The Rotunda Hospital Ambulatory Hysteroscopy Service at Connolly Hospital
Gynaecology Service Development Phase 1
FFiiinnaalll VVeerrrssiiioonn Date: 11th February 2016
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CONTRIBUTORS
Ms Pauline Treanor Secretary General Manager Rotunda Hospital
Ms Margaret Philbin DOM/N Rotunda Hospital
Ms Marie Keane ADOM/N Rotunda Hospital
Dr. Eve Gaughan Consultant Obstetrician/Gynaecologist, Rotunda Hospital
Ms Judy McEntee DON Connolly Hospital
Ms Patricia Meade ADON Connolly Hospital
Ms. Louise Collins Director of Clinical Services, Connolly Hospital
Mr. Jim Hussey Director of Finance, Rotunda Hospital
Mr. Sean Williamson Materials Manager, Rotunda Hospital
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CONTENTS Page
1. Introduction 5
2. Background 5
3. Proposal 6
4. Current Gynaecological Service Overview 6
4.1 RCSI Hospital Group 6
4.2 Rotunda Hospital Gynaecological Activity 2014 7
5. Ambulatory Hysteroscopy Service Phase 1 Proposal 8
5.1 Ambulatory Outpatient Service – Resource 8 Requirement 6. Patient Pathway 9
7. Cherry Ward Ambulatory Procedure Room 9
8. Decontamination 9
9. ICT Support 10
10. Medical Emergency Management 10
11. Waste Management 10
12. Technical Services 10
13. Portering Services 10
14. Security Services 10
15. Laboratory 11
16. Cherry Ward Facility Requirements 11
17.Discharge Protocol 11
18.GP Communication 11
19. Breakdown of Total Costs both once off and recurring 12
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APPENDICES
Appendix 1 Rotunda Ambulatory Hysteroscopy Service – Patient Flow Pathway 14
Appendix 2 Standard Operating Procedure Medication Management 15 Appendix 3 Standard Operating Procedure Checking and Labelling of Specimens/Samples 16
Appendix 4 Transport of Laboratory Specimens from the Hysteroscopy Day Service at 17 Connolly Hospital to the Rotunda Hospital
Appendix 5 Standard Operating Procedure for an Emergency Situation 18
Appendix 6 Standard Operating Procedure Surgical Vasovagal Episode 19
Appendix 7 Preparation of Local Equipment prior to transfer to RH 20
Appendix 8 Procedure Room Decontamination Pathway 21
Appendix 9 Equipment and Consumables 22
Appendix 10 Health Care Assistant Job Description 27
Appendix 11 Staff Nurse Job Description 31
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1. INTRODUCTION
The Rotunda Hospital is a Voluntary Hospital operating under a Charter from 1756 with a Board of Governors and a Mastership system. It is a member of the RCSI Hospitals Group. The hospital is a 198 bed stand alone maternity teaching hospital providing outpatient and inpatient services with public funding augmented by private patient income under a Service Level Agreement with the HSE.
The hospital is struggling with a large increase in obstetric activity leading to capacity pressure and to the constriction of benign gynaecology work and an increased volume of gynaecology referrals due to changing practices in other hospitals.
In June 2015 the Rotunda welcomed the announcement by the Minister for Health, Dr. Varadkar to relocate the Rotunda Hospital to a site on the Blanchardstown Campus. This will result in the Rotunda meeting its strategic objective to co-locate with an appropriate adult hospital.
2. BACKGROUND
In 2012, the Mater Hospital significantly reduced Benign Gynaecology to concentrate on Gynaecology Oncology. This increased the number of benign gynaecology referrals to the Rotunda by up to 40% that same year. By the end of 2013, it was clear that the hospital was exposed to a risk of failing to identify significant pathology within this cohort of waiting patients and the Board of Governors approved a pilot Waiting List Initiative. Under this initiative, patients with a defined set of indications were identified from the waiting list and seen in ‘urgent Gynaecology clinics’ with any associated surgical procedures carried out in the Mater Private Hospital Theatre. (See Table 1).
In October 2014, this pilot project was extended with the objective of reducing the Gynaecology Out Patient Waiting List in keeping with the national agreed timeframes. This initiative was again funded by the Rotunda Board of Governors. The provision of a service provided on this basis was not sustainable in the long term and an alternative solution was required.
This current proposal offers such an alternative which will alleviate the benign gynaecology services problem and also initiate a working relationship between the Rotunda and Connolly hospitals.
Table 1: Summary of the Mater Private Initiative from October 2014 to June 2015
Referrals sent to the MPH 1076 Patients seen 715 Surgical procedures performed 366 5
3. PROPOSAL
It is proposed to establish a new Rotunda Gynaecology Service at the Connolly Hospital site. The objectives for this service are to:
Assist in the management of the Out Patient Waiting List in the Rotunda Hospital Provide a more responsive service to women in the future Bring the Rotunda services in line with international best practice Initiate closer links with both hospitals
It is proposed to develop Rotunda Gynaecology services at the Connolly Hospital site in 2 phases. Phase one will establish a “one stop” ambulatory hysteroscopy service that should support approximately 25% of all referrals to the Rotunda. Phase 2 will aim to establish an additional Day Surgery session in Connolly to assist in the management of up to 70% of women referred to Rotunda. It is acknowledged that the additional Out Patient and Theatre sessions will not replace current Rotunda Hospital services but will enhance and supplement them.
4. CURRENT GYNAECOLOGY SERVICE OVERVIEW
4.1 RCSI Hospitals Group
The RCSI Hospitals Group has a high level of demand for Benign Gynaecology. There are also many residents of the Group that go “out of Group Hospitals for care” (Table 2). Analysis by Dr. Declan Bedford and colleagues in the RCSI Hospitals Group show that the Rotunda Hospital performed 52% of benign gynaecology activity within the Group in 2013.
Table 2:
Out of Group Discharges by Patient Type, Residents of RCSI Hospitals Catchment Area, 2013
RCSI Hospitals Out of Group Total N % N % Day-Patient 3,144 69.4 1,385 30.6 4,529 Elective In- 887 63.1 518 36.9 1,405 Patient Emergency 244 74.4 84 25.6 328 In-Patient Total 4,275 68.3 1,987 31.7 6,262
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There was a Group fall of 3% in benign gynaecology services in 2013, however in the same period the Rotunda showed a 2% increase in the same category as referenced in Table 3 below.
Residents of Meath and North County Dublin were the most likely to go out of group, followed by residents of North County Dublin. Residents of Cavan and Monaghan were least likely to attend a hospital outside of the RCSI Hospitals Group. However the potential to capture all Group residents would give an overall increase of 31% activity per annum. This potential increase should be factored into this proposal.
Table 3:
Total benign Gynaecology discharges in the RCSI Hospital Group for the years 2012 and 2013:
2012 2013
N N Change Rotunda 3,018 3,081 63 Beaumont 353 354 1 St. Joseph's Raheny 87 82 -5 Connolly 108 89 -19 Cavan General 564 469 -95 Monaghan General 52 65 13 Our Lady of Lourdes, Drogheda 378 316 -62 Louth County, Dundalk 476 425 -51
Total 5,036 4,881 -155
4.2 Rotunda Hospital Gynaecological Activity 2014 There were 1593 gynaecology elective procedures in the Rotunda Hospital theatre in 2014. These have been analysed to determine how they ideally could be conducted.
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Table 4|:
Rotunda analysis of possible alternative management pathway of 2014 discharges
2014 Gynaecology Activity – Possible Public Private Split for New Model Out Patient Office without Anaesthesia 169 235 Day Case with Anaesthesia 434 536 Inpatient 90 130
An analysis of Rotunda Theatre procedures for 2014 indicates that 25% of all elective procedures could be accommodated in a designated and purpose equipped Out Patient Facility (235 public and 169 private). Assuming that 25% of the patients accommodated through the Mater Private Treatment initiative could be Ambulatory this would be an additional 175 public patients. Therefore a predicted 410 Rotunda public patients and some private patients (not all Consultants will be working at Connolly) could be seen in an Ambulatory Hysteroscopy Care facility. It is likely these numbers will be greater if referrals from Connolly and Beaumont Hospitals are included and it is also likely that the service will attract additional referrals from other hospitals over time.
5. AMBULATORY HYSTEROSCOPY SERVICE – PHASE 1 PROPOSAL
Phase 1 of this proposal is to establish a Rotunda led outpatient service in Cherry ward, Connolly Hospital commencing with a 4 day out patient Hysteroscopy service. The service will be managed within the core working week. This initiative requires joint input from both the Rotunda Hospital and Connolly Hospital. The Rotunda Hospital will provide staffing, governance and management in relation to patient pathways of care, Connolly Hospital will provide the physical environmental facilities, storage and day to day Bioengineering Support in addition to limited patient administration and portering supports.
5.1 Ambulatory Outpatient Service – Resource Requirement
Consultant Gynaecologists
Three Rotunda Consultants will operate 4 clinics per week on the Connolly site.
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Nursing / Support Staff
To support a service that consists of 4 days Hysteroscopy/Gynaecological procedures the following Nursing/Support Staff are required 1 x Procedure Room “Scrub” Nurse (See Appendix 7 JD) employed by the Rotunda Hospital 1 x Procedure Room HCA (See Appendix 8 JD) as Patient Chaperone & Support employed by the Rotunda Hospital 1 x HCA to cover Procedure Room and Surgical Day Cases employed by the Rotunda Hospital
Administration Support All administration relating to the patient appointment will be managed by the Rotunda Hospital except for registration on Connolly PAS. All Health Care Records will be managed by the Rotunda Hospital Staff. Estimated additional 0.2 WTE will be required for this function.
6. PATIENT PATHWAY The patient will be referred to the Rotunda Hospital initially – letter from GP to Rotunda Hospital The Rotunda will triage and determine suitable women for this service The woman will be written to by the Rotunda offering her an appointment for this service based in Cherry Ward A Rotunda OP Healthcare Record will be created and will be brought by Rotunda staff to the Clinic (Connolly site) on the day of appointment The patient will be registered on the Connolly Patient Administrative System on arrival Following the procedure a letter will be issued to the patient on the day to be given to her GP All follow up appointments will be managed by the Rotunda (See Appendix 1)
7. CHERRY WARD AMBULATORY PROCEDURE ROOM Procedure room will be set up as for an office gynaecology service. Equipment will be procured using normal procurement processes. Requirements listed in Appendix 10.
8. DECONTAMINATION
Decontamination costings have been obtained from Zenhacker which currently provides services at Connolly Hospital. The estimated costs of this service to meet the Rotunda Clinic requirements is in the region of 107,000 euros per annum. The Rotunda Hospital considers this cost to be prohibitive and is currently exploring procuring transport facilities and providing decontamination in the Rotunda CSSD. The estimated cost of this service is in the region of 50,000 euros per annum. Local preparation of equipment will apply (see Appendix 11) prior to transfer of equipment to the Rotunda Hospital.
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9. ICT SUPPORT
The Rotunda has developed an IT Support Programme to manage the service. This will include a database of patient details, template letters to be issued to patients and GP’s. This work is now complete. The Service Delivery area will require a local PC and local printer which have been purchased.
10. MEDICAL EMERGENCY MANAGEMENT
Medical emergencies associated with this type of service are rare. Should a medical emergency relating to the procedure occur e.g. perforation of uterus or bleeding requiring further management the patient will be assessed and if stable transferred by ambulance to the Rotunda Hospital. If unstable the patient will be admitted to Connolly hospital for stabilisation and further management decisions. (See Appendix 5 and 6) *Dr. Lean / Dr. Gaughan to supply SOP for internal transfer
An Emergency Resuscitation Trolley is available on site and an agreed protocol for use of Emergency Bleep has been developed (See Appendix 5)
Connolly Hospital have existing arrangements in place to support Emergency Resuscitation Trolley on site
Pharmacy requirement – emergency analgesia may be required on occasion. Connolly Hospital have agreed to stock on site (See Appendix 2)
11. WASTE MANAGEMENT
Waste Management including Sharps will come under the governance of Connolly Hospital and on site protocols will apply.
12. TECHNICAL SERVICES
Connolly Hospital will provide the frontline Clinical Engineering Technical Support if required. The Rotunda Hospital will provide the technical support via phone in addition to managing the relevant periodic machine maintenance.
13. PORTERING SERVICES
Will be provided by Connolly Hospital on an ad hoc basis.
14. SECURITY SERVICES Will be provided by Connolly Hospital on an ad hoc basis.
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15. LABORATORY
Histology samples will be transported to the Rotunda Laboratory using an agreed transfer protocol and reports will be managed through Rotunda Protocols (See Appendix 3 and 4).
16. CHERRY WARD FACILITY REQUIREMENTS
REQUIREMENTS Refurbishment Responsibility Cost Centre
Waiting Room Using existing Connolly waiting room on Hospital Cherry Ward Floor Recovery Room Recovery Couch Connolly New Cost Blood Pressure Hospital (RH) monitor Furniture Chairs x2 Connolly New Cost Hospital (RH)
Catering Water Dispenser Connolly Hospital Linen Disposable roller Rotunda New Cost Hospital (RH)
Communication PR for service The Rotunda development Hospital / RCSI Hospital Group Signage Rotunda New Cost Hospital (RH)
17. DISCHARGE PROTOCOL
On discharge from a scheduled “See and Treat” Appointment the patient will be given advice on any possible complications and what to do if they arise. All records of the procedures undertaken will be held by the Rotunda Hospital.
18. GP COMMUNICATION
Mailshots to all local GP’s will be issued by the Rotunda Hospital advising of the service and how it will be managed. The GP will be advised in this communication that the patient will be issued with her summary letter for the GP on discharge. It will be the patient’s responsibility to make an appointment with the GP and give the summary letter.
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19. TOTAL COSTS - Rotunda Ambulatory Hysteroscopy Service at Connolly Hospital Capital Costs 2015 Works-Estimate provided by James Connolly 10,000
Medical Equipment 131,448 furniture/Fittings/IT equipment 7,700
Total Capital Requirements 2015 149,148
Recurring Costs 2016 Pay Staff Nurse- 1.2wte 46,071
Healthcare Assistants * 2 wte 60,186
Admin=0.2 wte Grade iv 6,050
Total Pay Requirement 112,307
Non Pay Medical and Surgical Expenses Gynae Examination Sets * 6 1,000
Minor Surgical Sets 1,000
Coil Retrieval and Punch Biopsy Devices
Medical and Surgical 10,000 Consumables/Cathethers/Linen/Towels
Myrosurelite tissue removal device-€462 170,016
Aquilex Tubing and scope seal * €55 550
Novosure Device* €520 5,200
Cook needle 36
Decontamination Costs 107,502
Medical Equipment-Life cycle costs 12,900
Transport costs 5,520 Total Non pay Costs 308,204
Total Estimated Recurring Costs ( Pay and Non-Pay) 420,511
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APPENDICES
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APPENDIX 1
Rotunda Ambulatory Hysteroscopy Service Cherry Ward, Connolly Hospital
Patient Flow Pathway
CONNOLLY HOSPITAL RECEPTION
CHERRY WARD
WAITING ROOM (SHARED)
PROCEDURE ROOM
CONSULTATION WITH CLINICIAN
CHANGING ROOM (EN SUITE)
PROCEDURE COUCH
CHANGING ROOM
CONSULTATION WITH CLINICIAN
RECOVERY ROOM – TEA COFFEE
HOME
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APPENDIX 2
STANDARD OPERATING PROCEDURE MEDICATION MANAGEMENT
Studies show that although patients may be anxious initially, most patients will tolerate outpatient hysteroscopy without the need for anaesthetic drugs or analgesia.
Pre-procedural analgesia is strongly recommended – Paracetamol 1g or Ibuprofen 400 mgs one hour before their appointment.
The presence of a Nurse/HCA to talk to the patient and reassure her (vocal anaesthesia) is essential.
Supply of: - Paracetamol 1 gram Ibuprofen 400mgs
Locked cupboard required for storage press
Nurse required to order supply for daily procedures weekly
Resuscitation trolley to be checked weekly
Other drugs that may need to be kept on site: Atropine (in resuscitation trolley) Lynocaine Mirena Coil Pregnancy Testing Kit
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APPENDIX 3
STANDARD OPERATING PROCEDURE CHECKING AND LABELLING OF SPECIMENS/SAMPLES
Pre Sample Collection
Explain to patient prior to taking blood/tissue sample Ensure patient chart and addressograph labels are at the patient’s bedside/couch Ask the patient to state their name and date of birth Confirm identification with patient
Post Sample Collection
Specimen label must be handwritten by the Doctor/Nurse who takes the sample Confirm identification with patient Patient data – forename, surname, on sample must be the same as information on form Label sample at bedside/couch immediately after sampling
Request Forms
Complete request form at bedside It is essential all information on the request form (Histology, Haematology) is the same as the information on the blood/tissue sample Addressograph labels are acceptable on the request form Samples must never be pre-labelled
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APPENDIX 4
Transport of Laboratory Specimens from the Ambulatory Hysteroscopy Service at Connolly Hospital to the Rotunda Hospital
Standard Operating Procedure
A specimen is any tissue, body fluid, foreign object or culture obtained at time of consultation during the clinic. The specimen must be collected, handled and stored in such a way as to maintain the integrity of the specimen for examination. Specimen samples for transportation to the Rotunda from the Hysteroscopy Day Service will be minimal pertaining mostly to Histology and occasionally haematology It is the responsibility of the Staff Nurse in charge of the Service to ensure safe delivery of the specimens back to the Rotunda Hospital
SOP Samples should be placed in a specimen Jar with a lid (provided by the Laboratory in the Rotunda) The patient’s name, Hospital number, Date of Birth, and Date the sample is taken must be handwritten clearly on the jar The corresponding form must be correctly labelled with the patient’s addressograph Samples are then transported back to the Rotunda Hospital in a specimen transport box The specimen transport box is placed in a locked car boot of the car accompanying the clinicians back to the hospital (TAXI) The Nurse /Doctor may have their own transport if so the specimen transport box can be placed in the locked boot of their car. On return to the Rotunda Hospital the specimens are removed from the specimen transport box and stored appropriately in the laboratory fridge until processed by the laboratory staff. Specimens should reach the laboratory before 15.00 hrs on the day of collection
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APPENDIX 5
STANDARD OPERATING PROCEDURE FOR AN EMERGENCY SITUATION
A Hysteroscopy is a very safe procedure. However complications can and do occur which include:
Fainting or significant discomfort (vasovagal reaction) Puncturing the neck of womb, bowel, bladder or blood vessel Extreme pain discomfort while performing the procedure
If the patient exhibits any of the above the following actions apply:
Check Blood Pressure, Pulse, Respirations and Oxygen Saturation Document on Early Warning Score Kardex (NEWS) Lower head and raise legs (head down on electronic couch). Glass of water given to the patient once recovered
Most cases will resolve quickly, if recovery is not immediate:
Administer oxygen Summon medical assistance i.e. local or Emergency Resuscitation Team as required – Emergency Bleep 2222 Establish intravenous access Adult Resuscitation Trolley available locally Decision required re discharge, admission to Connolly or Rotunda Hospital (protocols apply)
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APPENDIX 6
STANDARD OPERATING PROCEDURE
Surgical/Vasovagal Episode
Cervical manipulation or dilation can result in vaginal stimulation of the parasympathetic system. This results in bradycardia and vasodilalatation causing drops in blood pressure and fainting. Vasovagal rates are approximately 1-1.7% & during OPH.
Remove scope immediately Reassure patient. Most patients recover in a few seconds Lower head and raise legs Call for assistance if alone Check BP, Pulse, Respiratory Rate and oxygen saturation Consider oxygen, IV access and a 12 lead ECG if effects of vasovagal prolonged.
Look for adverse signs: Systolic BP<90mmHg Heart Rate <40 beats min Ventricular arrhythmias compromising BP Heart Failure
If present: Start oxygen, IV access Assist Medical Staff to administer Atropine 500mcg IV stat and start IV fluids If no satisfactory response call Resuscitation Team and follow algorithm
In rare cases where effects of vasovagal are profound or prolonged Follow Adult Bradycardia Algorithm (Posted on wall of OPH room)
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APPENDIX 7
STANDARD OPERATING PROCEDURE PREPARATION OF LOCAL EQUIPMENT PRIOR TO TRANSFER TO RH
Following procedure used hysterscopes are sprayed with Neozyme and placed in the hysterscope tray
The tray is then taken to the sluice area (dirty utility) and placed in a covered stacking tray
Used instruments will be collected on a daily basis and transferred to Rotunda Hospital CSSD for processing. Collection and delivery times to be agreed
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APPENDIX 8
PROCEDURE ROOM DECONTAMINATION PATHWAY
USED SCOPES UNDER BUTTOCK DRAPE WITH BODY FLUID INTO BASIN UNDER COUCH
SPRAYED BASIN TAKEN TO SLUICE ROOM
PUT BACK INTO TRAY CLINICAL WASTE BIN
TAKEN TO SLUICE
PLACED IN STACKING UNIT
TRANSFER TO CSSD RH
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APPENDIX 9 Equipment and Consumables
REQUIREMENT AREA NUMBER COST COMMENT Painting & works Cherry Ward 24,442.76 (RH portion 10,000 max) Desk, Chairs Consult room Examination couch Consult room 1 PC / printer Consult room 1 2,000 Seating Waiting room Existing seating Decontamination Removal of Maintenance in shower /water Connolly to review supply turned and assess off, in en suite Frosted glass on windows and door Sink to be upgraded and position in room changed Shelving in store room for consumables used on a monthly basis Stacking unit covered for clean utility (Hysteroscopy trays and scopes, RIMD’S Stacking Tray in sluice for dirty utility Recovery Couch Recovery 1,500 room Camera System Procedure 1 30,867.53 Olympus Room Gynae couch Procedure 1 2.200 Room Diagnostic Procedure 12 36,116 Storz(this Hysterscope Set Room is buy one get one free
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Minor Surgical sets Procedure 12 2144.40 Storz Room Ureathral dilator set Procedure 2 Room Dental Needle & Procedure 6 per clinic syringe Room disposable Fluid Warmer Procedure 1 Room Drip Stand Procedure 1 270 Room Instruments for Procedure 1 2449.23 Storz Operative Scope Room includes operative sheath, biopsy forceps, grasper, scissors and basket Ultrasound Procedure 1 30,000 machine Room Laboratory TAXI costs for Staff Rotunda 120.00 - 128.00 OFF METR
Myosure controller 1 No Cost Myosure Aquilex 1 No Cost Fluid Management System Myosurelite tissue Disposable device 448 462 devise removal device to single use with seal be used with scope Estimate will seal Disposable single 134 per use 2 per use box of clinic 10 seals therefore 8 Single per week if 4 devise clinics with running seal 3696 per Will cost week 462 177,408 annually
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Mirena Coil 6 290.00 Removal Forceps per Forceps – 1740.00 in total Aquilex Tubing and Disposable single 553 box Only need 5 scope seal use of 10 times per year Novosure controller 1 Free Novosure device Disposable single 520 Need max 10 use 5200 per year
Cook Needle 1 36 Surgeon Stool 1 300 Coil Retrieval 6 Device Pipelle Endometrial disposable biopsy device Seating for waiting Use of room existing waiting room Recliner chair and 3000 couch for recovery room
Gynae Couch Transfer existing couch from RH Bone Scan Room Lamp LED Heine 1 1476 examination Lamp on wheels Trolleys Instrument 2 1050 and Dressing 230
Pharmacy Cost Paracetamol x 230 1box Ibuprofen x 1 box Atropine Vials x 1 box Mirena Coil x 1 box 100 Pregnancy Will only Kits (recurring need for consumable) approx 10 3%mepivicaine cases per 0.5% bupivacine year for corneal block 24
Recurring Consumables (Estimated Cost 10,000 Euros Per Annum)
Bucket under Buttock 24 per wk x 1152 Drapes (Drain Sheet): 48 wks Incontinent Sheets: 24 per wk x 1152 48 wks Sterile Swabs (7x 10) 24 per wk x 1152 48 wks Disposable Gowns 24 per wk x 1152 48 wks Standard Giving Sets 24 per wk x 1152 48 wks 1 litre Pressure Bag 1 litre of Hartmans / 24 per wk x 1152 Normal Saline 48 wks 100 ml Bags of Normal Saline
Gelafusion
IV Cannualation Sets
Hibiscrub / Bethadine Scrub
Chlorohexidine
Nail Brushes (single 3 stack per 144 use) week x 48 Bethadine / Iodine Disposable Kidney Dishes
Hand Gel
Hand Towels
Disposable Sterile Gloves
Disposable Non Sterile Gloves
Latex free Gloves
Maternity Pads
Disposable 25
Speculums
Blood Bottles U/E, HB, G&S
Syringes Needles
Laboratory Item Histology Jars +/- Formalin
Pregnancy Test Kits
Stationery Item Histology Forms
CSSD Decontamination forms
Lab Specimen Book
Printer paper
Rotunda Letter Headed paper
Envelopes
Household Item Cleaning
Yellow Bags
White Bags
2 large waste bins (clinical waste and non clinical)
1 small bin
Water Machine
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APPENDIX 10
HEALTH CARE ASSISTANT JOB DESCRIPTION
Rotunda Ambulatory Hysteroscopy Service at Connolly Hospital
Job Title: Health Care Assistant (HCA) Ambulatory Hysteroscopy Service
Reports To: Clinical Nurse Manager Ambulatory Gynaecology Service
Accountable to: Assistant Director of Nursing Connolly Hospital while on Connolly Site and to the Assistant Director of Midwifery/Nursing Rotunda Hospital
Job Summary:
The Health Care Assistant (HCA) is part of the multidisciplinary team, undertaking assigned duties, which will assist in the efficient running of the Rotunda Ambulatory Hysteroscopy Service.
All duties will be carried out under the supervision of a Registered Nurse.
Principle Duties and Responsibilities:
Undertake all activities required as directed by the Nurse in charge and as appropriate to the job description for the position.
Contribute to the wellbeing of the patients and their families.
Develop good interpersonal relationships with patients, relatives and the other members of the multidisciplinary team.
Be aware of the responsibility of all employees to maintain a safe and healthy environment for patients and staff and to promote a safer environment by minimising environmental hazards e.g. safe disposal of spillages and ‘sharps’.
Adhere to all the relevant Connolly Hospital policies and procedures while on Connolly Campus.
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Be responsible for materials and equipment as directed by the Clinic Nurse.
Undertake continuing education and developmental activities consistent with the position.
Actively contribute to and participate in ensuring compliance with the key areas identified in the following: Infection prevention and control / decontamination National Quality/Hygiene Schemes All audits deemed necessary by the Rotunda Hospital Management Team
Patient related duties:
Direct patients to appropriate areas and rooms.
Ensure all patients are treated in the order they have reported for appointment.
Chaperone patients at clinics as required by the Nurse or Doctor.
Communicate and reassure patients while having procedure carried out.
Assist Midwife/Nurse with positioning of patient pre-hysteroscopy and treatment.
Ensure patient comfort during and following procedures under guidance of the Nurse.
Assist Midwife/Nurse with patient care including the provision, removal and disposal of kidney dishes containing body fluids.
Provide refreshments for patients when requested.
Assist with telephone enquiries. Refer telephone enquiries and relay messages to appropriate personnel.
Help maintain a safe environment by ensuring floor areas are dry and obstruction free and ensure fire exits are not blocked.
General duties:
Assist the Nurse to complete stores requisitions or order under supervision.
Receive stores and stock in the appropriate area. Inform the Nurse of any shortages/omissions from stock order.
Prepare instruments for C.S.S.D and keep instrument buckets clean. Deliver and collect instruments from C.S.S.D. Rotunda. Place all sterile C.S.S.D. instruments in correct place. 28
Keep store rooms/cupboards tidy and ensure that there is an adequate supply of all stores.
Ensure that adequate supplies of all stores are available in the clinical rooms.
Check and restock sharps bins as necessary.
Close and label sharps bins when full and store in the designated area.
Remove, label and report any broken equipment.
Assist with the transportation of specimens to the Rotunda Laboratory.
Assist Nurse or Doctor to prepare for and carry out clinical procedures.
Set up trolleys/trays with equipment required for procedures or treatments.
Prepare equipment for use at clinics.
Dispose of waste and equipment/sharps after use adhering to hospital guidelines.
Deal with spillages including body fluids adhering to Rotunda Hospital/Connolly Hospital guidelines and best practice in prevention and control of infection.
Clean Clinic equipment, including, drip stands, couches, equipment trolleys etc. daily.
Clean furniture in clinical rooms after each case, ensuring that there is no blood or body fluid spillage on any surface. Comply with Connolly Hospital policy on cleaning at all times including the wearing of personal protective equipment.
Stock and restock daily supplies of patient gowns, gloves etc. in clinical areas.
Check, stock and tidy clinic rooms before patients are seen and at end of clinics including hibiscrub dispensers, hand towel dispensers and roller towel for hysteroscopy couch.
Change linen and clean couches after each use.
Dispose of linen in accordance with hospital guidelines.
Empty and change yellow clinical bins as necessary.
Keep refreshment area stocked up and tidy.
Ensure waiting area is clean and tidy. 29
Note: These duties and responsibilities are a reflection of the present service requirements and may be subject to review and amendments to meet the changing needs of the hospital.
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APPENDIX 11
STAFF NURSE JOB DESCRIPTION
Rotunda Ambulatory Hysteroscopy Service at Connolly Hospital
Title of Post: Staff Nurse - Ambulatory Hysteroscopy Service
Accountable To: Director of Midwifery/Nursing Rotunda Hospital
Reports To: Assistant Director of Midwifery/Nursing Rotunda Hospital / Assistant Director of Nursing while on Connolly Campus
Essential Requirements: Registered Nurse with NMBI
Contract Hours: 24 Hours
PROFESSIONAL REQUIREMENTS: Adult Basic Life Support Phelebotomy and cannulation skills IT Skills Excellent Interpersonal and Organisational Skills Ability to work as part of a multidisciplinary team Excellent communication skills Ability to support and supervise staff Ability to carry out duties to carry out duties as a qualified Staff Nurse in relation to this specialised area
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PRINCIPAL RESPONSIBILITIES
Clinical Function effectively as part of the multidisciplinary team and ensure effective governance and management of the Hysteroscopy Service in Cherry Ward.
Plan and provide holistic nursing care in collaboration with other members of the multidisciplinary team, and in accordance with agreed hospital guidelines, protocols and policies.
Promote and maintain a safe environment for patients attending the Hysteroscopy Clinic.
Act as an advocate for women attending the service.
Be accountable for the quality of the service provided, including Customer Service.
Ensure Best Practices are implemented and maintained in relation to service provision.
Communicate effectively with all members of the multidisciplinary team.
Communicate effectively with patients attending the service.
Supervise and guide the Healthcare Assistants in attendance at the clinic.
Liaise with Clinical Consultant and Midwifery/Nursing Management on an ongoing basis to ensure a smooth running of the service.
Comply with Medication Management Guidelines.
Actively contribute and ensure compliance with the key areas as identified in national quality/hygiene schemes.
Administration Liaise with Rotunda Hospital Patient Services Staff in relation to chart management and ongoing services required to assist with the daily running of the service.
Ensure that all resources are utilised cost effectively.
Report accidents/incidents in accordance with local and Rotunda Hospital guidelines.
Investigate and manage complaints in accordance with hospital policy.
Undertake administrative duties as required to support the clinic.
Maintain appropriate records.
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Comply with Data Protection and documentation guidelines as per Rotunda Hospital policies.
Contribute to the contribution of plans for the service monitor and report on their implementation.
Research and Audit Undertake audits pertaining to the Hysteroscopy Service.
Support the implementation of initiatives to improve and further develop the service.
Be aware of and implement all Policies, Guidelines in relation to Infection Prevention and Control / Decontamination.
Actively contribute, participate and ensure compliance with the key areas identified in the following: o Infection prevention and control / decontamination o National Quality/Hygiene Schemes o B.F.H.I. o Risk Management o Health & Safety
Be aware of and comply with the policy on Staff Responsibility for the Protection and Welfare of Children.
Professional Development and Education Assist with the orientation, education and professional development of new midwifery/nursing/healthcare staff assigned to the clinic.
Keep up to date with new developments in nursing care and reflect this in care given.
Maintain up to date knowledge of clinical developments pertaining to this specialist area.
Maintain high standards in clinical skills, and continuously update both practice and education.
Assess own personal training and educational needs, and ensure that they are met.
Ensure that the appropriate up-to-date information is readily available for patients and staff in relation to the Hysteroscopy Service.
Identify opportunities for health promotion, and provide clear and accurate health information according to hospital guidelines.
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Finance
Manage the efficient use of all consumables required in the running of the clinic.
This Job Description is subject to review by the hospital authority from time to time.
This is a description of the principal responsibilities of the post and is not a comprehensive list of duties.
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