National Emergency Medicine Programme

Transcription

1 National Emergency Medicine Programme A Guide to Enhance Advanced Nurse Practitioner Services across Emergency Care Networks in Ireland September 2013 Valerie Small RGN,RANP, RNP,RNT MSc, PG Dip CHSE, Nurse Prescribing Cert, AE Cert Emergency Department, St James s Hospital, Dublin ANP Advisor National Emergency Medicine Programme

2 Introduction National Context Key Objectives of ANP Strategy & Approach Taken Current Status Findings - ANP ED Survey & Focus Group Consultation Strategic Plan - Key Recommendations 19/11/2013 Emergency Medicine Programme 2

3 National Context Population 4.5 Million Urban areas = High social deprivation Rural areas = social and geographic isolation / remoteness Predominately publically funded healthcare system Emergency department attendances = 1 million/per annum Emergency department healthcare costs = 196 million/per annum Department of Health / Health Service Executive (HSE) Directorate of Clinical Programmes and Strategy (HSE 2011) National Emergency Medicine Programme Strategy Report (2012) National Framework for Establishment of Advanced Nurse Practitioner Posts Nursing and Midwifery Board registration process for Advanced Nurse Practitioners

4 National Emergency Medicine Programme Overarching Aim: To improve patient safety, quality of care, access and value in Emergency Medicine and reduce waiting times for patients

5 Evolution of ANP (Emergency) 1996 Pilot Programme SJH November 1999 National Council for Professional Development Incremental role development June 2010 National Emergency Medicine Programme [2011] 1998 Commission on Nursing Report 2001 NCNM Framework 1 st ANP Accredited Prescribing Med /X-ray 2011 EMP Strategy Report Models of Care 2012 Strategy Report Launched 2012 EMP Implementation ANP Capacity Building Strategy

6 Three Side Solution to Improve Emergency Care ED Team -Quality Improvement -Model of Care - Standardisation of care National Level -Senior Management -Emergency Care Networks -ICT -Defining Standards & Improved KPIs Patient Care, 6-hour standard, Improved Patient Experience Hospital Management -Monitoring & management -Hospital capacity

7 Emergency Department Team Quality Improvement 6 Hour Target (Total patient experience time) Model of Care Senior clinical decision makers Workforce Models Standardisation of care Standard practice guidelines Competency based job specifications

8 Key Objectives of ANP Strategy Recommend number and location of ANP s required in EDs/ECN in the future Standardise role profile and scope of practice of ANP Standardise recruitment and education pathway ANP Promote continuous professional development for ANP s Sustain ANP delivered services through career and succession planning processes

9 Approach Survey 38 EDs/LIUs survey Number of ANPs ANP Services Scope of practise Candidates Education approval Workshops 4 Regions 73 Participants Themes: Planning Education CPD Career Guidance Communication Report Current Summary Survey & Workshops ANP Posts Service Activity Strategic Plan Workforce projections Job Description Recruitment CPD Implementation

10 Survey Findings Registered ANPs 21 Established ANP Services 43.3 WTEs Out of total Registered Units Nurse Prescribers 1 commenced 36 Nurse Sept 2012 Prescribers of Ionising Radiation 30 ED s Site Approved by NMBI / NCNM 3 ED s currently undertaking site preparation 5 ED s no preparation at present 28 ANPs in Development

11 Location of Advanced Nurse Practitioners in Ireland

12 Service Activity

13 Other Findings Scope of Practice 20 Sites - ANP caseload non-life, non-limb threatening injury & illness (similar to LIU) 1 Site - ANP caseload rapid assessment Advanced Triage Assessment within ambulatory care pathway (RAT) Audit/Research & CPD No standard number of hours allocated to CPD/ Audit/Research nationally Audit & research compete with clinical demands Variation across sites from no protected time, to maximum of 16 hrs per month Emergency Medicine Programme 13

14 Specific Themes from Focus Groups ANP s improve Access, Quality & Value for money Consistency needed related to ANP education programmes inclusion of ionising radiation & medicinal prescribing essential National model/framework for expanding scope, with guidance from NMBI Formal structure required for effective CPD for registered ANP s Career guidance for ED nurses requires central information point & succession planning Communication with key stakeholders through regular formal meetings with senior management.

15 Recommendations : Outline Workforce Plan Emergency Medicine Programme 15

16 Other Recommendations Recruitment National Approach Standard job descriptions Flexibility around scope of practice, rostering and movement ECN Network Grade code for ANP candidate recruitment Succession Planning Succession plan for each ED/ECN to sustain ANP services into the future Active PDP for all ED nurses Use of EMP website to support career guidance and provide expert advice on career pathway options CPD CPD NMBI requirements Nurses & Midwives Act Standardised CPD framework-expanding scope of practice & changing needs Clear governance - clinical supervision, peer review, hours research & audit. Clinical & academic partnerships encouraged Education Education programme must meet NMBI Requirements Programme content - needs of clinical caseload Nurse prescribing ionising radiation & medicinal prescribing should be incorporated as standard. Emergency Medicine Programme

17 Consultation & Implementation Strategic Level Department of Health & Office of Nursing & Midwifery Services Director Director of Clinical Strategy & Programmes HSE Integrated Services Directorate / HSE Recruitment & HR Regional Director of Operation s Hospital CEO s/trust Managers Directors of Nursing Clinical Directors Nursing and Midwifery Board of Ireland Emergency Medicine Programme Working Group / Advisory Group ENIG DONM Reference Group Registered ANPs & ANP candidates Service Level EMP Regional Lead ECN Nursing management Clinical Operations Group Microsystems 17

18 JUNE 2013 Strategy Publication/Launch A Guide to Enhance Advanced Nurse Practitioner Services across Emergency Care Networks in Ireland

19 Progress to Date 6 Registered ANP s in Sept 2013 = 51 total ANP(E) 4 registered by end of year (10/17.5) Site preparation St Lukes, Kilkenny. MRH Portlaoise / Tullamore National Forum ANP s - EMP Agreed Terms of Reference ANP Forum Committee selected Work streams commenced Standard National Job Specifications ANP (Adult, Adult/Children, Children) currently with HR HSE

20 Innovation Award in Advanced Practice Nursing 2 nd International Congress Advanced Practice Nursing & Advanced Nursing Practice- Berlin 2013 Recent Achievements

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22 Useful Links HSE Clinical Strategy & Programmes National Emergency Medicine Programme eport2012.pdf Nursing and Midwifery Board of Ireland