Answers to frequently asked questions from stakeholders across NSW local health districts and specialty health networks about the Emergency care assessment and treatment (ECAT) protocols.
Protocols
The ECAT protocols were co-designed by multidisciplinary teams to present best practice clinical guidance. They are based on a thorough evaluation of the evidence from existing local guidelines, published research studies, and expert consensus for the management of patients presenting to the ED.
The ECAT Protocol Development, Consultation and Review Process Report provides more detail on the protocol development process.
All medications included in the ECAT protocols are included in the NSW Health State Formulary. However, if a medication is not in stock, the nurse is able to select an alternate medication from the available medications on the protocol. Nurses are only able to administer medications directly following the ECAT protocols. If no alternate medicine is available, the nurse will need to escalate care using their local CERS processes.
Plain imaging is included on the protocols and can be requested by nurses who have completed the required education and training. Plain imaging includes chest x-ray, lower and upper limb x-rays, hip and pelvis x-rays, and abdominal x-ray.
The ECAT protocols are available online and printed copies will be distributed by the Agency for Clinical Innovation (ACI).
Existing local and state processes should be followed when reporting any incident.
Any “actual” or “near miss” incident which occurs while an ECAT protocol is in use must be reported according to the Incident Management (PD2020_47) policy directive. This includes reporting all “actual” or “near miss” incidents in IMs+ and ensuring the term ECAT is included if an ECAT protocol has potentially caused or contributed to the reporting.
The ACI and Clinical Excellence Commission are developing templates for ECAT safety huddles, to be used during the transition to business as usual (BAU) phase during implementation.
Safety huddles are:
- brief (less than 10 minutes)
- a focused exchange of information about potential or existing safety risks which may affect patients, staff and any person accessing the healthcare environment.
Implementation
The ECAT Implementation Plan outlines a 90 day go-live schedule. Each LHD/SHN Executive Steering Committee must determine the most appropriate time for each site to transition. LHDs/SHNs should notify the ACI of their proposed go live date and work with the ACI in the lead-up to the go live date.
An ECAT Implementation Plan and Go Live schedule have been developed to assist LHDs and SHNs with milestones to be achieved prior to going live with the ECAT protocols.
Communications will also be shared with LHDs and SHNs to assist with messaging and awareness within their districts and networks.
The implementation of ECAT will be led by LHDs and SHNs and overseen by an ECAT Executive Sponsor in each district or network. As part of implementation, each LHD/SHN will have developed a governance committee to monitor the implementation of ECAT locally. LHDs/SHNs are encouraged to join the ECAT Implementation Community of Practice or email the Emergency Care Institute (ECI) to understand opportunities for implementation support appropriate for their LHD/SHN.
Education
Two education modules have been developed as part of the ECAT program. They consider the existing education and skills, knowledge and experience required to use the protocols.
The ECAT program builds on existing nurse-initiated guidelines, standing orders and protocols. The ECAT team have worked in partnership with the Health Education and Training Institute (HETI) to develop an ECAT Education and RPL Guide to support the transition of the existing nursing workforce to use the protocols by recognising and documenting prior learning.
The ECAT Education and RPL Guide was developed following an extensive review of the learning outcomes of current statewide educational programs (as at July 2023) for emergency nurses and an in-depth analysis of the knowledge, skills and training required to use the protocols.
At a minimum, registered and enrolled nurses must have completed the following education and training appropriate for their patient cohort, prior to using the ECAT protocols:
- Courses targeted as part of the Statewide Mandatory Training Policy (red flagged in My Health Learning) and courses targeted by Local Health District Chief Executives (blue flagged in My Health Learning); and
- Learning Pathway Between the Flags: Recognise and Respond to Deterioration in Adult Patients (Nursing) and/or Learning Pathway Between the Flags: Recognise and Respond to Deterioration in Paediatric Patients (Nursing)
- Nursing in emergency care settings module
- ECAT – Introduction to protocols module
Always refer to the ECAT Education and RPL guide and The Use of Emergency Care Assessment and Treatment (ECAT) Protocols Policy Directive for the most up to date information.
ECAT education modules are now available on My Health Learning. Local education leads will coordinate preparation and completion of the required education and recognition of prior learning for nursing staff in the lead-up to the LHD/SHN go-live date.
Key milestones to support the rollout of education are included in the go-live schedule, which will be monitored by local ECAT steering committees.
Other
The following will be rescinded as each LHD transitions to using ECAT:
- All existing local Standing Orders
- Rural Adult Emergency Care Guidelines
- Rural Paediatric Emergency Care Guidelines
- Nurse Delegated Emergency Care Guidelines.
The Clinical Initiatives Nurse Education Program and the current Transition to Practice Emergency Nursing Program (2011) will be rescinded after the redesign and publication of the Transition to Specialty Practice Program.
ECAT does not change the existing definitions for “nurse seen date and time” which “stop the clock”.
The ECAT protocols fulfil the requirements for nurse seen date and time, as outlined in the NSW Health Emergency Department Data Dictionary. If available, nurses are to use an ED-approved protocol PowerForm to indicate which ECAT protocol has been initiated, and this will auto-populate the nurse seen date and time.
The requirements for nurse seen date and time will be considered as fulfilled when the following occurs:
- Identification and documentation of an appropriate ECAT protocol
- Initiation of care, starting with a patient assessment (including patient history) according to the patient’s presenting problem
- The intention to continue nurse-initiated assessment and treatment under the ECAT protocol, until care of the patient is taken over by a medical practitioner, nurse practitioner or physiotherapist.
The protocols will be available on the internet with easy access from eMR screens. The protocols will be supported with Powerplans to enable ordering of medication, pathology and radiology. There will be a PowerForm available for the nurse to indicate selection and commencement of an ECAT protocol. SHNs and LHDs without Cerner eMR are developing local alternative solutions.
The ACI has developed an evaluation plan and is working with LHDs to monitor the use of ECAT following implementation. The evaluation measures include qualitative and quantitative measures.
Agency nurses are able to use ECAT protocols, provided they have completed the prerequisite education on My Health Learning, as outlined in the ECAT Education and RPL Guide and The Use of Emergency Care Assessment and Treatment (ECAT) Protocols Policy Directive. It is up to each LHD/SHN to determine how they will support agency nurses to use the ECAT protocols.
Nurse practitioners will not use the ECAT protocols, as they have their own scope of practice. An ECAT protocol ceases when a nurse practitioner takes over care, and usual nursing practice continues.
The redesign of the Transition to Specialty Emergency Practice is underway and modules will be released as they become available throughout 2024 to 2025.
The new program will provide a standardised (yet, flexible) blended education pathway to transition nurses to specialty emergency practice.
The work is a partnership between the Ministry of Health Nursing and Midwifery Office, the ACI's Emergency Care Institute and HETI.