In 2015, QNIS funded two community nurses for Learning Visits. Fiona Oag, a Clinical Nurse Team Lead from Kirkwall in Orkney, was one of these, and she visited a district nursing team in Kelso, in the Scottish Borders.
Below is the account of her experience.
The team has a band 7 Clinical Team Lead, 2 District Nurses, 3 Band 5’s and a nursing auxiliary. They have an evening service which operates from 17.00 until 22.00 from the local hospital. A nurse is identified before the shift ends that day who will deliver and collect the Out Of Hours (OOH) communication book from the hospital and take it back to the office the following day for call outs/ messages/updates.
One of the objectives of my learning was to enhance my leadership/management skills. The Kelso team is a cohesive team, with a broad range of skills, and each and every member is a valued part of the team. Visits are allocated before the shift ends each day as some staff start from home; this is cost effective when covering large remote and rural areas. Documentation is kept in the patient’s home and on first home visit an assessment is undertaken by the nurse to assess criteria/ referral to caseload. This is an area which would reduce our visits if this assessment could be implemented within my caseload.
The Kelso team works closely with the ‘Home care team’ who undertake all weekly catheter care i.e.; changing catheter bags, securing devices and documenting everything in a catheter passport booklet. This has reduced the number and length of visits, enabling the band 7 to lead on long term conditions, dementia, intermediate care and palliative care. Time is used effectively and evidence of this is displayed on their office wall in the way of graphs. They are pro-active in ‘Leading Better Care’
No phone calls are received regarding continence products as this is done direct from the supplier and only one pad is kept in stock for emergency. Within my practice, numerous calls are taken daily on this matter, which could be prevented if a more robust system was in place enabling time to be used more effectively.
The Kelso team were most envious of my i-pad which my team is piloting. This is particularly useful when updating care plans and risk assessments with the patient, photographing complex wounds for referral to tissue viability and CHAD data.
The nursing team are situated in a purpose built health centre where they have access to GP’s; podiatry, diabetes and Community Psychiatric Nursing (CPN) services. Their store room is a dream of organised and labelled shelves where, in a hurry, required items are easily retrieved. Intermediate care is along the corridor from them and the team leader spends one day every fortnight discussing the caseload with the team. It is apparent that this is working well for all by looking at the outcomes of the patient’s journey in promoting independence at home/ prevention of hospital admission/ and discharge from hospital.
They do not have a nurse on call overnight as this is covered by NHS24 and an OOH’s GP. If a patient on the District Nursing (DN) caseload has required input from these services overnight, this is highlighted on Daybook/ EMIS electronic system by the Practice Manager and followed up by the nursing team ensuring continuity of care to appropriate services.
As a result of my visit, I have managed to make small changes to our practice where we have adopted the SBAR technique for communication: A situation briefing model, this is useful when having daily reports.
I have returned to Orkney with loads of their paperwork which I am hopeful of adapting to improve our communication between hospital and community which is always positive. Inside the patient’s community nurse notes there is a simple laminated card which states on one side ‘ ON ADMISSION TO HOSPITAL PLEASE GIVE THIS CARD TO WARD NURSES ‘On the other side ’I AM KNOWN TO THE KELSO DISTRICT NURSING TEAM. PLEASE TELEPHONE …… TO DISCUSS MY NURSING CARE NEEDS.
Funding from QNIS was extremely helpful as it gave me the opportunity to shadow another team lead which highlighted similar pressures, and how to help ease them i.e; Lone working, staff shortages and a demanding and busy caseload. The Kelso team never tired of my endless questions, and this made for a helpful experience. I have taken much of their working practices on board, and was also able to share some insights from Orkney, and I believe this was a very positive experience all round.