Service Improvement Plan Executive Summary District nurses face a lot of challenges in their work. One major challenge in this respect is heavy workloads that come with insufficient rest, stress and related problems. This problem can however be solved if the number of referrals that come their way is reduced…
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The project involving nurses at the district and ward levels will involve filling of the checklist before referrals are made to district nurses. A pilot study will be done to establish the effectiveness of the proposed criteria before necessary changes are made to improve the criteria and associated processes. Evaluation of the project will be based on the number and type of referrals to district nurses after the implementation of the criteria in comparison to data obtained before the institution of the project. Introduction Several changes have been witnessed in nursing practice at the district level over the last couple of decades. Some of the changes that are evident include the introduction of new technologies to help in nursing, the rise in morbidity rates, and the increase in mortality rates. Yet another major change in the same respect is the attendance to more complicated cases in the community. With this being the case, it is beyond doubt that the nursing fraternity in the district has become overloaded which has effectively increased the stress levels experienced by the nurses. In order to solve this problem it is proposed that a District Nurse Checklist be created and instituted for use in deciding whether or not a patient should be referred to a district nurse for care. The proposal will rely on a SWOT analysis of the proposal considering its effectives in predicting the internal and external forces that may affect the success of the project. During implementation, the PDSA cycle will be applied considering its effectiveness, limited resource requirements and limited risk association. Analysis of Change Needed According to the Royal College of Nursing (2003), a major problem facing district nurses is the huge number of referrals that they have to handle. More specifically, the problem is seen when such referrals are uncalled for. Clover (2010) notes that for every single inappropriate referral to a district nurse, close to five hours of precious time is lost. A study conducted in the past revealed that several patients were discharged from hospital with community nurses taking little or notice of the events (Clover 2010). The study further revealed that several cases of referrals were inappropriate and therefore had to be re-routed or altogether declined. It must be taken into account that there are several alternatives that can effectively be applied to ensure proper home are to patients who have been discharged. Some of these alternatives according to Vafeas (2000) include practice nursing, visiting clinics and making outpatient hospital visits. A report by the Audit Commission (1999) reveals that of all referrals to district nurses, 11% are unwarranted. Practical experience during clinical practice as a member of district nursing teams has shown that inappropriate referrals are associated with a lot of time and resource wastages. What this means is that without a proper referral criteria that assists clients and other health practitioners in deciding when and when not to effect a referral, the situation is bound to get worse. In effect, when a referral criteria is developed, various parties will better understand their responsibilities and roles, the district nursing service will enjoy greater credibility, and health practitioners will be encourage to work in unity. Health practitioners, patients and clients among other parties should appreciate the reason for the establishment of the
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