Chronic Disease Nurse

IN RELATION TO DIABETES MANAGEMENT The clinician should have an in depth understanding of diabetes and the health implications associated with the disease and how diabetes is diagnosed, treated/managed. The clinician running clinics is expected to: Initiate the process of diagnosis for patients with suspected diabetes and refer to GP as appropriate. Assist in the management of patients with newly diagnosed diabetes following practice guidelines, protocols and policies Support patients in the management of their diabetes (type I and type II) Support educate and provide literature for patients with diabetes Provide emergency treatment for hypo/hyperglycaemic emergencies Make appropriate referrals (dietician, podiatrist etc) Be able to adjust medication/give guidance in changing dosage of insulin and refer to GP as necessary. Contribute to the implementation of the National Service Framework Contribute to the maintenance of the practice diabetic register Manage diabetic patients in line with
the Quality & Outcomes Framework (QOF), including the use of relevant templates.

Attendance at in-house and external review meetings. The clinician should work with the relevant Administrator to ensure appropriate patients are invited and attend relevant Chronic Disease Clinics. IN RELATION TO THE MANAGEMENT OF CORONARY HEART DISEASE & ATRIAL FIBRILLATION The clinician should have an understanding of CHD and AF The clinician running clinics is expected to: Contribute to the implementation of the National Service Framework. Develop and maintain practice register for primary & secondary prevention of CHD.

Work within agreed protocols when managing risk factors to enable patients to manage their own disease. Provide psychological support by discussing interventions and treatments. Work with patients to set action plans for changes of lifestyle . Advise patients on lifestyle management and drug compliance for reducing the CHD risk factors eg: Hypertension, Angina, Myocardial infarction & Cerebrovascular accident.

Manage patients in line with the Quality & Outcomes Framework (QOF), including the use of relevant templates. Attendance at in-house and external review meetings. The clinician should work with the relevant Administrator to ensure appropriate patients are invited and attend relevant Chronic Disease Clinics. IN RELATION TO HYPERTENSION The clinician should have an understanding of hypertension.

The clinician running clinics is expected to: Contribute to the implementation of the National Service Framework Develop and maintain practice register for hypertension. Work within agreed protocols when managing risk factors to enable patients to manage their own disease. Manage patients in line with the Quality & Outcomes Framework (QOF), including the use of relevant templates. Be competent at performing and analysing blood pressure readings and advising/ prescribing as appropriate.

IN RELATION TO PATIENT REVIEWS The clinician should have an understanding of stroke and myocardial infarction and be able to carry out patient reviews including review of post admission medication once the patient has been discharged and provide appropriate follow-up advice. IN RELATION TO OTHER CLINICAL WORK SCREENING Undertake routine & opportunistic screening and health checks BP checks, height, weight, BMI, smoking status, alcohol intake, blood sugar measurement, peak flow (if clinically competent). HEALTH PROMOTION Recognise patients readiness to change in supporting their attempts to change unhealthy behaviour. Provide healthy eating advice to individuals or to groups.

Provide smoking cessation signposting individually in opportunistic and planned consultations. Provide individual advice to patients about increasing activity or exercise. Offer advice on recommended safe limits for alcohol consumption and safe drinking practice. Contribute towards the maintenance of health promotion material within the practice and waiting room notice boards.

Refer as appropriate. INFECTION CONTROL Support patients and colleagues in adopting sound infection control measures. Apply infection control measures within the practice according to national and local guidelines. This includes: Completion of Infection Control Audits, and acting upon any identified areas.

Universal hygiene precautions. The collection and handling of laboratory specimens. Segregation and disposal of waste material. Decontamination of instruments and clinical equipment.

Reporting and treatment of sharps injuries in accordance with the Practice Needlestick injury policy. Dealing with blood and body fluid spillage. Educate colleagues in adopting sound infection control measures. EMERGENCY MANAGEMENT Maintain competency in basic anaphylaxis and resuscitation techniques.

Attend two yearly update re managing anaphylaxis. Attend annual resuscitation training. Attend annual defibrillation training. CHILD HEALTH/CHILD PROTECTION Recognise the signs, symptoms and categories of child abuse.

Understand the importance of recognition, observation, documentation and communication. Awareness of child health procedures, statutory local procedures and points of referral. Knowledge of other practitioners and agencies roles. Understand basic legal issues around child abuse.

SAFEGUARDING Recognise the signs, symptoms and categories of abuse in children and vulnerable adults. Undergo appropriate levels of safeguarding training at designated intervals. Extensive knowledge of in-house safeguarding procedures. Knowledge of other practitioners and agencies roles.

Understand basic legal issues around abuse or children and vulnerable adults. MENTAL HEALTH Recognise and have awareness of appropriate referral mechanisms for family violence, vulnerable adults, substance abuse and addictive behaviours. Recognise psychological needs of patient presenting with depression or suicidal tendency. DEPENDING ON THE SKILLSET OF THE CLINICIAN, THE ROLE COULD ALSO INCUDE: MENS HEALTH Initiate opportunistic consultations with patients to cover issues of mens health.

Raise awareness and give basic advice on issues covering: Testicular self examination. Testicular self examination. Incontinence and prostatic disease. Family planning.

Sexual health. Participate in screening programmes as appropriate. Make appropriate referrals. CONTRACEPTION AND SEXUAL HEALTH ADVICE Advise patients on available methods of contraception and refer patients as appropriate.

Support patients attending for emergency contraception and prescribe/refer as appropriate. Perform interval health checks for patients using hormonal contraception. Offer health promotion / lifestyle advice to patients on reducing risk of sexually transmitted infection and refer as appropriate in line with practice policy. Undertake appropriate diagnostic and / or screening tests for sexual infection as clinically indicated following a period of training and supervision.

WOMENS HEALTH Advise patients on national and local cervical cytology and mammography screening programmes. Undertake routine and opportunistic cervical cytology sampling (if in skill set) in accordance with the NHS Cervical screening programme following a period of accredited training and supervision. If undertaking audit a minimum of twenty consecutive smears each year to demonstrate an adequate sampling rate of 12.7%. Promote breast self-awareness, demonstrate breast self examination and provide supporting literature.

WOUND MANAGEMENT Devise and follow appropriate wound management plans for individuals. Perform wound care using aseptic technique. Suture and clip removal. Assist with minor surgical procedures.

Assist with IUCD insertions/checks. IMMUNISATIONS, VACCINATIONS & INJECTABLES Administer medications and vaccinations under an individualised prescription or Patient Group Direction and in accordance with the Guidelines for Administration of Medicines (NMC 2000). After a period of training and supervision to deliver the national Childhood Vaccination Programme. Ensure safe storage, rotation and disposal of vaccines and drugs throughout the surgeries - including those held in doctors bags MEDICINES MANAGEMENT Work in collaboration with the PCN Pharmacy Team on medicines optimization and quality improvement.

PRESCRIBING Qualified Independent or supplementary prescribers to prescribe within scope of competence.