Challenges in POA

1
Challenges in POA

• Mrs Jane Jackson SRN MPhil MCGI
• Consultant Nurse
• Honorary Fellow University of Hertfordshire
• jane.jackson_at_whht.nhs.uk

2
Early beginnings but were they patient centred?

• 1930s
• Consultant led service only for complex surgery

3
How has POA developed?

• Day Surgery
• 1993 - POA for all patients
• Worldwide delivery of care / sharing of knowledge
  and experience
• From Nurse led to Patient Led care
• possibly as a Nurse run service

4
Shaping of the POA service

• Healthcare professionals
• Delivery of service, audit, patient survey
• e-mail and Internet and networking exchange of
  POA procedures / delivery of care
• www.pre-op.org
• Demands for efficiency, lean thinking, lean
  working
• Advances in Day Surgery

5
Life expectancy at age 65 yrs.Life expectancy
Source Office for National Statistics
Government Actuarys Department
                                                
                                                  
                                           Life
expectancy at age 65, United Kingdom
6
The most common causes of death in England and
WalesAge-standardised mortality rates for
selected broad disease groups, England Wales
                                                
                                                  
                                         
7
Department of Health / CNO

• Health of the Nation 1998
• The NHS Plan 2000
• Creating a patient led NHS Delivering the NHS
  Improvement Plan 2005
• Healthcare Associated Infections 2006 -reduction
  in the rates of MRSA / C.Diff
• 18-week patient pathway 2006
• Patient Choice 2007
• Healthy weight, healthy lives 2008.

8
Clinical practice

• NICE clinical guidelines
• European working times directive
• For nursing staff, Advanced practice Modernising
  nursing careers

9
18 week pathway

• 85 compliant in England and Wales by March 2008
• 90 compliant by Dec 2008
• Key words
• Patient led care
• Clock starts referral
• Clock stops - treatment

10
POA at decision to treat
Referral
CATS /OPD
dtt
/- investigations
POA
ffs
W/L
not ffs
11
Challenges of 18 week delivery through one stop
POA

• Re-organisation of the OPD / POA / admission
  process
• Involves changes for all the surgical division
  Consultant, secretary, POA, records.
• Primary and Secondary care cohesion
• Key clarity for patient of the 18 week process

12
Benefits of 18 week

• Short journey for patient
• Lean thinking and lean working
• the patient receives the right care, at the
  right time and of the right quality without
  unnecessary delays.Delivering the 18 week
  patient pathway DOH 2007
• Effective use of resources - notes
• Appropriate referrals

13
Patient led care through Inter professional
teamwork
14
Annual Conference A Risky Business 6th
November 2008 at Royal Court Hotel,
Coventry Registration 190 (members of the
POA) 225 (non-members) For further details
including registration forms, please visit
www.pre-op.org or contact meetings_at_pre-op.org
15
Pre Operative Assessment 2008

• Providing a service for the user
• Effective assessment
• Location convenient to the patient

16
A practical guide to developing and running
effective pre assessment

• Predicting and explaining risk of surgery
• Developing a POA face to face and telephone
• How to set up POA
• The role of POA in meeting the 18-week pathway

• Legal aspects
• Career developments
• Team leadership
• IT support
• Audit