A day in the life of a senior ICT nurse
Last week, we told you about the role of the Intermediate Care team, and we spoke to John and Amy about the important work they do in helping people to stay out of hospital.
This week, we take a closer look at the work of the team. We spent a morning following Rachel, one of the Senior Sisters, while she carries out initial assessments visiting newly referred patients. The team receive referrals from a variety of places including GPs, the East Midlands Ambulance Service (EMAS), patients who have already been under the service and family members.
On average the team receive around 30 NEW referrals every day. Once a patient has been referred to the service, the nurses working within the single point of access will take the patient's details and use criteria to determine how quickly the patient needs to be seen. Depending on their clinical need, this can vary from under 2 hours, to under 4 hours or the following day. When a patient is referred into the team, they are assessed by a senior nurse, who will carry out a holistic assessment and determine the next course of action for the patient.
The nurse in charge of the Intermediate care team contact the nurses out on the ground, in this case Rachel, and give brief details of the patients that she needs to go out and assess for that day, Rachel is able to remotely log into the patient records so that she has as much information as possible about the patient before she arrives and during the visit.
As Rachel explains in the video, when she enters a patient's home, she is carrying out a thorough assessment, looking at the patient and also looking at their surroundings. She looks to see how well the patient is managing at home, whether they can move around safely and whether they are staying on top of daily activities. Sometimes a family member or carer will be able to provide additional information that helps Rachel and her team to form a picture of what is going on for that patient.
The first patient Rachel is due to see has been referred by his daughter following a fall. When Rachel arrives at the property, there is already a carer in attendance. Following her visit, she concludes that there are not any further actions for the ICT team to do for the patient, he already has some other forms of support in place. She makes a plan to follow up with the patient's daughter about his medication and then updates the notes on the system before travelling to the next location.
Rachel then travels to the next patient's home. The second patient has been referred to the ICT team by her GP. They were concerned that some levels in a recent blood test were not quite right, and asked the ICT team to visit and do some follow up blood tests.
Rachel arrives and starts the assessment by asking a few questions. She takes the patient's blood pressure, pulse and temperature, before then taking a repeat blood test. She asks the patient about any recent medication changes and enquires about her overall health.
The ICT team can often see the same patient for a few days in a row, carrying out observations to check for any noticeable changes over a short period of time. Rachel arranges a follow up appointment with this patient and takes the blood away to be processed at one of the two county hospitals. The results of the blood test can determine whether a patient is safe to stay at home, requires further monitoring or changes to medication, or whether a patient may need to go to hospital. The intermediate care team also have access to some point of care testing machines, where they can get some blood test results back within minutes, even within the patient's home. We have recently piloted these machines and hope to roll out the purchase of more machines soon.
Rachel continues to see patients for initial assessments throughout her day. Typically, a nurse will see between 3-8 patients a day for initial assessments depending on the length of the shift, the complexity of each case and the travel time between patients and the hospitals to ensure blood samples are processed. On average, 80% of the patients we see for initial assessments, will avoid a hospital admission because of the short-term support we can offer at home.
Watch this short video to see Rachel carrying our her initial assessments.