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Planning Minor Injury Services The Interdisciplinary Approach

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Sr. Brenda Matron. Bernie Reilly Practice Development NMPDU. Marina O'Connor Practice Development ... 500 Hours St James' Hospital (under supervision of ANPs ... – PowerPoint PPT presentation

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Title: Planning Minor Injury Services The Interdisciplinary Approach


1
Planning Minor Injury Services/ The
Interdisciplinary Approach
  • Mary Duff
  • Director of Nursing and Midwifery Services
  • Our Lady of Lourdes Hospital, Drogheda

2
Programme
  • Background and Process Used
  • Consultants Input
  • Students Experience
  • Questions and Answers

3
Hospital Groups within the North Eastern Health
Board
  • Louth/Meath
  • Drogheda
  • Navan
  • Dundalk
  • Cavan/Monaghan
  • Cavan
  • Monaghan

4
Service 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

5
Monaghan 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

6
Reports
  • 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

8
Service 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

9
ANP 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

10
The 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

11
The 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

12
Time 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

14
Future 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

15
Developing an ANP service the consultant role
  • Conor V Egleston
  • Consultant Emergency Medicine
  • Our Lady of Lourdes Hospital
  • Drogheda

16
Previous 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

17
Previous experience in UK 2
  • Lymington
  • Small community hospital
  • ED 15,000 attendances per year
  • Bypassed for certain conditions by EMS
  • I started training ENPs

18
Personal 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

19
Why do Emergency Medicine want ANP service to
develop?
  • Bigger hospitals with consultants based in EDs
  • Smaller hospitals with sessional input from
    Emergency medicine consultants

20
Why 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

21
What 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

22
What 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

23
What do you need to do? 2
  • 2 Support Guidelines
  • Supervise
  • Develop

24
Problems and no problems our experience
  • No problem
  • Public
  • ED nurses
  • ED medical staff
  • Fracture clinics
  • Orthopaedic medics
  • Problems
  • Radiology

25
Caution 1
  • ANPS not cheap
  • ANPs wont see everything
  • ANPs probably wont of themselves be quicker

26
Caution 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

27
Summary
  • Rewarding experience
  • Not as many problems as anticipated
  • Radiology and prescribing issues to be sorted out
  • NOT an ED panacea

28
Questions at end of session
29
(No Transcript)
30
Unfortunately
31
PLANNING MINOR INJURY SERVICES-THE
INTERDISCIPLINARY APPROACH
  • SIOBHAN ROTHWELL

32
OUR LADY OF LOURDES HOSPITAL
33
EDUCATION
  • MSc Nursing T.C.D.
  • Clinical Module St James Hospital
  • Clinical Diagnositic Skills for Advanced
    Nurse Practitioners (Emergency Nursing)

34
CLINICAL MODULE
  • Anatomy
  • Theory and Practice of Injury and Wound
    Management
  • Documentation and History Taking
  • Radiology
  • Pharmacology
  • 500 Hours Supervised Practice

35
SUPERVISED 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)

36
SCOPE OF PRACTICE
  • Adult Minor Injuries
  • Paediatric Minor Injuries
  • - Significant service need
  • - Consultant led education and supervised
    practice
  • Clinical Protocols developed collaboratively

37
SITE 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

38
SITE 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

39
SITE 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

40
MINOR INJURIES UNIT
41
MINOR INJURIES UNIT
42
JOB 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

43
JOB DESCRIPTION cont/d
  • Geographical aspects of the service/demographics
    of the region
  • Service Need
  • Purpose of the post

44
SCHEDULE OF EVENTS
  • Guidance from the National Council
  • Bi-monthly meetings of the working group
  • Goals identified and set
  • Time frames highlighted
  • Objectives achieved

45
SUBMISSION 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

46
SUBMISSION 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

47
PHILOSOPHY
  • 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

48
PLANS 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

49
Planning Minor Injury Services the
Interdisciplinary Approach
  • Part 2
  • Margaret Mallen

50
Monaghan General Hospital
51
Education
  • UCD MSc in Nursing (advanced practice).
  • Generic programme.
  • Pathology, physiology, pharmacology, complete
    physical assessment.
  • Documentation and history taking.

52
Supervised Practice
  • 1000 hrs supervised practice under care of
    consultant in emergency medicine.
  • Review clinic Mon, Wed, Fri.
  • Weekly teaching sessions with emergency
    department SHOs.

53
Supervised Practice cont/d
  • Individualised teaching as deemed appropriate by
    consultant.
  • All patients seen are presented to consultant or
    registrar prior to discharge.

54
Clinical 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.

55
Clinical 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

56
Framework.
  • Guidelines to Nurses and Midwives on the
    Development of Policies, Guidelines and
    Protocols.
  • An Bord Altranais 2000.

57
Sample 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

58
REFERRALS FROM THE MINOR INJURY SERVICE
PRIMARY CARE
NURSE-MINOR INJURY SERVICE
SPECIALIST TEAMS OR CLINICS
ALLIED HEALTH PROFESSIONALS
59
Liability
  • 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.

60
Core Concepts
EXPERT PRACTITIONER

RESEARCHER
AUTONOMY IN CLINICAL PRACTIC
PIONEERING AND PROFESSIONAL LEADERSHIP
NCNM 2001
61
Challenges
  • Time Management
  • Meeting Targets for MSc and Working Group
  • Hard Work

62
Strengths
  • Team Building
  • Support
  • Combining MSc with Site Accreditation
  • Ownership of the process
  • Sense of achievement
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