N URSE D ELEGATED E MERGENCY C ARE Level 4, Sage Building, 67 Albert - - PowerPoint PPT Presentation

NURSE DELEGATED EMERGENCY CARE

Level 4, Sage Building, 67 Albert Avenue PO Box 699 T 02 9464 4674 www.ecinsw.com.au Chatswood NSW 2067 Chatswood NSW 2057 F 02 9464 4728 ABN 89 809 648 636

OVERVIEW

• What is NDEC?
• What is the ECI doing about facilitating roll out of NDEC?
• How can you can get involved?

What is NDEC?

• Framework offering standardised, delegated care by nurses

for low risk / low acuity, unscheduled care, patients

• Delineated and robust patient inclusion and exclusion criteria
• Episodic care by accredited RNs through
• Nursing Management Guidelines
• Standing Orders
• Documentation templates
• Discharge and follow-up procedures
• Scheduled follow-up with GP
• Follow-up phone call from RN within 24 hours of presentation

Nursing Management Guidelines

• Burns (minor)
• Ear ache
• Eye problems
• Foreign bodies
• Head injuries
• Insect bites
• Limb injuries
• Pain (any cause)
• Rashes
• Respiratory type illness
• Tick bite
• Urinary Symptoms
• Vomiting and diarrhoea
• Wounds

Background

Walcha Multi-Purpose Service

BACKGROUND

Challenges of rural & remote emergency care

• Small centres, very finite resources, lack of the full range of hospital resources
• Geographical isolation
• Chronic workforce challenges
• Attracting and retaining General Practitioners (GPs) to work rural and remote
• Variable, limited or absent authority of the Registered Nurse (RN) to manage a minor injury or

illness through to discharge within legislated scope of practice

• Necessity of the RN to call the GP for minor injury or illness 24/7
• Patients waiting for GP to arrive at ED may experience an extended wait time and / or discharge

prior to completing assessment and treatment

AT WALCHA

• Dr Adrian Allen, GP
• Collaborative, multidisciplinary approach to program development
• Extensive pre and post implementation audit regime
• Nursing Management Guidelines developed from “top 10” presentations
• Extensive post implementation analysis and refinement
• Clinical update integration and model refinement ongoing

‘THE WALCHA MODEL’ PILOT

• Initially piloted “out-of-hours” at Walcha MPS, now operates 24/7
• LHD rollout to additional level 2 EDs
• Excellent feedback from accredited RNs, patients and GPs
• Ongoing review of the ‘Walcha Model’

LESSONS

• GP leadership and ongoing support is essential
• Successful model roll out needs support of the whole team
• Formal implementation is required
• Local community engagement should be planned
• Local adaptation and hybrid options viable
• Auditing and review must be ongoing
• Updates in evidence based best practice are able to be integrated efficiently

Nurse Delegated Emergency Care

Why is the ECI interested?

Overall, 38% emergency care patients present to “rural”* emergency facilities with 12% presenting to level 2 services.

* as defined in NSW HIE

The NDEC model addresses several ‘Top Challenges’ identified in rural & remote settings*

• Lack of staff / workforce shortages / recruitment / retention
• Training and training support for staff
• Patient and public expectations

Reference: ECI stakeholder survey 2012

(http://www.ecinsw.com.au/sites/default/files/field/file/Combined%20final%20survey%20report%202012.pdf)

ECI PROGRESS

• Walcha model presented to inaugural ECI symposium 2011
• Appointment of a dedicated project officer
• Information gathering
• Stakeholder engagement: emergency care community, ECI Executive Committee

support, Rural Critical Care Taskforce support, and many others ongoing

• Initial and subsequent site visits
• Initial GP contacts (individuals and organisations)
• Attendance at HNELHD training session
• Level 2 ED survey of potential future sites (81 sites surveyed)
• Formation of a NDEC Working Party
• Development of NDEC Suite of resources for implementation and ongoing supports

ECI NDEC Suite

Implementation Education RN Accreditation Patient Care Auditing Governance Review & Updates

NDEC - project timelines

Month (2013) Activity May Working group established June Document suite endorsed Formal EOI process to sites Education /accreditation module development start July Audit and evaluation framework reviewed August Initial site work commences September Roll-out of finalised education / accreditation module and audit and evaluation framework to initial sites Ongoing consultation and communication

NDEC – WORKING GROUP

Membership to include:

• Nursing, medical (GP) and HSM staff WITH experience using the

NDEC

• Nursing, medical (GP) and HSM staff WITH NO experience using the

NDEC

• LHD executive
• Consumer
• Rural Health Network
• ECI
• Rural Critical Care Taskforce

Note: members may fulfil more than one role above

NDEC - PARTNERSHIPS

• Professional groups/ organisations/ training bodies
• Individual clinicians at identified sites and more broadly
• Local Health Districts
• Rural Health Network (ACI)
• Other ACI Networks
• Medicare Locals
• Pillar organisations (HETI etc)
• Consumers
• Ministry of Health
• Rural Critical Care Taskforce

HOW CAN YOU HELP?

• Regular updates provided by the ECI via www.eci.nsw.com.au
• Communication (2 way channels) – tell us about your successes and

challenges

• Cooperation through supporting site implementation processes
• Champion NDEC locally – promote the initiative with your clinician

base

• Identify resource / knowledge gaps for ongoing program support

REFERENCES

Hunter New England Local Health District (2011) Walcha Multi Purpose Service Emergency Department Model of Care ‘Triage Away’ ATS 4 & ATS 5 Patients, Hunter New England Local Health District, New Lambton NSW Health (2004) Triage in NSW rural and remote Emergency Departments with no on-site doctors NSW Health, North Sydney

http://www0.health.nsw.gov.au/pubs/2004/pdf/triage_rural_remote.pdf

NSW Ministry of Health (2012) NSW Rural Adult Emergency Clinical Guidelines: NSW Rural Critical Care Taskforce NSW Ministry of Health, North Sydney

http://www0.health.nsw.gov.au/policies/gl/2012/pdf/GL2012_003.pdf

Committee of Presidents of Medical Colleges Strategic position statement Interprofessional collaboration May 2013

http://www.cpmc.edu.au/?page=contents&subpage=policy-document

Level 4, Sage Building, 67 Albert Avenue PO Box 699 T 02 9464 4674 www.ecinsw.com.au Chatswood NSW 2067 Chatswood NSW 2057 F 02 9464 4728 ABN 89 809 648 636

Dwight Robinson

Nurse Project Officer (contact for NDEC)

dwight.robinson@aci.health.nsw.gov.au

Sally McCarthy

Medical Director

sally.mccarthy@aci.health.nsw.gov.au

Vanessa Evans

Network Manager

vanessa.evans@aci.health.nsw.gov.au

Sophie Baugh

Manager Special Projects

sophie.baugh@aci.health.nsw.gov.au