Sue Bacon, clinical nurse specialist in DVT, said: ‘In the past patients with clots were treated in hospital on an infusion drip of unfractionated heparin, when you could have a daily injection. They would sit around doing nothing when they were essentially healthy.’ Sue who was an E grade staff nurse in medical admissions before taking on her current role.
‘I was frustrated to see fit, well patients who were staying in. Then I read an article about patients being treated for DVTs in outpatients.’
Two years after Sue took on her current role - the first of its kind in the trust – patients with a suspected DVT are now able to access the clinic directly rather than being admitted via A&E.
Now, the treatment of patients admitted for other reasons, such as surgery, but who then develop a DVT, as well as those with a past history of DVT or with high risk factors, also receive improved care. Through education sessions from Sue, staff are much more aware of the correct treatment protocol and are also able to contact Sue who then provides input and care until the patient is stable.
Sue sees education and patient safety as a crucial part of her role and that of other clinical nurse specialists around the UK who have been making similarly important improvements in the treatment and prevention of DVTs.
‘With warfarin therapy, if you take too much you can end up not clotting at all and can bleed to death. Not enough and the clot can get larger, lead to a pulmonary embolism and possible death,’ she stresses.
‘When I came into the post I was asked to look at what the trust was doing to prevent clots. There was a bit of information here and there - but if you were a staff member new to the trust, the information was all over the shop and therefore impossible to piece together,’ she says.
She also holds regular training sessions for junior doctors and medical students. ‘It is not just about stopping clots - it’s about active management.
‘Now there is a stamp that goes on the drug sheet of high risk patients, so that the medics know they need to be written up for anti-clotting medication,’ says Sue.
Patient education is equally important. 'Often I will go through information with a patient and afterwards they will say to me "that's the first time someone has explained that to me".'
When she took on the role, Sue carried out an audit and risk assessment and identified ways of improving patient care. As well as improving care pathways and speeding up patients’ access to treatment, she has also establishing fast-tracked ultrasound appointments.
Sue believes the most important aspect of preventing DVTs is risk assessment. ‘Not all patients are the same. People have to remember that patients are individuals and don’t fit into boxes.’
Some of the risk factors include: post-operative phase of care, cancer, HRT or the contraceptive pill, smoking, family history or patient history of DVTs, muscle strains (as they can damage a vessel and not heal properly) and long-haul flights.
A House of Commons report in July 2005 agree with all the points recommended by the Health Committee. These included having guidelines that were consistent around the country. NICE guidelines are due to be published in 2007.
The development of her role has also assisted the trust financially. Currently, the annual cost to the whole of the NHS of treating DVTs is £640 million. Nurse-led services such as Sue’s help to prevent DVTs occurring and provide quick treatment of those that do develop, thus minimising complications and danger to patients’ health.
How patients are benefiting from a clinical nurse specialist in DVT
Improved care pathways and access to the service Improved patient access
Fast-tracked ultrasound appointments Patients benefit from a more informed, up-to-date service with better patient monitoring
Staff benefit from improved job satisfaction
The clinical nurse specialist (CNS) is able to keep abreast of current guidance and research
The CNS is able to educate other nursing staff, medical students and other healthcare providers
Using the Verity database allows the trust to benchmark its performance