Haemoglobinopathy Care Coordinator
3 weeks ago
Specific duties / patient care 1 Contribute to the holistic needs assessment and the development of individual care plans under the direction of the Clinical Nurse Specialist. Implement, monitor and review aspects of the care plan with the patient and carer, reporting any changes in the patients condition to the Clinical nurse Specialist. Evaluate outcome of care delivery with the Clinical Nurse Specialist. To review patients on the ward under the direction of the Clinical Nurse Specialist.
Demonstrate the ability to recognise and respond appropriately when faced with a sudden deterioration or an emergency situation, alerting the team or enabling rapid response as appropriate. To triage incoming calls into the service and provide initial triage to patients or carers contacting the service. Take queries and assess the most suitable method of solution, liaising and discussing complex cases with the Haemoglobinopathy Clinical Nurse Specialists Provide general telephone advice, signposting patients/carers to other sources of support as appropriate, such as other Healthcare Professionals, websites, written information etc. Coordinate appointments or investigations for efficiency and patient experience.
Liaise with the MDT coordinator to ensure a seamless service for patients and smooth transition through the patients care journey. To identify patient/carer general informational needs, accessing / signposting to the support services in the community. Identify indication of need or changes in need through telephone contact and respond appropriately. Support the Clinical Nurse Specialist in the coordination of care to facilitate safe and effective transition between services in order to provide seamless support for people.
Support the delivery of patient and carer advice and education. Advise patients on individual self-care management support and education as necessary to non-complex patients, including how to self-assess. Encourage and support healthy life style choices To provide Level 1 psychological support to patients/carers, referring patients who require Level 2 support to the Clinical nurse Specialist. Make scheduled catch up calls to patients to check on health and wellbeing and any emerging / ongoing needs and refer to Nurse Specialists if appropriate.
To coordinate the follow up investigations required as part of the patients treatment. To maintain an accurate and validated Haemoglobinopathy data base(s) e.g. glucose tolerance test. To develop and maintain a good professional relationship with patients and with the specialist Haemoglobinopathy team.
To facilitate access to health and well-being services and other support services. To provide basic telephone advice and refer on or sign-post to other sources of support as per instruction. Prepare relevant written patient related information. Provide supported self-management through coaching around managing side effects of the disease or treatment as well the psychological, financial, and social and employment burdens of living with a Haemoglobinopathy.
Provide health promotion advice to patients and their carers/relatives around being active and making healthy lifestyle choices, and make referrals as appropriate. To be a point of contact for patients whilst they remain Haemoglobinopathy patients.
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