Endoscopy Unit Royal Infirmary of Edinburgh

Transcription

1 Endoscopy Unit Royal Infirmary of Edinburgh Orientation and Induction Programme Name. Mentor. Date commenced.

2 INDUCTION AND ORIENTATION PROGRAMME FOR STAFF NURSES IN ENDOSCOPY INTRODUCTION The Endoscopy/Bronchoscopy Unit is based at the Royal Infirmary of Edinburgh. This is a busy clinical unit that has strong links to other departments within the Lothian University NHS Trust. The main links include the Department of Medical Physics (GI research), Department of Internal Medicine, Department of Surgery, Department of Radiology (TIPSS insertions for variceal bleeding), the Scottish Liver Transplant Unit and the GI & Endoscopy Unit at the Western General Hospital and St. Johns Hospital in Livingston. Every year, over 8,000 procedures are performed by Specialist Medical staff (Gastroenterologists), Surgical staff, Respiratory Medical staff, and the Clinical Nurse Endoscopist, in 4 Endoscopy Suites and the ERCP room (in the Department of Radiology). A 24h emergency Endoscopy service is operational for acute cases, and is operated by an on-call system with trained Nurses, and the GI medical staff on duty. There are a number of Consultants involved with carrying out GI Endoscopy lists within the Department, as well as covering different wards and clinics: Dr Andrew Bathgate Dr Carol Blair Prof. Peter Hayes Dr Alistair MacGilchrist Dr Ian Penman Dr John Plevris Dr Ken Simpson Dr Ken Trimble Dr Nick Church Consultant Gastroenterologist Consultant Gastroenterologist Professor of Hepatology Consultant Gastroenterologist Consultant Gastroenterologist Consultant Gastroenterologist Senior Lecturer in Hepatology and Hon Consultant Consultant Gastroenterologist & Lead for Endoscopy Consultant Gastroenterologist There are also a number of Surgeons doing GI Endoscopy, Respiratory consultants involved with Bronchoscopy, and Cardiology consultants carrying out TOE s within the Unit. Departments within the Lothian University Hospitals Division are Tertiary referral centres and that reflects on the complexity of procedures performed within the Endoscopy Unit. The Unit has active scientific and clinical research interests. It enjoys the combined resources of the University and that of the prestigious teaching hospitals situated in Edinburgh. Particular areas of expertise include Endoscopic Ultrasound, the management of upper gastrointestinal/variceal bleeding, staging and management of gastro-oesophageal cancer, and disorders of oesophageal dysmotility.

3 A variety of diagnostic and therapeutic Endoscopic procedures are being offered by the Unit as follows: Diagnostic: Upper Gastrointestinal Endoscopy & High Definition Endoscopy Enteroscopy & Double Balloon Enteroscopy Colonoscopy & Double Balloon Colonoscopy Flexible sigmoidoscopy Endoscopic Ultrasound for cancer staging Endoscopic Ultrasound with diagnostic FNA ERCP (Diagnostic ERCP being replaced by MRCP) Bronchoscopy Bronchoscopic Ultrasound with diagnostic FNA Trans-Oesophageal Echo Colonic Capsule Endoscopy Therapeutic: Banding of oesophageal varices Variceal Sclerotherapy Oesophageal Dilatations Oesophageal stents insertion Pneumatic dilatations Botulin injections for achalasia Haemostasis of gastrointestinal bleeding, using adrenaline or heater probe. Argon Plasma Coagulation Placement of Percutaneous Endoscopic Gastrostomy tubes (PEGs). Polypectomy of upper and lower GI tract. Endoscopic drainage of pancreatic pseudocysts Therapeutic ERCP (biliary stents, sphincterotomy/stone extraction) Placement of nasojejunal feeding tubes Other: Oesophageal manometry Oesophageal ph Monitoring Oesophageal Impedance Monitoring C13 urea breath testing Glycose hydrogen breath test Lactose hydrogen breath test Small Bowel Capsule Endoscopy Upper GI Capsule Endoscopy Colonic Capsule Endoscopy

4 IMPORTANT PHONE NUMBERS EMERGENCY PHONE NUMBER FOR CARDIAC ARREST/FIRE/MAJOR HAEMORRAGE IS 2222 SECURITY PHONE NUMBER IS GI REGISTRAR ON-CALL BLEEP NO. #6361 Sr. Helen Chisholm Charge Nurse ext /21602 D.C/N Paul Hamilton Deputy Charge Nurse ext D.C/N Samantha Bow ERCP Specialist Nurse ext Inpatient co-ordinator Nurses station ext Inpatient recovery ext Outpatient reception Reception area ext Outpatient admission room ext Outpatient recovery MDC ext /21839 Outpatient booking office WGH ext Outpatient booking office mobile WGH Outpatient co-ordinators office RIE ext Endoscopy Fax machine RIE ext Procedure room 1 ext Procedure room 2 ext Procedure room 3 ext Procedure room 4 ext ERCP room in X-ray Main X-ray ext Scope cleaning room ext Sarah Douglas GI Lab ext Porters Patient movement ext Porters Fax ext Haden ext WGH Endoscopy Unit WGH ext St John s Endoscopy Unit St.Johns ext

5 INDUCTION PROGRAMME This programme has been designed specifically to give you a structured orientation to your new job and will ensure you will receive the knowledge and skills to work safely within the Endoscopy Unit. When you start you will be assigned to a mentor who will give you the necessary support that you will need to achieve your learning objectives. Your learning is competency based, and is structured so that you will be able to achieve the desired outcome of assessment within your induction programme. It is expected that Registered Nurses will achieve competency in the diagnostic procedures within the first 3 months and that you will be competent in common therapeutic procedures within 6 months of your commencement date, although this may not always be possible to achieve due to the workload in the department, particularly for part-time staff. The competence assessment framework scoring system comprises of seven levels from novice to expert. Level 3 is the minimum standard for competence in a particular area. These competencies should be scored by your mentor, in discussion with yourself, or by other senior members of staff who have witnessed your performance during the various procedures undertaken within Endoscopy. MENTORSHIP Your mentor will be primarily responsible for your orientation during your first three months. The mentor should undertake ongoing assessments with you during the orientation programme, to help assess your progress, and to give you the opportunity to discuss any performance issues, and raise any problems or queries. New staff will work alongside their allocated mentor, as much as possible, to ensure they have the opportunity to learn new skills, in order to achieve competence on completion of the induction programme. During your first formal assessment, after approximately 2 weeks, please take the opportunity to discuss any worries or concerns you may have. At your second formal assessment, in your sixth week, you should be half way through this task, and should be able to discuss your progress with your mentor. By week twelve you should be orientated to a satisfactory level. You should take this opportunity to discuss further professional development that you may wish to undertake. The length of this programme is approximately 6 months for full-time staff, but may be longer for part-timers. The training programme should be flexible in order to meet the needs of the individual Nurse, and may be adapted depending on experience. You will be encouraged to use books and articles, which are available in Sister s office, and on the Intranet and Internet and, wherever possible, teaching sessions will also be arranged. At the end of both 3 and 6 months, the Charge Nurse and mentor should review your progress and discuss any relevant points.

6 ENDOSCOPY UNIT PHILOSOPHY The staff in the Endoscopy unit believe that patients have the right to receive specialized nursing care that is research based and reflects the personal needs of the individual and is provided within a safe and calm environment. To achieve our aim, we believe that: Each patient has the right to receive clear and comprehensive information at all stages of their care. Each patient has the right to privacy, confidentiality and respect for individual religious, cultural and personal beliefs. We also believe that: Nurses should support and respect each other, and that their specialized knowledge and skills be recognized and valued by all members of the healthcare team. Nurses have the right to work within a safe environment, where appropriate training and safety equipment is provided. Nurses have a professional responsibility to maintain and update their own knowledge and clinical skills. Nurses are professionally accountable for the care they provide and will therefore work within the principle of the NMC Code of Conduct and the Scope of Professional Practice (June 1992). All staff in the Endoscopy unit will work as a TEAM in providing high quality care to all patients utilising the unit.

7 ORIENTATION Geography of - Endoscopy Unit - Medical Day Case - X-ray - ITU, HDU and Theatres. Introduction to staff in unit. - Nursing - Medical - Clerical - GI Lab Uniform policy for wearing scrubs. OBJECTIVE DATE Coffee room and payment for tea, coffee and milk. Procedure in case of Cardiac Arrest. List phone number Location of emergency equipment. List location of Arrest Trolley Familiarise yourself with layout of trolley Procedure in case of Major Haemorrhage. List phone number Location of Fire points and equipment. List locations of - 4 Break glass points - 4 Fire action notices - 5 Fire extinguishers - Fire exits - Assembly point Procedure in case of Fire. List phone number Location of medical gases cut-off taps. - 2 Cut-off taps Contact for Security. List phone number

8 Location of Duty folder and A/L book. Procedure for requesting annual leave or days off, and location of - Off-duty folder - Annual leave request book Procedure for absence reporting. Understand and use phone and page system, and know location of numbers. Use of Haden collection and Pod system for specimens. Rubbish and dirty linen disposal. Location of different policy and procedure manuals, including - COSHH - Infection Control - Manual Handling - Policy Manual. Computer Log-in. X-ray badges. Monthly staff meetings. Trak training. Internal training requests. Identify and discuss the different procedures undertaken in Endoscopy - Endoscopy - Enteroscopy - Colonoscopy - Flexible Sigmoidoscopy - Endoscopic Ultrasound (EUS) - Bronchoscopy - Bronchoscopic Ultrasound (EBUS) - Endoscopic Retrograde Cholangiopancreatography (ERCP) - Double Balloon Enteroscopy and Colonoscopy - Trans-Oesophageal Echo (TOE) Identify drugs used within Endoscopy, their effects and any side effects. Identify drugs used to counteract the sedation used in Endoscopy.

9 COMPETENCE ASSESSMENT SCORING SYSTEM COMPETENCE SCORE Cannot perform the activity safely in the clinical environment. 0 Can perform the activity, but not without constant supervision and direction from an experienced Endoscopy nurse. 1 Can perform the activity satisfactorily, but requires some supervision and assistance from an experienced Endoscopy nurse. 2 Can perform the activity satisfactorily without assistance or supervision from an experienced Endoscopy nurse 3 (COMPETENT) Can perform the activity satisfactorily without assistance or supervision with acceptable speed and quality. 4 Can perform the activity satisfactorily with more than acceptable speed and quality, and uses initiative and adapts to problem situations. 5 Can perform the activity satisfactorily with more than acceptable speed and quality, shows initiative and adaptability), and can demonstrate the safe activity to others, (staff/patients). 6 (EXPERT)

10 INFECTION CONTROL (KSF C3 level 2 & HWB5 level 2) The Endoscopy Nurse is able to: - Explain the importance of infection control in Endoscopy. Discuss the importance of hand washing and using alcohol gel in the Endoscopy rooms and in other areas in the department. Discuss the different types of Personal Protective Equipment (PPE) available in Endoscopy. Discuss the precautions taken to prevent the spread of MRSA in the Endoscopy setting. Discuss the precautions taken to prevent the spread of Hepatitis in the Endoscopy setting. Discuss the precautions taken to prevent the spread of CJD in the Endoscopy setting. Discuss the precautions taken to prevent the spread of TB in the Endoscopy setting. Discuss the precautions taken to prevent the spread of Clostridium Difficile in the Endoscopy setting. Discuss the type and use of detergents and disinfectants in an Endoscopy setting. Discuss the functions and processes involved in the decontamination of Endoscopic equipment. Discuss the process of traceability of instruments, and explain the system used in Endoscopy. Identify the location of the Infection Control folder.

11 PROFESSIONAL VALUES AND INTERPERSONAL EFFECTIVENESS (KSF C1 level 3 & C2 level 3) The Endoscopy Nurse: - Presents self in a manner, which promotes a positive image of the Endoscopy/Bronchoscopy Unit. Respects patient s dignity, privacy, autonomy and equal rights as service users. Respect patients cultural and spiritual concerns in relation to health care needs. Safeguards and maintains confidentiality of patients, carers and colleagues. Develops and manages professional relationships with patients, carers and colleagues. Co-operatives effectively with all members of the Endoscopy team and other members of the multidisciplinary team. Recognises ethical and legal implications and responsibilities presented by particular situations in practice. Acts as a healthcare advocate. Demonstrates listening and reflection skills in interaction with patients, carers and colleagues. Spoken communication is clear, concise, accurate and appropriate. Written communication is clear, concise, accurate and appropriate. Reliable, honest and punctual. Recognises roles, functions and skills of other members of the Endoscopy/Bronchoscopy team. Identifies, uses and accepts opportunities to learn from other members of the Endoscopy/Bronchoscopy team.

12 COMMUNICATION AND PATIENT ASSESSMENT (KSF C1 level 3 & HWB2 level 3) The Endoscopy Nurse is able to: - Obtain a full nursing history, identify actual and potential problems and implement a plan of care for individual patients. Pre-assess patients for Endoscopic procedures including information on procedure, sedation, preparation, after care and follow up particular to individual patients. Demonstrate effective communication skills when talking to patients on the phone about pre-procedure care and advice on follow up care. Ensure all patients have the necessary information to make informed decisions about their care. Ensure the appropriate avenues are followed for those patients unable to give informed consent. Communicate effectively with the co-ordinator and colleagues to ensure smooth running of lists. Communicate effectively with individual patients pre-, during and post procedure. Ensure patients, relatives and carers are informed of the patient s progress through the Unit and are aware of any delays. Ensure all nursing documentation and Endoscopy records are up-to-date, complete and filed in the appropriate place. Explain the results of an Endoscopic procedure to a patient, giving advice on minor ailments and discharge them safely. Prioritise in-patient Endoscopy requests with senior support, inform all relevant people and departments and complete necessary documentation. Give advice to diabetic patients for Endoscopy procedures. Give advice to patients taking anti-coagulant therapy for Endoscopy procedures.

13 EQUIPMENT TRAINING The Endoscopy Nurse has been trained to prepare, use and clean the following equipment: - Endoscopes - Gastroscope - Twin Channel Gastroscope - Colonoscope - ERCP scope - EUS scope - EUS Miniprobe - Bronchoscope - EBUS - Double balloon Enteroscope and Colonoscope - TOE probe Light source and processors - Olympus - Fujinon - EUS - Mini-probe - On-call stack Diathermy unit. Argon Plasma Coagulation unit. Smoke evacuator for APC. Heater Probe unit. Scope guide. Leak tester. Sterilox generator. QED auto-disinfector. Labcaire auto-disinfector. Pulse oximeter and Dynamap. Blood Glucose monitor. Cardiac defibrillator and portable suction.

14 DESIGN AND FUNCTION OF ENDOSCOPY EQUIPMENT (KSF C3 level 2 & HWB7 level 3) The Endoscopy Nurse is able to: - Discuss the design and function of GI Endoscopes (i.e. air/water, suction and biopsy channels, light source and camera chip). Discuss the design and function of Bronchoscope (i.e. suction and biopsy channels, light source and camera chip). Discuss the function of the control wheels on the different Endoscopes. Explain the channel diameters on different scopes and know where to obtain the information. Explain how the air/water function works in GI Endoscopes. Identify the correct water bottle for each Endoscope. - Olympus - Fujinon White balances an Endoscope and gives rationale for doing so. Identify the different valves used in the different Endoscopes. - Olympus - Fujinon - EUS - ERCP - Bronchoscope Set up a scope for use and check that it is functioning correctly. - Olympus - Fujinon - EUS - ERCP - Bronchoscope Have knowledge for the use of specialist scopes (i.e. variable stiffness, twin channel, EUS, ERCP).

15 CLEANING & DECONTAMINATION OF ENDOSCOPES (KSF C3 level 2 & HWB7 level 3) The Endoscopy Nurse is able to: - Demonstrate the inspection of Endoscopes to ensure they are ready for use. Prepare auto-disinfector for the decontamination of scopes including validation documentation. - QED - Labcaire Initiate immediate pre-cleaning of the Endoscope after use and give rationale. Demonstrate and discuss the importance of leak testing scopes. - Olympus - Fujinon Manually clean scope in accordance with Decontamination Policy. Manually clean all ancillaries in accordance with Decontamination Policy. Correctly attach scope to the QED for and initiate correct cleaning cycle. Remove scope from auto-disinfector into tray and attach valid documentation. Explain the rationale for scope traceability and keeping an accurate record. Store Endoscopes correctly during and after Endoscopy lists. Apply Scope Protection System wipes to all Olympus scopes. Demonstrate the care and maintenance of ancillaries and accessories, including traceability. Prepare a scope prior to being returned for repair, and complete appropriate documentation.

16 UPPER GASTROINTESTINAL ENDOSCOPY (UGIE) (KSF C1 level 3, C3 level 2, HWB2 level 3, HWB5 level 3, HWB7 level 3) The Endoscopy Nurse is able to: - Discuss the indications and risks associated with diagnostic UGIE. Discuss the indications and risks associated with therapeutic UGIE. Explain the procedure and the risks involved to a patient/carer. Perform a risk assessment on a patient undergoing UGIE, and anticipate individual risks to each patient. Explain the choices of sedation or throat spray, and the associated risks. Set up procedure room for UGIE. Assist with UGIE looking after the patient s airway. Assist the Endoscopist with diagnostic and therapeutic Endoscopy. Safely care for and monitor a patient during UGIE. Take and record biopsies for - Histology - -CLO. Control UGIE bleeding by - Banding - Injection therapy - Clip fixing - Heater probe Use Argon Plasma Coagulation - Switch on and check APC machine - Connect APC probe - Ensure settings are correct for use - Use smoke evacuation system Assist with Oesophageal Dilatation - Savary Gillard - CRE balloons Take and record brushings for cytology. Assist with removal of food bolus from oesophagus.

17 COLONOSCOPY & FLEXIBLE SIGMOIDOSCOPY (KSF C1 level 3, C3 level 2, HWB2 level 3, HWB5 level 3, HWB7 level 3) The Endoscopy Nurse is able to: - Discuss the indications and risks associated with colonoscopy and flexible sigmoidoscopy. Explain the procedure and risks involved to a patient/carer. Perform a risk assessment on a patient undergoing colonoscopy or flexible sigmoidoscopy and anticipate individual risks to each patient. Give advice on bowel preparation for colonoscopy and flexible sigmoidoscopy. Explain the sedation and analgesia used, and the associated risks. Set up procedure room for Colonoscopy. Set up and use scope guide Olympus Fujinon Assist the Endoscopist with diagnostic and therapeutic Colonoscopy. Safely care for and monitor a patient during Colonoscopy. Take and record biopsies for histology. Take and record Hot biopsies. Snare and retrieve Polyps. - Snare - Graspers - Suction trap Control Colon bleeding by - Injection therapy - Clip fixing - Heater probe Use Argon Plasma Coagulation - Switch on and check APC machine - Connect APC probe - Ensure settings are correct for use - Use smoke evacuation system

18 BRONCHOSCOPY (KSF C1 level 3, C3 level 2, HWB2 level 3, HWB5 level 3, HWB7 level 3) The Endoscopy Nurse is able to: - Discuss the indications and risks associated with Bronchoscopy. Explain the procedure and the risks involved to a patient/carer. Perform a risk assessment on a patient undergoing Bronchoscopy, and anticipate individual risks to each patient. Explain the sedation, throat spray and lignocaine used, and the associated risks. Set up procedure room for Bronchoscopy. Assist with Bronchoscopy looking after the patient s airway. Assist the Endoscopist with diagnostic and therapeutic Bronchoscopy. Safely care for and monitor a patient during Bronchoscopy. Take and record biopsies for histology - Bronchial - Transbronchial Take and record bronchial washings. Take and record brushings for cytology.

19 Endoscopic Retrograde Cholangiopancreatography (E.R.C.P.) (KSF C1 level 3, C3 level 2, HWB2 level 3, HWB5 level 3, HWB7 level 3) The Endoscopy Nurse is able to: - Discuss the indications and risks associated with diagnostic ERCP. Discuss the indications and risks associated with therapeutic ERCP. Explain the procedure and the risks involved to a patient/carer. Perform a risk assessment on a patient undergoing ERCP, and anticipate individual risks to each patient. Explain the sedation and analgesia used, and the associated risks. Set up procedure room for ERCP. Explain the risks associated with a procedure undertaken with x-ray guidance, the protection available for staff, and precautions taken by staff and patient. Assist with ERCP, looking after the patient s airway. Assist the Endoscopist with diagnostic and therapeutic ERCP procedures - Sphincterotomy - Stone crushing and removing - Biliary stenting - Biliary brushing and biopsy - Drainage of pancreatic pseudocyst Assist with dilatation/oesophageal stenting under x-ray guidance. Safely care for and monitor a patient during ERCP.

20 Endoscopic Ultrasonography (E.U.S.) (KSF C1 level 3, C3 level 2, HWB2 level 3, HWB5 level 3, HWB7 level 3) The Endoscopy Nurse is able to: - Discuss the indications and risks associated with diagnostic EUS. Discuss the indications and risks associated with therapeutic EUS. Explain the procedure and the risks involved to a patient/carer. Perform a risk assessment on a patient undergoing EUS, and anticipate individual risks to each patient. Explain the sedation and analgesia used, and the associated risks. Set up procedure room for EUS. Assist with EUS, looking after the patient s airway. Assist the Endoscopist with diagnostic and therapeutic EUS procedure. Take and record biopsies for FNA Quickcore Assist the Endoscopist with Radio Frequency Ablation (RFA) Halo 360 Halo 90 Assist The Endoscopist with Endoscopic Mucosal Resection (EMR). Safely care for and monitor a patient during EUS.