1. 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

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

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

5. 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)

6. 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)

7. 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)

8. 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

9. 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

10. Decision Support tools
5 mins- Share the takeaway toolkit

11. Decision Support tools
5 mins- Share the takeaway toolkit

12. Decision Support tools

13. 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

14. 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

15. 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

16. 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

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
* RCN

18. Comments
Questions
Discussion