Community Matron

MAIN DUTIES Facilitate the ongoing support of frail and complex Haringey clients in their homes and the wider community. You will be actively supporting the avoidance of unplanned hospital admissions wherever possible through your clinical knowledge and support from the Multi-disciplinary Team. . Be aware of and utilise the resources a multi-disciplinary team offers in the provision of total patient care. To support manage the team on a day to day basis, providing other staff with your clinical knowledge for better decision making and skills development. Act as a link for the MACC Team with GPs, other community based nurses, LAS, Social Services and other relevant professional areas And organisations as necessary. Use the standardized initial assessment tool used by all MACC Team professionals to gain a holistic overview of health and social care need. Undertake a comprehensive baseline assessment for each identified patient in conjunction with the AEC consultant, patient, relatives, carers and patient care team. Use the assessment to agree and implement a patient held personalised plan of care to be agreed with the patient, relatives and carers and the patient care team. Ensure that there are effective communications with other agencies regarding care planning and maximize the input of other agencies to support patients at home. Promote self management and health gain through patient education and health promotion activity. Undertake prescribing as required and to ensure that medications are reviewed and highlight possible interactions and changes in line with Whittington Health Nurse Prescribing policy. Perform and document episodic examinations to support proactive monitoring of chronic diseases and identification of early symptoms of exacerbation and liaise with professionals from specialist teams as necessary. Work collaboratively with all of the MACC Multi-Disciplinary team to offer the Haringey client a truly holistic level of health and social care service. Ensure that as far as possible the patient care is provided in the community and to work with the MACC Team to facilitate this and reduce hospital admission. Ensure that all discharges from the caseload are discussed and agreed with the patient and Line Manager. Lead by personal example of best infection control practice at all times.Leadership Assist in evaluating the effectiveness of the service in relation to patient outcomes. Act as a role model in assisting to develop the practitioner role according to service demand and evolving models of care. Provide senior clinical advice relating to patients with complex needs to the MACC team. Undertake duties as delegated by the Line managers; this may include standard setting, clinical audit and benchmarking in order to ensure the delivery of effective, evidence- based care. Work with colleagues and users, to identify the changing needs of Whittington Health Community Services and the population it serves and promote practice that is dynamic, efficient, innovative and continuously improved in its relevance and responsiveness to the needs of clients and patients. Assist in developing strategic initiatives to reduce and avoid unnecessary hospital admissions and move forward community long term conditions management and integrated working agendas. Use information technology and ensure that relevant and up to date information on clinical and service developments are provided to agreed timescales. Participate in managing and coordinating the work of the junior staff, offering support and development as appropriate. Assist in the recruitment and selection of staff for the team and to participate in induction and orientation programmes as appropriate. Promote good communication, employment practices and relationships within the team. Participate in (and lead where appropriate) team meetings.Risk Management Assist in ensuring that clinical risk is assessed and managed in line with professional and Whittington Health standards. Ensure that comprehensive risk assessment and management strategies are incorporated into all patient assessment and care Ensure that the information contained in any Comprehensive Risk Assessment is responsibly shared with members of the Multidisciplinary team, Social Services and other agencies in order to appropriately manage and reduce risk. Adhere to Whittington Health and Safety guidance at all times and to lead by personal example of good practice.Record Keeping Ensure accurate, contemporaneous records are kept that facilitate safety and continuity of patient care. This is to include both paper and electronic records kept within the office and in the patients own home. Ensure accurate statistical data is promptly submitted in line with Whittington Health Guidelines.Quality Work within Whittington Health Quality and Assurance Standards including the monitoring and reviewing of quality standards, policies and protocols as required within the service. Take the service lead in areas where there is a specific nursing need as agreed with the Lead Matron. Ensure that the care given meets the standards and policies set by Whittington Health. To inform line management of constraints that will prevent these standards from being met. Respond promptly to any incident where service quality has fallen below an acceptable standard and report to the Lead Matron. To investigate such incidents and set action plans to ensure that identified weaknesses are resolved. Investigate complaints and clinical incidents as delegated by the Lead Matron making recommendations about changes to practice and service that may result.Professional Development and Responsibilities Act within the Nursing and Midwifery Council The Code (2018 revised) Undertake further educational qualifications and training in order to increase professional knowledge and remain updated Participate in research projects, clinical audit and/or innovations following agreed policy and protocol, leading on these in certain areas as agreed with the Lead Matron. Submit timely information relating to service performance indicators and the Quality and Assurance Department. Regularly participate in clinical supervision and act as a clinical supervisor to junior staff. Where the post holder has particular expertise, act as advisor/resource person to other staff.

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