Discussion Forum: Tests and investigations, problems and solutions

1
Discussion ForumTests and investigations,
problems and solutions

• Kate Davies
• Clinical Nurse Specialist, Paediatric
  Endocrinology
• Kings College Hospital, London
• Pauline Musson
• Clinical Nurse Specialist, Paediatric
  Endocrinology
• Southampton University Hospital

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Introduction

• Clinical Competence
• Communication
• ITT
• BM v Lab glucose
• Issues regarding administration of Actrapid
• Other issues in the workplace
• Water deprivation tests Why are they so
  problematic?

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Competence Endocrine testing

• RCN Competency Framework for Paediatric Endocrine
  Nurses (in print)
• Care of children and young people with growth and
  endocrine disorders
• Level 5 Novice in speciality
• Level 6 Competent
• Level 7 - Expert

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Competence Endocrine testing

• Level 5
• Assist senior nurse or medical practitioner in
  carrying out tests
• KSF HWB6 Level3
• Assess physiological and/or psychological
  functioning and develop, monitor and review
  related treatment plans

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Competence Endocrine testing

• Level 6
• Be able to explain rationale behind protocols for
  endocrine function tests
• Have understanding of limitations of tests
• Safely and competently carry out shorter tests
  with minimal supervision
• Safely and competently carry our complex tests
  with supervision from senior nurse or experienced
  medical practitioner
• Be able to identify results outside normal limits
  and liaise with medical personnel
• KSF HWB6 Level 3
• - IK2 Level 2
• - Gather, analyse and report a limited range
  of data
• and information
  

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Competence Endocrine testing

• Level 7
• Develop and update evidence based protocols for
  endocrine function tests
• Provide advice on all aspects of endocrine tests
  at local and regional level
• Carry out endocrine tests adhering to
  organisational policies and procedures
• Initiate new tests where indicated and
  appropriate usage of standard operational
  procedures
• Accept direct referrals from other consultants as
  agreed by local protocols
• Supervise nursing and medical practitioners
  undertaking tests
• Interpret results and act appropriately as
  indicated

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Competence Endocrine testing

• Level 7
• KSF HWB6 Level 4
• Assess physiological and/or psychological
  functioning when there are complex and/or
  undifferentiated abnormalities, diseases and
  develop, monitor and review related treatment
  plans
• KSF IK2 Level 3
• Gather, analyse, interpret and present extensive
  and/or complex data and information

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Communication

• Patient / family
• NBM procedures
• Medication beforehand
• Lab
• Urgent samples e.g. Water Deprivation Test
• Computerised labels
• Ward

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Other issues..

• Environment staffing
• Medical training shifts
• 18 week pathway
• Variations in protocols
• How many tests does it take to make you
  competent?
• Which tests should only be done in specialist
  centres?

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Insulin Tolerance Tests

• UCLH research
• Glucometers failed to detect the high 19/21 (94)
  prevalence of true hypoglycaemia at 20 minutes in
  4/19 (21) patients
• Routine glucose rescue 20 minutes after insulin
  injection (regardless of BM)
• Have since changed protocol for hypoglycaemia
  from 2.6mmol/L to 3.0mmol/L
• BSPED 2005
• MR Nortier, K Babinska HA Spoudeas

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More about ITTs

• Staffing
• Administration of Actrapid
• Who should do young adults/transition tests?

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Water deprivation tests

• Why are they so problematic?
• What issues are there?
• How could we improve this?

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Lucy
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Extended test
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