Common use of Timing/Process Clause in Contracts

Timing/Process. The timing values, for use in ExcelCare, are recorded by nurses/midwives using work-sampling techniques. The relevant definition is for stop/start times. That is, timing commences at the point when the nurses begins preparation for the activity and stops when the nurse and midwife completes the activity, including cleaning up and disposal of equipment where this is defined in the OI. Interruptions are excluded from the time. A total of 20 timings are collected randomly and should be representative of all areas and patients where the activity occurs and a range of nursing expertise. If the timings sample reveals that some patient groups have significant deviations from the mean, consideration should be given to reviewing if the UoC is appropriate to the needs of the patient group. Possible bias that may occur during the timing process, that may influence the quality of timings, could include: • reliability of collection • definition and specificity of activity to be timed • skill of nurse performing procedure • differences in procedures/activities between areas • geography of work areas • patient variables If there is bias operating related to geography and skill then the total sample should included 20 timings of each skill or type of geographical setting. The direct timing should be collected within a few weeks to reduce any possible bias's that may occur. If it is not possible to collect the timings within this period of time, then the UoC should: • Professionally assessed time added until there is significant timings collected; or • The UoC should be time adjusted. As agreed to by the Department of Human Services (now DH) and the then ANF (now ANMF) on 22 November 2002: References 1. Department of Human Services, Directors of Nursing, Australian Nursing Federation, 'Operational Issues Associated With Excelcare' (v2 300902), 2003 2. South Australian Health Commission, Nursing Automated Systems Project, 'Direct /Indirect Timings' Document 3. South Australian Health Commission Nursing Automated Systems Project, ‘Statistical Validation of Timings for Excelcare’ Document. 2 As Agreed by Department of Human Services, Directors of Nursing, Australian Nursing Federation, 'Operational Issues Associated With Excelcare' (v2 300902), 2002 Section 1: Nursing and Midwifery Shift by Shift Staffing Requirements Decision Making Tree Section 2: Staffing Methodologies in Emergency Departments, Intensive Care Units, Peri-Operative Services and Endoscopy Units Section 3: Staffing Methodologies in Units other than Excelcare (Non-Standard Based) Section 1: Nursing and Midwifery Shift by Shift Staffing Requirements Decision Making Tree REVIEW PROCESS CLINICAL ASSESSMENT Step 1. Nurse/Midwife assesses patient REVIEW OF PATIENT CARE REQUIREMENTS Step 2. Provides expert clinical knowledge to review and appropriately amend UOC/Care Plan in collaboration with clinicians. Total projected hours x skill mix x workload. This decision making tree defines the sequential decision making steps to be undertaken in priority order for the provision of staffing to meet patient care requirements. It is noted that terms used in this decision making tree may vary from site to site. It is noted that this decision making tree will be applied within the existing health unit site's bed management procedures/policies provided that the necessary reduction in activity is achieved. CSC or delegate in the ▇▇▇▇/unit prioritises patient care requirements to reduce workloads to match available skill mix and staff numbers for that shift. Management Facilitator assesses resources available to meet requested additional requirements. based on LEGEND CSC or delegate UOC Management Facilitator Level 5 or delegate DON/M SECTION 2: STAFFING METHODOLOGIES IN EMERGENCY DEPARTMENTS, INTENSIVE CARE UNITS, PERI-OPERATIVE SERVICES AND ENDOSCOPY UNITS CENA STANDARDS 2007 (Applicable to Emergency Departments) Tertiary: FMC, LMH, RAH, TQEH, WCH, (NB TQEH to be treated as a General Hospital once service changes) General: RGH, NHS, Modbury Country: Mt Gambier, Whyalla, Port Pirie, Port Augusta, Gawler, Port Lincoln & Berri Extended short care ACCCN STANDARDS 2003 (Applicable to ICU, HDU, CCU, PICU, NICU) Metro + Mt Gambier and Whyalla in CHSA only GESA STANDARDS 2006 (Applicable to Endoscopy Units) ACORN STANDARDS 2010 (Applicable to Operating Rooms, Pre-Admission Areas, Day Surgery Units, Post-Anaesthetic Recovery Rooms) o 1:1 nurse patient ratio Paediatric Patient (regardless of age) until they meet d/c criteria (Post anaesthetic recovery room - Stage 1) o 1:1 nurse patient ratio during initial administration of IV opiods/pain protocol and no less than 1:2 thereafter (Post anaesthetic recovery room - Stage 1) • Post anaesthetic recovery room - Stage 2 / Day surgery unit o Minimum of 2 nurses, 1 must be a competent recovery nurse o Minimum of 1:4 nurse pt ratio when all pts are stable/for a paed pt over 5yrs of age with a family member or caregiver present • 1 nurse during elective surgery hours - Holding Bay (excluding RGH, NHS, CHSA) • 1 nurse during elective surgery hours - Stock Room (excluding RGH, NHS, CHSA) • Clinical Nurse Educator (excluding RGH, NHS, CHSA) • Nurse Sedationist – where role in place, will be considered as an additional resource • Medical Assistant Substitution (CHSA) - where role in place, will be considered as an additional resource

Timing/Process. The timing values, for use in ExcelCare, are recorded by nurses/midwives using work-sampling techniques. The relevant definition is for stop/start times. That is, timing commences at the point when the nurses begins preparation for the activity and stops when the nurse and midwife completes the activity, including cleaning up and disposal of equipment where this is defined in the OI. Interruptions are excluded from the time. A total of 20 timings are collected randomly and should be representative of all areas and patients where the activity occurs and a range of nursing expertise. If the timings sample reveals that some patient groups have significant deviations from the mean, consideration should be given to reviewing if the UoC is appropriate to the needs of the patient group. Possible bias that may occur during the timing process, that may influence the quality of timings, could include: • reliability of collection • definition and specificity of activity to be timed • skill of nurse performing procedure • differences in procedures/activities between areas • geography of work areas • patient variables If there is bias operating related to geography and skill then the total sample should included 20 timings of each skill or type of geographical setting. The direct timing should be collected within a few weeks to reduce any possible bias's that may occur. If it is not possible to collect the timings within this period of time, then the UoC should: • Professionally assessed time added until there is significant timings collected; or • The UoC should be time adjusted. As agreed to by the Department of Human Services (now DH) and the then ANF (now ANMF) on 22 November 2002: ‘Where new UoCs are being developed or implemented without timings that have been validated through this process, the relevant nursing and midwifery staff should be consulted about the interim timing to be used and this process should reflect the same consultative process as set out for the review of UoC2.’ References 1. Department of Human Services, Directors of Nursing, Australian Nursing Federation, 'Operational Issues Associated With Excelcare' (v2 300902), 2003 2. South Australian Health Commission, Nursing Automated Systems Project, 'Direct /Indirect Timings' Document 3. South Australian Health Commission Nursing Automated Systems Project, ‘Statistical Validation of Timings for Excelcare’ Document. 2 As Agreed by Department of Human Services, Directors of Nursing, Australian Nursing Federation, 'Operational Issues Associated With Excelcare' (v2 300902), 2002 Section 1: Nursing and Midwifery Shift by Shift Staffing Requirements Decision Making Tree Section 2: Staffing Methodologies in Emergency Departments, Intensive Care Units, Peri-Operative Services and Endoscopy Units Section 3: Staffing Methodologies in Units other than Excelcare (Non-Standard Based) Section 1: Nursing and Midwifery Shift by Shift Staffing Requirements Decision Making Tree REVIEW PROCESS CLINICAL ASSESSMENT Step 1. Nurse/Midwife assesses patient REVIEW OF PATIENT CARE REQUIREMENTS Step 2. Provides expert clinical knowledge to review and appropriately amend UOC/Care Plan in collaboration with clinicians. Total projected hours x skill mix x workload. This decision making tree defines the sequential decision making steps to be undertaken in priority order for the provision of staffing to meet patient care requirements. It is noted that terms used in this decision making tree may vary from site to site. It is noted that this decision making tree will be applied within the existing health unit site's bed management procedures/policies provided that the necessary reduction in activity is achieved. CSC or delegate in the ▇▇▇▇/unit prioritises patient care requirements to reduce workloads to match available skill mix and staff numbers for that shift. Management Facilitator assesses resources available to meet requested additional requirements. based on LEGEND CSC or delegate UOC Management Facilitator Level 5 or delegate DON/M SECTION 2: STAFFING METHODOLOGIES IN EMERGENCY DEPARTMENTS, INTENSIVE CARE UNITS, PERI-OPERATIVE SERVICES AND ENDOSCOPY UNITS CENA STANDARDS 2007 (Applicable to Emergency Departments) Tertiary: FMC, LMH, RAH, TQEH, WCH, (NB TQEH to be treated as a General Hospital once service changes) General: RGH, NHS, Modbury Country: Mt Gambier, Whyalla, Port Pirie, Port Augusta, Gawler, Port Lincoln & Berri Extended short care ACCCN STANDARDS 2003 (Applicable to ICU, HDU, CCU, PICU, NICU) Metro + Mt Gambier and Whyalla in CHSA only GESA STANDARDS 2006 (Applicable to Endoscopy Units) ACORN STANDARDS 2010 (Applicable to Operating Rooms, Pre-Admission Areas, Day Surgery Units, Post-Anaesthetic Recovery Rooms) o 1:1 nurse patient ratio Paediatric Patient (regardless of age) until they meet d/c criteria (Post anaesthetic recovery room - Stage 1) o 1:1 nurse patient ratio during initial administration of IV opiods/pain protocol and no less than 1:2 thereafter (Post anaesthetic recovery room - Stage 1) • Post anaesthetic recovery room - Stage 2 / Day surgery unit o Minimum of 2 nurses, 1 must be a competent recovery nurse o Minimum of 1:4 nurse pt ratio when all pts are stable/for a paed pt over 5yrs of age with a family member or caregiver present • 1 nurse during elective surgery hours - Holding Bay (excluding RGH, NHS, CHSA) • 1 nurse during elective surgery hours - Stock Room (excluding RGH, NHS, CHSA) • Clinical Nurse Educator (excluding RGH, NHS, CHSA) • Nurse Sedationist – where role in place, will be considered as an additional resource • Medical Assistant Substitution (CHSA) - where role in place, will be considered as an additional resourceM