Aims and objectives:
The Queen's Medical Centre is working towards being a 'Hospital of Choice' so we aim at all times to give patients a choice of dates both for their pre-admission appointment and for their operation.
We aim to ensure all children have their operation without cancellation and delay and that they and their parents are well informed about their operation and the impact it will have on them/their child.
To prepare the children/parents with a clear understanding of how they/their child may be feeling before and after their operation and to allow them the opportunity to ask any questions that they may have about their operation.
To deliver the child safely to theatre after completing the appropriate tests and investigations.
To develop the extended role of the nurse, so that she can competently examine the child and take the medical history, therefore reducing the amount of time that junior doctors work, thus complying with The European Directive on doctor's working hours.
To evaluate this service and to ensure the patient's needs and expectations are being met.
To reduce Waiting Lists, to utilise the time that is wasted by non-attenders and to reduce the time that children spend in hospital, therefore freeing more beds for emergencies.
Support for the change:
I have had encouragement, advice and support from Matron/Head Nurse for my Department and also from The Professional Development Nurse. The hospital has given me the time to gain the expertise and experience to be confident and competent in this role. Also my insight and enthusiasm for the role has helped, together with me imagining how the process would eventually operate and develop.
Patient and public influence:
I have developed additional pre-admission appointments in the early evening, which suits parents who have children at an age where they do not want to miss any school by attending hospital appointments. These appointments also suit working parents who do not want to keep asking for time off from their employment.
Parents now have more choice about when their child has their pre-admission appointment and their operation, they are always given at least two dates to choose from for these appointments. We always try and accommodate parents who want their child to have their operation in the school holidays. Now that patients and their families are given more choice, the amount of non-attenders who waste valuable hospital time have been reduced.
In line with new government targets children now wait up to a maximum of 6 months for their operation instead of the previous 18 months. Many operations are booked when the child visits the Consultant at the Outpatient Clinic and therefore are 'Fully Booked'. The government targets are 100% of all operations to be 'Fully Booked' by December 2005.
Impact on the workforce:
To operate the service, one Nursery Nurse has been employed to accomplish this together with the Paediatric Nurse who has been trained in an extended role to be a Nurse Practitioner. Junior doctors (who used to do this role) now have more time to concentrate on ward work and meet their new working hours.
The Nursery Nurse had developed a pre-admission booklet in Makaton for children.
Measuring the results:
Paediatric nurse led pre-admission is in its early stages and we are innovators of this. We have given questionnaires to patients and then audited our results and achieved 100% patient satisfaction with service, information and efficiency. Adult pre-assessment have carried out a similar audit and the two have compared favourably.
Improved performance:
The results of the audit showed that we reached:
100% patient satisfaction with our service, most patients were seen on time and all patients said that they received adequate and clear information about their operation and hospital stay.
100% of patients said they were happy to be seen by the Paediatric Nurse Practitioner as opposed to a doctor and were sufficiently prepared for the operation.
Reflecting diversity:
I have visited outreach areas of The Ear, Nose and Throat Department including The Children's Hearing Assessment Centre at The Ropewalk and Newark Hospital where clinics are held. I have informed them of the service available, completing displays and leaving leaflets accessible. I have had leaflets translated into Urdu and Punjabi.
I see the majority of children who are listed for an operation when they first attend The Out-Patient Clinic in the Ear Nose and Throat Department. I spend time explaining any concerns that the parent/child may have and the involvement expected of them when their child has an operation.
We need to make sure that patients and their parents are satisfied therefore raising the profile of this department in this busy hospital.
Sharing the learning:
I have put protocols in place throughout the Paediatric Unit so that we are all working within the same boundaries.
I teach nursing students both in the hospital and university on this developing role. I work continually with the Nurse for Professional Development to further the extended role and assist and encourage other appropriately qualified nurses to gain the competence and experience to gain the qualification.
With the confidence of the success of Ear, Nose and Throat pre-admission I have introduced pre-admission appointments into Ophthalmology.
During July 2005 I will be organising a National Study Day based on the development of this new extended role and setting up a pre-admission service.
I have visited the community teaching children in schools about operations, therefore equipping them with the confidence and knowledge should they find themselves needing an operation in an emergency or routine situation.
I have enabled a nurse in a wheelchair who is now employed by the unit to complete her 'Back to Nursing' course.
Outstanding features:
I have injected the Ear, Nose and Throat Department with paediatric input and made the predominantly adult area more child friendly. I have motivated my colleagues to consider a more positive and enthusiastic approach to Ear, Nose and Throat. I have gained job satisfaction and achieved personal and professional satisfaction by highlighting the need for this unit, then implementing it and continuing to be part of the continuing success.
