Service

RNs use a variety of thinking strategies and the best available evidence in making decisions and providing safe, quality nursing practice within person-centred and evidence-based frameworks

1.2 develops practice through reflection on experiences, knowledge, actions, feelings and beliefs to identify how these shape practice

1.3 respects all cultures and experiences, which includes responding to the role of family and community that underpin the health of Aboriginal and Torres Strait Islander peoples and people of other cultures

1.4 complies with legislation, regulations, policies, guidelines and other standards or requirements relevant to the context of practice when making decisions

1.5 uses ethical frameworks when making decisions

1.6 maintains accurate, comprehensive and timely documentation of assessments, planning, decision-making, actions and evaluations, and

1.7 contributes to quality improvement and relevant research.

1.2 develops practice through reflection on experiences, knowledge, actions, feelings and beliefs to identify how these shape practice

1.3 respects all cultures and experiences, which includes responding to the role of family and community that underpin the health of Aboriginal and Torres Strait Islander peoples and people of other cultures

1.4 complies with legislation, regulations, policies, guidelines and other standards or requirements relevant to the context of practice when making decisions

1.5 uses ethical frameworks when making decisions

1.6 maintains accurate, comprehensive and timely documentation of assessments, planning, decision-making, actions and evaluations, and

1.7 contributes to quality improvement and relevant research.

1.2

1.3

1.4

1.5

1.6

1.7 I have established a regular scheduled audit process and allocated portfolios to CN staff to conduct and monitor required audits. Audits are routinely disseminated to staff via unit Q&S meetings.

Standard and their requirements are discussed each month and staff are encouraged to participate and/or implement quality projects.

This is also evidence by the increase in accountability and the increase of performance and reporting within the unit.

I have also ensured that all work instructions, procedures and protocols are regularly monitored and amended as required.

2.2 communicates effectively, and is respectful of a person’s dignity, culture, values, beliefs and rights

2.3 recognises that people are the experts in the experience of their life

2.4 provides support and directs people to resources to optimise health-related decisions

2.5 advocates on behalf of people in a manner that respects the person’s autonomy and legal capacity

2.6 uses delegation, supervision, coordination, consultation and referrals in professional relationships to achieve improved health outcomes

2.7 actively fosters a culture of safety and learning that includes engaging with health professionals and others, to share knowledge and practice that supports person-centred care

2.8 participates in and/or leads collaborative practice, and

2.9 reports notifiable conduct of health professionals, health workers and others.

2.2 As I have personally a varied background and strong cultural foundations I have endeavoured to emphasise the necessity of this standard to both staff and patients alike. I believe this to be a core requirement of health care professionals.

2.3 recognises that people are the experts in the experience of their life

2.4 provides support and directs people to resources to optimise health-related decisions

2.5 advocates on behalf of people in a manner that respects the person’s autonomy and legal capacity

2.6 Irregularly meet with both medical and senior nursing executives to discuss current status, progress, future planning and required outcomes.

2.7 I have regular safety meeting with staff and engage them in participation and discussion in formulating processes of care.

2.8 participates in and/or leads collaborative practice, and

2.9 reports notifiable conduct of health professionals, health workers and others.

2.2 I Have lead this by example. Within my daily rounding routine, I ask staff (medical & Nursing), if there are any issues regarding anything at all. We discuss deferring opinions often and I try to manage a quiet listening culture between staff. Regardless of personal opinion I encourage staff t remain professional and emulate GCHHS values. When situations get tense I always try to bring it back to where we are and why we are doing what we do. This is a standard I believe is important to practice efficiently and effectively as a health care professional.

2.3

2.4

2.5

2.6 Since I have been in a management position I have evolved in how I direct and lead in regard to outcomes. Firstly, I have had to learn to delegate more to achieve required outcomes. Even though I have delegated I still supervise and direct actions and goal accomplishment. This delegation and coordination of care direction has provided senior staff with a sense of worth as well as accountability which enhances participation and staff satisfaction.

2.7 Another benefit rising from this and that I have noticed and encourage, is the engagement between staff (all Multi-disciplinary team members), and the concentration on providing the best care with the resources available rather than just asking for more help all the time.

2.8

2.9

3.2 provides the information and education required to enhance people’s control over health

3.3 uses a lifelong learning approach for continuing professional development of self and others

3.4 accepts accountability for decisions, actions, behaviours and responsibilities inherent in their role, and for the actions of others to whom they have delegated responsibilities

3.5 seeks and responds to practice review and feedback

3.6 actively engages with the profession, and

3.7 identifies and promotes the integral role of nursing practice and the profession in influencing better health outcomes for people.

3.2 provides the information and education required to enhance people’s control over health

3.3 uses a lifelong learning approach for continuing professional development of self and others

3.4 As a NUM I have to answer to may nursing executives on a regular basis regarding the provision, financial status, direction and future planning of my unit.

3.5 seeks and responds to practice review and feedback

3.6 actively engages with the profession, and

3.7 identifies and promotes the integral role of nursing practice and the profession in influencing better health outcomes for people.

3.2

3.3

3.4 As I am given reasonable leeway with the day to day running of the peri-operative (peri-op) unit, accountability is ever present in mind. Discussions are held regularly where I share the current status of unit statistics and human relations issues. I share this information with subordinates as much as possible so that the unit can run more efficiently as a team. However, at times I have to direct, or redirect staff accordingly to ensure unit functionality, quality and safety is maintained.

3.5

3.6

3.7

4.2 uses a range of assessment techniques to systematically collect relevant and accurate information and data to inform practice

4.3 works in partnership to determine factors that affect, or potentially affect, the health and wellbeing of people and populations to determine priorities for action and/ or for referral, and

4.4 assesses the resources available to inform planning.

4.2 As I see that provision of care is a Multi-disciplinary team effort, I believe it necessary to collect data form the many various available source to gain a better overall picture of care being provided. Or able to be provided.

4.3 works in partnership to determine factors that affect, or potentially affect, the health and wellbeing of people and populations to determine priorities for action and/ or for referral, and

4.4 assessing available resources, and/or potential resources helps to understand current and future care possibilities. As a NUM I have to be aware of current and future resource availabilities.

4.2 Both qualitative and quantitative data provide information to enhance clinical practice. Therefore, besides audits discussions within meetings, previous minutes, as well as personal interviews/discussions are seen as valuable tools to create a picture of care and processes being provided. I have also encouraged staff to utilise state tools, such as prime, to assist with coming up with suggested action planning enhancing practice.

4.3

4.4 One way that helps me plan care is to share relevant information with the team. Together we can often come up with ways to improve care, enhance safety and mitigate potential issues prior to them becoming a problem. I do however have to direct and often lead staff as they are often unaware of restrictions and other concerns. Human resourcing is also a consideration and session planning and prioritisation of care often requiring monitoring.

5.2 collaboratively constructs nursing practice plans until contingencies, options priorities, goals, actions, outcomes and timeframes are agreed with the relevant persons

5.3 documents, evaluates and modifies plans accordingly to facilitate the agreed outcomes

5.4 plans and negotiates how practice will be evaluated and the time frame of engagement, and

5.5 coordinates resources effectively and efficiently for planned actions.

5.2 collaboratively constructs nursing practice plans until contingencies, options priorities, goals, actions, outcomes and timeframes are agreed with the relevant persons

5.3 documents, evaluates and modifies plans accordingly to facilitate the agreed outcomes

5.4 within the peri-op unit session planning and provision/allowance for emergency care require that I evaluate timeframes, engagement of medical staff and negotiate practice planning and outcomes.

5.5 coordinates resources effectively and efficiently for planned actions.

5.2 

5.3

5.4 Each week I hold meetings with the Multi-disciplinary team to review future session planning, emergent planning and obtainability of medical engagement. This requires constant monitoring and review due to the nature of the peri-op service. Therefore, I have to be aware of unit status and be continually negotiating and evaluating to provide quality and safe patient flow and outcomes.

5.5 coordinates resources effectively and efficiently for planned actions.

RNs provide and may delegate, quality and ethical goal-directed actions. These are based on comprehensive and systematic assessment, and the best available evidence to achieve planned and agreed outcomes

6.2 practises within their scope of practice

6.3 appropriately delegates aspects of practice to enrolled nurses and others, according to enrolled nurse’s scope of practice or others’ clinical or non-clinical roles

6.4 provides effective timely direction and supervision to ensure that delegated practice is safe and correct

6.5 practises in accordance with relevant policies, guidelines, standards, regulations and legislation, and

6.6 uses the appropriate processes to identify and report potential and actual risk related system issues and where practice may be below the expected standards.

6.2 Scope of practice is not only guided by skill level, experience or ability but also legislation, standards and job descriptions. Therefore, consideration of the whole is an important aspect of my own and my staffs practice.

6.3 appropriately delegates aspects of practice to enrolled nurses and others, according to enrolled nurse’s scope of practice or others’ clinical or non-clinical roles

6.4 provides effective timely direction and supervision to ensure that delegated practice is safe and correct

6.5 Relevant policies, guidelines, standards, regulations and legislation are provided within the unit for all staff to view as they, and if they, require. These are for the guidance of each health care provider to deliver safe outcomes and work as a team. As a NUM I am required to not only abide by them but ensure my staff are aware of and are compliant.

6.6 uses the appropriate processes to identify and report potential and actual risk related system issues and where practice may be below the expected standards.

6.2 As stated my practice is directed by national legislation all the way down to local job description and policy. Discussion is held at regular PDP reviews and at intermittent times if required. I often seek advice from my immediate superiors regarding various applications within my position. This discussion together with documented requirement is a guide to myself and how I direct my staff regarding scope of practice. There have been times when I have had to restrict staff regardless of experience or ability due to scope of practice. This ensures quality and safety of care and best outcomes for the patients.

6.3

6.4

6.5 During unit meeting, and as situations arise within the unit, policies, guidelines, standards, regulations and legislation are discussed to reinstate awareness and requirements of positional obligations and scope. During Individual PDP review relevance to mention such has been required at times also. Besides duty of care all health care providers agree by terms of their employment, agree to work under the conditions thuds specified. Sometimes we forget this and need a gentle reminder.

6.6

7.2 revises the plan based on the evaluation, and

7.3 determines, documents and communicates further priorities, goals and outcomes with the relevant persons.

7.2 revises the plan based on the evaluation, and

7.3 Within the peri-op unit we have many various meetings to cover the many aspects goals, priorities and required outcomes with both my immediate executives and subordinates alike.

7.2

7.3 Data, statistics, meetings, personal discussion, electronic communication are all utilised throughout each week to ensure that HHS, local and unit goals are known by all relevant parties. I often chair unit meetings and discussions to disseminate relevant information. I also often submit reports, which includes various data in the form of graphs, tables and scholastic research to nursing executives and subordinates as required.

• I have established Unit wide management system to ensure implementation, development and regular reviews of procedures, policies and work instructions.

• Allocated portfolios include training, data collection, reporting guides, and risk management.

• Patient safety and quality of care is always considered when I make business decisions. Feedback is provided to me from both Peers within meetings from patients via feedback data collection.
• Establishment of action plains resulting from audits and data analysis.

• I perform regular performance appraisals for those within my workforce.
• Complaints management systems are maintained via investigation, interview and data analysis. This is then reported to relevant stakeholders. Open disclosure is occasionally disseminated to relevant parties by myself or a qualified Open Disclosure Officer.

• Developed and allocated portfolios, subdivisions and reporting responsibilities between team members, both clinical & non-clinical reporting up to myself.
• I have personally taught each portfolio manager how to create spread sheets, recognise risk and develop risk mitigation strategies via regular discussions and intermittent review.
• Established regular scheduled meetings where reports, data, audits, performance and strategies are communicated and discussed to both clinical & non-clinical team members.
• Established regular sharing/reporting of action plans and audit results to quality coordinators and executives on a monthly basis. All data is used to improve systems and patient outcomes by regular review.
• Evidenced by records maintained within the employees’ personal folders.
• Reports are maintained by myself (electronically), patient liaison, quality coordinators and executives. These are often highly confidential.

• Development of procedures, policies and work instructions are reviewed and take into account patient feedback.
• Patient information pamphlets are kept up-to-date and place strategically where patient journey is directed. Patient feedback forms are also provided within the Day Procedure Unit.
• Consumers do not directly attend Unit meetings as I work within a restricted environment where sensitive equipment and surgical attire is required.

• When development/review of procedures, policies and work instructions are undertaken patient feedback data and relevant action plans viewed to help guide the content and processes.
• Designated areas within the peri-operative environment are kept stocked with up-to-date pamphlets and other information where patients and significant others have easy access.
• Executive meetings often have consumer representation at a higher level.

• Governance and systems for infection prevention, control and surveillance.

• Infection prevention and control strategies.

• Managing patients with infections or colonisations.

• Antimicrobial stewardship.

• Cleaning, disinfection and sterilisation.

• Communicating with patients and carers

• Regular monitoring of policies is conducted on a yearly basis with CNs’ and other relevant senior staff to ensure-up-to-date practice is adhered to. These meetings are minuted. Monthly Hand Hygiene Audits are analysed graphs created and presented at the monthly Unit Quality & Safety (Q&S) meetings as well as displayed within the Unit.
• Daily, Weekly and other routine cleaning schedules are adhered to as well as discussed at unit meetings chaired by me. Immunisation status of staff is monitored and Immunisation programme made available free to staff each year. Staff have Theatre attire provided and there are controlled restricted areas that are enforced. Staff are also required to complete yearly education on HAI’s, aseptic techniques and standard precautions. All of which is fed back to me and I report back to relevant staff within their PDP and meetings.
• When possible all patients with communicable disease are sent to me and I disseminate this information to all the Theatre staff prior to care provision. When patient infection status is recognised intra-operatively I ensure that the required information is entered as required. Any issues of human failures are documented and discussed at the Units Quality meetings and strategies implemented as discussed.
• Current cleaning products are provided and utilised for all surface and hand cleaning. This is as per hospital policy and national standards.
• I have introduced disposable airway products and other single use items to minimise reuse and cross infection risk. Products and policy are reviewed regularly for efficacy and cost efficiency.
• Passing on this information does not generally happen within the peri-op environment. However if it does it is usually discussed via medical staff.

• Governance and systems for medication safety.

• Documentation of patient information.

• Medication management processes.

• Continuity of medication management.

• Communicating with patients and carers

• It is part of my position to ensure that all national state and organisational standards and policies are adhered to. One way I do this s is to do a weekly audit on controlled drugs. The results are graphed, presented and discussed at relevant unit meetings.
• The majority of patients that have surgery are already screened and processed by medical staff. Therefore, patient medications and comorbidities are previously documented for my staff. We have a pre procedure checking process that is governed by standards and policies. I have to regularly address these with staff and ensure that patient information is correct to the patient being cared for. I do this by regular meeting with staff both nursing and medical. This information is also attended via the handover processes.
• Within the peri-op environment all medications are kept within a double locked cupboard or within a room where access is vis swipe card only. I have little to do with this process apart from being able to give out or revoke staff access to these areas.
• As I predominately work within a peri-op environment drugs used are fairly stable and sew changes are made. However, all new drugs are discussed with the relevant staff and information disseminated via meetings, email and personal discussion.
• Apart from check for allergic issues to drugs changes to patient routine medications are rarely seen. If this does occur the information is passed to ward staff to disseminate appropriately.

• Identification of individual patients.

• Processes to transfer care.

• Processes to match patients and their care

• Since I have been NUM I have introduced staff to using open ended questions only (where possible). This ensures that patients are identified correctly and in line with legislation and policy. Arm bands are used in accordance with policy.
• The handover process is designed for patient matching. I review this procedure with senior staff on a routine basis.
• The WHO Procedure and check list is also another method/tool used to ensure patient identification and procedural matching. A reporting process called PRIME is utilised to record and act upon any incidents.

• Governance and leadership for effective clinical handover.

• Clinical handover processes.

• Patient and carer involvement in clinical handover

• Currently the organisation (GCHHS) uses a tool known as SBAR for handover. Since I have been a NUM I have instigated this process at every point within the patients’ journey throughout the peri-op unit.
• A handover audit tool has been developed and quarterly audits conducted. The results are disseminated and discussed at the units Q&S meetings.
• The majority of our patient’s journey the patients are not conscious or under the influence of various drugs. Therefore, the handover process remains largely a clinical staff responsibility. A reporting process called PRIME is utilised to record and act upon any incidents.

• Governance and systems for blood and blood product prescribing and clinical use.

• Documenting patient information.

• Managing blood and blood product safety.

• Communicating with patients and carers

• All blood & blood products are disseminated as per GCHHS policy. There is regular communication with the transfusion committee and audits undertaken by them are share at unit Q&S meetings. A reporting process called PRIME is utilised to record and act upon any incidents.
• Any and all relevant patient information regarding blood & blood products is documented at the time of transfusion and handed over as per clinical handover protocols. A reporting process called PRIME is utilised to record and act upon any incidents.
• Within the peri-op unit both medical and nursing staff monitor product safety. All of my staff are to complete yearly blood safety training as a mandatory requirement. I review this and discuss with each staff member within their PDP.
• All relevant documentation and procedural requirements are discussed with the patient and significant others prior to the procedure where possible. Post procedural discussions are held within the ward environment.

• Governance and systems for the prevention and management of pressure injuries

• Preventing pressure injuries.

• Managing pressure injuries.

• Communicating with patients and carers.

• The Peri-op unit utilises a variety of gel pads on the operating tables and its extensions. I ensure that these are available and in good order and that they are cleaned in accordance with guidelines.
• Pressure areas are discussed and noted prior to procedure where applicable and handed over throughout the patients peri-op journey.
• We also utilise air mattresses for transfers and pressure relieving mattresses within the recovery areas. where appropriate these devices are taken to the ward areas post discharge from our unit.

• Establishing recognition and response systems.

• Recognising clinical deterioration and escalating care.

• Responding to clinical deterioration.

• Communicating with patients and carers.

• As we are a ‘Critical Care environment the majority of our emergency requirements are dealt with “in-house”. This means that I ensure that my staff are adequately trained and maintain a robust ongoing educational requisite.
• Our escalation process is to utilise the call bell system for emergent situations. Both medical and nursing staff are always available to respond accordingly. Communication of patients’ progress and/or deterioration are passed to medical staff on an ongoing basis whilst patients remain within the unit.
• I have made it a requirement that all PACU staff are to be ALS trained as part of their employment. I have also instigated a unit MET Call team that rotates daily to respond to such emergencies.
• The State ADDS chart ids used within the PACU area and relevant criteria has to be met prior to discharge to the wards, or alternate arrangements are made such as HDU or ICU admission.
• All data is recorded and kept at the time of each incident. A reporting process called PRIME is utilised to record and act upon any incidents.
• Staff are also encouraged to utilise the PACE system for escalation if they feel care is inadequate. Ryan’s Rule is also shared with patients families and significant others.

• Governance and systems for the prevention of falls.

• Screening and assessing risks of falls and harm from falling.

• Preventing falls and harm from falling.

• Communicating with patients and carers.

• Falls risks are noted on admission via routine documentation or via ward
• The majority of patient going through our unit are either on beds, trolleys of wheelchairs. Therefore, risk of falls is minimised.
• Patients within the peri-op unit are never left unattended so the risk of falls is minimal.
• We have not recorded a patient fall for some years within our unit. However the risk of falls and falls risk assessment is still undertaken and documented when appropriate.