Understanding Impact……of an Advanced Nurse Practitioner in a care home setting Erskine and LIST collaborating Jennifer Boyd, Advanced Nurse Practitioner, Erskine Esther Morris, Information Manager, LIST

Introductions Jennifer Esther 5 mins- Introduction – us and what we are going to talk about Jennifer Esther

Introducing Erskine 10 mins - Background info on Erskine – Jenn introducing with a video?

Transforming Nurse Roles (2016) National Picture Transforming Nurse Roles (2016) Definition An Advanced Nurse Practitioner (ANP) is an experienced and highly educated Registered Nurse who manages the complete clinical care for their patient, not solely any specific condition. Advanced practice is a level of practice, rather than a type or speciality of practice. Advanced Nursing Practice Clinical Practice Leadership & Management Facilitating Learning Research & Development Features of Advanced Practice: Clinical assessment Differential diagnosis Investigations Treatment (Admission, discharge and referral)

Data Collection and Analysis First meeting October 2017 Reviewed process of data collection – use of Daily House Visit Sheet Free Text and relatively unstructured Signed off by local data controller Shadow effect to be used: “Drop Shadow Rectangle” 5 mins- Esther – review we did and establishing data collection and analysis N.B. When scaling images/objects, please hold Shift key while scaling, to keep proportional shapes)

Created Spreadsheet Template Restructured some of data collected Controlled format of data entry Ran data Quality checks Created pivot table techniques to enable local analysis Shadow effect to be used: “Drop Shadow Rectangle” N.B. When scaling images/objects, please hold Shift key while scaling, to keep proportional shapes)

Number of requests received for GP review Analysis Feb 2017 to Nov 2017 313 GP only 29% 276 – not diverted 37 – potentially diverted (prescribing) 3.5% 245 ANP only 23% 11 to see GP because of prescribing limitations 509 GP+ANP 48% 499 potentially seen by ANP – prescribing limitations 47% ANP – actual and potential = 73% 1070 requests for GP – Triaged 5 mins - Present some data/evidence Missing data items for 3 records

Potential time could be reallocated for GP Assume each GP/ANP visit = 10 mins Analysis Feb 2017 to Nov 2017 313 GP only 29% 52 hours 276 – not diverted 37 – potentially diverted (prescribing) 3.5% 6 hours 245 ANP only 23% 41 hours 11 to see GP because of prescribing limitations 509 GP+ANP 48% 85 hours 499 potentially seen by ANP – prescribing limitations 47% 83 hours ANP – actual and potential = 73% 130 hours 1070 requests for GP – Triaged 178 hours Missing data items for 3 records

Decision Support tools 5 mins- Share the takeaway toolkit

Decision Support tools 5 mins- Share the takeaway toolkit

Decision Support tools

Erskine Governance >14.00hrs 08.00hrs 11.00hrs Follow up and/or 2nd ANP Triage 11.00hrs 1st visit to each House >14.00hrs Follow up and/or 2nd visit to each House

Case examples Resident known to have biliary sepsis x 4 previously requiring admission Staff recognised her deteriorating, ANP reviewed her, she was being sick however observations were within normal range: she didn’t want to go to hospital. Shared care to monitor and ANP to review - clinically there were no admitting reasons. 2hrs later she spiked a temp – treated temp rise and commenced prophylactic antibiotics. Staff were keen to nurse her within the home and resident didn’t want admitted unless there was no other option. Previously: GP would be called or 999 as staff were worried she was going to become as ill as she had been in the past. 5 mins - So what – and the impact – residents/colleagues voices ?video/quotes

Actual impact of ANP now able to prescribe Before ability to prescribe After ability to prescribe Month Request for GP input Post ANP triage – requiring GP input July 2017 22 17 July 2018 54 August 2017 13 8 August 2018

ANP visit types Reason for input – July & August 2018 Number of residents UTI 21 Chest Infection 15 Skin/Cellulitis 29 Confirmed diagnosis and treatment of SEPSIS 6 Pain control 9 Bowel management 7 Other 17

ANP* GP** 2017-18 pay levels Most at AfC B7 £32,013 to £42,205 Midpoint = £37109 ANP* Salaried GP £56,525 to £85,928 Midpoint = £71,226 GP** **BMA 2017-18 * RCN 2017-18

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