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Sherwood Forest Hospitals non-invasive ventilation Nursing Lead presents at the British Thoracic Society Summer conference

Posted Friday, June 7, 2019 8:14 AM

Sherwood Forest Hospitals non-invasive ventilation Nursing Lead presents at the British Thoracic Society Summer conference

Justin Wyatt, Charge Nurse on Ward 43, King’s Mill Hospital and winner of the 2018 Chief Nurse Award in the Efficient and Safe category will be presenting the non-invasive ventilation teams’ quality improvement work on the development of an innovative new Acute Respiratory Nurse role at the British Thoracic Society Summer conference in June.

The acute NIV (non-invasive ventilation) team have previously shared their work on developing a new NIV prescription and demonstrated their success on their real-time online service dashboard with the British Thoracic Society, resulting in the prescription being adopted as part of the NIV toolkit. You can view the case study of their improvement journey here.

The 2017 ‘Inspiring Change’ NCEPOD report (National Confidential Enquiry into Patient Outcome and Death) on NIV demonstrated essential concerns with treatment in the UK. King’s Mill Hospital relied on 3.4 FTE (full time equivalent) agency Nurses and could not provide outreach for rapid delivery of care which then led to delays.

To combat this challenge, an innovative speciality NIV Nurse role was created which attracted additional Band 6 Nurses to the Trust and ensured 24-hour cover for patients. Each Specialist Nurse undergoes a comprehensive training programme which includes dedicated time with the Critical Care Outreach Practioners, Respiratory Physiotherapists, COPD Nurse Specialists and Cardio-respiratory Physiologists prior to the completion of a competency assessment.

Further development of the role has allowed independence in the arterial blood gas collection and interpretation whilst ongoing education is undertaken with quarterly training days, morbidity and mortality review meetings and attendance to the NIV quality improvement group. The role has also extended to specialise in tracheostomy and learning disability care.

The development works for the advanced Acute Respiratory Nurse role has led to improvements in the service and a reduction in agency spend of £230,000. The role has also allowed the development of NIV outreach service, reducing delays in patient care. King’s Mill Hospital has also increased NIV capacity from four beds to eight to ensure single sex accommodation and improve capacity for new admissions.

To ensure that 1:2 nursing ratios are maintained, a standard divisional operating procedure was created. The ratio is particularly important to maintain if patients require a NIV or if patient thresholds increase. The real-time online dashboard saw an improvement in 1:2 nursing from 35.5% to 89.3% of days. This allows the receipt of locally agreed level two tariffs for our patients, which in turn generates more income for the Trust.

The acute NIV service was highlighted for its outstanding care in the latest CQC inspection and the Trust was given an overall ‘good’ rating and ‘outstanding’ for care. In the CQC report it was noted that the staff in the acute NIV service “demonstrated an awareness of the needs of local population and developed services accordingly.”

The acute NIV service has also been nominated as finalists for the Quality Improvement Initiative of the Year at the HSJ Patient Safety Awards and shortlisted for the Excellence in Patient Care Awards by the Royal College of Physicians in the Quality Improvement awards.

If you would like to find out more information on how the acute NIV team successfully developed the innovative nursing service, you can find more information on the below links:

Sherwood Forest Hospitals NHS Foundation Trust business case paper to purchase four portable NIV monitors to be utilised on ward 43.

Staffing Escalation policy for the Respiratory Support Unit (RSU)

Admission and Escalation policy for the RSU.

Development of an Acute Respiratory Nurse role