Nurse Practitioner Clinical Practice Guideline …health.act.gov.au/sites/default/files/Emergency Department Nurse... · Nurse Practitioner Clinical Practice Guideline Page: ... Calvary

Nurse Practitioner Clinical Practice Guideline Page: 1 of 29 Emergency Department Version: 6.2 Calvary Health Care ACT Approval Date: Nov 2006

Nurse Practitioner Clinical Practice Guideline Emergency Department Calvary Health Care ACT

for the

Management of acute episodic presentations

Calvary Health Care ACT is situated on the north side of the Nation's Capital, Canberra, in the Australian Capital Territory (ACT). It is a modern health care service complex comprising a 159-bed public district general hospital (which is an associate teaching hospital with The University of Sydney and the new Australian National University Medical School (ANUMS) and a co-located 109-bed private hospital. The emergency department of Calvary Health Care ACT has been accredited by the Australasian College of Emergency Medicine (ACEM) as an advanced training in emergency medicine facility. The emergency department of Calvary Health Care ACT provides a 24 hour, seven day a week emergency health service to the residents of Canberra. These services include resuscitation, acute medical and surgical complaints as well as general practice type presentations. Calvary Health Care ACT is not a designated trauma Centre. On average the emergency department sees 46,000 presentations per year (2005). Approximately 20% of these annual presentations are paediatric patients. The emergency department caters for all patients throughout the age spectrum and of varied acuities.


Contents Page Title Page 1 Contents Page 2 Local Clinical Practice Guideline Development Team 3 Evidence of Endorsement and Agreement from Stakeholders 4 Disclaimer 4 Plan for Dissemination, Implementation, Review and Evaluation 5 Patient/Client Assessment Framework 6 Nurse Practitioner Clinical Practice Guidelines Haemodynamically Unstable 7 Haemodynamically Stable Life Threatening 8 Limb or Organ at Risk 9 Acute 10 Sub Acute 11 Non Acute 12 Clinical Indicators for Referral or Consultation 14 Appendix A Diagnostic Medical Imaging 18 Appendix B Pathology 19 Appendix C Medication Formulary 20 Appendix D

Risk Minimization 22 Appendix E Clinical References 23 Appendix F Attachment 1 Position Statement 24 Attachment 2 Duty Statement 28

Attachment 3 Scope of Practice 29


Disclaimer This document has been established to provide a framework for the clinical practice of the emergency department nurse practitioner at Calvary Health Care ACT. The guidelines reflect the specific scope of practice of both the position and the skills and specialty knowledge of the current incumbent. This guideline should not to be considered inclusive or be used in exclusion of other relevant references, policies and clinical guidelines. They do not replace the need for professional and clinical judgement according to specific clinical requirements that may or may not be included in this document. The default to any situation that is not clearly defined in this guideline is for the nurse practitioner to consult with a senior medical officer as clinically indicated.


Plan for Dissemination, Implementation, Review and Evaluation

• The approved emergency department nurse practitioner clinical practice guidelines will be placed on the Calvary Health Care ACT intranet for access by all staff

• Staff directly related to the practice of the nurse practitioner will be informed of the clinical practice guidelines

• The approved emergency department nurse practitioner clinical practice guidelines will be placed on the ACT Health website for access by interested parties

• The approved emergency department nurse practitioner clinical practice guidelines will be shared amongst the nurse practitioner community through conferences and through the nationally based Australian Nurse Practitioner Association

• This emergency department nurse practitioner clinical practice guideline will be reviewed and evaluated on a regular basis through a local multidisciplinary team to ensure that it suits the needs of the patients, Calvary Health Care ACT and the appointed nurse practitioner

• Formal review and evaluation of the clinical practice guidelines is required every two years. Interim updates to the ACT Clinical Practice Guideline Committee are required annually (or earlier if there is a population change or change in practice) to ensure that they remain at the level of best practice.


Patient/Client Assessment Framework

Nurse Practitioners in the ACT – The Framework (2005)


Nurse Practitioner Clinical Practice Guideline Haemodynamically Unstable

• All patients that fit the Medical Emergency Team (MET) calling criteria will be referred to a senior Medical Officer (MO). The nurse practitioner will assist with the management of these conditions under the direct supervision of a senior medical officer

• The list representing presentations within this category is not inclusive. Presentations not listed, seen by the nurse practitioner will be referred as previously stated for this category

Persons presenting with observations outside a normal limit:

MET Criteria (Adult) • Threatened airway • Respiratory arrest • RR < 5 or >36 • SaO2 < 90 % FiO2 R/A • Cardiac arrest • PR < 40 or >140 • Systolic BP < 90 • Sudden fall in GCS > 2 points • Repeated or prolonged seizures


Haemodynamically Stable Life Threatening

• All patients presenting with life threatening conditions will be referred to a senior MO. The nurse practitioner will assist with the management of these conditions under the direct supervision of a senior medical officer


Presentations:

Anaphylaxis Burn > 15% TBSA (Child >10%) Hypovolemia Poisoning Acute myocardial infarction Pancreatitis Haemorrhage Perforated bowel Pulmonary oedema

Diabetic ketoacidosis Hyperosmolar hyperglycaemia non-ketotic syndrome

Hypoglycaemia Meningitis Status epilepticus Eclampsia

Severe asthma Epiglottitis Ectopic pregnancy Spinal injuries


Haemodynamically Stable Limb or Organ at Risk

• All patients that present with limb or organ at risk conditions will be referred to a senior MO. The nurse practitioner will assist with the management of these conditions under the direct supervision of a senior medical officer


Presentations:

Acute angina Acute glaucoma Torsion of the testis Antepartum haemorrhage

Limb neurovascular injury Limb crush injury


Haemodynamically Stable Acute

• All patients that present with an acute condition will be treated by the nurse practitioner in consultation with a senior MO. The nurse practitioner will assist with the management of these conditions under the direct supervision of a senior medical officer

• The list representing presentations within this category is not inclusive. Presentations not listed, seen by the nurse practitioner will be treated as previously stated for this category

Presentations:

Venous thrombosis Hypertension Supraventricular tachycardia Atrial fibrillation/flutter Acute abdominal pain Biliary colic Epididymitis Orchiditis

Prostatitis Renal colic

Rhabdomyolysis Electrolyte imbalances

Febrile Fractures (Complex) Seizures Postpartum haemorrhage Menorrhagia Pre-eclampsia Pelvic inflammatory disease

Asthma Neck of femur fractures Bronchiolitis Acute exacerbation of chronic obstructive airways disease Pneumonia (Systemic affect)


Haemodynamically Stable Sub Acute

• All patients that present with a sub acute condition may be treated by the nurse practitioner autonomously. Consultation with a senior MO as required


Presentations: Otitis externa Otitis media Acute sinusitis Pharyngitis Tonsillitis Acute vestibular disorder Bacterial conjunctivitis

Periorbital cellulitis Dyspepsia Acute diarrhoea Diverticulitis Nausea and vomiting Intestinal parasitic infections

Sexually transmitted infections Urinary tract infections Urethritis and cervicitis Dental or oral abscess

Gout Back pain Soft tissue injuries Fractures (Simple) Migraine

Bell’s palsy Hyperemesis gravidarum Vaginitis

Bronchitis Croup Pneumonia Cellulitis Bite wounds Mastitis Impetigo Scabies Urticaria and pruritus Varicella (Chickenpox) Zoster (Shingles)


Haemodynamically Stable Non Acute

• All patients that present with a non acute condition will be treated by the nurse practitioner autonomously. Consultation with a senior MO as required


Presentations:

Wound dressings Plaster application and aftercare Soft tissue grazes Sprains and Strains


Clinical Indicators for Referral or Consultation

This list of clinical indicators for referral or consultation should not be considered inclusive. Clinical situations / presentations not listed, that are outside the scope of practice or clinical expertise of the nurse practitioner will be referred or treated in consultation with a medical officer. Paediatric patients treated autonomously by the nurse practitioner, will be done so in consultation with a medical officer. Persons presenting with observations outside a normal limit

• MET Criteria (Adult)

Threatened airway Respiratory arrest RR < 5 or >36 SaO2 < 90 % FiO2 R/A Cardiac arrest PR < 40 or >140 Systolic BP < 90 Sudden fall in GCS > 2 points Repeated or prolonged seizures

Liverpool Hospital, Sydney (1990) (Adapted)

• Paediatric Normal Ranges

Age Weight HR RR

<30

Days 3.5 110-160 30-60 6

Months 7 100-160 30-40 1 Yr 10 100-150 30-40

2 12 95-140 25-30 4 16 95-140 20-30 6 20 80-120 20-25 8 24 80-120 20-25 10 30 80-110 15-20 12 40+ 60-100 15-20

Broselow Emergency Tape (2002)

Neurological

• Acute change in mental state • New presentation of neurological deficit (including post trauma) • Cranial vault compromise • Chronic neurological conditions • Severe headache with sudden onset • Symptomatic hypertension


• Clinically raised ICP

Ocular • Red Eye • Acute visual deficit • Severe intraocular pain • Penetrating injuries • History of (or suspected) significant ocular conditions

Dental and Oral

• Compromise of the airway • Swallowing complications • Aspiration complications or potential for same • Chronic dental or oral conditions • Facial cellulitis

Ear Nose and Throat • Compromise of the airway • Postauricular erythema and oedema, tender mastoid process • Systemically unwell • Chronic otitis media

Cardiovascular

• Acute change in cardiac output • Chest pain with cardiac risk factors • Suspected ischaemic chest pain • Acute shortness of breath • Positive Wells score – PE • Implantable thoracic devices – Defibrillator / Pacemaker • Clinical signs of aortic aneurysm • Congenital cardiac disorders • Chronic cardiovascular conditions • Cardiac arrhythmia • Presence of co-morbidities • All children

Respiratory

• Ventilation perfusion compromise • Acute shortness of breath • Signs of tension pneumothorax • Signs of hypoxia • Fever of unknown origin • Chronic respiratory conditions • Potential to progress to airway/ventilation compromise - Angioedema, airway

burns or epiglotitis • Co-morbidities (including suspected metabolic disturbance)


Musculoskeletal • Open/compound fracture • Multiple injuries post trauma • Neurovascular compromise - Dislocation or compartment syndrome • Fracture involving a joint/articulation surface • Chronic musculoskeletal conditions • Systemically unwell • Child at risk

Gastrointestinal

• Absence of bowel sounds • Clinical signs of aortic aneurysm • Acute abdomen – Peritonism • Active bleeding • Shoulder tip pain • Pain greater than clinical findings • Irreversible hernia • Chronic gastrointestinal conditions • Jaundice • Pregnancy • Presence of co-morbidities • Undifferentiated diagnosis • Public health reportable disease

Obstetrical and Gynaecological

• Pregnancy > 20 weeks • Heavy PV bleeding • Clinical signs of an ectopic pregnancy • Threatened / Spontaneous miscarriage • Acute abdomen • Sexual assault • Chronic obstetrical and gynaecological conditions • Systemically unwell

Genitourinary

• Urinary retention • Testicular pain, swelling, deformity or inflammation • Genitourinary trauma • Uncontrolled pain • Changes in renal function • Frank haematuria • Strangulated inguinal hernia • Sexual assault • Chronic genitourinary conditions • Systemically unwell


Dermal • Neurological deficit • Vascular compromise • Full thickness and circumferential burns • Lacerations with muscle or tendon involvement • Multiple dermal layer involvement • Chronic dermal conditions • Suspected underlying systemic illness • Child at risk • Systemically unwell • Public health reportable disease

Psychological

• Persons behaving in a threatening or dangerous manner • Acute psychiatric presentations • Suspected at risk of self harm

Other

• Toxicology presentations


Appendix A Diagnostic Medical Imaging

Radiology Plain Axial Skeleton Plain Chest Cervical Spine Jaw Extremity Foot Ankle Hand Wrist Knee Elbow Shoulder Clavicle Arm Proximal Arm Distal Leg Proximal Leg Distal Neck Of Femur/Pelvis

• Requests for diagnostic medical imaging not listed will be made in consultation with

a medical officer • Medical diagnostic imaging as indicated by hospital and departmental policy and

the emergency department nurse practitioner clinical practice guidelines • Medical diagnostic imaging (for example, cervical spine) will be requested

according to the ‘traffic light system’ established within the emergency department in consultation with the medical diagnostic imaging service provider

• Diagnostic imaging that is unreported will be reviewed in consultation with a medical officer


Appendix B Pathology

Pathology

Full Blood Count Urea Electrolytes Creatinine and GFR Blood Sugar Level Amylase Lipase Liver Function Test Blood Culture m/c/s Midstream / Catheter Urine m/c/s CSF m/c/s Serum Osmolarity Swab m/c/s Faecal Specimen m/c/s Monospot Paracetamol Level Venous Blood Gas Arterial Blood Gas Lactate Ethanol Level Cross Match FFP Group and Hold BHCG

• Requests for pathology investigations not listed will be made in consultation with a medical officer

• Pathology will be requested according to the ‘traffic light system’ established within the emergency department in consultation with the pathology service provider

• Pathology investigations as indicated by hospital and departmental policy and the emergency department nurse practitioner clinical practice guidelines


Appendix C Medication Formulary

Generic Name

Trade Name (Example)

Specific NP Prescription Permitted / Restricted

Adrenaline ALS Protocol * Adult Diphtheria and Tetanus Vaccine ADT Amethocaine Eye Drops Amiodarone Cordarone ALS Protocol * Amoxycillin Alphamox Amoxycillin and Clavulanic acid Augmentin Ampicillin Ibimicyn Antacid Gastrogel Aspirin Atropine ALS Protocol * Azithromycin STI Only ** Benzylpenicillin BenPen Bupivacaine Marcain Ceftriaxone Rocephin CAP Protocol *** Cephalexin Keflex

Chloramphenicol Chlorsig Ointment and

Drops

Codeine Administration by Standing Order#

Diazepam AWS Protocol **** Dicloxacillin Doxycycline Enoxaparin Clexane Chest Pain Protocol Erythromycin

Fentanyl Administration by Standing Order#

Flucloxacillin Fluorescein Eye Drops Glyceryl Trinitrate GTN Chest Pain Protocol Heparin Chest Pain Protocol

Hepatitis B Vaccine II Hep B Vax II

Hydrocortisone Ibuprofen Nurofen Indomethacin Indocid Intravenous fluid therapy IVT Initial Bag Ipratropium Atrovent Lignocaine Xylocaine Loperamide Imodium Metoclopramide Maxolon Metoprolol Betaloc Chest Pain Protocol Midazolam Hypnovel Acute Seizures

Morphine Administration by Standing Order#

Naloxone Narcan


Naproxen Naprosyn Ondansetron Zofran Failed Maxolon Oxygen Therapy 02 Paracetamol Panadol Prednisolone Redipred Asthma / Croup Prochlorperazine Stemetil Promethazine Phenergan Roxithroymicin Rulide Salbutamol Ventolin Tramadol Tramal Trimethoprim Triprim

Prescriptions for medications on this list may be presented for dispensing to the hospital pharmacy, or to a community pharmacy. Medications prescribed by the authorised and appointed emergency department nurse practitioner will be prescribed in accordance with the ACT medicines legislation. * Advanced Life Support (ALS) – Australian Resuscitation Council ** Sexually Transmitted Infection (STI) – Therapeutic Guidelines *** Community Acquired Pneumonia (CAP) – Therapeutic Guidelines **** Alcohol (ETOH) Withdrawal Scale (AWS) # Nurse practitioners can administer but not prescribe drugs of dependence under ACT legislation


Appendix D Risk Minimisation

Pathology Nurse practitioners are specialists in their area of practice.

Nurse practitioners work within a professional scope of practice specific to their area of specialty. Nurse practitioners are educated to a Masters level tertiary education specific to the area of pathology diagnostics. Nurse practitioners are experienced nurses with expert knowledge and skills that are applied within professional practice. Patients being treated in consultation with a medical officer will have all pathology results reviewed with that MO during the acute care period.

Formal pathology results will be reviewed by a consultant of the emergency department through the standing process of daily review of pathology results.

Diagnostic Imaging Nurse practitioners are specialists in their area of practice.

Nurse practitioners work within a professional scope of practice specific to their area of specialty. Nurse practitioners have Master level tertiary education specific to the area of diagnostic imaging. Nurse practitioners are experienced nurses working at an advanced and extended level of professional practice. Diagnostic medical imaging that is unreported at the time of clinical interpretation and review will be reviewed in consultation with a medical officer. Diagnostic medical imaging formal reports will be reviewed by a consultant of the emergency department through the standing process of daily review of radiological reports.

Medication Formulary

Nurse practitioners are specialists in their area of practice. Nurse practitioners work within a professional scope of practice specific to their area of specialty. Nurse practitioners have Master level tertiary education specific to the area of pharmacology. Nurse practitioners are experienced nurses working at an advanced and extended level of professional practice. Medications prescribed for a patient being treated in consultation with a medical officer, will be prescribed in consultation with that MO. Medications prescribed for a patient being treated autonomously by the nurse practitioner will be as per the formulary and prescribed as guided by current references such as the Australian Medicines Handbook and the Therapeutic Guidelines, and the Australian Approved Product Information Guide.


Appendix E Clinical References

• ACT Nursing and Midwifery Office (2005). Nurse Practitioners in the

ACT – The Framework. ACT Health, Canberra. • ACT Pathology, (2005). ACT Pathology Handbook. ACT Pathology,

Canberra. • AMH, 2006. Australian Medicines Handbook. Australian Medicines

Handbook, Adelaide. • AMH, 2004. Australian Medicines Handbook – Emergency and

Primary Care Drug Choice Companion. Australian Medicines Handbook, Adelaide.

• Broselow (2002). Broselow Emergency Tape. USA. • Brown A., (2001). Emergency Medicine: Diagnosis and Management,

2nd Edition. Heinemann, Butterworth. • Calvary Health Care ACT Policies / Procedures / Guidelines • Ma J., Cline D., Tintinalli J., Kelen G. and Staphczynski S., (2005).

Emergency Medicine Manual, 6th Edition. McGraw-Hill Companies, Sydney.

• Medical Emergency Team (MET) (1990). MET calling criteria. Liverpool Hospital, Sydney.

• Queensland Health and The Royal Flying Doctor Service (Queensland Section), 2005. Primary Clinical Care Manual, 4th Edition. North Queensland Health Workforce Unit, Cairns.

• Senior Medical / Nursing Staff • Therapeutic Guidelines Limited, 2006. Therapeutic Guidelines.

Therapeutic Guidelines Limited, Melbourne.


Appendix F Calvary Health Care ACT Emergency Department Nurse Practitioner Attachment 1 Position Statement Attachment 2 Duty Statement

Attachment 3 Scope of Practice


Attachment 1 Position Statement

Position details Local Title Nurse Practitioner Classification Registered Nurse Practitioner Level 4.2 Department/ Ward Emergency Department Position number(s) Type Fortnightly hours 76 Ins. No. 99/99 Cost Centre 1105

Reporting details Supervises Line responsibility /

authority / accountability

Operational: Clinical Nurse Manager Professional: Clinical Nurse Manager

Assoc Director of Nursing Director of Nursing

Clinical: Clinical Nurse manager Director of Emergency Dept Legislative: Nurses Board of the ACT

ACT Health Calvary Health Care ACT

Nurse Practitioner Position Primary Function

• A Nurse Practitioner (NP) is a registered nurse educated to function autonomously and collaboratively in an advanced and extended clinical role.

• The nurse practitioner role includes assessment and management of clients using nursing knowledge and skills and may include, but is not limited to, the direct referral of patients to other health care professionals, prescribing medications, and ordering diagnostic investigations.

• The nurse practitioner role is grounded in the nursing profession’s values, knowledge, theories and practice and provides innovative and flexible healthcare delivery that compliments other healthcare providers.

• The scope of practice of the nurse practitioner is determined by the context in which the nurse practitioner is authorised to practice.

Adopted from (The ACT Nurse Practitioner Project, Final report of the Steering Committee, July 2002)

Clinical Science – Assessment, Clinical judgement and decision making

The nurse practitioner: • Completes advanced level triage/prioritisation skills and appropriate comprehensive

health assessments that include health history, physical examination, cultural, spiritual and social assessment

• Demonstrates advanced holistic nursing expertise in clinical judgement by applying principles of pathophysiology, aetiology, pathogenesis and clinical manifestations appropriate to the client group

• Initiates, implements and evaluates care of clients within the scope of practice, clinical guidelines and competencies of a nurse practitioner

• Practices within a clinical framework that is evidence based, relevant and current. • Demonstrates comprehensive understanding of specific pharmaceuticals and

diagnostic tests related to area of practice • Demonstrates proficiency in documentation of clinical case management for either

singular or multiple client groups

Professional Accountability

The nurse practitioner: • Is responsible for their own practice within the definitions of their current nursing

registration and the ACT Nurses Act of 1988 • Complies with the relevant legislation, standards, codes of practice and competencies

consistent with the nurse practitioner role • Works within ACT Health and area of service procedures and policies


• Is aware of their therapeutic scope including the limitations and determination of appropriate and timely referral

• Maintains their own professional portfolio and commitment to learning and development through the utilisation of evidence based practice and research

• Participates in peer review processes • Develops strong collegial links and partnerships with other nurse practitioners

Clinical Leadership

The nurse practitioner: • Provides clinical leadership in their area of speciality and demonstrates leadership

qualities to all health professionals • Provides expert nursing knowledge to the multidisciplinary team, providing direct

clinical care, guidance, support, education and advice on the clinical case management of clients

• Assumes a team leadership role when required, challenges and is prepared to be challenged constructively, and is accountable for decision making

• Acts as an advocate, mentor, clinical teacher, resource and support person • Ensure staff, at all levels have an understanding of key organizational strategies and

can see how their work contributes to higher-level objectives • Establishes effective, collaborative and professional relationships with clients,

members of the multidisciplinary team and other stakeholders • Assumes responsibilities that broaden the advancement of clinical practice, eg change

leadership embracing research-based clinical directions Consumer Safety

The nurse practitioner: • Acts within the legislative and legal requirements that promote excellence in nursing

practice • Identifies potential adverse outcomes and implements proactive strategies to achieve

risk minimisation, ensure client safety and workplace safety is maintained • Works within the guidelines policies and practices of Calvary Health Care ACT • Works collaboratively with all members of the multidisciplinary team

Professional Development

The nurse practitioner: • Contributes to the development of professional practice, including participation in and

promotion of quality improvement, evidence based practice and research • Engages in continuing self-professional development to enhance knowledge and

clinical skills, including participation in development programs • Engages in professional organisations and relevant practice committees • Initiates, develops and maintains clinical practice guidelines

Working Relationships

Hospital Based Clients Multidisciplinary team

Community Based Clients GPs Other health providers within the community Local health care providers Local government health services

Organisational environment and context

ACT Health is a vibrant organization that attracts committed and highly skilled staff. It provides a range of coordinated healthcare services to improve the well-being of the ACT community and surrounding southern area of New South Wales — a population of some 500,000 people. ACT Health is committed to the development of local, regional and national health policy, aimed at making our health system work better. ACT Health incorporates The Canberra Hospital, Calvary Health Care ACT, Community Health, Mental Health ACT, Population Health and central office. ACT Health employs over 4000 people in a wide range of occupations covering professional, scientific, technical, clinical, administrative areas and


patient support services. As an organization, ACT Health relies on attracting and supporting people who are willing to be part of an organization representing a set of values that allow for the provision of high quality health care. In return, ACT Health aims to provide a workplace environment that equips people to perform within a system that is complex and constantly evolving. This position offers the appointee the opportunity to contribute to the creation of an innovative nurse practitioner model of care within the ACT health system.

Communication

The nurse practitioner: • Possesses a high level of written and oral communication skills and negotiation,

conflict resolution and other interpersonal skills; • works in a collaborative partnership with other healthcare providers to ensure an

integrated approach to client/patient care across the continuum of care; • Actively and constructively participates on appropriate committees and shares

information with staff of all levels; • Facilitates mechanisms to ensure all staff are aware of the nurse practitioner’s role

and requirements; • Establishes and maintains excellent professional relationships within ACT Health,

relevant professional bodies and other groups; and • Provides written evaluation reports to all relevant stakeholders

Research and Teaching

The nurse practitioner: • Fosters a culture that supports research and innovation; • Possesses an ability to undertake and evaluate nursing research; • Operates computer systems and client databases utilising various software packages; • Plans, conducts and evaluates education sessions for individuals, client and

community groups and health professionals in a variety of settings; • Actively participates in quality improvement processes through the initiation, planning,

implementation and evaluation of programs; and • Conducts systematic reviews of clinical practice.

Professional Development

The nurse practitioner: • Contributes to the development of professional practice, including participation in and

promotion of quality improvement, evidence based practice and research; • Engages in continuing self-professional development to enhance knowledge and

clinical skills, including participation in development programs; • Engages in professional organisations and relevant practice committees; and Initiates,

develops and maintains clinical practice guidelines. Cultural and linguistic diversity

The nurse practitioner: • Respects and takes into account the rights of individuals from diverse cultural and

linguistic backgrounds and acts as an advocate for clients and groups. Workplace Principles

The Nurse Practitioner: • Consistently displays commitment to, compliance with and leadership in high quality

customer service, workplace diversity, occupational health and safety and industrial democracy principles, practices and relevant legislation relating to these areas, and an understanding of and commitment to the organization’s values.


Attachment 2 Duty Statement

Position details Local Title Nurse Practitioner Emergency Department Classification Registered Nurse Practitioner Level 4.2 Department/ Ward Emergency Department Position number(s) Type Fortnightly hours 76 Ins. No. 99/99 Cost Centre 1105

Reporting details Supervises RN Level 1 &2

clinical nurses Line responsibility /






Specific for this position, in priority order:

1. Provide a comprehensive emergency based nurse practitioner service in both outpatients and outreach venues, managing the clinical care for asymptomatic and symptomatic health complaints of patients in consultation with a medical practitioner or referring as required

2. Conduct outpatient physical assessment and take a medical history of patients attending the emergency department and record findings appropriately

3. Apply clinical knowledge and experience in the clinical assessment and investigation of patients

4. Order pathology and radiological investigations as appropriate is accordance with guidelines

5. Prescribing of appropriate pharmacological and non-pharmacological therapies in accordance with guidelines

6. Undertake review of investigative results 7. Liaise with members of the hospital and community health services multidisciplinary

team through a professional system of patient referral 8. Participate in clinical research, quality and safety management and improvement

initiatives and patient education activities 9. Develop, implement, review and revise emergency nurse practitioner clinical practice

guidelines and medication formulary, following the required processes outlined in (Nurse Practitioners in the ACT: The Framework (ACT Government:2005)

10. Display a high quality of customer service 11. Undertake professional development

Approved Service Director: Heather Austin Approved HR Department Mary-Ann O’Sullivan


Attachment 3 Scope of Practice Statement

Position details Local Title Nurse Practitioner Classification Registered Nurse Level 4.2 Department/ Ward Emergency Department Position number(s) Type Fortnightly hours 76 Ins. No. 99/99 Cost Centre 1105

Reporting details Supervises Line responsibility /






Emergency Nurse Practitioner Role

• A nurse practitioner is a Registered Nurse with advanced knowledge, skills and recognised clinical competence, authorized by the Nurses Registration Board of the ACT.

• A Nurse Practitioner practices within a professional role working autonomously, with the freedom to make decisions and act on those decisions, consistent with their specific scope of practice.

• The Emergency Nurse Practitioner should be a recognized specialist nurse in emergency care and have specific knowledge and education within the specialty, including; advanced life support, trauma and other specialty inputs required to perform the specifics of the role.

• The Nurse Practitioner’s knowledge should be supported by a Master of Nursing (Nurse Practitioner).

• The Nurse Practitioner should be published and be active in education of fellow nursing staff.

• The Nurse Practitioner displays a commitment to the professional development of both themselves and their departmental colleagues.

• The Nurse Practitioner provides acute health care services to the community within a framework guided by professional guideline of practice through assessment, diagnosis and management of health issues in a complex, busy and unpredictable environment.

Aim

• To provide appropriate timely care to those requiring episodic acute health care services by appropriate members of a multidisciplinary health professional team.

• Develop the advanced nursing practice role, working autonomously, within a scope of practice, with measurable quality outcomes.

Environment • The Emergency Nurse Practitioner works autonomously within the Emergency Department and within services providing acute health care.

• The Nurse Practitioner has the expertise to support referral to other health care professionals.

• Clinical consultation with persons seeking acute health care may be made autonomously and/or in collaboration with senior medical staff, primarily based in the Emergency Department.

• The Nurse Practitioner works within a multidisciplinary team inclusive of medical, nursing and allied health staff as well as other health care professionals.


• The Nurse practitioner works both as a colleague and in a consultant role with departmental nursing staff.

Formulary

• The Emergency Nurse Practitioner will work from a formulary based on medications required in the provision of episodic acute care. This formulary will be prescribed within a framework of clinical guidelines both specific to clinical practice within the Emergency Department and those established and accepted as best practice such as the therapeutic guidelines.

Process of Care

Assessment of Health Status • Triage • Resuscitation and Stabilisation • Obtains relevant health history • Performs an appropriate physical examination • Identifies health risks • Applies crisis intervention when indicated Diagnosis • Formulates appropriate differential diagnosis based on clinical findings • Identifies individual requirements to access health data from relevant persons • Identifies individual requirements to access health care services to support the

implementation of acute care Development of a Treatment Plan • Priorities are established and a mutually acceptable plan of care is devised to

maximise the health potential of the individual. This includes, though is not limited to:

Ordering appropriate diagnostic tests Prescribing appropriate pharmacological agents Assessing non-pharmacological interventions Analysis patient education opportunities Treatment plan is based on evidence based best practice

Implementation of Treatment Plan • Interventions are based upon priorities and clinical guidelines • Treatment is individual specific to the situation • Treatment is based on scientific principles, theoretical knowledge and clinical

expertise Intervention Actions • Within the acute setting, providing episodic health care Including though not

limited to: Accurately conducting and interpreting diagnostic tests Prescribing pharmacological agents Prescribing non-pharmacological therapies Making appropriate referrals to other health care professionals

and community agencies Providing relevant patient and/or family health

promotion/restoration education Follow Up • Follow up and evaluation of appropriate episodic acute health care issues • Referral for follow up appropriate community agency/LMO


Categories of Care

The Emergency Nurse Practitioner will provide acute episodic health care intervention and education for persons presenting to the Emergency Department. This will cover a broad spectrum of both age and condition. These presenting conditions may include, though not limited to: • Abdominal Pain • Chest Pain • Respiratory Complaints • Resuscitation • Limb Injuries

Strains Fractures

• Wound Management

Lacerations Abrasions Burns Ulcers Cellulitis

• ENT Complaints • Eye Complaints (With collaboration) • Pyrexia • Diabetic Emergencies • Foreign Body Removals • Sharps Injuries Acute Assessment • Envenomation • CBR/Environmental Emergencies • Urinary Symptoms • Sexual Health and STI Acute Care • Mental Health Acute Assessment and Referral

Role Evaluation

Regular Emergency Nurse Practitioner role effectiveness, appropriateness and productiveness will be assessed in conjunction with supervising personnel.

Acknowledgements

Jane O’Connell EDNP North Sydney Area Health Service NSW Greater Murray Area Health Service ACT Health: Nurse Practitioners in the Australian Capital Territory – The Framework

Documents

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