16 January 2015

NICE sets out draft safe staffing guidance for A&Es

NICE has outlined draft guidance to help A&E departments ensure there are enough nursing staff available to provide safe care at all times to patients.

The number of A&E visits increased in 2014 by more than 40,000, with many hospitals currently declaring 'major incidents' as they struggle to cope with demand.

The figures published by NHS England revealed that there were over 14.6m visits to A&E in 2014 - an increase of 446,049 on 2013.

This latest guidance aims to ensure that A&E departments have the capacity to provide all necessary emergency care, as well as specialist input for children, older people or those with mental health needs.

NICE recommends that organisations consider minimum ratios when planning what nursing staff they need to fund in advance. Minimum ratios can also be used on a shift-by-shift basis to help work out what services can be made available at that time. These are based on the seriousness of a person’s condition and the level of care they need, for example:

•           2 registered nurses to 1 patient in cases of major trauma or cardiac arrest

•           1 registered nurse to 4 cubicles in either ‘majors’ or ‘minors.

Demand in A&E can change rapidly and the draft guideline recommends that when planning the number of nurses for the establishment, departments should allow for enough nursing staff to care for higher than the average number of patients who attend the department on a daily basis. By increasing weekly nursing staff hours to cover above average attendance numbers, staff can deal with unexpected peaks in the demand for A&E services and be moved around the department flexibly to respond to changing situations.

Red flags

The draft recommendations also cover the process for senior nurses on each shift to check whether there are enough nursing staff at that time. Throughout the shift, nurses are also advised to look out for red flags that may show something is wrong, such as patients falling or leaving the department without being seen, or the department being crowded. These should be reported immediately to the nurse in charge who can take action to stop the situation getting worse.

Organisations should also publicise red flags to patients, family members or carers, and ensure they are able to report incidents such as untreated pain or delays receiving food and drink, to the nurse in charge.

Enough staff, with the right skills

Professor Mark Baker, director of clinical practice at NICE said: “Over 14 million people attended A&E departments in England last year. Nursing staff are often among the first to see patients and we know the care they provide is essential for successful treatment of every patient. Ensuring there are enough available nursing staff, with the right skills, helps to make sure people in need of immediate medical help, will get safe care, whatever the time of day or night.

“As demand on A&E services continues to increase, we want to ensure that each and every A&E department across the country is clear on how to get nurse staffing right and is able to provide safe care to the millions of patients who walk through the door.”

Miles Scott, chief executive officer at St George’s Healthcare NHS Trust said: “Thousands of people come to major A&E departments every week with a range of serious injuries and illnesses, from blood loss after an accident, to severe chest pain, to loss of consciousness. Organisations not only need to deal with this variety of patients they also need to be prepared for unpredictable peaks in attendance numbers.

“Getting nursing staffing right is one of the ways to help A&E departments cope with the challenges of changing demand and still provide safe care to patients regardless of service pressures.

“This draft guideline advises hospital managers and senior nurses on how to allow for flexibility and the actions to take to enable responsiveness. It also includes recommendations for A&E nursing staff on the signs to look out for when patients’ needs are not being met and when to escalate issues to senior staff.”

Have your say and comment on the draft guidance which is now out for public consultation until 12 February 2015.  The final guideline is expected in May 2015.

As demand on A&E services continues to increase, we want to ensure that each and every A&E department across the country is clear on how to get nurse staffing right

Prof Mark Baker, NICE

Getting nursing staffing right is one of the ways to help A&E departments cope with the challenges of changing demand and still provide safe care to patients regardless of service pressures

Miles Scott, St George's Healthcare NHS Trust