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Discussion Forum: Tests and investigations, problems and solutions

Discussion Forum: Tests and investigations, problems and solutions. Kate Davies Clinical Nurse Specialist, Paediatric Endocrinology King’s College Hospital, London Pauline Musson Clinical Nurse Specialist, Paediatric Endocrinology Southampton University Hospital. Introduction.

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Discussion Forum: Tests and investigations, problems and solutions

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  1. Discussion Forum:Tests and investigations, problems and solutions Kate Davies Clinical Nurse Specialist, Paediatric Endocrinology King’s College Hospital, London Pauline Musson Clinical Nurse Specialist, Paediatric Endocrinology Southampton University Hospital

  2. Introduction • Clinical Competence • Communication • ITT BM v Lab glucose Issues regarding administration of Actrapid • Other issues in the workplace • Water deprivation tests – Why are they so problematic?

  3. Competence – Endocrine testing • RCN Competency Framework for Paediatric Endocrine Nurses (in print) • Care of children and young people with growth and endocrine disorders • Level 5 – Novice in speciality • Level 6 – Competent • Level 7 - Expert

  4. Competence – Endocrine testing • Level 5 • Assist senior nurse or medical practitioner in carrying out tests • KSF – HWB6 Level3 • Assess physiological and/or psychological functioning and develop, monitor and review related treatment plans

  5. Competence – Endocrine testing • Level 6 • Be able to explain rationale behind protocols for endocrine function tests • Have understanding of limitations of tests • Safely and competently carry out shorter tests with minimal supervision • Safely and competently carry our complex tests with supervision from senior nurse or experienced medical practitioner • Be able to identify results outside normal limits and liaise with medical personnel • KSF – HWB6 Level 3 - IK2 Level 2 - Gather, analyse and report a limited range of data and information

  6. Competence – Endocrine testing • Level 7 • Develop and update evidence based protocols for endocrine function tests • Provide advice on all aspects of endocrine tests at local and regional level • Carry out endocrine tests adhering to organisational policies and procedures • Initiate new tests where indicated and appropriate usage of standard operational procedures • Accept direct referrals from other consultants as agreed by local protocols • Supervise nursing and medical practitioners undertaking tests • Interpret results and act appropriately as indicated

  7. Competence – Endocrine testing • Level 7 • KSF – HWB6 Level 4 • Assess physiological and/or psychological functioning when there are complex and/or undifferentiated abnormalities, diseases and develop, monitor and review related treatment plans • KSF – IK2 Level 3 • Gather, analyse, interpret and present extensive and/or complex data and information

  8. Communication • Patient / family • NBM procedures • Medication beforehand • Lab • Urgent samples e.g.: Water Deprivation Test • Computerised labels • Ward

  9. Other issues….. • Environment & staffing • Medical training – shifts • 18 week pathway • Variations in protocols • How many tests does it take to make you competent? • Which tests should only be done in specialist centres?

  10. Insulin Tolerance Tests • UCLH research: • Glucometers failed to detect the high 19/21 (94%) prevalence of true hypoglycaemia at 20 minutes in 4/19 (21%) patients • Routine glucose rescue 20 minutes after insulin injection (regardless of BM) • Have since changed protocol for hypoglycaemia from 2.6mmol/L to 3.0mmol/L BSPED 2005 MR Nortier, K Babinska & HA Spoudeas

  11. More about ITT’s • Staffing • Administration of Actrapid • Who should do young adults/transition tests?

  12. Water deprivation tests • Why are they so problematic? • What issues are there? • How could we improve this?

  13. Lucy

  14. Extended test

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