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