The Orthopaedic Clinical Nurse Specialist (CNS) works within the multidisciplinary team (MDT) and in line with the five core competencies of the CNS role: Clinical Focus (direct & indirect care), Patient Advocate, Education and Training, Audit and Research & Consultant.
The Orthopaedic CNS service is delivered from University Hospital Limerick (Dooradoyle site) the department of Trauma Orthopaedics is within the Peri- Operative Directorate. In-patient & Out-patient service provided.
Clinical Focus: (direct care)
- Participation in daily MDT ward rounds to monitor the effectiveness of care provided to orthopaedic patients and as a resource of specialist knowledge and clinical expertise.
- Co-ordinates the information, education and training received by patients and families by the development of evidenced based guidelines & patent information leaflets.
- Actively participates within fracture clinics by undertaking the removal of k-wires following surgical repair of wrist fractures independently.
- Provides care and education to patients who are experiencing a delay in fracture healing, Ultrasound treatments available once requested by an Orthopaedic Consultant.
- Undertakes data collection required for the National Irish Hip Fracture Database (In-patient & Out Patient)
CNS Hip Fracture Review Clinics:
- 6 clinic sessions weekly
- Mobility assessment/clinical examination/history taking
- Assessment for post op complications
- Ordering & examination of x-ray
- Education on expected post operative out come
- Assessment for compliance of Bone Protection Medications
- Referral for Dexa if necessary
- Follow up on bone histology/Micro
- Authority to discharge
- Liaise with General Practitioner (letter) on discharge
- Patients can attend (self referral) outside of routine follow up if required
Limb Reconstruction Clinic
- Weekly clinic
- Pre & Post operative assessment of patients who will or who have undergo Limb Reconstruction Procedures
- Pre- Operative CNS assessment (highlighting any medical risk for surgery with medical team)
- Bloods, x-rays, ECG, surveillance swabs
- Pre-operative education of patient and families
- Pre- operative measurement for limb fixator
- Post operative wound care
- Post operative re-construction of frames
- Change of clickers, rods, frame dynamisation, removal of broken hardware
- Independent X-ray ordering & interpretation and amendment of plan of care as required
- Liaise with MDT (GP, PHYSIO, PHN, SOCIAL WORKER, PAIN TEAM, MICROBIOLOGISTS)
- Post operative monitoring for complications
- Pin-site infections, reduced range of movement above or below fixator, premature/delayed consolidation
- Independent removal of fixator
- Patients can attend out-side of routine follow up if required by contacting CNS directly.
- Attends theatre for application of Ilizarov external fixator to assist or undertake frame construction
- Provide education and support to patients following application of external halo brace for cervical spine fractures/injuries
- Assist with removal of halo brace in out-patients
- Point of contact for halo patients following discharge
Clinical Focus: (indirect care)
- Development and implementation of Orthopaedic Nursing Guidelines/Policies to unsure best practice and evidenced based care.
- Development of patient pathways (hip fracture) and patient information leaflets
- Management and ordering of ilizarov stock required for out-patient service
- Co-ordination of admission of elective orthopaedic procedures that are required to be undertaken in UHL.
- Encourage patient groups to be involved in the decision making process regarding their care and accurately represent the patients views within the MDT
Education and Training
- Inform on best practice through guidelines and patient information leaflets and changes in practice
- Delivery of educational sessions
- Education and training of new nursing staff and junior NCHD’S on specific aspects of trauma orthopaedic care
- Remain up to date on new developments of orthopaedics by extensive reading and attendance at national orthopaedic conferences.
Audit and Research
- Promote and advocate MDT audit and research and implement findings
- Assist and has led out on multiple research and audit projects, findings disseminated locally and nationally. Publications in the International Journal of Orthopaedic Nursing, Irish Medical Times and The Journal of Bone and Joint Surgery.
- Three clinical papers that were presented were awarded “Best Clinical Paper” at the Atlantic Orthopaedic Meeting 2012 & 2009 and Irish Foot and Ankle Meeting 2010
- Available to other nurses for consultation including students and PHN as a resource for resource of specialist orthopaedic knowledge.
- Assists and leads on service improvement projects
- Promotes a collaborative approach to care and service delivery.