Bendigo Health & Bendigo Community Health Services Inc.

Transcription

1 Bendigo Health & Bendigo Community Health Services Inc. Nurse Practitioner Service Plan Collaborative Health Education and Research Centre - Bendigo Health

2 Table of contents Executive Summary Introduction Aim Methodology Literature review Governance Group Working parties Learning Sessions Consultation with clinical units and consumers Liaison with other DHS Nurse Practitioner projects Results...5 Bendigo Health & Bendigo Community Health Services Inc. Nurse Practitioner Service Plan...7 Introduction... 7 Vision... 7 Mission... 7 Our goals are:... 7 Goal 1: Governance...9 Objective Objective Goal 2: Policy framework...10 Objective Objective Objective Goal 3: Communication and marketing strategy...11 Objective Objective Goal 4 Education and mentoring framework...11 Objective Objective Goal 5 Integration of the Nurse Practitioner role into existing services...13 Objective Objective Objective Goal 6 Spread and sustainability...14 Objective Objective Objective Objective Goal 7: Identification of Nurse Practitioner roles...15 Objective Objective Goal 8: Research...16 Objective Objective Goal 9 Credentialing...17 Goal 10 Leadership...18 Objective Objective Objective Suggested areas for implementation of the Nurse Practitioner role Appendix 1. Nurse Practitioner Governance Group Terms of Reference...20 Appendix 2. Communication strategy...22 Appendix 3: Generic Nurse Practitioner Candidate Position Description...25 Appendix 4: Appointment process...29 Appendix 5: Expression of interest template...30 Appendix 6: Full submission template...36 Appendix 7: Credentialing policy...56 Appendix 8: GP referral policy & procedure...57 Appendix 9: Chronic care coordinator referral policy & procedure...59 Appendix 10: HITH referral policy & procedure...61 Appendix 11: Outpatients clinic referral policy & procedure

3 Appendix 12: Specialist referral policy & procedure...66 Appendix 13: Admission to hospital procedure...69 Appendix 14: Discharge from hospital procedure...71 Appendix 15: Medication prescribing policy & procedure...74 Appendix 16: Ordering pathology procedure...78 Appendix 17: Ordering radiology procedure...80 Appendix 18: Terms of reference CPG working party...82 Appendix 19: CPG authorisation tree...84 Appendix 20: Terms of reference education working party...85 Appendix 21: Case review process

4 Executive Summary 1. Introduction Careful planning prior to implementation of the Nurse Practitioner role is a critical step towards successful and seamless integration of this new role into existing health services. This project enabled Bendigo Health (BH) and Bendigo Community Health Services Inc. to develop a readily transferable plan to enable implementation of the Nurse Practitioner role within a large regional health service, smaller outreach services and in a community health setting. The implementation plan will be sustainable after completion of the project and will form the foundation for operationalising the Nurse Practitioner role within the two organisations and sustaining and extending Nurse Practitioner roles in BCHS. The Service Plan was designed to be readily transferable to other organisations in the rural and regional settings. BH and BCHS collaborated to develop a service plan that enables both organisations to implement and sustain the role of the Nurse Practitioner into existing health services. BH was the lead agency for this project and BH s Collaborative Health Education and Research Centre (CHERC) managed the project. CHERC is a business unit of BH. Collaboration between these key health service providers in Bendigo was seen as critical to the development of a service plan that supports implementation of the Nurse Practitioner role. The development of a service plan that embraces both acute and community health providers will enhance provision of seamless care across the continuum. Recruitment and retention of nurses in rural and regional areas is widely recognised as an ongoing challenge and one that is compounded by rural issues such as geographic isolation. Similar challenges face recruitment and retention of rural general practitioners leading to limited access for to a broad range of health services. BHCG and BCHS support the idea that development and implementation of the Nurse Practitioner role is an innovative strategy that will provide an incentive for nurses to move to rural and regional locations for employment opportunities and remain there. This will assist in alleviating some of our workforce issues. 2. Aim The aim of this project was to develop a service plan to implement and sustain the Nurse Practitioner role within Bendigo Health Care Group and Bendigo Community Health Services Inc. that will assist in strengthening the capacity of the health system and be readily transferable to other health services. 3. Methodology Action research was used as the theoretical framework for this project. Action research was selected as it is designed specifically to bridge the gap between theory, research and practice and involves collaboration between researcher and practitioner in finding a solution to a practical problem. To compliment and assist in achieving optimal outcomes change management principles were adopted throughout this project. 3.1 Literature review Current literature was reviewed in relation to Nurse Practitioners and health service planning to identify models of best practice in the development, sustainability and 4

5 implementation of the Nurse Practitioner role in the acute and community health settings. 3.2 Governance Group A Governance Group with representatives from key stakeholder groups was convened to provide project guidance and support. Ms Clare Turner (BH), and Ms Karen Riley (BCHS) acted as chief advisors to the project. 3.3 Working parties Two working parties were convened during the project and each had specific portfolios related to the key outcomes for the service plan. The two working parties that were convened were the Peer Review and Clinical Practice Guideline Working Parties. 3.4 Learning Sessions A series of three plan, do, study, act cycles were conducted throughout the project and each cycle was punctuated by a learning session. Learning sessions facilitated communication between key stakeholders and enabled the service plan to be developed, refined and finalised. 3.5 Consultation with clinical units and consumers Consultation with clinicians from all areas and disciplines in both BH and BCHS was ongoing throughout the project and enabled opportunities to comment on the development of the Nurse Practitioner service plan. Links were formed with consumer groups to enable provision of information in relation to Nurse Practitioner activities within the two organisations. 3.7 Liaison with other DHS Nurse Practitioner projects Links were formed with other DHS Nurse Practitioner projects and learning was shared and findings disseminated between the groups. Close links were also maintained with DHS Nurse Policy Branch to enable project information to flow. 4. Results The Governance Group meet monthly throughout the project and was responsible for providing support and direction for the project. A communication strategy was developed by the project team and aimed to engage and inform key stakeholders and enable successful and implementation and sustainable outcomes. The communication strategy was implemented by members of the Governance Group and project team to assist in dissemination of project information during the Scoping project. Two working parties were convened to assist in development of the service plan in relation to objectives outlined in the project submission. The purpose of the Clinical Practice Guideline Working Party was to facilitate the development of clinical practice guidelines for Nurse Practitioners. The Nurse Practitioner Candidate Peer Review Working Party was developed to support Nurse Practitioner Candidates working towards endorsement form the Nurses Board of Victoria. A total of eighty key stakeholders participated in the three Learning Sessions and included representatives from across BH and BCHS. Senior managers from surgical and medical services, clinicians and allied health services were represented at the workshop. 5

6 Learning Session participants identified key areas that may benefit from the implementation of the role and commenced discussions on the issues that may be barriers to implementing this role, for example clearly identifying the scope of practice for the Nurse Practitioner. A number of small work groups were assembled from the areas identified during Learning Session 1 for implementation of the Nurse Practitioner role. These sessions were facilitated the Project Manager and were conducted over an hour. A number of distinct areas were identified during Learning Session 1 as having potential to develop into a Nurse Practitioner role these are included in Section 11 of the Service Plan. Data collected during the consultation process was analysed and presented at Learning Sessions 2 and 3, the Governance Group and Working Party meetings. This data informed the development of the Service Plan. 6

7 Bendigo Health & Bendigo Community Health Services Inc. Nurse Practitioner Service Plan Introduction Although Nurse Practitioners are not new to health care systems, the concept is relatively new to Victoria. The introduction of a new role to any organisation, particularly one that requires changes to existing models of care and work practices creates a certain sense of insecurity to working teams. It is for this reason that careful planning prior to implementation of the Nurse Practitioner role is a critical step towards successful and seamless integration of the new role into existing health services. This service plan will enable Bendigo Health (BH) and Bendigo Community Health Services Inc. to implement the Nurse Practitioner role within a large regional health service, smaller outreach services and in the community health setting. The service plan will enable the Nurse Practitioner role to be implemented and sustained by using a systematic approach that is based on change management principles. The Service Plan was designed to be readily transferable to other organisations in rural and regional settings. Vision To integrate the Nurse Practitioner role into the health system to enhance services in Bendigo. Mission To design an effective strategic plan for introducing and sustaining the Nurse Practitioner role into Bendigo Health and Bendigo Community Health Services Inc.. Our goals are: 1. To develop a clinical governance structure that supports the introduction and development of the Nurse Practitioner role. 2. To develop systems that enable identification and prioritisation of areas where there is potential to develop a Nurse Practitioner role. 3. To develop a policy framework that supports the Nurse Practitioner role in BH and BCHS. 4. To develop a communication and marketing strategy. 5. To develop an education and mentoring framework that supports the Nurse Practitioner role. 6. To support the integration of the Nurse Practitioner role into existing health services and to align the role with the business plan of the clinical unit and the strategic plan of the organisation. 7. To enable development of a sustainable Nurse Practitioner program that can spread across different aspects of the health services. 8. To develop a Nurse Practitioner research agenda. 9. To recognise the importance of formal and regular credentialing of Nurse Practitioners to ensure that all Nurse Practitioners practice within 7

8 a framework of competence and safety. 10. To support Nurse Practitioners to develop leadership skills that are in line with the practice area in which they are applying for endorsement and will meet the requirements of the Nurses Board of Victoria. 8

9 Goal 1: Governance To develop a Clinical governance structure that supports the introduction of the Nurse Practitioner role. Objective 1.1 Establish a Nurse Practitioner Governance Group with representation from key stakeholder groups to provide guidance to Nurse Practitioners across the organisation. Strategies Convene a Nurse Practitioner Governance Group as a sub-set of Senior Nurse Council with the following membership: Executive Director of Nursing (Chair) Nursing Director Surgical Services Nursing Director Medical Services Nursing Director Residential Services General Manager of Primary Health Bendigo Community Health Services Inc. Head of School (Nursing & Midwifery) LaTrobe University Bendigo Area Organiser, ANF Operations Manager, CHERC Project Coordinator Develop Terms of Reference for the Governance Group that include details such as frequency of meetings and quorum. See Appendix 1 for Governance Group Terms of Reference Provide governance for all Nurse Practitioner functions including review and approval of: Expressions of interest to implement a Nurse Practitioner role; Full submission to implement a Nurse Practitioner role (including areas of expanded practice); Policies and procedures developed or modified to incorporate the Nurse Practitioner role; Clinical practice guidelines developed for the Nurse Practitioner role; Conference Presentations relating to the Nurse Practitioner role; Education and mentoring activities; Support structures; Research activities and Publications relating to the Nurse Practitioner role. Objective 1.2 To ensure evolving Nurse Practitioner roles link to the Nurse Practitioner Service Plan and the Organisation Wide Strategic Plan. Strategies The Governance Group will oversee the development of expanded practice activities for Nurse Practitioner roles within the organisation to ensure these link with the Nurse Practitioner Service Plan and 9

10 Organisation Wide Strategic Plan The Governance Group will determine the time frame for completion of all aspects of Nurse Practitioner candidate activities that contribute to endorsement as a Nurse Practitioner by the Nurses Board of Victoria The Governance Group will develop a generic position description for a Nurse Practitioner role. (See Appendix 3). Goal 2: Policy framework To develop a policy framework that supports the introduction of the Nurse Practitioner role in BH and BCHS. Objective 2.1 To drive the development of policies, guidelines and processes which support Nurse Practitioner clinical practices so that integration into existing work practices and necessary changes to models of care are undertaken in a way which supports safe and efficient practice. Strategies To undertake an analysis of those areas where policy development and change is required to support the introduction and sustain the Nurse Practitioner role in BH and BCHS Identify those areas where policy development is required to support the introduction of the Nurse Practitioner role (for example admission and discharge of patients, ordering, medications and pathology and radiological tests). See Appendices 5 to 14 for policies developed to date Identify existing policies that require change to support Nurse Practitioner practice Monitor policy development across BH and BCHS to ensure new or modified policies articulate with, and take into consideration the Nurse Practitioner role. Objective 2.2 To utilise the literature and findings from the BH and BCHS Nurse Practitioner projects to inform the development of policies associated with the Nurse Practitioner role. Strategies Analyse the literature and past and present Nurse Practitioner projects for policy implications. Where appropriate, develop policy in response to the information analysed Develop a periodic review system for policies relating to the Nurse Practitioner role. Objective 2.3 Inform and engage key stakeholders in policies relating to the Nurse Practitioner role. 10

11 Strategies Disseminate policy document to key stakeholder's regarding the Nurse Practitioner role Develop a system that includes all key stakeholders in the development and authorisation of policies relating to the Nurse Practitioner role Engage Clinical Effectiveness Unit in the development process for policies relating to the Nurse Practitioner role Disseminate new policy information widely once authorized. Goal 3: Communication and marketing strategy To develop a communication and marketing strategy that informs key stakeholders and enables successful implementation of the Nurse Practitioner role. Objective 3.1 To identify key stakeholders including acute and community health services, health professionals and consumers of health services. Strategies Develop a communication strategy that takes into account different opinions and perspectives enables information to be disseminated to key stakeholders in a systematic and comprehensive way Scope service area for key stakeholder groups including other health service providers (medical, nursing and allied health), consumer groups and Nurse Practitioner special interest groups Review Communication Plan annually (or as required) and update contents so that they are consistent with current activities. Objective 3.2 Provide all key stakeholders with current information regarding the role of the Nurse Practitioner. Strategies Develop presentations and information packages (including posters, brochures, and oral presentations) that explain the role of the Nurse Practitioner and Nurse Practitioner candidate for different audiences (for example health professionals, consumers and media organisations) Form links with community advisory committees and community groups and present to these groups on a regular basis Identify appropriate forums in which to present information about the Nurse Practitioner role to colleagues Respond to invitations to address forums in a timely manner. Goal 4 Education and mentoring framework To develop an education and clinical mentoring framework to support the Nurse Practitioner role that is based on evidenced based best practice. 11

12 Objective 4.1 Develop and implement multidisciplinary Clinical Practice Guideline Working Parties in the service stream where the Nurse Practitioner role is being developed. The working parties will assist in the development and verification of Clinical Practice Guidelines for Nurse Practitioners (See Appendix 19 for Terms of Reference for the Clinical Practice Guideline Working Party). The working parties will report to the Nurse Practitioner Governance Group. Strategies Convene a Clinical Practice Guideline Working Parties that comprises of the following members: Nursing Director (from applicable service stream) Nurse Unit Manager (from applicable Department) Department Clinical Director Department Specialist (Fellow of the applicable Specialist College) Nurse Practitioner/Nurse Practitioner Candidates Director of Pharmacy Director of Pathology Manager of Medical Imaging The working parties will review Clinical Practice Guidelines and protocols and ensure they are developed using evidence based best practice and integrate with other organisational policies, procedures and clinical practice guidelines The Clinical Practice Guideline Working Parties will facilitate multidisciplinary communication through monthly meetings and enable the Nurse Practitioner to have access to a multidisciplinary team of experts Identify and engage clinical mentors (senior clinicians) to work with Nurse Practitioners Develop a Clinical Practice Guideline Authorisation Tree that enables all key stakeholders to review and have input into Nurse Practitioner clinical practice guidelines prior to implementation (See Appendix 20 for Clinical Practice Guideline Authorisation Tree) Review Clinical Practice Guidelines and progress in line with Clinical Practice Guideline Authorisation Tree. Objective 4.2 Develop and implement an Education and Mentoring Working Party that reports to the Nurse Practitioner Governance Group and aims to support the education components of the Nurse Practitioner role and enable the Nurse Practitioners to develop new skills and have access to senior nurses for advice and assistance. Strategies The Education and Mentoring Working Party will comprise of senior nurses and nurse education experts with the aims of supporting Nurse Practitioner s /Nurse Practitioner Candidates by: Linking with current education programs; Identifying appropriate scholarship opportunities; Establishing networks of Nurse Practitioners to act as mentors for Nurse Practitioner Candidates as they commence in the organisation; Establishing a case review process that focuses on reflective practice (See Appendix 22 Case Review Process); Providing education mentors to support the Nurse Practitioner Master level education; 12

13 Developing an forum group to enable access to opinions from external agencies members of the Working party and Governance Group between scheduled meetings and Providing education to Nurse Practitioners/Nurse Practitioner Candidates in clinical and management systems. For example many nurses who are clinical experts have not had exposure to management systems (including funding structures, policy development or committees) Develop Terms of Reference that reflect the aims and objectives of the working party (See Appendix 21 for Terms of Reference for the Education and Mentoring Working Party) Develop a Nurse Practitioner Candidate Case Review Group with the aim of providing professional support to Nurse Practitioners and Nurse Practitioner Candidates in the clinical areas and to expand the clinical inquiry and skills of nurses working in sites external to the main campus Develop a clinical education program that addresses the learning needs of the Nurse Practitioner Candidates in collaboration with senior medical and nursing staff Develop an forum to enable access to opinions from external agencies members of the Working Party and Governance Group between scheduled meetings Identification and development of cadre of nurses who are eligible to enter Nurse Practitioner Candidate training, who practice at an advanced level and focus on clinical excellence, and have a demonstrated interest in Nurse Practitioner status. Goal 5 Integration of the Nurse Practitioner role into existing services To support the integration of the Nurse Practitioner role into existing health services and to align the role with the business plan of the clinical unit and the strategic plan of the organisation. Objective 5.1 To provide timely communication with all key stakeholder groups regarding the Nurse Practitioner role prior to its introduction in specific clinical units. Strategies Utilise the communication strategy (developed as strategy under Goal 3 See Appendix 2) as a guide to the distribution and depth of material presented to the various stakeholders Evaluate the effectiveness of the information presented Review information in light of the evaluation process and continue to maintain open communication processes. Objective 5.2 To use a multidisciplinary "implementation team" approach to identify and implement the Nurse Practitioner role into the clinical unit. Strategies Convene a multidisciplinary team with representatives from nursing, medicine and allied health disciplines and management representatives Appoint a team leader to "champion" implementation of the new role 13

14 into existing services Develop shared goals between the "implementation team", unit managers and staff working on the unit Align shared goals of the implementation team with the business plan of the clinical unit and the strategic plan of the organisation Review implementation planning process and goals to ensure alignment with the units' business plan and strategic plan of the organisation. Objective 5.3 Develop an Expression of Interest (EOI) and Full Submission (FS) process to submit to Group Executive that identifies potential Nurse Practitioner roles. The EOI will identify clearly the new Nurse Practitioner role and outline the benefits of implementing the role. A costing model that includes identification of funding to support the position will be completed as part of the FS document. Strategies Develop Expression of Interest (EOI) and Full Submission (FS) templates for development of a Nurse Practitioner role (See Appendices 19 & 20) for EOI and FS templates) Develop a system for the Nurse Practitioner Governance Group to review EOI and FS for development of a Nurse Practitioner position Develop an education package that accompanies the process Provide education to clinical units who express an interest in developing, or have identified a potential Nurse Practitioner role Develop an infrastructure within the organisation to manage the EOI and FS processes for the Nurse Practitioner role. For example, the Nurse Practitioner Governance Group will act as a filter for EOl's and FS prior to linking in with standard operational processes within the organisation for implementation of new roles within the health service. See Appendix 4 Appointment Process for Nurse Practitioners Nurse Practitioner Governance Group will provide written feedback to units considering the development of a Nurse Practitioner role Monitor and review the EOI and FS templates and processes to ensure currency and timely response to proposals submitted to the Nurse Practitioner Governance Group for consideration. Goal 6 Spread and sustainability To enable development of a sustainable Nurse Practitioner program that can spread across different aspects of the health service. Objective 6.1 To develop and maintain effective and sustainable Nurse Practitioner roles within BH and BCHS. Strategies Build a clinical unit level financial review process into the EOI proforma and FS document Complete a full costing for a Nurse Practitioner position to the organisation (including clinical education provided to candidates) Conduct a cost benefit analysis for the Nurse Practitioner role Develop a system for monitoring the costs associated with implementing a Nurse Practitioner role. 14

15 Objective 6.2 Review opportunities to provide input into funding decision making. Strategies Maintain links with DHS on a regional level (LMR) and in metropolitan Melbourne via Nurse Policy Branch and Workforce Planning Branch. Objective 6.3 Develop and maintain strategic alliances with DHS and other potential funding bodies. Strategies Attend DHS meetings as required Examine funding opportunities for research and development for the Nurse Practitioner role including State and Federal sources and including workforce planning and quality improvement grants Examine potential joint submissions with LaTrobe University Respond to funding rounds as appropriate. Objective 6.4 Develop a generic evaluation framework for the Nurse Practitioner role that indicates the general efficacy of the role. Strategies Develop a template to collect relevant data that will support the efficacy of the Nurse Practitioner role and includes items such as: Timeliness of treatment (reduced time to treatment and discharge); Quantity of treatment (increasing number of patients seen); Quality of treatment (no increase in adverse events, no decrease in patient satisfaction) and Cost of treatment (decreased cost per treatment) Analyse data to monitor performance of role and compared to alternative treatment models Collect and analyse variance data associated with Clinical Practice Guidelines and Nurse Practitioner policies and procedures Modify systems in collaboration with key stakeholder groups in response to variance reporting. Goal 7: Identification of Nurse Practitioner roles To develop systems that enable identification and prioritisation of clinical areas where there is potential to develop the Nurse Practitioner role. Objective 7.1 Identify clinical areas suitable for the implementation of the Nurse Practitioner role. Strategies Prioritise the roles through examination of: Data (including clinical and patient outcome data); 15

16 Process mapping on the clinical unit; Potential to streamline service; Potential cost benefits and Potential to improve patient satisfaction Convene a multidisciplinary implementation team as described in Section Identify areas where the role of a Nurse Practitioner may be clinically beneficial through consultation with key stakeholders at the clinical unit level. Objective 7.2 To utilise the EOI and FS templates to initiate the process of implementing the Nurse Practitioner role. Strategies Goal 8: Research Utilise EOI template as a guide to assist prioritisation of potential Nurse Practitioner role and submit completed template to the Nurse Practitioner Governance Group for comment and recommendation to complete and FS Utilise Full Submission template to refine further the potential Nurse Practitioner role identified by the clinical unit and submit to the Nurse Practitioner Governance Group for recommendation to complete HR 1 (See Appendix 4 Nurse Practitioner Appointment process). To develop a Nurse Practitioner research agenda that supports the development of a Nurse Practitioner portfolio suitable for submission to the Nurses Board of Victoria. According to the Nurses Board of Victoria, research activities include, but are not limited to, journal reading and journal club, membership of research committees, program evaluation, quality improvement activities and future and current plans for research. Objective 8.1 Integrate evidence based best practice into Nurse Practitioner clinical practice guidelines. Strategies Review literature to collect evidence that supports Nurse Practitioner Clinical Practice Guidelines Liaise with clinical experts via Clinical Practice Guideline Working Party to seek verification of best practice Utilise Clinical Practice Guideline Authorisation Tree to gain authorisation of all Clinical Practice Guidelines. Objective 8.2 Develop a Nurse Practitioner research strategy by facilitating independent Nurse Practitioner research agendas that are in line with the operational and strategic directions of BH and BCHS and the clinical area in which the Nurse Practitioner is working. 16

17 Strategies Nurse Practitioners to develop and review the Nurse Practitioner Research agenda annually in collaboration with the Nurse Practitioner Governance Group and members of sub-committees of that group the Clinical Practice Guideline and Education and Mentoring Working Parties Provide support for Nurse Practitioners to develop a research agenda that includes links to the LaTrobe University Clinical School and other research faculties within BH for example CHERC and the Centre for Rural Mental Health Enable Nurse Practitioners to hold joint appointments between BH and LaTrobe University. Subject to organisational approval Identify potential research ideas, develop research proposals and identify potential partners and funders in collaboration with members of the Nurse Practitioner Governance Group Develop submissions for funding Nurse Practitioner research proposals Publish Nurse Practitioner research and development activities in relevant peer reviewed journals in collaboration with LaTrobe University School of Nursing and present at relevant conferences and scientific meetings. Goal 9 Credentialing To recognise the importance of formal and regular credentialing of Nurse Practitioners to ensure that all Nurse Practitioners practice within a framework of competence and safety Objective To develop a policy and procedure for credentialing Nurse Practitioners within the organisation that supports organisational processes by reducing clinical risk. Strategies Develop a credentialing policy that ensures all Nurse Practitioners practice within a framework of competence and safety (See Appendix 7 for Draft Nurse Practitioner Credentialing Policy) Develop a credentialing policy to set out the way credentialing and an approved scope of clinical practice are determined for an individual Nurse Practitioner undertaking independent practice Develop a credentialing policy to provide for an approved scope of practice Develop a credentialing process that supports the Nurse Practitioner credentialing policy Amend relevant organisational policies to incorporate the Nurse Practitioner credentialing process as outlined in the organisation s Credentials Committee Terms of Reference to include relevant sections of the Nurses Act (1993) and the Drugs, Poisons and Controlled Substances Act (1991) The Organisation s Credentials Committee advises the Chief Executive of the outcome of the credentialing process for all Nurse Practitioner staff Qualifications of the candidate seeking credentialing must be verified by the Credentials Committee before any offer of a position is made. 17

18 Review and monitoring of compliance Ongoing compliance for all Nurse Practitioner staff is monitored through supervision and performance review processes. Goal 10 Leadership To support Nurse Practitioners to develop leadership skills that are in line with the practice area in which they are applying for endorsement and will meet the requirements of the Nurses Board of Victoria. Clinical and health care system leadership skills will be developed. Objective 10.1 Develop mechanisms to support the development of leadership skills into the existing Nurse Practitioner infrastructure. Strategies Link leadership activities with the Nurse Practitioner Education Working Party Link leadership activities with Nurse Practitioner /Nurse Practitioner Candidates research activities Link Nurse Practitioners /Nurse Practitioner Candidates into relevant committees within the organisation and where relevant represent the organisation on external committees and boards (for example Emergency Nurses Association). Objective 10.2 Support Nurse Practitioners to develop leadership skills in the areas of education and research. Strategies Support Nurse Practitioners /Nurse Practitioner Candidates to enable presentation of their education and research activities. Presentations should be to multidisciplinary team members within their department, across the organisation and at national and international conferences where applicable Support Nurse Practitioners / Nurse Practitioner Candidates to ensure their research and education activities link with the strategic plan of the organisation and are linked to quality improvement processes across the organisation. Objective 10.3 To enable Nurse Practitioners to participate actively in the development and/or review of relevant policies. Strategies Engage Nurse Practitioners in relevant committees so that they have an opportunity to have input into the development and/or review of policies relating to the Nurse Practitioner role and other relevant policies such as those that relate to clinical practice. 18

19 11. Suggested areas for implementation of the Nurse Practitioner role. A number of potential Nurse Practitioner roles were identified and prioritised during the development of the Service Plan. Participants were invited to rank the three most important areas to implement the Nurse Practitioner role. Although this list is not conclusive it could be used as an indicator of clinical areas where the role is most needed. Table 1 Suggested areas for implementing the Nurse Practitioner role in order of priority (as described above). Clinical Unit Aged Care Psychiatric Services Oncology Outpatient Rehabilitation Clinic Diabetes Service Hospital Admission Risk Program Anaesthetics Patient Services Palliative Care Critical Care Unit Orthopaedics Inpatient rehabilitation Bendigo Community Health Inc. Home Assessment and Rehabilitation Team (HART) Inpatient rehabilitation (GEM) Continence Service Bendigo Community Health Inc. Nurse Practitioner role identified Aged Care Nurse Practitioner Mental Health Nurse Practitioner Regional Cancer Nurse Practitioner Wound Management Nurse Practitioner Diabetes Nurse Practitioner Respiratory Nurse Practitioner Cardiothoracic Nurse Practitioner Cardiac Rehabilitation Nurse Practitioner Pain Nurse Practitioner Pre-admission Nurse Practitioner Outpatient Nurse Practitioner Palliative Care Nurse Practitioner ICU Liaison Nurse Practitioner Orthopaedic Nurse Practitioner Neuroscience Nurse Practitioner (Stroke) Drug and Alcohol Nurse Practitioner Neuroscience Nurse Practitioner (Cognitive impairment) Aged Care Nurse Practitioner Continence Nurse Practitioner Primary Health Care Nurse Practitioner Youth Health Nurse Practitioner Diabetes Nurse Practitioner Total Nurse Practitioner roles identified 22 19

20 Appendix 1. Nurse Practitioner Governance Group Terms of Reference Nursing Governance Group Extended Scope of Nursing Practice Projects TERMS OF REFERENCE TITLE: Nursing Governance Group PURPOSE: To provide leadership to the BH Extended Scope of Nursing Practice RN Div 1 Projects. OBJECTIVES: To identify and agree on key priorities for the project To oversee the implementation of the projects To monitor the performance and outcomes of the project To report to the BH Group Executive and other relevant boards and committees regarding project progress and outcomes To agree on the role definitions for extended/expanded scope of practice eg Clinical Nurse Consultants and Nurse Practitioners at BH Identify and review guidelines and protocols KEY PERFORMANCE INDICATORS: Regular attendance at meetings Members have a clear understanding of the project/s Project/s in line with original plan, including budget and timeframe MEMBERSHIP: BHCG Executive Director of Nursing (Chair) Nursing Director Surgical Services Nursing Director Medical Services Nursing Director Residential Services General Manager of Primary Care, Bendigo Community Health Inc. Head of School, Latrobe University Bendigo ANF Area Organiser Operations Manager, CHERC Project Coordinators DURATION OF MEETING: 1.5 hours FREQUENCY OF MEETING: Once per month, to be reviewed after first 6 months of the project QUORUM: Half the membership plus one. TERM OF COMMITTEE / PROJECT TEAM Until project is completed REPORTING TO: BHCG Executive, via Senior Nurse Council 20

21 Department Human Services REPORTING MECHANISM: Periodic reports to BHCG Executive Reports as required by Department of Human Services to fulfil project requirements APPROVED:.. (Title) COMMENCEMENT DATE: ANNUAL REVIEW DUE: (date) 21

22 Appendix 2. Communication strategy Communication Strategy-Nurse Practitioner Aim The aim of the communication strategy for the Nurse Practitioner projects is to engage and inform key stakeholders to enable successful and sustainable implementation and outcomes from each project. Principles Identifying and engaging stakeholders Preparing appropriate type, depth, and quantity of information to provide to stakeholders Agreement on project progress and outcomes Valuing different opinions and perspectives Establishing key messages that are consistent Flexible processes that can accommodate change Understanding and use of a common language Transparency in communication and consultation Active listening Methods Informal: Face to face discussions / personal communication Telephone Patient handover Information poster Formal: 1. Print media Newsletters (i.e. Bendigo Health News, Nursing News, Division of GP s newsletter) Intranet Local newspaper (via Public Relations Manager) Professional journals 2. Organisational Committees and Work Groups: Nurse Practitioner Governance Group Sub-Acute, Ambulatory, and Community Services Change Planners Group Patient Access Committee Senior Nurse Council Consumer Reference Group Heads of Department Medical and Surgical Services Heads of Department Group Pharmaceutical Advisory Committee Group Clinical Standards Committee Information Security Committee Information Standards Committee Health Information Services 3. Organisational meetings: Group Executive Medical/Surgical Senior Management Group Psychiatric Services Senior Management Group Group Business Managers Clinical Risk Management 22

23 Quality Care Council Consumer Advisory Council Group Staff Development Quality Representatives Ambulatory Care 4. Business Unit Meetings and team meetings Collaborative Health Education and Research Centre Clinical Effectiveness Unit Emergency Department Unit 5. Professional group meetings: Senior Nurse Council SNC Nursing Education Senior Allied Health Council Union Consultative Committees Visiting Medical Officers Group Meetings Staff Specialists Group 6. Consumers Acute (Medical & Surgical Services) Consumer Reference Group Residential Consumer Reference Group Veterans Affairs Focus Group Poster in ED 7. Department of Human Services Meetings: Department of Human Services (DHS) Nurse Policy Branch and Workforce design strategy meetings project manager meetings. 23

24 Nurse Practitioner Projects Communication plan Reporting to Information required Frequency Medium By whom Achieved/ Personnel BH Group Executive BCHS inc. Executive Team Key milestones achieved, identified barriers / risks to project progress and proposed contingency plan Monthly and as required Written report and meetings & as required Governance Group members Project Manager & Officer /Date Governance Group CHERC manager Operations BH Emergency Department Clinical Managers (Director, Senior Doctors, NUM & A NUM s) Clinical Unit Managers and staff of nominated service areas Acute, Subacute, Psychiatric Services and BCHS inc. executive managers, and medical staff, SMG, Senior Nurse Council Key milestones of three projects, project and project management strategies. Including all proposed project activities. Project progress, risk management strategies, and key milestones Project progress, risk management strategies, and key milestones Project progress & outcomes Monthly & as required Weekly & as required Monthly & as required Monthly and as required Governance Group meetings, phone, , face to face meetings, intranet, meetings & . Meetings, phone, , reports Senior Doctors meetings, ACN Meetings, phone, Formal and informal meetings, SMG reports, phone, , intranet, information brochures & posters CHERC Operations Manager, Project Officer, Project Manager & Relevant members of Governance Group. Project Manager & Officer Project Officer, CNC, ED NPC Project Team Visiting Officers Medical Project progress & outcomes Twice throughout project Formal meetings Project Team and Emergency Department Physician / Director. Other interested parties Consumers, staff at BH, partnership organisation (BCHS inc) Project progress and outcomes As required at a minimum quarterly Intranet, internet, newspapers, newsletters, meetings, posters and information brochures. Project officer & Project Team (Adapted from Dwyer, Stanton, and Thiessen, Project Management in Health and Community Services, 2004 and Inpatient Rehabilitation Patient Centred Care Project Communication Strategy 2005) 24

25 Appendix 3: Generic Nurse Practitioner Candidate Position Description GENERIC POSITION DESCRIPTION FOR NURSE PRACTITIONER ROLE IMPLEMENTATION DESIGNATION: REPORTS TO: DATE: NURSE PRACTITIONER CANDIDATE Nurse Manager Clinical Department XXXXXX Purpose of Position Within an action research framework to trial and define the role of Nurse Practitioner in Bendigo Health Care Group s XXXX Department. To work towards attaining Nurse Practitioner status by meeting the Nurses Board Victoria eligibility requirements. Key Activities 1. Specific Responsibilities To provide care to a select groups of patients within a framework of approved clinical practice, in collaboration with relevant medical staff, within BHCG policies and procedures and the Nurses Board of Victoria Nurse Practitioner Competency Framework. To collaborate with other like services to develop evidence based clinical practice guidelines and medication formulary to enable implementation of the extended role. To work collaboratively with the Nurse Practitioner Governance Group to: define the role of the Nurse Practitioner in the XXXX Department utilise change management strategies to integrate the extended roles of nursing practice in the XXXX Department communicate with and engage key stakeholders in the process of integrating the new nursing role participate in relevant internal and external committees and working parties assist with evaluation of the new role 2. Organisational Responsibilities To practice within the philosophies and policies of Bendigo Health Care Group Participate in team/departmental meetings and other organisational meetings as required Participate in staff development and training as required Maintain accurate records, statistics and reports as needed Participate in service development as required 25

26 Position prerequisites Current registration as a Div 1 Registered Nurse with the Nurses Board Vic. Post graduate qualifications in nursing speciality and Hold or working towards a relevant Master of Nursing, including Nurse Practitioner mandated studies Extensive clinical experience in a speciality nursing field is essential Award Nurses Victorian Health Services Multi-Employer Agreement Nurses Victorian Health Services Award Registered Nurses commencing a Nurse Practitioner Candidate role will be paid their substantive salary during their candidature. Hours A minimum of 24hrs per week Performance Appraisal After the two (2) month probationary period Annually thereafter, unless required earlier. Occupational Health & Safety Each employee has the right to a safe working environment and s/he should advise the supervisor of any risk or condition likely to result in accident or injury. Each employee has the responsibility to cooperate with the Group s OHS policies and to participate in appropriate safety education and evaluation activities. Infection Control Each employee has a responsibility to minimise exposure to incidents of infection/cross infection of residents, staff, visitors and the general public. This minimisation can be most effectively achieved by all staff adhering to the policies and procedures as set out in the Group s Infection Control Manuals. Disaster or Emergency Responsibility Bendigo Health Care Group is the principal regional health provider in the event of disaster and emergency. The occupant of this position understands and acknowledges that he/she may be required to work as assigned if requested to meet the Group s responsibilities in a disaster or emergency situation. Quality Improvement Each employee has a responsibility to participate and commit to ongoing quality improvement activities using the EQuIP (Evaluation and Quality Improvement Programme) model. Workplace Harassment & Bullying 26

27 Bendigo Health Care Group adopts and applies the Victorian State Government Code of Conduct. Each employee has the right to a work environment free from any form of workplace harassment and bullying. From an employee s orientation and throughout their employment, each employee must apply BHCG policy and participate in education and training. BHCG Policies & Procedures Bendigo Health Care Group policies and procedures are fully set out in the Group s clinical and managerial policy manuals located on the BHCG intranet and in hard copy held on all departments/units. It is the responsibility of each employee to familiarise themselves with these policies especially those in the Human Resources Handbook. Confidentiality Policy Each employee has a responsibility to comply with the Group s Confidentiality Policy, as it is a condition of employment. Any breach of the Confidentiality Policy will result in disciplinary action and/or dismissal and a possible fine under the conditions of the Health Services Act (Vic). Key Selection Criteria KSC 1 KSC 2 KSC 3 KSC 4 KSC 5 KSC 6 KSC 7 KSC 8 KSC 9 KSC 10 KSC 11 Current registration as a Registered Nurse Division 1 with the Nurses Board of Victoria. A clinically relevant Masters level of nursing qualification (or working towards) Completed the therapeutic medication management module at an approved university (or working towards) A commitment to seek endorsement by the Victorian Nurse s Board as a Nurse Practitioner A minimum of 3-5 years clinical experience post specialist qualification, and evidence of working at a level of advanced practice in the clinical area Active involvement in research, publication, teaching, quality improvement and best practice activities Clinical leadership, collaboration and professional role modelling skills A focus on best patient outcomes within a multidisciplinary team High level interpersonal and communication skills across a broad range of health professionals A conceptualisation of the Nurse Practitioner model that is patient centred and within a nursing model of practice The capacity to be critically reflective 27

28 KSC 12 An understanding of and sensitivity to the political dimension of developing the Nurse Practitioner role and an ability to promote the role in a positive manner Authorised by (Executive Director of Nursing) Date Reviewed 28

29 Appendix 4: Appointment process If accepted, organisational new position process followed Complete HR 1 form (sign off by Operations manager, Executive Director, to Group Executive for approval of position by Chief Executive) Full Submission considered by Senior Nurse Council & accepted or rejected with feedback to author Multidisciplinary team complete and submit Full Submission to Senior Nurse Council If accepted an invitation for a Full Submission is extended Expression of Interest considered at Senior Nurse Council & supported or rejected with feedback to author On positive advice from Executive Director Nursing, Director & EDON Multidisciplinary team convened (NUM, Medical, Allied health and nursing clinicians) Draft EOI to Executive Director of Stream and EDON Identification of potential Nurse Practitioner role in clinical setting 29

30 Appendix 5: Expression of interest template EXPRESSION OF INTEREST NURSE PRACTITIONER ROLE The Nurse Practitioner role extends current clinical nursing practice, is advanced, with a strong foundation in knowledge, skills and competencies 1 In Victoria their practice extends the nursing role outside of the current scope of practice for a registered nurse in limited prescribing and at least one other of the following areas: initiation of diagnostics referral to medical specialists admitting and discharging privileges approval of absence of work certificates 2 The Nurse Practitioner role is the apex of clinical nursing practice. The role requires a highly experienced Registered Nurse with a clinically relevant Masters Degree (or working towards the same), to work autonomously and collaboratively in an expanded clinical role that continues to have a nursing focus. There is an expectation that the Nurse Practitioner will contribute actively to research, publication, teaching, quality improvement and other activities that indicate a high level of leadership and clinical expertise. In order for the Bendigo Health (BH) Senior Nurse Council to respond to and prioritise areas for the development of Nurse Practitioner roles across the organisation, a two stage process has been developed. Stage 1. Expression of interest. It is important that prior to completing the Expression of Interest form, consideration is given to the criteria for Stage 2 (attached). This will ensure you will be able to adequately address these criteria if you are invited by the SNC to complete a more detailed submission. There is also an expectation that the following will have occurred: a. Discussion regarding the proposed role with the Stream Executive Director, EDON and relevant Nursing Director. b. Information from the Nurses Board Victoria website is accessed and understood. Follow the links to Nurse Practitioner information under Frequently asked Questions. Stage 2. Submission for a Nurse Practitioner role (To be completed at the invitation of BH Stream Executive Director, EDON) Resources Australian Nursing and Midwifery Council (ANMC) National Competency Standards for the Nurse Practitioner, Jan The Nurses Board Victoria also offers regular information workshops for potential candidates. Details can be found on their website. 30

31 References 1. Department of Human Services (2000) Victorian Nurse Practitioner Project: Final Report of the Taskforce, Melbourne 2. Expression of Interest Name of Service Name of Person Completing the Submission Position/Title Phone/Fax address For the proposed Nurse Practitioner Model please provide an attached document that details responses to the following criteria (in no more than 2 pages): a) the current service/model of care (brief outline only). b) the role of the Nurse Practitioner/s in the clinical setting, including the extensions to practice that will be utilised. c) how existing health services will be enhanced or new services will be provided to meet the needs of a patient group or an organisational need, or address a service gap. Examples of anticipated benefits need to include improved service access, costeffectiveness, timeliness of service provision, client satisfaction etc. d) what support there is from key stakeholders for the introduction of this role at this stage. This needs to include an indication of in principle support from key Executive, Managerial and Medical staff, whose signatures are required as part of this Expression of Interest. e) strategies that will allow for funding the Nurse Practitioner model within the existing unit budget, including itemisation of additional costs associated with the development of the model, education and mentoring, which may require a minimum of one day per week of non-clinical time for the initial 12 months, and/or supplementary funding streams. 31

32 Salaries for Nurse Practitioner Roles as of June 2006 are as follows: Nurse Practitioner Candidate Remains at substantive salary Endorsed Nurse Practitioner Year 1. (Grade beds) $ Endorsed Nurse Practitioner Year 2 and thereafter (Grade beds) $ Name of author (print) Signature of author Date Department I have read the above EIO for the development of a Nurse Practitioner role and support the proposed model in principle. I am able to confirm that the development of the role will occur within the existing unit budget as indicated within the proposal or through a supplementary funding option. Stream Executive Director Relevant Nursing Director Date AND Executive Director of Nursing Signature Date Please direct any further queries and forward your response to: Collaborative Health Education and Research Centre Telephone (03) [email protected] Level 3 Anne Caudle Centre Bendigo Health Supported/Rejected Chair SNC Date Feedback to Author Date 32

33 STAGE 2. BENDIGO HEALTH NURSE PRACTITIONER SUBMISSION CRITERIA Stage 2. These criteria are to be completed only at the invitation of the Bendigo Health Senior Nurse Council, following the required approvals of an Expression of Interest. Please note: An example of a completed submission is available from the Collaborative Health Education and Research Centre and may be used as a guide to completing this submission. The accompanying template seeks the following information: 1. THERE IS A DEMONSTRABLE NEED. 1.1 Describe the existing model of care for the clinical area. 1.2 Describe how existing health care services could be enhanced or new services provided, to meet the needs of a patient group, or an organisational need, or to address a service gap? Examples of anticipated benefits need to include improved service access, cost-effectiveness, timeliness of service provision, client satisfaction etc. 1.3 What data/information is there to support the requirement for this change to the health care service? 1.4 In what ways is a Nurse Practitioner the most appropriate health professional to provide this service? 1.5 How would patient/organisational outcomes of the new/expanded service and Nurse Practitioner role be evaluated? Include details of key performance indicators that would be crucial for the new role, and examples of data that would be collected and analysed as part of the evaluation. 2. THERE IS A CLEARLY DEFINABLE SCOPE OF PRACTICE. 2.1 What would be the role of the Nurse Practitioner/s in the clinical setting? Your response needs to address: a) the scope of practice b) the patient presentations to be seen/target patient population c) the extensions to practice required including: - prescribing - initiation of diagnostics - referral to medical specialists - admitting and discharging privileges - approval of absence of work certificates d) the proposed reporting structure 2.2 How would the Nurse Practitioners scope of practice be linked to Clinical Practice Guidelines? 2.3 How would the Nurse Practitioner function within a multidisciplinary team? In your response, consider opportunities for autonomy and collaboration. 2.4 What changes to the current model of care would be required to implement this Nurse Practitioner role? In your response, consider the impact on any existing roles. 2.5 Are there any other Nurse Practitioner Models in an equivalent clinical area? If so, 33

34 please provide details, and comment on useful learnings that are applicable to your proposed model? 3. THERE IS DEMONSTRATED SUPPORT FOR THE ROLE FROM KEY STAKEHOLDERS. 3.1 What evidence is there of support for the introduction of this Nurse Practitioner role from the following groups? Nursing (including clinical staff, Nurse Manager, Nursing Director) Medical (including clinical staff and Clinical Director) Allied health (includes all relevant allied health disciplines) Executive and senior management (including Nursing Director / Operations Manager etc) Consumers 3.2 What specific multidisciplinary input is available to collaborate in the development of the Nurse Practitioner role, within the revised model of care? 4. THE ROLE CAN BE FUNDED WITHIN THE EXISTING UNIT BUDGET. 4.1 What strategies allow for funding the Nurse Practitioner/s within the existing budget? In addition to ongoing funding for the role, there needs to be consideration of the requirement for: The 12 month candidature for the Nurse Practitioner/s The need for non-clinical time for education/training and the development of Clinical Practice Guidelines, which may be a minimum of one non-clinical day per week for the initial 12 months. (Note: if the candidate is eligible for 4 hours of DHS study leave per week for the 26 weeks of the academic year, this will be factored in as part of the allocated non-clinical time) Any additional resources such as equipment or work facilities for either clinical or non-clinical components of the role. 5. THE REQUIREMENTS FOR AN EDUCATION PROGRAM AND OTHER NECESSARY RESOURCES HAVE BEEN IDENTIFIED. 5.1 What are the educational requirements of the Nurse Practitioner Candidate that will enable and sustain extensions to practice? Please give consideration to: Health Assessment Diagnostic Testing Prescribing Documentation 5.2 What multidisciplinary input is required for the Nurse Practitioner Candidate education program? What indication is there that this will be available? 5.3 Are you aware of any existing relevant educational programs (internal and/or external) that can be accessed by the Nurse Practitioner Candidate? For example there may be existing registrar education programs that are relevant. 5.4 Is there a team of medical consultants prepared to participate in clinical mentorship? It is expected that this will require at least 2 hours per week of one to one teaching and supervision of the candidate, in addition to providing direct clinical support on a day to-day basis. Specify consultants who have indicated willingness to offer clinical mentorship. Describe how the mentorship team will operate to ensure the appropriate level of support and clinical supervision, and how the model will be incorporated within the existing service. 34

35 6. THERE IS POTENTIAL FOR A SUITABLE NURSE PRACTITIONER CANDIDATE. 6.1 Are there potential Nurse Practitioner Candidates who have: A clinically relevant Masters level of nursing qualification (or working towards) Completed the therapeutic medication management module at an approved university (or working towards) A commitment to seek endorsement by the Victorian Nurse s Board as a Nurse Practitioner A minimum of 3-5 years clinical experience post specialist qualification, and evidence of working at a level of advanced practice in the clinical area Active involvement in research, publication, teaching, quality improvement and best practice activities Clinical leadership, collaboration and professional role modelling skills A focus on best patient outcomes within a multidisciplinary team High level interpersonal and communication skills across a broad range of health professionals A conceptualisation of the Nurse Practitioner model that is patient centred and within a nursing model of practice The capacity to be critically reflective An understanding of and sensitivity to the political dimension of developing the Nurse Practitioner role and an ability to promote the role in a positive manner 6.2 If there is no suitable internal candidate, what potential is there to recruit externally? 7. OTHER CONSIDERATIONS 7.1 Are there any other ways (not already described) in which the Nurse Practitioner role may impact upon: Patients Nursing Staff Other disciplines, including existing training commitments for other health professionals Your clinical area Other departments/clinical areas? Provide details of barriers and risks you have identified in connection to implementing the role and contingencies you will adopted to overcome them. 7.2 Any additional comments or information: 8. SIGNATURES 8.1 Signatures indicating support and financial feasibility of the model are required from: Department Manager Clinical Director Nursing Director (Medical/Surgical/Residential Services) Operations Manager 8.2 Further signatures of support for the model are required from: Executive Director of Nursing Chief Medical Officer Director of Pathology Director of Pharmacy Director of Radiology (This document is based on work conducted by The Alfred Hospital and has been modified with their permission.) 35

36 Appendix 6: Full submission template SUBMISSION FOR A NURSE PRACTITIONER ROLE The work of the endorsed Victorian Nurse Practitioners, in conjunction with demonstration projects and the literature on Nurse Practitioner roles, have helped identify criteria that can influence the degree of success when developing and implementing the new role. The framework for this submission has therefore been developed around these criteria to assess the suitability of a clinical area for the development of a Nurse Practitioner role. It will also give an indication as to any issues or areas that need further exploration or refinement prior to implementation. The information provided will assist the Bendigo Health Nurse Governance Group in developing an organisational wide strategy for the implementation of Nurse Practitioner Roles. (This document is based on work conducted by The Alfred Hospital and has been modified with their permission.) Process: Stage 1. Expression of interest. Stage 2. Submission for a Nurse Practitioner Role This detailed submission should only be completed at the invitation of the Bendigo Health Senior Nurse Council. Please fill out the submission framework, providing as much information/data as is available; including letters or statements of support as appropriate. Please note that all criteria are mandatory. (Useful references and resources are listed within the Expression of Interest Form) Direct any queries, and forward completed submissions to: 36

37 Kate Hyett Project Manager Nurse Practitioner Projects c/o Collaborative Health Education & Research Centre Telephone (03) rd Floor, ACC [email protected] Bendigo Health Name of Service Name of Person Completing the Submission Position/Title Phone/Fax address CRITERIA RESPONSE Add additional lines to each section as needed. Attach additional documents as required 1. THERE IS A DEMONSTRABLE NEED. 1.1 Describe the existing model of care for the clinical area. 37

38 1.2 Describe how existing health care services could be enhanced or new services provided to meet the needs of a patient group, or an organisational need, or to address a service gap? Provide examples of anticipated benefits, need to include improved service access, cost-effectiveness, timeliness of service provision, client satisfaction etc. 38

39 1.3 What data/information is there to support the requirement for this change to the service? 39

40 1.4 Why is a Nurse Practitioner the most appropriate health professional to provide this service? 40

41 1.5 How would patient/organisational outcomes of the new/expanded service and Nurse Practitioner role be evaluated? Include details of key performance indicators that would be crucial for the new role, and examples of data that would be collected and analysed as part of the evaluation. 2. THERE IS A CLEARLY DEFINABLE SCOPE OF PRACTICE. 2.1 What will be the role of the Nurse Practitioner in your clinical setting? The response needs to address: 1. the scope of practice 2. the patient presentations to be seen/target patient population 3. the extensions to practice that are required: a. prescribing 41

42 b. initiation of diagnostics c. referral to medical specialists d. admitting and discharging privileges e. approval of absence of work certificates 4.the proposed reporting structure 2.2 How will the Nurse Practitioner s scope of practice be linked to Clinical Practice Guidelines? 42

43 2.3 How will the Nurse Practitioner function within a multidisciplinary team? In your response, consider any opportunities for autonomy and collaboration. 2.4 What changes to the current model of care are required to implement this Nurse Practitioner role? In your response, consider the impact on existing roles. 43

44 2.5 Are there any other Nurse Practitioner Models in a similar clinical area? If so, please provide details, and comment on useful learning s that are applicable to your proposed model. 44

45 3. THERE IS DEMONSTRATED SUPPORT FOR THE ROLE FROM KEY STAKEHOLDERS 3.1What evidence is there of support for the introduction of this Nurse Practitioner role from: Nursing (including clinical staff, Nurse Unit Manager, Nursing Director) Medical (including clinical staff and Clinical Director) Allied health Executive and senior management (including Nursing Director etc) Consumers 45

46 3.2 What specific multidisciplinary input is available to collaborate in the development of the Nurse Practitioner role, within the revised model of care? 4. THE ROLE CAN BE FUNDED WITHIN THE EXISTING UNIT BUDGET. 4.1 What strategies will allow for funding the Nurse Practitioner/s within the existing budget? In addition to ongoing funding for the role, there needs to be consideration of the following requirements: The 12 month candidature for the Nurse Practitioner/s The need for non-clinical time 46

47 education/training and the development of Clinical Practice Guidelines, which may be a minimum of one non-clinical day per fortnight for the initial 12 months. (Note: If the candidate is eligible for 4 hours of DHS study leave per week for the 26 weeks of the academic year, this will be factored in as part of the allocated non-clinical time.) Additional resources such as equipment or work facilities for either clinical or non-clinical components of the role. 47

48 5. THE REQUIREMENTS FOR AN EDUCATION PROGRAM AND OTHER REQUIRED RESOURCES HAVE BEEN IDENTIFIED. 5.1 What are the educational requirements for the Nurse Practitioner Candidate that will enable/support extensions to practice? Please give consideration to: Health Assessment Diagnostic Testing Prescribing Documentation 48

49 5.2 What relevant allied health input for education is required? What indication is there that this will be available? 5.3 Are there any existing relevant educational programs (internal and/or external) that can be accessed by the Nurse Practitioner Candidate? For example, there may be registrar education programs that have useful components. 49

50 5.4 Is there a team of medical consultants prepared to participate in clinical mentorship? It is expected this will require at least 2 hours per week of one to one teaching and supervision of the candidate, in addition to providing direct clinical support on a day to day basis. Specify consultants who have indicated willingness to offer clinical mentorship. Describe how the mentorship team will operate to ensure the appropriate level of support and clinical supervision, and how the model will be incorporated within the existing service. 50

51 6. THERE IS POTENTIAL FOR A SUITABLE NURSE PRACTITIONER CANDIDATE. 6.1 Are there potential Nurse Practitioner Candidates who have: - A clinically relevant Masters level of nursing qualification (or working towards) - Completed the therapeutic medication management module at an approved university (or working towards) - A commitment to seek endorsement by the Nurses Board Victoria as a Nurse Practitioner - A minimum of 3-5 years clinical experience post specialist qualification, and evidence of working at a level of advanced practice in the clinical area - Active involvement in research, publication, teaching, quality improvement and best practice activities 51

52 - Clinical leadership, collaboration and professional role modelling skills - A focus on best patient outcomes within a multidisciplinary team - High level interpersonal and communication skills across a broad range of health professionals - A conceptualisation of the Nurse Practitioner model that is patient centred and within a nursing model of practice - The capacity to be critically reflective - An understanding of and sensitivity to the political dimension of developing the Nurse Practitioner role and an ability to promote the role in a positive manner 6.2 If there is no suitable internal candidate, what potential is there to recruit externally? 52

53 7. OTHER CONSIDERATIONS 7.1 Are there any other ways (not already described) in which the Nurse Practitioner role may impact upon: Patients Nursing Staff Other disciplines, including existing training commitments for other health professionals Your clinical area Other departments/clinical areas? Provide details of barriers and risks you have identified in connection to implementing the role and contingencies you will adopted to overcome them. 53

54 7.2 Any additional comments or information. 54

55 I have read the above submission for the Nurse Practitioner role and support the proposed model. I am able to confirm that the development of the role will occur within the existing unit budget or a supplementary funding stream. Department Manager Signature Date Clinical Director Signature Date Operations Manager Signature Date Nursing Director Signature Date I have read the above submission for the Nurse Practitioner role and support the proposed model. Executive Director of Nursing Signature Date Chief Medical Officer Signature Date Director of Pathology Signature Date Director of Pharmacy Signature Date Director of Radiology Signature Date 55

56 Appendix 7: Credentialing policy TITLE: Credentialing Nurse Practitioner staff Policy Date of development: Policy review and co-ordination responsibility: Last reviewed: Next review: Authorised by: Executive Director Nursing N/A Group Executive PURPOSE: Bendigo Health Care Group recognises the importance of formal and regular credentialing of Nurse Practitioners to ensure that all Nurse Practitioners practice within a framework of competence and safety. This policy sets out the way credentialing and approval of clinical scope of clinical practice is determined. POLICY: 1. Nurse Practitioners at BHCG will undergo a formal credentialing process prior to commencement of practice. 2. The credentialing process shall be undertaken by BHCG Credentials Committee which is structured to perform this role. 3. Credentialing will occur on a continuing regular basis. 4. Each Nurse Practitioner credentialed shall have their approved scope of clinical practice and the duration of such approval confirmed in writing. 5. The Executive Director of Nursing, shall maintain a register of all credentialed Nurse Practitioners, their specific approved scope of clinical practice and the duration of such approval. 6. Nurse Practitioner candidates are supervised by senior nursing and medical staff and are therefore not subject to this formal credentialing process but will undergo regular reviews and assessments consistent with their level of training and length of engagement. On completion of candidature and upon endorsement by the Nurses Board of Victoria, the Nurse Practitioner must undertake the BHCG credentialing process to practice within Bendigo Health Care Group. Personal information and health information as defined in the relevant Victorian law, which is required to be collected, used, disclosed and stored by BHCG in order to achieve the purpose of this policy, will be handled by the Group and its employees in accordance with their legal obligations. ASSOCIATED DOCUMENTATION: Introduction of New Clinical Procedures/Techniques Policy ACSQHC - National standard for credentialing and defining the scope of clinical practice. BH/BCH Nurse Practitioner Service Plan Authorised: Date: (Chief Executive) 56

57 Appendix 8: GP referral policy & procedure CLINICAL POLICY & PROCEDURE MANUAL PROCEDURE TITLE: Nurse Practitioner Candidates (NPC) procedure for referring patients back to their General Practitioners (GP s) after caring from them in the Emergency Department (ED) at Bendigo Health (BH). Date of development: Policy review and co-ordination responsibility: Last reviewed: Next review: Authorised by: March 2006 Emergency Department Director Emergency Nurse Practitioner Candidates New Policy 6 Months Group Clinical Standards Committee RELEVANT STANDARD ACHS EQuIP Standard: Continuum of Care PURPOSE This procedure aims to ensure that patients who have been cared for in the Emergency Department (ED) by the Nurse Practitioner Candidates (NPC) are managed efficiently, and that there has been effective communication from the NPC to the patients General Practitioner (GP) about the care their patients received whilst in the ED. A comprehensive letter written by the NPC will outline the treatment and procedures the patient underwent whilst in the NPC and the results and follow up (if any which have been organised for this patient). Ensure that the patient has consented that they are happy for their GP to be notified of their visit to the ED. A copy of the letter is given to the patient and another copy is faxed directly to the GP s room. Another copy is kept in the patients history at the hospital. Whilst the Emergency Nurse Practitioners are still Candidates all the patients they care for in the ED must be presented to one of the Senior Emergency Doctors prior to being discharged home. The ENPC will refer patients back to their GP s within the boundaries of their Clinical Practice Guidelines and will independently complete the GP letters. The NPC will stamp all GP letters with the Emergency Nurse Practitioner Candidate stamp which clearly identifies their name and designation to the referring GP. Regular correspondence about the NPC s in the ED has been via the Division of GP (Bendigo Region) newsletter. 57

58 Important Patients who present to the Emergency Department who are Department of Veteran Affairs (DVA), Traffic Accident Commission (TAC) or Workcover (W/C) patients must have all their radiology request forms (x-rays, ultrasounds, CT scans, MRI s) countersigned by a Senior Emergency Doctor for billing purposes. PROCEDURE The following provides a framework to facilitate this process. The patient is referred by the Emergency Nurse Practitioner Candidate back to their General Practitioner (GP) for follow up after being cared for in the ED at Bendigo Health. The NPC has presented the patient s case to one of the Senior Emergency Doctors prior to referring the patient back to their GP. The Senior Emergency Doctor will ensure that the GP is the most appropriate referral for the patient. The NPC will ensure that all follow up appointments are made and that the patient is clear on the discharge instructions. All pathology, radiology and any procedures are clearly written on the discharge letter for the GP. Ensure that the patient has been given clear discharge instructions. The patient has verbally consented to NPC that they would like their GP notified about their ED presentation. The Division of GP s (Bendigo Region) have been informed about the role of the NPC in ED every three months via their newsletter. The ED Medical Director is responsible for responding to failure in this system and initiating appropriate actions. REFERENCES Personal information and health information as defined in the relevant Victorian law, which is required to be collected, used, disclosed and stored by BHCG in order to achieve the Purpose of this policy, will be handled by the Group and its employees in accordance with their legal obligations. Authorised: (Chairperson, Group Clinical Standards Committee) Date: 58

59 Appendix 9: Chronic care coordinator referral policy & procedure CLINICAL POLICY & PROCEDURE MANUAL PROCEDURE TITLE: Nurse Practitioner Candidates (NPC) procedure for referring patients to the Emergency Department Care Coordinator at Bendigo Health (BH). Date of development: Policy review and co-ordination responsibility: Last reviewed: Next review: Authorised by: May 2006 Emergency Department Medical Director Emergency Nurse Practitioner Candidates Care Coordinator Emergency Department New Policy 6 Months Group Clinical Standards Committee RELEVANT STANDARD ACHS EQuIP Standard: Continuum of Care PURPOSE This procedure aims to ensure that patients who have been cared the Emergency Nurse Practitioner Candidates (ENPC) are managed efficiently and effectively. All patients cared for by the ENPC s must have their Patients Risk Screen (MR2) completed on arrival to the cubicle. Any patient response falling within the shaded area needs to be referred immediately to the ED Care Coordinator. Alternatively, if the patient comes to the ED after hours an orange form needs to be completed outlining the reason for the patient s presentation to the ED and what services may be appropriate for this patient. The ENPC will ensure the patient is safe to go home if the Care Coordinator is not available and may need to contact PAC to arrange alternative arrangements for the patient. During business hours the ED Care Coordinator will speak to the patient or family about the patient s home situation and offer services which they believe are appropriate for this patient. The ED Care Coordinator can refer patients to a number of services within and around the hospital. The services which the ED Care Coordinator offers within Bendigo Health include: Diabetes educator Physiotherapist Speech pathologist Occupational therapist Dietician Hospital Admission Risk Program Post Acute Care (this includes meals on wheels, district nurse, PCA) HART The risk assessment is your first step to effective discharge planning for your patient. The Care Coordinator, after receiving your referral, follows up, coordinates and liaises with appropriate services in all areas for patient's with issues that range from; need of further 59

60 education with a chronic disease nurse, need for services, those who may be carers who may need links to what's available, also finding urgent respite (if possible). The HARP program is a vital link to assist you with effective discharge planning. Whilst the Emergency Nurse Practitioners are still Candidates all the patients they care for in the ED must be presented to one of the Senior Emergency Doctors prior to being discharged home. The ENPC will refer patients to the ED Care Coordinator within the boundaries of their Clinical Practice Guidelines. PROCEDURE The following provides a framework to facilitate this process. The Emergency Nurse Practitioner Candidates complete the patient risk screen on arrival to the cubicle. The Nurse Practitioner Candidate will speak to the patient and or family members about the patient s level of care at home. If the patient falls within any of the shaded areas within the risk screen assessment a referral to the ED Care Coordinator is required. The NPC will speak to the patient and family about the role of the Care Coordinator and how this service can be of assistance to getting them home after being discharged from the ED. The Care Coordinator will speak to the patient and or family about their risk screen and will be able to coordinate and liaise with appropriate services in all areas for patient s with issues that range from need for further education with chronic disease, need for services, those who may be carers who may need links to what is available in the community and also find urgent respite (if possible). The Care Coordinator is a vital link to assist with effective discharge planning. The patient is discharged from the ED safely and all appropriate services are in place. Personal information and health information as defined in the relevant Victorian law, which is required to be collected, used, disclosed and stored by BHCG in order to achieve the Purpose of this policy, will be handled by the Group and its employees in accordance with their legal obligations. Authorised: (Chairperson, Group Clinical Standards Committee) Date: 60

61 Appendix 10: HITH referral policy & procedure CLINICAL POLICY & PROCEDURE MANUAL PROCEDURE TITLE: Nurse Practitioner Candidates (NPC) procedure for referring patients to the Hospital in the Home (HITH) program at Bendigo Health (BH). Date of development: Policy review and co-ordination responsibility: Last reviewed: Next review: Authorised by: May 2006 Emergency Department Medical Director Emergency Nurse Practitioner Candidates New Policy 6 Months Medical Surgical Clinical Standards Committee RELEVANT STANDARD ACHS EQuIP Standard: Continuum of Care PURPOSE This procedure aims to ensure that patients who have been cared the Emergency Nurse Practitioner Candidates (ENPC) are managed efficiently and effectively. Whilst the Emergency Nurse Practitioners are still Candidates all the patients they care for in the ED must be presented to one of the Senior Emergency Doctors prior to being referred to hospital in the home (HITH). The ENPC will admit patients to HITH within the boundaries of their Clinical Practice Guidelines. The ENPC will ensure that the patient meets the HITH selection criteria prior to referral. 61

62 PROCEDURE The following provides a framework to facilitate this process. The Emergency Nurse Practitioner Candidate will undertake their patient assessment under the supervision of a Senior Emergency Doctor. The patient case will be presented by the ENPC to the Senior Emergency Doctor to ensure that HITH is an appropriate referral for this patient. The ENPC has treated the patient within the boundaries of their Clinical Practice Guidelines. The ENPC will ensure that the patient meets the HITH selection criteria prior to phoning HITH about a potential admission. If the ENPC and the Senior Doctor believe HITH is the best option for this patient the HITH coordinator will be contacted on or Pager 425. The specialty unit will also need to be contacted as per the boundaries of the ENPC Clinical Practice Guidelines after discussion with a Senior Emergency Doctor. The ENPC or Doctor will contact the specialty unit most appropriate for this patient. The Specialty Unit will admit the patient under the care of the HITH program. The coordinator from the HITH program will admit the patient from a nursing perspective. The ENPC is not to write the patients medical notes or drug chart up for the Specialty Unit. The HITH coordinator and ENPC will ensure that the patient is discharged from the ED safely and educated about how the HITH program runs. The ENPC is not to write the patients medical notes or drug chart up for the Specialty Unit. The HITH coordinator and ENPC will ensure that the patient is discharged from the ED safely and educated about how the HITH program runs. Personal information and health information as defined in the relevant Victorian law, which is required to be collected, used, disclosed and stored by BHCG in order to achieve the Purpose of this policy, will be handled by the Group and its employees in accordance with their legal obligations. Authorised: (Chairperson, Group Clinical Standards Committee) Date: 62

63 Appendix 11: Outpatients clinic referral policy & procedure CLINICAL POLICY & PROCEDURE MANUAL PROCEDURE TITLE: Nurse Practitioner Candidates (NPC) procedure for referring patients to the Outpatients Unit for Specialist appointments (Public patients) after caring from them in the Emergency Department (ED) at Bendigo Health (BH). Date of development: Policy review and co-ordination responsibility: Last reviewed: Next review: Authorised by: March 2006 Emergency Department Director Emergency Nurse Practitioner Candidates New Policy 6 Months Group Clinical Standards Committee RELEVANT STANDARD ACHS EQuIP Standard: Continuum of Care PURPOSE This procedure aims to ensure that patients who have been cared the Emergency Nurse Practitioner Candidates (ENPC) are managed efficiently and effectively. All patients cared for by the ENPC s who require an outpatient appointment are to discuss their patient s presentation findings with one of the Senior Emergency Doctors prior to the referral being made. When the ENPC is referring a patient to the Bendigo Health Outpatient Clinic the specialist unit who the referral is being made too will need to be contacted and an appropriate Outpatient appointment time for this patient will be given. The patient s notes and authority of the appointment need to be placed in the blue folder marked Outpatients Appointment Book which is located in the Emergency Department. The patient will be contacted with a more accurate date and time of their Outpatient appointment by the Outpatient unit via mail. It is important to let patients know if they have not received an appointment date and time in the mail within a week of the referral process to contact the Outpatient Unit. The Specialist Unit may also want to review the patient in the Emergency Department prior to discharging them home to ensure the referral is appropriate. The Specialist Unit may request a further x-ray or scan be undertaken by the patient prior to their Bendigo Health Outpatient appointment. 63

64 Ensure that the patient has consented that they are happy for their General Practitioner (GP) has been notified of their visit to the ED and of their referral. A copy of the referral letter is given to the patient (for the specialist) and another copy is faxed directly to the GP s room. Another copy is kept in the patients history at the hospital for future reference. Occasionally, a patient may be referred back to their GP for the Outpatient Referral if this is the case the same process needs to occur to ensure the GP can forward the correct information about treatment to the Outpatients clinic. Whilst the Emergency Nurse Practitioners are still Candidates all the patients they care for in the ED must be presented to one of the Senior Emergency Doctors prior to being discharged home. The ENPC will refer patients to the Outpatients unit within the boundaries of their Clinical Practice Guidelines and will independently complete the GP letters. The NPC will stamp all the GP letters with the Emergency Nurse Practitioner Candidate stamp which clearly identifies their name and designation to the referring Specialist. Regular correspondence about the NPC s in the ED has been via the Division of GP (Bendigo Region) newsletter. Important Patients who present to the Emergency Department who are Department of Veteran Affairs (DVA), Traffic Accident Commission (TAC) or Workcover (W/C) patients must have all their radiology, pathology and pharmacy requests countersigned by a Senior Emergency Doctor for billing and legal purposes. 64

65 PROCEDURE The following provides a framework to facilitate this process: The patient is referred by the Emergency Nurse Practitioner Candidate to a Specialty Unit for Outpatient Appointment after being treated in the ED. The ENPC has presented the patient s case to one of the Senior Emergency Doctors prior to referring the patient to the Specialty Unit. The Senior Emergency Doctor will ensure that the referring Specialty Unit is the most appropriate referral for that patient. The NPC needs to photocopy the patients Emergency Notes and stamp the notes with the Authorising Doctor Name clearly printed on the referral (this is the Specialty Doctor who you speak to about referring the patient to their Outpatients Appointment). The ENPC or Senior Doctor needs to discuss the case with the Specialty Doctor to ensure they are aware of the patient and to organise an appropriate appointment date and time for the patient. The NPC will ensure that all follow up appointments are made and that the patient is clear about the discharge instructions. Ensure that the patient has been given clear discharge / referral instructions. The patient is discharged from the ED safely. The ED Medical Director is responsible for responding to failure in this system and initiating appropriate actions. Personal information and health information as defined in the relevant Victorian law, which is required to be collected, used, disclosed and stored by BHCG in order to achieve the Purpose of this policy, will be handled by the Group and its employees in accordance with their legal obligations. Authorised: (Chairperson, Group Clinical Standards Committee) Date: 65

66 Appendix 12: Specialist referral policy & procedure CLINICAL POLICY & PROCEDURE MANUAL PROCEDURE TITLE: Nurse Practitioner Candidates (NPC) procedure for referring patients to a Specialist (Private / TAC / DVA and self pay patients only) after caring from them in the Emergency Department (ED) at Bendigo Health (BH). Date of development: Policy review and co-ordination responsibility: Last reviewed: Next review: Authorised by: March 2006 Emergency Department Director Emergency Nurse Practitioner Candidates New Policy 6 Months Group Clinical Standards Committee RELEVANT STANDARD ACHS EQuIP Standard: Continuum of Care PURPOSE This procedure aims to ensure that patients who have been cared the Emergency Nurse Practitioner Candidates (ENPC) are managed efficiently and effectively. All patients cared for by the ENPC s who require a Specialist Referral are to discuss their patient s presentation findings with one of the Senior Emergency Doctors prior to the referral being made. The NPC needs to write an informative letter to the Specialist and attach the patients ED notes to the letter. Until the NPC are endorsed this letter needs to be read and co-signed by the same Senior Emergency doctor who has been assisting you with this patients case. The NPC or Senior Emergency Doctor needs to speak with the Specialist about the patient s case and ensure the referral is appropriate. The Specialist will also need to be contacted about the patient s referral by either the ENPC or Senior Emergency Doctor. The patient may have to wait in the ED until the Specialist has reviewed the patient prior to discharge home. The Specialist Unit may also want to review the patient in the Emergency Department prior to discharging them home to ensure the referral is appropriate. The Specialist Unit may request a further x-ray or scan be undertaken by the patient prior to their Bendigo Health Outpatient appointment. Ensure that the patient has consented that they are happy for their General Practitioner (GP) has been notified of their visit to the ED and of their referral. A copy of the referral letter is 66

67 given to the patient (for the specialist) and another copy is faxed directly to the GP s room. Another copy is kept in the patients history at the hospital for future reference. Occasionally, a patient may be referred back to their GP for the Specialist Referral if this is the case the same process needs to occur to ensure the GP can forward the correct information about treatment to the Specialist. Whilst the Emergency Nurse Practitioners are still Candidates all the patients they care for in the ED must be presented to one of the Senior Emergency Doctors prior to being discharged home. The ENPC will refer patients to Specialists within the boundaries of their Clinical Practice Guidelines and will independently complete the GP letters. The NPC will stamp all the GP letters with the Emergency Nurse Practitioner Candidate stamp which clearly identifies their name and designation to the referring Specialist. Regular correspondence about the NPC s in the ED has been via the Division of GP (Bendigo Region) newsletter. Important Patients who present to the Emergency Department who are Department of Veteran Affairs (DVA), Traffic Accident Commission (TAC) or Workcover (W/C) patients must have all their radiology, pathology and pharmacy requests countersigned by a Senior Emergency Doctor for billing and legal purposes. 67

68 PROCEDURE The following provides a framework to facilitate the Specialist Referral process. The patient is referred by the Emergency Nurse Practitioner Candidate to a Specialist for follow up after being cared for in the ED. The ENPC has presented the patient s case to one of the Senior Emergency Doctors prior to referring the patient to the Specialist. The Senior Emergency Doctor will ensure that the referring Specialist is the most appropriate referral for that patient. The NPC needs to write a detailed letter to the Referring Specialist outlining the treatment the patient underwent in the ED. The Referral letter needs to be countersigned by the same Senior Emergency Doctor who has been assisting the NPC with their patients care. The ENPC or Senior Doctor needs to discuss the case with the Specialist to ensure they are aware of the patient and to organise an appointment date and time. The NPC will ensure that all follow up appointments are made and that the patient is clear about the discharge instructions. All pathology, radiology and any procedures are clearly written on the referral letter for the Specialist. Ensure that the patient has been given clear discharge / referral instructions. The patient is discharged from the ED safely. The ED Medical Director is responsible for responding to failure in this system and initiating appropriate actions. Personal information and health information as defined in the relevant Victorian law, which is required to be collected, used, disclosed and stored by BHCG in order to achieve the Purpose of this policy, will be handled by the Group and its employees in accordance with their legal obligations. Authorised: (Chairperson, Group Clinical Standards Committee) Date: 68

69 Appendix 13: Admission to hospital procedure CLINICAL POLICY & PROCEDURE MANUAL PROCEDURE TITLE: Emergency Nurse Practitioner Candidates (NPC) procedure for admitting patients into Hospital. Date of development: Policy review and co-ordination responsibility: Last reviewed: Next review: Authorised by: March 2006 Emergency Department Medical Director Emergency Nurse Practitioner Candidates New Policy 6 Months Group Clinical Standards Committee RELEVANT STANDARD 1.1 ACHS EQuIP Standard: Continuum of Care PURPOSE This procedure aims to ensure that patients who have been cared for in the Emergency Department (ED) by Nurse Practitioner Candidates (NPC) are managed efficiently and effectively. Whilst the Emergency Nurse Practitioners are still Candidates all patients cared for by them will be closely managed in collaboration with one of the Senior Emergency Doctors at all times. The NPC will stamp all their diagnostic and pathology request forms with an Emergency Nurse Practitioner Candidate stamp which clearly identifies their name and designation. Important Patients who present to the Emergency Department who are classified as Department of Veteran Affairs (DVA), Traffic Accident Commission (TAC) or WorkCover (W/C) patients must have all their radiology request forms (x-rays, ultrasounds, CT scans, MRI s) countersigned by a Senior Emergency Doctor for billing purposes. PROCEDURE The following provides a framework to facilitate the admission of a patient to hospital who is under the care of an Emergency Nurse Practitioner Candidate. The patient is referred by the Emergency Nurse Practitioner Candidate to a specialist unit for possible admission to hospital. The NPC has discussed the patient s presentation findings with the Senior Emergency Doctor and the referral to the specialist unit is made for possible admission. 69

70 The Emergency Nurse Practitioner Candidate contacts the appropriate specialty unit via the hospital paging system regarding the patient s presentation to the Emergency Department. The Emergency Nurse Practitioner Candidate or Senior Emergency Doctor will discuss the case with the specialty unit and order any further tests (as requested by the specialty unit). When the specialty unit arrives to see the patient in the Emergency Department the Nurse Practitioner Candidate or Senior Emergency Doctor will present the patient to the unit again and ensure everything has been completed for the patient to be admitted to the ward. The Emergency Nurse Practitioner Candidates do not have admitting rights to the Bendigo Hospital, and are not to write a patient s admission up for any specialist unit. The Emergency Department Medical Director is responsible for responding to failure in this system and initiating appropriate actions. Personal information and health information as defined in the relevant Victorian law, which is required to be collected, used, disclosed and stored by BHCG in order to achieve the Purpose of this policy, will be handled by the Group and its employees in accordance with their legal obligations. Authorised: (Chairperson, Group Clinical Standards Committee) Date: 70

71 Appendix 14: Discharge from hospital procedure CLINICAL POLICY & PROCEDURE MANUAL PROCEDURE TITLE: Nurse Practitioner Candidates (NPC) procedure for discharging patients from the Emergency Department (ED) at Bendigo Health. Date of development: Policy review and co-ordination responsibility: Last reviewed: Next review: Authorised by: March 2006 Emergency Department Medical Director Emergency Nurse Practitioner Candidates New Policy 6 Months Group Clinical Standards Committee RELEVANT STANDARD 1.1 ACHS EQuIP Standard: Continuum of Care PURPOSE This procedure aims to ensure that all patients discharged from the Emergency Department (ED) at Bendigo Health (BH) by a Nurse Practitioner Candidate (NPC) are managed efficiently and effectively to reduce the risk associated with any further complications. All patients seen by the NPC in the ED at BH are discussed at length with one of the Senior Emergency Doctor s prior to discharge and the appropriate follow up, medications, and discharge instructions are given to the patient. The ENPC will initiate appropriate discharge instructions and information within the boundaries of their Clinical Practice Guidelines (CPG s). The ENPC will independently complete the patient s discharge paperwork (except for the patient discharge medications which will need to be written and signed by the Senior Emergency Doctor working with the ENPC) prior to the patient being discharged. The NPC will stamp all their discharge notes with the Emergency Nurse Practitioner Candidate stamp which clearly identifies their name and designation. Each patient who is cared for by the ENPC will be registered in the ENPC Patient Registry. The Patient Registry is a document which needs to be completed by one of the Senior Emergency doctors on the level of supervision the NPC requires for each patient they see in ED. Important Patients who present to the Emergency Department who are classified as Department of 71

72 Veteran Affairs (DVA), Traffic Accident Commission (TAC) or WorkCover (W/C) must have all their radiology and pathology request forms (x-rays, ultrasounds, CT scans, MRI s) countersigned by a Senior Emergency Doctor for billing purposes. 72

73 PROCEDURE The following provides a framework to facilitate the patient discharge from the Emergency Department by the Nurse Practitioner Candidate. The NPC presents the patient s case to one of the Senior Emergency Doctors prior to the patient being discharged from the ED. The NPC and Senior Emergency Doctor discuss the most appropriate follow up (if required) for all patients prior to discharge. The NPC will ensure that all results from tests (pathology and radiology) are back and that the results have been discussed at length with a Senior Emergency Doctor prior to discharging the patient home or back to their residential care. The NPC will ensure that the patient s Risk Assessment has also been completed prior to discharge. Does the patient need to be referred to the ED Care Co-ordinator prior to discharge? A letter for the patients General Practitioner (GP) must also given to the patient prior to discharge. The NPC s letter for the GP will clearly state why the patient presented to the ED, the treatment and tests which were ordered whilst in the ED, and the results from these treatments / tests. The NPC will clearly write their name, designation and a contact number on the bottom of the GP letter. Clear and concise progress notes written by the NPC in the patients ED history. All tests and procedures ordered by the NPC also need to be clearly documented in the progress notes. The NPC will ensure that the patient has all their appropriate lines removed (I.V. cannula, ECG leads) prior to being discharged. The Triage Nurse / Associate Charge Nurse / Clinical Nurse Consultant / Clinical Nurse Specialist will immediately notify the Nurse Practitioner Project Officer (during hours on ext: 7829) or one of the Senior Emergency Doctor (after hours) when there is a discrepancy between the NPC s discharge follow up or if the patient has presented within 48 hours of being discharged from the ED whilst under the care of the NPC. A patient label needs to be placed into the Representation Exercise Book at the triage desk. Any patient who represents within 48 hours of being treated in the ED by one of the Emergency Nurse Practitioner Candidates needs to be treated and consulted by one of the Emergency Senior Doctors to ensure appropriate follow up and treatment. The Emergency Department Medical Director is responsible for responding to failure in this system and initiating appropriate actions. Personal information and health information as defined in the relevant Victorian law, which is required to be collected, used, disclosed and stored by BHCG in order to achieve the Purpose of this policy, will be handled by the Group and its employees in accordance with their legal obligations. Authorised: (Chairperson, Group Clinical Standards Committee) Date: 73

74 Appendix 15: Medication prescribing policy & procedure TITLE: Medication Prescribing Policy. POLICY NUMBER: J31 Refers to Procedure Number: J31 CLINICAL POLICY & PROCEDURE MANUAL PROCEDURE Date of development Date of review Department Responsible for Review Ratified by Coordination Responsibility October 2001 March 2006 Director of Pharmacy Pharmaceutical Advisory Committee Clinical Standards Coordinator INTRODUCTION: This policy relates to the prescribing of any drug, except those that are part of an intravenous or epidural infusion. Intravenous infusion orders are documented on the Intravenous orders form and for epidural infusion orders, the Analgesia infusion orders & Administration form This policy must be read in conjunction with the attached procedure. POLICY: Medication will only be administered if prescribed on a Bendigo Health (BH) Medication Chart. This includes herbal and naturopathic remedies and the oral contraceptive pill. Medication orders are legal when written and signed by a Medical Officer (MO). A medication order can also be generated when an emergency telephone order is taken, and it is recorded in the section for telephone orders (as indicated in policy J23). A Nurse Practitioner Candidate (NPC) can prescribe medications only for inpatient use under specific restrictions, where the supervising Medical Officer also establishes the therapeutic need for the drug, signs the NPC patient register and countersigns the inpatient order. All medication orders must be written legibly and signed by either a MO, or by a NPC, which is then co-signed by the supervising MO. Medications must be ordered by generic name. Proprietary or trade names may also be written for clarification only. The Pharmacy Department has the authority to provide a generic equivalent of any medication used within BH. Known allergies or adverse reactions must be recorded on the Medication chart and must include a description of the reaction. Where there is No known allergy (NKA), this must be recorded. 74

75 REFERENCES : Clinical Abbreviations Policy K10 Checking & Administration of Drugs Policy & Procedure J21 Telephone Prescribing Policy J23 Nurse Initiated Medication Policy J27 Drugs Poisons and Controlled Substances Act, Victoria 1981 Drugs Poisons and Controlled Substances Regulations, Victoria, 1995 PROCEDURE NUMBER: J31 MEDICATION PRESCRIBING PROCEDURE Refers to Policy Number: J31 Date of development: Date of Reviews: Department Responsible for Review: Ratified by: co-ordination responsibility October 2001 March 2006 Director of Pharmacy Pharmaceutical Advisory Committees Clinical Standards Co-ordinator INTRODUCTION: This procedure relates to the prescribing of any drug, except those that are part of an intravenous or epidural infusion. Intravenous infusion orders are documented on the Intravenous orders form and for epidural infusion orders, the Analgesia infusion orders & Administration form This procedure must be read in conjunction with the attached policy. PROCEDURE: General prescribing Nurse Practitioner Candidate (NPC) Prescribing A NPC can prescribe a drug only when all of the following conditions are met; for inpatients in their care, within the designated practice area of the NPC for medications actually administered in the designated practice area (not for discharge, outpatient use or if transferred to another inpatient area) prescribed on an inpatient drug administration form used in the designated area. e.g. An emergency department NPC can only prescribe on forms MR2 or MR2A for drugs specified in the Bendigo Health (BH) approved NPC Clinical Practice Guidelines; and if the supervising Medical Officer establishes the therapeutic need for the drug by examining the patient and countersigns the inpatient order and also signs the designated section of the NPC patient register. If any of the above conditions are not met, the NPC is not allowed to prescribe the medication. For each medication order, the Medical Officer or Nurse Practitioner Candidate (NPC) must CLEARLY write on the Medication Chart: Known allergies/adverse reactions, including the reaction description, or Nil known allergies in the appropriate section Generic name of drug in block letters and form (eg tab, supp, liq). Strength/dose of drug (g, ml, mg, mcg % etc.) 'ug' should not be used to avoid confusion - use microgram or mcg. 75

76 Route (IM, SC, IV, O, PV, PR, sl, top). Accepted abbreviations only may be used refer to policy K10. Frequency. Accepted abbreviations only eg. 4/24 not q 4h - refer to policy K10. Administration times. Standard scheduled times mane 0800, nocte 2200, bd 0800 & 2200, tds 0800, 1400, 2200, qid 0800, 1200, 1700, Doctors signature must be legible, otherwise name printed underneath signature to confirm identity. Medication dose changes: When the dose or frequency of a medication is changed, the original order must not be altered. A new medication order must be written and the original order cancelled (by crossing out with a single line). Any change in medication should also be documented in the progress notes and the reason for the change stated. Cessation of therapy: To indicate that an order is cancelled, the MO must draw a single oblique line through the medication order and enter their initials and date in the 'cease' column (MR114) or 'date ceased' box (MR 114A, 115, 167, 8) 'PRN' doses: For medication ordered on an 'as needed' basis, minimum does intervals are to be specified e.g. 4 hrly prn or 4/24 prn. Once Only and Premedication Orders: Medications that are prescribed as once only doses or for premedication are to be written on the dedicated section on the medication chart. Variable Dose Orders (MR 114 only): For medication (e.g. warfarin) ordered in varying daily doses. The dose must be documented on the day required in the "Administered' section of the Medical Chart. Duration of the chart: A new medication chart must be written for therapy to continue beyond the last day of the current chart. The original starting date of the drug to be transcribed to succeeding charts. When a medication is required for less than the duration of the chart this should be indicated in the cease date box Formulary The formulary is a listing of those drugs that are authorised by the Pharmaceutical Advisory Committee for prescription within BH. Where a non-formulary drug is ordered, the Pharmacy Department will, before supplying, check that authority to prescribe has been obtained from the relevant Executive Director. If a patient is admitted on a non-formulary drug the Pharmacy Department will supply the drug at its discretion or may ask that the patient's own supply be used. Drugs not originating from the Pharmacy Department must be checked first by a pharmacist before being used within BH. If it is not possible for the patient's own supply to be used, the Pharmacy Department will supply the drug. Herbal and alternative therapies (including naturopathic remedies) are to be supplied by the patient. Additions to the Formulary are authorised only by the Pharmaceutical Advisory Committee, which body will consider submissions from medical, nursing, pharmacy and other paramedical staff. 76

77 REFERENCES: Clinical Abbreviations Policy K10 Checking & Administration of Drugs Policy & Procedure J21 Telephone Prescribing Policy J23 Nurse Initiated Medication Policy J27 Drugs Poisons and Controlled Substances Act, Victoria 1981 Drugs Poisons and Controlled Substances Regulations, Victoria, 1995 Developed by: K Bell - Manager of Medical Services & Marianne Molenar Director of Pharmacy Date: October, 2000 Reviewed By: C. Richardson Clinical Standards Co-ordinator Date: May, 2002 Reviewed By: Alex Crawford Nurse Practitioner Project Officer & Kate Hyett - Project manager, CHERC & K MacMillan Deputy Director of Pharmacy Date: March,

78 Appendix 16: Ordering pathology procedure CLINICAL POLICY & PROCEDURE MANUAL PROCEDURE TITLE: Emergency Nurse Practitioner Candidates (ENPC) procedure for ordering Pathology Tests in the Emergency Department. Date of development Policy review and co-ordination responsibility Last Reviewed Next Review Authorised by March 2006 Emergency Department Director Emergency Nurse Practitioner Candidates New Policy 6 Months Group Clinical Standards Committee RELEVANT STANDARD ACHS EQuIP Standard: Continuum of Care PURPOSE This procedure aims to ensure that all pathology tests ordered by Nurse Practitioner Candidates (NPC) in the Emergency Department (ED) are managed efficiently and effectively to reduce the risk associated with the misinterpretation and delays in reporting. The NPC will initiate pathology tests within the boundaries of their Clinical Practice Guidelines (CPG s) and independently complete the Bendigo Health pathology request forms. To easily identify requests made by the NPC, a stamp will be used that clearly prints the NPC s name and designation onto the pathology request slips. 78

79 PROCEDURE The following provides a framework to facilitate this process. The Emergency Nurse Practitioner Candidate will order appropriate pathology as per their Clinical Practice Guidelines. The Senior Emergency Doctor will be continuously consulted by the Emergency Nurse Practitioner Candidate about their patient s condition, and will be aware of the pathology tests which have been ordered for patient s being cared for by the Emergency Nurse Practitioner Candidate. The requesting Emergency Nurse Practitioner Candidate independently completes the Pathology Request form, noting provisional diagnosis and other relevant patient information. The Emergency Nurse Practitioner Candidate stamps the pathology request forms to alert the pathology staff that the patient is being cared for by one of the Nurse Practitioner Candidates in the Emergency Department. The requesting Nurse Practitioner Candidate in the Emergency Department ensures the completed Pathology Request form accompanies the pathology (bloods, swabs, urine) and the tests are sent immediately to pathology for analysis. (Any incomplete Pathology Request forms are to be returned to the ED for immediate completion) The Pathology staff will immediately notify one of the Senior Emergency Doctors and the Emergency Nurse Practitioner Candidate when there is a discrepancy between the requesting Emergency Nurse Practitioner Candidates clinical findings, and their report to ensure appropriate clinical management of the patient. If there is a significant abnormality with the pathology result for the patient being cared for the by Emergency Nurse Practitioner Candidate the patients care will be immediately transferred to the care of the Senior Emergency Doctor who has been assisting the Nurse Practitioner Candidate with the care of the patient. The patient will no longer be cared for by the Nurse Practitioner Candidate and they will EXIT their Clinical Practice Guidelines. The Emergency Department Medical Director is responsible for responding to failure in this system and initiating appropriate actions. REFERENCES The Royal College of Pathologists Australasia, RCPA Manual. 2004, Personal information and health information as defined in the relevant Victorian law, which is required to be collected, used, disclosed and stored by BHCG in order to achieve the Purpose of this policy, will be handled by the Group and its employees in accordance with their legal obligations. Authorised: (Chairperson, Group Clinical Standards Committee) Date: 79

80 Appendix 17: Ordering radiology procedure CLINICAL POLICY & PROCEDURE MANUAL PROCEDURE TITLE: Nurse Practitioner Candidates (NPC) procedure for initiating Radiological Tests and Diagnostic Imaging (x-rays, ultrasounds, CT and MRI scans) in the Emergency Department (ED). Date of development Policy review and co-ordination responsibility Last Reviewed Next Review Authorised by March 2006 Emergency Department Director Emergency Nurse Practitioner Candidates New Policy 6 Months Group Clinical Standards Committee RELEVANT STANDARD ACHS EQuIP Standard: Continuum of Care PURPOSE This procedure aims to ensure that all radiological tests and diagnostic imaging ordered in the Emergency Department (ED) by the Nurse Practitioner Candidates (NPC) are managed efficiently and effectively to reduce the risk associated with the misinterpretation and delays in reporting. Whilst the Emergency Nurse Practitioners are still Candidates most of their radiology and diagnostic imaging will be discussed with a Senior Emergency Doctor prior to the imaging being taken. All ultrasounds, CT and MRI scans will need to be discussed at length with a Senior Doctor, and will also need to be countersigned by the same Emergency Doctor prior to imaging. The ENPC will initiate diagnostic imaging within the boundaries of their Clinical Practice Guidelines and will independently complete their radiology request forms for plain film x-rays. The NPC will stamp all their radiology request forms with an Emergency Nurse Practitioner Candidate stamp which clearly identifies their name and designation to the Radiographer/Radiologist is able to easily identify when the ENPC are requesting imaging. Important Patients who present to the Emergency Department who are Department of Veteran Affairs (DVA), Traffic Accident Commission (TAC) or WorkCover (W/C) must have all their radiology request forms (x-rays, ultrasounds, CT scans, MRI s) countersigned by a Senior Emergency Doctor for billing purposes. PROCEDURE 80

81 The following provides a framework to facilitate the process of Radiology and Diagnostic imaging in the ED. The patient is referred by the NPC from the Emergency Department to Radiology for their imaging as requested. The NPC will present the patient s case to one of the Senior Emergency Doctors prior to imaging. The radiology request form is clearly signed and stamped by the ENPC, and countersigned by a Senior Emergency Doctor (if required). Following completion of the imaging the Radiographer ensures that an Emergency X-ray Report form is attached to the patient s X-ray films (bag) to be returned to ED for the requesting Nurse Practitioner Candidates (NPC) and senior Emergency Doctor to review. The requesting Nurse Practitioner Candidate or Senior Emergency Doctor completes the Emergency X-ray Report form, noting provisional diagnosis and other relevant patient information. The requesting Emergency Doctor or Nurse Practitioner Candidate in the ED ensures the completed Emergency X-ray Report form accompanies the x-ray films when returned to Medical Imaging for reporting. The Radiologist will immediately notify the most Senior Emergency Doctor when there is a discrepancy between the requesting Emergency Doctor or Nurse Practitioner Candidate clinical findings and the Radiologist s report. This will ensure appropriate clinical management of all patients in the ED. (Any incomplete Emergency X-ray Report forms are to be returned to the ED for immediate completion) The ED Medical Director is responsible for responding to failure in this system and initiating appropriate actions. REFERENCES Coroner s Case No 3124/00. Victorian Coroners Court Lau L. Imaging Guidelines. 4th Edition The Royal Australian and New Zealand College of Radiologists: Surrey Hills. Personal information and health information as defined in the relevant Victorian law, which is required to be collected, used, disclosed and stored by BHCG in order to achieve the Purpose of this policy, will be handled by the Group and its employees in accordance with their legal obligations. Authorised: (Chairperson, Group Clinical Standards Committee) Date: 81

82 Appendix 18: Terms of reference CPG working party Extended Scope of Practice Projects Clinical Practice Guideline Working Party TERMS OF REFERENCE TITLE: Nurse Practitioner Project in the Emergency Department Multidisciplinary Working Party PURPOSE: To provide multidisciplinary input into the development of the Clinical Practice Guidelines for ED Nurse Practitioner Candidates and ED Clinical Nurse Consultants. OBJECTIVES: To report to the BH Nursing Governance Group and other relevant boards and committees regarding project progress and outcomes Identify and review Clinical Practice Guidelines and protocols To facilitate multidisciplinary communication KEY PERFORMANCE INDICATORS: Regular attendance at meetings Members have a clear understanding of the project Project in line with original plan, including budget and timeframe MEMBERSHIP: Nursing Director Medical Services Emergency Department Nurse Unit Manager Emergency Department Medical Director Emergency Department FACEM Emergency Nurse Practitioner Candidates CHERC Project Coordinators Director of Pharmacy Director of Pathology Manager of Medical Imaging DURATION OF MEETING: 30 mins 82

83 FREQUENCY OF MEETING: Once per month, to be reviewed after first six months of the project QUORUM: Half the membership plus one. TERM OF COMMITTEE / PROJECT TEAM Until project is completed REPORTING TO: BH Senior Nurse Council, via Nursing Governance Group Department Human Services REPORTING MECHANISM: Periodic reports to Senior Nurse Council Reports as required by Department of Human Services APPROVED:.. (Title) COMMENCEMENT DATE: ANNUAL REVIEW DUE: (date) 83

84 Appendix 19: CPG authorisation tree NURSE PRACTITIONER CANDIDATES CLINICAL PRACTICE GUIDELINE AUTHORISATION TREE Nurse Practitioner Candidates/Nurse Practitioner Project Officer Two Emergency Department Senior Physician s (FACEM) Emergency Department Director Emergency Department Nurse Business Manager Director Pathology Director Radiology Director Pharmacy Director of Surgery & Director of Medicine Nurse Practitioner Candidate s trial Clinical Practice Guidelines X 10 Medical and Surgical Services Clinical Standards Working Party Pharmaceutical Advisory Committee Executive Director Nursing / Surgical Services Chief Medical Officer / Medical Services Submission of Clinical Practice Guidelines to Bendigo Health Medical Surgical Clinical Standards Committee for Approval Emergency Nurse Practitioner Candidates commence use of Clinical Practice Guidelines Annual review of Clinical Practice Guidelines (or as necessary to ensure evidenced based practice) * Please note there is a two week time limit on all Clinical Practice Guidelines 84

85 Appendix 20: Terms of reference education working party Emergency Nurse Practitioner Candidates Education Working Party TERMS OF REFERENCE TITLE: Emergency Nurse Practitioner Candidates Education Working Party. PURPOSE: To provide educational support to Emergency Nurse Practitioner Candidates (ENPC) at Bendigo Health and to challenge and expand the ENPC clinical inquiry and skills of Emergency Nursing. OBJECTIVES To report to the BH Nursing Governance Group and other relevant boards and committees regarding project progress and outcomes To facilitate multidisciplinary communication Reflection on practice Learning and consolidation in clinical practice Confidence in presentation Peer review Quality improvement Mentoring roles Successful implementation of an educational forum with all members (internal and external) of the Emergency Nurse Practitioner Candidates Education Working Party Exploration, clarification and acceptance of the role of the Nurse Practitioner at Bendigo Health and within the Bendigo Community KEY PERFORMANCE INDICATORS Regular attendance at meetings Members have a clear understanding of the project Project in line with original plan, including budget and timeframe INTERNAL MEMBERSHIP Nursing Director Medical Services Nursing Director Surgical Services Acting Operations Manager Medical Services Senior Nurse Educator Emergency Department Nurse Unit Manager Emergency Department Medical Director Emergency Nurse Practitioner Candidates Nurse Practitioner Project Officer Nurse Practitioner Project Manager EXTERNAL MEMBERSHIP Nurse Practitioner, New South Wales Retired Nursing Professor, United Kingdom DURATION OF MEETING: 60 mins 85

86 FREQUENCY OF MEETING: Once per month, to be reviewed after first six months of the project. QUORUM: Half the membership plus one. TERM OF COMMITTEE / PROJECT TEAM Until project is completed REPORTING TO BH SNC, via Nursing Governance Group Department Human Services REPORTING MECHANISM Periodic reports to BH Executive Reports as requested by Department of Human Services APPROVED:.. (Title) COMMENCEMENT DATE: ANNUAL REVIEW DUE: (date) 86

87 Appendix 21: Case review process CASE REVIEW AND CLINICAL LEARNING OPPORTUNITIES 2006 The Nurse Practitioner Candidate Case Review Group has been set up to support nurses working towards Nurse Practitioner authorisation. The aim of the group is to provide professional support to nurses in the clinical areas and to expand the clinical inquiry and skills of nurses working in the remote sites. What is case review? A case review is a process of professional reflection where a practitioner presents a patient/client care case (s). The case can be current or retrospective and which is/has been particularly challenging or interesting or which are not progressing according to plan and where other professional advice might be useful. How does this benefit professional practice? Much of the work of health professionals is about adapting care strategies to different situations to meet the needs of patients/clients. Developing expertise relies on experience and coaching - case review is an approach, which encourages people in a team to learn from each other. Professionals working in advanced positions need a forum to talk about what worked and what didn t and to get constructive feedback and suggestion. Ability to give and receive peer review demonstrates professionalism. Case review is a component of continuous quality improvement. Case review can be part of a debriefing process which ensures that all team members know the facts, can discuss their perceptions and also contribute to constructive resolution. How does case review work? Interested members of a team meet on a regular basis. It is agreed that what is discussed is confidential to the group. One or more members of the team present a situation or patient/client presentation, which they found interesting, difficult, challenging, or complex. They describe: the presenting symptoms and the context, interesting issues that arose in assessment, the plan of care that was devised and how the plan was implemented, issues that arose over a time period what worked, what didn t and what you believe you could have done differently and what you learned from the situation. The team then asks questions or provides comment/suggestions about the scenario that was presented. The professional may link this situation to a similar experience to highlight different strategies that could be used or trends that are becoming obvious. The team might refer to literature or international experiences that they have observed/heard about. Questions might be asked about whether something needs to be changed or improved in the team practices as a result of the scenario/situation. The person presenting a concurrent case might be asked to think about what was discussed and at the next case review to talk briefly about how you benefited from the discussion in resolving their difficulties. Who is involved? Team members working with NP candidates and those in mentor roles Multidisciplinary team members where possible A facilitator The same core group of people where possible (not essential) to build up trust and confidence even when case reviews are open to a larger attendance 87

88 Learning objectives Reflection on practice Learning and consolidation in clinical practice Confidence in presentation Peer review Quality improvement Exploration, clarification and acceptance of the role of the Nurse Practitioner in remote area practice Criteria to be used Nurses Registration Board criteria for application as a Nurse Practitioner which are as follows Health assessment relevant specialist anatomy and physiology, pathophysiology, pharmacology, triage Diagnosis differential diagnostic skills, problem solving rationale, interpretation of pathology and radiology Therapeutic management Evaluation 88