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Nurses and midwives are contributing at all levels of the National Clinical Programmes, writes Geraldine Shaw
The HSE Nursing and Midwifery Services are led by Dr Michael Shannon, National Director Nursing and Midwifery Services (ONMSD). With the continued support of nursing and midwifery staff nationwide, significant progress and contributions have been made to the National Clinical Programmes at both a clinical and a national strategic level. The aim continues to be to improve patient care while also meeting the objectives of both the HSE and Department of Health.
The following is a reflection on some of the achievements to date of the National Clinical Programmes, focusing on some of the areas of contribution from nursing and midwifery staff. Note: please be mindful that this article only gives a snapshot and does not cover all of the programmes’ achievements due to the confines of space. Therefore it is not intended to be exhaustive.
National Clinical Programme for Acute
Medicine (AMP)
Introduction of the National Early
Warning Score (NEWS): NEWS has been
implemented in all acute and single specialty
hospitals in Ireland. This initiative
was enabled by the National Clinical Programme
and led by the National Nursing
Lead for Acute Medicine. This tool has
proved to be of great benefit to both nursing
and medical staff while also providing
benefit to our patients. The tool received
the Public Service Excellence Award from
An Taoiseach in 2013. For more information
on this tool visit: http://www.hse.ie/go/nationalearlywarningscore/
National Clinical Programme for
Obstetrics and Gynaecology
Introduction of the Irish Maternity
Early Warning Score (I-MEWS): In 2013
the National Clinical Programme in conjunction
with ONMSD established a
multidisciplinary design team to develop
a national standardised I-MEWS, observation
chart and associated material.
Midwives from 19 maternity hospitals contributed,
collaborating on its development
and implementation, thus demonstrating
the benefit of multidisciplinary ‘top down
– bottom up’ workings.
The I-MEWS is used for all pregnant women from the time of confirmation of a clinical pregnancy up to and including 42 days post delivery. The design, development and implementation of this work was presented by lead midwives at the International Confederation of Midwives (ICM), Prague in May, 2014. For more information on this tool visit: www.hse.ie/eng/about/Who/clinical/natclinprog/obsandgynaeprogramme/imews
A Midwifery Workforce Planning Review has been jointly commissioned by the Office of Nursing and Midwifery Services Director and the Joint Standing Maternity Committee of the Dublin Maternity Hospitals. This review is supported by the National Clinical Programme for Obstetrics and Gynaecology and the National Director Clinical Strategy and Programmes Division. This review incorporates a Birthrate Plus® (BR+) study in six maternity units in Ireland. The data when analysed will provide a benchmark for the group which will inform national staffing figures.
Midwives and healthcare professionals have contributed to the production of 32 National Clinical Guidelines which are available on the HSE website: www.hse.ie/eng/about/Who/clinical/natclinprog/obsandgynaeprogramme/obsgyneguide.html
National Clinical Programme for
Paediatrics and Neonatology
Introduction of the Paediatric Early
Warning Score (PEWS): A National steering
group was established in early 2014
and is actively progressing the development
of PEWS. This group has a Group
Children’s DON to provide direction and
support. The roll out will be led and driven
by a nursing project co-ordinator in 2014.
Nursing has led on the initiation of a National Senior Paediatric Nursing Network in collaboration with the National Clinical Programme for Paediatrics which includes all paediatric units in the country. This was established in Q1 2014. This will enable sharing of information and standardisation of best practice initiatives nationwide. To date, two national network events have been run successfully.
National Clinical Programme for Stroke
Nurses and stroke clinical nurse specialists,
along with the medical staff and
multidisciplinary teams, are providing and
leading on patient care and service initiatives
which are delivering the following
outcomes;
National Clinical Programme for Diabetes
The Integrated Care Diabetes Initiative
was an agreement between primary and
secondary care and identifies best practice
for the management of the condition
based on the type and severity, and a commitment
on behalf of the HSE to ensure
that the model of care for Integrated Care
Diabetes will provide that:
To implement this initiative 17 integrated care diabetes nurse specialists were approved for appointment (many of these nurses are in place working across primary and secondary care). These nurses are dealing with patient caseloads, providing specialist care to maintain patients in the most appropriate setting.
A national model of care to deliver CS11 therapy to children with type 1 diabetes under five years of age has been developed and implemented. This model has been implemented through the work of nursing and clinical nurse specialist staff, working with the local multidisciplinary teams.
For more information on the work of the programme visit: www.hse.ie/diabetesprogramme
National Clinical Programme for
Emergency Medicine
The programme in conjunction with
ONMSD has:
National Clinical Programme for
Productive Ward
This nurse-led initiative has been successfully
piloted in many sites across
Ireland in two distinct phases. Every
participating ward and site has reported
improvements (under various headings)
to their environment, the direct patient
care times or an element of patient
safety. The national team won the International
Lean Healthcare Academy award
in 2013. Sligo General Hospital won the
award in 2014.
In a recent communication from the National Directors Clinical Strategy and Programmes Division and ONMSD to service managers (Hospital Groups and ISAs) it was articulated how this initiative will transition to operational business as usual during 2014.
The ONMSD and the Nursing and Midwifery Planning and Development Units will continue to provide training and advice for sites commencing the Productive Ward Initiative. The transition from a national initiative, to being fully implemented and owned operationally within a three-year period, illustrates what works well within nursing and midwifery services.
National Clinical Programme for
Anaesthetics
Work is underway to develop a
condensed nursing foundation education
programme for 2015 to enable
professional development and succession
planning for this specialist area. This is
being led jointly by the national clinical
lead and ONMSD in association with the
College of Anaesthetists.
National Clinical Programme for Acute
Coronary Syndrome
The programme introduced a national
optimal reperfusion service (ORS) in
January 2013. The ORS service, provides
that a patient with an acute heart attack
who is within 90 minutes travel time
from a designated primary percutaneous
coronary intervention (PPCI) centre is
transported straight to the PPCI centre
where they receive emergency treatment
in the cardiac catheter lab. These
centres were in part enabled by nurses
up-skilling and changing their rosters to
provide this service, as well as an on-call
service.
National Clinical Programme for
Audiology
The National New Born Screening
Service for children, which is conducted
within four weeks of birth is fully operational
nationally. To date, more than
100,000 babies have been screened. This
service continues to be supported by nursing
and midwifery services through PHNs
throughout the country.
National Clinical Programme for
Epilepsy
Since 2010 the epilepsy service has
been driven and delivered by 10 ANPs,
supported by a further 20 nurse specialists.
The Programme was awarded
an international nursing award for its
description of the new National Epilepsy
Service of Ireland. (The ‘Limelight’ award
is part of the international care challenge
series by Sanofi that allows nurses from
around the world to showcase nursing
innovations).
A National Director of Nursing & Midwifery Reference Group, chaired by Dr Shannon, provides impartial input and endorsement to clinical programme material as required on an ongoing basis.
Detailed information on all programmes is available at: www.hse.ie/clinicalprogrammes
Geraldine Shaw is director of Nursing and Midwifery/ National Clinical Programmes, ONMSD, Clinical Strategy and Programmes Division HSE
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