The Role of the Enhanced Recovery Facilitator

Abstract

The key to ensuring successful implementation of enhanced recovery is engagement, commitment and involvement of the multidisciplinary team across the local health community. Enhanced recovery (ER) will fail without teamwork and the role of the ER facilitator is paramount to the success of the programme [1]. The ER facilitator must have access to all the key members of the team and be able to convince reluctant colleagues of the importance of change. Since this ER programme crosses all areas of the patient journey, the facilitator will need to have a good understanding of the issues related to each aspect of care. The role of the facilitator is not to give the care at each patient episode but to oversee the programme and ensure that it is carried out in each department.

Appendices

Appendix 9.1: Sample Job Description for Enhanced Recovery Facilitator

Title

Enhanced Recovery Nurse

Grade

Band 7

Key Relationships

Line Manager, Matron, Ward Sisters and Ward staff, Consultants & Teams, Anaesthetists, Physiotherapists, Occupational Therapist, Acute Pain Team, POA, Admissions, Surgical Site Infection Nurse, Enhanced Recovery Nurses from other specialities, Consultant Secretaries, Outpatients, Theatres staff, Business Manager, Social Worker, Pharmacist, Patient’s & Relatives.

Job Summary

The post holder will be responsible for:

• Developing the role of the Enhanced Recovery Nurse, caring for patients undergoing elective surgical procedures.

• To manage the care of the patients in the Enhanced Recovery Programme.

• To develop training programmes for Ward Staff and other disciplines in the Enhanced Recovery Programme.

Main Duties and Responsibilities

Clinical Practice and Practice Development

• 1. The post holder will create and sustain key relationships with the Multi Disciplinary Team, (MDT) the Primary Healthcare professionals and social care to support the interface between primary and secondary services and provide expertise regarding the management of surgical procedures and the needs of patient’s pre and post operatively.

• 2. Identify patients that may have the correct criteria for the Enhanced Recovery Programme and promote appropriate timely referral to the MDT, Primary Healthcare Professionals and liaise with other health and social care providers to promote high standards in discharge planning and remapping patient pathways.

• 3. To work consistently and autonomously as a clinical expert in the post of Enhanced Recovery Nurse.

• 4. To undertake assessment of patients cared for in the Enhanced Recovery Programme, to ensure their suitability and that all potential risks are identified and managed.

• 5. Provide accurate written and verbal information for patients and relatives pre operatively and promote health education.

• 6. Liaise with other health care professionals, documenting the ongoing care requirements and communicating any changes.

• 7. Ensure good communication both written and verbal between all members of the multi disciplinary team, patients and relatives.

• 8. Be a point of contact/professional liaison for all the members of the multi disciplinary team.

• 9. Be a patient advocate.

• 10. Ensure accurate and comprehensive patient records are kept and that all members of the multidisciplinary team are using the correct documentation.

• 11. Ensure patients receive all the relevant information, appointment and discharge documentation on discharge. Provide a telephone follow up service once discharged, be able to provide effective telephone post-operative advice.

• 12. Demonstrate appropriate behaviour in stressful and difficult situations. Support junior members of staff encountering difficult situations.

• 13. Maintain and encourage high standards of practice, challenging those who do not. Ensure corrective action is taken.

• 14. Promote evidence-based decision-making.

• 15. Demonstrate counseling skills for patients and relatives, being supportive when they receive bad news.

Service Development and Management

• 1. Actively support the implementation of the Enhanced Recovery Programme to improve patient care.

• 2. Assist in the development of protocols and pathways, which are evidence based to manage the assessment and treatment of patients on the Enhanced Recovery Programme.

• 3. Provide expert advice to Senior Nurses, Consultants and the MDT to secure quality improvements within the organization and across boundaries.

• 4. Prepare and write regular reports on the outcomes of the Enhanced Recovery Programme for presentation to the Division.

• 5. Maintain a database for all patients on the Enhanced Recovery Programme.

• 6. Participate in presentations in the Trust and for outside organisations in the Enhanced Recovery Programme.

• 7. Keep up to date with developments in the service, introducing new ideas to improve patient care.

• 8. Develop some understanding of the commissioning process to support and inform service redesign across the local health economy.

• 9. Attend relevant meetings providing information as requested.

Research and Audit

• 1. Ensure care being provided is evidence based

• 2. Develop relevant audits to support the development of the Enhanced Recovery Programme and implement recommendations to ensure sustainability of the service.

• 3. Monitor standard of care being delivered. Research and lead on improvements of care.

• 4. Audit outcomes of the Enhanced Recovery Programme, benchmarking other Trusts undertaking the Enhanced Recovery Programme.

• 5. Implement and maintain Surgical Site Infection Surveillance as determined by the Health Protection Agency, liaising with the Trust Surgical Site Infection Nurse.

Professional/Education and Training Role

• 1. To promote the role of the Enhanced Recovery Nurse in the Trust.

• 2. To act as a role model and provide leadership to junior staff.

• 3. Provide guidance and act as a resource for members of staff, supporting and motivating them.

• 4. Provide day-to-day guidance for nursing and junior medical staff.

• 5. Formulate a training programme for nursing and junior medical staff. Promote an active learning environment.

• 6. Actively participate in appraisals, identifying training requirements and maintaining competencies.

• 7. Adhere to the NMC Code of Conduct and Trust Policies.

Financial Responsibility

• 1. Be aware of financial constraints and savings programmes.

• 2. Promote cost saving initiatives.

• 3. Consider financial implications when prescribing and implementing treatments.

Risk Management

• 1. In conjunction with the MDT, set and review standards, protocols and procedures, ensuring remedial action taken if standards fall below acceptable level.

• 2. Adhere to Trust policy by facilitating and using clinical risk evaluation and incident reporting.

• 3. Take responsibility to resolve or remove risk where possible, notifying and working with Manager when not possible.

Note

The duties and responsibilities outlined in this job description although comprehensive are not definitive and you may be required to perform other duties at the request of your manager.

This job description is designed to reflect duties currently incorporated in this post. These may change in the light of changes in the service provided by the Trust. Any such changes will be fully discussed with the post holder.

Person Specification Form

Job title: Enhanced Recovery

Grade: Band 7

Factors	Essential requirements	Desirable requirements
Qualifications	• First level RGN	• Independent nurse prescriber
	• Mentorship & Preceptorship or ENB 998	• Degree in nursing or working towards
	• Good written and spoken English
	• IT skills
	• Evidence of continued Professional development
Knowledge	• Extensive current working and theoretical knowledge of surgical nursing
Experience	• Three years senior nurse experience in surgical nursing	• Experience of presenting to groups of staff
	• Experience of managing a team of nurses	• Experience of counselling
	• Experience of research and implementation of new practices	• Experience of Nurse Led Clinics
	• Experience of developing and writing integrated care pathways	• Nurse led discharges
		• Working in the community
Skills and ability	• Effective communication skills	• Previous experience of undertaking audits
	• Good leadership qualities	• Evidence of leading change management
	• Experience of teaching	• Implementation of new ways of working
	• Experience in change management
	• Able to work autonomously and as part of a team
	• Ability to write reports
	• Ability to work across boundaries
	• Ability to cope with stress and work under pressure
	• Works under own initiative
	• Car driver
Personal qualities	• Motivated
	• Approachable
	• Good interpersonal skills
	• Organised
	• Calm & objective
	• Open to change with the ability to adapt to rapidly changing environments
	• Able to update and manage own development

Appendix 9.2: Sample Flow Charts and Protocols

Fig. A.9.1

Enhanced recovery programme day of admission

Fig. A.9.2

Enhanced recovery programme day of surgery

Fig. A.9.3

Postoperative day 1

Fig. A.9.4

Postoperative day 2

Fig. A.9.5

Postoperative day 3

Fig. A.9.6

Postoperative pain control