trust board meeting - watford general hospital...trust board meeting - 14 may 2015 nursing and...

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Trust Board Meeting

14 May 2015

Title of Paper: Nursing and Midwifery Safe Staffing Report

Agenda Item:

12/27

Lead Executive:

Tracey Carter Chief Nurse and Director of Infection Prevention and Control

Author: Toni Nettleton – Lead Nurse Workforce

Trust Objectives:

Achieving continuous improvement in the quality of patient care that we provide and the delivery of service performance across all areas

Purpose: Provides an update on the progress regarding the arrangements within the Trust for managing safe nursing and midwifery staffing levels within inpatient wards

Please add which panel and/or group that the paper has been previously discussed at prior to Trust Board

Name and Date: Committee: Group:

TLEC Workforce Committee

30.04.15 5th May 2015

Benefits to patients and patient safety implications To assure we have sufficient qualified, skilled and experienced staff to meet patient’s care needs on a shift-by-shift, day-by-day basis to give safe quality care to patients. Risk implications for the Trust

Patient safety and clinical quality of care are likely to suffer as a consequence of not having the right staff with the right skills in the right place at the right time. This will lead to a suboptimal patient experience and potential poor Trust publicity

Mitigations actions (controls) Utilisation bank and agency to maintain safe staffing levels. Implementation of a real time database with trust-wide shared access for senior nurses to identify risks and manage nursing and midwifery staffing levels on a day-to-day, shift-by-shift basis. Reducing bed base to mitigate staffing shortages. Reporting mechanisms robust and assured

Links to Board Assurance Framework, CQC outcomes, statutory requirements The Care Quality Commission (CQC), under regulation 10(3) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010

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Legal implications

Financial implications

Use of temporary staff to support specials use, vacancies and maternity leave. Recommendations

To note the contents of this report.

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Agenda Item: 12/27

Trust Board Meeting - 14 May 2015 Nursing and Midwifery Safe staffing report Presented by: Tracey Carter,

Chief Nurse and Director of Infection Prevention and Control

1. Purpose 1.1 This paper provides an update on managing safe nursing and midwifery staffing levels within inpatient wards during February and March 2015.

2. Background

2.1 Papers and reports follow the route of; Trust Leadership Executive Committee (TLEC) and Workforce Committee.

2.2 The Trust submitted all unify data to NHS England as required by 12 March (February data) and 12 April (March data). See appendix 1 for unify data returns by site and ward.

3. Analysis/Discussion

3.1 Planned versus actual nursing hours for March 2015 was 3.9% below planned hours (Includes trained nurses/midwife and healthcare assistant hours combined). This was an increase of 0.6% from February 2015.

3.2 In March 2015 there were a total of 29 areas out of 31 where staffing fell below planned hours. This was an increase of 2 areas from the 32 reported last month (Churchill ward at Hemel Hempstead Hospital is now closed).

3.3

3.4

3.5 The monthly trend of planned versus actual nursing hours within our inpatient wards,

showed a stable trend of between 97.9% (August 2014) to 96.7% (February 2014). The month of March 2015 of 96.1% is a decrease of 0.5% to the 96.7% reported in February. See figure 1

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Figure 1

3.6

Figure 2

May June July August September October November December January February March April

Trained Nurses/Midwives Day

100.8% 97.9% 97.9% 96.9% 95.4% 97.7% 97.4% 94.0% 95.2% 94.0% 92.3%

Trained Nurses/Midwives Night

99.0% 99.1% 98.8% 99.1% 99.4% 98.7% 99.3% 98.8% 99.7% 99.6% 99.4%

Health CareAssistants Day

99.8% 99.0% 103.1% 95.7% 96.8% 92.0% 95.1% 93.2% 97.4% 95.0% 96.4%

Health Care Assistants Night

108.2% 100.3% 104.5% 100.6% 100.7% 98.6% 98.2% 98.9% 98.3% 99.6% 98.1%

Target Fill Rate 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

60.0%

70.0%

80.0%

90.0%

100.0%

110.0%

120.0%

130.0%

140.0%

Av

era

ge

Fil

l R

ate

West Herts Trust Overall

3.7 Division of Medicine

In the month of March 2015 2 areas used more hours than planned, this equated to less than 1% above planned hours for each area. .

The two areas using increased hours relate to additional shifts due to 1:1 specialing and a higher level of patient nursing dependency needs.

In March 2015 there were 3 areas who reported that their actual nursing hours fell below planned by more than 5%.

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This was a decrease of 2 areas from February.

The largest proportion of red/amber alerts was within the division of Medicine at 8.5% (211 shifts). Out of 22 areas recorded the top three recording red/amber alerts were Heronsgate/Gade with 22 shift alerts, Sarratt ward 18 shifts of which 4 were rated red and Red Suite 15 shifts.

3.8 Division of Surgery

No areas were recorded to have actual nursing hours over planned in the month of March 2015. This was a decrease of 2 areas from February 2015.

In March 2015 1 area reported that their actual nursing hours fell below planned by more than 5%. This was a decrease of 1 area from February.

The division of surgery recorded 2.3% (58 shifts) red/amber shifts alerts. Out of 9 areas the top three who recorded red/amber shifts were Emergency Surgical Assessment Unit 23 shift alerts, Letchmore 13 shift alerts and Ridge ward with 7 alerts.

3.9 Division of Women and Children

No areas were recorded to have actual nursing hours over planned in the month of March 2015. This is the same as the previous month of February 2015.

In March 2015 there were 4 areas who reported that their actual nursing hours fell below planned by more than 5%. This was a decrease of 1 area from February 2015.

The division of Women and children recorded 2.7% (66 shifts) red/amber alerts. Out of 12 areas the top three who recorded red/amber shifts were Delivery Suite 19 shifts, Elizabeth Ward 13 shifts Katherine ward 12 shifts.

Appendix 3 shows by division, at ward level, the 3 months (January – March 2015) percentage of actual vs. planned hours used.

3.10 Workforce red flag events continue to be closely monitored and reported through the

daily ‘onion’ meetings. See appendix 4 showing monthly trend graphs for red flag events and supervisory hours lost overall and by ward for the months of January February and March 2015

In March 2015 the Trust recorded 5 (0.2%) red flag shifts where there were less than 2 registered nurses on duty; this was the same as the month of February.

There were 248 (12.1%) red flag shifts recorded where more than 8hrs of trained nursing hours were less than planned. This was a 2.4% increase from the previous month.

total of 254 shifts or 1,877 (33.3%) supervisory hours were lost in March 2015 to mitigate against unfilled hours and maintain safe patient care. This was an increase of 6.0% in comparison to February 2015. Supervisory lost hours will impact on the ability of the Band 7s to carry out their full role.

3.11 Professional judgement shift Red, Amber, and Green (RAG) ratings. See Figure 3 below for overall monthly Trust percentages of shifts raged red amber and green.

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See appendix 5 for monthly trend graphs by division for the percentage of shifts rated red amber and green in March 2015. Figure 3


Green 98.0% 95.39% 97.3% 95.7% 94.6% 93.5% 94.2% 87.2% 89.8% 89.2% 86.5%

Amber 2.0% 4.57% 2.7% 4.3% 5.3% 6.2% 5.8% 12.4% 9.9% 10.4% 13.0%

Red 0.0% 0.04% 0.0% 0.0% 0.1% 0.3% 0.04% 0.4% 0.3% 0.4% 0.6%

Target RAG 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%R

AG

Pe

rce

nta

ge

West Herts Trust Overall

All shifts day and night are professionally judged by the nurse in charge of the clinical area for safety by RAG rating. Rag rates across wards and areas also include areas not included in the unify data collection e.g Accident and Emergency.

In March 2015, 86.5% (2,151) of shifts were rated green and safe.

13.6% (337 shifts) of shifts were rated red and amber in March 2015; this was an increase of 2.8% from February 2015. The monthly trend of shifts reported red and amber has increased since January 2015 which is concerning and related to the Trust vacancy rate.

. The Nursing & Midwifery Staffing Escalation Policy followed.

The directorate’s senior nursing teams continue to maintain support and supervision with the ward sister/charge nurses to ensure safe staffing levels are maintained.

See appendix 6 for exception report with mitigations by shift for February and March 2015

3.12 The Recruitment and retention of nursing staff remains a priority for the Trust, but is

an ongoing challenge. Stabilising and retaining the nursing workforce in clinical areas is a concern as we move through 2015.

As of 31 March the vacancy for registered nurses and midwives was 19.1% (275.9wte). This is an increase of 2.9% from February. The Healthcare assistant vacancy is currently 18.2% (82.6wte) and is an increase of 3.3% from February. The current vacancy rate does not include new starters in the pipeline who are waiting to start at the Trust.

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Biweekly cohort recruitment continues to take place for registered nurses and healthcare assistants. As of 31 March there were 112 registered nurses and midwives and 51 unqualified healthcare assistants waiting to start.

International recruitment is due to take place in May to support the filling of vacant posts. It is however projected that the nurses will be unavailable to work as a registered nurse within the United Kingdom until the end of 2015.

Appendix 7 shows the current Nursing and Midwifery workforce position with a projected three month vacancy position.

4. Next Steps 4.1 To continue to reduce the overall bed base across the three hospital sites to mitigate

vacancies and reduce the temporary staffing usage. This action will also support patient safety.

4.2 Review of Nursing & Midwifery Staffing Escalation Policy to include non invasive ventilation staff to patient ratio. Guidance for escalation area staffing.

5. Risks

5.1 Data is currently sourced from both electronic and manual data entry, to enable

ratification of robust data collection. User error and administrative failure remain a

risk to data quality.

5.2 The Trust continues with high activity levels and vacancy rates. Recruitment and

retention of staff is a key to enable the reduction of the vacancy rate and use of

temporary staff.

6. Recommendation

6.1 The Trust Board are asked to note the contents of the report

Tracey Carter Chief Nurse and Director of Infection Prevention and Control

16 April 2015

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Appendix 1 West Hertfordshire Hospitals Unify Fill rate indicator return Staffing: Nursing, midwifery and care staff February 2015

Day Night

Registered midwives/nurse

s Care Staff

Registered midwives/nur

ses Care Staff Day Night

Site Name

Total monthly planned staff

hours

Total monthly actual staff

hours

Total monthly planned

staff hours


hours

Total monthly planned staff

hours


hours


staff hours

Total monthly actual

staff hours

Average fill rate -

registered nurses/midwi

ves (%)

Average fill rate - care staff (%)

Average fill rate - registered

nurses/midwives (%)


Hemel Hempstead Hospital 2447 2294.5 2288.5 2238.5 2162 2139 2162 2139

93.8% 97.8% 98.9% 98.9%

St Albans City Hospital 1890.5 1775 885.5 797.5 1196 1196 322 276

93.9% 90.1% 100.0% 85.7%

Watford General Hospital 46278 43502 24851.5 23583 40422.5 40250 18492 18469

94.0% 94.9% 99.6% 99.9%

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Appendix 1 West Hertfordshire Hospitals NHS Trust Unify Fill rate indicator return by ward February 2015

Day Night Day Night

Ward name

Main 2 Specialties on each ward

Registered midwives/nurses

Care Staff Registered midwives/nurses

Care Staff

Average fill rate - registered nurses/midwives (%)




Hospital Site name Specialty 1

Total monthly planned staff hours

Total monthly actual staff hours







RWG02

Watford General

AAU Blue Level 1 300 - GENERAL MEDICINE

1094 1048 644 667 966 966 644 644 95.8% 103.6% 100.0% 100.0%

RWG02

Watford General

AAU Yellow Level 1 300 - GENERAL MEDICINE

1086 1082 644 644 966 966 644 655.5 99.6% 100.0% 100.0% 101.8%

RWG02 Watford General

AAU Green Level 1 300 - GENERAL MEDICINE

1093.5 1040 644 690 966 943 644 621 95.1% 107.1% 97.6% 96.4%

RWG02

Watford General

AAU Red Suite 300 - GENERAL MEDICINE

1116 1005 644 598 966 943 322 345 90.1% 92.9% 97.6% 107.1%


AAU Blue & Yellow Level 3 300 - GENERAL MEDICINE

2404.5 2339.5 1610 1556 2254 2231 1288 1288 97.3% 96.6% 99.0% 100.0%


Cardiac Care Green & Purple

320 - CARDIOLOGY 2022 1930 644 793.5 1610 1610 322 575 95.5% 123.2% 100.0% 178.6%

RWG02

Watford General

Bluebell 430 - GERIATRIC MEDICINE

1430.5 1274 1288 1253.5 1288 1276.5 1288 1288 89.1% 97.3% 99.1% 100.0%


Winyard 430 - GERIATRIC MEDICINE

1103 1049.5 644 517.5 966 966 644 609.5 95.1% 80.4% 100.0% 94.6%

RWG02

Watford General

Sarratt 430 - GERIATRIC MEDICINE

3086 2834.5 2898 2537 2576 2622 1932 1851.5 91.9% 87.5% 101.8% 95.8%


Oxhey 430 - GERIATRIC MEDICINE

779 659 644 552 644 644 322 333.5 84.6% 85.7% 100.0% 103.6%

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Heronsgate & Gade 300 - GENERAL MEDICINE

2224.5 1976 1288 1196 1932 1897.5 644 644 88.8% 92.9% 98.2% 100.0%

RWG02

Watford General

Aldenham 300 - GENERAL MEDICINE

2070.5 1829 977.5 950.5 1610 1541 322 460 88.3% 97.2% 95.7% 142.9%


Cassio 300 - GENERAL MEDICINE

1108.5 1039.5 644 724.5 966 954.5 322 460 93.8% 112.5% 98.8% 142.9%

RWG02

Watford General

Tudor 300 - GENERAL MEDICINE

1438 1377 1610 1541 1288 1288 1288 1276.5 95.8% 95.7% 100.0% 99.1%


Acute Stroke Unit 300 - GENERAL MEDICINE

2284.5 2094.5 1288 1253.5 1932 1920.5 1288 1253.5 91.7% 97.3% 99.4% 97.3%

RWG08 Hemel Hempstead

Churchill 300 - GENERAL MEDICINE

1331 1228 1196 1161.5 1196 1196 1196 1207.5 92.3% 97.1% 100.0% 101.0%

RWG08

Hemel Hempstead

Simpson 300 - GENERAL MEDICINE

1116 1066.5 1092.5 1077 966 943 966 931.5 95.6% 98.6% 97.6% 96.4%

RWG03 St Albans City

De La Mare/Beckett 100 - GENERAL SURGERY

1890.5 1775 885.5 797.5 1196 1196 322 276 93.9% 90.1% 100.0% 85.7%

RWG02

Watford General

Letchmore 100 - GENERAL SURGERY

1116 1055 644 805 966 954.5 322 448.5 94.5% 125.0% 98.8% 139.3%


Flaunden 100 - GENERAL SURGERY

1369 1354 1035 1000.5 1276.5 1265 333.5 333.5 98.9% 96.7% 99.1% 100.0%


Ridge 100 - GENERAL SURGERY

1438 1262 966 874 966 943 644 632.5 87.8% 90.5% 97.6% 98.2%


Cleves 100 - GENERAL SURGERY

1108.5 1051 966 1003.5 966 966 644 954.5 94.8% 103.9% 100.0% 148.2%


Langley 100 - GENERAL SURGERY

1024 924.5 414 460 644 644 322 345 90.3% 111.1% 100.0% 107.1%

RWG02

Watford General

Combined ITU 192 - CRITICAL CARE MEDICINE

4814 4607.5 287.5 253 4945 4807 230 161 95.7% 88.0% 97.2% 70.0%


Starfish 321 - PAEDIATRIC CARDIOLOGY

1334.5 1220.5 322 345 1000.5 1023.5 310.5 299 91.5% 107.1% 102.3% 96.3%

RWG02

Watford General

SCBU 321 - PAEDIATRIC CARDIOLOGY

2012.5 2130.5 885.5 670.5 1966.5 2104.5 874 563.5 105.9% 75.7% 107.0% 64.5%

RWG02 Watford General Elizabeth 502 - GYNAECOLOGY 1438 1289.5 644 597.5 966 966 644 621 89.7% 92.8% 100.0% 96.4%

RWG02 Watford General Delivery Suite 501 - OBSTETRICS 3048 2907 644 529 2898 2898 644 529 95.4% 82.1% 100.0% 82.1%

RWG02 Watford General ABC 501 - OBSTETRICS 966 900.5 322 272 966 966 322 276 93.2% 84.5% 100.0% 85.7%

RWG02 Watford General Victoria 501 - OBSTETRICS 651.5 651.5 322 295 644 644 322 264.5 100.0% 91.6% 100.0% 82.1%

RWG02 Watford General Katherine 501 - OBSTETRICS 1295.5 1260.5 966 705 966 977.5 644 483 97.3% 73.0% 101.2% 75.0%

RWG02

Watford General

Knutsford 501 - OBSTETRICS 322 310.5 322 299 322 322 322 253 96.4% 92.9% 100.0% 78.6%

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Appendix 1 West Hertfordshire Hospitals Unify Fill rate indicator return Staffing: Nursing, midwifery and care staff March 2015

Day Night


Care Staff


Care Staff Day Night

Site Code Site Name













RWG08

Hemel Hempstead Hospital 1246 1200.5 1334 1242 1081 1069.5 1058 1058

96.3% 93.1% 98.9% 100.0%

RWG03

St Albans City Hospital 1763.5 1649.5 812.5 836 1230.5 1207.5 356.5 218.5

93.5% 102.9% 98.1% 61.3%

RWG02

Watford General Hospital 49155.5 45299.5 25610.5 24677.5 42906.5 42688 18986.5 18733.5

92.2% 96.4% 99.5% 98.7%

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Appendix 1 West Hertfordshire Hospitals NHS Trust Unify Fill rate indicator return by ward March 2015

Day Night Day Night

Hospital Site Details Ward name Main 2 Specialties on each ward Registered midwives/nurses

Care Staff Registered midwives/nurses

Care Staff Average fill rate -

registered nurses/mi

dwives (%)

Average fill rate - care staff

(%)

Average fill rate -

registered nurses/mi

dwives (%)

Average fill rate - care staff

(%)

Hospital Site name Specialty 1 Specialty 2 Total monthly planned staff hours



staff hours


hours


staff hours


hours


staff hours


RWG02 Watford General Hospital - RWG02

AAU Blue Level 1 300 - GENERAL MEDICINE 1231 1151 713 701.5 1069.5 1058 713 713 93.5% 98.4% 98.9% 100.0%


AAU Yellow Level 1

300 - GENERAL MEDICINE 1231 1093.5 713 736 1069.5 1058 713 713 88.8% 103.2% 98.9% 100.0%


AAU Green Level 1

300 - GENERAL MEDICINE 1242.5 1089.5 713 736 1069.5 1069.5 713 724.5 87.7% 103.2% 100.0% 101.6%


AAU Red Suite 430 - GERIATRIC MEDICINE 1234.5 1077.5 713 713 1069.5 1069.5 356.5 391 87.3% 100.0% 100.0% 109.7%


AAU Blue & Yellow Level 3

300 - GENERAL MEDICINE 2660.5 2378.5 1782.5 1840 2495.5 2415 1426 1426 89.4% 103.2% 96.8% 100.0%


Cardiac Care 320 - CARDIOLOGY 2281.5 2093.5 713 943 1782.5 1782.5 356.5 356.5 91.8% 132.3% 100.0% 100.0%


Bluebell 430 - GERIATRIC MEDICINE 1606 1376.5 1426 1483.5 1426 1380 1426 1449 85.7% 104.0% 96.8% 101.6%


Winyard 430 - GERIATRIC MEDICINE 1226.5 1184.5 713 609.5 1069.5 1069.5 713 713 96.6% 85.5% 100.0% 100.0%


Sarratt 430 - GERIATRIC MEDICINE 2172.5 1720 2139 2043 1782.5 1851.5 1426 1334 79.2% 95.5% 103.9% 93.5%


Croxley 430 - GERIATRIC MEDICINE 1212 1108.5 1069.5 1012 1069.5 1058 713 713 91.5% 94.6% 98.9% 100.0%


Oxhey 430 - GERIATRIC MEDICINE 765.5 750.5 713 632.5 713 713 356.5 379.5 98.0% 88.7% 100.0% 106.5%


Heronsgate & Gade

300 - GENERAL MEDICINE 2409 1930.5 1426 1456.5 2139 2116 713 828 80.1% 102.1% 98.9% 116.1%


Aldenham 300 - GENERAL MEDICINE 2151 1798 1058 1058 1771 1702 356.5 425.5 83.6% 100.0% 96.1% 119.4%


Cassio 300 - GENERAL MEDICINE 1234.5 1158 713 770.5 1069.5 1023.5 356.5 448.5 93.8% 108.1% 95.7% 125.8%

RWG02 Watford General Acute Stroke Unit 300 - GENERAL MEDICINE 2289 2220.5 1426 1399 2139 2139 1426 1426 97.0% 98.1% 100.0% 100.0%

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Hospital - RWG02

RWG08 Hemel Hempstead Hospital - RWG08

Simpson 300 - GENERAL MEDICINE 1246 1200.5 1334 1242 1081 1069.5 1058 1058 96.3% 93.1% 98.9% 100.0%

RWG03 St Albans City Hospital - RWG03

De La Mare/Beckett

100 - GENERAL SURGERY 1763.5 1649.5 812.5 836 1230.5 1207.5 356.5 218.5 93.5% 102.9% 98.1% 61.3%


Letchmore 100 - GENERAL SURGERY 1227 1082 713 759 1069.5 1058 356.5 391 88.2% 106.5% 98.9% 109.7%


Flaunden 100 - GENERAL SURGERY 1576 1453.5 1069.5 1081 1426 1414.5 356.5 356.5 92.2% 101.1% 99.2% 100.0%


Ridge 100 - GENERAL SURGERY 1576 1419 1069.5 1012 1069.5 1069.5 713 747.5 90.0% 94.6% 100.0% 104.8%


Cleves 100 - GENERAL SURGERY 1234.5 1108 1069.5 999.5 1069.5 1058 713 839.5 89.8% 93.5% 98.9% 117.7%


Langley 100 - GENERAL SURGERY 1116 1016.5 460 448.5 713 713 356.5 356.5 91.1% 97.5% 100.0% 100.0%


Combined ITU 192 - CRITICAL CARE MEDICINE 5201 4998.5 379.5 264.5 5094.5 5071.5 276 195.5 96.1% 69.7% 99.5% 70.8%


Starfish 321 - PAEDIATRIC CARDIOLOGY 1491.5 1390 368 356.5 1069.5 1081 356.5 322 93.2% 96.9% 101.1% 90.3%


SCBU 321 - PAEDIATRIC CARDIOLOGY 2219.5 2379 885.5 747 2173.5 2288.5 885.5 701.5 107.2% 84.4% 105.3% 79.2%


Elizabeth 502 - GYNAECOLOGY 1576 1502.5 713 686 1069.5 1046.5 713 724.5 95.3% 96.2% 97.8% 101.6%


Delivery Suite 501 - OBSTETRICS 3388.5 3323 713 582 3208.5 3197 713 586.5 98.1% 81.6% 99.6% 82.3%


ABC 501 - OBSTETRICS 1077 1011 356.5 297.5 1069.5 1035 356.5 322 93.9% 83.5% 96.8% 90.3%


Victoria 501 - OBSTETRICS 728 727.5 356.5 314 713 724.5 356.5 276 99.9% 88.1% 101.6% 77.4%


Katherine 501 - OBSTETRICS 1441 1402 1069.5 758.5 1069.5 1069.5 713 598 97.3% 70.9% 100.0% 83.9%


Knutsford 501 - OBSTETRICS 356.5 356.5 356.5 237.5 356.5 356.5 356.5 276 100.0% 66.6% 100.0% 77.4%

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Appendix 2 Trend graphs by percentage for average fill rates by hospital and division



100.5% 97.7% 97.5% 96.8% 95.5% 97.7% 97.4% 93.8% 95.1% 94.0% 92.2%


99.0% 99.0% 98.8% 99.1% 99.4% 98.7% 99.5% 98.8% 99.8% 99.6% 99.5%


99.8% 98.9% 102.5% 95.0% 96.0% 91.5% 95.0% 91.2% 96.6% 94.9% 96.4%


108.4% 100.5% 104.7% 100.6% 100.7% 98.8% 98.2% 98.5% 98.2% 99.9% 98.7%

Target Fill Rate 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

60.0%

70.0%

80.0%

90.0%

100.0%

110.0%

120.0%

130.0%

140.0%

Ave

rage

Fill

Rat

e

Watford General Hospital



106.5% 103.7% 107.9% 98.4% 93.2% 96.5% 99.2% 99.7% 100.4% 93.9% 93.5%


97.5% 101.0% 100.0% 99.0% 101.0% 100.0% 94.3% 98.1% 97.0% 100.0% 98.1%


98.2% 101.7% 120.5% 115.7% 118.8% 104.5% 96.5% 94.7% 100.1% 90.1% 102.9%


100.0% 90.0% 96.8% 100.0% 100.0% 90.6% 96.7% 84.3% 86.7% 85.7% 61.3%

Target Fill Rate 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

60.0%

70.0%

80.0%

90.0%

100.0%

110.0%

120.0%

130.0%

140.0%

Ave

rage

Fill

Rat

e

St Albans City Hospital



91.8% 94.5% 93.8% 96.3%


99.1% 98.2% 98.9% 98.9%


118.1% 105.3% 97.8% 93.1%


109.3% 101.4% 98.9% 100.0%

Target Fill Rate 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

60.00%

70.00%

80.00%

90.00%

100.00%

110.00%

120.00%

130.00%

140.00%

Ave

rage

Fill

Rat

e

Hemel Hempstead General Hospital

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101.5% 97.7% 99.4% 97.2% 97.0% 98.3% 98.0% 92.7% 93.1% 92.8% 89.1%


99.0% 98.7% 98.6% 97.5% 98.9% 99.6% 99.3% 98.0% 99.1% 99.2% 98.9%


105.9% 104.4% 108.9% 97.7% 98.4% 94.2% 98.2% 96.5% 99.0% 96.3% 100.1%


116.0% 107.1% 115.8% 103.2% 103.7% 102.1% 103.8% 101.7% 99.8% 102.6% 102.2%

Target Fill Rate 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

60.0%

70.0%

80.0%

90.0%

100.0%

110.0%

120.0%

130.0%

140.0%A

vera

ge F

ill R

ate

Medicine



101.6% 99.8% 99.3% 98.5% 94.9% 97.6% 96.4% 94.7% 96.3% 94.3% 92.9%


97.1% 98.9% 97.9% 98.9% 99.6% 97.3% 99.9% 98.8% 98.6% 98.3% 99.3%


102.9% 98.3% 101.8% 98.7% 103.0% 96.8% 97.0% 93.2% 101.3% 99.9% 96.9%


127.2% 100.8% 106.5% 116.8% 117.5% 109.1% 98.5% 108.8% 114.8% 111.8% 99.3%

Target Fill Rate 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

60.0%

70.0%

80.0%

90.0%

100.0%

110.0%

120.0%

130.0%

140.0%

Ave

rgae

Fill

Rat

e

Surgery



98.7% 96.4% 93.5% 94.0% 95.5% 96.5% 97.5% 96.0% 99.2% 96.4% 98.5%


100.2% 100.2% 100.0% 102.8% 99.4% 98.5% 98.9% 100.0% 101.8% 101.8% 100.6%


75.6% 81.8% 85.8% 85.8% 96.0% 79.0% 82.9% 82.0% 86.5% 83.9% 82.6%


79.7% 83.2% 75.6% 84.9% 100.7% 83.0% 83.5% 84.1% 82.5% 80.6% 85.5%

Target Fill Rate 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

60.0%

70.0%

80.0%

90.0%

100.0%

110.0%

120.0%

130.0%

140.0%

Ave

rage

Fill

Rat

e

Womens & Childrens

of 33

Appendix 3 Actual percentage of nursing hours vs. planned by division and ward for the months of January, February and March 2015

-15.0%

-10.0%

-5.0%

0.0%

5.0%

10.0%

15.0%

AAU Blue Level 1

AAU Yellow

Level 1

AAU G

reen Level 1

AAU Red Suite

AAU Blue &

Yellow Level 3

Cardiac Care Green &

Purple

Bluebell

Winyard

Sarratt

Croxley

Oxhey

Heronsgate &

Gade

Aldenham

Cassio

Tudor

Acute Stroke Unit

Churchill

Simpson

Ward

Medicine Actual v Planned %

Jan-15 Feb-15 Mar-15

-15.0%

-10.0%

-5.0%

0.0%

5.0%

10.0%

15.0%

De La Mare/Beckett Letchmore Flaunden Ridge Cleves Langley Combined ITU

Ward

Surgery Actual v Planned %


-15.0%

-10.0%

-5.0%

0.0%

5.0%

10.0%

15.0%

Starfish SCBU Elizabeth Delivery Suite ABC Victoria Katherine Knutsford

Ward

Women's & Children's Actual v Planned %


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Appendix 4 Monthly trend graph for the percentage of shifts with red flag events

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

November-14 December-14 January-15 February-15 March-15

Pe

rce

nta

ge o

f sh

ifts

wit

h R

ed

Fla

gs

Month

Trust Overall Red Flags

Percentage of shifts less than 2 RN's on shift Percentage of shifts more than 8 RN hours less then planned

Monthly trend graph for the percentage of supervisory hours lost

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

October-14 November-14 December-14 January-15 February-15 March-15

Pe

rce

nta

ge o

f H

ou

rs L

ost

Month

Overall Supervisory Hours Lost

Trust Overall

Percentage of supervisory hours lost by ward for the months of January February and March 2015

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

AA

U B

lue

Le

vel 1

AA

U Y

ell

ow

Le

vel 1

AA

U G

ree

n L

eve

l 1

AA

U R

ed

Su

ite

AA

U T

riag

e

AA

U B

lue

& Y

ell

ow

…

Car

dia

c C

are

Blu

eb

ell

Win

yard

Cro

xle

y

Sarr

att

Oxh

ey

He

ron

sgat

e &

Gad

e

Ald

en

ham

Cas

sio

Tud

or

Acu

te S

tro

ke U

nit

Ch

urc

hil

l HH

GH

Sim

pso

n H

HG

H

De

La

Mar

e

Letc

hm

ore

Flau

nd

en

Rid

ge

Cle

ves

Lan

gle

y

Co

mb

ine

d IT

U

Star

fish

Safa

ri D

ay U

nit

Eliz

abe

th

Pe

rce

nta

ge o

f H

ou

rs L

ost

Area

Supervisory Hours

Supervisory Hours % Lost January Supervisory Hours % Lost February Supervisory Hours % Lost March

of 33

Appendix 5 Monthly trend graphs by division for the percentage of shifts rated Red Amber and Green in March 2015


Green 99.0% 98.0% 97.7% 95.3% 95.6% 94.5% 95.4% 84.8% 88.6% 88.5% 84.1%

Amber 1.0% 2.0% 2.3% 4.7% 4.2% 5.4% 4.6% 14.8% 10.9% 11.1% 15.1%

Red 0.0% 0.0% 0.0% 0.0% 0.2% 0.1% 0.0% 0.4% 0.6% 0.4% 0.9%

Target RAG 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

RAG

Per

cent

age

Medicine


Green 99.0% 98.6% 96.5% 97.1% 95.0% 93.7% 94.1% 87.9% 88.8% 91.4% 88.9%

Amber 1.0% 1.1% 3.5% 2.9% 5.0% 6.3% 5.9% 11.9% 11.2% 8.1% 11.1%

Red 0.0% 0.2% 0.0% 0.0% 0.0% 0.0% 0.0% 0.2% 0.0% 0.4% 0.0%

Target RAG 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

RA

G P

erc

en

tage

Surgery


Green 95.0% 87.0% 97.2% 95.5% 92.3% 91.5% 91.9% 91.4% 93.1% 88.6% 89.4%

Amber 5.0% 13.0% 2.8% 4.5% 7.7% 7.6% 7.9% 8.0% 6.9% 11.0% 10.3%

Red 0.0% 0.0% 0.0% 0.0% 0.0% 0.9% 0.2% 0.6% 0.0% 0.3% 0.3%

Target RAG 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

RA

G P

erc

en

tage

Womens and Childrens

of 33

Appendix 6 February 2015 Trust safe staffing exception report by shift Nursing & Midwifery Professional Judgement safe staffing RAG Rates

Green - Staffing numbers are as expected on the rota and ward is assessed as being safely staffed taking into consideration workload and patient acuity. Staffing numbers are not as expected but safe according to current workload.

Amber - Staffing numbers are not as expected and minor adjustments need to be made to bring staffing to a reasonable level given workload and acuity or staffing numbers are as expected but given workload and acuity additional staff are required.

Red - Staffing levels inadequate to cope with current patient needs.

Division Area Date Shift

Professional

Judgement

Rag Rating

Comments, Mitigation - Actions taken to Ensure safe Staffing Levels

Med

icin

e

AAU Blue L1 20/02/2015 Day A Supervisory to be included in the numbers and work in the bay. Shift 12-8

21/02/2015 Day A x1 RN down, HCA from SURG moved in to blue and Sister from Yellow to float between both bays

AAU Green L1

16/02/2015 Night A Support form AAU L1 areas

19/02/2015 Night A RN down for night shift. Support AAU L1 Areas

20/02/2015 Day A RN DNA for day shift band 7 to work in the bay

22/02/2015 Night A Support from AAU L1 areas

24/02/2015 Night A HCA for night shift out to bank. Support AAU L1 areas

AAU Triage

01/02/2015 Day A Support fron AAU L1 areas

02/02/2015 Day A no supervisory sister working clinically

04/02/2015 Day A no supervisory sister working clinically to support

06/02/2015 Day A Rn on the early supervisory band 6 to supoort bay on the late. GP controller to help.

08/02/2015 Night A Support from AAU L1 areas

09/02/2015 Day A Supervisory in the numbers to support clinically

10/02/2015 Day A no supervisory, band 7 supporting clinically

16/02/2015 Day A no supervisory sister working clinically to support

20/02/2015 Day A Band 7 to work in the bay

23/02/2015 Day A Amber due to triage being done by a band 4 with support of the band 6. Band 7 will be counted in the numbers to support the bay.

24/02/2015 Day A Triage nurse and trolley nurse are covered by HCA. Band 6 will support staff. Band 7 will support the bay- not supervisory.

25/02/2015 Day A Down RN DAY Band 7 to support early

26/02/2015 Day A Supervisory to work on numbers

AAU Red Suite

01/02/2015 Day A Staff redeployed to support

01/02/2015 Night A Staff redeployed to support

04/02/2015 Day A Band 7 on late shift. Due to workload, the ward will be challenging to manage with decreased staffing numbers.

05/02/2015 Day A Agency not arrived. Will leave only 2 rns at 3pm. Supervisory in the numbers to help support clinically

08/02/2015 Day A Currently on ward we have 2 x confused patients Band 7 on level one informed and will inform Matron on call when arrives.

08/02/2015 Night A Currently on ward we have 2 x confused patients Band 7 on level one informed and will inform Matron on call when arrives.

09/02/2015 Day A Mental health nurse required to special a confused patient

12/02/2015 Day A 1 RN shift not filled. Out to NHSP not covered. HCA shift also not filled. 2 very confused agitated patients on ward. Senior nurse informed on lvel 1 AAU.

Extra HCA redeployed to support

14/02/2015 Day R RN and HCA down, leaving staffing levels which could compromise patient care. Bed managers and band 7 on AAU level 1 made aware.

16/02/2015 Day A RN shift not filled out to NHSP. Supervisory to be in the numbers until 3pm. Adjustments to staffing made but patient care will be compromised from 3pm.

20/02/2015 Day A Rn long day down. Supervisory in numbers until 3pm, then 2 trained and 2 HCAs. Numbers down but patient care safe.

21/02/2015 Day A RN shift not yet filled by NHSP. Staffing numbers safe but only 1 RN to do Ivs on the shift.

22/02/2015 Day A 1 Rn down but numbers adjusted so patient care safe.

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23/02/2015 Day A 1 HCA down as did not attend. Supervisory now in the numbers.

27/02/2015 Day A RN to go to Tudor but went home sick. Supervisory in numbers but at interviews all morning. Matron aware. Patient care compromised.

28/02/2015 Day A 1 RN down and shift not filled by NHSP. Only 1 RN can do IV administration for 18 patients. Will escalate to matron and senior nurse. Extra HCA redeployed

by senior nurse

AAU Blue &

Yellow L3

20/02/2015 Day A no supervisory, working clinically

26/02/2015 Day A supervisory RN will support clinically in bay but cannot also cover Discharge planners role

27/02/2015 Day A RN to support clinically until 15:00 Amber from 15:00-19:45

28/02/2015 Night A One trained nurse outstanding for the night shift. Nurse to patient 1:6 staff to bed 1:4

Cardiac Care

Green & Purple

01/02/2015 Day A Support from yellow and blue as required

05/02/2015 Day A 1 Band 6 nurse short. Band 7 working clinically to support

10/02/2015 Day A band 7 supporting clinically

20/02/2015 Day A Extra HCA to support

21/02/2015 Day A Support from Blue and yellow as required

24/02/2015 Day A one RN off sick and agency HCA not reported. SSR in numbers.

25/02/2015 Day A senior sister in number

27/02/2015 Day A Support from supernumary nurse on duty

28/02/2015 Day A Support from Blue/yellow as required

Bluebell

05/02/2015 Day A 2 ladies both agitated, needing two staff to care for at intervals during the day. Supervisory supporting clinically

06/02/2015 Day A sr to support

10/02/2015 Day A 1 patient 2 nurses to 1 awaiting a psychiatric bed, 1 patient 1:1awaiting a psych assessment. Band 7 working clinically to support

20/02/2015 Day A staff reallocated around ward for challenging patients

27/02/2015 Day A sister away from ward, sr charlotte on winyard will support

Winyard

05/02/2015 Day A X1 RN down as sent to oxhey ward. band 7 supporting clinically

05/02/2015 Night A x1 HCA down. X1 HCA sent from oxhey

13/02/2015 Night A Care prioritised according to need support from Blubell ward as required

14/02/2015 Day R Long day shifts put out on the system. Registered nurse who is supernumerary to support clinically. RN to patient 1:6

18/02/2015 Night A Needs Band 5 to escort patient to L & D for EEG appointment at 10:30 today. Support from Bluebell as required on night shift

19/02/2015 Day A x1 RN and x1 CSW down. Out to agency. . Unsafe with current staff levels RN short after 3pm. Supervisery nurse supporting clinically

20/02/2015 Day A x1 HCA down band 7 supporting

24/02/2015 Day A Sending home HCA due to being unwell SR .supervisory supporting clinically

25/02/2015 Day A Band 5 shift still not covered- out on the system. To prioritise clinical care

27/02/2015 Day R 1 HCA cancelled, bed manager informed and voice message left to Matron Lyn O’Donnell. HCA Support from oxhey ward

A&E

06/02/2015 Day A enp redeployed to main department , matron aware.

09/02/2015 Day A Supervisory Senior nurse supporting clinical Extra HCA on duty

26/02/2015 Day A 2 RN's short on LD (not covered by NHSP)

27/02/2015 Day A no ENP service - nurse moved in dept support from CED

Acute Stroke Unit

02/02/2015 Day A No supervisory supporting clinically

03/02/2015 Day A No supervisory

20/02/2015 Day A NEED 1:1 TO SPECIAL PT DAYTIME AND NIGHT

21/02/2015 Day A senior nurse informed but no staff available

26/02/2015 Day A 1 RN had RTA on way to work so out of numbers. Will only be 5 RN on late shift and surge area is open with no cover. Band 7 working clinically to support.

27/02/2015 Day A early trained and LD trained uncovered. Escalated to matron but no staff available

28/02/2015 Day A 1 LD trained not covered and 1 Agency nurse booked for LD only stayed for early. Senior nurse aware. Extra HCA sent from AAU to support

Aldenham 05/02/2015 Night A Night - 1 RN did not arrive and 1:1 for pt under DOLS not covered - staff to be extra vigilant

Croxley

06/02/2015 Night A 1 hca night shift out. Support from Sarratt

09/02/2015 Day A 1 RN short from 3pm until 7.45pm. RN ratio then 1:11. Supervisery supporting clinically

10/02/2015 Day A down 1 rn from 3pm. Band 7 supporting clinically

12/02/2015 Day A Band 7 to take bay on early then after 3pm will make ratio 1:11. Band 7 stayed long day as ward was very busy.

13/02/2015 Day A from 3pm - 7.15pm ratio will be 1:11. Supervisery supporting clinically

14/02/2015 Day A Clinical care prioritised

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16/02/2015 Day A after 3pm ratio will be 1:11. Supervisory supporting clinically

19/02/2015 Day A ratio after 3pm will be 1:11 across croxley.no supervisory, band 7 working clinically

20/02/2015 Day A from 3pm ratio for ward will be 1:11. Supervisory supporting clinically

22/02/2015 Day A ratio for ward 1:11. Support from Sarratt ward as required

23/02/2015 Day A 1 RN down aftr 3pm, ratio will be 1:11 across the ward. No supervisory, working clinically.

28/02/2015 Day A ratio for long day 1:11. RN shift out to bank. Care prioritised

Sarratt

02/02/2015 Day A HCA down x 2. Care prioritised. Stuents x 3 on duty

03/02/2015 Day A Students x 3 on duty.

09/02/2015 Day A RN early in numbers, down 1 RN from 3pm - 7.45pm. Supervisery supporting RN ratio after 3pm 1:8 across ward staff worked across bays.

09/02/2015 Night A 1 HCA short on nights out to nhsp so all HCA worked across bays

10/02/2015 Day A down one band 4 and band 5 so supervisory supporting clinically. From 3pm ratio for RN' across the ward 1:10.5 staff worked across bays. Students x 4 on duty

11/02/2015 Day A early RN in numbers in a bay until 3pm . From 3pm Ratio 1:8 across the ward staff worked across bays. Students x 5 and supernumary untrained x 1

12/02/2015 Day A 1 RN not covered- bay covered by shift leader doing early and band 7 doing late shift supporting clinically. 1 band 4 down staff nurses either side of bay to take

three patients each.

13/02/2015 Day A from 3pm the ratio across the ward is 1:8.4. night duty two band four's. staff work across bays. Students x 1

14/02/2015 Day A staff working across bays ratio RN 1 :10.5

15/02/2015 Night A Support from croxley ward

16/02/2015 Day A band 7 in bay untill 3pm - 715pm. Band 6 working in bay making ratio 1:8.4. staff working across bays

19/02/2015 Day A band 7 in numbers on early. Ratio from 3pm - 7.15pm will be 1:10.5 across sarratt. RN form Churchill to support

20/02/2015 Day A down one band 4 ratio for ward from 3pm - 7.15pm will be 1:8.4 staff working across bays.

21/02/2015 Day R ratio for long day will be 1:10.5.all shift out not covered. Staff working across bays , care prioritised. Assessed by senior nurse LO'D as safe

23/02/2015 Day A staff working across bays care prioritised. Supernumary untrained x 1 supporting

27/02/2015 Day A staff working across bays care prioritised. Supernumary HCA supporting clinically areas safe

28/02/2015 Day A 1 band 4 in a bay . After 3 pm - 7.15pm ratio 1:10.5 RN to patients. Staff working across bays care prioritised. Area declared safe Matron AB

Heronsgate Gade

01/02/2015 Day A Agency cancelled shift on 31/1/15, bed manager infromed.

02/02/2015 Day A attempted to call staff in to cover on 31/1/15 but staff unable to. Shifts covered on Monday but staff cancelled. No supervisory supporting clinically.

03/02/2015 Day A x1 rn required for gade ward x1 csw dna. 3 students on duty

08/02/2015 Night A Due to sickness only one member of permanent staff on Heronsgate/Gade over night, pulled nurse from stroke unit to cover.

09/02/2015 Day A supervisory to step into number this am due to agency worker cancelling LD. HCA short due to agency cancelling. Staff called in sick over night leaving the

ward down by 1 RN over due to acutiy on the ward at this time it leaves the ward short.

09/02/2015 Night A supervisory to step into number this am due to agency worker cancelling LD. HCA short due to agency cancelling. Staff called in sick over night leaving the ward down by 1 RN over due to acuity on the ward at this time it leaves the ward short.

12/02/2015 Day A Staffing safe for early shift but will be one short on late shift. Band 7 supporting clinically

13/02/2015 Day A day- x1 csw extra escort to mvh am

14/02/2015 Day A x1 rn and x1 csw not filled as of yet. Staff redeployed to support

16/02/2015 Day A 2 x rn shifts not covered by bank or CSW, staff moved from night to cover day leaving night short by 1x RN, shift out to bank. No supervisory,working

clinically to support

16/02/2015 Night A 2 x rn shifts not covered by bank or CSW, staff moved from night to cover day leaving night short by 1x RN, shift out to bank. No supervisory,working

clinically to support

19/02/2015 Day A Supervisory to step into numbers on am shift will be short after 3pm. Care prioritised

23/02/2015 Day A Band 7 supporting clinically band 6's will step into bays for early shifts. Late will be short 2 RN's.Senior Nurse Informed. Supernumerary trained supporting am

24/02/2015 Day A 1 Bank not covered on system early stepped into numbers for morning but will leave short 2 RN on late. Escalated to matron. Supernumary trained supporting

clinically

26/02/2015 Day A will be short on late shift as supervisory will step into numbers on am shift.

Oxhey 23/02/2015 Day A CSW sent to H'Gate Band 7 assessed ward as safe

Tudor/Castle

01/02/2015 Day A Care prioritised according to clinical need

02/02/2015 Day R No supervisory supporting clinically. Extra HCA supporting

04/02/2015 Day A Supervisory Band 7 Taking 9 Patients. Down with 1 RN. Supervisoyr will finish at 15:00. Extra HCA and supernumary HCA supporting on long day

13/02/2015 Day A band 7 in numbers staff sent to help

27/02/2015 Day A no supervisory band 7 working clinically. RN sent from CCU to work LD.

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Cassio

18/02/2015 Day A 4 x students - shifts out for 1 trained and 1 special not filled. No supervisory band 6 working clinicaly to support

19/02/2015 Day A 4 Students band 6 in numbers until 15.00 then deemed safe until night shift correct safe staffing on night

26/02/2015 Day A Band 7 in numbers plus 3 rd year students

Churchill HHGH

06/02/2015 Day A Support for simson ward as required

11/02/2015 Day A Extra HCA SUPPORT FROM Simpson ward

18/02/2015 Day A Supervisery supporting clinically

21/02/2015 Day A shifts out for both a CSW and RN. Support from Simpson ward as required

23/02/2015 Day A Band 7 working clinically

Simpson HHGH

05/02/2015 Night A Support from Churchill as required


11/02/2015 Day A supervisery supporting clinically

18/02/2015 Day A sending a CSW for escort to St Marys. So 3 CSW until their return support form churchill if required

Su

rger

y

Combined ITU

03/02/2015 Day A outreach pulled to ICU for day shift

18/02/2015 Day A Outreach and supernumary nurse pulled to cover unit needs. Supernumary nurse finishing at 16:00. No outreach cover for night shift.

21/02/2015 Day A Day shift - Outreach pulled, Ward nurse nursing 2 patients on ICU, and Matron came in to take level 3 patient from Recovery.

Langley 14/02/2015 Day A 1 X HCA duty outstanding LD. Patient acuity high. Support from Ridge ward

16/02/2015 Day A one HCA off sick .no supervisory working clinically

Letchmore

09/02/2015 Day A RN LD unfilled-escalate to matron. Supervisory supporting clinically. Supernumary trained supporting. Extra HCA

14/02/2015 Day A 3rd RN not covered, additional HCA to help due to extra load for RNs

17/02/2015 Day A 1 RN LD unfilled, band 7 counted in the numbers and supervise supernumerary

18/02/2015 Day A 1 RN sick LD band 7 counted in numbers until 3pm.

26/02/2015 Night A additional HCA per shift due to increased workload.One nurse down for night shift.

27/02/2015 Day A 2 senior RNs sick LD, requests not filled, senior staff moved from ESAU. 2nd RN LD has not passed drug assessment yet. Additional HCA per shift due to

increased work load, senior sister working clinically until 3pm. Update HCA swapped for RN for another ward

ESAU

02/02/2015 Day A 2nd RN unfilled, Letchmore to help as required

03/02/2015 Day A 4 medical patient in ESAU.

04/02/2015 Day A 2nd RN LD unfilled Letchmore to help as required

05/02/2015 Day A 2nd RN LD not filled Letchmore to help as required

06/02/2015 Day A Letchmore to help as required

09/02/2015 Day A RN LD unfilled-escalate to matron SUPPORT FROM Letchmore


11/02/2015 Day A 2nd RN unfilled Letchmore to help as required

12/02/2015 Day A 2nd RN LD moved to Letchmore ward

13/02/2015 Day A 2nd RN unfilled LD Letchmore to help as required

14/02/2015 Day A 2nd RN unfilled, Letchmore to help as required

16/02/2015 Day A 2nd RN LD unfilled but band 7 will oversee









27/02/2015 Day A 2nd RN LD unfilled, Letchmore to help as required

Ridge

06/02/2015 Day A 1 r/n ad hca long day not covered.Band 7 taking a bay

19/02/2015 Day A Band 7,2 RN'S off sick.1 RN moved from langley and Matron to help on Ward.

21/02/2015 Day A 1 RN sick not covered. Support from langley

Beckett SACH 10/02/2015 Day R agency nurse cancelled due to previous poor performance on ward. Support from Delamare

13/02/2015 Day A . All admisions to beckett ward . Hope to close later. No inpatients

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23/02/2015 Night A 11 admissions to Beckett ward today. I x lady under section from But will have carer with her. Amber flag in place since we have only 1 x substantive R/N on

nights- First night that she has done- Not IV Drug approved.

De La Mare

SACH

05/02/2015 Day A 1 x R/N Agency called in sick this am. 9 admissions due in today. Band 7 in dept but investigating SI- Need to colect more information from staff and write

report.

20/02/2015 Day R all admissions today on Beckett ward. Down x 2 Trained staff today- Red Flag. No staff able to be obtained. Band 7 worked a Long Day clinically- Another

band 6 worked on day off from 4pm- 20.00 Hrs. Datix completed.

23/02/2015 Night A 2 x Agency staff booked for night shift tonight. 1 x Junior band 5 on night shift. Senior Band 5 phoned off sick. Band 7 working clinically on the ward all day. 1 x Substantive staff left ward at 10.30 am to come back to work a night.

Wom

ens

& C

hil

dre

ns

Pa

edia

tric

s

CED

18/02/2015 Day A Support from A&E

18/02/2015 Night A Support from A&E

27/02/2015 Day A x1 qualified nurse down on the 10-22.30 shift. We have HCA's working.

28/02/2015 Day A x1 qualified nurse down on the 10-22.30 shift. Hca supporting support from A&E

Safari Day Unit 17/02/2015 Day A BAND 7 IN NUMBERS SUPPORT FROM childrens emergency and Head of nursing

Starfish

18/02/2015 Day A One nurse short as NHSP unable to fill the shift and one nurse had to go on transfer to another hospital. Band 7 covered ward whilst nurse on transfer.

22/02/2015 Night A Down 1 hca support from CED if required

26/02/2015 Day A x1 camhs patient that needs specialing RMN cancelled late last night, HCA from CED able to cover for a few hours.

Neonatal Unit 12/02/2015 Night A 1 staff off sick

Transitional Care 23/02/2015 Day A Support from Katherine ward

Gy

na

ecolo

gy

Elizabeth

03/02/2015 Day A No senior staff on the ward (Matron & band 7). 6 oncology patients to be bedded. Currently a lot of dependent patients on the ward who needs a lot of care. Care

prioritised

05/02/2015 Day A No band 7 supervisory. Enhanced recovery nurse will have to work in the numbers due to activity. 6 elective patients to come in. No empty beds. 11 medical

patients. X1 HCA phoned in sick for LD.

06/02/2015 Day A No supervisory Band 7. 5 TCI's today, no beds to start the day. Other specialty patients: 9 Medical, 2 Surgical. Enhanced Recovery Nurse will support as able.

10/02/2015 Day A x HCA off sick and its not covered. X 5 electives to come in. x9 medical patients.

11/02/2015 Day A

1 HCA shift unfiled-cancelled @ 0700hrs. 1 RN short for the late shift. ERN will support the staff as much as she can. There will be a negative inpact on the the staffs ability to respond to patients needs in a timely manner. Electives will have to wait for beds before going to theatre. Supervisory supporting clinically

HCA from AAU to support ward on the long day. Still RN short for the late and activity high.

12/02/2015 Day A

No supervisory shift. 1 RN short for the late shift. 9 TCI's for today all Oncology, no beds available for admissions at 0700hrs. 2 confirmed discharges. Outliers 8 medical and 3 surgical patients. 3 gynae outliers on Letchmore, AAU1 & ESAU. Care provision to patients will not be as prompt as would be

expected.

18/02/2015 Day A x 1 HCA phoned in sick. X 3 electives to come in today. X1 pt in the doctors room waiting to be seen by the doctor.

20/02/2015 Day A No Supervisory today. 3 RN's on LD this morning, 1 RN on Late shift. 3 HCA's, 1 to special an elderly othopaedic patient with Dementia awaiting theatre. 4

TCI's today, 7 medical & 3 surgical patients, no beds to start the day. Update 1 extra HCA to special did not arrive.

21/02/2015 Day A 1 HCA short for a long day. No saftey issues raised with senior nurse on site for day shift

23/02/2015 Day A 1 RN short for Long day. No supervisory-working clinically

24/02/2015 Day A x5 patients TCI. I bedded. X 10 medical patients. Supervisery supporting clinically

25/02/2015 Day A x 5 electives to come in. No empty beds, ? 5 discharges. X 8 medical patients. X1 RN down this afternoon and x 1 HCA down this afternoon. Shifts out to NHSP

but not filled. Supervisory supporting clinically

26/02/2015 Day A Short band 5 long day, Band 7 in numbers for early. X5 pts tci, 2 bedded and no ring-fenced with only 1 confirmed discharge and 3 possibles.

27/02/2015 Day R Short x2 band 5's for long day and no cover from NHSP/Agency. Band 7 to help for early but no cover from 13.00 hrs. x2 pts tci and no beds with 0 confirmed

discharges at present. Band 7 supporting clinically. Extra HCA on longday. Specialist nurse supporting am. RN Support from Flaunden 4 pm

28/02/2015 Day A No issues of patient saftey raised with senior nurse on site

Ma

tern

ity

Delivery Suite

02/02/2015 Day R 2xLD 1xE unfilled clinical facilitator and midwife from night shift asked to change shift to provide cover. 1 midwife re-deployed from triage with MDAU

providing cover.

05/02/2015 Day A 1 x HCA shift vacant, midwife available for clinical care

07/02/2015 Day A 1 Midwife short. Shift out to bank. Staff redeployed from another area

08/02/2015 Day A Acuity high only one bed available on d/s Triage closed.

09/02/2015 Day A 2 midwife shifts unfilled redeployment from another clinical area, depending on acuity.

11/02/2015 Day A 1 x RM and 2 x HCA shifts vacant on day shifts. All out on nhsp, agency requested. Staff redeployed from another area

14/02/2015 Day A Workload exceeds staffing one midwife short, shift gone out to NHSP, staff went sick overnight, triage closed to make labour ward safer staffing levels. NIGHT

SHIFT: 3 midwives short at handover - x1 car broken down unable to come in. X2 late in traffic. D/S very busy, high risk lady in OOB.

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14/02/2015 Night A Workload exceeds staffing one midwife short, shift gone out to NHSP, staff went sick overnight, triage closed to make labour ward safer staffing levels.NIGHT

SHIFT: 3 midwives short at handover - x1 car broken down unable to come in. X2 late in traffic. D/S very busy, high risk lady in OOB.

15/02/2015 Night A RM shift unfilled on night shift, put out to NHSP, covered from 23.00. also x 1 HCA down on triage. Midwives to cover workload

16/02/2015 Day A RM down on long day shift on NHSP. Staff redeployed from another area

19/02/2015 Day A 1 x HCA short on shift , out to NHSP. Staff redeployed from another area

20/02/2015 Night A 1 x HCA short on shift out to NHSP. Staff redeployed from another area

26/02/2015 Night A HCA vacancy on day and night shifts. Both shifts out on NHSP. Will need to redeploy HCA from another area depending on work load.

27/02/2015 Night A 1 x HCA short on night duty, shift out to nhsp. Staff redeployed from another area

ABC

02/02/2015 Day A ward manager used to cover am shift shift unfilled for afternoon, to review midday depending on acuity.

08/02/2015 Night A 1 Midwife short on Night shift. NHSP shift not filled. Acuity managed with available staff and utilisation of support roles.

09/02/2015 Day A 1 midwife redeployed to cover acitivity in another clinical area.

10/02/2015 Day A 1 x HCA short on day shift will redeploy by sharing with victoria ward

15/02/2015 Night A no HCA midwives to cover workload

16/02/2015 Night A HCA down on night shift, staff shared from Victoria ward, safe cover

19/02/2015 Day A 1 x RM short on long day , shift out on NHSP and agency, staff to be redeployed when needed as per escalation policy

24/02/2015 Day A Vacancy for HCA on late shift. Shift out to NHSP but ask HCA to help from another area if needed if shift not filled. 1 midwife shift unfilled to utilise

supernummary staff

25/02/2015 Day A Vacancy for HCA on long day. Shift out to NHSP. Will redeploy HCA to help from another area

26/02/2015 Day A HCA vacancy on day and night shifts. Both shifts out on NHSP. Will need to redeploy HCA from another area depending on work load.

27/02/2015 Day A 1 x HCA short on long day shift out to nhsp, HCA shared from Victoria as required.

Victoria 05/02/2015 Night A 1 x HCA short on shift , staff cover between 2 wards, areas safe.

20/02/2015 Night A 1 x HCA short on shift out to NHSP, HCA shared from ABC if needed. MW on duty safe cover

Katherine

02/02/2015 Day A ward manager used to cover asking midwife from night to change shift to provide cover for pm shift.

05/02/2015 Night A 1 x HCA short on shift, staff cover between 2 wards, areas safe.

09/02/2015 Night A Vacancy not filled for HCA on night shift. Cover provided from another clinical area.

11/02/2015 Day A No support staff, midwife available.

16/02/2015 Day A RM down on early shift, put out on NHSP. HCA down on both night and day shift. Due to the anticipated workload today a surge shift has also been requested

and is outstanding on NHSP

24/02/2015 Day A Vacancy for HCA on late shift. Shift out to NHSP. Covered by midwives at present.

25/02/2015 Day A Vacancy for midwife on long day. Shift out to NHSP. May need to redeploy midwife to this area if shift not filled to help if work load increases

27/02/2015 Day A 1 x nusery nurse short on long day, HCA shift out on nhsp to cover

28/02/2015 Day A Midwife shift unfilled support provided from another clinical area.

Knutsford

02/02/2015 Day A midwife from Katherine covering

11/02/2015 Night A short of HCA shift on NHSP, staff shared from other wards to maintain safety

16/02/2015 Day A No HCA on long day, staff shared with Katherine Ward area safe as MW cover

19/02/2015 Day A HCA short on both long day and night out on NHSP shifts, HCA shared from Katherine Ward as required, MW on duty safe cover

19/02/2015 Night A HCA short on both long day and night out on NHSP shifts, HCA shared from Katherine Ward as required, MW on duty safe cover

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Appendix 6 March 2015 Trust safe staffing exception report by shift

Division Area Date Shift Professional

Judgement Rag Rating

Comments, Mitigation - Actions taken to Ensure safe Staffing Levels

Un

sch

ed

ule

d C

are

AAU Blue L1

02/03/2015 Night A Extra health care for SR 43

06/03/2015 Day A Band 7 on numbers till 3 pm.

07/03/2015 Day A Support from AAU level 1 areas

09/03/2015 Day A Band 7 to support. Nurses take bay each. Supernumary staff will be supported by RN.

11/03/2015 Day A RN on early Band 7 from yellow to support on the late shift

15/03/2015 Day A Band 7 to support the bay. RN out to bank for night.

15/03/2015 Night A aau LEVEL 1 areas to support. Supervisery sick

16/03/2015 Day A Support from AAU level 1 areas. Supervisery sick

22/03/2015 Night A HCA support from AAU level 1 areas

26/03/2015 Day A Band 7 to support clinically on longday

AAU Green L1

02/03/2015 Day A extra HCA needed as patients in bay with BIPAPS. RN shift out to bank. Not covered. Supervisery supporting clinically

04/03/2015 Day A Band 7 in the bay till 3pm

06/03/2015 Day A Band 7 to work in the bay

09/03/2015 Day A Band 7 Senior Sister Supporting the Bay. Extra Healthcare to support. Each nurse to take a bay each and share siderooms.

14/03/2015 Day A AAU Band 7 to support the bay. Extra HCA

23/03/2015 Day A Extra HCA to support clinically

24/03/2015 Day A Band 7 supervisory supporting clinically

29/03/2015 Day A Support from AAU Level 1 areas

30/03/2015 Day A 1 unfilled shift, RN - LD. Band 7 to support clinically

AAU Yellow L1

02/03/2015 Day A Extra health care for Bipap

06/03/2015 Day A band 7 to work on numbers.

07/03/2015 Day A Support from AAU Level 1 areas. Extra HCA. AAU Supervisory to support on late shift

14/03/2015 Day A band 7 to support the staff .

15/03/2015 Day A Band 7 to support the bay .

15/03/2015 Night A AAU Band 7 to support the bay . Support from AAU level 1 areas at night

19/03/2015 Day A RN down in the day. Supervisory supporting clinically.

21/03/2015 Day A 1 HCA down in bay. Band 7 to support clinically if needed.

23/03/2015 Day A Band 7 working on numbers on LD

24/03/2015 Day A supervisory supporting clinically

27/03/2015 Day A Band 7 supporting clinically on longday

AAU Triage

03/03/2015 Day A Supervisory working on numbers and still short with 2 RN. Supported with extra HCA

04/03/2015 Day A Green to support.

05/03/2015 Day A Supervisory to work on numbers to support the bay .

11/03/2015 Day A RN with no pin- working with band 5

17/03/2015 Day A Supernumary staff looking after patients under supervision.

20/03/2015 Day A 1 RN down, Green to support

23/03/2015 Day A band 7 to support bay.

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25/03/2015 Day A Green to support to purple.

26/03/2015 Day A Band 7 to support clinically

28/03/2015 Night A Night team not to triage. Support from green.

29/03/2015 Day A Band 7 help in bay.

31/03/2015 Day A Band 7 to support clinically.

AAU Blue & Yellow L3

04/03/2015 Day A supervisory RN to work clinically LD still leaves Isolation running with only 1 trained

05/03/2015 Day A 1 HCA sick and 1 HCA special also required due to ward requirments

09/03/2015 Day A agency band 5 sent made numbers correct

13/03/2015 Day A HCA sent from AAU L1 yellow to help with washes but went back to level 1 the ward worked shot in the bays

15/03/2015 Night A Support from cardiac care as required

17/03/2015 Day A hca from tudor /castle noe =5 Hca

23/03/2015 Day A 1 HCA Booked to cover 1 RN outstanding Supervisory RN to work clinical to cover 2 RN outstanding still 1 unfilled HCA reqired for special

24/03/2015 Day A 1 extra HCA to cover 1 RN 1 HCA booked for special in L3Y will leave 1 RN to 12 patients @ 15:00.supervisory supporting clinically

25/03/2015 Day A Band 7 supoporting clinically. Support from Cardiac care for breaks and with RN after 3pm.

26/03/2015 Day A Supervisory RN supporting Clinically till 15:00

27/03/2015 Day A Staff nurse starting at 10am support to be given from Cardiac care

28/03/2015 Day A x2 band 5 angency sent

Cardiac Care Green & Purple

01/03/2015 Day A AGENCY NURSE CANCELLED AT 0645 SHIFT RETIMED FOR 10AM START

03/03/2015 Day A shift out to bank Band 7 not supervisory supporting clinically

04/03/2015 Day A SHORT STAFF> 2 PATIENTS NEED ESCORTING GOING FOR A PROCEDURE TO Hsmith and Harefield. Bed manager aware,.band 7 to support clinically.

05/03/2015 Day A 1 trained nurse short >out to the bank, 1 HCA booked for transport band 7 working clinically to support

08/03/2015 Day A shift was out, not covered by agency.

09/03/2015 Day A Senior sister supporting clinically.

10/03/2015 Day A SSR to support clinically as one nurse down.


16/03/2015 Day A QUALIFIED NURSE FOR LD OTB Supervisery supporting clinically

19/03/2015 Day R three RN shift out to bank including, one band 5 and one band 6 called off sick. One agency cancelled short notice. All shifts out to bank. Late RN was covered by AAU 1 staff EXTRA hca. No patient safety issues occurred.

20/03/2015 Day A One RN agency cancelled. Supervisory supporting clinically. Extra HCA

23/03/2015 Day A OUT TO BANK.supervisory working clinically

30/03/2015 Day A rn and hca shift not filled informed level 1 in case of any surg staff

A&E

03/03/2015 Day A Enp and Matron supporting clinically

13/03/2015 Day A Matron supporting

16/03/2015 Day A Support from Matron, extra HCA

17/03/2015 Day A no ENP service

18/03/2015 Day A no ENP service

19/03/2015 Day A Support from Matron extra HCA

20/03/2015 Day A Staff redeployed within department

20/03/2015 Night A Staff redeployed within department

27/03/2015 Day A Matron supporting

30/03/2015 Day A no ENP on shift as x2 RN down in main area - BM aware

Urgent Care Centre

01/03/2015 Day A working with GP led and HUC to support

03/03/2015 Day A HUC and GP led aware

05/03/2015 Day A HUC aware will support






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25/03/2015 Day A Nurse from MIU sent to support

27/03/2015 Day A nurse from watford sent to do assesments



Me

dic

ine

AAU Red Suite

01/03/2015 Day A HCA redeployed to winyard assessed safe by senior nurse

02/03/2015 Day A 2 x RNs down on the long day. Supervisery in numbers until 3pm. Then only 1 RN to 18 patients. Patient care will be unsafe from 3pm. Senior nurse aware on level 1 AAU. Shifts out to NHSP.

04/03/2015 Day A 1 RN down, shift not filled ny NHSP. Supervisery in numbers on early shift. HCA booked as escort for patient to Hammersmith treat and return.

05/03/2015 Day A 1 RN shift not filled by NHSP. Supervisery to go into the numbers but patient care may be compromised after 3pm when supervisery leaves. 1 substansive and 1 agency after 3pm.

07/03/2015 Day A HCA cancelled taken from surg and staff nurse taken from red to work on Sarratt ward

09/03/2015 Day A ! RN down during the day. Supervisery stayed until 8pm.

11/03/2015 Day A 1 RN down so supervisory in numbers until 3pm. Work load adjusted to prioritise care. Shift out to NHSP.

14/03/2015 Day A 1 X RN sent to level 3 B/Y at 12.15 at matron on-calls request there then leaving us amber.

17/03/2015 Day A 1 senior RN down due to sickness. Supervisery to go into numbers. Will leave 1 junior nurse and an agency at 3pm. Patient care will be comprimised. Shift out to NHSP and Matron aware.

18/03/2015 Day A 1 RN down. Supervisery in the numbers. Confused wandering patient on the ward. Needs 1-1. Will be moved to Bluebell today.

23/03/2015 Day A Hca down and patient workload very demanding and heavy patient load prioritised.

25/03/2015 Day A RN shift not filled by NHSP. " RNs to 18 patients on the late shift. Given the workload and acurity more staff are needed. Level 1 AAU advised.

27/03/2015 Day A RN down and HCA down. Shifts not filled by NHSP. Supervisery in numbers until 3pm. Then patiet care will be compromised. Due to acuity and workload of patients care will be prioritised. Senior nures on AAU level 1 aware. Extra HCA deployed

28/03/2015 Day A RN tasken to Sarrett ward. Left with 1 RN that cannot do Ivs and heavy workload and acuoity of patients. Care compromised.Senior nurse aware. Datix report completed.

31/03/2015 Day A 1 RN down. Supervisery to go into the numbers.

Bluebell

01/03/2015 Day A Assessed safe by senior nurse on site

16/03/2015 Day A senior sister in the numbers

22/03/2015 Day A Extra registered nurse

26/03/2015 Day A supervisory to clinically support. Contacting own staff to ? Cover a late shift. Late shift to put out to bank

Winyard

09/03/2015 Day A x1 HCA down due to sickness. Out to NHSP. Ward safe and band 7 supporting

12/03/2015 Day A x1 RN down. Band 7 in numbers for early shift. Ward high acquity. Escalated to matron.

15/03/2015 Day A Deemed safe by senior nurse on site

16/03/2015 Day A x1 RN short due to sickness. Not filled by NHSP/agency. Band 7 in numbers again

17/03/2015 Day A HCA (Agency)currently not turned up - chasing with NHSP.Supervisery to support clinically

24/03/2015 Day R 1 RN and 1HCA off sick. Not covered yet ,supervisory supporting clinically. Supernumary untrained supporting. Assessed by Matron staff redeployed to maintain saftey.

29/03/2015 Day A x1 HcA short for LD. Assessed by senior nurse as safe

30/03/2015 Day A Own HCA for today called sick at 21:00 last night. Bed manager aware. Still not covered on the system.

Aldenham

09/03/2015 Night A 2 RN's to Sarratt on LD. 2 agency RN's did not arrive for night shift - NHSP/senior nurse aware. Support from heronsgate as required

13/03/2015 Day A 2 RN shifts not covered - all 27 beds occupied. Supervisery supporting clinically

15/03/2015 Day R Senior Nurse aware. Unable to get hold of 1 nurse, DNA for 2 shifts in week, called a number of times msg left on phone. Band 4 x 1 extra Hca redeployed to support. Now deemed safe by senior nurse on duty

16/03/2015 Day A LD - Senior Sister in numbers

18/03/2015 Day A Senior Sister in numbers in morning - amended shift on bank to see if can get L cover

21/03/2015 Day R Senior Nurse aware - High acuity Bay 4- 3 NIV, 1 Trachy and 1 high news/ unstable. Bay 3- 2 NIV. Nurse needed in bay 3 and 4 at all times to monitor.

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Assessed safe by senior nurse on site

29/03/2015 Day A HCA went sick during shift. Bed Manager informed of Ward Staffing. N - 1 x RN/Agency Surge swap

30/03/2015 Day A HCA didn’t turn up for shift. Band 7 in numbers

31/03/2015 Day A RN sent to Sarratt. Acuity high x7. Band 7 on clinical leaders day

Cassio

15/03/2015 Day A RN went home due to sickness. Deemed safe by senior nurse on site

26/03/2015 Day A Band 7 in numbers on long day

27/03/2015 Day A Band 7 covering cassio and oxhey

28/03/2015 Day A R/N long day out to NHSP Night skill mix dirrerent should be 3:1. Assessed safe by senior nurse on site

29/03/2015 Day A short on dat 1 CSW and night 1 R/N. Assessed safe by senior nurse on site

30/03/2015 Day A staff nurse moved to gade skill mix should be 3:1 was 2:2 on both shifts. Supervisery supporting clinically.

30/03/2015 Night A staff nurse moved to gade skill mix should be 3:1 was 2:2 on both shifts. Supervisery supporting clinically.

31/03/2015 Night A skill mix on nights should be 3:1 is 2:2. extra HCA on nights to mitigate only 2 RN

Croxley

02/03/2015 Day A RN ratio 1:11 across the ward after 3pm as Supervisory RN on early is in the numbers RN x1 sent to sarratt LD

04/03/2015 Day A ratio for nurses 1:11. supervisery staff supporting clinically. Assessed by Matron as safe

08/03/2015 Day A ratio for nurses both shifts.1:11. Staff redeployed to support from Gade on day shift and and elizabeth ward for night shift

08/03/2015 Night A ratio for nurses both shifts.1:11. Staff redeployed to support from Gade on day shift and and elizabeth ward for night shift

23/03/2015 Day A ratio after 3pm will be 1:11.supervisory suppporting clinically

28/03/2015 Day A ratio for trained nurse is 1:11. Assessed as safe by senior nurse on site. Support fron Sarratt ward as required

29/03/2015 Day A rn ratio will be 1:9 as croxley had to take bay 4 from Sarratt to support

30/03/2015 Day A ratio after 3pm 1:11 patients.supervisory supporting clinically

Sarratt

01/03/2015 Day R Staffing escalated to senior nurse on duty. 1RN sent from ESAU now 4 RN on LD one Rnon early- shift ends at 3pm.Croxley ward to support after 3pm.

02/03/2015 Day A supervisory RNx2 on early in numbers 2 band 4 in bays ratio RN/band 4 after 3pm across ward 7.3 RN ratio after 3pm 14.6 x3 HCA redeployed from other wards to sarratt RN x1 redeployed from Croxley to sarratt

03/03/2015 Day A 2 band 4 LD. Staff redeployed to support .Ward assessed as safe by Matron.

04/03/2015 Day A RN x1 moved from Aldenhm to work LD

05/03/2015 Day A no supervisory.

07/03/2015 Day R BAND 4 LONG DAY. OUT TO NHSP/AGENCYStaff shortage .escalated to Senior nurse on duty,RNx1 sent from Red suite for LD and RNx1 from ASU and HCA x1 from AAU to work 15.00-19.45hr when early shift goes home.Care prioritised.

08/03/2015 Day A staffing escalated to senior nurse. RN x1 sent from Aldenham for LD . RNx5 now on duty.

15/03/2015 Day A staffing escalated to senior nurse on duty RNx1 sent from Croxley for LD and HCA sent to Croxley. Assessed as safe by senior nurse on duty.

16/03/2015 Day A No supervisory. Team Coordinator working clinically

21/03/2015 Day A Staffing escalated to senior nurse . Staff from Cassio to work LD. Area assessed by senior nurse on duty as safe.

23/03/2015 Day R No supervisory , area will be short from 3pm when early shift goes home. AAU will send support from 3-7.45pm. Assessed by Matron as Red from 3-7.45pm.

26/03/2015 Day A Supervisery supporting as coordinator

27/03/2015 Day A Supervisery supporting clinically as coordinator

28/03/2015 Day A support from Croxley

29/03/2015 Day A support from Croxley

30/03/2015 Day A After 3pm ratio of 1:11 with acute care patients. Support from Croxley.

31/03/2015 Day R Ratio of 1:11 after 3pm. Within numbers Band 4 included. Only 2 band 5 on LD plus 2 band 4. Extra HCAS . Nurse sent from Aldenham

31/03/2015 Night A Ratio of 1:11 after 3pm. Within numbers Band 4 included. Only 2 band 5 on LD plus 2 band 4. Extra HCAS . Nurse sent from Aldenham

Heronsgate & Gade

03/03/2015 Day A supervisory to step into numbers this am to cover heronsgate ward. Will be short 1 x rn on late. Gade will be short 1 x nurse on long day as no supervisory to cover.

04/03/2015 Day A supervisory to step into numbers to cover ward on am shifts. Wil be short on late. One escourt shift not covered to Transfer patient to mt vernon, will send ward staff but will make LD short HCA.

06/03/2015 Day A will be short one rn on late shift. One HCA to go on transfer which leaves ward short.

07/03/2015 Day A one agency shift not yet covered, secondary assignment to csw out to agency. 2 agency workers did not arrive for shift one moved to support ward.

08/03/2015 Night A one agency nurse cancelled.

09/03/2015 Day A Amber for am shift, supervisory to step into numbers. Supervisory to do longday to cover one rn. Will be amber on late as one nurse short.

12/03/2015 Day A 1 supervisory to step into numbers this am and one rn to cover on late shift. Remains 2 RN shoprt on long day due to agency not covered and 2 HCA short

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duew to agency not covering. No staff avalliable to pull from other shifts to cover.

13/03/2015 Day A 2 x rn short on Long day, supervisory to step into numbers to support.

14/03/2015 Day A secondry assignment out to csw to cover long day but not filled.

15/03/2015 Day A one HCA called in sick, agency did not cover. Secondry assigfnment out to bank to cover RN but not covered.

17/03/2015 Day A supervisory to step into numbers due to shifts not covered. Will be HCA Short as escourt shift not covered by agency.

19/03/2015 Day A Heronsgate 2 RN on long day only no supervisory. Gade supervisory to step into umbers to make safe on early but will be short on late. Extra HCA booked for escourt to mt vernon.

20/03/2015 Day A supervisory to step into numbers will be short on late.

21/03/2015 Day A One staff memeber taken to aldenham to cover leaving ward amber as 2 nurses to cover 17 patients.

22/03/2015 Day A one hca booked to cover one agnecy DNA- leaving the ward amber. Assessed as safe by senior nurse on duty.

24/03/2015 Day A 1st year first placement. 1 x RN cancelled shift leaving them down overr night. Ward assesssed as safe by Matron.

24/03/2015 Night A 1st year first placement. 1 x RN cancelled shift leaving them down overr night. Ward assesssed as safe by Matron.

26/03/2015 Day A 2 x rn not covered, secondry assignment to csw put out and not covered. Band 7 to support both wards in morning but will remain red due to current work load of 14 all care patients over two wards will not be manageable. RN redeployed to support clinical workload. Matron supporting

27/03/2015 Day A one hca went home sick, one rn moved to support another ward leaving the ward short.

28/03/2015 Day A Rated Amber as two RN down, shift put out to NHSP but stillnot covered .Assessed as safe by senior nurse on duty.

29/03/2015 Day A Rated Amber as One RN short for long day.Area assessed by senioir nurse on duty

30/03/2015 Day R shifts out to bank and agency not covered by rn, one extra shift for CSW covered one remeains not covered. 20 patients out of 37 require assistance of 2 nurses/csw. This will not be managed with current staffing levels.

Oxhey

26/03/2015 Day A 1 csw special aggressive patient who was in numbers

27/03/2015 Day A band 7 supporting covering cassio and oxhey

28/03/2015 Day R only 1 R/N on out to NHSP. HCA cancelled shift. Not covered. Out to NHSP. Satff redeployed by senior nurse to cover late shift to give 2 rns

29/03/2015 Day A HCA moved to sarrett ward . Assessed safe by senior nures on site

30/03/2015 Day A HCA MOVED TO GADE. Assessed safe by Matron

Tudor & Castle

06/03/2015 Day A Band 7 to support clinically

17/03/2015 Day A sent hca to B&Y to help band 7 in numbers

20/03/2015 Day A band 7 in numbers till 15.05pm will need cover Extra HCA

30/03/2015 Night A Support from AAU level 3 if required

Acute Stroke Unit

03/03/2015 Night A trained nurse moved to heronsgate ward so band 7 supported clinically. Surge RN not covered so patients absorbed into ward workload

08/03/2015 Day A escalated to senior nurse. No trained available but extra hca sent to support ward

12/03/2015 Day A one HCA for 1:1. supervisory supporting clinically

13/03/2015 Day A Band 7 to support clinically. Surge area full with 3 pts but no staff to cover

15/03/2015 Day R escalated to senior nurse. No staff available to support. Surge staff not covered so patient care absorbed into ward workload. 2 band 4s on duty Assessed safe by senior nurse on site

16/03/2015 Day R Supervisery supporting clinically. HCA sent at 3pm to support for late shift. Surge shifts not covered so patient care absorbed into ward workload. Matron supporting clinically from 3pm

23/03/2015 Day A 1:1 Requested for patient, however now used in the numbers. Will require a nurse for late duty - alreadyput out to NHSP

25/03/2015 Day A supervisery supporting clinically. Matron aware

31/03/2015 Day A supervisory nurse supporting clinically

Churchill HHGH

09/03/2015 Day A have put out for a RN late shift. Satff to be deployed from Simpson

11/03/2015 Day A RN short for LD. Sister to be in numbers for early shift and have put out for a late shift

12/03/2015 Day A have modified to reqest RN for late shift supervisory supporting clinically

21/03/2015 Day A Staff redeployed from Simpson

Simpson HHGH

12/03/2015 Day A .have modified to request RN for late shift. Supervisory to clinically support this morning

16/03/2015 Day A have contacted NHSP to chase CSW that not turned up. Supervisory to support.

21/03/2015 Day A Contacted NHSP to alter start times for unfilled LD RN shift. Escalated to Senior Sister on call

Surg

ery

Combined ITU

02/03/2015 Night A outreach pulled overnight

13/03/2015 Day A No Outreach on LD

20/03/2015 Day A One member of staff not available for full day. Outreach will need to be pulled for any admissions

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Cleves 20/03/2015 Day A Senior Sister to work in a bay

Flaunden

09/03/2015 Day A supervisory supporting clinically

14/03/2015 Day A band 7 supporting clinically

16/03/2015 Day A supervisory nurse supporting clinically

18/03/2015 Day A long day band 5 out with nhsp. Band 7 working clinically early shift

31/03/2015 Day A band 7 working clinically not covered by nhsp

Langley

06/03/2015 Day A 1 X band 5 off sick. Band 7 working clinically; however Band 7 also bleep holder

08/03/2015 Day A HCA x1 moved to ESAU. Assessed safe by senior nurse

11/03/2015 Day A Band 7 working clinically to cover band 5 sickness. Band 2 off sick. Matron aware. Ward deemed safe by Matron for day shift.

12/03/2015 Day A Band 7 working clinically to cover band 5 off sick on LD - not covered by NHSP

29/03/2015 Day A HCA (bank) went to Flaunden ward. Assessed safe by senior nurse on duty

Letchmore

07/03/2015 Day A escalated with the senoir manager on call Janet Buckley. HCA came to help after lunch, Assessed by senior nurse as amber from lunchtime.

08/03/2015 Day A escalated with sen manager on call Karen Bowler- Agency HCA from langley came at 1000 hrs up to 1945. Assessed by senior on site rating amber from 10.00hrs

09/03/2015 Day A Two trained down, one moved from Ridge. No a band 7 today.

12/03/2015 Day A 1 RN LD request unfilled, 1 RN LD sick, band 7 in the numbers until 3. Nurse called to come in and do bank

13/03/2015 Day A 2 Senior RN on after 3pm additoinal HCA given to support late shift.

14/03/2015 Day A 1 HCA offsick, not covered

16/03/2015 Day A 1 RN down, no band 7. Matron helped after 3 pm

17/03/2015 Day A RN LD unfilled, CSW moved from ESAU, band 7 working clinically until 3pm

24/03/2015 Day A Band 7 off sick. On call senior manager & surgical bleep holder aware.1 HCA sent over for LD

27/03/2015 Day A 1 HCA special LD, 1 RN unfilled, 2nd RN ESAU to help out, will esculate to nurse in charge

28/03/2015 Day A 1 HCA UNFILLED FOR LONG DAY. Hca sent from cleves to help this morning, then to help for a bit this afternoon.

29/03/2015 Day A 1 RN unfilled, informed Matron.Assessessed as safe by senior nurse on duty.

31/03/2015 Day A 1 band 6 LD sick, shift unfilled, band 7 counted in numbers, no senior to take charge after 3pm

ESAU

02/03/2015 Day A 2nd RN LD unfilled.support from letchmore

03/03/2015 Day A 2nd RN LD unfilled,support from letchmore

04/03/2015 Day A 2nd RN LD unfilled. Support form letchmore as needed

05/03/2015 Day A 2nd RN LD unfilled.support from letchmore as required.

06/03/2015 Day A 2nd RN moved to Letchmore to cover sickness

09/03/2015 Day A 1 RN not covered. Support form letchmore as needed.

10/03/2015 Day A 2nd RN LD unfilled.Support from letchmore as needed.

11/03/2015 Day A 2nd RN LD unfilled. Support from letchmore as needed.

12/03/2015 Day A 2nd RN LD unfilled also no HCA/admin until 2pm, admin from Letchmore to help

13/03/2015 Day A Matron supporting during the day

14/03/2015 Day A 2nd RN not covered


16/03/2015 Day A 1 RN unfilled. Escualted to Matron.

17/03/2015 Day A 2nd Nurse (CSW) moved to Letchmore as RN unfilled


19/03/2015 Day A 2nd RN LD agency nurse cancelled shift, support will be given from Letchmore ward


21/03/2015 Day A 2nd RN unfilled.Support from letchmore as needed.

28/03/2015 Day A 1 HAC unfilled for long day and night. Esculated to Incharge incharge nurse.

28/03/2015 Night A 1 HAC unfilled for long day and night. Esculated to Incharge incharge nurse.

29/03/2015 Day A RN started shift from 11 - 19 hrs. 1 HCA down, informed matron. Assesssed as safe by senior nurse on duty.



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Ridge

02/03/2015 Day A 1 r/n long day off sick,band 7 working in bay.ward reported safe by Matron AB for the day shift.

03/03/2015 Day A 1r/n and 1 hca long day not covered by NHSP.Band 7 working in numbers. Ward deemed safe by Matron .

06/03/2015 Day A Band 7 supporting clinically. Ward deemed safe by senioe sister

09/03/2015 Day A 1 RN moved to Letchmore.

15/03/2015 Day A 1 RN moved to medical ward.ward assessed safe by senior nurse on call

16/03/2015 Day A ,1 r/n moved to Letchmore ward,Band 7 working clinicaly

17/03/2015 Day A 1R/n moved to letchmore ward, Band 7 working clinicaly

De La Mare SACH

23/03/2015 Day A 14 patients 8 admissions to ward. 7 TCI's coming in today.on DLM/ 7 Beckett ward. I R/N in brighton- thought she was on a night. Will try her best to come in for a late shift. DSU contacted- They have had to send x 1 R/N Home. No one else able to work- Called staff. Band 7 working clinically. 1 x Ward Clerk down. Housekeeper on Leave. Painting and decorating works in progress in dept/ as well as taking off roof panels.

Wo

men

s &

Ch

ildre

ns

Pae

di

atri

cs

Starfish 05/03/2015 Night A ced was able to assist on the night from 22:30 - 05;00

09/03/2015 Night A Band 7 working long day

Gyn

aeco

logy

Elizabeth

01/03/2015 Day A Short by 1 RGN , SNR Nurse on call informed. Assessed by senior nurse onduty as safe.

03/03/2015 Day A On green but Knutsford opened overnight and not staffed.4 gynae pts tci and breast on top of that with only 2 confirmed discharges and no ring fenced. Amber due to the opening of Knutsford and no staff booked. ERP Nurse cover until 1600hrs then Band 6 from Ward cover the late. Staff booked for the night shift.

09/03/2015 Day A RN did not arrive for shift. Support requested from Bed Manger but none sent over. Delayed in obtaining blood for patient due to shortage of staff. Bed Managers asked for support to retreive blood but not available.

10/03/2015 Night A x2 gynae oncology patients to come in. X 3 breast patients to come in. 7 medical patients. Potentially 6 discharges. Ward assessed as safe by DHoN

11/03/2015 Day A x3 RNs only until 10am when another one arrives. Only 1 HCA this pm after 15:00hrs. X3 electives to come in,. 9 medical patients. 5 surgical patients. Area assessed as safe by DHoN

12/03/2015 Day A Only 3 RNs on duty for the LD, should have 5. The band 7 will have to support clinically. X5 electives, no beds to start with. 8 medical patients. 5 surgical patients.

14/03/2015 Day A HCA short due to last minute sickness - extra HCA nights to provide 1-1 care

17/03/2015 Day A band 5 short LD. B7 will cover on ward to co-ordinate etc. x4 gynae pts tci and 2 confirmed discharges presently. Band 5 for night shift cancelled - called in permenant member of staff to support.

18/03/2015 Day A 7 Medical & 2 surgical patients. 4 TCI's no beds to start the day. 1 RN shift not filled by NHSP but have Band 5 awaiting PIN who can support with the Band 7 also supporting where required.

19/03/2015 Day A 7 medical & 2 surgical patients. 8 to come in for surgery, no beds to start the day. ?4 discharges awaiting ward round. Supervisory will support but with only 1 HCA support with patient care will be slow or may not be able to provide as much support as we would like. No fill by NHSP for the Band 5 or the Band 2.

23/03/2015 Day A short band 5 LD. B7 will work clinical until 16.00 hrs, by then beds should be sorted for the all day list and majority of discharges complete, this will cut down on risk. X7 pts tci today.B2 sent home at 11.30 as unwell and pregnant. Asked for help from other divisions. Housekeeper came in to support with Suppers at 1730hrs.

24/03/2015 Day A x2 HCAs phoned in sick, only x1 HCA on duty and she started in the trust only 6 weeks ago. X2 breast patients to come in. x8 medical patients. X6 surgical patients. Supervisory to work clinically.

30/03/2015 Day A x6 pts tci with 4 confirmd discharges. 2 RN's on a long day, x 2 off sick. 10 Medical & 6 Surgical patients, no beds to start the day.supervisory supporting clinically. Red after 13.00hrs. Update: 3 RN's now on duty after 1600hrs.

Mat

ern

ity

Delivery Suite

05/03/2015 Night A high levels of activity in Delivery Suite, patients exceeding staffing capabilities; staff redeployed from areas with less acuity to make area safe.

06/03/2015 Day A 1 X HCA short , shift out to NHSP, will redeploy from areas with less acuity utilise shared work with midwives to provide safe care.

07/03/2015 Day A 1 midwife vacancy on long day. Shift out to NHSP. Will redeploy from other ares to enable safe patient care

09/03/2015 Day A Vacancy for midwife on late. Shift out to NHSP.Will need to redeploy from another area to facilitate safe patient care depending on workload and acuity

10/03/2015 Day A Vacancy for HCA on long day and night. Depending on workload and acuity will need to redeploy from another area to enable safe patient care. Shifts out to NHSP.

10/03/2015 Night A Vacancy for HCA on long day and night. Depending on workload and acuity will need to redeploy from another area to enable safe patient care. Shifts out to NHSP.

12/03/2015 Night R Despite shift fill levels activity required redeployment from community areas to provide safe levels of patient care, escalation for maternity initiated.

13/03/2015 Day A no HCA to cover night duty, both shifts out on nhsp, not yet filled. Will assess activity and redeploy where possible. Redployment locally with midwives providing care to ensure safe level of patient care.

14/03/2015 Day A Vacancy for midwife X2 on for long day. Shift out to NHSP. Redployment of staffing to ensure safe levels of patient care. Consider escalation to community should acuity demands increase.

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15/03/2015 Night A Staff redeployed from other clinical areas to enable safe patient care midwives and support staff. Shifts unfilled by NHSP. Consideration for maternity escalation should acuity increase above current levels.

15/03/2015 Night A Staff redeployed from other clinical areas to enable safe patient care midwives and support staff. Shifts unfilled by NHSP. Consideration for maternity escalation should acuity increase above current levels.

16/03/2015 Night A Staff redeployed from other clinical areas to enable safe patient care midwives and support staff.

18/03/2015 Day A 1 Midwife short. Shifts requested NHSP. Local redeployment to provide safe clinical care.

19/03/2015 Night A Local reployment to provide safe levels of clinical care in other maternity areas.

20/03/2015 Day A 1 Midwife shift vacant local redployment to enable safe llevels for clinical care.

21/03/2015 Day A x1 RM shift vacant requested NHSP. Locally redeployment to enable provision of safe levels of clinical care.

23/03/2015 Day A 1 HCA vacant clinical care provided by midwives.

24/03/2015 Day A Support shifts unfilled midwives available to provide clinical care.

27/03/2015 Night A 1 x HCA short on long day , will redeploy from areas with less acuity

ABC

02/03/2015 Day A Amber for early due to no HCA. HCA from Victoria ward to help as required. D/S RM to cover Knutsford shortfall. Workload managable at start of night shift.

07/03/2015 Day A 1 midwife vacancy on long day. Shift out to NHSP, will redeploy from other ares to enable safe patient care

09/03/2015 Day A Vacancy for midwives on long day and vacancy for HCA on late shift. Both out to NHSP but to redeploy staff according to workload and acuity.

10/03/2015 Night A Vacancy for HCA on night. Depending on workload and acuity will need to redeploy from another area to enable safe patient care. Shift out to NHSP.

12/03/2015 Night A 1 x RM short due to reported late staff sickness. Redployment within service to provide safe levels of care.

15/03/2015 Day A Acuity and safe staffing provided within current levels, local redeployment depending on acuity demands.. Shifts out to NHSP remain unfilled.

20/03/2015 Day A Local reployment to provide safe levels of clinical care in other maternity areas.

24/03/2015 Day A Support shifts unfilled midwives available to provide clinical care.

Victoria

06/03/2015 Night A 1 X HCA short , shift out to NHSP, will redeploy from areas with less acuity utilise shared work with midwives to provide safe care.

14/03/2015 Day A vacancy for midwife. Shift out to NHSP. Will need to redeploy midwife from another area to enable safe patient care.

15/03/2015 Night A HCA shift vacant requested NHSP. Staff redeployed depending on acuity demands.



21/03/2015 Day A Support staff shift unfilled, midwives available to provide clinical care.

23/03/2015 Day A Support staff shift unfilled, midwives available to provide clinical care.

Katherine

02/03/2015 Day A I midwife down, Knutsofrd suite midwife assisting with discharges.

05/03/2015 Day A 1 early shift still vacant on NHSP for a midwife cover provided from Katherine ward to provide safe patient care

06/03/2015 Day A 1 X HCA short , shift out to NHSP, will redeploy from areas with less acuity utilise shared work with midwives to provide safe care.

10/03/2015 Day A Vacancy for HCA on long day. Depending on workload and acuity will need to redeploy from another area to enable safe patient care. Shift out to NHSP.

13/03/2015 Day A Early and Late HCA shift vacant unfilled by NHSP. Midwifery staff will provide clinical care.


17/03/2015 Day A Kath ward x 1 HCA short on late shift. X1 Nursery nurse short. Both shifts on NHSP, midwives available to provide clinical care.

18/03/2015 Day A 1 Midwife shift vacant. Requested NHSP. Midwife redeployed to provide safe levels of clinical care.



27/03/2015 Day A 1 x HCA short on late , will redeploy from area with less acuity

29/03/2015 Day A no HCA on postnatal ward or Knutsford suite on night shift staff to be utilised from Victoria ward to work on post-natal ward.

Knutsford

03/03/2015 Day R NO HCA on early, will need support from another area


17/03/2015 Day A x 1 HCA shift short sue to sickness. Shift on NHSP midwives available to provide clinical care.


23/03/2015 Day A Support staff shifts unfilled midwives available to provide clinical care.

23/03/2015 Night A Support staff shifts unfilled midwives available to provide clinical care.

25/03/2015 Day A x 1 HCA shift short sue to sickness. Shift on NHSP midwives available to provide clinical care.

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Appendix 7 Recruitment Planning Report - NURSING & MIDWIFERY

Summary - 31 March 2015

Vacancy rate - Qualifed establishment change in est. staff in post (sip) change in sip (%) vacancies % pipeline

As at 31/1/15 1438.3 1192.8 245.5 17.1 NOW as at 31/3/15 1447.4 0.63% 1171.5 -1.79% 275.9 19.1 112

Forecast 3 months ahead 228 15.8

Vacancy rate - Unqualifed establishment change in est. staff in post (sip) change in sip (%) vacancies %

As at 31/1/15 548.6 432.0 116.6 21.3 NOW as at 31/3/15 588.9 7.30% 481.6 11.48% 107.4 18.2 51

Forecast 3 months ahead 82.9 14.1

Vacancy rate - TOTAL establishment change in est. staff in post (sip) change in sip (%) vacancies %

As at 31/1/15 1986.9 1624.8 362.1 18.2 NOW as at 31/3/15 2036.4 2.49% 1653.1 1.74% 383.8 18.8 163

Forecast 3 months ahead 310.9 15.3

Forecast assumes:

All candidates currently in the pipeline start within next 3 months Turnover continues at a rate of 1.5% per month (18% per year)

Commentary

1) Qualified N&M joiners just about kept pace with turnover, with c 40 leaving and joining in the period; whilst the establishment increased by 10

2) Unqualified nursing & midwifery joiners considerably exceeded turnover, with net staff in post increasing by 11.5% in two months 3) Due to a significant increase in establishment over the same period, the reduction in vacancy rate for unqualified nurses

doesn't entirely reflect the high volume of activity; had the establishment stayed the same, the vacancy rate at at 31st March would be 12.2% rather than the 18.2% shown, a considerable drop from the 21.3 at the end of January

4) There are currently 112 qualified and 51 unqualified recruits in the pipeline

trust board meeting - watford general hospital...trust board meeting - 14 may 2015 nursing and...

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