The patient type must be checked before acuity indicators are confirmed

• Actualisation of all acuity indicators must be completed at the end of each shift

• Actualisation of the ‘Allocate Staff’ screen showing staffing areas, MUST be updated at the end of every shift

Guidelines for ‘Acuity’ Indicators

• _Specialling – Should ONLY be used if the patient CANNOT be left unattended for the period indicated and narrative about why this indicator is applied is required in ‘Shift Notes’

• _Mobility - This is recorded for all 3 shifts specific to the patients changing condition

• _Hygiene – This is N/A at night as hygiene care rarely done during sleep hours

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• _Nutrition- This is N/A at night as there are no meals overnight

• _Incontinence– Includes wash and linen change so DO NOT add hygiene as well

• _{Thought process}– mark this indicator for impact on cognition, DO NOT also select communication/behaviour unless giving explanation in ‘patient‘ notes on T/C, Check the definitions carefully . If a patient has a watch/special to maintain safety, then this indicator should not be added.

• _{Communication}- This does not include semi/unconscious patients, and if ‘thought process’ is already marked, then communication is already part of that indicator so if also marked, a comment in patient notes is helpful e.g. Deaf patient with dementia

• _{Medications –}General administration of meds and flushing of cannulas are included in baseline hours, select this indicator for frequent/continuous infusion and consider high dependency ‘patient type’ if 2nd_{or 3}rd_{involved medication is required.}

• _{Extensive Treatment –} Basic wound care is included in baseline hours for most patient types, and is inclusive of standard reasonable setup time and does not account for disorganisation or poor time management. If the extensive treatment took 15 mins, and the rest of the time was educating patient/family about wound care , then mark the Teaching indicator NOT both.

• _{Teaching/Counselling/Emotional support –} Should rarely be marked on nights unless a specific incident /event occurs, check definitions, should reflect care plan and if it is required, then likely a support/social worker referral should be sent and

evidenced in care plan. Up to 30 mins is already allocated within most ‘patient types’

• _{Discharge Planning –}Should only be indicated usually the day before and day of Discharge. Likely to be routine when returning home, or to previous care facility unless a significant change is occurring e.g. New home care package, Initial discharge to new care facility etc

Predictions

Check care plans and ‘Patient Type’ before completing your patient acuity prediction Morning Shift

By 10am

• Review patient notes

• Commence 24 hour predictions for all allocated patients for morning, evening, night and following day shift

• Review and update all allocated patient diets for current day shift 1400-1515 (Close to end of Shift)

• Complete actualization for all allocated patients ensuring it reflects what care level the

patient actually received/required (A day shift Actual can only be achieved 4 hours after the start of the day shift)

• Upgrade any predictions for evening, night and next day if required

• Update T/C patient notes for handover sheet printouts

• Actualise Nurse hours by checking non clinical and out of ward hours are allocated correctly in the Allocate Staff screen

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• Print handover sheets for evening shift staff (Shift Coordinator) Afternoon shift

2130-2230

• Check any new admissions have been added to evening, night and day shifts

• Actualise evening predictions for all allocated patients and update night and day

predictions (An evening shift Actual can only be achieved 4 hours after the start of the evening shift)

• Review and update all allocated patient diets on current, night and day shift

• Update T/C patient notes for handover sheets

• Print handover sheets for night shift staff (Shift coordinator) Night Shift

0500-0630

• Check any new and expected admissions have been added to night and day shifts

• Actualise night shift predictions and update day predictions

• Review and update all patient diets on current and day shift

• Update patient notes for handover sheets

• Print handover sheets for day shift staff

• Allocate patients to day staff (Team Leader) Actualisations

• The ‘patient type’ must be checked before acuity indicators are confirmed

• Actualisation of all acuity indicators must be completed at the end of each shift

• Actualisation of the ‘Allocate Staff’ screen showing staffing areas, MUST be updated at the end of every shift

Handover Notes On-going Notes:

• Information written in this section will change the notes including the shift they were entered and all future shifts

• Clinical risk information must be updated and recorded here (e.g. Falls, Thought disorder, and any ongoing clinically significant information)

• _{On-going shift notes should be printed in CAPITAL letters, to distinguish} between ‘This shift only’ notes when printed

Ongoing notes reviewed every shift and updated as required and may include-

• ALLERGIES

• SAFETY SCREEN (FALLS RISK/PRESSURE INJURY/ NUTRITION ETC)

• TESTS DONE, DATE COMPLETED

• NFR AND DATE DOCUMENTED

• ISOLATION TYPE

• BIPAP

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This Shift Only Notes:

• Entered into this section for the next shift e.g. Am nurse enters notes for pm nurse, pm nurse for night nurse etc.

• This information is relevant for the following shift only, It is not for progress notes-these are always written in the patients clinical notes

• Any patient who has a ‘watch’ or ‘special’ for part or all of a shift should have it written into ‘this shift only’ notes

‘This shift only’ notes should only include information pertinent to the nurse coming on shift and may include:

• EWS

• Tests scheduled(Should be removed once completed and put into ‘ongoing’ notes)

• New orders

• IVF, IVAB’s, FB

• Any stat meds due Roster Development

• Rosters will be published not less than 28 days prior to the commencement of the roster, provided that less notice may be given in exceptional circumstances. Rosters posted will show duties for a minimum 28 day period. Changes in roster, once posted, shall be by mutual agreement (NZNO DHB MECA 1 March 2013 – 28 February 2015)

• Rosters should reflect all planned leave and hours to be worked

• Posting the roster captures a snapshot of the original, BEFORE any changes are made

• Roster changes should be updated both electronically and to the printed hardcopy

• Each new roster should be made from the Ward Template after it has been checked and updated to add or remove relevant staff

• Roster codes are to be developed in conjunction with Clinical areas BUT added/removed only by TrendCare coordinator

‘Allocate Staff’ Screen Function

• The staff allocation screen tracks actual staff hours and activities undertaken

• Each area will liaise with TrendCare coordinator to maintain their minimum, short and extended lists to suit their departments activities

• The Nurse Managers/shift coordinators must ensure all rostered staff are entered & their hours are accounted for accurately and in a timely manner, every shift

• Nurses MUST check / actualise their hours worked at the end of every shift

• Total hours are to reflect the actual time the staff member has worked.

• Either subtracting time from the clinical in department and adding to another staffing area / ward as appropriate to total 8hrs (if no extra time worked)

OR

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• Entering time in the different staffing area and leaving the time in clinical in department if the staff member worked over their 8hrs shift (Overtime to be recorded)

WCDHB Specific ‘Allocate Staff’ Screen Guidelines

This Staff activities MUST be allocated in the staff allocate screen according to these guidelines, developed and approved by the TrendCare Steering Committee and the

Coordinator. Check definitions of ‘Staff allocate’ columns by R) clicking over the titles, and access ‘all’ options by checking the drop down box on bottom R) of staff allocate screen.

• _{Shift Coordinator} - Usually 2hrs allocated, however, if a CNM available these hours are not always required, If acuity is low no hrs OR only 1 hr may be required, Not required at night.

• _{NetP new graduates} - Allocated 2hrs ‘transition’ to assist in their learning, for the first year of their placements, however, if Acuity is high and clinical need greater , these hours can be moved back into ‘Clinical in Dept’ especially as their placements near the end of each 6 months

• _{Student Supervision-} 2hrs allocated to nurses working with students, however, these are not mandatory as the student especially if 3rd_{year , often adds value to the nurses} clinical hrs, so may only be 1hr or no time altered. This will be more evident as our DEU placement students arrive and we have several students present on every shift.

• _{Clinical Supervision –} Use when working with non-student staff such as new orientating staff, however only 1hr /shift should be required if registered nurses

• _{Environment –} Time captured for cleaning and resetting bed areas for next admissions after discharges – Usually 15mins per discharge, may be more if a longer term patient discharged

• _{Escort –} Hours recorded for transporting patients to other facilities, must capture any overtime hours also in overtime column

• _{Consult Nurse –} 30 mins for venepuncture / cannulation on patients other than your own

• _Equipment – Use to record daily / weekly, equipment / trolley checks etc

• _{Data Entry} – use for FIMS/ACC and other significant documentation or data entry

• _Clerical – Use only when usual clerical hours are not covered, share usual hours between staff on shift

• _{Patient Transfer}– Use if transferring a patient to another area in Grey Hospital, external transfer should be recorded under Escort hours

• _{Miscellaneous}– Use when an activity (not patient care) has taken significant time but has no specific area but MUST add narrative in comments column

‘Shift Notes’ Guidelines

• _{Entering Shift notes-}Can be done by anyone , however, it is best practice that this is in discussion with CNM/Shift coordinator or Duty Nurse Manager

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• _{Content –}Notes if entered, should reflect the general activity and ‘churn’ of the ward especially if it is not reflected in acuity of the patients, e.g. Several admissions or equipment issues etc, that require significant staff time. It can also record staff activity when the area is in positive overage e.g. Online education, clinical reading etc

• _{Out of hours DNM’s –} This is a useful place to record requests for additional staff and responses to negative variance or busy ward ‘Churn’ days.

HRM – Maintaining Staff records

• New staff are added by TrendCare coordinator after a request either through IT or CNM and training arranged directly with the new staff member.

• Initial access and password for TrendCare is allocated by TrendCare coordinator.

• Ongoing security level access will be reviewed and altered as appropriate in discussion with TrendCare coordinator

• CNM’s should be updating and maintaining their Ward list for APC Registration details and appraisals etc. If appraisal supports PDRP or NetP appraisal this should be noted in comments section

• Training/Inservice/Competency records should only be entered by CNE’s and TrendCare coordinator Definitions are

• _COMPETENCY - The achievement of skill and clinical judgement required to perform a task within the context of employment at WCDHB e.g. IV administration, Epidural, Venepuncture, cannulation etc

o CNE’s and TrendCare coordinator should enter new competencies and updates when notified of their completion and evidence produced

o CNM’s are responsible for ensuring staff maintain their competencies annually or as required

• TRAINING - Approved learning resources and /or formal education sessions delivered within the WCDHB educational framework

o Mandatory training usually captured by Learning and Development Corporate office

o CNE’s and TrendCare coordinator should enter new training sessions when notified of their completion and evidence produced like attendance register

• INSERVICE - An informal teaching session, generally delivered within once clinical area, of at least 15-30 mins duration

o This can be a regular or infrequent event, but must be on different topics o CNE’s and TrendCare coordinator should enter new training sessions when

notified of their completion and evidence produced like attendance register o When entering a generic Inservice session, the topic MUST be entered in the

comments section of the inservice register

• CONFERENCE - Education delivered by an external provider to WCDHB staff who attend usually offsite , preferably by an accredited provider with NZQA approval

• _{QUALIFICATION -}Undergraduate and post graduate qualifications provided by an accredited provider, achievement of discrete papers is not entered, only completed qualifications.

Security

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• Staff are assigned an appropriate logon and initial password by the TrendCare Coordinator

• They must change the password at first logon and kept it secure for their use only

• If they forget their logon or password contact the TrendCare coordinator for assistance

• Access to different security levels within TrendCare are assigned by job description, if you want a different level of access this can be discussed with your T/C coordinator Contacts

• TrendCare co-ordinator - Ext 5014 o Password /access issues

o Retrospective alterations if > 2 days for nursing o Reports from TrendCare

o History / Education records for individual staff off TrendCare o Security level changes

o Education/support with TrendCare use

• IT Help desk – Ext 2911

o Hard ware issues with work stations/printers

o Getting TrendCare added to your workstation/desk top o iPM and TrendCare interface

o Dietary and TrendCare interface

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The roles and responsibility table below is a guide only and will vary between areas depending on

roles within that service.

Role Current activity and responsibilities in your area Senior nursing/midwifer y Roles including Clinical Nursing and Midwifery Managers

• Roster development/ updates and approval

• Management of leave planner

• Actualisation - Response to audits

• ‘Allocate staff’ review daily/weekly as required

• Register for Annual Practicing Certificates, Appraisals etc

• Identify/support the TrendCare Resource Nurse with IRR / Training

• Respond to Variance / other TC reports as required

• Review of historical trends for planning and service development Shift coordinators

/2IC’s • ‘Allocate staff’ screen review every shift, to ensure corrections and assign new admissions to nurses

• Allocate workloads /update workloads as new admissions arrive

• Review predictions for completion/revision at end of shift

• Staff allocation for next shift as appropriate

• Correct placement of patients to beds/rooms

• Staff handover sheets Out of hours Duty

Nurse Manager • • DNM rosters/update DNM hours Review wards - staffing / Acuity – Respond to negative variance situations, and record in ward notes what action was taken

• Update staff allocate screens – escorts / deployment /overtime Clinical Nurse

Educators • Update HRM training/in service/competency records Registered

Nurse/Midwife • Predict / actualise patient acuity (am nurse/midwife does 24hr predictions)

• Actualise own hours in staff allocate screen daily

• Admit, discharge, transfer patients

• Bed patient notes/shift notes updated

• Handover sheets next shift as required Enrolled Nurses • Predict / actualise patient acuity

• Actualise own hours in staff allocate screens Clerical • Admit/Discharge/transfer patients

• Patient movement to correct beds/rooms

• Roster changes/staff allocate hours/updates as requested by CNM

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