Barwon Health, University Hospital Geelong The Night Shift Clinical Resource Nurse Making Night Shift Safer Gail Joordens After Hours Hospital Manager Maree Bennett Manager Access and Patient Flow
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Gen Med admissions per day
Red, orange, purple, MET, Access Alert, Escalation, Stemi, Black, Yellow, Brown, Grey, Blue, paed blue, paed met, stroke, Trauma and cancelled codes excluded. As measured by UHG switchboard log.
Red, orange, purple, MET, Access Alert, Escalation, Stemi, Black, Yellow, Brown, Grey, Blue, paed blue, paed met, stroke, Trauma and cancelled codes excluded. As measured by UHG switchboard log.
The Hospital at Night Nurse ratios during the day/evening 1:4 plus Nurse in charge Night shift 21.00 07.30 1:8 with no supernumery in-charge Junior medical staff
After Hours Hospital Managers (AHHM) are located within Access and Patient Flow Central Resource Unit (CRU) employs / manages casual staffing Float employed by CRU, but costed across medical surgical areas 50/50 Work under the direction of the AHHM Float home is CRU office
Clinical Resource Nurse - Rationale for introduction Winter demand strategy for UHG Increased general medical cohort during winter months Increased sick leave during winter months Opening of RAPU taking admissions direct from EMD triage Introduced June 2015
Employed skilled RN 7 nights per week in float roll Deployment /delegation of tasks decided by AHHM to meet situational demand needs of the hospital Cost shared 50/50 between medical and surgical divisions
Clinical Resource float nurse Provide nursing support to wards with the following issues Increased acuity individual patient or ward Need to transfer a pt to medical imaging CT or X-Ray Confused patients Emergent sick leave Skills needed
Skills of the float nurse Independent Adaptable Experienced IV cannulation Self confidence Completed all general ward competencies Common sense
What the float does not do Routine staff short falls. Routine meal breaks
ED Ward transfers Allow extra time to close cubicles Cover for meal breaks Ward admissions of patients transferred at night
The float is amazing, they allow us to get patients to the ward and clear the department. Cathy ED Knowing the float can be called to assist during a busy period relives the stress levels of ED night staff. Melissa ED The float was great they bought the patient up form EMD at 22.15, settled them and did the admission paperwork as we were still trying to settle the ward patients
Transfer of patients theatre to wards Escorting patients from theatre to the ward decreases the time a pt. waits in recovery overnight. On return to the ward they can settle the patient on return
High Acuity Response Assist wards during periods of high acuity Care for patients post met call who have short term high nursing needs Cannulation overnight to reduce delays in IV drug administration and analgesics During or following code blue or MET calls Stopping an escalating situation
One night 2 of our staff spent 1 hour replacing a complex dressing on a patient. The float was able to answer buzzers and look after the other patients while we were caught up. We had a patient who deteriorated and was unable to go to ICU as there were no beds. The additional float nurse enabled us to safely care for this pt. until they could go to ICU. The float was able to backfill me while I spent time with a family who we had called in overnight as their family member had deteriorated and were needing support and explanation
Specialised skill backfill I had to attend another ward to perform peritoneal dialysis at our busiest time of the morning (0545) The float was able to backfill me while I was off my ward.
Confused patients Patients often become confused and agitated overnight. Float can provide 1:1 support to maintain patient safety.
Unplanned sick leave/meal relief If a night staff member becomes sick there is no chance of finding a replacement in the middle of the night. The float has been used on several occasions to fill this gap. One of the nurses arrived well at the start of the shift and at about midnight had sudden onset of D&V. Without the float backfilling this position we would have been left with 3 nurses to look after 32 patients on a very busy night. Simone Meal break relief on busy wards Since we have had the float nurse on the night shift, we have been able to have a meal break every night. Rebecca
Medical Imaging (MI) MI has no nursing support overnight Average of 4-6 CT scans and 2-3 x-rays in MI overnight, requiring nurse escort. Ward or ED pt.'s Using float for pt.'s going to MI improves patient safety by maintaining minimum nurse/pt. ratios on the wards In MI the float nurse more efficiently assists with scans / procedures
Its more efficient having regular staff (float nurse) come with the patient for CT. They know where the equipment is and what is needed. It also means we are not waiting for patients to arrive due to staff being free to bring the patient to CT. We can plan better or scans and complete more Radiographer
Cons None identified Float getting a meal break
Float nurse thoughts ID tag identifying they are float Meal breaks 80% busy 20% quiet Can always find something to do Blur of locations Difficult to get away
Benefits Reassurance that there is someone who can be called Decrease stress levels of ward staff and AHHM Improved care and flow Increased patient safety
Thank you gailj@barwonhealth.org.au Questions?