Implementing a Patient Assessment Framework in Acute Care

Lees L, Hughes T (2009) Implementing a patient assessment framework in acute care. Nursing Standard . 24, 3, 35-43. Date of acceptance: June 26 2009. College of Physicians 2007). The acute emergency assessment area was merged with the inpatient medical admissions ward and renamed the acute medicine unit (AMU). The new AMU comprises 27 patient-assessment cubicles , ten beds for patients requiring a short stay in acute medicine and ten chest pain assessment beds. A level 1 area has been created for patients at risk of their condition deteriora ting, or who are in need of higher levels of care, for example patients with sepsis, chest pain and cardiac failure (Department of Health (DH) and NHS Modernisati on Agency 2003, National Institute for Health and Clinical Excellence (NICE) 2007, Higgins et al 2008). Acute medicine units An AMU is a specialist area in a hospital that assesses and co-ordinates a high volume of acute medical patient referrals from GPs and the emergency department (Royal College of Physicians 2007). AMUs are staffed by acute physicians, junior doctors, experienced nursing staff and other members of the multidisciplinary team, for example physiotherapists, occupational therapists, speech and language therapists and pharmacists. The length of inpatient stay on an AMU is usually up to 48 hours, after which patients are transferred to appropriate wards or discharged home (DH 2004, Royal College of Physicians 2004). Purpose of the secondment In December 2007, an acute medical c onsultant from the AMU recognised that there was a need for additional clinical expertise among the acute medicine nurses given the increased acuity of the patients (Ryan et al 2008). Early in the develo pment of the AMU, the consultant real ised Implementing a patient assessment framework in acute care september 23 :: vol 24 no 3 :: 2009 35 NURSING STANDARD THE DIRECTORATE OF ACUTE MEDICINE at the Heart of England NHS Foundation Trust, Birmingham, underwe nt significant transformatio n during 2007. This followed a new strategy to manage acute medical patients requiring assessment and admission (Royal Summary This article describes the secondment of a critical care practitioner to an acute medicine unit. The aim was to develop the acute assessment skills of the unit’s nurses and to implement a new assessment framework . The secondment took place over four months from December 2007 to March 2008 at the Heart of England NHS Foundation T rust, Birmingham. There were sever al stages to the project, commencing with exploration of existing practice and culminating with evaluation of the project’s effect on practice. A review of the multi-professional patient records was conducted six months after the conclusion of the secondment. This revealed that the assessment framework continued to be used in practice. The secondment demonstrated that supporting nurses to embrace new skills resulted in a change in practice. However, a permanent change cannot be assured unless practice is revisited and supported on a continual basis. Authors Liz Lees, consultant nurse, acute medicine, and T ara Hughes, critical care outreach practitioner, Heart of England NHS Foundation Trust, Heartlands Hospital, Birmingham. Email: [email protected] Keywords Change management, intensive care, nursing: education, patient assessment These key words are based on the subject headings from the British Nursing Index. This article has been subject to double-blind review . For author and research article guidelines visit the Nursing Standard home page at nursingstandard.rcnpublishing.co.uk . For related articles visit our online archive and search using the keywords. If you would like to contribute to the art and science section contact: Gwen Clarke, art and science editor, Nursing Standard, The Heights, 59-65 Lowlands Road, Harrow-on-the-Hill, Middlesex HA1 3AW. email: [email protected] .uk

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Implementing a Patient Assessment Framework in Acute Care