The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [14]
Annual Hygiene Code inspections (for more information, see Chapter 3).
Nurses obviously play a significant role in meeting these measures. A charter for the ‘new’ role of the matron (DH 2004a) set out ten commitments in respect of a cleaner safer hospital (Box 1.2), building on the principles set down by Florence Nightingale in the 1800s.
Let whoever is in charge keep this simple question in her head (not, how can I always do this right thing myself, but) how can I provide for this right thing to be always done? (Nightingale 1859, p.24)
Box 1.2 Commitments of a matron (DH 2004a)
1. Keeping the NHS clean is everybody’s responsibility.
2. The patient environment will be well maintained, clean and safe.
3. Matrons will establish a cleanliness culture across their units.
4. Cleaning staff will be recognized for the important work they do. Matrons will make sure they feel part of the ward team.
5. Specific roles and responsibilities for cleaning will be clear.
6. Cleaning routines will be clear, agreed and well publicized.
7. Patients will have a part to play in monitoring and reporting on standards of cleanliness.
8. All staff working in healthcare will receive education in infection control.
9. Nurses and infection control teams will be involved in drawing up cleaning contracts and matrons have authority and power to withhold payment.
10. Sufficient resources will be dedicated to keeping hospitals clean.
The High Impact Actions for Nursing and Midwifery
A current political initiative in the nursing profession to drive up standards of care is The High Impact Actions for Nursing and Midwifery (NHS Institute for Innovation and Improvement 2009). Eight high-impact actions (see Table 1.1) have been selected, from over 600 postings to the High-Impact website, by a group of senior nurses in the NHS. They have been selected as areas where significant improvement to quality can be achieved for patients and have been made available with relevant research evidence developed by academic experts to support day-to-day nursing practice.
Table 1.1 High-Impact Actions for Nursing and Midwifery
Category of action Action Relevant chapters
Your skin matters No avoidable pressure sores in the NHS 4
Staying safe, preventing falls Demonstrate a year-on-year reduction in the number of falls sustained by older people in NHS-provided care 7
Keeping nourished, getting better Stop inappropriate weight loss and dehydration in NHS-provided care 8
Promoting normal birth Increase the normal birth rate and eliminate unnecessary caesarean sections through midwives taking the lead role in the care of normal pregnancy and labour, focusing on informing, educating and providing skilled support to first-time mothers and women who have had one previous caesarean section Not applicable
Important choices – where to die when the time comes Avoid inappropriate admission to hospital and increase the numbers of people who are able to die in the place of their choice 2
Fit and well to care Reduce sickness absence in the nursing and midwifery workforce to no more than 3% Not applicable
Ready to go – no delays Increase the number of patients in NHS-provided care who have their discharge managed and led by a nurse or midwife where appropriate 2
Protection from infection Demonstrate a dramatic reduction in the rate of UTIs for patients in NHS-provided care 3, 6
The NHS Constitution
The new NHS Constitution aims to make explicit what a person can expect from the NHS so they can feel more empowered as a participant in their own care.
The Constitution was developed in consultation with patients, the public and NHS staff as part of the NHS Next Stage Review led by Lord Darzi. The NHS Constitution