Gateshead Health NHS Trust NHS Foundation Trust Procedure Investigation Unit Profile of Learning Opportunities POLO Review Date April 2011 1
Introduction This document has been devised to provide details of learning opportunities within the Procedure Investigation Unit. It is intended that students and mentors use this together to select the learning opportunities from this placement, which will meet the learner s individual requirements. Some of the learning opportunities presented in this document are generic to other wards and departments, whilst other are unique to this area. Students should not expect to access all the opportunities whilst on placement, but will be assisted to select those appropriate to fulfil their learning outcomes. This pro-active approach to planning and organisation of the student placement promotes forward thinking and is geared towards supporting the student as part of the team. 2
AREA PROFILE PIU The Procedure Investigation Unit provides a service to the whole of the Trust including, medicine, surgery, radiology, gastroenterology, cardiology, haematology, rheumatology, endocrinology and respiratory medicine. Piu is also closely linked to the cardiac catheter lab, staff are expected to rotate between the two areas. Piu accommodates day case patients along with those requiring overnight stay. All staff on the unit are committed to providing high quality, individual patient centred care. The unit is predominately nurse led but some input from medical staff is required at times. Nurse led discharge is regularly practiced and encouraged on the unit. Training development is also encouraged and supported on Piu. The department consists of one band 7 ward manager, two band 6 junior sisters, several band 5 staff nurses and several health care assistants. Piu welcomes students and hopes that you will find the experience educational and enjoyable. Each student will be allocated a mentor and co-mentor and will work with their mentor at least 50% of their time. Students will also have the opportunity to visit other departments and work with other members of the MDT as they dip in and out of the learning zones. You will gain experience in the provision of care for patients on care pathways. When planning and delivering patient care a multi-disciplinary approach has been adopted within the Procedure Investigation Unit. You will be encouraged to follow the progress of patients from Piu to other areas within the learning zone in order to maximise your learning experience. This will further enable you to achieve your clinical competencies. 3
Care and communication The Unit has several beds along with treatment chairs used for infusions etc, each patient is allocated a named nurse. Communication is one of the most important factors in delivering patient care both within the team and with patients and their families. The needs of our patients must be communicated within the team as to provide safe, effective care. Piu liaises with several other departments within the trust and communication must be at a high standard at all times. Knowledge will also be gained in ward handovers. Essence of care is also high on our agenda and there may be opportunities to take part in the audit process whilst on Piu. Shifts The working week comprises of 37.5 hours. Shifts are spread over seven days Sunday - Saturday and the off duty is prepared at least three four weeks in advance. Requests for specific off duty can be requested via the self rostering process and students may vary their hours to suit their needs provided the correct number of hours is worked and they are gaining the most out of their learning by working with their mentor. Early shift 7.45 start 3pm finish Late shift 1pm start 20.15 finish Long day 7.45 start 20.15pm finish The learning Zone is a learning environment which provides experience outside the placement area. The learner can achieve their learning 4
outcomes in a variety of care settings within this zone. The zone will enable the learner to appreciate inter-disciplinary aspect of care. Piu learning zones CT scan Ultrasound Bed manager cardiac catheter lab CCU Infection control team Nutritional nurse Dietician Heart failure nurse Social services CROP team Microbiology Community discharge team Radiology Pharmacy Macmillan nurse Physiotherapist Outpatients G.Ps Cardiac rehabilitation nurse Vascular team Theatres Vascular nurse Piu Tissue viability nurse Discharge liaison nurse Endoscopy unit ECG Surgical wards Critical care outreach team Endoscopy Ergonomics Diabetes specialist nurse Chemo day unit Medical wards Respiratory nurse Blood transfusion nurse Smoking cessation nurse Parkinson s disease nurse colorectal specialist nurse Night site managers Arrest team Resources 5
The trust library is situated in the clinical skills centre adjacent to the staff dining room, and is available for all staff to use. All trust policies and documents are available to staff and can be accessed at ward level. The trust intranet is available to learners. Piu has several learning resource files with are situated in the ward managers office. Your Mentor and other ward staff will assist you in gaining access to all the available learning resources. Anatomy, physiology and pathology Respiratory system Learning opportunity Chest infection COPD/chronic lung disease Lung cancer/tumours Aspiration Oxygen therapy Nebulisers/medication Sputum collection/suction P.E Care of tracheotomy Resources Respiratory nurse Medical staff Ultrasound dept CT scan and X-ray Pharmacy Pathology Physiotherapy Macmillan nurse and 6
Investigations Broncoscopy CT X-ray Lung biopsy Interpreting blood gas results palliative care team Microbiology SALT Dietician Infection control team Biochemistry Cardiovascular system Learning opportunity Cardiac arrest Myocardial infarction Heart failure LVF Angina Shock ECG and Echo Medication Arrithymia Pace maker Hypertension Resources s CCU Critical care ECG department Echo scan Cardiac arrest team Pharmacist Cardiac rehabilitation nurse Smoking cessation nurse Heart failure nurse 7
Fluid retention/oedema Cardiac catheter lab Endocrine system Learning opportunity Diabetes Thyroid function Pancreatitis Medication Administration of insulin Use of GKI Resources Medical staff Diabetes specialist nurse Pharmacist Dietician Protocol Files Pituitary problems Adrenal Dysfunction 8
Gastrointestinal system Learning opportunity Resources Upper and lower GI bleed Cancer of upper and lower GI tract Constipation/bowel obstruction Nausea and vomiting Dysphasia/swallow assessment Video fluoroscopy Endoscopy/Colonoscopy ERCP Barium swallow Abdominal Ascitic Tap Nasogastric feeding Peg insertion and peg feeding GI Specialist nurse Endoscopy department Surgery Pharmacy Medical staff Dietician Nutritional nurse specialist Gastro team, nursing staff Medical Staff X-ray Medical Staff/protocol files Medication policy and protocols Endoscopy Dept/Dietician Colostomy Medication/bowel prep 9
Renal and urinary system Learning opportunity Acute/ Chronic renal failure Urinary tract infections Specimen collection Catheter insertion/removal Fluid balance Incontinence Urinary retention Resources Health care assistants Medical staff Continence adviser Policies and procedures Ward based continence nurse Musculoskeletal system Learning opportunity Osteoarthritis/Rheumatoid Assessment management and prevention of falls Infections Rheumatologic Conditions Resources Medical staff Specialist Nurses Radiology staff Trust protocols and policies 10
Diagnostic Imaging Osteoporosis Medication Aspiration of joints Rehabilitation X-ray/MRI Surgery Falls Team Outpatients/Fracture clinic OT Rheumatologists Pharmacy Medical Team Physiotherapy Nervous system Learning opportunity CVA TIA Epilepsy Parkinson s Disease M.S Infection Resources Stroke team Stroke nurse CT scan Medical staff Pharmacy 11
Brain tumour/metastases Confusion intracranial haemorrhage/transfer to NGH Ambulance liaison P.D. nurse Mental health liason nurse Trust policies and procedures Medication Liver and Billiary system Learning opportunity Liver failure Gall stones Billiary sepsis Alcoholic liver disease Alcohol withdrawal Resources Medical Staff Registered Nurse USS and CT Palliative care team Pharmacy Ascitis/ Drain Jaundice Tumours/metastatic Disease ERCP Medication 12
Electrolyte balance/imbalance Learning opportunity Fluid balance Dehydration I.V.therapy Obtaining and interpreting blood results Fluid restriction Medication Resources s Health care assistants Medical staff Medical/nursing Staff Pharmacy Night-site manager Haematology and Biochemistry 13
Clinical skills Learning opportunity Resources Maintaining hygiene needs Assessment and documentation including any necessary risk assessment. Providing all aspects of hygiene needs including nails, mouth and hair Use of equipment such as hoist, shower chair and bath aids. Health care assistant Ergonomics Medical devices lead. O.T E.O.C.documentation Referral to Occupational therapist for washing/dressing practice if necessary. 14
Medication administration Oral medication N.G./P.E.G. medication I.V. and Sub cut and I.M. Rectal medication Controlled drugs Documentation Side effects and contraindications Ordering Self administration e.g. insulin and inhalers Cannulation Care of I.V/S.C cannula including risk assessment Medical staff/nursing Staff Pharmacist Pharmacy technician Drug information leaflets B.N.F. Medicine management policy Specialist nurses such as Respiratory and Diabetic nurse. Blood transfusion nurse Transfusion Policies and procedures Blood transfusion Haematology 15
Blood Components/Formation Collecting of Specimens Blood Transfusion Groshong Line Insertion Treatment of Thrombosis Prevention of Thrombosis Haematological Conditions Registered Nurse Medical Staff Specialist Nurses Transfusion Nurse Policy File Intranet Pathology Lab Staff Bone Marrow Biopsy Venesections Prevention and treatment of pressure damage Assessment of skin and risk assessment Use and ordering of pressure relieving equipment Vascular nurse Tissue viability nurse Wound formulary 16
Wound management Aseptic technique How to swab a wound Trust intranet and E.O.C Policies and procedures Microbiology Infection control Correct hand hygiene Waste disposal Aseptic technique Barrier and reverse barrier nursing Managing infections Infection screening Policies and procedures Health care assistant Infection control team Link nurse Microbiology Setting up equipment e.g. catheter insertion, lumbar puncture, wound dressing. Physiological observations Blood pressure Temperature, pulse, respirations Oxygen saturations Health care assistants Education resource files Diabetic nurse 17
Blood glucose Urinalysis Urine volumes Weight/BMI Respiratory nurse Alert course Medical staff CCOT EWS score Peak flow Recognising normal/abnormal parameters Management of falls Risk assessment for falls and bed rails Identifying medical problems such as postural hypotension Management Falls prevention equipment such as chair monitors Medical staff Falls team Physiotherapist Occupational therapist Pharmacy Referral to falls team Medication Datix incident reporting 18
Nutrition Nutrition assessment Calculating BMI Monitoring dietary intake Knowledge of specialist diets Swallow assessment Dietician referral Nasogastric tube/ P.E.G insertion and feeding Assistance with feeding i.e. equipment, positioning. Health care assistant Nutritional nurse Dietician Policies and procedures Endoscopy Occupational therapist Medical staff Catering staff Menu selection to include altered texture Supplements 19
Clinical devices How to use, check, decontaminate and report. Infusion pumps Syringe drivers Blood glucose monitor Urine testing machine Dynamap and tympanic Cardiac defib Suction and oxygen E.C.G.machine Feeding pump Other ward staff Medical devices lead Medical devices link nurse Cascade trainers Policies and procedures Student competency booklet Ergonomics Physiotherapist Infection control team Hoist and other moving and handling equipment Falls/bed monitor Scales 20
Meeting elimination needs Promote continence Managing incontinence Use of devices Collection of specimens Insertion and care of urinary catheters Managing stomas Measuring and recording urine output/fluid balance Constipation Diahorrea Health care assistant Continence advisor Continence link nurse Medical staff Policies and procedures Stoma nurse Pathology lab Pharmacy Patient advice leaflets Urinalysis Discharge advice/health promotion Medication District nurse referral 21
Preparation for investigations Obtaining consent and information for each procedure e.g. check lists. CT scans, guided biopsies USS scans, MRI scans Endoscopy and colonoscopy Bronchoscopy Barium studies Sigmoidoscopy X-rays Administration of preparation such as contrast/ bowel prep Ordering transport e.g. porter or ambulance Informing individual departments of any special arrangements e.g. for infection Medical staff USS department Endoscopy department CT MRI X-ray Policies and procedures Trust protocols Trust intranet Ambulance liaison Infection control Chaplaincy Education resource files Patient education leaflets Obtaining results and documentation Informing patient and family/breaking bad news. 22
Risk assessment Falls Nutrition Mouth care Skin integrity Bed rails Phlebitis Moving and handling COSH Medical devices Infection control Violence and aggression Other ward staff Policies Dietician Medical devices coordinator Ergonomics Tissue viability nurse Trust intranet Trust risk assessment manager Infection control team Use of DATIX incident reporting Documentation 23
Care of the dying patient Implementation of Liverpool pathway Syringe drivers Breaking bad news Transfer to DHH Privacy and dignity Family and carer support Pastoral support for staff Religious and cultural beliefs Medical staff Health care assistants Chaplaincy Policies and procedures Mortuary technician Privacy and dignity E.O.C lead and folder PALS D.N.R. orders Last offices Health promotion Smoking cessation Diabetes Cardiac rehabilitation Obesity Continence care Bowel disorders e.g.i.b.s. Patient advice leaflets Smoking cessation nurse Dietician Diabetic specialist nurse Cardiac rehab nurse Physiotherapist 24
Communication and record keeping Learning opportunity Using the telephone, bleep and fax Nurse handover, giving and receiving information MDT meetings Computer and intranet/email Interaction with patients and families/carers Ward rounds Outside agencies Non verbal communication Communication with hearing, sight or speech impairment Complaints Diary tool White board Datix incident reporting Written referrals Resources Other ward staff Telephonists Porters Night site manager IT department Policy and procedure file MDT Bed manager E.O.C.lead E.O.C files Ward clerk Nursing documentation Housekeeper Computer Chaplaincy PALS Informed consent 25
Completion of check lists Admission and discharge documentation Care standards and care Evaluation. Data protection Emergency situations e.g. fire, cardiac arrest Breaking bad news Estates, shift fitter, supplies 26
Management Learning opportunity Managing a team or group of patients Bed management and patient flow, identifying boarders Staffing and off duty Risk management Delegation skills Prioritising/ time management Resources Bed manager Matrons Night site manager E.O.C. documentation Policies and procedures Stores and supplies Communication with M.D.T. Maintaining standards Budget control Vascular System Peripheral Vascular System Abnormalities Lifestyle Factors Nursing Staff Radiology Vascular Nurses 27
Treatment of DVT Pre-Assessment for Angiogram Preparation for Angiogram Medical Staff Smoking Cessation Diabetes Nurse Specialist Recovery from Procedures Angioplasty Parameters for Safe Discharge 28
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