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Grant will allow expansion of nurse-led paracentesis service


A nurse-led service, which has helped transform care for patients with chronic liver disease, has won a £10,000 award to develop its innovative work.

The Ascites Management Project, developed by nurses and doctors at Nottingham University Hospital, was awarded first place in the Shire Award for Gastrointestinal Excellence (SAGE) grant programme.

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Since launching in September last year, it has reduced waiting times and cut stressful and costly emergency admissions for people with end stage liver disease, as well as ensuring better all round care.

The service was developed in response to a surge in the number of patients needing paracentesis – a procedure to remove fluid that has collected in the abdominal cavity – and has seen experienced nurses trained up to perform paracentesis and then teach others.

“We used to see patients who came to the day case unit become increasingly frustrated because on arrival the nurse did the obs but then they would have to wait up to two hours for a doctor to come from the gastro ward to perform the procedure,” said Fazlin Vivier, deputy sister at the Queen’s Day Case Unit.

“They rarely got to see the same doctor more than once and sometimes, if they needed treatment over the weekend, they would have to go via A&E, which was really upsetting for them and us too.”

“We have reduced the time people wait from having their obs and paperwork done to just half an hour”

Fazlin Vivier

Three senior nurses – project lead sister Aquiline Chivinge and deputy sisters deputy sisters Ms Vivier and Deborah Simpson – went to visit an established nurse-led paracentesis service at Addenbrooke’s Hospital in Cambridge before learning how to perform the procedure themselves.

While it is still early days, Ms Vivier said the launch of the new service about a year ago had already made a “huge difference” to patients, whose satisfaction scores had shot up.

“We have reduced the time people wait from having their obs and paperwork done to just half an hour,” she told Nursing Times.

“Before, 29% waited more than three hours if, for example, doctors were caught up with a poorly patient on the ward,” she said. “We have also seen a dramatic reduction in admissions via A&E.”

The new arrangement has allowed nurses to build good relationships with patients and ensure they get more information and education about how to manage their condition and are referred to other help and support, she added.

This has involved developing stronger links with community nursing and palliative care teams to ensure patients are swiftly referred for help with alcohol problems or end of life services.

The team does outreach work, carrying out assessments of patients in intensive care or on other inpatient wards and performing the procedure if necessary.

“It shows that as nurses you can make a difference and be recognised for that”

Fazlin Vivier

The trio also train doctors and other senior nurses on how to perform paracentesis including those based at a sister campus, Nottingham University Hospitals Trust’s City Hospital.

Ms Vivier stressed a key factor in making the service a success was “great support from consultants”.

The £10,000 grant will allow the team to develop the service further, including investing in technology to help monitor patients at home and alert them when they need to come in.

“It was great to get the grant because we haven’t been running the service for that long and it has really boosted our morale,” said Ms Vivier. “It shows that as nurses you can make a difference and be recognised for that.

“I now have 100% job satisfaction, because I can see patients benefitting and know we are achieving better outcomes.”

The SAGE awards, which are judged by an independent panel of experts, are supported and funded by Shire Pharmaceuticals. The 2016 SAGE awards will shortly be open to entries.


Nottingham University Hospital

The winning team at the 2015 SAGE awards , including lead nurse Aquiline Chivinge (second from the right)


Readers' comments (4)

  • michael stone

    This is the sort of thing that seems sensible to me (not something I could say about all 'NHS behaviour').

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  • Re:michael stone | 17-Sep-2015 2:21 pm
    That's probably because the work of these advanced practice nurses is not 'NHS behaviour' but rather the application of expert knowledge and skill by members of one profession within the service.

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  • Such innovation shows outstanding leadership & innovation amongst the team, the absolute drive was the 'patient is at the heart of everything we do'. The difference to patients is fantastic & the ability to empower patients to contribute in managing there disease is inspiring. The support from the medical staff & nursing colleagues has been key to making this a success. I feel I can make these comments truthfully as I manage this great team of nurses.

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  • michael stone

    Anonymous | 17-Sep-2015 11:10 pm

    Setting the 'scheme' or 'idea' up is part of 'NHS behaviour' - this uses the nurses's skills to help patients in what looks like a better way than previously. That type of objective is often thwarted by what I would term [on a bad day] 'NHS bureaucratic stupidity'.

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