Care Assurance Visits

Guidance for Care Assurance Visits

Background

The purpose of the care assurance visit is to observe the clinical environment with fresh eyes and to provide the clinical team with objective feedback. The information gained will provide a better understanding of how patients and service users first experience their care environment and also how welcome visitors are made to feel on entering the clinical environment. (15 steps NHS England 2017 - accessible here)

Guidance Podcast

Objectives of the visit:

1. To provide leadership, professional development and support to colleagues delivering clinical care
2. To assure the delivery of safe, effective and person-centred care.
3. To give objective feedback to the clinical team regarding the clinical areas visited
4. To provide expert, visible nursing/allied health professional (where available)  leadership
5. To identify examples of good practice for sharing & themes for quality improvement
6. To provide a data set of quality of care at ward, hospital and sector level 

Who should carry out the assurance visit?

An associate chief nurse or lead nurse and senior charge nurse/practice development nurse/allied health professional who are not from that clinical area

How often should the CCAAT be carried out?

It is envisaged that one CCAAT will be carried out twice annually as a minimum(dependent on the RAG status/improvement plan),  and the corporate assurance visit should count as one of those CCAATs.

How long do the visits take?

Once the assurers have read the 15 steps guidance (NHS England), watched the podcast and familiarised themselves with the CCAAT, the visit should probably take on average 2.5-3hrs.  As part of the visit, it is envisaged that the assurers observe a mealtime within designated clinical area.

Initial Approach in Clinical Environment 

• Spend time in reception/waiting area
• Spend time walking through the clinical area
• If possible, spend time in an empty bed space/trolley space with the curtains closed-what can you hear?
• How does this environment make you feel?
• How long before you are approached by a member of staff to ask if you need help?

Arrival in Clinical Area 

All staff on assurance visits must be in uniform and should identify themselves on arrival to the nurse in charge, explaining the purpose of the visit. Also ask if a previous CCAAT has been carried out and if so is it available to look at? Assessment of 5 sets of patients case notes, considering the following category of patients:

• Patients in isolation
• High acuity patients
• Boarded patients in ward
• Patients whose family have raised concerns
• Palliative care patients
• Cognitively impaired patients

Speaking to Staff, Patients & Carers

Take time during your visits to speak to staff, patients and carers/visitors to gain feed-back about the clinical area from their perspective. However please check with nurse in charge should there be any patients that should not be approached due to their clinical condition.

CCAAT sections

Clinical area visited details, including date, SCN/SCM/TL, Nurse in Charge name & staffing skills mix

Welcoming ward Section

Quality Assurance Section

1. What & Who matters to me?
2. Maintaining patient dignity and privacy
3. Decision making, consent & capacity
4. Initial Assessment on admission to Hospital
5. Comprehensive Geriatric Assessment
6. Pharmaceutical care
7. End of Bed documentation
8. Delirium
9. Dementia
10. Falls assessment, prevention & management
11. Rehabilitation
12. Discharge planning
13. Care transition/ Patient Pathway & Flow
14. End of Life care
15. Mealtime observation

End of the Visit

Completion of the CCAAT should be done together by the two assurers, who discuss, agree and record their observations/comments into the electronic document. The assurers should then feedback to the senior charge nurse/nurse in charge. The completed CCAAT tool should then be saved and title with clinical area name and date of assurance visit. It should be emailed to the clinical areas SCN/SCM/TL and the lead nurse respectively.

Improvement Plan

Where the CCAAT has been categorised by red (compliance of less than 70%) or amber (compliance 71%-85%) then the SCN/SCM/TL and Lead Nurse from that clinical area will develop an improvement plan to address the issues identified during the visit.