ABSTRACT
Background/Aims The Paediatric Rheumatology Team at the Great North Children's Hospital (GNCH) provides care to children and young people (CYP) across the northern region. On average 70 new CYP are diagnosed annually with rheumatic conditions. Approximately 1/3 will require long-term treatments and long-term rheumatology follow-up. The team support over 300 patients receiving treatments for at home, with 75 CYP requiring regular treatments administered in hospital. Tocilizumab targets IL-6 and is used to treat rheumatic conditions. Tocilizumab, approved for use in children with certain subtypes of JIA in 2011, is normally administered via an intravenous infusion on the Paediatric Day Unit, at GNCH. The procedure takes approximately 3 hours and involves a cannula for administration. Part of Continuity and Emergency Planning for the COVID- 19 pandemic the Medicines & Healthcare Products Regulatory Agency (MHRA) compiled a list in April 2020 of medications including tocilizumab, not to be exported from the UK or hoarded. Tocilizumab was a proposed treatment for hyper-inflammatory response for COVID-19 and concern that supplies would be affected. NHS hospitals were advised to reduce routine activity and footfall through the hospital. The team agreed the need to consider alternative treatment delivery. Methods A patient cohort were identified attending GNCH for intravenous infusions. 38/65 (58%) patients were receiving tocilizumab. The pharmacist agreed to switch CYP from intravenous to subcutaneous tocilizumab. A total of 34 eligible patients were identified (32/38 current patients and two new patients) Using a multi-disciplinary approach, the pharmacist established agreement, arranged supply and delivery of medication to the families. The CNS contacted all families via nurseled telephone clinic and invited eligible CYP to a face-to-face clinic, to received counselling and training to administer. The rheumatology consultants supported the change with prescription management. Over a 6-week period all eligible CYP transferred to subcutaneous form of tocilizumab administered at home. Medication was transported to families via home care delivery company. Results 34 patients switched, 9/34(26%) reported localised injection-site reactions, varying in severity but could lead to discontinuation of treatment. An inconsistent approach to managing these reactions was recognised by the pharmacist and CNS. Collaboration with the paediatric allergy teams, devised a standardised approach to manage injection-site reactions using an algorithm. Conclusion • Reduce pressure on precious hospital resources • More convenient for families - minimise long distance travel for treatment and time off school/ work • True collaboration and recognition of multidisciplinary team working swiftly to find a solution to a problem impacting upon patients, their family and the Trust • Algorithm devised by the paediatric pharmacist using easily accessible oral and topical treatments for families to use at home to manage site reactions. • Tocilizumab has proven to be useful in treatment of critically unwell patients infected with COVID-19.
ABSTRACT
Background/Aims We evaluated the RCN Competency Framework for Rheumatology Nurses published in March 2020. The competency aims to support personal development plans, continuing professional development (CPD) and career progression for rheumatology nurses to advanced practice acting as a benchmarking tool, providing a framework to support succession planning and service development, forming the base for a nationwide standard curriculum for training. This evaluation explores rheumatology nurses' views of the competency, and identify benefits, limitations, and recommendations. Methods We used a sequential research design utilising a questionnaire circulated from 13 March to 25 April 2021 followed by semi-structured interviews between May 2021 and August 2021. Results 106 people responded to the survey, 99 (93%) working as adult rheumatology nurses. There were 55 (52%) band 7 nurses and a wide range of job titles. Most nurses, 93 (87%) had academic qualification at degree or Master's level. Most respondents 77 (73%) were from England. 74 (70%) found out about the competency via the RCN Rheumatology Nursing Forum Facebook page, or via the BSR website (35%). Most (71%) respondents had their present role for five years or more and 103 (50%) nurses had been in their role for more than 10 years. When asked whether they had used the competency in their practice, 57 (54%) said they had. Reasons for using it were;to provide a framework for learning, to use as a benchmarking tool, for CPD, for teaching, to demonstrate skills and knowledge, when managing others, to show managers how their role can develop. Redeployment due to COVID-19 and workforce issues were the main reason why the competency was not implemented fully. However, using it with new staff was cited as beneficial. Free text comments described very good detail and identification of learning needs, giving good understanding of the underpinning knowledge. 15 nurses responded for interviews and 14 were conducted. The average was 12 minutes totalling 171 minutes. We asked why they used the competency, for any potential strengths or limitations, how much time it took to complete, would they use it again, improvement suggestions, if they would recommend it to others, and whether it was easy to locate. People said a paediatric rheumatology module and an accessible course focussed on leadership is needed. When asked to summarise the competency in five words, one said it was 'a reliable tool to improve quality care and set standards for education of nurses'. Conclusion The competency was well received as a strengthening resource for UK rheumatology nurses. We recommended that these competencies are universally adopted. Further dissemination is required and education needs must be addressed. A development framework is planned. Further analysis will be published in 2022. A review of the competency is due in 2023.