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Steep rise in reported assaults against NHS staff

There were 18,720 assaults in 2016/17 compared to 15,469 the previous year.

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Last year in England physical assaults on NHS staff rose by nearly 10% compared to 2015/16, according to new figures published today by UNISON and HSJ.

The figures were obtained following a Freedom of Information request – submitted by HSJ working on behalf of UNISON – to all the 244 NHS trusts in England. Answers were received from 181 organisations.

The biggest increase was in the acute sector, with reported attacks on health workers in hospitals with an A&E department up a staggering 21%, says UNISON. There were 18,720 assaults in 2016/17 in the acute trusts who responded, compared to 15,469 the previous year.

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The data collected suggests that last year NHS trusts struggling to meet their performance targets were likely to fare particularly badly. Trusts who treated 90% or fewer of their patients within 18 weeks of referral saw an average increase in reported assaults of 36.2% in 2016/17, up 1,857 on the previous year.

Similarly, NHS trusts struggling with huge financial deficits were also likely to have witnessed a big rise in the number of reported attacks on staff, according to the data.

The HSJ/UNISON figures suggest that assaults in the trusts that are more than £20m in the red were up 23.1% on the previous year. This compares to an increase of just 1.5% for organisations that were comfortably in the black, and had surpluses in excess of £5 million.

The trusts responding to the FoI request reported physical assaults on staff of 56,435 in 2016/17, a 9.7% increase on the 2016/16 data.

If these figures are extrapolated to cover the whole of the NHS in England, the number of reported violent incidents in 2016/17 is likely to be closer to 75,000, the equivalent of 200 every single day.

When measured per 1,000 staff, the rise in reported assaults was 6% on the 2015/16 figures.

UNISON asked HSJ to carry out the research, as it is concerned that since the abolition of NHS Protect last year, there is no meaningful collation or comparison being made of the data on assaults.

Commenting on the figures, UNISON head of health Sara Gorton said: “Across the entire NHS, staff shortages are harming patient care and helping to create a hostile environment where health workers are increasingly at risk of being assaulted.

“It’s no accident that trusts where the pressures seem the most extreme – where there are huge financial deficits or where it’s a struggle to meet growing demands on services – have seen the steepest rise in the number of attacks. This desperate situation is only set to worsen as the squeeze on resources gets tighter.

“Now that there is no NHS or government organisation collecting data on assaults nationally, the picture is growing increasingly unclear. The safety of staff, who care for us when we are sick or injured, and their patients should be paramount. The government should reverse its ill-thought out decision to axe NHS Protect immediately”

Although staff working in mental health are seven and a half times more likely to be attacked, this was a smaller increase from 2015/16 of 5%. This seems to suggest the sector is having some success in preventing a difficult situation from getting any worse.

Clinical Care

Hourly rounding ‘may not be the best way for nurses to deliver care’, finds study

Hourly rounding places an emphasis on ‘tick box’ care.

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Nurse with patient in bed

Hourly rounding made a minor contribution, if at all, to the way nurses engage with patients.

A new report by researchers at King’s College London has found that the widespread practice of hourly or intentional rounding, may not be the best way for nurses to deliver care to patients.

The report also found that rounding makes a minor contribution, if at all, to the way nurses engage with patients.

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Hourly or intentional rounding involves standardised regular checks with individual patients at set intervals and was introduced in hospitals in England in 2013, with 97% of NHS acute Trusts in England implementing it in some way.

The majority of NHS trusts adopted the ‘4Ps’ (Position, Pain, Personal needs, Placement of items) model of rounding.

The research was commissioned and funded by the National Institute for Health Research (NIHR) and was led by Professor Ruth Harris in the Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care.

Hourly rounding places an emphasis on ‘tick box’ care.

The NIHR report – Intentional rounding in hospital wards to improve regular interaction and engagement between nurses and patients: a realist evaluation – is the first study of its kind in the world.

The study found that rounding placed an emphasis on transactional ‘tick box’ care delivery, rather than individualised care. However, patients were found to value their interactions with nursing staff, which the study argues could be delivered during other care activities and rather than through intentional rounding.

The report also found that rounding was implemented without consultation, careful planning and piloting in the interests of political expediency following the Francis Inquiry Report into care failures in the NHS.

Ruth Harris, Professor of Health Care for Older Adults at King’s College London, said; “Checking patients regularly to make sure that they are OK is really important but intentional rounding tends to prompt nurses to focus on completion of the rounding documentation rather than on the relational aspects of care delivery.

“Few frontline nursing staff or senior nursing staff felt intentional rounding improved either the quality or the frequency of their interactions with patients and their family.”

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Clinical Updates

Nurses’ ‘worry’ better than most early warning scores, finds study

Nurses were asked to grade patients between ‘no concern’ and ‘extreme concern’. 

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Observations

A sense of worry can provide important information for the detection of acute physiological deterioration.

Nurses’ worry has a “higher accuracy” than most published early warning scores (EWS) at predicting if a patient is becoming more unwell, according to a recent study.

The study looked at 31,159 patient-shifts for 3185 patients during 3551 hospitalisations across two surgical and two medical wards. Researchers compared if the nurses were worried about a patients potential for deterioration using ‘the Worry Factor’ with early warning score indicators.

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Nurses were asked to grade each patient between “no concern” and “extreme concern”.

The Worry Score

Out of 492 potential deterioration events identified, researchers found that when nurses had an increasing worry factor the patient was more likely to require emergency medical treatment – 7 cardiac arrest calls, 86 medical emergency calls and 76 transfers to the intensive care unit.

The study also revealed that accuracy rates were significantly higher in nurses with over a year of experience.

The researchers concluded that “nurses’ pattern recognition and sense of worry can provide important information for the detection of acute physiological deterioration” and was often more reliable than traditional early warning systems.

They also noted that the worry score could be used alone or easily incorporated into existing EWS to potentially improve their performance.

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