Community Nurse In-reach Community Nurse In-reach (CNIR)(CNIR)

Providing safe & effective nursing Providing safe & effective nursing

discharges across the Hospital & discharges across the Hospital &

Community Interface.Community Interface.

BackgroundBackground

Experience of the Case finder Project (2003-Experience of the Case finder Project (2003-2004).2004).

Evidence of the Berkshire ‘High Tech’ Team.Evidence of the Berkshire ‘High Tech’ Team.

District Nursing Modernisation (2004-2006).District Nursing Modernisation (2004-2006).

CNIR team appointed Feb 2006.CNIR team appointed Feb 2006.

Two WTE DN Sister Band 6, One at the BCH Two WTE DN Sister Band 6, One at the BCH and one UHD.(2006)and one UHD.(2006)

Four WTE DN Sisters Band 6 and WTE Band7 Four WTE DN Sisters Band 6 and WTE Band7 Team Leader/Lead Nurse (2013)Team Leader/Lead Nurse (2013)

Team Aims:Team Aims:

• To prevent unnecessary admission to hospitalTo prevent unnecessary admission to hospital

• To facilitate early supported dischargeTo facilitate early supported discharge

Community Nurse In-reach Community Nurse In-reach (CNIR)(CNIR)

CNIR Roles to meet the CNIR Roles to meet the TargetsTargets

Case finderCase finder

FacilitatorFacilitator

Consultative/EducatorConsultative/Educator

AdvocacyAdvocacy

Case finderCase finder Patient selection is key to safe service Patient selection is key to safe service

provisionprovision

Attend daily bed meetingsAttend daily bed meetings

Hospital BasedHospital Based

Visible presence in A/E, AMAU, Outpatients and WardsVisible presence in A/E, AMAU, Outpatients and Wards

FacilitatorFacilitator Provides knowledge of and access to the Provides knowledge of and access to the

community service menu.community service menu. Acts Acts asas a conduit between hospital and a conduit between hospital and

community.community. Work in partnership to facilitate discharges Work in partnership to facilitate discharges

through a more structured, co-ordinated and through a more structured, co-ordinated and standardised approach.standardised approach.

Establishes good sustainable links between the Establishes good sustainable links between the primary and secondary care.primary and secondary care.

Identifies community alternatives and seeks Identifies community alternatives and seeks patient consentpatient consent

Consultative/ EducatorConsultative/ Educator Identify and advise on new development potential.Identify and advise on new development potential. Provides professional and clinical leadership in the Provides professional and clinical leadership in the

implementation of service development.implementation of service development. Identifies service development potential and associated Identifies service development potential and associated

training needs of community staff.training needs of community staff. Develop policies, guidelines and protocols to introduce new Develop policies, guidelines and protocols to introduce new

procedures or initiatives.procedures or initiatives. Carry out joint visits with District Nurses to support and Carry out joint visits with District Nurses to support and

supervise practice if required.supervise practice if required.

Advocacy

Promotes mutual understanding across primary and secondary interface.

Patient care is provided in an environment that is essentially their own, where they feel at ease with the potential for a faster recovery.

Family and carers are more involved in the care.

Reduces the risk of hospital acquired infections

Learning & DevelopmentLearning & Development

What has been achieved: Intravenous Therapy- OPHAT (Wards, O/P & A/E)Intravenous Therapy- OPHAT (Wards, O/P & A/E) Community Midline serviceCommunity Midline service Expediting delayed discharges- fast tracking Expediting delayed discharges- fast tracking

equipmentequipment Dehydration issues in Nursing HomesDehydration issues in Nursing Homes Increased number of complex palliative patients Increased number of complex palliative patients

now supported at Homenow supported at Home Enhanced early discharge Colorectal and Breast Enhanced early discharge Colorectal and Breast

Care patients Care patients Participating in Community Urgent Care PilotParticipating in Community Urgent Care Pilot

Measured OutcomesMeasured Outcomes Jan-Dec 2007 Referrals 777 Bed Days saved Jan-Dec 2007 Referrals 777 Bed Days saved

22932293

Jan-Dec 2008 Referrals 729 Bed Days saved 3473Jan-Dec 2008 Referrals 729 Bed Days saved 3473

Jan-Dec 2009 Referrals 1129 Bed Days saved 4822Jan-Dec 2009 Referrals 1129 Bed Days saved 4822

Jan-Dec2010 Referrals 1365 Bed Days saved 6195Jan-Dec2010 Referrals 1365 Bed Days saved 6195

Jan-Dec2011 Referrals 1342 bed days saved 7118Jan-Dec2011 Referrals 1342 bed days saved 7118

Jan-Dec2012 Referrals 1805 Bed Days saved 9512Jan-Dec2012 Referrals 1805 Bed Days saved 9512

Any Questions?Any Questions?