Audrey McAdam

Whilst continuing my training and education in Primary Care I worked alongside GP and ANP colleagues who supported my development in the following role responsibilities:

• Manage the complete clinical care for patients within the area of responsibility, to enhance patient care and improve patient flow in line with national standards.
• Undertake comprehensive physical and mental health assessments, analysing differential diagnoses and decide on the appropriate treatment based on clinical findings for patients with complex multi-dimensional acute or chronic clinical conditions.
• Prescribe medication as appropriate, order investigations, refer to other professionals for tests or examinations and admit or discharge autonomously within the scope of agreed clinical guidelines.
• Identify the need for improvement and change within the area of responsibility and following agreement and approval, implement new policies and practices and where appropriate, service re-design solutions to better meet the needs of the patients and the service.
• Provide clinical leadership to other staff within the area of responsibility that will ensure that they are provided with the relevant clinical advice, guidance and support to undertake their duties.

After the Covid Assessment Centre was up and running well, I was moved to be part of the Care Home Assessment and Response Team (CHART). Many care homes within the Forth Valley area of Scotland had significant outbreaks of coronavirus with many residents affected, some of whom were dying, therefore a dedicated multi-professional and multi-agency team was brought together as a single point of management for care homes to contact. The CHART team was formed of different professionals that included GPs, social care workers, palliative care specialist nurses and Advanced Nurse / Paramedic Practitioners which gave me invaluable experience of working with a large and varied team.

My role within this team was:

• Daily meetings via Teams with Public Health, Social Care and the PCIP CHART team leads.
• Record daily care home patients who were Covid positive to manage outbreaks and the individual patients.
• Daily calls to all care homes who had positive Covid residents to offer face to face clinical support if required.
• Attend to Covid positive care home residents, assess, diagnose and treat autonomously, including end of life care alongside with support from palliative care clinicians.
• Communicating with families who were not able to see their relatives that were deteriorating and discussing end of life care.

A few months after starting my role within the Primary Care Improvement Programme (PCIP), the pandemic hit and I was quickly moved to coordinate the new Covid Assessment Centre in Stirling. My role was to:

• Organise GP, ANP and other support staff to ensure appropriate staffing levels to manage the numbers expected to attend.
• Training staff on appropriate procedures and use of PPE including donning and doffing of PPE and ensuring a safe environment for both staff and patients.
• Triage and distribution of the appropriate clinical work that was referred to the centre.
• Assess, treat and refer or discharge patients autonomously.
• Complete daily clinical and sampling audits for both the NHS and PCIP teams.

As an Advanced Paramedic Practitioner (APP) working in Urgent & Primary Care within the SAS, I provided independent decision-making, including assessment, diagnosis, management and treatment including prescribing, of patients with complex multidimensional needs. I worked within a rotational model as part of the multidisciplinary team in primary care during week days doing home visits for the practice GP's, and operationally at the weekends providing professional support for other clinicians and providing response on behalf of the Scottish Ambulance Service.

This role was part of a pilot scheme funded by the Government to place Paramedics in primary care and was one of only a few projects that were allowing APP's to work outside of the SAS which I was keen to be involved in.

• To treat and transport emergency and urgent cases in accordance with JRCALC guidelines, HCPC guidelines and service protocols
• Assume immediate control of accident and emergency situations
• Handling and administering non-prescription, prescription and controlled drugs
• Resuscitation and stabilization of patients Cardiac and stroke interventions, including pre-hospital thrombolysis, ECG recognition, FAST test pathways for stroke and the diagnosis, treatment and referral of a range of cardiac conditions
• To communicate, report and document the patient history, condition and treatment to a full range of medical staff
• Undertaking emergency driving duties for various emergency medical vehicles
• Maintaining confidentiality of staff and patient information and records
• Assist in major incidents and when necessary act in an incident managerial role

• Undertake manual, semi-automatic and fully automatic laboratory investigations
• Interpret laboratory results and take appropriate actions
• Perform mass spectrometry analysis
• Analyse and diagnose hematological conditions via the use of microscopy
• Recognise different antibodies present in recipient blood prior to cross match
• Be able to group and cross match donor blood
• Be competent in the issue of fresh frozen plasma and platelet products whilst liaising with senior clinicians.