Authors (including presenting author) :
Yeung W(1), Mak YM(1)(2), Mak KS(1), Ho YL(2), Chu WT(1), Chan YH(1), Tsung WC(1), Chan LW(2), Ng WC(2), Lam PL(2)
Affiliation :
(1)Infirmary Unit, Cheshire Home, Shatin (2)Disabled Unit, Cheshire Home, Shatin
Introduction :
Nursing is a team work. From top-down, Ward Managers (WM), Advance Practice Nurse (APN) and Nursing Officer (NO) provide supervision and clinical support to frontline nurses. Vice-versa, frontline nurses report clinical issues to supervisors from bottom-up.
To strengthen the clinical supervision and support, as well as the communication within nursing team, the clinical nursing management system was revamped to cater the increasing complexity of clinical situation.
Objectives :
1. To strengthen clinical supervision in wards of Cheshire Home, Shatin (SCH)
2. To enhance the clinical support from nurse supervisors to junior frontline staff
3. To strengthen the reporting system
4. To improve the quality of patient care
Methodology :
Firstly, WM took up on call shift supervisor role during office hour. NO and APN participated more actively in ward activities. Transmission of advanced skills and sharing of experience from NO/APN to junior frontline colleagues, particularly fresh graduates could be achieved. Clinical monitoring and supervision was enhanced. Timely on-site support to frontline staff and patients could also be provided.
Besides, satellite stations were set up in wards. Monitoring of patients which were remote from the main nurse station were enhanced. Prompt support would be provided to patients. Also, there was extension of working spaces.
Furthermore, two-way communication was enhanced by Daily Reminder and Team Briefing. Ward Manager prepared daily reminder to disseminate important information to frontline staff. Team briefing was carried out daily to disseminate information, collect feedbacks, provide prompt support and follow-up actions to frontline staff accordingly.
Lastly, reporting system was reengineered to widen and ensure transfer of information. Daily ward report mechanism was implemented. All nurses were encouraged and engaged in the preparation of ward report. Shift Nurse Supervisor provided necessary support and advice. Ward reports were summarized by Department Operation Manager (DOM) and further submitted senior management level.
Result & Outcome :
Staff Survey
Staff survey was carried out to collect the feedback from frontline staff. The questionnaire contained four 5-point Likert Scale questions:
1. Clinical supervision in ward was strengthened.
2. More clinical support and backup for frontline staff was received.
3. Communication among staff was enhanced.
4. Patient care was improved.
Beside, overall satisfaction on the Strengthening of Clinical Supervision and Support in SCH was collected.
102 returns were received. Return rate was 60%. The overall satisfaction was 3.8 out of 5.
81.4% agreed that the clinical supervision in ward was strengthened. 78.4% agreed that more clinical support and backup for frontline staff was received. 80.4% agreed that the communication among staff was enhanced and patient care was improved.
Review of Nursing Quality Indicator (NQI)
NQI regarding Fall and Pressure Injury was reviewed. Under the zero restraint environment, the fall rate inside ward was dropped from 0.103% in 2018 to 0.004% in 2019 (from January to August). The hospital acquired pressure injury rate dropped from 0.025% in 2018 to 0% in 2019 (from January to August).
Conclusion
The improvement measures strengthened the clinical supervision in wards of SCH. Frontline clinical staff particular junior colleagues received more support and backup. Communication among staff was enhanced. Patient care was improved with the evidence of improvement in in-hospital fall rete and pressure injury incident rate.
