Title : Using advanced nursing roles to develop the only nurse led dementia assessment unit in Europe
The concept of developing a Nurse Led Unit started in 2003 due toconcerns around the over prescribing of psychotropic medication in dementia care, with ‘Person centred care’ talked about, but not observed in practice. The Trust was developing a new Unit but had no vision around developing something different “If you only do what you have always done you will only get what you have always had” Albert Einstein.
Following discussion with the commissioners, the medical and nursing director, I put a business plan forward for the development of a Nurse Led Unit as well as a training development plan for myself and the staff. With the completion of the non-medical prescribing course in 2004 I started reviewing the patient’s medication, reduced and stopped antipsychotics and looked at behavioural management, pain relief and alternative therapies.
I started to take on the role of assessing, diagnosing, prescribing medication and discharging patients under the mentorship of the Consultant Psychiatrist. As my confidence and competencies grew his hours on the ward reduced until he had one session a fortnight and this was to review the patents who were detained under the Mental Health Act.
In 2007 the Mental Health Act was reviewed and allowed a broader range of professionals to carry out a range of functions under the Act. Nurses were now able to undertake the Approved Clinician (AC) and Responsible Clinician role. A Responsible Clinician (RC) is the AC who has been given overall responsibility for a patient’s case. ACs allocated as RCs would undertake the majority of the functions previously performed by Responsible Medical Officers (RMOs), whose role ended on the implementation date of the Act.
Following the AC training, it has enabled me to be the Responsible Clinician for all the patients admitted to the Dementia assessment ward, the role normally held by a Consultant psychiatrist, and only require the Consultant for clinical supervision and covering my annual leave.
Identified outcomes include:
• Reduced costs- nurse RC cheaper than medical RC.
• Improved patient experience- reduction in psychotropic medication, reduced falls.
• Improved relatives experience – ‘I have my husband back’, ‘closer relations with RC’ ‘talks in layman’s terms’.
• Increased staff confidence, competence and satisfaction, reduced sickness.
Audience Take Away:
• Have confidence in Advancing the Nurses Role.
• Use Advanced Nursing Roles and innovative practice to improve patient care.
• Think creatively to fill the gaps in your service.
• It’s not all about the ‘profession’ now, it is about who is best to take on the role.