Catriona Briers was the first NHS nurse in Northern Ireland to undertake a blood transfusion in a patient’s home back in 1999. It’s something she is extremely proud of, and is fairly sure she is also one of the first in the UK to do this.
At the time, Ms Briers was working for Down and Lisburn Trust, Hospital at Home Service. “It was essentially a multi-disciplinary service providing a “hospital level of care” in the patient’s own home”, she says.
“The reason we did that first transfusion was because it was the right and compassionate thing to do. The patient was terminally ill with a prolapsed fungating rectal tumour, the transfusion was critical to sustain life but to move them to hospital would have been life threatening. The patient and her family didn’t want her to go.
“I talked to the GP and said if you are happy to take responsibility, I am happy to do the transfusion. And so we did it. I had the necessary skills in anaphylaxis should any issue arise. With repeated home transfusions and the patient lived comfortably for another two years.”
“The transfusion was critical to sustain life but to move them to hospital would have been life threatening”
Ms Briers, now the lead nurse for Rapid Response Nursing Service in South Eastern Health and Social Care Trust in Northern Ireland since 2009, is passionate about providing as much care as possible for patients at home. “I am driven to prevent hospital admissions and facilitate early discharges,” she explains.
Ms Briers started training in 1986, and then worked in the Mater Hospital in Belfast, a small acute hospital. “I worked in surgery and the emergency department here, and I always believed my career would develop in hospitals. I worked my way up to ward sister, but then I had a baby and was also studying for my master’s degree so I left for a part-time job in the community in 1998 as I needed more flexible hours”.
She took on the role of Hospital at Home Co-ordinator in November 1998, a service built around short-term rehabilitation mainly for people recovering from fractured neck of femur or hip replacements. She says the service was the first of its kind in Northern Ireland.
“We were prompted us to look at what other treatments we could provide for patients at home”
“But many of these patients came home with wound infections, so we started doing intravenous antibiotics and this along with that first blood transfusion at home, prompted us to look at what other treatments we could provide for patients at home,” Ms Briers says.
“There were two large regional cancer units around Belfast, and patients would go and sometimes wait all day for their blood. Frail older people might be collected at 7.30am and not get home until 9pm, and sometimes not get all the blood they needed and have to return the following day.
“Now, we work closely with the hospital consultants completing hundreds of transfusions at home every year.”
The Hospital at Home Service was restructured and divided into Community Rehabilitation and Rapid Response Nursing in 2007. Rapid Response manages all nursing between 6pm and 8am particularly palliative and crisis calls. The different elements combine providing 24-hour nursing care seven days a week.
“I am driven to provide patients with the best care at home”
Rapid Response provides a range of intravenous drug treatments at home such as methylprednisolone which is used to treat multiple sclerosis; so many patients particularly from rural areas do not have to travel to regional units.
Two of her senior nurses are currently training in non-medical blood authorisation and will be the first community nurses in Northern Ireland to undertake this role.
The service has also set up a clinic to diagnose and treat iron-deficiency anaemia so that patients can be treated much closer to home. The treatment provided reduces the need for repeat blood transfusions, and also dramatically cuts the time taken for the transfusion of two units of red cells over four hours to a 20-minute iron infusion.
Ms Briers has pioneered much care in the community, but she is determined to do more. “I am driven to provide patients with the best care and treatment they require at home. It’s conducive to improved health, recovery and wellbeing for patients to be in familiar surroundings and in a comfortable environment during treatment if possible” she says.
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