Virtual Ward Co-ordinator

Job description

Job responsibilities

PLEASE SEE THE ATTACHED JOB DESCRIPTION FOR FULL DUTIES OF THE ROLE.

Main Purpose of the Job:

The post holder will work as a senior Coordinator for the Recovery at Home Team, based within the Hospital site and Community Site when needed.

The post holder will need to work closely with key stakeholders within the Acute Trust and including all Community Services delivering a community driven, discharge to assess approach to discharge enabling the effective flow of people into the right service at the right time.

Where necessary such as at the point of discharge from the virtual ward, the post holder should ensure good communication and joined up working is in place with the person's registered GP practice

To work autonomously, assessing an individual patients needs, identifying people appropriate for Virtual Ward based care: determining a plan of care and initiating appropriate holistic, research-based health information and care.

To work within agreed Trust Pathways of Care, ensuring safe, prompt and effective decision making.

Lead and manage a Multi-disciplinary Team to ensure the day-to-day operational delivery of high-quality care for those patients admitted to the Virtual Ward. This role will include working across the wider health system to ensure the delivery of proactive management of this group of patients

Work collaboratively with Multi-Disciplinary Teams to ensure practice is efficient, effective, evidence based and to help create clinical management plans to support patients to remain safely at home.

To act as a resource for all members of the Multi-Disciplinary Team, providing expert advice concerning aspects of the persons management plan.

Alongside the Virtual Ward team to deliver effective communication about the virtual ward patient with the person's registered general practice, ensuring that information is conveyed appropriately and supports delivery of a seamless care pathway

As Virtual Ward Coordinator, you will ensure successful and timely onward transition to the next step in a persons pathway.

The Virtual Ward Coordinator will use a problem- solving approach, working with members of the multidisciplinary team to facilitate effective discharges into the Virtual Ward, with a focus on a persons clinical and holistic needs working within the Virtual Ward pathways

To work to ensure a seamless interface between acute colleagues identifying people medically fit for discharge, then ready to leave hospital.

To contribute to the overall management and development of the service

To lead, motivate and support the colleague's approach to delivering new and innovative models of care for people.

To lead a continuously improving service, by ensuring systems are in place to support clinical governance, quality monitoring and ongoing research and audit of practice.

Ensure systems and processes are in place to maintain patient safety.

To be responsible for ensuring that agreed professional standards are reflected in practice and to have overall responsibility for monitoring the standard of care.

To improve the patient journey by increasing access to assessment and appropriate care and treatment, by auditing and reviewing the Virtual Ward regularly

Support the development and delivery of new national initiatives both in relation to, Virtual Wards

Proactively plan for and enable timely discharge of patients from the Virtual Ward, liaising with other agencies to provide ongoing care if required

The role may include caring for people and their relatives/informal carers who are anxious, confused or distressed and clear communication skills and empathy is required to offer reassuring and guidance. A part of each working day involves talking to patients either via the telephone, videocall or face to face.

Provide a high-quality support service to patients on the Virtual Ward caseload.

Promote the knowledge and understanding of the range of services available across organisations

Act as a link person between the wider Virtual Ward team and other agencies, maintaining and promoting positive working relationships with all referring agencies

Participate in the development of initiatives within the service

If required, will manage staff including assuring completion of supervision, appraisals and compliance with mandatory training

Oversee and delegate remote monitoring of patients across a variety of clinical pathways including respiratory and frailty

Undertake clinical assessment of patients on the Virtual Ward and develop, implement and evaluate care and treatment plans.

Use their advanced assessment skills to assess patients who are on the virtual ward, and whose observations taken via remote monitoring require further assessment and review face to face.

Ensure there is an effective referral pathway for the Virtual Ward including initial triage. Referrals will be received

The Virtual Ward Coordinator will support caseload management, ensuring that service delivery is implemented to the highest standard inclusive of best practice and utilises a patient centred approach.

The Virtual Ward Coordinator will be a liaison and a single point of coordination for those readmitted to Hospital or stepped up to SDEC for investigations. The Coordinator will discuss the outcome of assessments with the clinical team and support, where possible a timely discharge back to the Virtual Ward.

The post holder will provide patients with a physical health and biopsychological assessment and where necessary will complete frailty assessments for frailty patients. In partnership with the Frailty Team ensure monitoring of Clinical Frailty Score for all patients identified with frailty alongside a Comprehensive Geriatric Assessment.

To work alongside Assistive Technology teams to ensure that all patients have access to tablet and a data connection.

The post holder will demonstrate detailed knowledge of digital monitoring and be able to support patients with familiarising themselves with technology and monitoring devices such as BP or SP02 monitors.

Person Specification

Qualifications

Essential

• Degree in a health-related subject and current professional registration (NMC or HCPC)
• Mentorship/ Practice Assessor/ Educator qualification or equivalent qualification or equivalent
• Advanced physical assessment and history taking course

Desirable

• Masters in health / leadership related subject
• Management and leadership training
• ILM qualification
• Independent NMP Prescribing Qualification

Experience

Essential

• Extensive post registration experience, some of which will be at a senior level within the required specialist area of practice
• Portfolio of evidence of continuous professional development
• Experience of practice development, clinical education or leading change
• Experience of leading clinical Audits
• Experience of working in Community/Acute Setting with experience of managing frailty and or patients with long term conditions.
• Previous experience of multiagency collaboration working across professional boundaries
• Experience of practice development, clinical education or leading change in practice to upskill and support staff
• Clinically credible, with significant experience at Senior Nurse level

Desirable

• Caseload management
• Involvement in service review and development
• Knowledge of Digital Health Monitoring Systems

Skills and Knowledge

Essential

• Demonstrable leadership skills and an understanding of own leadership style
• Excellent interpersonal and communication skills
• Evidence of ongoing professional development,
• Expert assessment, analytical, interpretation and clinical decision making
• Ability to work autonomously within role in a complex / changing environment
• Significant knowledge of Community service provision, including social care and charity delivered services
• Knowledge and understanding of relevant National polices and guidelines relevant to the area (admission avoidance and early supported discharge services)
• In depth knowledge of frailty and Long-Term Conditions
• Ability to effectively challenge stakeholders while maintain professional relationships
• Excellent written and verbal communication skills
• Effective time management skills
• Effective team working
• Effective planning and organisational skills - ability to prioritise workload
• Competent in IT skills

Desirable

• Caseload management
• Understanding of budget and financial control systems
• Research skills

Physical Skills

Essential

• Ability to assist patients to move as per Trust Moving and Handling Policy
• Car Driver (full license)

Disclosure and Barring Service Check

This post is subject to the Rehabilitation of Offenders Act (Exceptions Order) 1975 and as such it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service (formerly known as CRB) to check for any previous criminal convictions.

Certificate of Sponsorship

Applications from job seekers who require current Skilled worker sponsorship to work in the UK are welcome and will be considered alongside all other applications. For further information visit the UK Visas and Immigration website (Opens in a new tab).

From 6 April 2017, skilled worker applicants, applying for entry clearance into the UK, have had to present a criminal record certificate from each country they have resided continuously or cumulatively for 12 months or more in the past 10 years. Adult dependants (over 18 years old) are also subject to this requirement. Guidance can be found here Criminal records checks for overseas applicants (Opens in a new tab).

UK Registration

Applicants must have current UK professional registration. For further information please see NHS Careers website (opens in a new window).

Employer details

Employer name

South Tyneside and Sunderland NHS Foundation Trust

Address

Sunderland Royal Hospital

Kayll Road

Sunderland

SR4 7TP

Employer's website

https://www.stsft.nhs.uk (Opens in a new tab)