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Every good idea has its time. Jill Windle RGN, MSc. FFEN Lecturer Practitioner in Emergency Nursing. Time to reflect on …. Demonstrate achievements (spanning 20 years) Discuss innovations in practice Learning from mistakes (hindsight is a wonderful thing) Sharing good practice

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Every good idea has its time

Every good idea has its time

Jill Windle RGN, MSc. FFEN

Lecturer Practitioner in Emergency Nursing


Time to reflect on
Time to reflect on ….

  • Demonstrate achievements (spanning 20 years)

  • Discuss innovations in practice

  • Learning from mistakes (hindsight is a wonderful thing)

  • Sharing good practice

  • Future challenges


Local pressures
Local pressures

  • Fast, fair and convenient access to health care

  • No waiting!

  • The right clinician to see the right patient at the right time


Sustaining the ed quality indicators
Sustaining the ED Quality Indicators

  • Achievement required

  • This level of activity is proving difficult

  • Capacity always an issue

  • If we do not work as a team we cannot succeed!




Support roles
Support roles

  • Limited number of Band 3 HCSW

  • Well trained – NVQ Level 3

  • Clear roles & responsibilities

    • Triage – venepuncture, cannulation and ECG

    • Resus - cubicle preparedness, relatives support

    • Transfer facilitator role, safe & efficient transfer and improves time to ward from decision to admit


Developing band 5 role
Developing band 5 role

  • Competency based orientation programme (FEN)

  • Strong mentorship and clinical supervision

  • Structure for achievement – timeframes

  • Triage

  • PGDs

  • Nurse requested X Rays


Obstacles to overcome
Obstacles to overcome

  • Radiology resistance to Nurse initiated X Rays

  • PID / stakeholder involvement

  • ENP & AP primary interpretation

  • AP now CT, MRI range of presentations


Making the most of the change
Making the most of the change

  • February 2010 target reduction of £7.2m set for Salford Healthcare.

  • 2011 closure of all five Walk-in centres

  • New build ED and PCC co-located including GPOOH service

  • Why not use MTS to signpost patients to right clinician, right place at the right time

  • Presentation Priority Matrix (PPM) offered creative solutions (2nd Eds)


Stakeholder engagement

R

O

Y

G

B

Stakeholder engagement

  • ED Consultants

  • Senior ED Nurses

  • Primary Care Nurses

  • GPs

  • Primary Care Physician

  • Emergency Care Practitioners (ECP)


The deflection process
The Deflection Process

  • PPM developed to safely deflect patients from the ED to primary care

  • Run by key practitioners with additional primary care training (ECP)

  • Short consultation

  • Recording of observations but no in-depth physical exam

  • Patient education essential

  • The discussion is more important than the action


Enps band 6 7
ENPs: Band 6 & 7

  • Developing Clinical Skills module

  • Defined presentations managing ambulatory caseload

  • Assess, diagnose, treat

  • Practice guidelines

  • PGDs / NMP

  • Choice for patients


Enp ad hoc practice
ENP ad hoc practice

  • 2 years limited exposure (2009 – 2011)

  • OSCAs reveal retained competence across injury skill set

  • Loss of confidence not competence


Advanced practitioners
Advanced Practitioners

  • A hybrid not a traditional nursing role

  • Masters level - Clinical Practice

  • Trained to high standards using a Bio-Medical model

  • Certainly not a junior doctor substitute

  • Funding?

  • Organisational preparedness

  • Clinical career pathway for Senior nurses


Advanced practitioners1
Advanced Practitioners

  • 1999 1st AP post 2013 = 8 NPs in ED, 6 in PANDA

  • A truly autonomous role

  • Clinical expertise

  • Managing complex clinical case load

  • Non-Medical Prescribers

  • Role models & innovators in practice


Trauma centre status
Trauma Centre status

  • Problem

    • Lack of role clarity

    • Lack of training

  • Structure

    • Team leader

    • Team number

  • Organisation

    • Task allocation

    • Horizontal / vertical activity


Saving lives
Saving lives

  • Experienced team – train together work together

  • 65% nursing staff TNCC trained

  • Team allocation & organisation

  • Inter departmental links


Measuring achievement
Measuring achievement

  • Multi skilled workforce delivering right care to right patient at point of entry

  • Streams of care with designated staffing and expertise

  • Nursing roles – improving patient journey

    • Time to definitive management

    • Patient choice & experience

    • Staff recruitment & retention benefits


Measuring achievement1
Measuring achievement

  • Trauma team developments = improved patient outcomes

  • Improved time to senior clinical decision maker Drs and Aps

  • Continued collaboration, sharing experiences

  • National input across the team, shaping the future


The future of the ed team
The future of the ED team?

  • Continued political directive

  • Driven by a changing workforce

  • Emergency Nurses & Medical staff will be central to change

  • Challenges from NHS & private sector, to deliver treatment & care to patients

  • Ultimately the patients right to choose will shape future healthcare


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