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Nursing Workflow – Metrics

Nursing Care Indicators and Patient Feedback

Chief Nurse, Mandie Sunderland has implemented a set of nursing care and patient experience metrics across Heart of England Foundation Trust. The nursing care metrics were initially developed in the North West of England and are shortly to be adopted by the NPSA as a national care indicator set. HEFT is one of the Trust’s teaching and influencing this initiative.

The nursing care indicators cover those areas which are our highest concerns in terms of risk:

  • Patient observations
  • Pain management
  • Falls assessment
  • Tissue Viability
  • Nutritional assessment
  • Continence Assessment
  • Medication administration
  • Infection Prevention and Control

Concurrently patient experience indicators aim to explore the patient’s perspective of many of the above elements of care and in addition such issues as privacy and dignity and communication.

These Metrics measure our standards of recordkeeping for the core activities that we undertake for our patients. It is vital that they demonstrate our professionalism and give an accurate and contemporaneous record of our patients care. These provide a range of patient quality, safety and experience metrics which allow us to have robust monitoring of standards of care.

A clinical ‘Back to the Floor’ approach from all matrons, corporate nurses, Head Nurses and the Deputy and Chief Nurse is used and real time data collection and reporting is available Trust wide following extensive collaboration with the IT Directorate. There has been a vigorous campaign to ensure that staff are prepared, with information giving sessions aimed at all groups of Nursing Staff.

Concurrently, a non-clinical ‘Back to the Floor’ with commitment from band seven and above non-clinical managers is being used to collect patient feedback from general ward areas; asking a minimum of 15 patients ten questions based on the Care Quality Commission’s Inpatient Survey.


  • Trust wide implementation General Areas since January 2010 Neonatal, Paediatrics and Theatres care indicators implemented
  • Maternity, Emergency Department, OPD, Endoscopy due to be fully implemented June 2010
  • Standards of care closely monitored and results reported to Quality and Standards Committee
  • Problem areas identified and remedial action taken immediately to protect standards of care
  • Patient Satisfaction – real-time feedback using a ‘Back to the Floor’ approach for non- clinical staff
  • A dedicated section of the nursing intranet has useful information


Example of Care Indicator Audit Tool
Example of Care Indicator Audit Tool

Example of Patient Feedback question


From December 2010, three new categories will be introduced to the nursing care indicators:

  • Diabetes monitoring and treatment
  • Discharge checklist
  • Quality assurance

These 3 new categories will be collected at the same time as the original 8 nursing care indicators (to make 11 care indicators in total). Although the scores will be available to view online from December 2010, the scores for the 3 new categories will be collated separately until they are embedded in practice to ensure that the original 8 care indicators are sustained and progress is recognised. The 3 new categories will become integral to the overall Metrics scores from April 2011 onwards. For more information about the 3 new care indicators, please view the Metrics Information Booklet – Stage 2 document below.

Please click below to download the Metrics Information Booklet

Metrics Booklet

Please click below to download the Metrics Information Booklet – Stage 2

Metrics Booklet Stage 2

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