Improving patient care and staff satisfaction in north west England

Nursing Standard's series celebrating modern nursing roles around the UK continues with a focus on nurses in north west England.

Nursing Standard's series marking the RCN’s centenary year by celebrating modern nursing roles around the UK continues as Alison Whyte focuses on nurses in north west England

‘These are challenging times in the NHS,’ says RCN north west regional director Estephanie Dunn. ‘We are endeavouring to safeguard already diminishing budgets and services while there are increasing pressures on staff.

‘This is why it is essential for nurses to lead on initiatives to improve services that improve patient care and staff satisfaction. We are proud of all of our nurses here and Sara, Dave and Rita are perfect examples of the talent we have in our region.’

Sara Kewin is advanced nurse practitioner for hydrocephalus at the Walton Centre NHS Trust in Liverpool. She set up an emergency access hydrocephalus clinic in 2012.

‘I believe this is the only nurse-led, emergency access hydrocephalus clinic in the country. Before I set up the service, patients required admission to hospital for observation for up to 48 hours once they had been reviewed by a consultant. This delayed discharge and used up inpatient resources for investigations which could be performed as outpatients.

Sara Kewin

'All the patients we see have a cerebrospinal fluid (CSF) diversion to treat their hydrocephalus, which may be due to premature birth, congenital problems, or later onset because of tumours or head injuries. The condition can be life-threatening and patients can be very unwell, but if it’s correctly managed they can live full and normal lives.

'Along with two other specialist nurses who I manage, I use my extended clinical skills to assess and treat patients. The complexity of the diagnosis can be challenging, especially when non-specific symptoms need multiple investigations.

'Changing the way patients contacted us and giving them the information they needed to manage their condition were the main challenges. We also needed support from the trust to provide education so that the team could perform high-level assessment to run the clinic safely.

'We triage up to 400 emergency access patients every year. We take a full history, examine them, arrange images and blood tests, and admit them if required.


The number of emergency access patients triaged every year at the hydrocephalus clinic at Walton Centre NHS Trust

'If patients become symptomatic between appointments or after discharge, we triage their symptoms by phone and advise them to attend emergency services, see their GP or return to our clinic within 24 hours. Patients appreciate being seen at short notice in a specialist centre by a team of nurses they know.

'We provide around 1,400 annual follow-ups. We also do pre-operative assessments and see all inpatients for a daily review. We know some patients quite well, which helps to build their confidence, and I know we are valued by medical and nursing colleagues.

'Emergency department consultants ask us to see patients, and we get referrals from consultants whose clinics are full. We have significantly reduced observational admissions.

'I’ve been a neuroscience nurse at the Walton Centre for almost 23 years. I love the variety of my job and I’m proud of this service. The patients are so diverse and I’m endlessly fascinated by the anatomy, pathways and symptoms of the condition.’

Dave Appleton is deputy clinical service manager at Rosewood Unit, Bowmere Hospital, Cheshire and Wirral Partnership NHS Trust. He has pioneered semi-independent living accommodation.

Dave Appleton

‘Rosewood is an inpatient unit for 15-20 people with a diagnosis of serious mental illness who may have been admitted to acute services a number of times.

'Although we already had an effective service, I wanted to create a rehabilitation package that enabled people to develop and test the skills required for daily living.

'There was a big empty space at the back of the unit so we put in a proposal for the development of two self-contained studio flats. This was approved and funded by the trust.

'The flats are unique because they have their own separate entrance – people have a front door key and do their own shopping and cooking. They can come and go as they please, but are free to come into the unit.

'One man who had been on the unit for several months had developed his daily living skills and we wanted to test if he was ready for independent living. He moved into a flat, but his symptoms deteriorated; he self-harmed and just couldn’t cope.

'If we had followed the usual pathway and he had been discharged into the community, he would have ended up back on an acute ward.

'We were able to tailor his discharge plan to his individual needs – so that he had support at certain times of the day when he struggled – and he is now living in the community.

'The project has been very successful and we have had very few readmissions. If we open another ward we’ll develop more of these flats.

'My first post as a staff nurse was on a psychiatric intensive care ward and I absolutely loved it. From day one it felt right, and that I was made to do this. But I enjoy working with people for longer periods, and at Rosewood it can be up to 2 years.

'I now have managerial responsibility as well as being the trust’s rehabilitation operational lead. I want to ensure a high quality, positive experience for the individuals accessing our rehabilitation services.

'Motivating this group of people can be challenging, but I feel proud of the way we have improved outcomes for them and how we have helped them to live their lives better. This is what we’re here to do.’

Rita McLauchlan is a vitreoretinal (VR) nurse specialist in ophthalmology at the Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust. She has responsibility for discharging some VR post-operative patients.

Rita MacLauchlan

‘Discharge practice for VR patients in our ophthalmic services are varied - post-operative patients could have long waits to see the doctor, and day surgery patients might be sent to follow-up appointments in other departments before they came to our daily acute retina clinic. They may then have to wait if the doctor was dealing with a retinal emergency.

'Delayed discharge is not good for the patient experience. After deciding this could not continue, I explained to the lead nurse and VR consultant Mr Patton that I would like to discharge the patients myself. They were happy for me to expand my role in one-day, post-op assessment and discharge patients into the next consultant’s clinic.

'I spent 6 months with a mentor — an emergency eye nurse practitioner – and was taught by doctors how to examine the whole of the eye. I began to examine patients and record my findings, and a doctor would then assess the patient and inform me if I had missed anything.

'Of the last 50 of the 180 patients I examined, no discrepancies were found. On a few occasions I identified complications which were confirmed by the doctors.


The number of patients who have been discharged since January by VR nurse specialist Rita McLauchlan

'All the VR consultants were supportive throughout my training, and Mr Patton developed specific ophthalmic criteria for patients it would be safe for me to discharge. This included post-operative patients with Macular Holes, Epi-retinal membrane and Vitreous haemorrhage. These patients would return to see the consultant in 2 weeks.

'I was given the green light to discharge patients in January. Since then, I have discharged about 50 patients, freeing up medical staff to spend more time in surgery or on complex cases. This means more patients can access a clinic appointment or have surgery.

'I want patients to have the best possible experience, for them to be seen in a timely manner and to be comfortable. I take time to answer their questions and tell them to call me directly if they have any queries.

'I love this specialty because we are helping people to preserve their vision. As a team, we bring new ideas and do audits and research. Our work is evidence-based and everything is in the best interests of our patients.’

Alison Whyte is a freelance journalist

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