The use of a nursing HCA to work as part of the MDT in critical care, working across professional boundaries.

Purpose

The purpose of this project was to evaluate the role of the nursing HCA as part of the critical care multi professional rehabilitation team, with the express purpose of boosting rehabilitation during periods when there was no therapies services, and to fully embed the ethos of 24/7 hour rehabilitation into the critical care culture.  

Approach

HCA establishment within critical meant there was scope to release a band 2 nurse to join the rehabilitation team and work across professional boundaries (Physiotherapy, occupational therapy, SALT and dietetics).

Initially this was for a secondment period of 6 months.

A job role and description was devised and profession specific competencies developed.

The HCA was then embedded in the rehabilitation team (working full time over 4 long days, including weekends)

The role included assisting with physical and non physical rehabilitation, facilitating self-care, empowering the patients and relatives to be more involved in rehabilitation, acting as a vital link between the therapists and the rest of the critical care team.

Simple functional outcome measures were collected (JH HLM- Johns Hopkins Highest level of mobility- and an occupational therapy personal care score)

These outcomes were collected and retrospectively compared to the scores prior to the establishment of the HCA rehabilitation role.

Outcomes

The number of patients achieving their rehabilitation goals across the 6 month period increased , with significant improvements in those able to reach their goals at weekends when no existing rehabilitation service was available.

Feedback from staff was very positive, with rehabilitation having become embedded in the culture of the ITU.

This role was felt to have bridged the gap between therapy and nursing care delivered to critically ill patients.  

The role was successful with improvements seen in simple outcome measures and therapy input over 7 days as opposed to 5 .

The role was initially trialled for 6 months and will now continue with all HCA staff on ITU being given the opportunity to work as part of the rehabilitation team for 6 months at a time.

Cost and savings

Cost was for a 1.0 wte band 2 HCA , this came out of the existing critical care establishment and budget. 

Difficult to assess the impact on LOS as in critical care this is multifactorial. 

Implications

  • Improvements in patients physical and functional outcomes as well as non physical support for patients and families.
  • Overall impact on LOS has not been assessed.
  • Job satisfaction and skill enhancement for HCA staff. 

Top three learning points

  1. The importance of choosing the right person for the role.
  2. Provisions for support of the HCA when therapy staffing numbers were low or reduced.
  3. Expansion of outcome measures and data collection.

Fund acknowledgements

Band 2 HCA post was funded by the Critical care directorate at the Royal Liverpool and Broadgreen University Hospitals NHS Trust. 

Additional notes

This work was presented at Physiotherapy UK 2019, and ICS state of the art meeting 2019. 

 

For further information about this work please contact Sarah Dyson.