Annex A > Chapter 18 - Medical and Clinical Audit > Audit at district and unit level > Involvement of the District in nursing audit
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Involvement of the District in nursing audit
256 The reporting of nursing audit activities [308] became a requirement of the contract made with purchasers. Ms Evans told the Inquiry that the DHA saw:
`... a number of reports which relate either to nursing audit and auditing aspects of the service for children, or to the patients' surveys which took place both in the cardiac surgery ward and in the Children's Hospital, and which sought parent and sometimes children's opinions on various aspects of the service. So there were a number of ways in which we tried to check that the trusts were being active in this area.' [309]
257 Ms Evans cited examples of audit undertaken by nursing staff. In 1992/93:
`The nursing staff in cardiac surgery were active ... [in] defining nursing care standards and monitoring them. The 1992/1993 Report describes several of these including an audit of cardiac theatres using the National Association of Theatre Nurses audit documents.' [310]
258 Part of this audit referred to departmental organisation. It included the following:
`Standard 3 - "The department has an annual quality improvement programme". Although induction programmes had been devised, they were often not put into practice. It was felt that due to a shortage of experienced staff, new members of the nursing staff were often being trained in the practical skills without an all round induction to the entire work of the unit. Staff were not able to express a departmental statement of objectives or philosophy of care.' [311]
259 In the next year, 1993/94, Ms Evans stated that:
`... the UBHT's monitoring reports begin to report a shift from uni-professional audit ... to multi-professional "clinical" audit.' [312]
260 In the `UBHT Quality Monitoring Report' for October 1993 to March 1994 it was noted that:
`The move towards multidisciplinary clinical audit described in the Nursing Audit report is welcomed. Discussions are taking place between United Bristol Healthcare Trust and Bristol and District Health Authority on areas for clinical audit in 1994/1995. It is important that nursing staff are involved in this process ... It is good to see the positive action taking place as a result of nursing audit, in particular the recommendations from standard four: safety and the environment. The potential for confusion with both corporate standards and local directorate standards is noted.' [313]
261 Ms Evans stated that the report for 1994-1995:
`... also described work in progress on audit across the nursing teams in the newly established directorate and appends the nursing standards specific to Ward 5 (which includes some standards relating to the care of children).' [314]
`Nursing standards and audit are well established and the emphasis now is to move closer to multidisciplinary audit.' [315]
Reporting of accidents/incidents
263 In 1955 the Ministry of Health issued a Circular, `Reporting of Accidents in Hospitals'. [316] The Inquiry was informed, in written evidence, by Mr John Gray, Manager, UBHT Legal Services since 1991, that this document was generally known within the NHS as `Reporting Accidents and Untoward Occurences' [317] and was always followed by the UBHT.
264 Before the change to general management, patients' incidents statements generated by nursing staff would normally be considered by a senior nurse before being passed to the hospital administrator. In more recent times there is initial consideration by the clinical nurse manager and a report made to the directorate manager or, in a larger directorate, to the assistant general manager of the directorate. Mr Gray indicated in his statement that `there was no formal policy in the NHS during the relevant period as to which incident should be reported to the Chief Executive, or what specific action should be taken'. [318]
265 Mr Gray went on that under the chief executiveship of Dr Roylance:
`It was a matter for the professional responsibility and judgment within Clinical Directorates as to what was drawn to the attention of the General Manager by the Assistant General Manager; or in turn by the General Manager exercising discretion as to what matters should be drawn to the attention of the Trust's Chief Nurse Advisor or Director of Operations; and in turn whether those matters needed to be drawn to the attention of Dr Roylance as the Chief Executive.' [319]
`... a formal analysis was not usually maintained, although a specific incident or series of incidents might prompt a retrospective analysis.' [320]
267 Mr Gray indicated that he could `find no written policy relating to the period 1984-1995' on the reporting of accidents and untoward occurrences. Mr Gray's written evidence on the matter was drawn from his own knowledge and after consultation with Ian Barrington, Manager of Children's Services, and Rachel Ferris, Manager of Cardiac Services.
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Footnotes
[308] For details of the approach of the UBHT to nursing audit, see below at para 379 onwards
[310] WIT 0159 0031 Ms Evans
[311] WIT 0159 0239 Ms Evans
[312] WIT 0159 0031 Ms Evans
[313] WIT 0159 0193 Ms Evans; `UBHT Quality Monitoring Report'
[314] WIT 0159 0032 Ms Evans
[315] WIT 0159 0185 Ms Evans
[316] WIT 0137 0032 Mr Gray
[317] WIT 0137 0026 Mr Gray
[318] WIT 0137 0026 - 0027 Mr Gray
[319] WIT 0137 0027 Mr Gray
[320] WIT 0137 0028 Mr Gray