Nurse Led Clinics-Guidelines and Protocols

NURSE LED CLINICS-
GUIDELINES AND
PROTOCOLS
LINDA EDMUNDS
CONSULTANT NURSE CARDIAC CARE
CARDIFF AND VALE NHS TRUST
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Nurse led clinics
What are nurse led clinics?
Why do we need them?
How to make guidelines/protocols successful?
What is Nurse led care?
Common features.
Direct referral mechanism
Assessment and technical skills
Freedom to initiate diagnostic tests
Prescription of medications
Increased autonomy and scope for decision
making
Discharge
(Briggs 1997)
Why?
To enhance patient care
Why is change needed?
Modern health care is dynamic
Expectations and demands of patients have shifted moving
focus away from clinician to patient need
Changes in provision of care

Target driven?
Shorter hospital stays
Quicker access
Greater provision of community care
Education and professional development
Recruitment and retention
National Drivers
The New NHS: Modern and dependable
Making a difference (DOH 1999)
The National Plan (DOH 2000a)
CHD NSF (DOH 2000)
WAG Tackling CHD (2001)
Locally
Here is Pooh Bear, coming
down the stairs now, bump,
bump, bump, on the back of
his head, behind Christopher
Robin. It is as far as he
knows, the only way of
coming downstairs, but
sometimes he feels that there
really is another way, if only
he could stop bumping for a
moment and think of it….
(House at Pooh Corner; A.A. Milne)
Failure V Success
Idea Idea
Talked to colleagues Research
Secured Clinic time Planning
Developed guidelines Collaboration
Commenced service Guideline and protocol
Outcomes poor development
Frustrated, worn out Commenced service with
Six months clinic ceased support
Audit/evaluation
Twelve months clinic
remains successful
Collaboration !
Guidelines and protocols are a part of nurse led
care which are a part of the patients journey
Breaking down barriers between professional

groups, changing culture, empowering nurses
What are Guidelines and Protocols?
Guidelines – are evidence-based recommendations on
the appropriate treatment and care of patients with
specific diseases and conditions within the NHS in
England and Wales, but do not replace, the knowledge
and skills of experienced health professionals (NHS
Modernisation Agency ).
‘…a series of systematic statements (derived from the
best available evidence) and designed to guide the
practitioner and patient to make informed decisions
about health care for specific clinical circumstances’.
(Institute of Medicine 1992).
Protocols
Protocols – are underpinned by the guidance of validated

clinical guidelines (NSFs, NICE)
Provide detailed descriptions of steps taken to deliver care

Local protocols are multidisciplinary, and reflect local services
and resources
Specific detail on who and how (detailed procedures)
‘..provide a specific framework with specific criteria for

providing an aspect of patient care. Unlike a guideline, they are
less flexible’ (Institute of medicine1992)
Protocol-Based Care benefits-
Patient
Clinician
Workforce
Clinical Governance
The Board
How
Improves safety Clarifies roles
Promotes high quality Promotes team working
Improves consistency Utilises skills
Improves informed Crosses boundaries
consent New ways of working
Streamlines care Clinical governance
Minimises error Audit and record keeping
Increases patient Meets targets
involvement Minimalise delay
Developing guidelines
Four
One Two Three Agree
Topic Team Patients objectives
Twelve Five
Review Build
Commitment
Eleven Six
Monitor Gather
variations information
Ten Nine Eight Seven

Implement Pilot protocol Base line
assessment
Topic
Clinical standards
Workforce changes
Skill mix
Improvement to care
Local service improvement priorities
Team members and roles
‘Think broad’
Clinical leader to facilitate
Audit
Teaching
Clinical champion
Patients
Managers
Multidisciplinary team
I.T and Support services
Role
Support
Strategic ‘fit’
Plan
Timescale
Communication
Patient Involvement
Patient representative
Patient forums
Consumer groups
Complaints
Patient feedback
Objectives
What is the protocol aiming to achieve?
Awareness and commitment
‘It must be considered that there is nothing more
difficult… doubtful of success…dangerous to
handle, than to initiate a new order of things. For
the reformer has enemies in all those who profit by
the old order and only lukewarm defenders in all
those who profit by the new order.., partly because
of the incredulity of mankind, who do not truly
believe in anything new until they have actual
experience of it’.
Machiavelli
Gather information and baseline
Information- Clinical guidelines, best practice,
NSFs, National Standards,
Base line audit
Protocol
Simple and a guide for staff
Agree format (corporate style)
Patient agreement and consent for treatment,
including use of protocol
Agree level of patient access
Signed off at corporate level before pilot
Requirements of a protocol
Focuses on needs of Easy to record variations
patient and users of Facilitates audit
service Highlights
Simple in design and easy responsibilities/accounta
to use bility
Short and concise Reference and version
Logical sequence number, date, review
Realistic goals/ date and contact name
timeframes
Pilot
When Compliance monitored
Timescale Feedback
Numbers How problems will be

tackled
Staff training
How evaluated
Implement, monitor and review
Pilot addressed operational issues
Early links commissioning
Staff training/written instructions
Lead person
System to monitor
Review- change to best practice/new guidelines/new
staff/support clinical governance
Feedback to staff and patient groups
In Conclusion- Success with guidelines
and protocols-
Guidelines and protocols are a small part of the
patients journey
They need to be planned and developed as part
of the overall planning of nurse led services
Collaboration and support
Planned, implemented and reviewed
References
www.nelh.nhs.uk
www.prodigy.nhs.uk
www.doh.gov.uk/nsf
www.nice.org.uk
www.doh.gov.uk/clinicalgovernance
www.chi.nhs.uk
www.modern.nhs.uk
www.doh.gov.uk/nhsplan
www.sign.nhs.uk
www.rcn.org.uk
References
Briggs M (1997) developing Nursing Roles. Nursing
standard 28;11;49-54
DOH (1997) The New NHS: Modern and Dependable.
DOH, London
DOH (2000) The National Plan. DOH, London
Thank you
Questions?
Linda Edmunds
Consultant Nurse cardiac care
Cardiff and Vale NHS Trust
www.cncforum.me.uk

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NURSE LED CLINICS-

Why do we need them?

How to make guidelines/protocols successful?

To enhance patient care

Changes in provision of care

Making a difference (DOH 1999)

The National Plan (DOH 2000a)

CHD NSF (DOH 2000)

WAG Tackling CHD (2001)

(House at Pooh Corner; A.A. Milne)

Breaking down barriers between professional

Protocols – are underpinned by the guidance of validated

Provide detailed descriptions of steps taken to deliver care

‘..provide a specific framework with specific criteria for

Ten Nine Eight Seven

Base line audit

Numbers How problems will be

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