ICU Nurse Practitioners
ICU Nurse Practitioners
Audrey Jackson
Audrey Jackson
Advanced Nurse Practitioner Critical
Advanced Nurse Practitioner Critical
Care
Care
NHS Lanarkshire
NHS Lanarkshire
Wishaw
Hairmyres
Advanced
Advanced
Nurse Practitioners Critical Care
Nurse Practitioners Critical Care
(ANPCC
(ANPCC
)
)
Why ANPCCs?
Why ANPCCs?
Who are the ANPCCs?
Who are the ANPCCs?
What do ANPCCS do?
What do ANPCCS do?
Why ANPCCs ?
Why ANPCCs ?
Workforce Modernisation
Workforce Modernisation
……
……
. Because:
. Because:
EWTD
EWTD
MMC
MMC
-
-
reduction in anaesthetic trainees
reduction in anaesthetic trainees
--
already ^ anaesthetic trainee time in
already ^ anaesthetic trainee time in
ICU
ICU
--
Deanery potential
Deanery potential
“
“
removal of trainees
removal of trainees
”
”
--
ICU
ICU
-
-
three
three
Theatres case cancellations
Theatres case cancellations
Who are They ?
Who are They ?
Selection & Recruitment
Selection & Recruitment
Post Requirements
Post Requirements
RGN RGN -- 5 yrs ICU experience5 yrs ICU experience
Degree essentialDegree essential
Post grad qualification in critical carePost grad qualification in critical care
Selection Process
Selection Process
OSCEs OSCEs -- scenario based scenario based
Day psychometric testingDay psychometric testing
Critical Reasoning Skills
Critical Reasoning Skills (Watson Glaser)(Watson Glaser) Numerical
Numerical (RANRA)(RANRA) Personality testing (16 PF)
Personality testing (16 PF)
The Team (1
Who are They ?
Who are They ?
Education and Training
Education and Training
3 year programme
3 year programme
:
:
Post graduate cert in Advanced Practice (1
Post graduate cert in Advanced Practice (1
ststyr)
yr)
MSc
MSc
Clinical Competency framework & log book
Clinical Competency framework & log book
Intensivist mentor & consultant nurse coaching
Intensivist mentor & consultant nurse coaching
Extensive weekly tutorial programme
Extensive weekly tutorial programme
Non Medical Prescribing
Non Medical Prescribing
Post Grad certificates!
Post Grad certificates!
ANPCCs : What do they do ?
ANPCCs : What do they do ?
Work in three ICUs / Work in three ICUs /
Hybrid HDUs
Hybrid HDUs
-- Support medical teamSupport medical team
-- Patient assessmentPatient assessment
-- Admissions & clerk inAdmissions & clerk in
-- Treatment planningTreatment planning
-- DischargeDischarge
ANPCCs : What
ANPCCs : What
else
else
do they do?
do they do?
Skills & ProceduresSkills & Procedures
-- central venous accesscentral venous access
-- arterial accessarterial access
-- advanced airway advanced airway management
management
-- Non Medical PrescribingNon Medical Prescribing
-- Blood and blood productsBlood and blood products
-- XX--ray requestorsray requestors
-- Cardiac arrest page Cardiac arrest page
(airway trial)
“
“
Value
Value
”
”
-
-
Experiences in NHSL
Experiences in NHSL
Anaesthetic Rota compliance measurementsAnaesthetic Rota compliance measurements
Medical Deanery MMC stipulationsMedical Deanery MMC stipulations
-- anaesthetic trainee ICU time v Theatre timeanaesthetic trainee ICU time v Theatre time
-- future trainee provisionfuture trainee provision
Future ICU service provision securedFuture ICU service provision secured
Theatre activity Theatre activity -- avoidance of cancellationsavoidance of cancellations
ANPCC pilot evaluation ANPCC pilot evaluation -- test the theorytest the theory
Cardiac arrest pilot Cardiac arrest pilot
Research study (2011)Research study (2011)
ANPCC Pilot Evaluation 2010
ANPCC Pilot Evaluation 2010
Method
Method
-- Three ICUs junior medical rotas suspendedThree ICUs junior medical rotas suspended
-- Eight week audit periodEight week audit period
-- ANPCC formally on medical rota (no trainees in ICU)ANPCC formally on medical rota (no trainees in ICU)
-- Mon to Friday 08 Mon to Friday 08 -- 18301830
-- One ANPCC work load data collected One ANPCC work load data collected
-- Incidents, near misses, unplanned medical support etc recordedIncidents, near misses, unplanned medical support etc recorded
-- Questionnaire & interview medical staff / ICU staff follow upQuestionnaire & interview medical staff / ICU staff follow up
Findings
Findings
-- Coped well without medical traineeCoped well without medical trainee
-- No adverse / critical incidents reportedNo adverse / critical incidents reported
-- Education gaps and challenges indentifiedEducation gaps and challenges indentified
Grounded Theory Study
Grounded Theory Study
Consultant AnaesthetistsConsultant Anaesthetists
“
“
CouldnCouldn’’t imagine life without themt imagine life without them”” ………. . ““InvaluableInvaluable”” .. .. ………………. . ““Already been sole person on rotaAlready been sole person on rota””
ICU Nurse
ICU Nurse
“
“Things are done a lot quicker now that they are here and it makeThings are done a lot quicker now that they are here and it makes our s our jobs a bit easier because they
jobs a bit easier because they’’re here and part of the teamre here and part of the team””
Junior Doctor
Junior Doctor
‘
‘
ItIt’’s maybe shorts maybe short--sighted but Isighted but I’’m there to achieve specific skills and m there to achieve specific skills and increase my knowledge about critically ill patients. The ANPCCsincrease my knowledge about critically ill patients. The ANPCCs are are there permanently and have a lot more time to get what they need
there permanently and have a lot more time to get what they need..’’
NMP Audit
NMP Audit
-
-
Outcomes
Outcomes
Full analysis awaited
Full analysis awaited
Provisional data analysis suggest
Provisional data analysis suggest
--
Low error rate
Low error rate
--
No major errors
No major errors
--
No harm
No harm
The Team (except me!)
The Team (except me!)
The Challenges!
The Challenges!
Then & Now
Then & Now
Resistance & acceptanceResistance & acceptance
Role actualisation for new ANPCC Role actualisation for new ANPCC
Local competition for experience with traineesLocal competition for experience with trainees
Prescribing Prescribing -- IVI opiates / anaestheticsIVI opiates / anaesthetics
Future
Future
Measuring impact on mortality / morbidityMeasuring impact on mortality / morbidity
Measuring patient experience (ethical challenge)Measuring patient experience (ethical challenge)
National transferability National transferability
Succession planningSuccession planning
Summary
Summary
-
-
Value Measurements to consider
Value Measurements to consider
Quantitative
Quantitative
ANPs on medical rota (% of time)ANPs on medical rota (% of time)
Patient Safety Patient Safety
-- compliance / service improvements (compliance / service improvements (processes)processes)
-- incidents / adverse events / infection rates / Meds (outcincidents / adverse events / infection rates / Meds (outcomes)omes)
Service provisionService provision
-- Theatre targetsTheatre targets
-- HEAT targetsHEAT targets
-- Local targets (Audit of work load / activity)Local targets (Audit of work load / activity)
MMC & EWTD rota complianceMMC & EWTD rota compliance Qualitative
Qualitative
ANPCC perceived value of role ANPCC perceived value of role (evidence)(evidence)
Acknowledgements
Acknowledgements
Martin
Martin CarberryCarberry (nurse consultant)(nurse consultant) Dr Rory
Dr Rory MacKenzieMacKenzie
Consultant Mentors
Consultant Mentors
Dr. Jim Ruddy
Dr. Jim Ruddy
Dr.
Dr. SanjivSanjiv ChohanChohan Dr. Ian Lang
Dr. Ian Lang
Dr. Veronica Watson
Dr. Veronica Watson
Dr. Tina
Dr. Tina MaclennanMaclennan Dr. Alan Morrison
Dr. Alan Morrison
Dr. Grant Haldane
