Julie Shardlow

1
Julie Shardlow

• Matron Cardiology Services
• Bradford Royal Infirmary
• e-mail
• 22-3_at_bradfordhospitals.nhs.uk

2
Nurse Initiated Thrombolysis

• Why
• What
• How
• Results
• One year later
• Lessons learned

3
Why

• 1997 - 25 of eligible patients received
  thrombolyisis within 60 minutes of arrival at
  hospital
• 1998 50 of eligible patients received
  thrombolyis within 60 minutes of arrival at
  hospital
• 2000 No patients received thrombolysis within
  30 minutes of arrival at hospital

4
Why

• Improve care
• Improve patient outcome
• Meet NSF targets

5
How

• No money
• No extra resources
• Lots of enthusiasm and support

6
Who

• E grades and above in CCU
• F Grades and above in A/E dept

7
Who

• Chief Nurse
• Ward staff
• Senior nurses
• Cardiologists Lead Clinician
• Pharmacist
• Nurse manager
• Practice development
• Professional development
• Trust advisory group (Advancing Practice Group)

8
Patient Group Direction

• specific written instruction for the supply or
  administration of named medicines in an
  identified clinical situation. It is drawn up
  locally by doctors, pharmacists and the
  appropriate professionals and approved by the
  employer. It applies to groups of patients or
  other service users who may not be individually
  identified before presentation..
• (Crown report 1988)

9
Principles of PGD

• PGD to be used where it provides an advantage to
  patient care without compromising safety
• All disciplines affected by the PGD to be
  involved in the development
• Regular formal review dates
• Changes to PGD to be submitted through formal
  process

10
When

• First course February 2001
• Courses scheduled throughout each year
• according to demand

11
Results

• 24hour cover by nurses on CCU.
• Senior nurses in A/E and CCU trained
• All patients thrombolysed by nurses safely and
  effectively.
• Improvement in door needle times

12
Results
13
Results
14
Results
15
Direct admission to NITs CCU
16
Problems.

• Bed availability on CCU
• Majority of patients were thrombolysed in A/E
• Senior staff trained to thrombolyse in A/E were
  often busy with other things
• Thrombolysis in A/E much slower

17
One Year Later

• Secured extra funding from PCTs ( Two E grades)
• Thrombolysis link sister in A/E
• Nurses in CCU bleeped to attend Chest pains in
  A/E to support thrombolysis
• (July 03)

18
Results
19
Results
20
Lessons learned

• Solve one problem find another one
• Continuous monitoring and review
• Everyone's problem
• Team approach is essential
• Communication and Education is on going
• Relationships matter

21
Lessons learned

• Continuous feedback is essential
• Accurate documentation/audit systems
• Requires multidisciplinary approach
• Eliminate interdepartmental barriers
• Develops Staff (confidence and communication and
  team work)
• Solutions dont always depend on extra funding

22
Lessons Learned

• NITs course evaluated very well
• Survey of A/E staff show NITs perceived to be
  extremely beneficial
• To extend it to E grade staff in A/E

23
Lessons Learned

• New ways
• of working