VOL: 98, ISSUE: 10, PAGE NO: 49
Jan Tait, RGN, RM, is nurse practitioner, gastroenterology;Janet Baxter, MPhil, SRD, RNutr, is coordinator of the HPN Network, Department of Digestive Diseases and Clinical Nutrition, Ninewells Hospital and Medical School, Dundee
It is widely accepted that patients receiving HPN should be supervised in units where there is experience and knowledge in its use (Pennington, 1996). The team requires experience in the prevention and treatment of disease and HPN-related complications. This can be achieved by establishing one specialised centre. However, in Scotland this would present difficulties because of the wide dispersion of patients throughout the country. One centre would be unable to provide emergency treatment for all and would cause inconvenience for patients who may be required to travel long distances for follow-up.
The network was launched in 2000. It has a coordinator whose remit is to identify HPN centres and patients, to disseminate protocols, procedures and standards and to collect and analyse audit and research data. A paediatric group is included within the network. While the same protocols, procedures and standards apply, a slightly different set of audit data will be collected to reflect the requirements of the paediatric service.
The aims of the network are:
An integral part of managed clinical networking is the existence of a quality assurance framework, which is acceptable to the Clinical Standards Board for Scotland (CSBS). The CSBS is an established special health board whose remit is to develop and run a national system of quality assurance and accreditation of clinical services. There are two key components of a quality assurance framework: a set of standards and agreed arrangements by which performance against the standards will be audited and monitored, with actions taken to implement any recommendations that are agreed in response to the findings.
The implementation of standards throughout the network will be monitored. Data collected between 1999 and 2000 on 40 patients from four centres will be used as a baseline for future results (McKie, 2001). It includes episodes of catheter-related complications, catheter insertion and removal, metabolic complications and hospital admission rates.
The development of standardised protocols and procedures, sharing audit results and exchange of experience should lead to changes in practice and improvements in outcomes. The network has identified 75 patients in 20 hospitals throughout the country. The smaller centres have been provided with evidence-based protocols and procedures, have been invited to network meetings and are encouraged to participate in audit.