skill mix in clinics – how to improve everyone’s life. samantha bower nurse specialist –...
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Skill mix in clinics – Skill mix in clinics – how to improve everyone’s life.how to improve everyone’s life.
Samantha Bower
Nurse Specialist – Breast care
The Ipswich Hospital NHS Trust
IntroductionIntroduction
Everyone’s experiencesTraining and supervisionIntroducing changeProblems encounteredHas it made a difference?
Patients experiencesPatients experiences
Waiting times
Consultations
Information
Repeat clinic attendances
Doctors experiencesDoctors experiences
Overloaded clinics
Inappropriate referrals
Low conversion ratio
Nurses experienceNurses experience
Service improvement
Keen to expand practice
New challenge
Training and supervisionTraining and supervision
2 years in breast careUndertaken A11 courseAttended Radiation Protection study dayPerformed 100 clinical examination
supervised by consultant
Nurse Led Breast Clinics (1)Nurse Led Breast Clinics (1)
Breast pain
Family History
Recurrent cyst aspiration
Nurse Led Breast clinics (2)Nurse Led Breast clinics (2)
Consultants refer from GP lettersWeekly20 minute slotsSpR also in clinicConsultant coverLetters to GP read by consultant
Problems encounteredProblems encountered
Clinic space
Radiology
Agreeing protocols
Inappropriate referrals
D isch arg e
G ive n on -cyc lica lb reas t p a in lea fle t
D iscu ss b reas t aw aren ess
S u g g es t n on -s te ro id a lan ti- in flam m ato ry d ru g s
D iscu ss d ie ta ry fac to rsb ra su p p ort
sm ok in g
R eass u ran ce an dexp lan a tion g iven
N on cyc lica lb reas t p a in
D isch arg e
G ive c os toch on d rit islea fle t
D iscu ss b reas t aw aren ess
S u g g es t n on -s te ro id a lan ti-in flam m ato ry d ru g s
A d vise g en tle exerc ise
D iscu ss lifes tyle tod e te rm in e cau se
C os toch on d rit is
R e fe r to c lin ica l su p erviso r
L u m p p a lp ab le
C lin ica l exam in a tion
H is to ry
Clinical Guideline 5
Non-cyclical Breast Pain
Does it make a difference?Does it make a difference?
Patients experience
Doctors experience
Nurses experience
Waiting times 2001Waiting times 2001
0
20
40
60
80
100
120
140
160
180
July Aug Sept Oct Nov Dec
Urgent
Soon
Routine
Waiting times 2002Waiting times 2002
0
10
20
30
40
50
60
Urgent
Soon
Routine