Taking Over the World

Passion, belief… and a desire to take over the world.

Tracy Earley, nurse consultant for the Integrated Nutrition and Communication Teams based in Preston, describes what it takes to make a rapid access seven-day a week clinic a success.

Tracy Earley sets her sights high. And while world domination might not be her actual goal in life, you clearly get the message that she has the drive to change things for the better.

When it comes to establishing a seven-days a week service for patients reliant on artificial feeding, that kind of commitment has helped Tracy and her colleagues break the mould of ‘no weekend’ cover.

‘You have to want to take over the world and have a bit of passion,’ says Tracy, a paediatric nurse by background who spent a decade or so in paediatric intensive care units, spells in Leicester and Nottingham and some US training, before heading to Preston in Lancashire.

‘If you are passionate about what you want to do, then you can normally find a way of getting people on board with you.  Believe in what you are doing and why you are doing it’.

It was this mentality which helped Tracy, who won the Nursing Times Nurse of the Year award in 2011, and her team to convince the powers-that-be at the Royal Preston Hospital that extending clinic access made good clinical and financial sense.

She says: ‘Aim high and listen to your patients. You cannot deliver a service based on what looks right on paper because it will never fit your patients’ needs, or the organisation.

‘When you know what patients’ need, use their stories to go and speak to your exec teams to change the world, because that is what we have done.’

One story in particular stands out. It was a patient who had a PEG (percutaneous endoscopic gastrostomy) tube fitted which fell out over the weekend. He went to A&E at another hospital but staff there were unable to help and the weekday clinic was obviously closed.

‘So the patient called me at home’ says Tracy. ‘I came in and we sorted his tube out over the weekend. If we hadn’t done this, he would have been in hospital for a few days until e managed to get him transferred over. By then the gastrostomy site would have healed over and he would have had to go through the whole process again. I took this story to our management executives when we were looking at opening seven days a week.

‘It meant they could see the problem from the patient’s perspective. There was an increased chance of illness because patients were not getting their feed or medicines. And they could see there was a significant impact on the NHS, including a stay in hospital and an expensive procedure that is preformed when it doesn’t necessarily need to be.

‘It was these kinds of stories that really helped make the change.’

So what exactly is the Integrated Nutrition and Communication Team and how does it work?

It’s made up of nutrition nurses, speech and language therapists, dieticians and a central venous access team. They work together with the patients, avoiding where possible artificial feeding.

But when patients do need to be artificially fed, the team ensures they get the best device and the best fit for them and provides a port of call for when things go wrong.

Seven days a week provision means patients can be seen by an expert group of nurses who can help replace their feeding device, without having to be admitted into hospital.

But there are still challenges.

‘My idea of quickly doesn’t necessarily match other people’s ideas,’ Tracy says. ‘If you have a patient whose feeding device has fallen out, this is time critical. So getting them into clinic quickly is important and can also be a challenge. This is something we are working on and the increase from a five day clinic to a seven day clinic has helped.’

Difficulties can also arise checking the position of a device to make sure that the patient is safely feeding and safely receiving their medicines. ‘Nasogastric tubes pose a particular problem when it comes to testing of the position by withdrawing gastric aspirate up the tube’, says Tracy.

But plans are afoot to improve things.

‘We are working on a technology with NGPod Global Ltd that will revolutionise the way we look after patients with nasogastric tubes,’ says Tracy. ‘It’s really exciting. It will provide a quick and reliable response on whether it is safe for patients to feed or not, which is better for them and will keep them in better health.’

But restricted opening is not the only thing that needs to change, she believes.

Another area that needs tackling urgently is the divide between hospital and community services. Tracy says: ‘At the moment these operate separately. I would like to see them integrate better, as it will provide a more seamless transition for patients. Once a patient is discharged from us, they are looked after in the community by a different set of nurses and dieticians.

‘I want the same staff to work in and out of hospital, so the patients don’t have any kind of difference in the approach.’

This is a crucial issue, she believes, because patients can become very expert at their own care very quickly. So they are inclined to notice the difference if anyone does things ever so slightly differently. ‘So I want our nurses to be able to go in and out of community and hospital to ease the passage for patients. It would give them confidence in their care, no matter where they are having that care delivered.’

This issue of patient choice is clearly one that is high on Tracy’s agenda. And the reason is simple. A happy, well-cared for patient is less likely to end up in hospital.

She adds: ‘We have to ensure that what we are doing is right for them. We try really hard to work within their lifestyles. It’s important to put the right device in for the patient because if you get it right they are happy and will stay out of hospital a lot longer.

We try to have good relationships with our patients in order to get the best fit for them.’

by Pat Hagan.

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