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The Medical Investigations Unit (MIU) ‘Leading the Way in Nurse Led Services’

The Medical Investigations Unit (MIU) ‘Leading the Way in Nurse Led Services’. Geoffrey Walker OBE JP MA RGN PgDip DipEd FAETC Matron for Cardiology, Medicine, Specialist Medicine, and Specialist Nursing Services Poole Hospital NHS Foundation Trust

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The Medical Investigations Unit (MIU) ‘Leading the Way in Nurse Led Services’

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  1. The Medical Investigations Unit(MIU)‘Leading the Way in Nurse Led Services’ Geoffrey Walker OBE JP MA RGN PgDip DipEd FAETC Matron for Cardiology, Medicine, Specialist Medicine, and Specialist Nursing Services Poole Hospital NHS Foundation Trust British Journal of Nursing UK Nurse of the Year 2013

  2. Quote “While the intellectual foot has made a step in advance, the practical foot has remained behind.” Florence Nightingale 1820 - 1910

  3. My Vision To provide a gold standard patient focused service ,that is Nurse Led, a direct alternative to Inpatient care and challenges accepted practice.

  4. The Primary Function of The MIU is as an Enabler To avoid inpatient stays by providing an out patient alternative to care. To facilitate early discharge by pathway changes. To prevent elective medical admission cancellations by commencing treatment before the inpatient bed is ready. To manage the Trust’s discharge facility to free up acute beds earlier. To support day case treatments and diagnostics which previously may have required an inpatient stay, as well as challenge and change previously accepted practise for admission.

  5. Keys to success • The Unit is Nurse led, by highly skilled and able nurses with advanced practice qualifications. • The service embraces the MDT approach to care and is supported by the medical teams. • The service is able to respond to individual patient treatments and requirements as needed. • The service is seamless. • The service is menu driven. • The service can respond to urgent as well as routine booked requests. • The service is gold standard with patient satisfaction and experience placed high on the list of priorities.

  6. Service Impact • 2009 – 30 patients per week 5 Day Service 8 hours per day. • 2010 = Phase 1 50/60 patient per week, 7 day service. • 2010 = Phase 2 100/110 patient per week. • 2011 = facilitated the reduction of medical inpatient beds and 135 patients per week • 2012 = 150 patients per week and supported the opening of a similar unit at RBH. • 2013 = extended the footprint by 50% 180/ 200 patients per week and incorporated the Trust Discharge Lounge within, • 2014 = Looking at new areas to develop with Gynaecology and Alcohol Detox. Monday – Friday 12 hours per day/ Saturday and Sunday 8 hours per day 33% reduction in inpatient medical beds with improved quality and pathways.

  7. Quality Impact • Advanced practise nurse led service. • PICC insertion clinics and outreach ability. • 600 + blood transfusions (including one of the first in England to have nurses prescribing blood routinely). • Biopsy’s approx. 288 per year. • Bone marrow aspirations approx. 384 per year. • Drug therapy including IV antibiotics. • Pantemadine nebuliser clinics. • Same day admission for pacemaker patients. • Elective admission service. • Heart failure Service. • Low infection risk. • CF pathway support. • Cardioversion service.

  8. Challenges and Issues • Recognition of the need to,’ spend to save’, and support at Trust Board Level. • Medical Staff engagement. • MDT involvement. • Training Packages. • Client group (Who is eligible and who is not). • Funding. • Recruitment. Cultural (Changing the patients expectations).

  9. How to begin a Service • Look for a Need that is Patient Focused. • Create a Vision. • Develop the Concept. • Be Entrepreneurial. • Prepare a Business Plan (Use Finance and Managerial Support). • Don’t be Risk Averse. • Self Belief, Trust yourself, You’re the Expert!

  10. Never Stand Still Look for new service opportunities • Identify a suitable service. • Hyperemesis Gravidarum (Gynaecology). • 72 Patients in 2013 required hydration= 126 inpatient days. • 4-6 hours IV therapy, and daily check of bloods etc. (Ideal for MIU) ! • Cost £ 250 per bed day . (Saving £31.500 - Nursing time 0.2 band 5 WTE = £6.200 Saving £25.300). • More importantly better quality of service to patients who can go home to their families.

  11. Most Importantly Sell your Vision Market you Concept Publicise your Service

  12. Quote “ For us who nurse, our nursing is a thing, which, unless we are making progress every year, every month, every week, take my word for it, we are going back” Florence Nightingale 1820 - 1910

  13. Quote “I attribute my success to this - I never gave or took any excuse. Florence Nightingale 1820 - 1910

  14. Poem ‘The Man in the Glass’.

  15. Thank You Questions?

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