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PRACTICE NURSE PROFILE Practice nurse appointments for new patients East Brunswick Medical Centre is a general practice located in the inner suburbs of Melbourne with four doctors and two nurses. Like many practices, we have experienced a growing demand to accommodate new patients due to population growth, the retirement of older solo practitioners and closure of their practices. While most local practices have ‘closed their books’ to new patients, we have always kept our doors open to these patients. Our policy was to provide all new patients with a 30-minute appointment with a doctor to take a full medical history. Our dilemma, however, was that in most cases patients were waiting up to six weeks for a ‘new patient’ appointment. We reviewed the structure of these appointments and realised that time-intensive medical history taking and recording of data in the electronic medical record was well within the scope of our practice nurses. In addition, feedback from our receptionists informed us that many patients wanted to be on our books to access a doctor when the need arose. Over a few weekly clinical meeting sessions, involving all the doctors and nurses, an agreed protocol was established for all new patients to be offered a ‘nurse registration appointment’. Patients do not see a doctor at this registration visit, unless an abnormality is noted, and the appointment is generally available within five working days. Patients could still choose to see a doctor for their initial appointment, but they will need to wait longer. Consultation was held with the practice medical indemnity insurers, who were satisfied that the specifications set down for the ‘nurse registration appointment’ would not in any way breach the cover provided under the practice insurance policy. The nurse registration appointments were launched. Nurses are responsible for taking a thorough history from the patient, including conditions, operations, medications, allergies and immunisations. Clinical assessment includes blood pressure, weight, height, waist measurement, urinalysis and random glucose. All details are recorded into the patient’s electronic medical record. If appropriate, a transfer of previous medical records is instigated. If the nurse detects an immediate clinical problem, there is a duty doctor allocated from each week day who can be accessed to provide a clinical assessment of the patient. Patients are charged a non-rebatable fee for the appointment, as it requires 30–45 minutes of the nurse’s time — the fee is $56.00, payable on the day. As a practice, we believe that this process has had several positive outcomes. Patients see the nurses as part of the clinical team; initial records are established in line with accreditation standards; doctors feels they have excellent information available to them when they consult with the patient; and, patients express satisfaction with the process as it enables them to be registered with a practice of their choosing. Importantly, nurses’ professional satisfaction is enhanced by their independent and responsible role. Since commencing this new process in August 2008, we have welcomed 1128 new patients to our Roslyn O’Reilly Roz has worked extensively in both public and private hospitals, and also worked as a supervisor in a regional laboratory of Melbourne Pathology. She made the move into general practice as a practice nurse approximately five years ago. Roz has been a member of the GP working party through St Vincent’s Hospital in Melbourne and is part of a research project with The University of Melbourne, Department of General Practice, focusing on introducing diabetic patients to and educating them about insulin. Teresa Reid Teresa has extensive nursing experience in the UK and Australia. She has worked in general practice since 2004 and at East Brunswick Medical Centre for the last three years. She is an immunisation provider and Pap test provider and has completed a Postgraduate Certificate in Women Centred Clinical Care. practice — 357 (32%) of these via a nurse registration appointment. One of our receptionists is the designated new patient co-ordinator. Initially, she had to encourage patients to accept the nurse registration option, but many new patients now ask to be booked for a nurse registration visit. Almost $20 000 in income has been generated from this initiative, which covers nurses’ wages for this service and generates income back to the practice. In addition, doctor time is available to see existing practice patients, and of course our new patients. Feedback is obtained monthly via a questionnaire sent out to a random sample of these patients. Feedback has been positive, with patients expressing satisfaction with their visit and the nurse’s thorough explanation about the centre and what it can offer patients. 16 Primary Times <strong>September</strong> 2010
idging the gap clinical audit Effectively manage your CVD patients The Bridging the Gap Clinical audit has been designed to enhance the clinical skills of practice nurses and support a multidisciplinary approach widely recognised as essential to the effective management of patients with CVD. This program is endorsed by RCNA and <strong>APNA</strong> for 10 continuing nursing education (CNE) points and participating GPs can obtain 40 RACGP Category 1 QA&CPD points. Free CAT Software for your practice Improve practice systems Team-based approach • Facilitates practice accreditation • Instantly produces disease registers, e.g. CHD • Identifies outstanding Service Incentive Payments (SIP) item numbers for patients with diabetes • Identify patients at risk of chronic disease • Develop patient recall systems • Routinely implement GP Manangement Plans (GPMP) and Team Care Arrangements (TCA) for patients with chronic conditions • Access related MBS items such as: – 721 GPMP & 723 TCA – 10997 PN patient review for those on a GPMP • The program supports the partnership between practice nurses and general practitioners Sign up today to bridge the gap in cardiovascular disease and earn CPD points. Spaces are limited. For more information, log on to www.bridgethetreatmentgap.com.au Sponsored by Pfizer Developed by Lifeblood Administered by Lifeblood ABN 43 926 343 251. 100 Mallet Street, Camperdown NSW 2050 Sponsored by Pfizer ABN 50 008 442 348. 38–42 Wharf Road, West Ryde NSW 2114 18149
Page 1 and 2: Supporting nurses in PRIMARY HEALTH
Page 3 and 4: CONTENTS EDITORIAL BOARD APNA NEWS
Page 5 and 6: PROFESSIONAL ISSUES Member question
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Page 13 and 14: PRACTICE MATTERS standards or guide
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September - APNA

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