The District Nursing Service provides high quality nursing care to individuals in their own homes and residential homes across Somerset. The service works in partnership with patients, their family and carers, primary care, acute care, social care, independent and voluntary sector, specialist community health teams, older person’s mental health teams and independent rehabilitation teams.
The District Nursing teams are each led by a Team Leader and consist of Community Registered Nurses, Assistant Practitioners, Registered Nursing Associates and Health Care Assistants. Across Somerset, the District Nursing teams are available 365 days per year throughout the 24hr period
The District Nursing service will triage referrals from anyone who contacts them, such as patients, relatives, carers and other professionals, such as GP's, Hospitals, Care Homes and Social Services
The service is available to patients over 18 who are housebound and require nursing care or meet one of the following criteria:
- Post-operative patients who are temporarily unable to travel
- Patients who require end of life care
- People who are neutropenic and undergoing chemotherapy, radiotherapy or whose health condition would lead to travel or attendance at a clinic being detrimental to their treatment or recovery
- Those for whom, in the professional opinion of the District Nurse Team Leader, treatment or care would be appropriate to be carried out in the patient's home
- Urgent: All urgent referrals will be telephoned and discussed with receiving nurse and clinically triaged within 4 hours
- Non-urgent will be clinically triaged with access to service within 24-48hours
- Routine will be clinically triaged with access to service with 1-3 days
- Post-operative Visit access to service on specified date
- Timed Visits for example specified medication requests
A Registered Nurse from the District Nursing team will undertake an initial assessment of the patients' needs through discussion with the patient and with the patient’s family or carer if appropriate. All records are entered onto Somerset Partnership NHS Foundation Trust’s electronic clinical record (RiO). A careplan will be provided in the form of a patient held record if requested by the patient. Consent will be obtained to share information with other services.
Principles for Practice:
- Provide high quality culturally sensitive nursing care for people in their own homes
- Promote and maintain independent living
- Promote a coordinated approach to hospital discharge
- Reduce the incidence/frequency of admission and readmission by supporting and educating both patients and carers to seek early intervention for potentially debilitating conditions
- Adopt a public health approach to all areas of practice to reduce ill health and promote healthy lifestyles
- Promote an evidence-based approach to clinical activities
- Promote user involvement in both service planning and delivery.
Provision of Care
The main focus is to provide nursing care to housebound patients in the home or residential care environment. District Nursing offers the following planned, individualised, patient centred care:
- Assessment co-ordination and management of complex, chronic and acute nursing needs
- Holistic wound assessment and management
- Palliative care for those who are terminally ill and care of the dying
- Technical nursing interventions, e.g. syringe drivers, central lines, intravenous drugs, etc.
- Bereavement support
- Promotion of continence and management of continence problems
- Assessment of nursing equipment
- Nursing procedures: ear care, injections, immunisations and vaccinations
Patients will be discharged from the service when:
- The treatment is completed
- When the patient can self-manage safely
- When transferred to another more appropriate service, e.g. Social Services,
- When patient moves out of area
Somerset is divided into nine GP Federations which are indicated by the coloured dots on the map. Each District Nursing Federation has a main hub which is the single point of access for referrals and administration for the Federation. Some Federations will also have smaller offices, 'spokes' to enable the nursing teams to effectively cover the very rural county of Somerset. The locations and contact details for the District Nursing Hubs can be seen in the map provided.
The District Nursing Federation HUBs operate from 08:00h to 18:00h Monday to Friday.
For Out of Hours (evenings, overnight, weekends and bank holidays) please contact 111