non-emergency patient transport (nept) escort … official use only guideline for official use only...

FOR OFFICIAL USE ONLY

GUIDELINE


Non-Emergency Patient Transport (NEPT) Escort Guideline

Document ID NEPT_003

Publication date July 2015

Summary This document outlines the minimum level of escort for patients being

transferred with Non-Emergency Patient Transport providers.

Policy Sponsor Jenny Van Cleef, State Manager, Non-Emergency Patient Transport

Application All Non-Emergency Patient Transport providers in the Greater Metropolitan

area, working in line with NSW Health NEPT Program.

Review date August, 2016

Jennifer Van Cleef

State Manager, Non-Emergency Patient Transport

HealthShare NSW

NEPT Escort Guideline Version: 1.1.1 of 18


Appendix A

NEPT Guideline Version: 1.1.1 of 18 FOR OFFICIAL USE ONLY


NEPT Guideline Version: 1.1.1 of 18

1. Purpose

This document outlines the minimum escort requirements for patients being transferred with Non-

Emergency Patient Transport providers, working in line with NSW Health NEPT Program. It will ensure safe

transfer of patients and that patient clinical requirements will be matched with an appropriately qualified

escort.

2. Scope

All non-emergency patient transport providers working in line with NSW Health NEPT Program, operating

as per the NEPT Service Specifications for Transport Providers1.

Non-emergency patient transport providers include:

• NSWAS NEPT fleet

• Local Health District NEPT fleets

• Applies to escorts supplied by the sending facility traveling in NEPT vehicles (non NEPT staff)

• Private transport companies

3. Guideline

There are 5 classes of transport that have been classified A – E. Classes B – D represent the group of

patients that will require transport with NEPT providers. See appendix A.

• Class A: NSW Ambulance emergency vehicle

• Class B: specialist RN/RM escort, to be provided by the sending facility.

• Class C: RN/RM or EN (without limitations on medication endorsement) escort.

• Class D: EN, AIN or PTO escort.

• Class E: No escort required.

Patients have been assessed by a Registered Nurse/Midwife or Medical Practitioner as having a low risk of

deterioration during transfer1. Patients must be “between the flags” prior to transfer unless altered criteria

documented, refer to local procedures.

All NEPT staff are responsible for obtaining a comprehensive handover and assessing patient’s suitability for

transfer with NEPT prior to accepting care of the patient.

Enrolled Nurses or Assistants in Nursing (AINs) working under indirect supervision must have access to a

designated Registered Nurse supervisor for both operational supervision and assistance with clinical

decision making2.

Registered and Enrolled Nurses/Midwives, AIN and Patient Transport Officers are responsible for ensuring

that they are not practising outside their scope of practice2.

All nursing staff must have a professional reporting line to another nurse identified.

http://www0.health.nsw.gov.au/policies/pd/2013/pdf/PD2013_049.pdf



3.1. Class B

The patient has an illness or injury that may require active treatment during transfer, and requires a level of

escort appropriate to the actual/potential clinical needs and ongoing continuity of care.

The nurse escort must be proficient in patient assessment skills and must have a current Basic Life Support

(BLS) accreditation. The nurse escort will also have additional skills or qualifications appropriate to the

actual or potential clinical needs of the patient. The escort nurse for a Class B patient transfer will be

supplied by the sending facility. (NB - there are a number of NEPT fleets that can provide an Advanced Life

Support (ALS) qualified Registered Nurse.)

Patient condition Escort Special considerations

Cardiac monitored RN RN must have ALS qualification and be proficient

in patient assessment skills and ECG

interpretation5

Obstetric patients Registered

Midwife

See section 3.4 Specialty Patient Transfers for

more information.

Neonate/humidicrib/Special Care

Nursery (SCN)

SCN or NICU nurse

Medium risk mental health

patient

Mental Health

escort(s)

+/- additional

security escort

See section 3.4 Specialty Patient Transfers for

more information.



3.2. Class C

The patient has an illness or injury that is unlikely to require active treatment during the transport, patient

monitoring is suitable; level of escort appropriate to actual/potential clinical needs en route has been

determined by a Registered Nurse or Medical Practitioner

The nurse escort must be proficient in patient assessment skills and must have a current BLS accreditation.

Patient condition Minimum escort Special considerations

Tracheostomy RN/RM Patient self-ventilating

Must not be transported with 72 hours of

tracheostomy insertion

Requires specialist equipment for transfer,

see appendix B.

Intra-thoracic drains (UWSD, ICC) RN/RM Drains must not be clamped unless

documentation by VMO or senior registrar.

Requires specialist equipment for transfer,

see appendix B.

PCA RN/RM Sedation score <1, respiratory rate >10

Infusion must have commenced prior to

transport

IV infusions via CVAD

(CVC, PICC, Hickmans, Portacath)

RN/RM Infusion must have commenced prior to

transport

IV Medication infusions e.g.

• Heparin infusion

• Insulin infusion

• Parvolex

• Iron (should not be first

dose)

RN/RM Infusion must have commenced prior to

transport

• Stable paediatric patients EN See section 3.4 Specialty Patient Transfers for

more information.

Patient transferring to/from

critical care units

RN/RM/EN Special consideration should be given to

patients transferring in or out of critical care

areas either for admission or after diagnostic

appointment. Thorough clinical assessment

should be undertaken prior to determining

level of nurse escort.



Patient condition Minimum escort level Special considerations

Patient transferring for specialty

care (to a nominated tertiary

referral facility)

RN/RM/EN Special consideration should be given to

patients transferring for speciality care or

increased level of care, which may be

provided at a tertiary referral facility.

Thorough clinical assessment should be

undertaken prior to determining level of nurse

escort.

IV therapy in progress via

peripheral IVC

EN Infusion must have commenced prior to

transport

Premixed potassium (KCL) solutions

EN Infusion must have commenced prior to transport

IV medication infusions e.g.

• antibiotics

EN Infusion must have commenced prior to

transport

Blood /blood products

transfusing

EN Transport must not occur within the first hour

of transfusion.

Blood products not being transfused must not

accompany patient.



escort.

Infusion must have commenced prior to

transport

Surgical drains

• Bellovac/surgivac

• JP drain

• Axiom drain

• VAC dressing

• nasogastric tube

EN

• Low risk mental health

patient

EEN See section 3.4 Specialty Patient Transfers for

more information.



escort.



Oxygen therapy in progress >

6LPM

EN

Parenteral narcotic or sedation

(aside from PCA)

RN < 15 mins

EN > 15 minutes



escort.

Vertebral fractures with brace

insitu

EN Thorough clinical assessment should be


escort.

Enteral feeding in progress

nasogastric/PEG tube

EN

3.3. Class D

The patient has an illness or injury that does not require active treatment and requires a level of escort

appropriate to actual/potential clinical needs en route, and has been assessed by a registered nurse or

medical practitioner as having a low risk of deterioration during transport.

Patient Condition Minimum level escort Special considerations

IDC or SPC PTO/AIN

Capped NG or PEG Tube PTO/AIN

Capped or “heparin locked” CVAD EN

Oxygen therapy 4-6 LPM EN

Oxygen therapy 1-4LMP PTO/AIN

Capped peripheral IVC AIN/PTO



3.4. Specialty patient transfers

All specialty patients requiring non-emergency patient transport must have a comprehensive assessment

undertaken by an appropriate clinician to determine that the patient is at low risk of deterioration during

transportation.

Mental Health/Drug and Alcohol (MHDA) transfers

MHDA patients must be assessed by a Mental Health Clinician at the sending facility3. Transport

arrangements and escort level will depend on the outcome of the assessment. In the case that the sending

facility has no Mental Health Clinicians, level of escort should be determined by the sending Medical

Officer.

Patients deemed as high risk are out of the scope of NEPT. Medium risk patients will require Mental Health

Escort, and may also require an additional security escort.

Mental Health Escorts are staff who accompany the patient during transfer to provide specialist heath care

to minimise patient distress and/or provide management strategies for responding to patient agitation

during transport. This could include nursing staff, HASA/PSA or hospital Security Officers. These escorts will

be supplied by the sending facility.



Level of risk Transport class Transport options

High risk patient

• Requires Mechanical Restraint Device (MRD) or

any other restraint

• IV sedation

• Serious risk of physical harm self or others

• Uncooperative

• Sedation not clinically appropriate or oral

sedation given with minimal effect

• Physical or verbal aggression

Class A

Out of scope of NEPT

NSW Ambulance

May also require

Mental Health

Escort.

Medium risk patient

• Involuntary patient

• Some agitation or restlessness

• Some bizarre or disorganise behaviour

• Confused

• Withdrawn or uncommunicative

• Medium risk of physical harm to self or others

• Oral sedation administered

Class B NEPT provider

Mental Health

escort.

Low risk patient

• Voluntary patient

• Low risk of danger to self or others

• No acute distress

• Uncomplicated physiological state

• Cooperative, communicative, amendable to

instruction

• No reported suicidal ideation

• No oral sedation administered

Class C NEPT provider with

RN/EN escort.



Obstetric Patients

Obstetric patients must be assessed by a Registered Midwife or obstetric Medical Practitioner prior to

transfer.

Condition Transport class Transport options

• Eclampsia/preeclampsia

• Antepartum haemorrhage with

haemodynamic compromise

• Established labour

• Antepartum haemorrhage with

ongoing bleeding, with/without

haemodynamic compromise

Class A

Out of scope of NEPT

NSW Ambulance

• Threatened premature labour

• Antepartum haemorrhage not

haemodynamically compromised

• Early labour; cervix 1-4cm

Class B NEPT provider

Registered Midwife escort

• Not in established labour,

membranes intact

• Return to local hospital post

antenatal stabilisation

• Referral to appropriate facility for

anticipated complications

Class C NEPT provider with RN/EN escort

Paediatric Patients

Stable paediatric patients are considered within the scope of NEPT provided they have been assessed as

being at low risk of deterioration during transfer.

All patients under the age of 16 must be escorted by a Registered Nurse/Midwife, Enrolled Nurse and/or

parent/guardian. Parents and carers should be offered the option of travelling with their child8. Special

consideration should be given to child protection cases.

The correct child restraints must be available prior to undertaking the transfer7, see appendix C.



Condition Transport class Transport options

• IV therapy including IV

medications

• Nebulised therapy

• Oxygen therapy

• PCA

• Suctioning

• History of seizures, no seizures

within 1 hour of transfer

Class C NEPT provider with RN/EN escort

• Single fracture or suspected

fracture that has been

stabilised

• Pain well controlled, not within

1 hour of analgesia being

administered

Class D NEPT provider with PTO/EN escort

If no nurse escort, must have parent or

guardian escort

Single patient only transfers

Some patient conditions require transfers to be undertaken with only one patient under the care of the

escort at one time. Such conditions include:

Class B patients

• Humidicrib transfers (it is acceptable to transfer twins simultaneously)

• Cardiac monitored or cardiac infusions, direct visual observation must be maintained by the escort5

• Mental health patients

• Obstetric patients

• Acute spinal injury

Class C patients

• Intra thoracic drains

• Tracheostomy requiring frequent suctioning

• Mental health patients

• Severe dementia, confusion or agitation

• Stable, asymptomatic cardiac patients being transported to a diagnostic procedure e.g. angiogram



4. Responsibilities

4.1. Wards/Units booking NEPT

• NEPT bookings will contain the necessary clinical information in order to match patients with the correct escort level.

• Patient must be assessed by a Registered Nurse or Medical Practitioner as being low risk of deterioration1.

• Ensure patient is wearing appropriate identification bands as per local Patient Identification procedures.

• Acceptance at destination is confirmed.

• Discharge paperwork and medications are ready, if applicable.

• Staff will provide clinical handover to NEPT crew.

4.2. Booking Hub

• GMBH Dispatcher with relevant experience will match patient conditions to escort levels as prescribed above.

4.3. Transport crew

• Receive clinical handover appropriate to their scope of practice before undertaking the transfer.

Document occurrence of clinical handover according to local procedures.

• Registered Nurses and Enrolled Nurses should perform a patient assessment to ensure patient is

“Between the Flags” prior to transfer6 and within their scope of practice to escort.

• Verify correct patient using at least 3 patient identifiers. Acceptable patient identifiers include

patient name, gender, date of birth, medical record number or address4.

• Ensure that any specialist equipment required for transfer is ready, including adequate oxygen if

applicable.

• During the transfer, patient(s) must be monitored at all times by direct line of sight, regular verbal

communication or by positioning of mirrors.

• Respond to any clinical deterioration with their scope of practice and follow local clinical escalation

procedures6.

4.4. NEPT provider

• NEPT providers will ensure that staff are appropriately skilled in order to be able to manage patient

conditions as outlined in this document. This may include but is not limited to:

o annual renewing of mandatory training

o completion of a learning package

o practical competency assessment

o attendance at a face-to-face study day

o eLearning course



• NEPT providers will ensure that Enrolled Nurses working under indirect supervision will have access

to a designated Registered Nurse supervisor for operational supervision and assistance with clinical

decision making. It should be clear who the designated Registered Nurse is both during hours and

after hours.

• NEPT providers will ensure that all nursing staff have an identified professional reporting line to

another nurse.

• Vehicles should also be configured to match the patient requirements as prescribed in Service

Specifications.

5. Definitions

NSW Health NEPT

Program

The NEPT program provides a centralised booking and dispatching service for

patients who require non urgent transport.

GMBH Greater Metropolitan Booking Hub, located at Parramatta, from which the

booking and dispatching functions operate.

NEPT provider Non-emergency patient transport provider which could include:

• ASNSW NEPT fleet

• Local Health District NEPT fleets

• Private transport companies

NEPT providers have either ambulance style vehicles and/or cars, staffed with

Drivers, PTOs and nursing staff.

NSWA NSW Ambulance

Escort NSW Health staff member accompanying a patient to ensure a clinically safe transfer

occurs

• Registered Nurse (RN)

• Registered Midwife (RM)

• Enrolled Nurse with appropriate training and notation of registration that is

board approved units of study for medication administration (EN)

• Assistant in nursing (AIN)

• Patient Transport Officer (PTO)

• Personal Service Assistant (PSA)

• Hotel services and security assistant (HASA)

SCN • Special care nursery



NICU • Neonatal intensive care unit

Intra thoracic drains • intercostal catheter (ICC)

• underwater sealed drain (UWSD)

CVAD Central venous access device

• Peripherally inserted central catheter (PICC)

• Central venous catheter (CVC)

• Capped or “heparin locked” CVAD are CVAD not currently being used to

administer IV therapy of any kind.

PCA Patient Controlled Analgesia

IV therapy Intravenous therapy

• Intravenous catheter (IVC)

LMP Litres per minute

Medical

attachments

Nasogastric tube (NGT)

Percutaneous endoscopic gastrostomy tube (PEG)

Indwelling catheter (IDC)

Supra-pubic catheter (SPC)

MHDA Mental Health Drug Alcohol

Mental Health

Escort

Staff who accompany the patient during transfer to provide specialist heath care

to minimise patient distress and/or provide management strategies for

responding to patient agitation during transport. This could include nursing staff,

HASA/PSA or hospital Security Officers.

Clinical handover The transfer of professional responsibility and accountability from some or all

aspects of care for a patient to another person or professional group on a

temporary or permanent basis.

Between the flags A program that supports clinical staff to better recognise and manage patients

who are clinically deteriorating.

A patient is “between the flags” when their observations are not in either the red

or yellow zone on the appropriate NSW Health observation chart.

Operational

supervision

Supervision by the Registered Nurse to the Enrolled Nurse in the clinical setting.

This can be indirect. Enrolled nurses require support on a day to day basis to make

decision on determining whether delegated activities are within their scope of

practice2.



Professional NEPT providers will ensure that all nursing staff have an identified professional

Supervision reporting line to another nurse.



6. Related documents

1. HealthShare NSW (2014) Service Specifications for Transport Providers NEPT PD2014_013 2. Australian Nursing & Midwifery Council (2002) Delegation and Supervision for Nurses and

Midwives 3. NSLHD (2013) Transport (inter-hospital) of Mental Health Consumers – MHDA PR2009_094 4. NSLHD (2013) Patient Identification Procedure NSLHD PO2011_301 5. NSW Health (2008) Cardiac Monitoring in Adult Cardiac Patient in Public Hospitals in NSW

PD2008_055 6. NSW Health (2013) Recognition and Management of Patients who are Clinically Deteriorating

PD2013_049 7. Transport for NSW Child Car Seats

http://roadsafety.transport.nsw.gov.au/stayingsafe/children/childcarseats/ (accessed 29/9/14) 8. NSW Health (2010) Children and Adolescents – Inter-Facility Transfer PD2010_031

7. Version history

Version Issued Author Reason for Change

1.00

October

2014

Jennifer Esson

Clinical Nurse Educator,

NSLHD

Initial Document

1.1.0

May 2015

Jennifer Esson


NSLHD

Feedback from State Directors of Nursing

1.1.1

June 2015

Jennifer Esson


NSLHD

Feedback from NSW Nurses Association and

Health Services Union.

http://roadsafety.transport.nsw.gov.au/stayingsafe/children/childcarseats/



Appendix B – specialist equipment for transfer

Patient condition Equipment required

Tracheostomy • Transport Tracheostomy kit o Tracheal dilators, Sterile gauze, 10 ml syringe

o Y Suction catheters 12g

o HME filters, lubricant sachets

o Normal saline ampoules, white tapes • Closed suction equipment

• Spare tracheostomy tube smaller than insitu

• Spare inner cannula

• Tracheostomy nebuliser mask

Intra-thoracic drains • Bottle of sterile water

• Set of (two) toothless clamps




Appendix C-child restraints

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