Title: Planning Minor Injury Services The Interdisciplinary Approach
1Planning Minor Injury Services/ The
Interdisciplinary Approach
- Mary Duff
- Director of Nursing and Midwifery Services
- Our Lady of Lourdes Hospital, Drogheda
2Programme
- Background and Process Used
- Consultants Input
- Students Experience
- Questions and Answers
3Hospital Groups within the North Eastern Health
Board
- Louth/Meath
- Drogheda
- Navan
- Dundalk
- Cavan/Monaghan
- Cavan
- Monaghan
4Service Need
- NEHB increase of 12.7 in the population
- Our Lady of Lourdes has seen an increase in
attendance at the Emergency Department from
34,807 in 2002 to 36,668 in 2003 - This has resulted in an overall increase in the
average waiting time for non-life threatening
injuries - Review showed that 30 could be classed as a
minor injury (2002) suitable to be seen by an
ANP
5Monaghan General
- Unique position in the NEHB with regard to
emergency services, off call since July 2002 - Monaghan has a treatment room which is the
designated Emergency Room, 10,747 attendances in
2003
6Reports
- National Health Strategy (2001)
- St. Pauls HRRI Report (2001)
- St. Pauls Consultancy (2003)
- Bonner Report (2003)
- Comhairle na nOspideal (2002)
- Hanley Report (2003)
7- Strategic regional decision to develop the
Advanced Nurse Practitioner within the North
Eastern Health Board - Drogheda - Trinity Programme
- Monaghan - UCD Programme
8Service Plan
- The decision to introduce A.N.P.s was included in
the OLOL 2003 2004 service plans - Monaghan had a suitable physical environment in
place - Working Group was established
- National Council framework for establishment of
ANP service was used to guide the preparation for
accreditation
9ANP AccreditationWorking Group
- Eddie Byrne Director of Nursing
- Sr. Brenda Matron
- Bernie Reilly Practice Development NMPDU
- Marina OConnor Practice Development
- Isobelle Steenson Practice Development
- Mary Yau CNM3 Emergency Dept
- Pauline Plunkett CNM 3 Emergency Dept
- Conor Egleston Consultant in Emergency
Medicine - Siobhan Rothwell Nurse Minor Injury Service
- Margaret Mallen Nurse Minor Injury Service
- Mary Duff Director of
Nursing/Midwifery
10The Process Used
- Kathleen McLellan Valerie Small met with the
working group in Our Lady of Lourdes Hospital
3rd June 2003 - Siobhan and Margaret were one year into the MSc
programme at this stage - Margaret was undertaking her 1,000 hrs supervised
clinical practice in OLOL
11The Process Used (Continued)
- Working Group met on a bi-monthly basis
- Using an interdisciplinary approach goals
timeframes were identified, set and achieved
leading to the development of the site
preparation and job description documents - Minor Injury service for adults children
12Time Frame
- The Group set their own time frame to have the
sites accredited to coincide with completion of
MSc in June 2004 - June 2003 - met with National Council
- Nov 2003 - 1st draft of site prep
- Jan 2004 - 2nd draft to National Council
13- March 2004 - Met with National Council to
review document and prepare for final
submission - April 2004 - Document submitted to
National Council - May 2004 - Review by accreditation
committee - August 2004 - Submit Portfolios
14Future Plans
- Development of structured educational programmes
across multi-disciplinary teams - Involvement in teaching on pre-registration and
post-registration programmes - Expansion to the body of emergency nursing
research - OLOL as a site for developing A.N.P.s for the
region
15Developing an ANP service the consultant role
- Conor V Egleston
- Consultant Emergency Medicine
- Our Lady of Lourdes Hospital
- Drogheda
16Previous experience in UK 1
- Southampton University Hospitals Trust
- University Hospital Emergency Department
- 70,000 attendances per year
- 11wte ENPs working in dept
- Active nurse education programme
- I slotted in as one of lecturers, supervisors
17Previous experience in UK 2
- Lymington
- Small community hospital
- ED 15,000 attendances per year
- Bypassed for certain conditions by EMS
- I started training ENPs
18Personal UK experience
- No problems working with ENPs
- Amazed that I could just start training with no
national standard/vetting procedure - Too big a task to do solo
19Why do Emergency Medicine want ANP service to
develop?
- Bigger hospitals with consultants based in EDs
- Smaller hospitals with sessional input from
Emergency medicine consultants
20Why ANPs in NEHB?
- 5 departments
- gt 100,000 attendances per year
- Reorganisation of trauma
- Consultants based in two departments only
- Maintenance of service in two types of hospitals
- Comhairle document re AE services in Ireland
21What do we know about ANPs/ENPs
- As good as SHOs at examination documentation
- As good as SHOs at interpretation of radiographs
- As good as SHOs at prescribing
22What do you need to do? 1
- 1. Talk ED medical staff
- ED nursing managers and nurses
- Director of nursing
- Other clinicians
- Directors of ANP programmes
23What do you need to do? 2
- 2 Support Guidelines
- Supervise
- Develop
24Problems and no problems our experience
- No problem
- Public
- ED nurses
- ED medical staff
- Fracture clinics
- Orthopaedic medics
25Caution 1
- ANPS not cheap
- ANPs wont see everything
- ANPs probably wont of themselves be quicker
26Caution 2
- Where are we going to get all the ANPs we need
- If we get all the ANPs we need whos going to
replace the nurses who change role
27Summary
- Rewarding experience
- Not as many problems as anticipated
- Radiology and prescribing issues to be sorted out
- NOT an ED panacea
28Questions at end of session
29(No Transcript)
30Unfortunately
31PLANNING MINOR INJURY SERVICES-THE
INTERDISCIPLINARY APPROACH
32OUR LADY OF LOURDES HOSPITAL
33EDUCATION
- MSc Nursing T.C.D.
- Clinical Module St James Hospital
- Clinical Diagnositic Skills for Advanced
Nurse Practitioners (Emergency Nursing)
34CLINICAL MODULE
- Anatomy
- Theory and Practice of Injury and Wound
Management - Documentation and History Taking
- Radiology
- Pharmacology
- 500 Hours Supervised Practice
35SUPERVISED PRACTICE
- 1000 Hours
- 500 Hours St James Hospital (under supervision
of ANPs - 500 Hours Our Lady of Lourdes Hospital (under
supervision of Consultant in Emergency Medicine)
36SCOPE OF PRACTICE
- Adult Minor Injuries
- Paediatric Minor Injuries
- - Significant service need
- - Consultant led education and supervised
practice -
- Clinical Protocols developed collaboratively
37SITE PREPARATION AND JOB DESCRIPTION
- Working group established following a meeting
with the National Council - Comprised of DONs both sites
- ED Consultant
- Representative NMPDU
- Practice Development
Nurse - Nurse Managers ED
- Nurses pursuing
Accreditation
38SITE PREPARATION
- Health needs
- Laws, rules, regulations and guidelines governing
nursing and midwifery practice - Vicarious Liability
- Guidelines for good practice
- Benefits to patients from the ANP service
- Consistency of service within Organisational
Philosophy
39SITE PREPARATION cont/d
- How change will meet the service plan
- Location of the service
- Integration of the ANP into the multidisciplinary
team - Definition of the role content within the
framework of nursing - Resource implications
40MINOR INJURIES UNIT
41MINOR INJURIES UNIT
42JOB DESCRIPTION
- Background to post
- - Generic Background
- - Specific Background
- - Evolution of the role of the Advanced Nurse
Practitioner - - Effects of policy changes on Professional
Practice of the Region
43JOB DESCRIPTION cont/d
- Geographical aspects of the service/demographics
of the region - Service Need
- Purpose of the post
44SCHEDULE OF EVENTS
- Guidance from the National Council
- Bi-monthly meetings of the working group
- Goals identified and set
- Time frames highlighted
- Objectives achieved
45SUBMISSION DOCUMENT
- Developed collaboratively
- Different service needs identified
- National Council Framework Document (2001) used
as a template - NCNM provided support and direction
- Drafts x 2 submitted before completion of final
document
46SUBMISSION DOCUMENT cont/d
- Site preparation and job description
- Relevant appendices
- Reference list
- Clinical Protocols
- Application form
- Letters from DON and NMPDU
- Financial approval form
- 2 COPIES 1 BOUND AND 1 UNBOUND
47PHILOSOPHY
- The Advanced Nurse Practitioner will acknowledge
the individual needs of each patient, and through
a partnership approach provide a responsive,
effective service which incorporates advanced
decision-making and an innovative approach to
care while retaining the philosophical
underpinnings of nursing
48PLANS FOR THE FUTURE
- Increase in number of ANPs in Emergency Nursing
in the North Eastern Health Board - Expansion of Scope of Practice as determined by
service need - Cross-site research and audit to add to the body
of knowledge and enhance the quality of patient
care
49Planning Minor Injury Services the
Interdisciplinary Approach
50Monaghan General Hospital
51Education
- UCD MSc in Nursing (advanced practice).
- Generic programme.
- Pathology, physiology, pharmacology, complete
physical assessment. - Documentation and history taking.
52Supervised Practice
- 1000 hrs supervised practice under care of
consultant in emergency medicine. - Review clinic Mon, Wed, Fri.
- Weekly teaching sessions with emergency
department SHOs.
53Supervised Practice cont/d
- Individualised teaching as deemed appropriate by
consultant. - All patients seen are presented to consultant or
registrar prior to discharge.
54Clinical Protocols
- Scope of clinical practice collaboratively
agreed. - All adults with minor injuries are treated.
- All children with minor injuries except children
under four who present with a head injury are
treated by the nurse in minor injury service. - Clinical protocols developed collaboratively.
55Clinical Protocols cont/d
- Collaboratively agreed that the clinical
protocols would be used across all sites in NEHB. - Research based.
- Adult and Paediatric clinical protocols were
developed with ED consultants. Paediatric
clinical protocols were reviewed by
paediatricians and senior paediatric nurses
56Framework.
- Guidelines to Nurses and Midwives on the
Development of Policies, Guidelines and
Protocols. - An Bord Altranais 2000.
57Sample List of Protocols
- Abscess
- Bites
- Corneal abrasions
- Fractures
- Elbow injuries
- Foreign bodies
- Tetanus
- Hand injuries
- Foot injuries
- Ankle injuries
- Shoulder injuries
- Minor head injuries
- Lignocaine
- Wounds
58REFERRALS FROM THE MINOR INJURY SERVICE
PRIMARY CARE
NURSE-MINOR INJURY SERVICE
SPECIALIST TEAMS OR CLINICS
ALLIED HEALTH PROFESSIONALS
59Liability
- Important to consider liability when developing
the service. - Clinical Indemnity Scheme (CIS) were contacted
through Risk Management department. - Letter received showing nurse covered by CIS.
60Core Concepts
EXPERT PRACTITIONER
RESEARCHER
AUTONOMY IN CLINICAL PRACTIC
PIONEERING AND PROFESSIONAL LEADERSHIP
NCNM 2001
61Challenges
- Time Management
- Meeting Targets for MSc and Working Group
- Hard Work
62Strengths
- Team Building
- Support
- Combining MSc with Site Accreditation
- Ownership of the process
- Sense of achievement