Development of Advanced Practice Roles: Service Needs Analysis

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Development of Advanced Practice Roles Service
Needs Analysis

• Jenny Hogan, BA (Hons), RGN, MSc (Research)
• The National Council for the Professional
  Development of Nursing Midwifery, Ireland

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Overview of this presentation

• Who are the The National Council for the
  Professional Development of Nursing Midwifery?
• The ANP/AMP Framework
• Conducting a service needs analysis
• Why?
• How?
• Theory
• Practice

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OKBNF

• OK Bad News First
• Undertaking a service needs analysis may not
  sound easy but its easier than robbing 3
  casinos..
• Listen to the negative spoiler voice in the
  background.

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http//www.youtube.com/watch?vrIDdx7NPJgo
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Background to the National Council

• Who are we?
• Where did we come from?
• Where are we going?

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Framework for the Establishment of Advanced
Nurse/Midwifery Practitioners

• Part One
• Job description and site preparation
• Part of the site preparation includes the SNA
• Why does the service require an ANP/AMP? The
  health service need MUST be demonstrated, ideally
  with identified anticipated positive clinical
  outcomes, and the benefits to the
  patients/clients.
• Purpose of the post and does it fit with
  national, regional and service level service
  planning priorities
• Part two
• Portfolio leading to ANP accreditation

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(No Transcript)
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The Service Needs Analysis (SNA)

• National
• NHS Policy High Quality Care For All NHS Next
  Stage Review Lord Darzi
• Regional
• Better Heart Disease Stroke Care Action Plan
• Local
• Regional demographics and epidemiology

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Overview of SNA

• Policy influences, DoH, disease specific
  strategies
• Data contributing to service need
• Epidemiology
• Population health statistics
• Hospital data
• Staffing levels and workforce planning
• Additional supporting evidence
• Business plan making a robust argument

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Population health statistics

• Local health statistics
• Migration trends and globalisation
• The ageing population
• Life expectancy rates
• Birth rate

• Health economics
• Womens health
• Genetics
• Environmental health
• Socioeconomic status
• Drug misuse
• Population distribution
• Biostatistics

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Hospital data

• Numbers of in-patient admissions
• Re-admission rates following discharge from
  hospital within unacceptable timeframe parameters
• Numbers of re-admission rates following discharge
  from Intensive Care
• Length of average stay of patients
• Routes of admission, e.g., GP referral, elective,
  Emergency

• Numbers and presenting complaint of Emergency
  Department attendees
• Bed occupancy rates
• Waiting times
• Number of patients seen per year, per service
• Skill mix of available staff with corresponding
  competencies

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The good news for Scotland!Information Services
Division

• Information Services Division (ISD) is Scotland's
  national organisation for health information,
  statistics and IT services.
• Scotland has some of the best health service data
  in the world. Few other countries have
  information which combines high quality data,
  consistency, national coverage and the ability to
  link data to allow patient based analysis and
  follow up.
• For example Bowel Screening uptake, waiting
  times, delayed discharges, cancer waiting times,
  suicide statistics!

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The real thing Irish style

• Cork University Hospital
• Conducted a Neonatal Activity Survey to support
  development of an ANP in Neonatology
• However, theory and structure, go to www.ncnm.ie
  First edition good, second much more
  comprehensive, due end of October

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The Activity Survey

• National and local epidemiology and demographics
• National
• 8-15 of newborns require intensive or special
  care
• 1985 a quarter of premature babies died, by 1996
  it was a sixth, ergo greater expectation that
  very small babies will survive

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Risk factors - National

• Women aged 40 and older (doubled since 1986 UK)
• Low maternal age (under 20)
• Early induction of labour
• Caesarean section rate high
• Multiple births
• Ethnic origin
• Obesity
• Medical complications (hypertension and diabetes)
• Smoking
• Assisted conception (trebled since 1991 UK)

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Local data

• 2007 Live births 7,998
• 2008 live births 8,745
• 71 normal delivery
• 17 elective c-section
• 12 emergency c-section
• As an outcome of hospital amalgamation and
  emergency c-sections number of admissions to NNU
  rose sharply
• 2007 910
• 2008 1,253

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The Activity Survey

• A snapshot of 100 neonates was conducted using an
  activity survey. Bespoke design due to poor
  (none!) IT infrastructure
• Captured not only critical decision making
  information such as
• Reason for admission
• Presenting problems premature, rule out sepsis,
  IUGR, observation, grunting
• Referral source
• Procedures and investigations undertaken -- CPAP,
  ventilation, nitrous oxide, incubator, photo
  therapy, cooling or surgery, lines
• Medications administered
• Communication (or lack of!)
• Involvement of MDT (Important for referral)
• LOS
• Discharge process (or lack of it)
• Really a process map!

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The Activity Survey

• But also identified gaps in service where ANP can
  fill
• This evidence backed up by international
  literature
• Beal Quinn (2002), parents perceived the ANP
  more supportive than medical staff

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The SNA case was built

• ANP blends advanced nursing practice and medical
  role functions with a holistic and humanistic
  approach to promoting health in critically ill
  neonates.
• They are known to be advocates of family centred
  care and developmental care.
• ANPs, working within agreed protocols, can
  assume responsibility for resuscitation,
  admission and stabilisation of neonatal
  emergencies and conducting the neonatal check.
• They can diagnose, request and interpret
  investigations and carry out complex clinical
  procedures and treatments independently.
• They provide a standard of care that is
  consistent, reliable, safe and timely.

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The argument for the requirement of an ANP was
built

• ANPs are cost effective and lead to better usage
  of manpower resources within the NNU.
• ANP help bridge gap between services and promote
  a collaborative model of practice.
• They contribute to the ongoing education of all
  staff on the unit and promote the application of
  research, audits, evidence based practice and
  where appropriate make recommendations to enhance
  practice and ensure cost effective use of
  resources.
• They can lead more effective and coordinated
  discharge planning.

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Secret weapon

• Site application went to The ANP/AMP Approval
  Committee 9/9/09 and was deemed to have meet the
  National Councils criteria. Commended for
  quality of work
• Anne Kelleher
• Project officer post funded by the NCNM
• E AnnM.Kelleher_at_hse.ie

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• Extremely brief introduction to the service needs
  analysis process
• If you would like to delve in deeper, come to the
  workshop!
• Thanks for asking and listening
• Any questions?