Wellington Intensive Care Unit

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PATIENT AT RISK (PAR) SERVICE

The PAR service is a nurse-led team managed from within the Intensive Care service in Wellington Regional Hospital. Their primary role is to support and educate ward staff in looking after acutely unwell adult patients in different ward settings.

They review around 2400 patients every year from a variety of sources. These include all Intensive Care patients discharged to ward areas, acutely deteriorating ward patients, and those who have a clinical emergency call made.

Since August 2010, the PAR nurse has been available 24 hours a day, 7 days a week within Wellington Regional Hospital as well as providing telephone advice for the Kenepuru campus. They are also an important component of the Early Warning Score (EWS) system in use in Wellington Hospital. As of October 2012, they also provide emergency assistance to Wellington Children's Hospital.

In 2011, a PAR Liaison Intensive Care specialist was appointed to help manage the medical & political aspects of critical care outreach in a large multidisciplinary tertiary hospital.

Data taken from all PAR referrals for 2011

ICU FOLLOW UP

All patients discharged from the Intensive Care Unit are followed-up within 24 hours by the PAR service. This helps to ensure the transition to ward-based care is smooth (particularly relevant for long-term ICU patients), answer any questions ward staff may have about ICU management, and has been shown to reduce ICU readmission rates. In addition, they have a valuable role in following-up patients referred to ICU who are deemed 'too well' to be admitted.

The most visited clinical areas are cardiology & cardiothoracics, acute medicine & general & vascular surgery.

CLINICAL EMERGENCIES

PAR nurses are primary responders to both cardiac arrest & medical emergency team (MET) calls through the hospital's '777' emergency alert system. This requires a swift response to assist with advanced airway, breathing and circulation support. They also provide support for the Intensive Care Registrar who attends such calls throughout the hospital.

ACUTE WARD REFERRALS

A PAR nurse review is an important early step in assessing patients who may be deteriorating on the ward. The EWS system in Wellington includes PAR involvement at an early stage of the escalation pathway. They will combine physical assessment with diagnostic skills to help ward nursing staff to provide comprehensive care for their sickest patients. They will also assist with timely and safe transfer of patients to alternative clinical areas if this is required.

THE PAR TEAM

The members of the PAR team all have critical care nursing experience and work at either 'proficient' or 'expert' level. There are 14 PAR nurses and 1 Clinical Nurse Specialist who leads the team. All PAR nurses work part-time (0.2 to 0.6 Full-Time Equivalent) with a second job in another specialty (usually Intensive Care or Emergency Medicine). This ensures clinical currency with critically ill patients. As with ICU, the PAR shifts are 12 hours long.

PAR nurses are expected to demonstrate skill & proficiency with:

Advanced airway management
Cardiovascular support
Resuscitation
Escalating care appropriately
Referral to appropriate specialties
Communication with all healthcare workers, patients and families
Education

SELECTION CRITERIA

PAR nurses must meet the following criteria:

A minimum of 2 years working in Intensive Care or Emergency Medicine
A 'Careers Pathway' progression of proficient, working towards expert
To have completed the ICU or trauma course, working towards certification
To have passed an advanced assessment/diagnostics course
A current NZRC certificate at level 6
Be an excellent communicator
Be able to work effectively under stress
Be able to recognise when intervention is necessary
The desire to extend their knowledge and appreciate the challenges of reviewing unwell ward patients

Nurses meeting these criteria who are interested in working for the PAR service are encouraged to contact the PAR Clinical Nurse Specialist (see details below) to enquire about current job availability.

Clinical oversight for the PAR service is provided by Sarah Imray (Clinical Nurse Specialist), Stephen James (ICU Charge Nurse Manager) & Dr.Alex Psirides (Clinical Liaison)

This page was last updated on Wednesday, 09 September 2020 09:40:00

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