Bridging the Gap Advanced Nurse Practitioners in the Emergency Department Consultant Georgina...
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Transcript of Bridging the Gap Advanced Nurse Practitioners in the Emergency Department Consultant Georgina...
Bridging the GapAdvanced Nurse Practitioners in the Emergency
DepartmentConsultant Georgina Robertson
ANP Janet OliverTrainee Advanced Physiotherapist Stuart Barker
East Lancashire Hospitals NHS Trust
180,000 patients per year 3 sites 7 Consultants 4 fulltime Speciality Doctors 3 part time Speciality Doctors 3 higher trainees in Emergency Medicine Full compliment of junior doctors
Three sites
Accrington Minor Injuries Unit Operates 08:00-20:00 Nurse led by Emergency Nurse Practitioners Supervision provided by Consultants at Royal
Blackburn Hospital
Urgent Care Centre at Burnley General Hospital
24 hour service Consultant led 09:00-17:00 Emergency Nurse Practitioners 08:00-23:00 Middle Grades and junior doctors GP 19:00-23:00 mon-fri 11:00-23:00 sat &
sun
Emergency Department and Urgent Care Centre at Royal Blackburn Hospital
Consultant led service from 08:00-00:00 Junior and Middle Grade doctors Emergency Nurse Practitioners 08:00-23:00 GP 19:00-23:00 mon-fri 11:00-23:00 sat &
sun
Service Developments
Advanced Nurse Practitioners First contact physiotherapists Advanced Physiotherapy practitioner Consolidation of ENP skills Enhanced skills of Clinical Support Workers Clinical Fellow rotation and middle grade
secondments Departmental GPs
Advanced Nurse Practitioners
Two fully qualified Three more in training Assess and manage majors patients in a
holistic manner refer to all specialities Senior, experienced members of staff Career progression clinically for nursing staff Development projects within the department Teaching and clinical support of nursing staff
within the department
First contact Physiotherapist
Paid for a physio service which provided mobility assessments and aids
Now have 1-2 physios assessing and managing MSK patients in both UCC 08:00-18:00
At UCC at RBH physio 14:00-18:00 sat & sun Physio run MSK clinic three times per week Can refer to fracture clinic and speciality
orthopaedic clinics Teaching within the department
Advanced Physiotherapy Practitioner
Assesses and manages patients with MSK problems Development of pathways within the Department in
conjunction with orthopaedics – Ankle Injury Pathway Teaching of medical and nursing staff Increased through put in the MSK clinic reducing
unnecessary referrals to fracture clinic Will have an extended scope of practice once
qualified e.g. head injuries, chest injuries, burns. Currently independently request and interpret x-rays.
Physio’s see 200 patients per month on average Offer real time clinical support to doctors and
nurses for MSK conditions and discharge planning Provide direct referral to outpatient physio without
the need for patients to be sent back to the GP Aiding with the development of links with
orthopaedics The Physio team has recently won extra funding
for additional staff. 3 wte to 5 wte.
Impact of Physiotherapy
Consolidation of ENP skills
Enhanced teaching programme to include minor illness
Peer review All moved to UCC at BGH with rotation to
MIU at Accrington
Clinical support workers
Departmental training days focused on the six ‘c’s
ECG recording, taking and recording of observations
IV cannulation and blood taking
Clinical Fellow Rotation
Six clinical fellows Rotate between ICU/Anaesthetics, MAU and EM
over a two year period Encouraged to take MCEM, paid for ALS,ATLS &
APLS Four hours per week of study time Progression to Middle Grade job Permanent Middle Grades given three month
secondments to other specialities (ICU/Anaesthetics/Paeds/MAU)
Departmental GPs
GPs given sessional contracts to work in UCC at RBH at weekends and to cover GP teaching
Streaming Pilot
6 month period UCC patients at RBH Computer programme to stream back to GP Majority of patients unwilling to go back to
the GP once in the department Triage took too long Service not continued
Facilitation of appropriate prescribing activities Tetanus
Oxygen
Implementation of an innovative approach to pain management in # Femoral Neck
Audit Staff development
Middle-grade teaching Nurse and health care support worker
development
ANP Service Improvement
Care Bundles Diabetic Keto-Acidosis
Referral Pathways and Patient Information Deep Vein Thrombosis
Implementation of national guidance via decision-making tools Chest Pain of Recent Onset (NICE CG95, 2010)
ANP Service Improvement