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Outpatients – the enigma Enhancing the Outpatient/Client Experience – through Staff Development, Service Improvement & User Engagement/ Involvement Barbara.

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Presentation on theme: "Outpatients – the enigma Enhancing the Outpatient/Client Experience – through Staff Development, Service Improvement & User Engagement/ Involvement Barbara."— Presentation transcript:

1 Outpatients – the enigma Enhancing the Outpatient/Client Experience – through Staff Development, Service Improvement & User Engagement/ Involvement Barbara McDowell Anderson South Eastern HSC Trust

2 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 Outpatient Nursing… it is more than: Directing lost patients and visitors Forwarding phone calls to relevant departments Handling patient records Chasing up missing notes/ results/ doctors Setting up before clinics Chaperoning doctors during consultations Clearing up after clinics Handing out leaflets Making review appointments

3 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 Outpatient Nursing… in SET includes: Routine clinic work up – ECGs/ spirometry/ bloods Ophthalmology – pre and post op assessment/ review clinics Urology – flow clinics DVT/ VTE - risk assessment/ prophylaxsis treatment Anticoagulant (Warfarin ) clinics ENT – micro-suction clinics Gynae – Pessary assessment clinics ED – injection clinics Diabetic clinics Dermatology clinics

4 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 Dermatology Service in SET Integrated team – Hospital Clinicians – Consultant/ Associate Specialist Registrar/ Staff Grade Doctors – Hospital Specialist Nurses – ICATS – GPwSI – ICATS – Specialist Nurses – GPs – Outpatient Nurses a general specialist or a special generalist

5 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 Dermatology – nursing Staff Training Commissioned courses - academic base Study Days Workshops In-house/ on the job training Service Improvement Establishment of a variety of nurse led clinics Patch Test Clinics Cryotherapy Clinics Roaccutane Clinics Biologics Clinics PUVA/ UVB Clinics PDT Clinics Botox Clinics ICATS Clinics User Involvement Patient Questionnaires Patient Stories User Involvement Staff Team Meetings Supervision Sharing Successes

6 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 Nurse-led Patch Testing allergy Clinics Dermatology Consultants refer patients to Nurse Led Patch Testing Clinics Appointments arranged Nurses prepare allergy tests in advance Treatment explained & test strips applied Patient attend 48 hours later for reading of patch tests Review with Doctor or Nurse and further treatment plan

7 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 Nurse-led Cryotherapy Clinics Dermatology Consultants refer patients to Nurse Led Cryotherapy Clinics Appointments arranged Treatment process explained Patient attend weekly/ fortnightly

8 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 Nurse-led Roaccutane Clinics Dermatology Consultants refer patients to Nurse Led Roaccutane Clinics Systemic drug therapy for treating acne Consultant only initiated treatment for 4 months 4 weekly review for ladies (pregnancy testing ) 4 & 16 week review for males

9 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 Nurse-led Biologics Clinics Dermatology Consultants refer patients with Psoriasis to Nurse Led Biologics Clinics Appointments arranged/ treatment/ process explained Information added to the Badbir Database Ongoing IV or SC drug therapy monitoring – 3 monthly

10 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 Nurse-led PUVA/UVB Light Therapy Clinics Dermatology Consultants refer patients with eczema /psoriasis to Nurse Led PUVA clinics Appointments arranged Treatment/ process explained Patient attend 3 times a week for 15 treatments Initial treatments are only seconds/ minutes long

11 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 Nurse-led PDT clinics Dermatology Consultants refer patients with oncological/ non- oncological conditions, including non-melanoma skin cancers and acne to Photodynamic therapy (PDT) Nurse Led Clinics. Particularly lesions in difficult, cosmetically sensitive and poor healing sites. Straightforward treatment: Procedure can be undertaken by a skilled nurse practitioner Bowens disease before and after

12 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 Nurse-led Botox clinics Dermatology Consultants refer patients with hyperhidrosis (excessive sweating) problems to Nurse Led Clinics. The Botox injections can be undertaken by a skilled nurse practitioner

13 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 Patient Centred – Safety Staff Training Policies, Procedures & Protocols Incidents/ Accidents Near Misses Complaints

14 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 Patient Centred – Quality Evidence Based Audit - practice Patient Attendance Staff Absence/ Turnover Communication/ Professional Forum

15 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 Patient Centred – Experience Patient Experience – Questionnaires – Patient Stories – User Involvement Staff Experience – Team Meetings – Sharing Success – Staff Involvement in professional forums

16 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 Patient Experience – Patient Care Survey Dermatology Outpatient Questionnaires – Online Patient Satisfaction Questionnaires Staff as Patients – Patient Stories/ Themes – User Engagement/ Involvement

17 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 Patient Care Survey Questionnaires (Dermatology)

18 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 Survey – January 2013 Response: – 53:150 = 35.3% Male: – 46% Female: – 54% <59 years: – 42% >60 years: – 58% Ethnicity – White: 98% – Other: 2% First Language – English: 95.5% Questionnaire easy to complete: – Very Easy: 64% – Easy: 36%

19 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April KPIs On arrival Respect Attitude Behaviour Communication Information Leaflets Privacy & Dignity Infection Control Consultation Waiting times Medical Records Treatment & Care Environmental Factors Overall Satisfaction

20 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013

21 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 Positive comments The relaxed manner and friendliness of the doctor & nurse in attendance Efficient & professional way at which the procedure was carried out Getting the all clear The doctor and nurse spoke directly to my daughter, they didnt talk over her That I was seen and treated by people who cared for my health and who did their best for me Local access, fairly prompt appointments / information given

22 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 Areas of improvement More punctual attendance at the clinic may – may help prevent long waits at the clinic Clearer contact details should they be needed Had to park in a public car park and walk across main road, in the pouring rain Difficulty with directions once inside the hospital Shorter waiting time for the appointment and in the department Need better facilities in the waiting area

23 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 Online Patient Questionnaires (Staff as Patients – n=34) November 2012 – February 2013

24 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 HOSPITAL ATTENDED

25 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 CLINIC ATTENDED

26 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 DID STAFF INTRODUCE THEMSELVES TO YOU WHEN YOU FIRST MET?

27 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 RESPECT

28 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 ATTITUDE

29 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 BEHAVIOUR

30 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 COMMUNICATION

31 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 PRIVACY & DIGNITY

32 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 OVERALL SATISFACTION

33 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 Patient Stories - themes

34 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 Staff It felt as if I was on a conveyor belt, just another person to be seen on a particular day Staff put me at easy and explained everything in a very warm and friendly manner. I felt that I was being treated by a friend who just happened to be a professional. The way staff put me at ease, they saw I was worried and were so kind and reassuring Receptionist very helpful and courteous

35 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 Person centred processes I am profoundly deaf. At the beginning of the appointment, the doctor finger spelled his name to me. It had never happened to me before. It was a lovely and thoughtful gesture, which made me feel at ease. The doctor was also willing to write everything down which was very helpful. If it was possible to be told who you could contact should you have a query as to your treatment or next appointment I am very pleased by the way I was spoken to and not spoken down to, everyone came to my level I think it would have been useful if the information leaflet given to me at the clinic had been posted to me prior to my appointment

36 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 Involvement in care Staff were really nice. Very respectful in promoting my privacy and dignity. Explaining everything really well to me and due to the nature of my appointment I was anxious. Staff were very reassuring. My daughter being so upset throughout the procedure however that was no-ones fault. We did however enjoy the fact that she left the clinic being able to hear properly The information provided allowed me to make an informed choice

37 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 Processes The time between referral and appointment was good The speed and efficiency with which my appointment was conducted There was a ½ hour delay but at least we were informed of that Booking in was confusing for a 90 year old

38 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 Environment The impossibility of car parking The open environment, clean and professional with a friendly atmosphere Better catering facilities at the clinic

39 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 ACTION PLAN Feedback and results shared with staff with specific reminders: – Confidentiality – Signage – Person Centred Practice Ongoing collection of patient satisfaction surveys and patient stories Transforming Your Care projects – OP Reform workstream working in tandem with the Long Term Conditions workstream to promote greater User Involvement

40 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 User Engagement/ Involvement

41 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 Questionnaire feedback I am profoundly deaf. At the beginning of the appointment, the doctor finger spelled his name to me. It had never happened to me before. It was a lovely and thoughtful gesture, which made me feel at ease. The doctor was also willing to write everything down which was very helpful. I think it would be an excellent idea to provide Deaf Awareness Training to medical staff. The standard Deaf Awareness training is 1 full day. The training enables the participants to become more informed on how to deal with a range of deaf people including those who use Sign Language and also Hard of hearing people. The Deaf Community will benefit hugely form this innovation, as that will ensure that the next generation of doctors are more aware how to deal with deaf patients with compassion.

42 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 Complaint - learning A child attending the Fracture Clinic had a plaster cast removed. The parent complained that the procedure was not explained to the child, nor was he shown the plaster saw or made aware of how noisy it was. Following investigation/ discussions the following actions were implemented: Patient information leaflet was reviewed Further training/ awareness for staff dealing with paediatric fractures Ear protectors made available Provision of Entonox gas as required for pain relief A patient attending the Fracture Clinic complained that they had not been offered (adequate) analgesia prior to fracture manipulation/ application of a plaster cast.

43 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 Incident review A patient should have had a 6 week review following a wider excision of melanoma. Regrettably this did not happen due to human error - in that the current administrative processes were found not to have been followed completely and the systems and processes were not robust enough to prevent or detect a failure Clarity of roles and responsibility of secretarial staff for clinic attendances Discussed at induction of new staff & reviewed at annual appraisal Clinical staff urged to provide clearer information/ instructions to patients Information reports utilised to validate and follow up patients with outstanding reviews Explore technology solutions for follow-up surveillance

44 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 What of the future… Outpatient Nursing is unlikely to be seen as: Life saving – ICU / Theatre Cute / lovely – Maternity & Paediatrics Emotive – Cancer Services Headline hitting – ED trolley waits Yet Outpatient Departments are uniquely placed at the Primary and Secondary Care interface & currently have ¼ - ½ million opportunities per year to provide Transformational Outpatient Care to all patients

45 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 Outpatient Nursing needs To exploit the natural conduit between Primary & Secondary Care To influence Trust/ Board/ Department for further opportunities and resources to provide more Outpatient Nurse Led Clinics To gain recognition for the work currently undertaken – Monetary/ Non Monetary To ask for a regional professional forum for Outpatient Department Sisters/ Managers To raise the professional profile of Outpatient Nursing

46 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 When I think about all the patients and their loved ones that I have worked with over the years, I know most of them don't remember me nor I them. But I do know that I gave a little piece of myself to each of them and they to me and those threads make up the beautiful tapestry in my mind that is my career in nursing. Donna Wilk Cardillo A Daybook for Beginning Nurses

47 Leading Care, Leading Teams – Shaping the Future Ward Sister/Charge Nurse and Team Leader Conference, 17 th April 2013 They may forget your name, but they will never forget how you made them feel– Maya Angelou Thank you & Questions


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