Reflections on Models Developed Over the Festive Period Lorraine Robertson Clinical Nurse Manager NHS Forth Valley

Purpose of RMN Input Within A&E Overall Purpose of Input: Support A&E staff during their busy period by providing assistance to individuals who present with mental health problems. Advise and support A&E staff in capacity as RMN. Consider and advise appropriate use of on-call junior psychiatric doctor. Carry out duties with professional responsibility and accountability. Utilise basic nursing skills to assist A&E staff. Assist in clinical decision making. Complete data sheet for audit purposes. Advise and signpost to community supports where appropriate.

Activity/Statistics Input commenced 24/12/08 at 5pm - not all shifts covered. Possible 28 shifts to be covered. 23 shifts had RMN input. Out of 23 shifts with input, 5 shifts had no referrals for RMN input. 18 shifts gained some benefit from RMN. From 18 shifts where RMN staff asked to get involved, there were 37 contacts.

Main Presenting Problems (N=37) Of 28 DSH/Suicidal, 10(36%) involved alcohol consumption

Alcohol or Substance Misuse involved (N=37)

Violence Involved (n=37)

Periods of Time Presenting (N=37)

Referrals per Day

Outcomes from A&E (N=37) (11 were identified for psychiatric follow-up)

Lessons Learned Specific job description - job requires an enhanced level of skills and knowledge to support decision-making. Communication could have been improved. There was limited awareness from both sides, with some resistance from A&E staff. There was some reluctance from RMNs to assist in basic nursing care. Majority of referrals had alcohol and drug intake therefore need to identify what exactly is required – psychiatric alcohol liaison nurse, substance misuse. ?Train A&E staff to deal with alcohol and drug misuse (or is it referral pathways and appropriate signposting?). Clinical supervision would require to be addressed if RMNs attached to A&E. Busy periods fluctuated. Should RMN be in A&E or attached to in-patient psychiatric ward.

Key Question Do we really need RMN staff within A&E or should A&E staff be provided with enhanced knowledge of mental health issues/illness?