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Haemoglobinopathy Nursing in the Acute Setting

Haemoglobinopathy Nursing in the Acute Setting. UK Forum Coventry 2008. Geographical Boundary. Ethnic Demographics (2001 Census) Birmingham. Patient Demographics 2008. Total -390. In the Olden Days……. All admissions through A&E Inappropriate admissions In patient orientated

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Haemoglobinopathy Nursing in the Acute Setting

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  1. Haemoglobinopathy Nursing in the Acute Setting UK Forum Coventry 2008

  2. Geographical Boundary

  3. Ethnic Demographics (2001 Census)Birmingham

  4. Patient Demographics 2008 Total -390

  5. 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

  6. Delays in A&E Length/frequency of admissions Lack of structured specialist input Lack of continuity of care on discharge Lack of HBO knowledge Venous access- risks of sepsis/thrombosis Hospital acquired infections Opiate issues Chronic pain management Precipitants for Change….. Patient Experience Iatrogenic

  7. 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

  8. 3 beds/ 2 trolleys 3 reclining chairs Fully equipped resource area for patients/visitors Private interview room Facilities

  9. Criteria for Access to Service…. • HBO • Referral from GP or other • Registered with service • Medical review (minimum annually)

  10. 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 Profile

  11. Service Philosophy • Bridge gap between home and hospital • Avoid admission • Promote productivity • Individualised treatment plan • Evidence based practice • Education • Support/advice

  12. Team Structure Clinical Lead Nurse Development /policy Deputy Lead Nurse Service manager Junior Sister Staff Nurse Staff Nurse Staff Nurse Haematologist Clinical Psychologist

  13. 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 Thalassaemia

  14. 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

  15. Evaluation • Baseline observations • History/ assessment • Complicated/uncomplicated • Establish venous access • ?infection screen • Bloods/ investigations • ?PCA/intermittent parenteral/oral analgesia

  16. Complicated Crisis • Fever/rigors->38c • 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

  17. 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

  18. Handheld Treatment Card • Defined treatment protocols • Protocol applicable to SWBHT only • Gatekeeper is the SCaT centre • Protocols reviewed every 2 years • Only for registered patients • Must have annual med review

  19. Feedback on Treatment Card • Less delay in A&E • Empowering • Increased independence • Increased feeling of security Shaw, E. 2006

  20. Role of Outreach • Daily review • Assess and evaluate progress • Recommend changes to treatment • Reassure patient • Liaise with family • Discharge planning • Educate ward staff

  21. Last Seven Years……

  22. 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 7-10d • Safety- no deaths following DC

  23. 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

  24. 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

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