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Enhanced Scope of Practice Model of Care

Murrumbidgee Local Health District
Project Added:
15 December 2014
Last updated:
15 December 2014

Enhanced Scope of Practice Model of Care

Summary 

The Enhancing Scope of Practice (ESOP) Model of Care was designed along with a supporting clinical governance structure, an education and training program and clinical pathways which define the scope of the ESOP Nurse.

By developing the current rural nursing workforce to ensure that patients in small communities were able to receive appropriate treatment, by an appropriate person, at the appropriate time, without having to be transferred to larger facilities some distance away. 

This project was a finalist in the Local Solutions category of the 2014 NSW Health Awards. Download a poster from the 2014 NSW Health Awards.

Aim

To develop the rural nursing workforce to ensure that patients in small communities were able to receive appropriate treatment, by an appropriate person, at the appropriate time, without having to be transferred to larger facilities outside their local area. 

Benefits

  • Improved access to care for rural patients needing treatment for minor problems rather than needing to travel.
  • Enhanced skills, knowledge and support for Nurses to treat people in their community.
  • Meeting patients’ needs locally and assisting patients to make informed decisions regarding seeking treatment locally.
  • Improving efficiency of resources.

Project Status

Sustained: The project has been implemented, is sustained in standard business. 

Background

In many rural areas, including Murrumbidgee Local Health District (MLHD), healthcare workforce shortages occasionally result in the situation where a facility is left without a medical officer (MO). This requires patients to travel outside their local area.

A reduction in the number of MOs working in rural sites is resulting in rural nurses working in an advanced capacity without support.

The patients that present to the emergency department (ED) on these occasions are assessed by the Registered Nurse (RN) and then transferred to the referral centre for definitive assessment and management.

The program sought to develop the rural nursing workforce to ensure that patients in small communities were able to receive appropriate treatment, by an appropriate person, at the appropriate time, without having to be transferred to larger facilities some distance away.

Within the MLHD there was no model of care to replicate or build from. This required the ESOP Project team to plan, develop, implement and sustain a unique model of care which is purposely designed to fit within all rural settings and address workforce shortages.

Implementation

The model was initially implemented in five sites and 12 RNs successfully completed the ESOP Program and undertook the role at their facility.

The model is designed for RNs working in rural EDs specifically targeting Australasian Triage Scale (ATS) category 4 and 5 conditions when a MO is not available in their local healthcare facility.

This was achieved by developing the unique ESOP Program which uses different modalities to deliver the education and training. It uses new technology and providing a different approach to education delivery such as, interactive online learning modules and videoconference education sessions. It is an opportunity for rural nurses to receive education and training, which is delivered to their door. As well as offering an opportunity for the participating RNs to consolidate knowledge and skills in their own sites and gain supported experience in a larger Base Hospital within MLHD.

The ESOP program addresses the gap for advanced nursing education which is often caused by distance, isolation, lack of local resources and support.

In January 2013 the model was introduced into five pilot sites, the implementation of the model at these sites was successful for four of the sites. Post this implementation the model was reviewed and the model and implementation evaluated. Using the finding changes were made to streamline the implementation into new sites. The ESOP Program was condensed from 6 months to 6-12 weeks, two new modules developed and the use of videoconferencing increased. 

The four original sites are still using the model and 16 RNs across the four sites are authorised to function in the ESOP role.

In January 2014 the ESOP Model was introduced into six new facilities across the MLHD and 19 RNs completed the ESOP Program and are now practicing in the ESOP role. More recently the five new facilities have opted to implement the model and 26 RNs currently undertaking the program across 15 facilities.

The model invests in the existing nursing workforce to improve service delivery and retention of rural general practitioners (GPs) and nurses.

The ESOP Program has been developed to be transferable to other LHDs using HETI Online, shared information technology systems and support from the MLHD.

Results 

The model improved access to health services and improved patient satisfaction.

163 patients were treated as part of the new model and 100% received the care they needed in their community. An evaluation found that 90% of patients were either satisfied or very satisfied with their overall experience.

Of the 163 patients treated by an ESOP Nurse using the ESOP clinical pathways:

  • No patient refused treatment or did not wait to be seen
  • No incidents or near misses have been reported
  • All patients have met their ATS category
  • 163 patients met the National Emergency Access Target (NEAT)
  • 24 have represented with 48 hours, 11 of which were planned representations for further investigations or GP review. 8 presentations were due to ongoing symptoms and for other unrelated conditions
  • 11 patients represented within 28 days. 9 with unrelated conditions and 2 for the removal of sutures
  • All 163 patients received timely and appropriate care where otherwise they would not have
  • 31 received treatment in their local facility rather than being transferred out of town to another facility and on 143 occasions the visiting medical officer (VMO) did not have to attend the ED
  • 100% of unnecessary patient transfers were prevented.

As part of the ongoing evaluation patient satisfaction surveys are being conducted. Currently 25% of patients have completed the survey.

  • 84% were satisfied with the time it took to be seen
  • 90% were either satisfied or very satisfied with their overall experience
  • 79% rated their experience either 9 or 10 out of 10.

An evaluation found:

  • 2/3 respondents from the ED team strongly agreed or agreed that the ESOP Nurse makes the ED team more effective, improves access to ED care and improves the quality of care
  • Managers have seen more comprehensive clinical assessment skills and documentation, better clinical decision making, more prompt and appropriate escalation of care, an increase in community support and the building of stronger nursing teams
  • RNs working in the role feel that they are able to provide a better service to the community and their knowledge, skill and self-esteem has improved which allows them to provide better care.

Of the 163 patients treated by the ESOP Nurse using the ESOP clinical pathways the following cost efficiencies have been found.

  • The 31 patients who were treated at their local facility rather than requiring a transfer to another facility for treatment has saved $44,180.28 associated ambulance transfer costs.
  • The 143 occasions were the VMO was not required to attend the facility to see or review the patient has resulted in saving of $30,763.50 in associated VMO costs.
  • Changes to the education and training have allowed more than double the number of RNs to participate.

References

  1. Sullivan, E., Francis, K., & Hegney, D. (2010). Triage, treat and transfer: reconceptualising a rural practice model. Journal of Clinical Nursing, 19, 1625-1634.
  2. Sullivan, E., Francis, K., & Hegney, D. (2012). Victorian rural emergency care - a case for advancing nursing practice. International Journal of Nursing Practice, 18, 226-232.
  3. Brown, J., Hart, A., & Burman, M. (2009, February). A day in the life of rural advanced practice nurses. The Journal for Nurse Practitioners, 108-114.
  4. Hegney, D., McCarthy, A., & Pearson, A. (1999). Effects of size of health service on scope of rural nursing practice. Collegian, 11, 21-26
  5. Cant, R., Birks, M., Porter, J., Jacob, E., & Cooper, S. (2011). Developing advanced rural nursing practice: A whole new scope of responsibility. Collegian, 18, 177-182

Contact

Summa Stephens
Enhancing Scope Of Practice Program Manager
Nursing and Midwifery Directorate
Murrumbidgee Local Health District
Phone: 0419 249810
Email: summa.stephens@gsahs.health.nsw.gov.au

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