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Reflections on Models Developed Over the Festive Period. Lorraine Robertson Clinical Nurse Manager NHS Forth Valley. Purpose of RMN Input Within A&E. Overall Purpose of Input:
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Reflections on Models Developed Over the Festive Period Lorraine RobertsonClinical Nurse ManagerNHS Forth Valley
Purpose of RMN Input Within A&E Overall Purpose of Input: • Support A&E staff during their busy period by providing assistance to individuals who present with mental health problems. • Advise and support A&E staff in capacity as RMN. • Consider and advise appropriate use of on-call junior psychiatric doctor. • Carry out duties with professional responsibility and accountability. • Utilise basic nursing skills to assist A&E staff. • Assist in clinical decision making. • Complete data sheet for audit purposes. • Advise and signpost to community supports where appropriate.
Activity/Statistics Input commenced 24/12/08 at 5pm - not all shifts covered. • Possible 28 shifts to be covered. • 23 shifts had RMN input. • Out of 23 shifts with input, 5 shifts had no referrals for RMN input. • 18 shifts gained some benefit from RMN. • From 18 shifts where RMN staff asked to get involved, there were 37 contacts.
Main Presenting Problems (N=37) Of 28 DSH/Suicidal, 10(36%) involved alcohol consumption
Outcomes from A&E (N=37)(11 were identified for psychiatric follow-up)
Lessons Learned • Specific job description - job requires an enhanced level of skills and knowledge to support decision-making. • Communication could have been improved. • There was limited awareness from both sides, with some resistance from A&E staff. There was some reluctance from RMNs to assist in basic nursing care. • Majority of referrals had alcohol and drug intake therefore need to identify what exactly is required – psychiatric alcohol liaison nurse, substance misuse. • ?Train A&E staff to deal with alcohol and drug misuse (or is it referral pathways and appropriate signposting?). • Clinical supervision would require to be addressed if RMNs attached to A&E. • Busy periods fluctuated. • Should RMN be in A&E or attached to in-patient psychiatric ward.
Key Question Do we really need RMN staff within A&E or should A&E staff be provided with enhanced knowledge of mental health issues/illness?