Skill mix in clinics – Skill mix in clinics – how to improve everyone’s life.how to improve everyone’s life.

Samantha Bower

Nurse Specialist – Breast care

The Ipswich Hospital NHS Trust

IntroductionIntroduction

Everyone’s experiencesTraining and supervisionIntroducing changeProblems encounteredHas it made a difference?

Patients experiencesPatients experiences

Waiting times

Consultations

Information

Repeat clinic attendances

Doctors experiencesDoctors experiences

Overloaded clinics

Inappropriate referrals

Low conversion ratio

Nurses experienceNurses experience

Service improvement

Keen to expand practice

New challenge

Training and supervisionTraining and supervision

2 years in breast careUndertaken A11 courseAttended Radiation Protection study dayPerformed 100 clinical examination

supervised by consultant

Nurse Led Breast Clinics (1)Nurse Led Breast Clinics (1)

Breast pain

Family History

Recurrent cyst aspiration

Nurse Led Breast clinics (2)Nurse Led Breast clinics (2)

Consultants refer from GP lettersWeekly20 minute slotsSpR also in clinicConsultant coverLetters to GP read by consultant

Problems encounteredProblems encountered

Clinic space

Radiology

Agreeing protocols

Inappropriate referrals

D isch arg e

G ive n on -cyc lica lb reas t p a in lea fle t

D iscu ss b reas t aw aren ess

S u g g es t n on -s te ro id a lan ti- in flam m ato ry d ru g s

D iscu ss d ie ta ry fac to rsb ra su p p ort

sm ok in g

R eass u ran ce an dexp lan a tion g iven

N on cyc lica lb reas t p a in

D isch arg e

G ive c os toch on d rit islea fle t

D iscu ss b reas t aw aren ess

S u g g es t n on -s te ro id a lan ti-in flam m ato ry d ru g s

A d vise g en tle exerc ise

D iscu ss lifes tyle tod e te rm in e cau se

C os toch on d rit is

R e fe r to c lin ica l su p erviso r

L u m p p a lp ab le

C lin ica l exam in a tion

H is to ry

Clinical Guideline 5

Non-cyclical Breast Pain

Does it make a difference?Does it make a difference?

Patients experience

Doctors experience

Nurses experience

Waiting times 2001Waiting times 2001

0

20

40

60

80

100

120

140

160

180

July Aug Sept Oct Nov Dec

Urgent

Soon

Routine

Waiting times 2002Waiting times 2002

0

10

20

30

40

50

60

Urgent

Soon

Routine