ANZICS S&Q 2014 - RRT: Michelle Topple on the Austin MET Nurse program
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The document provides an overview of the MET Nurse Program at Austin Health, a major tertiary health provider in Melbourne. It describes the roles and responsibilities of MET nurses, which include attending emergency calls, assessing and assisting with deteriorating patients, educating other staff, and working in the ICU. The MET Panel oversees the program and ensures a high quality of care. The program trains ICU nurses to become accredited MET nurses over the course of 6 months through lectures, workshops and supervised calls. So far 75 nurses have graduated from the program, helping to improve outcomes for deteriorating patients across the health service.
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ANZICS S&Q 2014 - RRT: Michelle Topple on the Austin MET Nurse program
- 1. MET Nurse Program Michelle Topple Associate Nurse Unit Manager MET Panel Chairperson Department of Intensive Care
- 2. Austin Health • Major provider of tertiary health in north eastern Melbourne • Operates 980 beds across acute, sub-acute and mental health – Over 560 acute beds • State referral service for liver transplantation and spinal cord injuries
- 3. Overview of ICU and the MET • Funded for 20 ICU beds • 2200 ICU admissions in 2013 • 2300 MET calls in 2013 • >12% of patients having MET calls in 2013 were admitted to ICU • 230 nursing staff (75 MET accredited) • Funded for a MET nurse 24/7 • MET = MET nurse and registrar
- 4. MET Panel • Consists of 4 senior nurses • Formed in September 2011 • Run MET Program • Provide leadership and accountability for MET nurses • Works closely with NUM, MET Director and ICNC service to ensure a quality MET service
- 5. Roles of the MET nurse • Attend Emergency calls – MET and Respond Blue (Austin Tower & ONJCWC) – Emergency Medical Review (EMR) and Respond Blue calls (Mental Health Precinct) • Review patients as requested by ICNC, ICU registrars, ANUM’s and/or other MET nurse esp. after hours
- 6. Roles of the MET nurse – cont. • Patient assessment • Assist with determining the aetiology of the deterioration • Providing advanced treatment requirements • Assisting with providing a management plan • Ensuring appropriate follow-up • Support and educate ward staff • Provide transport of patient to an appropriate location • Report adverse events
- 7. Roles of the MET nurse – cont. • Assist MET registrar with reviewing patients • Assist MET registrar with procedures on patients outside of the department
- 8. MET nurse role within the ICU Responsibilities may include, but are not limited to: • Checking the MET trolleys and equipment • Education and support • General nursing care within the department
- 9. Expectations of our MET nurses • A comprehensive knowledge of Austin Health protocols and procedures in relation to MET, EMR and Respond Blue calls Clinical performance • BSL and ACLS • Assistance with intubation, insertion of invasive lines & haemodynamic monitoring • Preparation and administration of medications required for resuscitation • Setting up and administering of NIV • To have advanced knowledge and assessment skills when attending to the deteriorating patient
- 10. Expectations of our MET nurses - cont. Professional Behaviour • To communicate effectively with all responding staff in a respectful, supportive, constructive and non-critical manner • Display accurate written and/or electronic documentation relating to the emergency call • Display a professional manner, promoting collegiality amongst the multiple care providers • Maintain a continuous professional development approach and be reflective of their practice • To ensure a timely review of patients when referred by the ICNC, ICU consultant, registrar or previous MET nurse
- 11. Application criteria for the MET Program • Min. 3 years Post Graduate experience in a level 3 tertiary ICU • March and September intake • 1 page expression of interest with 1 ICU ANUM as a referee • MET Panel assess (in consultation with the NUM) • 6 months to complete the program • MET mentor (senior MET nurse) • Handbook
- 12. Handbook Competencies • MET lecture • MET Behaviour workshop • MET trolley competency • 5 MET calls under supervision • Written Intubation competency • CPAP/High Flow practical • 2 verbal scenario’s • Navigation to remote areas of hospital
- 13. To Date • 4 MET programs have been completed • 8 participants in the first program • 6 in the following 3 programs • 1 nurse withdrew from the program • 1 nurse required an extension • Currently 75 accredited MET nurses – 25 of these completed this program • No March 2014 program to allow new MET nurses more opportunity to consolidate post program
- 14. What we have learnt along the way • 6 participants is the max. per program • Some ICU nurses are not suited to the MET • Behaviour & personalities can be difficult to manage – difficult conversations • Self directed learning has pro’s and con’s • Accept to hear all the negatives and less positive feedback • Good for staff moral, stepping stone for CNS
- 15. What about the future? • Continually review and evaluate the MET program (evaluations post each program) • Run a MET nurse symposium • Continue to analyse and review data • Continue to work towards timely management of the deteriorating patient to improve outcomes • Participate in future research activities (MET nurse role) • Utilisation of simulation in training MET nurse
- 16. Questions?
Editor's Notes
- MET Registrar also is responsible for a 5 bed pod
- 4 senior nurses being clinical nurse specialists and Associate Nurse Unit Managers
- Education of staff: assist with problem solving, support and educated student’s and fellow staff
- The Handbook guides staff through the requirements of the program Contains information regarding roles and responsibilities as the MET Nurse
- The MET Lecture discusses roles and responsibilities and the behaviour workshop outlines expected behaviour at a MET call and the negative impact poor behaviour can have for the service. They are conducted by the MET panel Trolley competency-show awareness of where and how to use equipment on MET trolley eg. Monitor Learning tool on equipment and common themes when assisting with intubation and requires participant to answer questions displaying advanced clinical knowledge CPAP/High Flow is a practical competency where participant must display how to put together equipment and knowledge of when to use it We have put together 4 scenarios in which we ask participants to talk us through how they would manage 2 of them displaying there clinical knowledge of the deteriorating patient and ability to problem solve We have the ONJC and the MHP outside the Austin Tower certain routes have been designated to promptly and safely get to MET calls in these areas and designated ways to get patients appropriately into the ICU using emergency access keys and swipe cards
- Too busy for more than 6 participants at a time and ensuring they get opportunity to attend MET calls with senior MET nurses for experience Some nurses do not feel comfortable caring for a deteriorating patient outside of the ICU Self directed learning some are better at it and more motivated than others Discussing issues with regards to performance or lack of clinical experience is not always easy A lot of staff look at being a MET nurse for variety, more responsibility in the unit or challenging themselves professionally
- Common themes from evaluations so far have been: wanting more time eg a half day study day/Symposium Looking at MET nurse role within the team, training and development of MET nurses