Raising standards of nursing care – Aintree’s Assessment and Accreditation (AAA) System

The problem All healthcare organisations strive to deliver high quality and appropriate care to patients. Achieving and maintaining consistently high standards across all ward/departments areas is the challenge and measuring the quality of care delivered by individuals and teams is not an easy task.

Aintree’s solution The Aintree Assessment and Accreditation (AAA) framework is based on the ‘Essence of Care’ benchmarks, the Care Quality Commission’s ‘Essential Standards of Quality and Safety’ and other key clinical indicators. In use since April 2014, it assists clinical leaders to understand how they deliver care, identify what works well and where further improvements are needed. The framework comprises 14 standards used to assess wards and theatres on an annual basis, as a minimum, to ensure the relevant standards are implemented and maintained.

The standards align with, and are aimed at delivering, the Trust’s three essential standards of care;

- Keeping you safe

- Treating you with respect

- Caring for your core needs

The assessments are unannounced and involve;

- Observation of care given

- Patients’ documentation

- Discussion with patients

- Discussion with staff members

Following assessment, ‘Green, Amber or Red’ status is assigned and an action plan to address shortcomings developed using the ‘SMART’ approach. Areas assessed as ‘Green’ undergo reassessment within 6 months; ‘Amber within 4 months and ‘Red’ within 2 months.

After three consecutive ‘Greens’, ‘Aintree Champions Excellence (ACE)’ status can be applied for and the area receives an unannounced visit by a panel of assessors.

On achieving ACE status, an ACE plaque is awarded and displayed near the entrance to the ward/department. Permanent members of staff receive an ACE pin badge worn in accordance with the Staff Uniform & Attire policy.

New staff to the area are also entitled to receive an ACE pin badge. AAA assessments are then undertaken on an annual basis for this area. If a Ward Manager leaves an area designated with ACE status, the ward retains it contingent on achieving ‘Green’ at the next AAA visit.

Aintree’s Outcomes This approach to improvement has been a great success. Since April 2014, 7 wards have achieved ACE status.

The evidence suggests that this approach has greatly improved standards and quality of care; we have seen

- A decrease in pressure ulcers

- A decrease in falls with harm

- We have improved our patient experience ratings and now feature in the top 20% of Trusts nationally

- Our inpatient family and friends test (FFT) score has been higher than the Merseyside and national average for over a year

Other aspects of working at Aintree have been enhanced by the AAA and include

- Significant improvements in assurance reports to the Board

- Team cohesion on wards

- Team pride

- MDT involvement in achievement of ACE

- Focussed and individualised plans for the ward/department for improving standards

- The opportunity for the Trust to recognise and celebrate hard work and achievement on the part of individuals and teams.

Next steps After two years in use, an updated framework will take effect from April 2016.

Other activities in the coming year will include

- Development of AAA for outpatients

- Collaborating with Aintree’s Business Intelligence team to produce real time electronic status reports

- Thematic reviews of the standards which wards struggle with to identify why and what support is required to assist improvement

For further information please contact June Taft, Corporate Assistant Director of Nursing Services [email protected] or Andrea Thomas, Deputy Director of Nursing [email protected]
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