The Advanced Paediatric Nurse Practitioner in Community-based Ambulatory Care

1. The Advanced Paediatric Nurse Practitioner in Community-based Ambulatory Care Katie Jones, RSCN, RGN, BA (Hons), MSc Advanced Paediatric Nurse Practitioner Smithdown Clinical Lead Smithdown Children’s NHS Walk-in Centre

2. Context Smithdown Children’s NHS Walk-in Centre Assessment of children’s unplanned minor illness and injury Children and Young People 0-15 years of age Hours: 8am – 8pm and 10am – 4pm weekends/BH Total consultation April 2011 – 2012 = 19,942 Skill mix = APNP, PNPs, HCA’s Stand alone unit but Service Level Agreement with Alder Hey for ‘hotline’ access to Reg/Consultant level support Direct referrals to: A/E, ENT, burns/plastics, urology, orthopaedics and ambulatory clinic

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5. Smithdown Attendances versus Alder Hey A&E Attends (2007 – 2011)

6. Smithdown Attendances versus Alder Hey A&E Attends (2007 – 2011)

7. Skill Mix APNPs (4) MSc qualified in advanced ambulatory paediatric practice All prescribers PNPs (11) Bands 5, 6, and 7 (two have almost completed APNP programme; one started September 2012) Prescribers = 4 Have completed (or are awaiting the start of) Children’s minor illness/injury and advanced physical assessment module Have completed an in-house history-taking and physical exam skills training with an observation component, extended period of supervised practice and set of paediatric minor illness/injury competencies Training in x-ray request and interpretation in accordance with IRMER 2000 regulations HCAs (2) Trained in obtaining observations in children and young people Dressing changes and minor injuries management (under supervision) Stock checks, ordering and admin duties

8. APNP Role Assessment and diagnosis of unplanned paediatric illness and injury Senior clinical opinion for assessment, management and referral decisions across team Clinical policy formulation and dissemination Quality improvement to children’s clinical services through audit and research Teaching responsibilities: PNP and APNP Champion children’s health care across organisation Children’s representation on cross organisational workgroups (governance, medicines management, quality)

9. Successes APNPs manage a high volume and wide diversity of episodic illnesses in the only community-based paediatric illness/injury management centre in the UK SCWIC maximises the clinical capabilities of the APNP, including those related to health promotion, anticipatory guidance and patient/family education Early implementer APNPs lead a well-established training and mentoring programme for new APNPs and there is a significant track record of APNP practice (> 6 years) APNPs lead service delivery within the SCWIC team and there is a clear understanding of the APNP role within the team

10. Next Steps (?) Increased participation of APNPs in children’s service design and the commissioning process at LCH Improvement/expansion of services within LCH as the new Children’s Directorate becomes embedded Continuing the positive trajectory of high quality children’s unplanned care services

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