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6.3 NQAT Report

6.3 NQAT Report

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Published by: Marco Bernabe Jumaquio on Jul 03, 2012
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Nursing Quality Assessment Tool – NQAT
 The aim of this report is to update the Trust Board on the progress and results of theimplementation of the Nursing and Quality Assessment Tool (NQAT) across NorthBristol NHS Trust.North Bristol NHS Trust (NBT) has made a commitment that all ward areas willachieve a total audit score of greater then 70% (Bronze award).The paper also introduces NBT’s Principles of Professional Practice – these reflectthe recommendation arising out of the Mid Staffordshire report requiring Trust’s tohave specified Nursing & Midwifery Standards of care.
The NQAT evaluationprocess provides the evidence that these standards of care are beingdelivered in practice.
The Nursing Quality Assessment Tool (NQAT)
NQAT is a comprehensive audit tool that examines the core fundamental standardsof patient care as set down by the Department of Health and the “Essence of Care”standards.Each audit is unannounced and centrally co-ordinated to ensure that the audit teamallocated are independent of the clinical speciality and directorate. Over seventyauditors have been identified, trained and almost all have participated in at least oneaudit.Auditors have been recruited from senior and specialist nursing staff, training andeducation dept, students, patient panellists and administrative staff.
The NQAT Audit Scoring Process
The audit process collects data from a real time patient survey questionnaire, reviewof documentation, direct observation of care and questioning of staff. The informationis collected and stored electronically using hand held “Tough books”.Each question within the audit is loaded with a point score dependent on the issueand importance. The most important aspects examined carry five points, for examplesignificant infection control issues. In addition these important areas of practice areweighted such that a ward can not achieve a high score (gold award) if they fail tomeet the relevant standard.A percentage score is calculated for each audit section. These are then combined togive and overall score for the ward. The final audit score is calculated based on 40%from direct observation of care audit, 20% from the documentation review audit and40% from the patient feedback. The wards are then allocated a final rating which is abronze award if their scores are 70 - 80%, silver if 81-90% and gold award in 91 – 100%. No award is given if the total score is below 70%.
NQAT Report – Trust Board – April 20111
The NQAT Audit Process
Every inpatient area within the Trust has been audited at least once in the last sixmonths to obtain a baseline score using the audit tool. Some significant technicalproblems have been identified throughout this inaugural cycle including, issues withthe software being used, Wi-Fi connectivity and reporting which have hamperedauditing and providing results. These problems have now all been resolved.
The NQAT Audit Results
All wards within the Trust have been audited with 98% achieving a “Bronze” score orabove. Of the wards audited, 2 wards failed to reach the minimum standard of 70%(bronze award).Two further wards have been reported as no award. This is because during the pilottesting phase of the tool some of the patient questionnaires were lost due totechnological difficulties, making the audit incomplete. A further nine wards havepieces of data missing from the report and therefore are reported as incomplete. Thiswas despite repeating some audits several times.All these wards will be given priority to be re-audited to obtain a full score for thearea. In four of these eleven areas, the Patient Surveys were not able to becompleted due to the clinical condition of the patients. Therefore full reports are notavailable. ITU have developed and are piloting a visitors/ relatives questionnaire toaddress this gap. This is a model that could also be used in palliative care anddementia.Overall the score achieved for patient satisfaction were good. All areas surveyedachieved at least 83% or a silver award. Eighteen areas achieved gold or above 90%for this section of the audit. Only four wards were judged at bronze.The observation audit is comprehensive and examines the knowledge of the staff aswell as the clinical practice witnessed on the ward. Five wards did not achieve 70%or above in this area.The main area for further action relates to nutrition and fluids for patients. This issueis already being taken forward by a Trust working group. The malnutrition screeningtool and regular assessment of patients is being introduced at present.The lowest scores overall were consistently achieved in the documentation section ofthe audit. Thirteen areas were assessed below 70% for documentation and onlyfourteen areas achieved a silver award. Further work needs to be carried out toimprove this area of practice Trust wide. Ward sisters will be able to use theelectronic tool to assess their own areas and develop an action plan to addressissues on their wards.The initial reports and detailed question responses are now available on the TrustInformation site and are attached in Appendix (1) and (2). From the results, theprioritised list for re-audit will be drafted and implemented from April 11.
Specific areas of concern following the NQAT Audit
Two wards, did not achieve the minimum standards and therefore overall score of70%. The wards and directorates will need to review the results to understand the
NQAT Report – Trust Board – April 20112
standards that they failed to reach and develop/implement an action plan to rectifythis. They will be the first to be re-audited.A detailed local documentation audit has also been undertaken and alreadyimplemented several changes to practice. In addition these wards have piloted andimplemented the malnutrition screening tool and improved their documentation ofaction taken for each patient regarding nutrition and fluid management. The wardsisters are now looking at the results in more detail in order to identify the next stepsto be taken.These results have also been feedback to the Heads of Nursing and ClinicalMatrons, with the understanding that they will be re-audited by the 14
May 2011 bywhich time; they must achieve the required score.
The NQAT Re-audit plan
 From the results, the prioritised list for re-audit will be drafted and implemented fromApril 11. This will then become a rolling program of continuous audit, review anddevelopment. The frequency of re-auditing areas will be taken from the overall scorethat the area achieves as detailed below. A Gantt chart has been prepared to planand monitor this activity and the frequency of the audits is dependent on the scoreachieved and is as follows:
Gold 91% to 100% - Re-audit after 6 months
Silver 81% to 90% - Re-audit after 4 months
Bronze 70% t0 80% - Re-audit after 3 months
Less than 70% is no award and re-audit is after 2 months
The NQAT Question review
Feed back from auditors strongly suggested that some of the questions requiredupdating and made more specific. The audit tool also offered the opportunity tocollect essential data in an efficient way for several purposes. For example the Trustquality account.As a result the content of the audit has been reviewed/completed with keystakeholders, for example infections control team, patient panellist, and ConsultantMedical Staff, matrons, dietetics and resuscitation dept. The questions have also nowbeen labelled by group topic so that the reporting tool can be developed further. Theaudit content will require ongoing review on an annual basis.
The North Bristol Trust (NBT) Professional Principles of Nursing and MidwiferyPractice
In response to this work as well as learning from the Mid Staffs enquiry which statesthat “Trusts
should ensure that its nurses work to a published set of principles,focusing on safe patient care”, the North Bristol Trust Professional Principles ofNursing and Midwifery Practice have been developed, being based on the RCN'sPrinciples of Nursing Practice and articulate what can be expected of nursing &midwifery in any setting (Appendix (3)
NQAT Report – Trust Board – April 20113

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