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Community Nurse In-reach Community Nurse In-reach (CNIR)(CNIR)
Providing safe & effective nursing Providing safe & effective nursing
discharges across the Hospital & discharges across the Hospital &
Community Interface.Community Interface.
BackgroundBackground
Experience of the Case finder Project (2003-Experience of the Case finder Project (2003-2004).2004).
Evidence of the Berkshire ‘High Tech’ Team.Evidence of the Berkshire ‘High Tech’ Team.
District Nursing Modernisation (2004-2006).District Nursing Modernisation (2004-2006).
CNIR team appointed Feb 2006.CNIR team appointed Feb 2006.
Two WTE DN Sister Band 6, One at the BCH Two WTE DN Sister Band 6, One at the BCH and one UHD.(2006)and one UHD.(2006)
Four WTE DN Sisters Band 6 and WTE Band7 Four WTE DN Sisters Band 6 and WTE Band7 Team Leader/Lead Nurse (2013)Team Leader/Lead Nurse (2013)
Team Aims:Team Aims:
• To prevent unnecessary admission to hospitalTo prevent unnecessary admission to hospital
• To facilitate early supported dischargeTo facilitate early supported discharge
Community Nurse In-reach Community Nurse In-reach (CNIR)(CNIR)
CNIR Roles to meet the CNIR Roles to meet the TargetsTargets
Case finderCase finder
FacilitatorFacilitator
Consultative/EducatorConsultative/Educator
AdvocacyAdvocacy
Case finderCase finder Patient selection is key to safe service Patient selection is key to safe service
provisionprovision
Attend daily bed meetingsAttend daily bed meetings
Hospital BasedHospital Based
Visible presence in A/E, AMAU, Outpatients and WardsVisible presence in A/E, AMAU, Outpatients and Wards
FacilitatorFacilitator Provides knowledge of and access to the Provides knowledge of and access to the
community service menu.community service menu. Acts Acts asas a conduit between hospital and a conduit between hospital and
community.community. Work in partnership to facilitate discharges Work in partnership to facilitate discharges
through a more structured, co-ordinated and through a more structured, co-ordinated and standardised approach.standardised approach.
Establishes good sustainable links between the Establishes good sustainable links between the primary and secondary care.primary and secondary care.
Identifies community alternatives and seeks Identifies community alternatives and seeks patient consentpatient consent
Consultative/ EducatorConsultative/ Educator Identify and advise on new development potential.Identify and advise on new development potential. Provides professional and clinical leadership in the Provides professional and clinical leadership in the
implementation of service development.implementation of service development. Identifies service development potential and associated Identifies service development potential and associated
training needs of community staff.training needs of community staff. Develop policies, guidelines and protocols to introduce new Develop policies, guidelines and protocols to introduce new
procedures or initiatives.procedures or initiatives. Carry out joint visits with District Nurses to support and Carry out joint visits with District Nurses to support and
supervise practice if required.supervise practice if required.
Advocacy
Promotes mutual understanding across primary and secondary interface.
Patient care is provided in an environment that is essentially their own, where they feel at ease with the potential for a faster recovery.
Family and carers are more involved in the care.
Reduces the risk of hospital acquired infections
Learning & DevelopmentLearning & Development
What has been achieved: Intravenous Therapy- OPHAT (Wards, O/P & A/E)Intravenous Therapy- OPHAT (Wards, O/P & A/E) Community Midline serviceCommunity Midline service Expediting delayed discharges- fast tracking Expediting delayed discharges- fast tracking
equipmentequipment Dehydration issues in Nursing HomesDehydration issues in Nursing Homes Increased number of complex palliative patients Increased number of complex palliative patients
now supported at Homenow supported at Home Enhanced early discharge Colorectal and Breast Enhanced early discharge Colorectal and Breast
Care patients Care patients Participating in Community Urgent Care PilotParticipating in Community Urgent Care Pilot
Measured OutcomesMeasured Outcomes Jan-Dec 2007 Referrals 777 Bed Days saved Jan-Dec 2007 Referrals 777 Bed Days saved
22932293
Jan-Dec 2008 Referrals 729 Bed Days saved 3473Jan-Dec 2008 Referrals 729 Bed Days saved 3473
Jan-Dec 2009 Referrals 1129 Bed Days saved 4822Jan-Dec 2009 Referrals 1129 Bed Days saved 4822
Jan-Dec2010 Referrals 1365 Bed Days saved 6195Jan-Dec2010 Referrals 1365 Bed Days saved 6195
Jan-Dec2011 Referrals 1342 bed days saved 7118Jan-Dec2011 Referrals 1342 bed days saved 7118
Jan-Dec2012 Referrals 1805 Bed Days saved 9512Jan-Dec2012 Referrals 1805 Bed Days saved 9512
Any Questions?Any Questions?