Clinical negligence team welcomes new NICE ‘red flag’ approach to ward staffing levels

Posted: 15/07/2014

The National Institute for Health and Care Excellence (NICE) has today published the final version of its guidance on safe staffing levels for acute inpatient wards in a drive to improve the delivery of safe patient care. These guidelines will play a crucial role in ensuring that hospital management and nursing staff are absolutely clear on what is considered best practice.

Although the introduction of a minimum ratio of patients to each member of nursing staff – similar to those used in California and parts of Australia – has been widely advocated, the guidelines to do not set any such minimum ratios. Instead, they stipulate that nurses in charge of shifts should monitor the occurrence of ‘nursing red flag events’ during each 24-hour period. The guidelines set out some examples of these red flag events which include delays of more than 30 minutes in providing pain relief to patients and failure to administer planned medication, to assist patients to visit the restroom, and to appropriately carry out vital signs checks when there is a clinical need.

It was anticipated that the guidelines would set a minimum of one nurse for every eight patients on any shift in an acute ward but NICE has moved away from this ratio approach. Its rationale is that a single figure is not appropriate if the aim is to deliver the right level of care for patients and  safe staffing is more complex than setting a single ratio. NICE believes that, by setting a single 1:8 nurse to patient ratio, this would be applied across all wards when it may not be appropriate in many scenarios.

Instead, the guidelines have further indicated that it would be a red flag event if it is found that there are fewer than two registered nurses present on a ward during any shift or where there is a shortfall of more than eight hours or 25% of registered nurse time available compared with the actual requirement for the shift. For example, if a shift requires 45 hours of registered nurse time, a red flag event would occur if less than 37 hours of registered nurse time is available for that particular shift.

Naomi Holland, an associate in Penningtons Manches' clinical negligence team, welcomes the introduction of the new guidelines: “Unfortunately, we see so many cases where patients have received very poor standards of basic nursing care during hospital admission resulting in a range of errors including severe dehydration, development of pressure sores, untreated infections, blood clots and avoidable falls.

“In cases involving the elderly, these errors can often result in death so they are not small problems. Some NHS wards have been operating on less than adequate staffing levels for many years, with stressed and over-stretched healthcare professionals, creating a potentially unsafe environment for patients. The release of these new guidelines is a significant step forward in improving patient care, particularly as they require on site assessment of individual wards and their needs rather than a blanket approach.”

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