Nurture report 2025

The report identified concerns regarding the availability and application of vascular access guidelines, particularly related to cannula insertion and fixation. Documentation of intravenous (IV) therapy procedures was incomplete and did not meet the standards set by the Royal College of Nursing (2016), highlighting deviations from national best practice.

The Trust updated its cannulation and difficult access guidelines in February 2025 and implemented Aseptic Non-Touch Technique (ANTT) standards across the acute site. The same standards are now being rolled out within Community Wellbeing and Mental Health services. Annual assessments, including ANTT competencies, are in place.

An IV Standards Working Group has been established to lead on improvements, supported by a best practice study group to ensure consistent implementation across all services. Nursing care quality indicators now include audits of compliance with vascular access standards.

We will continue developing our vascular access and IV therapy protocols, incorporating ANTT principles and Vessel Health and Preservation guidance (2020). This work is expected to be completed by the end of September 2025.

The report found there was no standardised Trust-wide IV therapy training, and no designated lead for vascular access education. IV therapy was being treated as an extended role rather than a core nursing competency, and the training provided did not cover essential areas such as site assessment, flushing, administration, and care of access devices.

To address this, the Trust established a dedicated IV practice working group, with representation from across the organisation. A review of training provision has been conducted and a refreshed IV study day is now in place.

We are developing an updated curriculum for IV therapy training, to be incorporated into induction for newly qualified nurses. This training will be standardised, competency-based, and reviewed annually, with full implementation beginning in January 2026.

The report recommends regular audits to monitor and improve IV therapy and vascular access care through the adoption of Device-Related Infection Prevention Practices (DRIPP), with quarterly audits commencing from June 2025.

The Trust has begun surveillance of central access device-related bacteraemia, identifying patterns in infection and care locations. Clinical audits have been carried out to provide assurance on IV practices and are now part of our Ward Accreditation Programme.

A new ANTT guideline was approved in January 2025, and IV practice is now regularly audited. The Trust’s Sepsis Safety Nurse began an embedding programme in March, and audit outcomes contribute to the nursing care quality indicators.

The report calls for a robust, evidence-based cannulation guideline, incorporating ANTT practices, dressing techniques, and clear escalation procedures for difficult insertions to be implemented by December 2025.

In response, we updated our cannula care guidelines in February 2025. Monthly audits began in October 2024, led by the Quality Matrons, and the results are reported via the Nursing Quality Dashboard. These audits are being incorporated into our new Ward Accreditation process.

The report recommended a review of the Trust’s medicines management policy to explicitly recognise intravenous therapy as a fundamental component of nursing practice, including mandatory training and competency assessment.

The Trust has developed a robust IV training programme for new nurses, which includes competency assessments and annual reviews. The medicines management policy is currently under review by the pharmacy team to ensure these training requirements are embedded.

The report recommends redesigning prescription chart formats to improve clarity and support safe prescribing and administration, with a review of double-signature requirements and a feasibility study for electronic prescribing by June 2026.

The Trust transitioned to a fully electronic Prescribing and Medicines Administration system for our inpatient areas in 2024. This system incorporates double-signature functionality and supports safer, clearer prescribing and administration.

The report identified inconsistencies in the documentation and escalation of Paediatric Early Warning Scores (PEWS) during Yusuf’s care, including missed opportunities for reassessment and incomplete vital signs monitoring.

In response, the Trust has implemented PEWS training as part of induction for newly qualified nurses. Additional training on escalation is being delivered through the 2025 training programme.

We have introduced the Patient and Carer Escalation (PaCE) framework, empowering families to escalate concerns directly to senior clinical staff. Sheffield Children’s is also an early adopter of Martha’s Rule, enabling parents to request an independent clinical review if they feel their concerns are not being heard.

Our Policy for Clinical Deterioration and related guidelines have been updated and widely communicated. Further enhancements are planned, including incorporating PEWS scores and family concerns into CareFlow handover sheets. These improvements will be included in Vitals Version 5—our updated electronic PEWS system—which we are testing as a pilot site ahead of its March 2026 release.

The review identified challenges with weekend medical oversight, including delays in diagnostic decision-making and inadequate documentation of escalation decisions.

The Trust currently has three consultant-led handovers each day over the weekend—morning, afternoon, and evening—in line with Royal College of Paediatrics and Child Health standards. We are reviewing these arrangements to determine whether further enhancements are required to ensure consistent consultant-led oversight and robust documentation.