Presentation on theme: "Discussion Forum: Tests and investigations, problems and solutions Kate Davies Clinical Nurse Specialist, Paediatric Endocrinology King’s College Hospital,"— Presentation transcript:
Discussion Forum: Tests and investigations, problems and solutions Kate Davies Clinical Nurse Specialist, Paediatric Endocrinology King’s College Hospital, London Pauline Musson Clinical Nurse Specialist, Paediatric Endocrinology Southampton University Hospital
Introduction Clinical Competence Communication ITT BM v Lab glucose Issues regarding administration of Actrapid Other issues in the workplace Water deprivation tests – Why are they so problematic?
Competence – Endocrine testing RCN Competency Framework for Paediatric Endocrine Nurses (in print) –Care of children and young people with growth and endocrine disorders –Level 5 – Novice in speciality –Level 6 – Competent –Level 7 - Expert
Competence – Endocrine testing Level 5 –Assist senior nurse or medical practitioner in carrying out tests –KSF – HWB6 Level3 Assess physiological and/or psychological functioning and develop, monitor and review related treatment plans
Competence – Endocrine testing Level 6 –Be able to explain rationale behind protocols for endocrine function tests –Have understanding of limitations of tests –Safely and competently carry out shorter tests with minimal supervision –Safely and competently carry our complex tests with supervision from senior nurse or experienced medical practitioner –Be able to identify results outside normal limits and liaise with medical personnel –KSF – HWB6 Level 3 - IK2 Level 2 - Gather, analyse and report a limited range of data and information
Competence – Endocrine testing Level 7 –Develop and update evidence based protocols for endocrine function tests –Provide advice on all aspects of endocrine tests at local and regional level –Carry out endocrine tests adhering to organisational policies and procedures –Initiate new tests where indicated and appropriate usage of standard operational procedures –Accept direct referrals from other consultants as agreed by local protocols –Supervise nursing and medical practitioners undertaking tests –Interpret results and act appropriately as indicated
Competence – Endocrine testing Level 7 –KSF – HWB6 Level 4 Assess physiological and/or psychological functioning when there are complex and/or undifferentiated abnormalities, diseases and develop, monitor and review related treatment plans –KSF – IK2 Level 3 Gather, analyse, interpret and present extensive and/or complex data and information
Communication Patient / family –NBM procedures –Medication beforehand Lab –Urgent samples e.g.: Water Deprivation Test –Computerised labels Ward
Other issues….. Environment & staffing Medical training – shifts 18 week pathway Variations in protocols How many tests does it take to make you competent? Which tests should only be done in specialist centres?
Insulin Tolerance Tests UCLH research: –Glucometers failed to detect the high 19/21 (94%) prevalence of true hypoglycaemia at 20 minutes in 4/19 (21%) patients –Routine glucose rescue 20 minutes after insulin injection (regardless of BM) –Have since changed protocol for hypoglycaemia from 2.6mmol/L to 3.0mmol/L BSPED 2005 MR Nortier, K Babinska & HA Spoudeas
More about ITT’s Staffing Administration of Actrapid Who should do young adults/transition tests?
Water deprivation tests Why are they so problematic? What issues are there? How could we improve this?
Lucy TimeWeightUrine volU.OsmoPlasma Osmo
Extended test TimeWeightUrine volU osmoPlasma osmo