These nightly on-call duties for liberal nurses for the benefit of EHPADs in Aveyron and Lozère

L’idée est d’assurer le meilleur suivi infirmier pour les seniors. Midi Libre – JEAN-MICHEL MART

L’organisation, active depuis début novembre et spécifique pour les territoires ruraux dont l’Aveyron, a été baptisée Diane (dispositif infirmier d’astreinte de nuit entre EHPAD).

Diane. A little name that is easy to remember and which – in addition – covers a reality on the ground that is as concrete as it is effective. "We started from the call for projects from the ARS (regional health agency) in order to provide continuity of care to those responsible for EHPADs in rural departments, Aveyron and Lozère in particular. Because these establishments often have neither a doctor nor a nurse at night."

Janis Francazal, general secretary of URPS Occitanie (Regional Union of Liberal Nursing Health Professionals) and pilot of the Diane project (*) recalls, in passing, that « liberal nurses cover the entire territory. Like other medical professionals, we do not have understaffed areas."

Continuity of care

"And we are aware, even more so after the health crisis, that there are weaknesses in maintaining people at home in medico-social structures. This poses concerns for the continuity of care."  In practice, since November 6, the Diane Occitanie application has been active in Aveyron (for 7 establishments totaling 868 beds), Lozère but also Gard and Tarn-et-Garonne. Six to eight nurses make up a team with an on-call schedule defined for the year.

"Today in EHPADs, whether in rural or urban areas, there is a lack of paramedical professionals. In the event of nocturnal problems, this leads to calls to 15 or to doctors on call who cannot always come." Janis Francazal thus evokes the case of "transport of patients to emergency services with, behind it, all the crisis that we are experiencing: lack of beds, staff… It can then happen that elderly patients have to wait for hours on stretchers. This can have deleterious effects."

And the death certificates ?

In response to the shortage of doctors, the nursing profession has, since the beginning of this year, been authorized to produce death certificates. An experiment which concerns six regions in France including Occitanie. And, therefore, Aveyron. "The Regional Health Agency told us that there was not a week without there being three to five reports of difficulty in getting a doctor to produce a death certificate in a time that is bearable for families" summarizes Janis Francazal, general secretary of URPS Occitanie. With specific compulsory training of 12 hours for nurses with at least three years of experience.

With Diane the ambition is therefore to be able to « manage care directly at the EHPAD with the right professional at the right time between 9 p.m. and 6 a.m. » And this includes weekends and public holidays, of course. The night alert made on the Diane application goes through the caregiver of the establishment concerned. "A form then arrives at the on-call nurse. Contact is made by telephone or video, particularly in Lozère where field conditions sometimes remain difficult."

A visit guaranteed within thirty minutes

Janis Francazal evokes a dialogue which allows, "depending on the patient's history, their treatment and the protocols put in place", an appropriate health response. This can be simple advice with remote night-time monitoring or direct intervention. Which is guaranteed by the on-call nurse within thirty minutes. "This may concern a change of infusion, urinary catheter or a call to 15 in the event of a real need for hospitalization. "

Since the launch of Diane, two night visits have taken place in Aveyron (three others in Lozère and Tarn et Garonne). Knowing that in 2020 a study estimated that a quarter of nighttime transfers of EHPAD residents to emergency rooms were, ultimately, inappropriate, Diane has many useful nights ahead of her.

(*): Diane for night-time on-call nursing arrangements between EHPADs. I subscribe to read more