Transcript Intensive Home Treatment Team

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:
• 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)
30
28
Of 28 DSH/Suicidal, 10(36%) involved alcohol consumption
25
20
15
10
5
5
1
1
1
1
CONFUSION
PSYCHOSIS
PSYCHOSOMATIC ABDO
PAIN
BURNS
0
DSH/SUICUIDAL
ALCOHOL
RELATED
PROBLEMS
Alcohol or Substance Misuse involved (N=37)
17, 46%
20, 54%
YES
NO
Violence Involved (n=37)
4, 11%
33, 89%
YES
NO
Periods of Time Presenting (N=37)
9
8
8
8
7
7
6
6
5
5
4
3
3
2
1
0
00:01-04:00
04:01-08:00
08:01-12:00
12:01-1600
16:01-20:00
20:01-00:00
24
/1
2/
20
08
25
/1
2/
20
08
26
/1
2/
20
08
27
/1
2/
20
08
28
/1
2/
20
08
29
/1
2/
20
08
30
/1
2/
20
08
31
/1
2/
20
08
01
/0
1/
20
09
02
/0
1/
20
09
03
/0
1/
20
09
04
/0
1/
20
09
05
/0
1/
20
09
Referrals per Day
12
11
10
8
8
6
4
3
1
0
3
3
2
2
2
2
1
1
0
0
Outcomes from A&E (N=37)
(11 were identified for psychiatric follow-up)
1, 3%
1, 3%
13, 35%
20, 54%
2, 5%
ADMITTED GENERAL
SENT HOME
UNKNOWN
ADMITTED PSYCHS
AMA
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?