N URSE D ELEGATED E MERGENCY C ARE 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
O VERVIEW • 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) •Pain (any cause) •Ear ache •Rashes •Eye problems •Respiratory type illness •Foreign bodies •Tick bite •Head injuries •Urinary Symptoms •Insect bites •Vomiting and diarrhoea •Limb injuries •Wounds
Background Walcha Multi-Purpose Service
B ACKGROUND 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
A T W ALCHA • 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
‘T HE W ALCHA M ODEL ’ P ILOT • 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 P ROGRESS • 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
Implementation Review & Education Updates ECI NDEC Suite RN Governance Accreditation Patient Auditing Care
NDEC - project timelines Month Activity (2013) May Working group established June Document suite endorsed and communication Ongoing consultation 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
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 - P ARTNERSHIPS • 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
H OW 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
R EFERENCES 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
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 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
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