Departmental Management Flashcards
Junior Performance Meeting
CONFIDENTIAL
REASON FOR MEETING
- I’m meeting with you today to discuss how you’ve been going in this position…
SELF-EVALUATION
- How have you been finding the job? How do you think you’ve been performing?
RAISE CONCERNS
- ….the consistent feedback has been that you’re not performing quite at the expected standard for your level
OR
- …I am aware that X happened, and I am quite concerned about this from a professional perspective.
Mistake: reassure.
Dodgy: state unacceptable.
**EXPLORE REASONS*
- Supervision, rostering, education
- Personal
MAKE PLAN
eg.
- Meet with cohort supervisor DEMT
- Period of leave
- Supervised practice, off nights
- Mentor/ individualised education
- Contact medical indemnity/ SRLS
TRAINEE SUPPORT
- ? Support at home
- Doctor/ employee helpline
- D&A, suicide risk
FOLLOW UP
Impaired Colleague
SIGNPOST
- I noticed…. the nurse in charge noticed….
- This is out of character for you, I wanted to see if you were okay and if I could help
EXPLORE STRESSORS
- Is there anything going on for you that is driving this change…?
EXPLICIT SAFETY/ SUICIDE CHECK
EXPLORE SUPPORTS
- Have you got anyone that you can go to/ get support from?
- The department can support you with sick leave. There is a doctor’s support line on…
NOTIFIABLE OFFENCES
- Encourage to self-report AHPRA
1- Intoxicated
2- Practice grossly deviated
3- Sexual misconduct
4- Undisclosed harmful condition (med/psych)
IMMEDIATE ACTIONS
- Take off floor
- Sick leave
- Self-report PRN
- Statement of SUPPORT and PRIVACY.
- Follow-up meeting
Disaster Planning
DECLARE EXTERNAL EMERGENCY
ACTIVATE LOCAL DISASTER PLAN
- Let’s discuss an overview of what needs to occur in these immediate stages/ first hours
- Lets write down these points as we discuss them
- I will aim to designate tasks as I go, but we may need to go back over the points at the end to do this
1 NOTIFY
Immediate:
- ED Director, NUM, Exec
- ICU, Anos, Surg, Paeds/NPICU
- Blood bank, radiology, pharmacy
- ED Huddle
–> From here can designate below tasks
2 DECANT
- Urgently discharge, admit or transfer
- Ambulatories out to alternative WR
- Utilise alternative spaces (conference room, office, cafeteria)
3 ZONING
- Set up Green, Yellow, Red and Black zones
- Assign a FACEM/ Snr Reg to each
- Use packs/ vests/ labels
4 TRIAGE
- SMART triage (incl packs)
- 2 points: ambos, walk-ins
- Switch to whiteboard/ label system
5 EQUIPMENT & MEDS
- Access surge supplies
- Trauma equip, blood, PPE etc.
- Radios
6 STAFFING
- Designate a staff manager
- Call in extra staff
- Set up roster
- Food, drink, rest area.
OTHER
- Media Liason
- Families
- Pastoral support
….. Delegate, and have everyone report back in 20 minutes
Overcrowding/ Surge/ Access Block: approaches
Code Yellow +-
Reduce DEMAND
Utilise:
- GP
- Covid at Home
- Community nurses
- HITH
- OP clinics
- Redirect to other facilities/ private hospitals
- WR announcement
- Improve access to outpatient follow
up (eg. TIA)
Increase CAPACITY
- Code yellow process
- Morning bed meetings
- Urgent discharge assessments on wards, weekend round
- Allied health- led discharges
- Cancel electives
- Open additional spaces/ overcapacity
- Transit Lounge
- Transfers
Increase FLOW
- Divert ambulances and WR
- Waiting room RATs
- Early FACEM reviews
- Early inpatient referrals
- Rationalise Ix
- Protocolised management
- Nurse-initiated Mx
Increase EXIT
….Quality improvement cycle. Monitor, audit, continuing improvement.
Debrief
- Thank you, great job. Is everyone okay?
- We are going to have a 5 minute team debrief
- You are encouraged to attend, but it is not compulsory
- It will confidential and no-blame
- Allocate facilitator (best not TL for power reasons), and scribe
“STOP for 5”
- S: Summarise case
- T: Things that went well
- O: Opportunities for improvement
- P: Points to action
- If anyone would like to talk about this further, you can X,Y,Z
- +/- cold debrief TBA
________
Function:
- Show of support, shared distress
- Clarify events
- Quality improvement
- Identifying those who need further support
Conflict Mediation (interprofessional)
Access Block Definition:
Admitted patients in ED excess of >8 hours due to no available inpatient beds.
Overcrowding Definition:
ED function impeded by number of patients exceeding physical space or staffing available
Mandatory Reporting- when required:
AHPRA
- Intoxicated
- Sexual misconduct
- Harmful, undisclosed condition
- Outlying practice ++
CHILD at risk
PERSON WITHOUT CAPACITY at risk
FIREARMS or CRIMINAL
NOTIFIABLE DISEASE
Referral Pushback:
Meet face to face if possible
Clearly define their concerns
- It sounds like you have some concerns about this referral.
- It seems we agree that this patient needs admission. What we’re not agreeing on, is the need for the CT results before being admitted to your ward. Is that right?
Better understand THEIR position, before defending your own.
- I’m keen to understand this from your perspective
- What is your major concern? How do you anticipate this admission should occur?…etc/
- Is there anything else I can help clarify for you?
Show empathy
- It sounds like you’re really under the pump
- I can hear that you have a lot of competing interests at the moment
Compromise if need be
- Interim Mx plan
- Write up main meds to save time etc.
- If you need a meal break first, that’s fine
________
