This issues relating to ambulance handovers and turn around delays are not new, they have been in existance for about fourteen years.
Individual acute trusts and ambulance trusts have come up with novel ways of managing delays in offloading patients; some of these involve the use of designated RNs to supervise patients waiting to entre EDs, even the deployment of inflatable 'major incident'.
tents to temporarily house patients waiting to access ED with non critical patients supervised by ambulance technicians.
The overiding solution to the delays lies not with the ED but rather with the hospital and its ability to facilitate patient discharges and have capacity and manpower to accommodate - almost always the cause of ED overload.
I need to read the full leglislative changes but at first glance this is most welcome.
Independent prescribers have been excluded from providing intra-nasal diamorphine for children with painful extremity injuries, the most appropiate route of administration and evidenced as best practice. Instead independent prescribers have needed to obtain intra-venous access in order to provide initial adequate analgesia to this vulnerable. group.
I really hope that the legislative changes incorporate this important aspect of patient care.
Minor Injury Units offer the ideal place for short alcohol interventions, whilst the study specifically looked at urban MIUs I can see no real reason why the number of drink related injuries should be different in rural MIUs.
Emergency nurses are very familiar and competent with managing alcohol related injuries both in the acute phase and those with delayed presentations.
The use of short 'alcohol interventions' in EDs is well established - this should be very easily transferable to the MIU environment.
Emergency Nurse Practitioners in MIUs should be providing comparable services (with comparable outcomes)to EDs for 'non-life threat' patients.
This is encouraging news for Scotland, however, it does not define the ENP role (something the NMC has still not addressed). Most important though is, at what level are these nurses functioning at, and what impact are they making on clinical care and waiting times? Ideally they should be managing at least 96% of their patients as 'completed episodes' in the MIU setting with a similar percentage in EDs.
Effective use of ENPs in EDs can result in the majority of ambulatory patients being successfully managed with the same 'outcomes' as other staff groups.
A study of Welsh ED and MIU services should show a similar increase. The above questions need to be asked across the UK.
I see no reason that the administration of naloxone should not be witheld from individuals who have OD'd on heroin - it must be comparable to the use of an epi-pen for use in patients with acute anaphylaxis.
For prison staff who are concerned about its use - would a pgd be applicable?
Surely to withold its administration would be negligent.
Somerset Community Health