Friday, 27 November 2015
A step closer in Wales
Wales today moved a step closer to legal staff to patient ratios in it's hospitals. If NICE will not publish it's guidance, maybe this is the way forward.
Thursday, 26 November 2015
Quantifying staff experience in the ED
When making comparisions in studies between different members of staff, the traditional band 5,6,7 approach does not allow enough depth to determine what skill sets make the biggest impact on the nursing care that is provided in the department. Does the A&E course have a big impact on the patient care that is delivered, or is the nubmers of years of experince the deciding factor? Not all staff are capable of the same skills, even at the same grade, and therefore how do we compare two shifts with very different staff mixes?
The simplest way to understand the different impact each course and trianing day that a nurse undertakes on their practice could be quantified through a points system. This would be able to take account of professional courses such as the ED course, and study days such as suturing and plastering courses. These "points" could then give a total for the nurse, and quantify how much experience is on a single shift.
For example:
A&E Course = 10 points
ALS course = 5 points
EPLS course = 5 points
ENP course (injury or illness) = 15 points
10 years A&E experience = 20 points
2 years Ward experience = 2 points
Total Points = 57
In this simple way you could arrive at the total number of points availble on any shift, and therefore the impact that each element of nurse training has on patient care.
The simplest way to understand the different impact each course and trianing day that a nurse undertakes on their practice could be quantified through a points system. This would be able to take account of professional courses such as the ED course, and study days such as suturing and plastering courses. These "points" could then give a total for the nurse, and quantify how much experience is on a single shift.
For example:
A&E Course = 10 points
ALS course = 5 points
EPLS course = 5 points
ENP course (injury or illness) = 15 points
10 years A&E experience = 20 points
2 years Ward experience = 2 points
Total Points = 57
In this simple way you could arrive at the total number of points availble on any shift, and therefore the impact that each element of nurse training has on patient care.
Tuesday, 28 April 2015
Friends and family test in A&E
This is a well written patient perspective on the friends and family test and it's use in A&E
Sunday, 26 April 2015
Professional Cross Over
Many university courses have mutli professional aspects to
their teaching, where students from nursing are taught along side
physiotherapists, paramedics and other members of allied health in some modules
such as anatomy and biosciences. This
approach recognises that there are many similarities to the many professions
that work in healthcare these days and aims to broaden a nurses understanding
of these professions through this joint training.
Sometimes however individuals after a number of years
practice in their profession may chose, or find it becomes necessary for health
or financial reasons for them to retrain in an alternative profession. Whilst the university training system
recognises that nurses who train initially as adult branch should only
undertake a small one year conversion course to accredit themselves as
qualified children’s nurses, no system currently exists for recognition of
other members of the multidisciplinary team should they wish to change
profession. There is currently
recognition when undertaking medicine at university of previous learning, with
graduate entry options that take into account previous medical experience, and
while some universities may offer this in other professions it is by no means
well publicised.
Whilst obviously moving between professions will not be as
simple as changing between an adult and child qualified nurse, there is a
significant amount of our professional activities that are
interchangeable. Patient assessment, a
key area that a great deal of time at university is spent teaching to student
nurses is no different than the patient assessment that is taught to paramedics
and emergency care practitioners.
Likewise all anatomy and pathophysiology will be the same irrespective of
the professional qualification that an individual may hold.
There would of course be important new skills to learn when
crossing profession, a paramedic may be highly skilled at removing patients
from an entrapped car and transporting them safely to hospital, but would need
training in drugs rounds, patient management on a ward, and the management of
other members of the professional team not found outside of the hospital
setting. Likewise a member of nursing
staff, even those working in the emergency department, may be well versed in
the emergency assessment of patients, but will require training to operate
safely at a road side accident or industrial chemical spill.
Whilst it would be ideal that we could recognise that
members of the multidisciplinary team with appropriate training could cross
professions there is always a cost implication.
These courses would have to be run by university institutions that must
always balance their books, and so therefore this is unlikely to be offered by
every institution. Those institutions
that already teach a number of professions in the same lecture hall may be
those best versed to offer a cross over course, however outside a few select
people it remains to be seen if there would be significant demand to make it financially
viable.
Friday, 23 January 2015
Improving 4 hours
It's improving:
http://www.bbc.co.uk/news/health-30949775
However it's still not there yet, and this is the traditional January lull before it picks up again
Friday, 16 January 2015
Safe staffing
Safe staffing in A&E, topical at any time, but this winter also very political.
Key points:
- 1:4 nurse to cubicle ratio
- band 7 on every shift
- 2 nurses to every trauma and cardiac arrest patient
- 2:4 ratio in resus
Monday, 12 January 2015
Friday, 9 January 2015
New year A&E figures
Figures are out for ED performance in the new year, after the Christmas period performance has returned to pre Christmas lows
Wednesday, 7 January 2015
The nub of the problem
The guardian have hit the nail on the head. With a normal wait to be seen time this is not an A&E crisis, it's caused by delays in discharge
Major incident - a short term fix
Major incident describes a situation when there is a massive overwhelming of nhs resources. To meet this extra staff are drafted in for the emergency situation, normally from other areas of the hospital. A good example of this in practice was the July bombings in 2007. The whole of the nhs came together to treat the emergency.
The problem with the current crisis is that unlike normal major incidents there is no defined end point. A hospital and it's staff can't stay on an emergency war footing forever. Sooner or later the staff or the nhs will break
Politics in the current problem?
Labour are calling for a sumit on the A&E crisis, the conservatives cause them of generating headlines.
It is clear there are problems, the conservatives have admitted this much, across the country A&E departments have failed to hit the target 3 months in a row, but this is not an A&E problem, it is a whole system problem, A&E is just were it becomes most apparent
Friday, 2 January 2015
Comprehensive review
A comprehensive review from the telegraph into the current problems in the NHS, very well written.
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