29/05/2012 - Reducing Unnecessary Documentation

#NurChat to discuss “Reducing Unnecessary Documentation” – 29/5/2012 at 8pm

Nursing assessments, care plans, risk assessments and daily notes are just a small snapshot of the amount of documentation that nurses need to complete for each and every patient seen.  A recent Nursing Times article (Ward staffing pressures leave vital care undone) identified that often the development of care plans was being left undone at the end of their shift the article identified this as being due to decreased staffing levels – but what about the sheer amount of documentation, is this an issue too ?  As students we are taught that documentation is an essential part of the nursing process – Assess, Plan, Implement, Evaluate – each stage requiring its own relevant documentation, but is the volume of paperwork that we now have really needed?

Do we need to start to question some of the paperwork we are required to fill out? Which parts of documentation are essential? How do we ascertain what is merely a tick box exercise and what is essential? How can we cut back on paperwork in order to spend more time at the bedside?  What strategies can we employ to ensure that necessary documentation doesn’t have a detrimental impact but enhances patient care? 


Thanks goes to @eileenshepherd for this great suggestion


Click on the picture to download a printable / emailable flyer to share the chat with colleagues


Below are some links you may find useful to read before the chat

Ward staffing pressures leave vital care undone - Nursing Times

Documentation and record keeping - RCN

Record Keeping Guidance for nurses and midwives - NMC

Summary by Teresa Chinn RN
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Post Chat Summary 

This chat kicked off very quickly by NurChatters talking about the RCN record keeping guidance and how it is very good but there is no mention of digital record keeping and it was generally  agreed that regardless of medium the same rules apply but nurses need to be confident electronic records are fit for purpose.

It was then raised that standardised documentation should be implemented throughout the NHS –some added why just keep it to the NHS, but others debated that we do niot have a one size fits all approach in nursing so this may not work.

NurChatters brought up the issue of who completes the documentation and it was raised that more documentation should be completed by HCAs.  There were some concerns that HCAs would not have time for this but many NurChatters agreed that care should be documented by the individual who carries out the care.  It became obvious that many nurses stay on past the end of their shift to complete paperwork.  

NurChat asked how participants felt about patient held records and it was discussed that midwifery patients have carried their own notes for a long time and it is very successful.  However NurChatters put this down to the midwifery patients often being young and capable and it may not be appropriate for frail elderly or prisoners or those with some MH issues to carry their own records.  

The use of tablets was raised and it was felt that these would be good bedside devices for recording care as it happened in addition to being a useful resource if wifi enabled.  

NurChat then asked “Will digital records reduce the need for duplication of info? Will this help release time to care?”  It was generally agreed that yes digital documentation should vastly reduce repetition.

The importance of good record keeping was then raised and that it is sometimesonly when you see poor documentation, perhaps during a court hearing, that you realisethe importance.  NurChatters advocated going to observe an NMC hearing as a good way of learning about the importance of record keeping.

To conclude NurChat asked “Can we reduce time spent documenting? Or is it time well spent ?”

@timcoupland replied “Mainly time well spent, but systems do need refining, GP systems do seem better”

@TaskerKaren said “Meaningful doc is time well spent, if it means I (any nurse) can come care for your patient when you go home”

@michellemellor3 added “Agree – reliable and accurate doc just as imp as care delivery to maintain continuity”

@TaskerKaren “We should be proud to document the excellent care we have given to a patient, it’s not an afterthought or extra”

Summary by Teresa Chinn RN

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Chat Transcript (via Storify)

Read from bottom up 

22/05/2012 - The Nursing & Care Quality Forum

#NurChat to discuss The Nursing & Care Quality Forum – 22/05/2012

Back in January #NurChat held a discussion about Prime Minister David Camerons statement on nursing in which he announced the launch of a forum to improve the quality of nursing. This forum has now been established and its main aims are set out in the Nursing and Care Quality Forums Mission Statement. The forum wants to help all in nursing and care to “deliver the fundamental elements of good care – compassion, dignity, respect and safety – first time, every time and to everyone” and “achieve their ambition of providing the very highest quality of care through supporting the adoption of best practice and promoting innovation”

So, with this in mind, will the nursing & care quality forum provide effective measures for improving care? Will the measures that they put in place make a difference to "at the bedside" nursing? And what would your recommendations be if you were part of the forum? What are the areas that you would concentrate on for improvement ? And what would you do to ensure that any measures were effective ?

Thanks goes to @dgfoord for this excellent discussion topic

Click on the picture to download a printable/ emailable flyer to share the chat with colleagues

Below is some suggested background reading for this discussion:

Nursing and Care Quality Forum outline work to improve nursing care - Department of Health

Nursing and Care Quality Forum Mission Statement - Department of Health

You own the quality forum Lansley tells nursing profession - Nursing Times

Summary by Teresa Chinn RN

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Post Chat Summary

This NurChat started off by asking what chatters first thoughts were on the Nursing & Care Quality Forum (NCQF) – responses were very sceptical from it being just another forum to those is Scotland being unaware of it; the political reasons behind the forum also came in for criticism some doubting what the Prime Minister knows about nursing.  Nurchatters were concerned that the money spent setting the NCQF forum up could be better spent on hiring more nurses and providing better training. Concerns were raised that more staff did not necessarily mean better quality care

Some Nurchatters felt that they didn’t need a forum to tell them how to be a nurse andit was asked if compassion, dignity, respect and safety (the four key aims of the NCQF)  truly exist in all healthcare environments ?  Answers ranged from a simple no to all can only happen if it’s a natural quality of the nurse. Some participants felt that if there was investment in high quality staff, and these staff being valued and trained this would then help.

It was then asked if participants felt that the right people were on the forum? Some thought that the NCQF member were impressive but hoped the outcomes would match this, some felt reassured that some names were familiar, some were concerned that there were not enough non nurses with quality expertise.

It was raised that with commissioning that any controls implemented may be difficult to keep track of nationwide.  Chatters agreed this was a very interesting point and it was further asked how tension between personalising at a local level and national consistency be met? It was agreed that a one size fits all approach was not a good idea.

NurChat asked how we, as nurses, can promote the right values and cultures in healthcare to ensure quality?  Some stated that we need to use front line nurses to improve and shape policy others ponted out that we should lead by example and be good role models especially in the remit of the NCQF’s four principles.  Some felt that breathing space to absorb change would be good but all agreed that we needed to ensure that we give our views to the NCQF after all they are asking us to contribute.  

As the chat drew to a close NurChat asked what participants thought the biggest challenges faced by the NCQF were? Suggestions included – keeping cynics happy, engaging quiet nurses, giving patients what’s needed, sustaining momentum, keeping politic out of it and becoming embedded in healthcare culture.   

The links below were shared during the chat :

anniecoops @NurChat the NCQF are asking you all to tell them directly what you think http://t.co/j6gE9DNI who will respond?#nurchat 

@JulieVuolo: @dgfoord @NurChat #NurChat here is the link to the forums membership http://t.co/PljNS3du #NurChat

@dgfoord: @NurChat Productivity and nurses doing the right things; more productive ward etc http://t.co/U2IFp6u8#NurChat 


Summary by Teresa Chinn RN

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Chat Transcript (Via Storify)

08/05/2012 - Restraining patients

#NurChat to discuss "Restraining patients" - 08/05/2012 8pm

@nursiedeb tweeted the suggestion for this NurChat – the restraint of patients – along with a link to a news story “Frail cancer patient died in handcuffs after nurses called police” – Mirror. This story outlines how Mr Philmore Mills was restrained by police and guards who were called following an episode agitated behaviour, Mr Mills died whilst being restrained. This story throws up interesting debate about when it is acceptable to restrain a patient and is it acceptable for abusive and agitated patients to be restrained in this way?

The RCNs advice “Lets talk about restraint” states that restraint can be described as “restricting movement or restricting liberty” and they go onto suggest that restraint falls into the following categories:

• Physical restraint – Holding, moving or blocking a person
• Mechanical restraint – Involving the use of equipment
• Technological surveillance – Tagging, CCTV, pressure pads
• Chemical restraint – Involving the use of medication
• Psychological restraint- constantly telling someone not to do something, deprivation of lifestyle choices.  

So given that restraint comes in many different forms when is it acceptable, legal and safe to restrain a patient?  Under what circumstances should we consider it ?

Thanks goes to @nursiedeb for suggesting this discussion

Click on the picture to download a printable/ emailable PDF to share with colleagues

Below are some links that you may find useful as background reading prior to the discussion?

Frail cancer patient died in handcuffs after nurses called the police - Mirror 

Decisions on bed rails must not be made through emotive arguments - Nursing Times

Nurses do care deeply about patient safety which is why they don't use restraining vests - Nursing Times

Why do UK nurses consider restraints unacceptable? - Nursing Times

Lets talk about restraint - RCN

Dementia patients denied basic rights says damning report - Daily Mail

Second annual report on the deprivation of liberty safeguards published today - CQC

Summary by Teresa Chinn RN

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Post Chat Summary 

This #NurChat started by asking participants how they would define restraint? Some defined it as sedation and physical restraint and others as limitations on ability to move freely, all agreed throughout the debate that restraint was not just physical.

It was raised that physical restraint may be illegal but it was then confirmed that if trained in control and restraint and if you are physically endangered it is not illegal.

Chemical restraint – the use of medication was discussed in depth.  Concerns were expressed that this from of restraint is not always questioned. It was expressed that sometimes chemical restraint may be better employed than physical but the point was then raised that chemical restraint can often lead to more episodes of challenging behaviour. The use of antiphychotics in the elderly was discussed and it was mentioned that CQC and the institute of innovation and improvement have helped to reduce the misuse to these in long term care settings.

There was a lot of empathy expressed for the person undergoing the restraint; Nurchatters agreed how terrifying it must be for the individual undergoing restraint of any sort.

NurChat asked about the use of everyday nursing objects to restrain …tables and bed rails? Participants agreed that these objects are used everyday but each patient should be treated individually and any restraint should involve team discussions.  The discussion progressed to the patient safety risks of bed rails and how much safer it is to nurse these pts on a mattress on the floor.

NurChat asked about prisoners in hospitals and whether it is acceptable to restrain them? NurChatters expressed confusion over why sedated and ventilated patient/prisoners are sometimes restrained - @MentalHelathCop a police inspector joined the chat and stated that communication is always key and it depends on the prisoner and medical issue, and raised the point that even a sedated patient may come round and be violent.

Training was mentioned and it was voiced that often only accident and emergency staff were trained in control and restraint in general settings, it was also raised that maybe mandatory yearly training would be beneficial to all nurses.

To conclude the discussion NurChat asked what the key principles were that participants could take away to ensure patient dignity and safety when restraint is used? Constant re-evaluation, regular assessment, MDT input and training were all seen as important.  

The links listed below were shared during the chat :

@MayboLimited: Good debate hosted by @NurChattonight. Many of you may find this guidance doc helpful :http://t.co/2d0iPNSl #nurchat

Bartontd #nurchat Late to the party - Deprivation of Liberty (DOL) http://t.co/LZGYFClL have we considered DOL in relation to restraint principles

Summary by Teresa Chinn RN 



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Chat Transcript (via Storify)