AMBULANCE EXTENDED CARE PRACTITIONERS PROCEDURES

AMBULANCE EXTENDED CARE PRACTITIONERS PROCEDURES DATE APPROVED: August 2012 APPROVED BY: Clinical Quality & Governance Committee IMPLEMENTATION DATE: August 2012 REVIEW DATE: August 2014 LEAD DIRECTOR: IMPACT ASSESSMENT STATEMENT: Director of Nursing & Quality No adverse impact on Equality or Diversity Policy Reference Number: CLN Procedure 031 (Version 3)

of 10 Change Control Document Number CLN Procedure - 031 Document Ambulance Extended Care Practitioners Procedures Version Three Owner Director of Nursing and Quality Distribution list All staff Issue Date Updated August 2012 Next Review Date August 2014 File Reference PO - 031 Impact Assessment No adverse Impact Author Head of Clinical Services, CPGM (C&W) and Head of Quality & Professional Standards Document History Date Change Comments/Authorised by Aug 08 Initial Draft document Director of Nursing & Primary Care Aug 08 Scope of Practice added Steve Edwards Aug 08 Medicines Management and Steve Edwards Prescribing added Aug 08 Framework for Health (Skills for Steve Edwards Health) added Aug 08 Reviewed and amended Clinical Team meeting Sept 08 Reviewed by clinical team and Director of Nursing & Primary Care further minor amendments Sept 08 Send to Clinical Governance Sub- Director of Nursing & Primary Care Committee for approval Sept 08 Approved Clinical Governance Sub- Committee Sept 08 Sent to Staff side Policy Group for Director of Nursing & Primary Care information Sept 08 Approved IGPC August 10 Re-written Mark Farthing Lead ECP Adele Pearson - Regional Head of Quality & Professional Standards August 10 Send to Clinical Governance Sub- Approved for release August 12 August 2014 Committee for approval Updated for clarity following NHSLA mock assessment (no change to clinical or operational responsibilities) Agreed by Trust senior clinicians Director of Nursing & Quality and Medical Director Renumbered from OPS Policy 007 due to change in directorate

of 10 CONTENTS 1 Background... 4 2 Ambulance Extended Care Practitioners Definition... 4 3 Scope of Procedures... 4 4 Accountabilities and Responsibilities... 5 5 Objectives... 7 6 Recruitment and Selection Arrangements... 7 7 Scope of Procedures/ Practice Reflecting the Educational Pathway... 8 8 Process for Assessment, Diagnosis, Treatment and Referral Decisions... 8 9 Process for Collaboration with Other Health Care Professionals... 9 10 Medicines Management (Emergency Care Practitioners only)... 9 11 Monitoring and Effectiveness of this Policy... 9

of 10 1 Background 1.1 The West Midlands Ambulance Service NHS Trust (WMAS) is committed to the active management of staff and clinical risk. This policy has been developed to reduce the risk to patients, the Trust and its employees, and to inform Ambulance Extended Care Practitioners (ECP) of the documents and policies relevant to their scope of working. 2 Ambulance Extended Care Practitioners Definition 2.1 All references within this document relating to Ambulance Extended Care Practitioners include First Contact Practitioners (FCPs), Advanced Paramedics (APs), Community Paramedic Officers (CPOs), Emergency Care Practitioners (ECPs) and Critical Care Practitioners (CCP). 2.2 The definition of Ambulance ECP, for the purpose of this document, is a healthcare professional who works to an agreed clinical model with the attitude, training, skills and knowledge base to deliver holistic care and treatment within the out of hospital primary and acute care setting. This broadly defined level of autonomy includes assessment, differential diagnosis, treatment and discharge at scene or referral to primary or secondary care. Ambulance ECPS operate in several forms within the Trust and include: Emergency Care Practitioner (ECP) Community Paramedic Officer (CPO) Advanced Paramedic (AP - Post successfully completing WMAS training package Sept 10 onwards) First Contact Practitioner (FCP) Critical Care Practitioner (CCP) 3 Scope of Procedures 3.1 This document sets out the scope of procedures expected of all Trust clinicians dependent on their level of training and education; this is particularly important where the scope of procedures of clinicians working within The Trust is outside of the JRCALC Clinical Guidelines or the Resuscitation Council UK (RCUK). 3.2 This document applies to all members of staff who have received additional training in primary care/extended care and operate under the titles of Emergency Care Practitioner (ECP), Community Paramedic Officer (CPO), First Contact Practitioner (FCP), Advanced Paramedic (AP) or Critical Care Practitioners (CCP). 3.3 Ambulance Extended Care Practitioners are permitted to treat patients with an additional range of skills when tasked by Ambulance Control or other healthcare providers to examine, treat and guide patients to alternative

of 10 pathways, using agreed and documented guidelines. 3.4 The term Ambulance Extended Care Practitioner used in this document refers to ECPs, CPOs, CCPs, AP s and FCPs etc. and makes no distinction between these groups. The extended training and education may be provided by independent training providers, from a higher education setting or from approved in-house training courses. Ambulance Extended Care Practitioners will be working within the scope of practice of their education and training. 3.5 Ambulance Extended Care Practitioners are required to work across primary, out of hospital, pre-hospital and secondary care. They provide primary clinical interventions within an integrated service model, aimed at improving the patient s experience by: Reducing time to diagnosis/treatment and fast-tracking the patient through the emergency care pathway to the appropriate medical facility/provider, which may include collaboration with other Health Care professionals. Reducing the demand for hospital admissions through access to appropriate care at the point of need. Providing innovative new services utilising the appropriate skills and knowledge of a range of healthcare professionals across the whole healthcare spectrum, offering the first point of contact at the appropriate place and time. 4 Accountabilities and Responsibilities 4.1 The Trust Board holds overall responsibility for ensuring that all Ambulance Extended Care Practitioners are clinically qualified and trained to carry out their duties. This includes all aspects of Ambulance Extended Care Practitioners activities. 4.3 The Clinical and Quality Governance Committee is responsible for: Monitoring the effectiveness of this policy. Development and monitoring of trust wide action plans. Monitor the effectiveness and completion of local action plans 4.4 The Director of Nursing and Quality has the responsibility for developing and defining the scope of practice delivered by Ambulance Extended Care Practitioners 4.5 The Medical Director is responsible for the delivery of safe, clinical care and ensuring the Trust Board is kept informed of any significant discrepancies.

of 10 4.6 The Director of Service Delivery is responsible for : The implementation of this procedure Ensuring staff receive training in accordance with the Trust training needs analysis. Ensuring clinical supervision is provided in accordance with relevant professional bodies. That Ambulance Extended Care Practitioners comply with all relevant Trust policies and procedures 4.7 Clinical Practice and Governance Managers will support the recruitment, development and ongoing supervision of Ambulance ECPs 4.8 Operational Managers are responsible for the ongoing management of operational and clinical management of all Ambulance ECPs 4.9 All Ambulance Extended Care Practitioners are responsible for: Abiding by the policies, procedures and guidelines of the Trust. Keeping a portfolio of evidence, highlighting training, and reflective practice of clinical care in accordance with the Trust s guidelines and procedures on reflective practice. Must ensure that they maintain their registration as per professional body requirements. 4.9.1 It is the responsibility of All Staff to identify risks and to highlight these to the appropriate manager, usually via the Incident Reporting form. Employees also have a responsibility to cooperate with managers and to contribute to the process of identifying areas of developments and reducing risks. 4.9.2 HR & Operational Development are responsible for working in partnership with internal and/or external identified leads in subject specific areas so that the most current guidelines and recommendations are incorporated into Ambulance Extended Care Practitioners education/update programmes. Where a department or function changes organisational practices, equipment, process etc it is the responsibility of this department/function or subject specific lead implementing these changes to inform Organisational Learning to enable the Education Programmes to reflect most current practice or guidance. Delivering education that supports workforce and organisational development Delivering mandatory essential education to staff as defined by the Trusts training needs analysis and relevant to job role. Capturing and reporting attendance and completion of evaluation and reporting of feedback.

of 10 5 Objectives 5.1 The objectives of this procedure are as follows: To provide a consistent approach to the functioning and scope of procedures for Ambulance Extended Care Practitioners. To ensure that WMAS meets its legal obligations in relation to the use of Patient Group Directions (PGDs ECP s only), training and maintenance registration (nurse and paramedic). To be an over-arching procedure for Ambulance Extended Care Practitioners and allow staff to be directed to more detailed policies and procedures which are available on the Trust s intranet. To ensure that WMAS achieves its objectives, both strategically and locally, in the following: o Care provision in the right setting o Improving clinical governance and safety o Improving clinical outcomes o Intervention to support the individual well-being of patients o To ensure that the service is delivered in the most efficient way possible o Reducing health inequalities across the WMAS catchment area o Timely, convenient and responsive access to patients care, including preventive interventions, diagnostic and hospital avoidance. 6 Recruitment and Selection Arrangements 6.1 Ambulance ECP are recruited based upon the Trust Recruitment and Selection Policy and are selected against the job description and personal specification, which is pertinent to the type of service commissioned. 6.2 Each job role under Ambulance ECP title will be expected to undertake a selection assessment which is applicable to the level of scope of practice for that role. 6.3 Paramedics working on rapid response vehicles will be offered the opportunity to undertake the Advanced Paramedic modules. 6.4 ECP roles are advertised with the requirement to have completed a recognised ECP training course (University accredited). This is a mandatory requirement 6.5 The Advanced Paramedic role involves staff successfully completing the prelearning module using the services E-nav (Virtual Learning Environment) as well as continual assessment during the course delivery. 6.6 Qualified ECP role involves post interview Objective Structured Clinical Examination (OSCE) on patient assessment performed by the Clinical Practice and Governance Manager that confirms suitable level of skills and knowledge.

of 10 7 Scope of Procedures/ Practice Reflecting the Educational Pathway 7.1 All Ambulance ECPs have access to the Trust s intranet, which contains agreed clinical policies, procedures and frameworks. All Ambulance ECPs must work to their scope of practice when exercising their clinical judgement in the diagnosis, treatment and pathway referral of patients. These guidelines do not over-ride the individual responsibility of all Ambulance ECPs to make decisions appropriate to the circumstances of each individual patient. 7.2 All patient decisions must be made in consultation with the patient, guardian, or legal carer and recorded on the patient report form. This outcome should include patient choice and consent. 7.3 All ECP have access to the Trust s Patient Group Directions (PGDs). Staff must sign the appropriate PGDs to state that they are trained and competent in the use of that medication and pathway and also use the medical model to diagnose and treat. 7.4 All Ambulance ECP must only operate to the Trusts agreed policies, guidelines and Patient Group Directions (PGDs ECPs). Under no circumstances, are any practitioners permitted or supported by the Trust to administer any medications which are not contained in JRCALC or the Trust s agreed PGDs. 7.5 The Policy for Non-Transport and Referral Policy should be followed when discharging patients and making referral s to other health care professionals through alternative pathways. 7.6 All Ambulance ECP can only operate within the scope of procedures for which they have been trained, agreed and signed off. Under no circumstances must Ambulance Extended Care Practitioners carry out assessments, diagnosis or skills for which they are not competent. 7.7 Each Ambulance ECP will keep a portfolio of evidence, highlighting training, reflective practice of clinical care and training needs. Clinical Supervision should be undertaken at regular intervals in accordance with the Trust s guidelines and procedures. This documentation will be evidence to support the Ambulance ECPs to ensure ongoing education, competence and highlight any training needs. 8 Process for Assessment, Diagnosis, Treatment and Referral Decisions 8.1 In case of leaving a patient at home, there is guidance within the Non- Transport and Referral Policy. Which is to serve as an aide-memoire and uniformity of patient information, an advice and guidance information is to be available after every guide for when the patient may not need any further medical intervention or contact.

of 10 9 Process for Collaboration with Other Health Care Professionals 9.1 All Ambulance Extended Care Practitioners will be able to refer to Ambulance ECP Guideline for Assessment, Treatment and Referral Decisions to understand process for collaboration with other health care professionals. Apart from giving details on referral criteria, assessment and diagnostic protocols, it directs Ambulance ECPS to collaborate/refer patients to the most appropriate healthcare professionals/ set-ups (e.g. GPs, District Nurses, Walkin Centres, Out-of-hour practices, Falls prevention team, Intermediate Care Team, Community Rehabilitation teams, Practice Nurse etc 10 Medicines Management (Emergency Care Practitioners only) 10.1 ECPs are provided with Patient Group Directions (PGDs) which allow them to undertake treatment plans and medications in addition to those included in JRCALC guidelines. These treatment plans are agreed by the Director of Nursing/Medical Director. 10.2 All medications held, stored and administered by Emergency Care Practitioners must be in accordance with: Trust Board-approved Medicines Management Policy. Standard Operating Procedure for the Management of Emergency Care Practitioner Only Medicines Standard Operating Procedure for the Management of Diazepam 2mg tablets and Codeine Phosphate 30mg tablets by Emergency Care Practitioners There are no exceptions to these rules. 10.3 It is the responsibility of the Director of Nursing and Quality to ensure that Patient Group Directions (PGDs) are reviewed regularly, are fit for practice, and that the range of drugs available to ECPs allow them to treat patients appropriately and in accordance with agreed guidelines i.e. National Institute of Health and Clinical Excellence (NICE) etc 10.4 The Trust s Medicines Management Policy is available on the Trust s intranet. 11 Monitoring and Effectiveness of this Policy 11.1 The author will monitor the implementation of this Procedure, including the minimum requirements of the NHS Litigation Authority Risk Management Standards, and take assurance to the CQGC. This report will be sent to the group on an annual basis, however if the ongoing monitoring of this Procedure shows that there are significant implications for the implementation of this Procedure then it will be sent to the Group sooner. 11.2 Ambulance ECP performance will be monitored by audit of PRFs through a clinical audit process that will monitor: The number and percentage of patients not transported to hospital.

of 10 The number and percentage of patients directed to alternative pathways. The medications that they administer (ECPs) 11.3 Ambulance Extended Care Practitioners documentation will be audited as per the Patient Clinical Record Policy and Procedure i.e. Criteria to include items required for identification of incident Quality of documentation e.g. compliance with JRCALC guidelines NICE guidelines and other national guidance