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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
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

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?