Challenges in POA

1. Challenges in POA Mrs Jane Jackson SRN MPhil MCGI Consultant Nurse Honorary Fellow University of Hertfordshire jane.jackson@whht.nhs.uk

2. 1930’s Consultant led service only for complex surgery Early beginnings – but were they patient centred?

3. How has POA developed? • Day Surgery • 1993 - POA for all patients • Worldwide delivery of care / sharing of knowledge and experience • From Nurse led to Patient Led care possibly as a Nurse run service

4. Shaping of the POA service • Healthcare professionals • Delivery of service, audit, patient survey • e-mail and Internet and networking exchange of POA procedures / delivery of care • www.pre-op.org • Demands for efficiency, lean thinking, lean working • Advances in Day Surgery

5. Life expectancy at age 65 yrs.Life expectancy Source: Office for National Statistics; Government Actuary’s Department Life expectancy at age 65, United Kingdom

6. The most common causes of death in England and WalesAge-standardised mortality rates for selected broad disease groups, England & Wales

7. Department of Health / CNO • Health of the Nation – 1998; • The NHS Plan 2000; • Creating a patient led NHS Delivering the NHS Improvement Plan 2005; • Healthcare Associated Infections 2006 -reduction in the rates of MRSA / C.Diff; • 18-week patient pathway 2006; • Patient Choice 2007; • Healthy weight, healthy lives 2008.

8. Clinical practice • NICE clinical guidelines • European working times directive • For nursing staff, Advanced practice Modernising nursing careers

9. 18 week pathway • 85% compliant in England and Wales by March 2008 • 90+% compliant by Dec 2008 Key words Patient led care Clock starts – referral Clock stops - treatment

10. POA at decision to treat Referral CATS /OPD dtt +/- investigations POA ffs W/L not ffs

11. Challenges of 18 week delivery through one stop POA • Re-organisation of the OPD / POA / admission process • Involves changes for all the surgical division – Consultant, secretary, POA, records. • Primary and Secondary care cohesion • Key – clarity for patient of the 18 week process

12. Benefits of 18 week • Short journey for patient • Lean thinking and lean working • “…the patient receives the right care, at the right time and of the right quality without unnecessary delays.”Delivering the 18 week patient pathway DOH 2007 • Effective use of resources - notes • Appropriate referrals

13. Patient led care through Inter professional teamwork

14. Annual Conference – “A Risky Business” 6th November 2008 at Royal Court Hotel, Coventry Registration: £190 (members of the POA) £225 (non-members) For further details including registration forms, please visit www.pre-op.org or contact meetings@pre-op.org

15. Pre Operative Assessment 2008 • Providing a service for the user • Effective assessment • Location – convenient to the patient

16. Legal aspects Career developments Team leadership IT support Audit Predicting and explaining risk of surgery Developing a POA – face to face and telephone How to set up POA The role of POA in meeting the 18-week pathway A practical guide to developing and running effective pre assessment