Community Nurse In-reach (CNIR)

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Community Nurse In-reach (CNIR)

• Providing safe effective nursing discharges
  across the Hospital Community Interface.

2
Background

• Experience of the Case finder Project
  (2003-2004).
• Evidence of the Berkshire High Tech Team.
• District Nursing Modernisation (2004-2006).
• CNIR team appointed Feb 2006.
• Two WTE DN Sister Band 6, One at the BCH and one
  UHD.(2006)
• Four WTE DN Sisters Band 6 and WTE Band7 Team
  Leader/Lead Nurse (2013)

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Community Nurse In-reach (CNIR)

• Team Aims
• To prevent unnecessary admission to hospital
• To facilitate early supported discharge

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CNIR Roles to meet the Targets

• Case finder
• Facilitator
• Consultative/Educator
• Advocacy

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Case finder

• Patient selection is key to safe service
  provision
• Attend daily bed meetings
• Hospital Based
• Visible presence in A/E, AMAU, Outpatients and
  Wards

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Facilitator

• Provides knowledge of and access to the community
  service menu.
• Acts as a conduit between hospital and community.
• Work in partnership to facilitate discharges
  through a more structured, co-ordinated and
  standardised approach.
• Establishes good sustainable links between the
  primary and secondary care.
• Identifies community alternatives and seeks
  patient consent

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Consultative/ Educator

• Identify and advise on new development potential.
• Provides professional and clinical leadership in
  the implementation of service development.
• Identifies service development potential and
  associated training needs of community staff.
• Develop policies, guidelines and protocols to
  introduce new procedures or initiatives.
• Carry out joint visits with District Nurses to
  support and supervise practice if required.

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Advocacy

• Promotes mutual understanding across primary and
  secondary interface.
• Patient care is provided in an environment that
  is essentially their own, where they feel at ease
  with the potential for a faster recovery.
• Family and carers are more involved in the care.
• Reduces the risk of hospital acquired infections

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Learning Development

• What has been achieved
• Intravenous Therapy- OPHAT (Wards, O/P A/E)
• Community Midline service
• Expediting delayed discharges- fast tracking
  equipment
• Dehydration issues in Nursing Homes
• Increased number of complex palliative patients
  now supported at Home
• Enhanced early discharge Colorectal and Breast
  Care patients
• Participating in Community Urgent Care Pilot

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Measured Outcomes

• Jan-Dec 2007 Referrals 777 Bed Days saved
  2293
• Jan-Dec 2008 Referrals 729 Bed Days saved
  3473
• Jan-Dec 2009 Referrals 1129 Bed Days saved
  4822
• Jan-Dec2010 Referrals 1365 Bed Days saved
  6195
• Jan-Dec2011 Referrals 1342 bed days saved
  7118
• Jan-Dec2012 Referrals 1805 Bed Days saved
  9512

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Any Questions?