MINUTE of MEETING of the AREA NURSING & MIDWIFERY COMMITTEE s2

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MINUTE of MEETING of the AREA NURSING & MIDWIFERY COMMITTEE

Board Room, John Dewar Building, Inverness /

12 AUGUST 2008 – 11.00 am

Present: / Heidi May (In the Chair)
Doreen Bell
Helen Bryers
Alan Caswell
Lynn Chalmers
Jonathan Gray
Laura Greenshields
Nigel Hobson
Hilda Hope
Alison Hudson
Veronica Kennedy
Marie Law
Stephen Loch
Una Lyon
Gill MacNeill
Margaret MacRae
Paula McCormack
Sarah McLeod
Muriel McNab
Ruth Miller
Helen Morrison
Joan Philip
Pat Tyrrell
Elizabeth Watson
Mhairi Will
Isobel Woods
Eric Wiseman
Sandie Young
Also Present / Findlay Hickey, Lead Pharmacist, Mid Highland CHP
In Attendance: / Brian Mitchell, Board Committee Administrator
Fiona Mundell
1 / WELCOME AND APOLOGIES
Apologies were received from Mary Burnside, Peter Cartwright, Lorraine Coe, Kathleen Clarke, Caroline Henderson, Malcolm Iredale, Trisha Kelly, Chrissie Lane, Jennifer Lobban, Jenny MacGregor, Alison MacLean, Liz McClurg, Iona McGauran, Mairi Milne, Patricia Morrison, Lesley Randall, Fiona Riddell, Fiona Sharples, Hazel Smith, Rachel Soplantila, Helen Tissington, Mary Vance, Angela Watt, and Catherine Zawalnyski.
2 / PATIENT GROUP DIRECTIONS
Mr Hickey gave a presentation to the Committee in relation to Patient Group Directions (PGDs), advising that these had emerged as a result of the expansion of professional roles within the NHS and the need for development of safe and effective new patient focused services. PGDs were considered by the Area Drug and Therapeutic Committee Sub Group of the same name. PGD themselves provided a written instruction for the supply or administration of medicines to groups of patients, subject to specified exclusions, where patients could not be individually identified prior to presentation for treatment. PGDs were legal documents and would only be valid once authorised by the PGD Sub Group. PGDs would be used by a range of healthcare practitioners although would be restricted to those named in the specific document, a master copy of which was to be held by a responsible person within the location. Practitioners were required to have been trained on and understand the PGD as well as ensure that their continuous professional development was up to date. HDL(20001)7 stated that “supply or administration of medicines under PGD should be reserved for those limited situations where this offers an advantage for patient care (without compromising patient safety) and where it as consistent with appropriate professional relationships and accountability.” PGDs would be useful in relation to drugs in routine use by healthcare professionals, would increase patient convenience without compromising safety, and provide clearly defined criteria and conditions such as in the case of administration of vaccines by practice nurses. It was stated that all professionals involved in the development, review and operation of the PGD must act within the legal requirements as well as their own professional code of practice and conduct. In terms of development of a PGD there would be need to consider whether this was appropriate, if there was an existing PGD in place, and if not then the development group would be required to collaborate with the PGD Sub Group. The draft PGD would then be submitted to the Sub Group, be disseminated accordingly, and be valid for a period of two years after approval with a planned review after 12 months. Mr Hickey then went on to outline the responsibilities of both Line Managers and Healthcare professionals and added that if supplying or administering a medicine under a PGD then the individual concerned required to ensure they had up to date knowledge relating to the clinical situation covered by the PGD, the medicine and its use for the indications specified. There was also a need to ensure that any training required for the operation of the PGD had been taken, for satisfaction that the PGD is legally valid and has the appropriate authorisation, that when medicines are supplied or administered the agreed protocol must be followed and the information specified in the PGD recorded, and that the individual acted within the legal requirements of the PGD as well as their own code of professional practice and conduct.
During discussion, Mr Hickey advised that in relation to reviewing PGDs the responsibility lay with the relevant Sub Group and the professionals involved. It was confirmed that the Sub group would initiate this process. On the matter of drugs that were not to be covered by PGDs it was stated that this would be Controlled Drugs but also include antibiotics, and those involving relevant licensing conditions. Ms May raised the issue of compliance monitoring and the need for formal guidance to be issued and Mr Hickey undertook to refer this point to the PGD Sub Group.
The Committee:
·  Noted the position in relation to Patient Group Directions.
·  Noted that Mr Hickey would refer the issue of governance and formal guidance to the PGD Sub Group for consideration.
Mr Hickey left the meeting at 11.25 am.
3 / MINUTE OF MEETING OF 8 APRIL 2008
The Committee Approved the Minute of meeting held on 8 July 2008.
4 / MATTERS ARISING
4.1 Appointment of Representative to Area Clinical Forum
Ms May advised that she had received 3 expressions of interest in undertaking the role of additional representative on the Area Clinical Forum, from this Committee. Ms May was to hold further discussion with the individuals before making a final nomination.
The Committee Noted the position.
4.2 Hand Hygiene Audits
Ms May expressed concern that NHS Highland may not meet the compliance requirements at the next audit and this was likely to be raised as part of the forthcoming Annual Review. It was stated that 2 wards at Lorne & Islands were still to be audited, that the eventual final compliance figure was to be 83-97%, and that it was possible NHS Highland would be the only Board to fail to meet the requirements. There was need for discussion with Lead Nurses as to next steps and audit processes, including notification of the position to CHP General Managers etc. Ms May also wished to record her thanks to those staff in areas where compliance rates had been met, recognising the great effort involved in this achievement.
The Committee:
·  Noted the position.
·  Agreed that the matter be discussed at the Informal Leads meeting that afternoon.
4.3 AAHP Professional Leadership
Ms May advised that the roles of Professional Heads of Service for Speech and Language Therapy, Physiotherapy had been advertised. CHP AHP Leads had been appointed for North, Mid, and Argyll and Bute CHPs. The post of Associate Director was to be advertised shortly and this would be for a fixed 2 year term at Senior Management (B) level.
The Committee Noted the position.
5 / REVIEW OF NURSING IN THE COMMUNITY IMPLEMENTATION
Ms May spoke to the circulated Implementation Plan, which had been agreed by the NHS Board at their meeting held on 3 June 2008. The Committee was advised Ms Sharples was now on maternity leave and as such project management arrangements were being considered.
The Committee Noted the position.
6 / GIRFEC
Ms Watson spoke to the circulated local NHS Highland GIRFEC Update, dated August 2008, relating to recent Key Achievements and significant issues including agreement as to the Child Plan for Health. Information was to be available shortly on the Intranet site and this was to include the assessment triangle previously considered by the Committee. Relevant training was underway, especially in RONC sites and a multi-agency structure had now been put in place. Ms Young added that there would be a strong quality assurance framework in place along with a necessary Transitional Protocol. Ms May requested that Ms Young consider and create a Strategy for Practice for RONC sites. On the point raised as to the role of Lead Professionals, it was stated that these would be named Professionals, be the most appropriate Health Professional involved, be dependent on the child’s age, and where there were issues relating to Child Protection/Education could be a Social Worker for instance.
The Committee
·  Noted the position.
·  Noted that Ms Young would consider and prepare a Strategy for Practice relative to RONC sites.
7 / KEEPING CHILDBIRTH NATURAL AND DYNAMIC
Sarah McLeod gave a presentation to the Committee in relation to the Keeping Childbirth Natural and Dynamic Programme (KCND), advising that this is a government led initiative and formed part of Better Health Better Care. It covered a multi-professional programme of work and the overarching aims covered ante, intra and post natal periods, providing a strategic and systematic approach throughout Scotland. In terms of delivery, each NHS Board had appointed a consultant grade midwife to lead and implement KCND and would work locally/regionally and nationally to a range of specific aims and objectives. There would also be development of national pathways, the drafts of which were to be issued for consultation shortly. It had been considered necessary to take this approach in light of the great variation in maternity care over the last 100 years and this plethora of change had led to confusion. In addition it was recognised that changes within the Health Service would lead to fewer obstetricians, that the new MMC and GMS contracts had associated implications, and reflecting that there had been an expansion in midwifery practice as well as introduction of Maternity Care Assistants. Overall there was a desire to provide women with an informed/evidence based choice. In terms of objectives, Midwives were to become the first point of contact for women, would carry out the initial risk assessment, and have caseload responsibility for healthy women who would be offered a normal birth pathway regardless of setting. There was to be discontinuation of Cardiotocograph (CTG) at admission and again there was to be provision of Nationally agreed pathways. To date NHS Boards had appointed Consultant Midwives, NHS QIS had prepared national referral criteria and care pathways, and NES had established a leadership programme with regional events for key stakeholders. In order to underpin KCND evaluation plan the Chief Scientists’ Office NMAHP Research Unit were to undertake a literature review. in NHS Highland there was a need to ensure engagement with all stakeholders, recognise the excellent work already undertaken, ensure that the Steering Group take a systematic approach, and ensure that the national lead was followed whilst being mindful of the uniqueness that existed in Highland. In summary KCND represented a unique opportunity for maternity care provision in Scotland, was woman focused, would involve the right care delivered by the right health professional, would provide a valuable contribution to the Public Health agenda, and was to be a long term Programme.
Mrs Morrison queried the assessment and monitoring of workload/workforce implications for relevant staff and was advised that much was already underway. Mrs Bryers advised that the work fed into the Women’s Health Network and Ms McLeod that this would form part of the relevant progress reporting process. On the point raised by Ms Hope it was stated that it was hoped the Programme would have a positive impact on the rate of c-sections undertaken. The issue of GP involvement was raised and Ms McLeod stated that this aspect would be challenging given that this was not an Enhanced Service although it was clear that they would have an important role to play. In relation to the proposed QIS pathway it was advised that the first draft was expected in early course, and that national pathways would take precedence.
The Committee:
·  Noted the position.
·  Agreed that a Steering Group be established, with membership including GPs and Lead Nurses.
·  Agreed that an Action Plan be prepared.
·  Agreed that there be engagement with Lead Midwives.
8 / REVENUE BUDGET 2008/09
Ms May advised as to the financial position for NHS Highland in 2008/09 and stated that there would be requirement in the coming year to identify a range of savings at operational level. Discussion identified several ways that Lead Nurses and Midwives may contribute:
·  Reduction in bank and agency.
·  Standardisation of equipment such as catheters.
·  Capping mileage and encouraging videoconferencing.
·  Economic use of lights, power and heating.
The Committee Noted that Mr Iredale, Director of Finance was to address the next meeting, as he was unable to do so today.
9 / LESSONS FROM RY CASE
Mr Hobson advised the Committee as to a complex clinical case that had learning implications for a range of staff. The main points that emerged were in relation to continuous assessment of high risk patients in terms of appropriate location for care and associated staff skill levels, usage of SEWS (Early Warning) Charts and associated roster/staff skill issues, the move from informal and uncoordinated care to utilisation of an hourly checklist, and the lack of a written formal Care Plan in this instance.
The Committee:
·  Noted the issues raised.
·  Agreed the need for structured shared learning from clinical incidents.
Elizabeth Watson left the meeting at 12.55 pm.