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urse staffing

embers of the RCN Critical Care Forum haveome together with BACCN and CC3N to look atritical Care Nurse staffing issues. There haveeen many changes in the Critical Care workforceince our staffing document was published in 2003http://www.rcn.org.uk) and now is the time topdate this work and to influence policy at theighest level. The advent of Advanced and Assis-ant Critical Care Practitioners together with theuropean Working Time Directive will have a hugempact on the way junior doctors and nurses in crit-cal care work and we need to be ready for thehallenges that lie ahead. The first meeting waseld in Birmingham in June and the second in Octo-er. The group are hoping to formulate a staffingtandard which will have the backing of the DOHnd the ICS.

ritical Care Technologist, Advancedurse Practitioner and Assistant Nurseractitioner

group has been set up by the Department ofealth as a subgroup of the Critical Care Stake-older Forum (CCSF) looking at the critical careorkforce and their remit is to investigate new and

eveloping roles, enhanced roles and new ways oforking across the whole of the multi-disciplinary

eam. The documents which were developed look atframework for the Assistant and Advanced Critical

964-3397/$ — see front matteroi:10.1016/j.iccn.2007.09.002

are Practitioner roles and will be funded by Skillsor Health.

are of the acutely ill patient on theard

he NICE clinical guideline was published on 25thuly 2007, followed by an editorial in the BMJ onth August. NICE have also developed an implemen-ation tool kit which is available to all Trusts to helpnd advise them in introducing this guidance.

Competencies have also been developed to sup-ort the implementation of the guidance. Thelinical guideline has been developed by an expertroup and they have concentrated on adults incute hospital settings but have excluded children,atients receiving palliative care and patients inritical Care locations under the care of Criti-al Care consultants. NICE have developed clinicalanagement and service delivery strategies that

ave focused on

. Identification of patients whose clinical con-dition is deteriorating; assessment of scoringtools and frequency of monitoring needed,the recording and interpretation of the dataobtained.

. Response strategies; identifying the appro-

priate interventions and the timing of theresponse, patient assessment, communicationand escalation of findings to relevant healthcareprofessionals.

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3. Discharge of patients from ICU; monitoringrequirements on the ward, timing of trans-fer, communication in the first 48 h which canenhance survival and recovery.

Progress of ‘payment by results’

A meeting of the Critical Care Information AdvisoryGroup (CCIAG) took place in the summer to dis-cuss the Critical Care Minimum Dataset (CCMDS) andpayment by results (PbR). More consultation will betaking place regarding the inclusion of specialityservices such as burns, hepatology and obstetricsinto or alongside CCMDS. Human Resource Groups(HRG’s) will now not be introduced into CriticalCare until 2009/10 when it is hoped more claritywill be evident in the calculation of the tariffs.In the interim, some Networks are being askedto be pilot sites and using their data, it is hopedthat a realistic tariff will be produced. A workinggroup will be set up, but no date has yet beenset for publication of recommendations. There maybe a collapsing of certain HRG’s to incorporatebasic respiratory and basic cardiovascular failureas these represent two-organ failure at presentand this makes the tariffs too sensitive. They willbe combined to form one-organ failure and it ishoped that the classification of organ failures willbe changed by the end of July. The audit com-mission propose putting together a questionnaireto send to all trusts asking them about completionof CCMDS, whether they are members of IntensiveCare National Audit and Research Centre (ICNARC),the number of funded and configuration of beds andhow data is collected.

RCN Critical Care Forum—–Welsh update

The Critical Care Networks have finally arrived inWales. There will be three of these; North Wales,Mid & West Wales and South East Wales. The Chairsand Clinical Leads have been appointed and we arejust awaiting the appointment of the Network Man-ager for Mid & West Wales. It will be interesting tosee how these develop and I will keep you updatedwith news as the Networks evolve.

The Welsh Critical Care Improvement Programme(WCCIP) is beginning the 2nd year of their projectand having successfully facilitated the implemen-tation of the Central Line Care Bundle and the

Ventilator Care Bundle, they are now moving for-ward with the Sepsis Care Bundle. It is hoped thatall critical care units in Wales will sign up to theSurviving Sepsis Campaign.

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News

South East Wales have developed a network forenior nurses who meet every 2 months to discussevelopments and share experiences within criticalare. The Network is exploring avenues for the jointraining of Advanced Health Care Support Work-rs at Band 3 level and the development of Band(HCSW’s or Assistant Practitioners). We eagerly

wait news of the issues of regulation and account-bility regarding unqualified staff within Wales andill update you when news is received.If you are currently employed within Wales and

ould like to share some relevant information thenlease contact me and I will ensure it is circulated:emma.ellis@cardiffandvale.wales.nhs.uk

ritical Care update from thendependent Sector

he challenge to deliver excellence in critical care,mproving and developing our service to customersn a climate of financial constraint is often difficult.he independent sector, like our NHS colleagues

s always looking at new ways of working to meethe challenge. At BUPA Hospitals we are develop-ng honorary contracts with local Teaching Hospitalrusts to enable our ITU staff to spend time workingn the Trust.

This benefits both the NHS and our staff. Weave the opportunity to update and extend practicehrough nursing ITU patients with different, some-imes more complex problems. This in turn benefitsur patients, as nurses develop their knowledge andkill, which enhances the service. The NHS benefitsy having experienced ITU Staff with no associatedosts and they too learn from our staff.

Like many we are updating and reviewing ourransfer policies, working in collaboration withocal critical care networks. Some key issues areocumentation, communication and the compe-ency of staff escorting on transfer.

This work brings opportunities to work withHS colleagues in closer collaboration developinggreed ways of working.

We are currently implementing a revised Earlyarning System to optimise early identification andffective management of changes in patient’s vitaligns. This provides an improved system for staffnd better outcomes for patients also.

If anyone working in the independent sectors interested in being more active or involved in

he forum’s work, you could consider becoming

link member. RCN Direct can offer more infor-ation about joining the forum. COVELLB@BUPA.

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oyal College of Nursing Critical Care Forumnews a

pdate from Critical Care Stakeholdersorum

Pharmacists—–have recently seen lots of NPSAalerts including many around issues associatedwith making up drugs in syringes. Ready madesyringes are the answer but would increase thepharmacy work load. National guidance is beingproduced on injectable drugs. There is workongoing around standardising syringe concentra-tions across the UK. The pharmacists group hasdeveloped guidance on delirium and are now

reviewing drugs used for hypertension and CRRT.The patient involvement lead reported they areworking on a website for relatives and patientsand the I-CAN website is up and running.

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Available online at www.

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Neurosciences—–Junior Minister, Rosie Wintertonhas set up a task force to investigate organdonation rates which have reduced in the UK.Alongside this we have the highest refusal rates inEurope. The group is looking at ways of address-ing this issue.Critical care networks are changing. Some aremerging as they get their funding from varioussources and all SHA’s (except London and southwest) are continuing to support networks.

ates for your diary 2008

2nd May RCN CCF Steering Committee meeting3th—14th June Forum conference, RCN Headquarters1th September RCN CCF Steering Committee meetingth November Link Member’s Day, RCN Headquarters

sciencedirect.com