Reflections on models developed over the festive period
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Reflections on Models Developed Over the Festive Period. Lorraine Robertson Clinical Nurse Manager NHS Forth Valley. Purpose of RMN Input Within A&E. Overall Purpose of Input:

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Reflections on Models Developed Over the Festive Period

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Reflections on models developed over the festive period

Reflections on Models Developed Over the Festive Period

Lorraine RobertsonClinical Nurse ManagerNHS Forth Valley

Purpose of rmn input within a e

Purpose of RMN Input Within A&E

Overall Purpose of Input:

  • Support A&E staff during their busy period by providing assistance to individuals who present with mental health problems.

  • Advise and support A&E staff in capacity as RMN.

  • Consider and advise appropriate use of on-call junior psychiatric doctor.

  • Carry out duties with professional responsibility and accountability.

  • Utilise basic nursing skills to assist A&E staff.

  • Assist in clinical decision making.

  • Complete data sheet for audit purposes.

  • Advise and signpost to community supports where appropriate.

Activity statistics


Input commenced 24/12/08 at 5pm - not all shifts covered.

  • Possible 28 shifts to be covered.

  • 23 shifts had RMN input.

  • Out of 23 shifts with input, 5 shifts had no referrals for RMN input.

  • 18 shifts gained some benefit from RMN.

  • From 18 shifts where RMN staff asked to get involved, there were 37 contacts.

Main presenting problems n 37

Main Presenting Problems (N=37)

Of 28 DSH/Suicidal, 10(36%) involved alcohol consumption

Alcohol or substance misuse involved n 37

Alcohol or Substance Misuse involved (N=37)

Violence involved n 37

Violence Involved (n=37)

Periods of time presenting n 37

Periods of Time Presenting (N=37)

Referrals per day

Referrals per Day

Outcomes from a e n 37 11 were identified for psychiatric follow up

Outcomes from A&E (N=37)(11 were identified for psychiatric follow-up)

Lessons learned

Lessons Learned

  • Specific job description - job requires an enhanced level of skills and knowledge to support decision-making.

  • Communication could have been improved.

  • There was limited awareness from both sides, with some resistance from A&E staff. There was some reluctance from RMNs to assist in basic nursing care.

  • Majority of referrals had alcohol and drug intake therefore need to identify what exactly is required – psychiatric alcohol liaison nurse, substance misuse.

  • ?Train A&E staff to deal with alcohol and drug misuse (or is it referral pathways and appropriate signposting?).

  • Clinical supervision would require to be addressed if RMNs attached to A&E.

  • Busy periods fluctuated.

  • Should RMN be in A&E or attached to in-patient psychiatric ward.

Key question

Key Question

Do we really need RMN staff within

A&E or should A&E staff be provided

with enhanced knowledge of mental

health issues/illness?

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