TrendCare Use Guidelines

Purpose

These guidelines describe the operational use of TrendCare throughout Grey Hospital. Any
request for a variation to these guidelines must first be discussed with the TrendCare
coordinator and be approved via the TrendCare steering committee.

TrendCare Use

All TrendCare users are required to record information into the system accurately and
in
a timely manner
Staff are responsible for predicting, actualising and updating information only on the
patients allocated to them in the workload allocation screen. Staff must not enter data
or change information on behalf of another staff member.
If a Shift coordinator, Nurse Manager or Duty Manager does not agree with how
another staff member has categorised a patient, they should discuss their concerns with
the staff member involved. It should be the staff member that changes the rating if
appropriate.
o Exception In urgent circumstances or when the staff member cannot be
contacted to have the discussion prior to the changes being made. However the
discussion should occur as soon as possible after the rating change if a change is
appropriate/necessary.
All staff MUST maintain the security of their own logon and password.

Data Integrity and System Maintenance

Each ward should have a representative as their TrendCare Resource Nurse and they
should have attended the Interpreter reliability workshop or have one on one training
for IRR.
Each area representative is to formulate an IRR plan with assistance from their
TrendCare Coordinator
Staff that do not achieve competence at IRR testing will have further TrendCare
training and be retested to achieve the desired standard.
Each area is to maintain Gold Standard Actualisation rates (100%) every month
Any issues with staff list information including: department, role or demographics are to
be sent to the TrendCare coordinator via email for problem identification and
resolution.
Patient types that consistently lie outside the benchmarked average hours (HPPD)
when categorised, should be reported to the TrendCare coordinator for review
Changes to Roster codes, leave codes, units, departments etc MUST be done by the
TrendCare coordinator after discussion/approval from the TrendCare steering
committee when appropriate.

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Document Owner: TrendCare Co-ordinator
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Minimum Staffing and Clinical Profile

Minimum Profile A level which is used in Staff Allocate Inpatient Variance screen
to highlight the need to staff to the minimum staffing profile. Useful in the event that
the acuity requirement is less than the minimum requirement.

Clinical Profile (also known as budgeted skill mix) The hours entered into this profile
are those hours planned/budgeted for patient care. Each CNM should ensure these are
correct and advise the TrendCare Co coordinator if they need changing.

Bed Management

Admission
The TrendCare system allows up to 9 patients to be admitted into any bed during a
shift
Patients should be entered into TrendCare via the IPM patient admission system,
MANUAL entry should be avoided if at all possible, but if used ensure the correct
date/time and patient details are captured.
If MANUAL entry is used, patient details, DOB, time and date of admission must be
recorded correctly to ensure the episode of care number is assigned to the manual
entry when iPM updates the patient admission
When a patient has been entered manually or more than once in error, the manual
admission should be cancelled NOT discharged
Ensure the correct patient type has been assigned before predicting/actualising care

Discharge
All expected date of discharges must be flagged as soon as possible after admission
Discharged patients must have their acuity updated/actualised before discharge
Patients discharged between 0645-1515 must be discharged on the day shift inpatient
screen in TrendCare
The discharge shift entered must reflect the time entered by IPM (rounded to within
15mins) so this should occur simultaneously. IPM populates TrendCare BUT
TrendCare DOES NOT inform IPM so discharge off IPM first if possible.
Patients that were discharged on the previous shift but are still on TrendCare need to
have from previous shift selected during the TrendCare discharge process.

Transfers between Departments

All patients, once admitted to TrendCare, and moving within Grey Hospital, are to be
transferred in by the receiving department during the transfer process, NOT discharged
(Hannan excepted)
The transfer in must not occur until the patient arrives at the receiving ward

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Document Owner: TrendCare Co-ordinator
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Care time for transfers between departments is to be indicated in the patient

categorisation screen NOT the staff allocate screen unless it is a complicated lengthy
transfer
Sending ward must actualise care prior to the transfer if > 4hrs since start of shift

On Leave
Patients going on leave are required to be categorised and actualised prior to selecting
starting leave if > 4hrs since start of shift
Patients returning from leave are required to be categorised on return and actualised
following selection end leave

Inpatient Shift Data

Patient Acuity
Patient Type MUST be reviewed each shift to ensure it correctly reflects patient
acuity
Staff altering Patient Type MUST also re predict shifts that the change in patient
type effects
If a patient is requiring complex medications or multiple observations a high
dependency patient type might be more suitable

Acuity Indicators
It is not possible to have a Guideline specific to every acuity indicator because this is
determined by patient type so staff MUST refer to the definitions to ensure accuracy
when updating , by right clicking on the acuity indicator the definition will be visible.
Staff must not add indicators (such as part special) for the sole purpose of increasing
Hours per patient day (HPPD) OR to fill their 8hrs, It must truly reflect patient acuity
and NOT Nurse activity, and should be consistent between staff when a patients
condition has not changed.
Selection of patient acuity indicators must be consistent with care plans and clinical
pathways, best practice guidelines and standards.

Actualisations
The patient type must be checked before acuity indicators are confirmed
Actualisation of all acuity indicators must be completed at the end of each shift
Actualisation of the Allocate Staff screen showing staffing areas, MUST be updated
at the end of every shift

Guidelines for Acuity Indicators

Specialling Should ONLY be used if the patient CANNOT be left unattended for
the period indicated and narrative about why this indicator is applied is required in
Shift Notes
Mobility - This is recorded for all 3 shifts specific to the patients changing condition
Hygiene This is N/A at night as hygiene care rarely done during sleep hours
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Nutrition - This is N/A at night as there are no meals overnight

Incontinence Includes wash and linen change so DO NOT add hygiene as well
Thought process mark this indicator for impact on cognition, DO NOT also select
communication/behaviour unless giving explanation in patient notes on T/C, Check
the definitions carefully . If a patient has a watch/special to maintain safety, then this
indicator should not be added.
Communication- This does not include semi/unconscious patients, and if thought
process is already marked, then communication is already part of that indicator so if
also marked, a comment in patient notes is helpful e.g. Deaf patient with dementia
Medications General administration of meds and flushing of cannulas are included in
baseline hours, select this indicator for frequent/continuous infusion and consider high
dependency patient type if 2nd or 3 rd involved medication is required.
Extensive Treatment Basic wound care is included in baseline hours for most
patient types, and is inclusive of standard reasonable setup time and does not account
for disorganisation or poor time management. If the extensive treatment took 15 mins,
and the rest of the time was educating patient/family about wound care , then mark the
Teaching indicator NOT both.
Teaching/Counselling/Emotional support Should rarely be marked on nights
unless a specific incident /event occurs, check definitions, should reflect care plan and
if it is required, then likely a support/social worker referral should be sent and
evidenced in care plan. Up to 30 mins is already allocated within most patient
types
Discharge Planning Should only be indicated usually the day before and day of
Discharge. Likely to be routine when returning home, or to previous care facility unless
a significant change is occurring e.g. New home care package, Initial discharge to new
care facility etc

Predictions
Check care plans and Patient Type before completing your patient acuity prediction

Morning Shift

By 10am
Review patient notes
Commence 24 hour predictions for all allocated patients for morning, evening, night
and following day shift
Review and update all allocated patient diets for current day shift

1400-1515 (Close to end of Shift)

Complete actualization for all allocated patients ensuring it reflects what care level the
patient actually received/required (A day shift Actual can only be achieved 4 hours after the start
of the day shift)
Upgrade any predictions for evening, night and next day if required
Update T/C patient notes for handover sheet printouts
Actualise Nurse hours by checking non clinical and out of ward hours are allocated
correctly in the Allocate Staff screen

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Document Owner: TrendCare Co-ordinator
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Print handover sheets for evening shift staff (Shift Coordinator)

Afternoon shift

2130-2230
Check any new admissions have been added to evening, night and day shifts
Actualise evening predictions for all allocated patients and update night and day
predictions (An evening shift Actual can only be achieved 4 hours after the start of the evening shift)
Review and update all allocated patient diets on current, night and day shift
Update T/C patient notes for handover sheets
Print handover sheets for night shift staff (Shift coordinator)

Night Shift

0500-0630
Check any new and expected admissions have been added to night and day shifts
Actualise night shift predictions and update day predictions
Review and update all patient diets on current and day shift
Update patient notes for handover sheets
Print handover sheets for day shift staff
Allocate patients to day staff (Team Leader)

Actualisations
The patient type must be checked before acuity indicators are confirmed
Actualisation of all acuity indicators must be completed at the end of each shift
Actualisation of the Allocate Staff screen showing staffing areas, MUST be updated
at the end of every shift

Handover Notes

On-going Notes:
Information written in this section will change the notes including the shift they were
entered and all future shifts
Clinical risk information must be updated and recorded here (e.g. Falls, Thought
disorder, and any ongoing clinically significant information)
On-going shift notes should be printed in CAPITAL letters, to distinguish
between This shift only notes when printed

Ongoing notes reviewed every shift and updated as required and may include-
ALLERGIES
SAFETY SCREEN (FALLS RISK/PRESSURE INJURY/ NUTRITION ETC)
TESTS DONE, DATE COMPLETED
NFR AND DATE DOCUMENTED
ISOLATION TYPE
BIPAP
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Document Owner: TrendCare Co-ordinator
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This Shift Only Notes:

Entered into this section for the next shift e.g. Am nurse enters notes for pm nurse, pm
nurse for night nurse etc.
This information is relevant for the following shift only, It is not for progress notes-
these are always written in the patients clinical notes
Any patient who has a watch or special for part or all of a shift should have it written
into this shift only notes

This shift only notes should only include information pertinent to the nurse coming on
shift and may include:
EWS
Tests scheduled(Should be removed once completed and put into ongoing
notes)
New orders
IVF, IVABs, FB
Any stat meds due

Roster Development

Rosters will be published not less than 28 days prior to the commencement of the
roster, provided that less notice may be given in exceptional circumstances. Rosters
posted will show duties for a minimum 28 day period. Changes in roster, once posted,
shall be by mutual agreement (NZNO DHB MECA 1 March 2013 28 February 2015)
Rosters should reflect all planned leave and hours to be worked
Posting the roster captures a snapshot of the original, BEFORE any changes are made
Roster changes should be updated both electronically and to the printed hardcopy
Each new roster should be made from the Ward Template after it has been checked and
updated to add or remove relevant staff
Roster codes are to be developed in conjunction with Clinical areas BUT
added/removed only by TrendCare coordinator

Allocate Staff Screen Function

The staff allocation screen tracks actual staff hours and activities undertaken
Each area will liaise with TrendCare coordinator to maintain their minimum, short and
extended lists to suit their departments activities
The Nurse Managers/shift coordinators must ensure all rostered staff are entered &
their hours are accounted for accurately and in a timely manner, every shift
Nurses MUST check / actualise their hours worked at the end of every shift
Total hours are to reflect the actual time the staff member has worked.
Either subtracting time from the clinical in department and adding to another
staffing area / ward as appropriate to total 8hrs (if no extra time worked)
OR

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Document Owner: TrendCare Co-ordinator
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Entering time in the different staffing area and leaving the time in clinical in
department if the staff member worked over their 8hrs shift (Overtime to be
recorded)

WCDHB Specific Allocate Staff Screen Guidelines

This Staff activities MUST be allocated in the staff allocate screen according to these
guidelines, developed and approved by the TrendCare Steering Committee and the
Coordinator. Check definitions of Staff allocate columns by R) clicking over the titles, and
access all options by checking the drop down box on bottom R) of staff allocate screen.

Shift Coordinator - Usually 2hrs allocated, however, if a CNM available these hours
are not always required, If acuity is low no hrs OR only 1 hr may be required, Not
required at night.
NetP new graduates - Allocated 2hrs transition to assist in their learning, for the
first year of their placements, however, if Acuity is high and clinical need greater , these
hours can be moved back into Clinical in Dept especially as their placements near the
end of each 6 months
Student Supervision- 2hrs allocated to nurses working with students, however, these
are not mandatory as the student especially if 3rd year , often adds value to the nurses
clinical hrs, so may only be 1hr or no time altered. This will be more evident as our
DEU placement students arrive and we have several students present on every shift.
Clinical Supervision Use when working with non-student staff such as new
orientating staff, however only 1hr /shift should be required if registered nurses
Environment Time captured for cleaning and resetting bed areas for next admissions
after discharges Usually 15mins per discharge, may be more if a longer term patient
discharged
Escort Hours recorded for transporting patients to other facilities, must capture any
overtime hours also in overtime column
Consult Nurse 30 mins for venepuncture / cannulation on patients other than your
own
Equipment Use to record daily / weekly, equipment / trolley checks etc
Data Entry use for FIMS/ACC and other significant documentation or data entry
Clerical Use only when usual clerical hours are not covered, share usual hours
between staff on shift
Patient Transfer Use if transferring a patient to another area in Grey Hospital,
external transfer should be recorded under Escort hours
Miscellaneous Use when an activity (not patient care) has taken significant time but
has no specific area but MUST add narrative in comments column

Shift Notes Guidelines

Entering Shift notes- Can be done by anyone , however, it is best practice that this is
in discussion with CNM/Shift coordinator or Duty Nurse Manager

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Document Owner: TrendCare Co-ordinator
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Content Notes if entered, should reflect the general activity and churn of the ward
especially if it is not reflected in acuity of the patients, e.g. Several admissions or
equipment issues etc, that require significant staff time. It can also record staff activity
when the area is in positive overage e.g. Online education, clinical reading etc
Out of hours DNMs This is a useful place to record requests for additional staff
and responses to negative variance or busy ward Churn days.

HRM Maintaining Staff records

New staff are added by TrendCare coordinator after a request either through IT or
CNM and training arranged directly with the new staff member.
Initial access and password for TrendCare is allocated by TrendCare coordinator.
Ongoing security level access will be reviewed and altered as appropriate in discussion
with TrendCare coordinator
CNMs should be updating and maintaining their Ward list for APC Registration details
and appraisals etc. If appraisal supports PDRP or NetP appraisal this should be noted in
comments section
Training/Inservice/Competency records should only be entered by CNEs and
TrendCare coordinator Definitions are
COMPETENCY - The achievement of skill and clinical judgement required to
perform a task within the context of employment at WCDHB e.g. IV administration,
Epidural, Venepuncture, cannulation etc
o CNEs and TrendCare coordinator should enter new competencies and updates
when notified of their completion and evidence produced
o CNMs are responsible for ensuring staff maintain their competencies annually
or as required
TRAINING - Approved learning resources and /or formal education sessions
delivered within the WCDHB educational framework
o Mandatory training usually captured by Learning and Development Corporate
office
o CNEs and TrendCare coordinator should enter new training sessions when
notified of their completion and evidence produced like attendance register
INSERVICE - An informal teaching session, generally delivered within once clinical
area, of at least 15-30 mins duration
o This can be a regular or infrequent event, but must be on different topics
o CNEs and TrendCare coordinator should enter new training sessions when
notified of their completion and evidence produced like attendance register
o When entering a generic Inservice session, the topic MUST be entered in the
comments section of the inservice register
CONFERENCE - Education delivered by an external provider to WCDHB staff
who attend usually offsite , preferably by an accredited provider with NZQA approval
QUALIFICATION - Undergraduate and post graduate qualifications provided by an
accredited provider, achievement of discrete papers is not entered, only completed
qualifications.

Security

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Document Owner: TrendCare Co-ordinator
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Staff are assigned an appropriate logon and initial password by the TrendCare
Coordinator
They must change the password at first logon and kept it secure for their use only
If they forget their logon or password contact the TrendCare coordinator for assistance
Access to different security levels within TrendCare are assigned by job description, if
you want a different level of access this can be discussed with your T/C coordinator
Contacts
TrendCare co-ordinator - Ext 5014
o Password /access issues
o Retrospective alterations if > 2 days for nursing
o Reports from TrendCare
o History / Education records for individual staff off TrendCare
o Security level changes
o Education/support with TrendCare use

IT Help desk Ext 2911

o Hard ware issues with work stations/printers
o Getting TrendCare added to your workstation/desk top
o iPM and TrendCare interface
o Dietary and TrendCare interface

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Document Owner: TrendCare Co-ordinator
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The roles and responsibility table below is a guide only and will vary between areas depending
on
Role Current activity and responsibilities in your area

Senior Roster development/ updates and approval

nursing/midwifer Management of leave planner
y Roles including Actualisation - Response to audits
Clinical Nursing Allocate staff review daily/weekly as required
and Midwifery
Register for Annual Practicing Certificates, Appraisals etc
Managers
Identify/support the TrendCare Resource Nurse with IRR /
Training
Respond to Variance / other TC reports as required
Review of historical trends for planning and service development

Shift coordinators Allocate staff screen review every shift, to ensure corrections
/2ICs and assign new admissions to nurses
Allocate workloads /update workloads as new admissions arrive
Review predictions for completion/revision at end of shift
Staff allocation for next shift as appropriate
Correct placement of patients to beds/rooms
Staff handover sheets

Out of hours Duty DNM rosters/update DNM hours

Nurse Manager Review wards - staffing / Acuity Respond to negative
variance situations, and record in ward notes what action
was taken
Update staff allocate screens escorts / deployment /overtime

Clinical Nurse Update HRM training/in service/competency records

Educators
Registered Predict / actualise patient acuity (am nurse/midwife does 24hr
Nurse/Midwife predictions)
Actualise own hours in staff allocate screen daily
Admit, discharge, transfer patients
Bed patient notes/shift notes updated
Handover sheets next shift as required
Enrolled Nurses Predict / actualise patient acuity
Actualise own hours in staff allocate screens

Clerical Admit/Discharge/transfer patients

Patient movement to correct beds/rooms
Roster changes/staff allocate hours/updates as requested by
CNM
roles within that service.
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Document Owner: TrendCare Co-ordinator
WCDHB-NURS Version 1, Issued 08/08/14 Master Copy is Electronic
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Document Owner: TrendCare Co-ordinator
WCDHB-NURS Version 1, Issued 08/08/14 Master Copy is Electronic