1. Community Nurse In-reach (CNIR) Providing safe & effective nursing discharges across the Hospital & Community Interface.

2. Background Experience of the Case finder Project (2003-2004). Evidence of the Berkshire ‘High Tech’ Team. District Nursing Modernisation (2004-2006). CNIR team appointed Feb 2006. Two WTE DN Sister Band 6, One at the BCH and one UHD.(2006) Four WTE DN Sisters Band 6 and WTE Band7 Team Leader/Lead Nurse (2013)

3. Team Aims: Team Aims: To prevent unnecessary admission to hospital To prevent unnecessary admission to hospital To facilitate early supported discharge To facilitate early supported discharge Community Nurse In-reach (CNIR)

4. CNIR Roles to meet the Targets Case finder Case finder Facilitator Facilitator Consultative/Educator Consultative/Educator Advocacy Advocacy

5. Case finder Patient selection is key to safe service provision Attend daily bed meetings Hospital Based Visible presence in A/E, AMAU, Outpatients and Wards

6. Facilitator Provides knowledge of and access to the community service menu. Provides knowledge of and access to the community service menu. Acts as a conduit between hospital and community. Acts as a conduit between hospital and community. Work in partnership to facilitate discharges through a more structured, co-ordinated and standardised approach. Work in partnership to facilitate discharges through a more structured, co-ordinated and standardised approach. Establishes good sustainable links between the primary and secondary care. Establishes good sustainable links between the primary and secondary care. Identifies community alternatives and seeks patient consent Identifies community alternatives and seeks patient consent

7. Consultative/ Educator Identify and advise on new development potential. Identify and advise on new development potential. Provides professional and clinical leadership in the implementation of service development. Provides professional and clinical leadership in the implementation of service development. Identifies service development potential and associated training needs of community staff. Identifies service development potential and associated training needs of community staff. Develop policies, guidelines and protocols to introduce new procedures or initiatives. Develop policies, guidelines and protocols to introduce new procedures or initiatives. Carry out joint visits with District Nurses to support and supervise practice if required. Carry out joint visits with District Nurses to support and supervise practice if required.

8. Advocacy Promotes mutual understanding across primary and secondary interface. Patient care is provided in an environment that is essentially their own, where they feel at ease with the potential for a faster recovery. Family and carers are more involved in the care. Reduces the risk of hospital acquired infections

9. Learning & Development What has been achieved: Intravenous Therapy- OPHAT (Wards, O/P & A/E) Intravenous Therapy- OPHAT (Wards, O/P & A/E) Community Midline service Community Midline service Expediting delayed discharges- fast tracking equipment Expediting delayed discharges- fast tracking equipment Dehydration issues in Nursing Homes Dehydration issues in Nursing Homes Increased number of complex palliative patients now supported at Home Increased number of complex palliative patients now supported at Home Enhanced early discharge Colorectal and Breast Care patients Enhanced early discharge Colorectal and Breast Care patients Participating in Community Urgent Care Pilot Participating in Community Urgent Care Pilot

10. Measured Outcomes Jan-Dec 2007 Referrals 777 Bed Days saved 2293 Jan-Dec 2007 Referrals 777 Bed Days saved 2293 Jan-Dec 2008 Referrals 729 Bed Days saved 3473 Jan-Dec 2008 Referrals 729 Bed Days saved 3473 Jan-Dec 2009 Referrals 1129 Bed Days saved 4822 Jan-Dec 2009 Referrals 1129 Bed Days saved 4822 Jan-Dec2010 Referrals 1365 Bed Days saved 6195 Jan-Dec2010 Referrals 1365 Bed Days saved 6195 Jan-Dec2011 Referrals 1342 bed days saved 7118 Jan-Dec2011 Referrals 1342 bed days saved 7118 Jan-Dec2012 Referrals 1805 Bed Days saved 9512 Jan-Dec2012 Referrals 1805 Bed Days saved 9512

11. Any Questions?