Adult emergency care (Prescribing)

Michael Geraghty, Adult Emergency Care Nurse Practitioner (Prescribing) Auckland District Health Board Population Emergency patients (aged 15 years and older).

Process to establish NP role within the Adult Emergency Department,
Auckland City Hospital:

Identified need
Before the development of the Nurse Specialist role in 2001, the emergency department
experienced poor compliance with triage sign-on times and poor patient satisfaction related to waiting times for medical review. The dissatisfaction with the service often manifested as violence towards staff and property as well as an unacceptable number of patients leaving the department without being seen.
The model initially developed was a hybrid of emergency nurse practitioner roles successfully established in the USA and UK, but tailored to the unique needs within New Zealand.

Service delivered

• Patients with uncomplicated injuries and illnesses that are assessed, diagnosed, treated and discharged.
• Specific patient groups with uncomplicated injuries and illnesses that benefit from earlier diagnosis and referral to acute inpatient specialty services
• Medical assessment and treatment to triage category groups, especially Australasian Triage Scale triage category 3, 4 and 5’s who exceed waiting times recommended by the Australasian College of Emergency Medicine.
• Nurse consultancy of patients with complicated injuries or illnesses.

Implementation/ funding of NP Position

• Clinical Nurse Specialist role prior to NP registration
• Development and presentation of a business plan to the DHB which outlined the gaps in service provision and the need to establish the NP role including the backfill for the previous Clinical Nurse Specialist role
• Funding for the position came from within the nursing budget.

Outcomes

• Increased patient satisfaction
• Decreased episodes of violence
• Decreased waiting times
• Increased compliance with triage sign on times
• Decreased length of stay for NP patient group

Evaluation

• Evaluation of the service is an ongoing process that includes patient satisfaction feedback, peer review, ongoing monitoring of return rates, triage waiting times and length of stay for the NP patient group

Feedback on NP contribution
“…Your willingness to contribute to nursing education from a sound base of advanced expertise and knowledge in your specialty area of emergency nursing is appreciated by students and staff…”

“….a committed and dedicated emergency nurse who has pioneered this role within the New Zealand’s emergency nursing specialty……”

“…The ability to maintain a nursing focus whilst developing a role which has a predominantly clinical focus – this is particularly evident in the time and effort spent exploring patient’s social circumstances, in discharge planning and in his overall patient care….”