Ward Based Cardiothoracic Nurse Practitioner Sandra Laidler MSc - PowerPoint PPT Presentation

Ward Based Cardiothoracic Nurse Practitioner Sandra Laidler MSc Practice Development BSc (Hons) Non Medical Prescriber Registered Nurse

Background  NP initiative (2009) at Freeman Hospital  12 months training period  Effective replacement of SHO/Locum doctors (2010)  Ward team (NPx10/ CT x2) covering 24/7 care

NP Responsibilities  CTPAC (1x NP: Mon- Fri 8am-4pm)  Ward cover (52 patients / 2 wards = 3x NPs day :1xNP night)  Ward rounds  Clerking, history taking & physical assessment (complete PATS forms)

NP Responsibilities  Order & analyse pre & post operative investigations  Document in medical notes & Erecord  Complete risk assessments (Government driven targets -compliance with CQUIN, VTE/Dementia screening)

NP Responsibilities  Cardiac Arrest Team (CALS / ALS trained)  Venepuncture, cannulation, suturing, ABGs (radial/femoral stab), catheterisation, NG tube / lasoo insertion, long line insertion, extensive wound care, VAC dressings, clagette procedure/chest pack changes  Prescribe medications

NP Responsibilities  Order discharge medications  Organise warfarin appointment follow up  Complete sick notes/insurance forms  Complete Intime discharge summaries for GPs (electronic discharge letter service)  Repatriation & external referrals  Care of ward attenders / post discharge reviews

Feedback  Legal & credible documentation  Access / Visibility  Continuity of care  Reliability & approachability  Improved handover, reporting and clinical record keeping

Feedback  Improved prescribing practice  Cost effective prescribing  Quality of care improvements  Attention to detail  Improved consistency of care

Findings in 6 years-  Effective replacement of junior locum doctors  Cost effective (after initial training period)  Quality service provision  Improvements noted by all MDT members  Improved documentation & compliance with target driven initiatives  Supportive SpR-Np team/relationship evolving  Positive reception of NP role by patients & family

Challenges  Prescribing blood  General dogsbody  Lack of ward support from SpR level  Inundated by ward staff  Blurring of roles & professional boundaries  Product of own success!  NP progression  Replacing NPs: 1 year training period

Progression  Adult congenital surgical patients  OOH (weekends, night & evenings) - LVADS  Other specialities are now considering taking on this service (cardio-paediatrics, PICU, CCU and cardiology)  HDU cover?  Drain insertion by NPs in future practice?

Thank you