Haemoglobinopathy Nursing in the Acute Setting UK Forum Coventry 2008
Geographical Boundary
Ethnic Demographics (2001 Census) Birmingham White (inc Irish/other white) 70. 4% British Asian 19. 5% Black/black British 6. 1% Chinese 0. 52% Mixed race 2. 9% Other 0. 63%
Patient Demographics 2008 SCD (total) Hb. SS (178) Hb. SC (139) Hb. SßThal (31) TI/EßT (13) TM (29) M 81 60 15 9 15 F 97 79 16 4 14 Total -390
In the Olden Days……. • • All admissions through A&E Inappropriate admissions In patient orientated Medical model of care No designated ward Uncoordinated Fragmented-little or no communication between agencies
Precipitants for Change…. . Patient Experience • Delays in A&E • Length/frequency of admissions • Lack of structured specialist input • Lack of continuity of care on discharge • Lack of HBO knowledge Iatrogenic • Venous access- risks of sepsis/thrombosis • Hospital acquired infections • Opiate issues • Chronic pain management
Sickle Cell and Thalassaemia Centre • • Opened in July 2000 Renovated supplies building Periphery of City hospital campus Monday- Friday (9 -5) Nurse led Outreach to wards Adult patients with major HBO
Facilities • 3 beds/ 2 trolleys • 3 reclining chairs • Fully equipped resource area for patients/visitors • Private interview room
Criteria for Access to Service…. • • HBO Referral from GP or other Registered with service Medical review (minimum annually)
Service Profile • Planned/unplanned activity • DC pain management • BT/RBCX • Monitoring • Multidisciplinary team • Antenatal/newborn screening • Hub & spoke model • Liaison with primary care/vol sector • Home review • Education • In house training • Accredited HBO course for nurses
Service Philosophy • • Bridge gap between home and hospital Avoid admission Promote productivity Individualised treatment plan Evidence based practice Education Support/advice
Team Structure Clinical Lead Nurse Development /policy Deputy Lead Nurse Service manager Junior Sister Staff Nurse Haematologist Staff Nurse Clinical Psychologist
Thalassaemia • Flexible BT arrangements • Monitor chelation/ concordance • Education - chelation, central line care, thumb tacks, importance of monitoring • MDT referrals • Rationale for Chelation • Information about dose, frequency, storage and method of administration • Importance of adherence • Side effects • When to seek help eg signs of infection • Monitoring • Medical review
Sickle Cell Disorder • Largely unplanned activity except RBCX/ top up BT • Emergency admissions • Direct access • Nurse led assessment within protocols/operational policy • Complicated cases admitted
Evaluation • • Baseline observations History/ assessment Complicated/uncomplicated Establish venous access ? infection screen Bloods/ investigations ? PCA/intermittent parenteral/oral analgesia
Complicated Crisis • • • Fever/rigors->38 c Tachycardia/palpitations (despite analgesia) Neurological symptoms (also ophthalmic concerns) Chest pain (other than bony pain) Tachypnoeic-hypoxia <92% on air Priapism Pregnancy Abdominal pain Hypotension Uncontrolled acute pain Other
Analgesic Response • Administer analgesia within 30 minutes- (mean 10 mins) • Pain score o/a, 30 minutes, 1 hour and 2 hours • Close monitoring for signs of respiratory depression • Titrate analgesia accordingly • Adjunctive
Handheld Treatment Card • Defined treatment protocols • Protocol applicable to SWBHT only • Gatekeeper is the SCa. T centre • Protocols reviewed every 2 years • Only for registered patients • Must have annual med review
Feedback on Treatment Card • • Less delay in A&E Empowering Increased independence Increased feeling of security Shaw, E. 2006
Role of Outreach • • Daily review Assess and evaluate progress Recommend changes to treatment Reassure patient Liaise with family Discharge planning Educate ward staff
Last Seven Years…… Yr 1 Yr 2 00/01 01/02 Yr 3 Yr 4 02/03 03/04 Yr 5 Yr 6 Yr 7 04/05 05/06 06/07 Total DC activity 672 1344 1748 1696 1568 1696 1480 DC pain 107 165 351 463 342 744 628 Admitted from D. C. 13 37 58 54 55 43 51 % Home 88 78 84 88 84 94 92 # Patients 100+ 150 250 400+
Day Case Model- Does it work? • 2000 - DC pain management accounted for 90% of activity (5% of pt database) • 2008 - 60/40 split with blood transfusion and pain management • Majority of in-patient admissions are for complicated sickle cell crisis • Average no of bed days for SCC is 7 -10 d • Safety- no deaths following DC
Service User Feedback (2008) • Expertise, warmth and support from nursing staff • Outreach service highly valued • Quick and efficient pain service • Flexibility of BT • Liaison with primary care
Areas we need to improve on…. . • Concern about privacy when being assessed • Recent nursing shortages • Clinic appointments and waiting times • Décor • Adjacencies of other depts- too far to walk when in pain
Скачать презентацию Haemoglobinopathy Nursing in the Acute Setting UK Forum
3c0e43c63fc640dee773508ec6710fc6.ppt