MINUTE of MEETING of the AREA NURSING & MIDWIFERY COMMITTEE

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MINUTE of MEETING of the AREA NURSING & MIDWIFERY COMMITTEE 14 AUGUST 2007 – 11.00 am Board Room, Assynt House, Inverness

Present: Heidi May (In the Chair, Items 1 to 6) Peter Cartwright (In the Chair, Items 7 to 17) Louise Corbett Nigel Hobson Hilda Hope Janet Kellock (for Item 5) Veronica Kennedy Elaine Lang Jennifer Lobban Stephen Loch Helen Macdonald Karen Mackay (for Item 5) Alison MacLean Gill MacNeill Caroline Matheson Liz McClurg Paula McCormack Ruth Miller Tricia Morrison Joan C. Philip, University of Stirling Lesley Randall Fiona Sharples Rachel Soplantila Pat Tyrrell Margaret Walker Angela Watt Faith Wilson Catherine Zawalnyski

In Attendance: Brian Mitchell, Board Committee Administrator

1 WELCOME AND APOLOGIES

Apologies were received from Helen Bryers, Mary Burnside, Alan Caswell, Lynn Chalmers, Pam Cremin, Lorraine Coe, Kate Earnshaw, Laura Greenshields, Caroline Henderson, Trisha Kelly, Chrissie Lane, Prue Lennox, Jennifer Lobban, Caroline Matheson, Sarah McLeod, Mairi Milne, Helen Morrison, Patricia Morrison, Hazel Smith, Liz Watson, Isobel Woods, Eric Wiseman, and Sandie Young.

Working with you to make Highland the healthy place to be

2 MINUTE OF MEETING OF 10 JULY 2007

The Committee Approved the Minute of meeting held on 10 July 2007.

3 MATTERS ARISING

3.1 Pressure Ulcer Prevention and Management Guidelines

Ms May advised that it had been agreed that governance be through the ANAMAC and appropriate arrangements would be established in association with Prue Lennox.

The Committee so Noted.

3.2 Research Sub Group

Heidi May requested that the draft Strategy be brought back to the Committee at the next meeting to be held on 11 September.

The Committee so Noted the position.

3.3 Resuscitation Training

Heidi May stated that she was to write to the Area Drug and Therapeutic Committee confirming that basic training would be provided for all staff.

3.4 Implementation of Breathlessness Assessment

Heidi May requested that Pat Tyrrell speak to the Respiratory Nurse Specialist regarding attendance at the Committee and the giving of a presentation of her work in this area.

3.5 Wound Management Sub Group

Heidi May advised that she had spoken to the Head of Podiatry concerning appropriate wound dressings and would contact Prue Lennox to ensure a consistent approach.

4 CONTINENCE AUDIT AND REVIEW OF PRODUCTS

Lesley Randall gave a presentation to the Committee in relation to the Review of Continence Products across NHS Highland detailing the relevant background, objectives, and methodology, which included Patient/ Carer and Staff feedback. The key results were outlined and a number of recommendations had emerged, all as more detailed in a circulated Summary Report. There were included a number of general comments from the Continence Nurse Advisor and it was stated that practitioners must be able to demonstrate their competence when using disposable body-worn pads as this was a core requirement of professional conduct as stipulated by the NMC. To date a staff training programme had been prepared for 2007, the results of the audit considered by the Clinical Governance Sub Group who had requested a further Action Plan, and Continence Lead Nurses had been informed of the audit findings. The further Action plan referred to had been considered and the key actions identified as developing the continence link nurse into the concept of nurse with special interests with appropriate resources, the agreement of continence treatment success targets with audited outcomes, the establishment of

continence clinics with a clear remit, and the establishment of a short life Working Group to take matters forward.

On the points being raised Lesley Randall confirmed that the relevant audit had included children and advised that the proposed short life Working Group to progress recommendations had yet to be established. Ms May stated that funding was an issue in respect of the Link Nurse system and that the possibility of external support was being considered and in this respect Hilda Hope suggested that better use of products could assist. Lesley Randall, echoed by Ms May advised that Link Nurses required support, had training issues to be considered, and would benefit from a higher profile overall.

The Committee otherwise Noted the position.

5 PRESENTATION ON INFANT FEEDING

Janet Kellock and Karen Mackay gave a presentation to the Committee in relation to breastfeeding of infants and in respect of which CHPs were important in ensuring a multi agency approach. The presentation outlined the importance of the Baby Friendly approach, including the benefits for both mother and child, which had been acknowledged as being the most important intervention in improving child health and was key to reducing inequalities in socially disadvantaged groups. Statistics were given as to the increased infant breastfeeding rates encountered in Baby Friendly hospitals and the status of NHS Highland Maternity Hospitals was also given which illustrated that Raigmore was the only one currently fully accredited. The relevant political drivers were referred to and the role of the Infants Advisor outlined which would include strategic leadership, networking, supporting changes in culture, beliefs and practices, promoting the health benefits, and the development of training strategies and policies. There was an indication of the Policy and Planning requirements moving forward along with the need for information, education, communication, and training. It was advised that protection, promotion and support would form a large part of the role of Infant Feeding Advisors through strict adherance to the WHO Code of Marketing of Breastmilk Substitutes and the Breastfeeding etc. Scotland Act (2005), and included a Healthy Start and Baby Welcome Sticker Schemes. There was also given an indication of the monitoring and research elements being considered and implemented.

Ms May raised the issue of a Framework and Strategy with a view to monitoring performance, was advised that this would be available in early course and that planning and policy would forma major part of the work of Advisors. Training would be provided on 28 to 30 August 2007 and in this regard interest had been high and it was acknowledged that peer support would be very important and a relevant Peer Support package was to be prepared. It was advised that a peer group had been established in the Caithness area. Catherine Zawalnyski raised the issue of data collection and was advised that Paddy Hopkins was seeking to establish an appropriate method, possibly with help from Health Workers. The Committee were advised that it was intended to speak one to one to those mothers not breastfeeding, that it was hoped that training packages would be established and that this would include for those with learning difficulties, involve links to National Childrens Homes etc, and involve appropriate activities and publicity. Pat Tyrrell emphasised the need to avoid concentrating on the hospital setting and approach this subject on a CHP basis, this point being agreed by those present. Ms May advised that CHP General Managers had agreed to appoint Lead Midwives and these were to be key points of contact and lead on the various issues concerned.

The Committee:

 Noted the position.  Noted that Ms May would establish whether the NHS Board would wish to receive the presentation given.

6 MEDICINE MANAGEMENT DEVELOPMENT NURSE

Ruth Miller gave a presentation to the Committee in relation to the role of the Medicine Management Development Nurse, a newly established role in NHS Highland, and advised that the main functions of the post would be to provide appropriate cascade training and the handling of such matters as drug errors, and identifying drug incident trends fro actioning etc. Another major area of work would be in relation to the storage and administration of drugs for Nursing including relevant audits and there would be need to consider Medical Administration errors and reporting arrangements with Committees etc. Ruth emphasised the need for consideration of Nursing medical management issues, appropriate training and information resources, and good communication. Ms May advised that the Symptomatic Relief Policy had been discussed with the Chief Pharmacist and that there was no intention to stop the use of this policy and that it can continue to be used in areas where already in place. Ms May advised that where a more appropriate process could be used eg PGDs or nurse prescribing then this would be discussed with staff. She also stated that an Internal Audit report considered previously by the NHS Board Audit Committee had illustrated a lack of consistency in the issue of Controlled Drugs, that this matter had both actual and potential disciplinary implications for staff and Guidance on what was expected from nursing staff was required. Ms Miller had agreed that she would undertake this work, and that a draft document was underway for consultation shortly. Ms May stated that there was a need to consider the issue of single person administration in relation to controlled drug administration, Hilda Hope raised the matter of a Community Policy and Ruth Miller in response advised that the Area Drug and Therapeutic Committee had indicated their preference for overarching Policies to be prepared. On the matter of drug errors Ms May stated that she would welcome the regular updates to Committee.

Elaine Lang expressed concern at the consultation paper relating to home carer staff administering drugs, in particular the element relating to emergency medication where changes in medication could be authorised over the telephone by a GP to the home worker. Ruth Miller advised that the consultation document was a joint one with the Highland Council and as such Allison MacRobbie was involved in its development. Hilda Hope advised that such staff would not be tied to by existing NMC Guidelines in this particular area and that Alison had been made aware of the concerns that existed in that regard. Pat Tyrrell reiterated that important issue would be to ensure clarity of instruction to staff members.

The Committee:

 Noted the position.  Agreed that regular reports on drug errors be brought the Committee.

Heidi May left the meeting at 12.45 pm

7 MENTAL HEALTH OFFICERS INDUSTRIAL ACTION – IMPACT ON NURSING SERVICES

Margaret Walker spoke to the circulated briefing paper relative to proposed industrial action by Mental Health Officers which included an impact assessment on nursing services showing both implications and suggested action. Margaret advised the Committee that action had been suspended to the following as an offer was expected from the employer side. The Committee was advised that staff received no additional remuneration for the role carried out, nor for on-call arrangements, leading to a nursing dilemma due to not being legally entitled to carry out certain treatment. Gill MacNeill advised that as a result of action the duty to monitor those patients on license from secure units was nor being undertaken. Margaret further advised that in this area complex issues

in respect of Community Treatment Orders had arisen in Caithness, the same being the case fro those from outwith the Highland area. Mr Cartwright advised that Social Work staff in Argyll and Bute were taking a keen interest in proceedings.

The Committee Noted the position.

8 HAND HYGIENE UPDATE

There had been circulated update in relation to the National Hand Hygiene Campaign which was to run to 31 March 2008. The update referred to the appointment of two part- time Hand Hygiene Coordinators and in this regard there was a need to establish an appropriate exit strategy. The second of three blocks of audit activity was to take place over a two week period commencing 3 September, 2007 and information was to be distributed to staff later that week. Reference was also made to staff awareness sessions and workshops which had been well attended, patient and public involvement, and partnership working arrangements. Moving forward there was a need for NHS Highland to consider how a sustainable change in culture in relation to hand hygiene can be achieved beyond the existing Campaign and with a view to enabling an exit strategy Lead Professionals were being asked to submit comments and suggestions regarding ways that Hand Hygiene could be taken forward within the organisation.

The Committee otherwise Noted the position.

9 REFERRALS TO AUDIOLOGY AND ENT SERVICES BY HEALTH VISTORS

The Committee Agreed to defer consideration of this Item to the meeting to be held on 11 September 2007.

10 NURSING, MIDWIFERY AND AHP STRATEGY

The Committee Agreed to defer consideration of this Item to the meeting to be held on 11 September 2007.

11 DRAFT NMAHP EDUCATION STRATEGY AND MANDATORY TRAINING

Mr Loch spoke to the circulated NHS Highland Learning and Development Strategy for Nurses, Midwives and AHPs and associated Learning and Development Priorities Action Plan, based on the 5 key themes. It was stated that the strategy had been developed by the Education Sub Committee of the Area Nursing and Midwifery Advisory Committee to inform the future direction of Learning and Development for Nursing, Midwifery and AHPs in NHS Highland and would support the implementation of Delivering for Health, NHS Highland Strategy for NMAHP’s and the NHS Highland Learning and Development strategy. Education and training were to be key aspects in improving patient care, staff development and service change. The Strategy outlined the philosophy behind continuous professional education (CPD) and training throughout an individual’s career and the key strategic statements of intent which were to underpin the actions in the strategic work plan. The Learning and Development priorities would be embedding in the community, management of long term conditions, a team based approach, increased use of technology, and an emphasis on quality. Moving forward there would be prepared an action plan with 6 monthly targets and milestones agreed by the Committee which would be used to review progress bi-monthly and work would be prioritised in relation to clinical risk and service change. Mr Loch advised that further work was required in relation to the two circulated documents and requested feedback in early course. During discussion it was confirmed that the action plan would be populated through the Education Sub Committee and it was advised that resources were required in relation to facilitators for the Cleanliness Champions and in relation to CPD relative to immunisation issues in respect of which a document on standards was being prepared and would be issued to

CHPs and GPs. On the point raised by Hilda Hope in relation to support for undertaking qualifications it was confirmed that this point would be raised with Helen Morrison, Associate Director (Clinical Workforce Development).

Faith Wilson, Paula McCormack, Catherine Zawalnyski, Rachel Soplantila, Louise Corbett and Margaret Walker left the meeting at 1.30 pm.

Mr Loch also spoke to the circulated Review of Mandatory Training for Nurses, Midwives and AHPs in NHS Highland, this report having been commissioned by the Board Nurse Director with a view to clarifying what training was mandatory or otherwise, the understand the relevant pressures on resources, and to recommend a future direction for mandatory training for NMAHPs. Training would be deemed mandatory in order to satisfy a legal obligation, the requirement of a professional body or an organisational imperative to help minimise a known risk although an organisation’s discretion in relation to what training it provides, and how, was significant. The paper differentiated between clinical and non-clinical training and in respect of the former the list was extensive, fulfilling either a professional or organisational requirement and in respect of which there was less clarity among managers as to the mandatory status. The Review went on to indicate that clinical leaders of Nursing, Midwifery and AHPs needed to influence the balance of resources between clinical and non-clinical mandatory training based upon systematic locally driven risk assessment and as such a number of recommendations were proposed, all as more detailed. During discussion Mr Hobson emphasised the need to differentiate between clinical and non-clinical issues with a view to reducing associated risk as well as maintaining staff competencies. Hilda Hope reminded the Committee of the difficulty for small teams in releasing staff for training purposes and suggested that cascade training would not be an ideal solution as this would only increase the role of those individuals, especially at a clinical level. On the point raised by Pat Tyrrell it was advised that the Review document would be presented to the Learning and Development Sub Group of the Board Partnership Forum.

After discussion the Committee:

 Noted draft NHS Highland Learning and Development Strategy and Action Plan.  Noted that the Action Plan would be monitored bi-monthly.  Noted that feedback was required in early course.  Noted that the issue of resources for undertaking qualifications would be raised with Helen Morrison.  Noted the Review of Mandatory Training for Nurses, Midwives and AHPs in NHS Highland.  Noted that the Review document would be presented to the Learning and Development Sub Group of the Board Partnership Forum.

Helen MacDonald left the meeting at 1.50 pm.

12 REVIEW OF PRE-REGISTRATION PREPARATION

There had been circulated report relating to the NMC Review of pre-registration nursing education as one of the priority areas in Modernising Nursing Careers which was being undertaken in close association with the Department of Health. Ms May requested that the Committee consider the document in detail.

The Committee Noted the circulated report.

13 USING BEDRAILS SAFELY AND EFFECTIVELY UPDATE

There had been circulated draft Protocol and Guideline for the Safe Use of Bedrails and associated Risk Assessment Form for those people within NHS Highland, both in hospital

and community settings. The Guideline described who was responsible for deciding on the use of Bedrails, a definition of restraint, guidance on appropriate use, documentation to support risk assessment, appropriate use of bedrails as standard practice, and written information for patients and carers. The Committee were asked to consider the document and provide comments or suggestions by end August 2007 with a view to this being reconsidered at the meeting to be held on 9 October 2007.

The Committee:

 Noted the Draft Protocol and Guideline.  Noted that comments and suggestions were to be submitted by end August 2007 with a view to being reconsidered at the meeting to be held on 9 October 2007.

14 SUB GROUP UPDATES

Clinical Governance – Hilda Hope advised that the relevant Action plan had now been completed.

Policy – Mr Loch advised that he had chaired the last Sub Group meeting and this had considered a number of subjects including Infant Feeding and X-Ray services. There was a range of work outstanding in relation to the review of existing policies and consideration required to be given as to how best to manage the workload in this respect and the processes involved.

15 REVIEW OF NURSING IN THE COMMUNITY

There had been circulated progress report in relation to the Review of Nursing in the Community (RONC) which outlined the establishment of governance arrangements within NHS Highland by virtue of a Steering Group, the membership of which had been agreed and was to be presented to the NHS Highland Partnership Meeting for agreement. It was also reported that the RONC Project Manager, Fiona Sharples, had been appointed on a two-year fixed term basis. A project initiation Document had been agreed by the Steering Group., as had an appropriate Communication Strategy supported by the Communications Team, and a relevant Risk Register. With regard to change management a consultancy company, QUARTO, had been appointed by the Scottish Executive to facilitate a best practice change management approach in the Early Implementer sites. In terms of Model development the Community Health Nurse (CHN) draft Capability Framework had been developed by NES, consulted upon and feedback referred to NES to inform the next draft. Staff had also been consulted on the role of the CHN and key aspects identified consistently both pan-Highland and pan-Early Implementer sites, indicating a clear and consistent vision developing this role. Feedback had been forwarded to the National RONC Project Manager to inform and the development of the job description and person specification for the CHN role. Key areas requiring further visioning had been identified including the delivery of the public health agenda, how child protection and children’s and young people’s services were to be delivered, and achieving effective patient and public engagement with this being developed by the Scottish Executive RONC Programme Board to achieve consistency both locally and nationally. Moving forward a Workforce Planning Template was being developed to facilitate the development of the RONC model in the four Early Implementer sites and would be used to support the project evaluation, a skills gap analysis and the logistics of the roll out of the model. Overall evaluation of the RONC Project was to go out to tender and work was underway to identify the key indicators that could be used to inform the impact of the model in the Early Implementer sites. A chart had been

developed and circulated detailing the key milestones of the project and this would be taken to the NHS Highland RONC Steering Group for sign-off and would be used to support staff with the visioning of the project development.

16 AOCB

There were no matters raised under this Item.

15 DATE OF NEXT MEETING

The next meeting of the Committee would be held on Tuesday 11 September 2007 in the Board Room, Assynt House, Inverness at 11.00am.

The meeting closed at 2.00 pm