General clinical practice getting the intermittent catheter the patient needs: considerations in coding, coverage, and documentation

Nurses with knowledge of catheter features, the Healthcare Common Procedural Coding System (HCPCS), reimbursement guidelines, and proper documentation will have the essential information needed to ensure that patients performing intermittent self-catheterization receive the right products.

Managing a pessary business

In this final article in a series of three, components of pessary fitting, provision, and follow up are reviewed from a business perspective related to supplies, patient flow, billing, and coding.

An indispensible role

Freezing the vacant posts of diabetes nurse specialists is affecting patient care and will cost the NHS more in the long run, warns a major charity.

A special relationship

Nurse specialists can make a world of difference to patients with rare diseases, who otherwise can struggle to get an accurate diagnosis and appropriate treatment.

Redesigning a continence prescription service to improve patient safety and experience

A review of prescribing practice for continence related products revealed shortcomings in the service that patients were receiving. This led to it being radically redesigned, with the continence service being responsible for prescriptions. The new service model also includes telephone triage before prescriptions are issued. Patient feedback on the new model has been extremely positive. This project won the 2009 Nursing Times continence award.

Specialists face up to more cuts

Patients find clinical nurse specialists invaluable, but the nurses often feel overworked and under-resourced.

House of Lords debate: specialist nurse future

This month sees the 10th Anniversary Meeting and Conference of the European Pressure Ulcer Advisory Panel with both European and International speakers providing a wealth of education and research in respect of pressure ulcer prevention and management. This promises to be a significant event in terms of adding to the evidence base in this field but also in respect of the ongoing debate regarding Grade-2 Pressure Ulcers. It is anticipated that both Commissioners and Providers of Services are represented at this conference to ensure optimum care for patients across the primary and secondary care interface.

Advanced nurse roles in UK primary care

Nurses increasingly work as substitutes for, or to complement, general practitioners in the care of minor illness and the management of chronic diseases. Available research suggests that nurses can provide as high quality care as GPs in the provision of first contact and ongoing care for unselected patients. Reductions in cost are context dependent and rarely achieved. This is because savings on nurses' salaries are often offset by their lower productivity (due to longer consultations, higher patient recall rates, and increased use of tests and investigations). Gains in efficiency are not achieved when GPs continue to provide the services that have been delegated to nurses, instead of focusing on the services that only doctors can provide. Unintended consequences of extending nursing roles include loss of personal continuity of care for patients and increased difficulties with coordination of care as the multidisciplinary team size increases. Rapid access to care is, however, improved. There is a high capital cost involved in moving to multidisciplinary teams because of the need to train staff in new ways of working; revise legislation governing scope of practice; address concerns about legal liability; and manage professional resistance to change. Despite the unintended consequences and the high costs, extending nursing roles in primary care is a plausible strategy for improving service capacity without compromising quality of care or health outcomes for patients.

Scientific evaluation of community-based Parkinson's disease nurse specialists on patient outcomes and health care costs

OBJECTIVE

To determine the effects of community based nurses specialising in Parkinson's disease on health outcomes and healthcare costs.

DESIGN

Two year randomised controlled trial in 438 general practices in nine randomly selected health authority areas of England.

PARTICIPANTS

1859 patients with Parkinson's disease identified by the participating general practices.

MAIN OUTCOME MEASURES

Survival, stand-up test, dot in square test, bone fracture, global health question, PDQ-39, Euroqol, and healthcare costs.

RESULTS

After two years 315 (17.3%) patients had died, although mortality did not differ between those who were attended by nurse specialists and those receiving standard care from their general practitioner (hazard ratio for nurse group v control group 0.91, 95% confidence interval 0.73 to 1.13). No significant differences were found between the two groups for the stand-up test (odds ratio 1.15, 0.93 to 1.42) and dot in square score (difference -0.7, -3.25 to 1.84). Scores on the global health question were significantly better in patients attended by nurse specialists than in controls (difference -0.23, -0.4 to -0.06), but no difference was observed in the results of the PDQ-39 or Euroqol questionnaires. Direct costs for patient health care increased by an average of pound2658 during the study, although not differentially between groups: the average increase was pound266 lower among patients attended by a nurse specialist (- pound981 to pound449).

CONCLUSIONS

Nurse specialists in Parkinson's disease had little effect on the clinical condition of patients, but they did improve their patients' sense of wellbeing, with no increase in patients' healthcare costs.

Towards a nurse-led service?

In recent years, there have been many changes in nursing, particularly in specialist areas. In the 1990 s, posts emerged in secondary care with the titles of nurse practitioner, advanced practitioner and nurse consultant. Nurse practitioners diagnose, refer, prescribe and provide complete episodes of care for clients with undifferentiated health problems. Nurse practitioners are undertaking the roles of junior doctors within neonatal units and pre-admission clinics, whereas other nurse practitioners work across the primary-secondary care interface and can prescribe following protocols for conditions such as asthma and hypertension. In units where specialist fertility practitioners demonstrate a higher level of clinical decision-making, the role of nurses has developed as their experience has been recognized. Nurses are able to monitor and improve standards of care through supervised practice, clinical nursing audit, developing and leading practice, contributing to research, teaching and supporting professional colleagues. This article will focus on the changes in fertility nursing over the years, which have placed nurses in a position to provide a holistic service for subfertile individuals. Motivated and experienced nurses within the area of fertility are fundamental to high quality patient care, and they can deliver a seamless service from primary to tertiary care, with appropriate support services made available when and if required.

Defining neuroscience nursing practice: the 2001 role delineation study

Studies that provided a blueprint for the Certified Neuroscience Registered Nurse (CNRN) examination were conducted in 1987, 1992, and 1997. In 2000, the American Board of Neuroscience Nursing (ABNN) formed a task force to re-examine the previous role delineation survey, obtain information to define current neuroscience nursing practice, and provide content validity for future CNRN examinations. Previous role delineation studies conducted by ABNN and a review of the literature provided the background for the study. The theoretical framework was the Nursing Intervention Classification (NIC) taxonomy and the methodology was a survey design. Computer Adaptive Technologies, Inc. (CAT), assisted the task force with survey development and data analysis. The survey, a three-part questionnaire, was mailed to 1,505 CNRNs and returned by 453 participants.

Primary eye care management

Due to a financial recession in South Africa, the registered nurses (RNs) at an excimer laser center faced dismissal. In order to continue a career in ophthalmology, these nurses needed to create their own income. To this end, a primary eye care (PEC) clinic was established to provide examination and treatment(s) to the underprivileged community with the assistance of local ophthalmologists. The PEC clinic, which provides basic services for a nominal fee, has bridged the gap between excellent private eye care and inadequate government eye care. Since 1999, 791 patients have been examined and 515 surgical procedures have been performed.

Specialist nurse management programmes: economic benefits in the management of heart failure

Chronic heart failure (CHF) is a modern-day epidemic in most developed countries. As such, it is both common and costly. Contrary to the impression given by clinical trial data, CHF mainly affects older individuals with approximately equal numbers of men and women and concurrent disease profiles likely to complicate or even prohibit the application of proven treatments. It is within this context that there has been an increasing interest in specific CHF-management programmes designed to limit costly hospital use in typically older individuals at high risk for poor quality of life, recurrent readmissions and premature death. This paper examines the evidence to suggest that CHF programmes involving individualised multidisciplinary post-discharge healthcare, with a major focus on specialist nurse management to ensure that the patient receives optimal treatment, are clinically and economically effective in reducing the typical burden imposed by CHF. These programmes appear to be most effective in 'high-risk' patients who typically have recurrent readmissions in high-cost units. Overall, the literature suggests that these programmes are able to reduce recurrent hospital stay by 30-50% relative to usual care (even in the presence of gold-standard treatment) in the short to medium term with comparable cost benefits. Recent data from a management programme involving a cohort of typically older and fragile patients with CHF in Australia showed that at 3 years post index admission, hospital utilisation costs were reduced by one-third relative to usual care. The potential for enormous cost benefits (both in terms of absolute cost savings and in terms of facilitating a more efficient healthcare system) if a specialist nurse programme of care was applied in the form of a UK-wide heart failure service was also recently examined. Based on year 2000 activity levels, it was found that for each specialist heart failure nurse appointed in the UK (with a caseload of 200-250 patients per annum), nominal savings of pound 49 000 per annum could be generated in order to make the healthcare system more efficient.

The WOC nurse: economic, quality of life, and legal benefits

Patients who require treatment for complications stemming from skin and wound care conditions represent a significant and costly clinical problem in the health care arena. An innovative approach used to manage these patients is utilization and employment of the specialty trained wound, ostomy, and continence (WOC) nurse. A review of the literature supports the role of the WOC nurse in providing quality care, minimizing the expenditure of health care dollars, and overseeing the use of pressure ulcer and wound care guidelines so that litigious events may be avoided.

Evaluation of the effectiveness of a specialist nurse in the management of inflammatory bowel disease (IBD)

OBJECTIVE

To determine the effect of a specialist nurse on the management outcome of patients with inflammatory bowel disease (IBD).

DESIGN

Audit of the management of a cohort of patients in the year prior to the employment of the specialist nurse and the year immediately after.

SUBJECTS

339 patients, both male and female, with either Crohn's disease or ulcerative colitis, resident in the Cambridge health district.

SETTING

Addenbrooke's Hospital NHS Trust Outpatient Centre.

MAIN OUTCOME MEASURE

Health status was measured by blood tests (C-reactive protein, albumin and haemoglobin) throughout the year, symptom indices, number of clinic attendances, admissions to hospital and length of stay. Quality of life was measured via a postal questionnaire.

RESULTS

Hospital visits were reduced from 1377 to 853 (38% reduction) and in-patient length of stay measured in bed-days from 516 to 417 (19% reduction). The number of patients in remission increased from 63 to 69%. Patient satisfaction improved in key areas, in particular, access to information on IBD and advice on avoidance of illness and maintaining health. Of a total of 251 calls to the telephone helpline, only 19 patients were referred for a medical opinion and five patients required hospital admission.

CONCLUSION

The IBD nurse specialist is a valuable and cost-effective member of the gastroenterology team.

Career development for nurses in today's health care environment and the value of nontraditional roles

Roles that were essential in the health care setting of the past are rapidly disappearing in today's era of redesign. Career development and advancement are tumultuous processes in the current health care environment. The article illustrates what nontraditional roles can offer nurses through a case study on the contract negotiation process. It is hoped that the article will encourage nurses to take risk in choosing career experiences. Such choices will facilitate the learning that is necessary to lead the complex health care organizations of today.