After considering the risks associated with this initiative, the following mitigating actions were implemented:
• Before the service started the paediatric community nurses undertook competency-based training, which has been updated annually.
• To ensure patient safety, protocols were designed for the nurses to follow when assessing and treating children and young people. The use of these is tracked and monitored and case discussions are held with the nurses. The protocols are reviewed annually and updated when required by the asthma/allergy specialist nurse, a paediatrician and a community pharmacist.
• All documentation relating to the initiative, including training schedule and competencies and the patient assessment and treatment protocols are agreed by the integrated clinical effectiveness committee.
• The PGD were ratified by the drugs and therapeutics committee. All patient assessment and treatment documentation is evidence-based, from the BTS-SIGN guidelines on the management of asthma (BTS-SIGN 2012). Additionally all protocols and PGD were peer-assessed by the clinical effectiveness group.
• The specialist asthma/allergy nurse is available via mobile phone for the nurses to contact if advice is needed. However, because the protocols have proved to be clear to follow and because case discussion is encouraged, it is mainly nurses who are new to the service who telephone the specialist nurse for advice.
• Risk assessments of the locality where patients reside are made to ensure nurse safety when visiting out of hours. Nurses all carry ‘lone worker devices’: a communication device that allows the nurse to alert a call centre if they get into difficulty/danger during a visit.
For further information please visit:
https://arms.evidence.nhs.uk/resources/qipp/601092/attachment