RESUMEN
NHS England Genomics introduced whole genome sequencing (WGS) with standard-of- care (SoC) genetic testing for haemato-oncology patients who meet eligibility criteria, including patients with acute leukaemia across all ages, and exhausted SoC testing. Alongside, the role of germline mutations in haematological cancers is becoming increasingly recognised. DNA samples are required from the malignant cells (somatic sample) via a bone marrow aspirate, and from non-malignant cells (germline sample) for comparator analysis. Skin biopsy is considered the gold-standard tissue to provide a source of fibroblast DNA for germline analysis. Performing skin punch biopsies is not within the traditional skillset for haematology teams and upskilling is necessary to deliver WGS/germline testing safely, independently and sustainably. A teaching programme was designed and piloted by the dermatology and haematology teams in Sheffield and delivered throughout the NHS trusts in North East & Yorkshire Genomic Laboratory Hub. The training programme consisted of a 90-min session, slides, video and practical biopsy on pork belly or synthetic skin, designed to teach up to six students at one time. To disseminate best practice, the standard operating procedure and patient information used routinely in Sheffield were shared, to be adapted for local service delivery. From January 2021 to December 2022, 136 haematology staff from 11 hospitals, including 34 consultants, 41 registrars, 34 nurses and 8 physician associates, across the NEY GLH region completed the skin biopsy training programme. Feedback from the course was outstanding, with consistently high scores in all categories. Practical components of the course were especially valued;98.6% (71/72) trainees scored the practical element of the programme a top score of 5 out of 5, highlighting that despite the challenges of delivering face-to- face teaching due to COVID-19, teaching of practical skills was highly valued;training in this way could not have been replicated virtually. Costs of the programme have been approximately 16 000, including consultant input and teaching/educational materials. Recent support has been provided by a separately funded Genomic Nurse Practitioner (GNP), with succession planning for the GNP to take over leadership from the consultant dermatologist. Plans are in place to use the remaining budget to disseminate the programme nationally. Our training programme has shown that skin biopsy can be formally embedded into training for haematology consultants, trainees, nursing team, and physician associates. Delivery of training can be effective and affordable across regional GLHs with appropriate leadership and inter-speciality coordination, and ultimately sustainable with specialist nursing staff, including GNPs.
RESUMEN
Introduction: During the COVID-19 pandemic, the FDA began allowing hospitals to use continuous glucose monitoring (CGM) on a "non-objection" basis in the inpatient setting to decrease direct patient contact and preserve personal protective equipment while increasing the availability of glucose date to inform patient management decisions in April of 2020. Our institution deployed CGM technology (Dexcom ™) in 55 patients across four inpatient hospital units beginning September 2020, with a median use of 6.5 days per patient. Objective: To explore perceptions and experience of nursing staff related to the use of CGM technology in patients with hyperglycemia admitted for COVID-19. Methods: A qualitative survey was distributed to 29 critical care nurses who routinely utilized CGM technology to obtain and interpret glucose trends impacting clinical decisions for patients during their admission with COVID-19. The survey included eight questions that used a 1 to 5 scale format, where 1 corresponds to "strongly disagree" and 5 corresponds to "strongly agree", and two open-ended questions (advantages and concerns). Results: 100% of the respondents "agree" or "strongly agree" that CGM technology is useful in glucose management and prefer when their patient has a CGM. 97% "agree" or "strongly agree" that CGM technology is user-friendly and its use minimized direct patient interaction or contact, thereby reducing utilization of personal protective equipment (PPE). 93% "agree" or "strongly agree" that they feel confident operating a CGM device and consider the CGM data reliable and accurate. 90% "agree" or "strongly agree" that the technical aspects of CGM technology are easy to manage and would like to see this technology offered to patients without COVID. The most significant benefits of CGM as rated by the survey participants include: fewer fingersticks, decreased COVID exposure, convenience, PPE preservation, continuous glucose monitoring, and improved glycemic management. Concerns include: calibration time, accuracy, potential malfunction, extended warm-up period, and protocol education. Discussion: This survey demonstrates that CGM technology previously primarily used in the outpatient setting can be easily adapted for inpatient use.Nurses eagerly accepted and competently integrated CGM technology into routine patient care, which, in turn, decreased exposure time in COVID-19 rooms and subsequently decreased PPE use. Proper education related to inpatient use of CGM technology and open communication between the nursing staff, the primary care team, and the endocrine consulting team have been identified as critical elements for a successful deployment and continued utilization.The use of inpatient CGM technology holds promise for improved glycemic control in hospitalized patients while increasing the safety of healthcare workers. Further studies demonstrating decreased exposure times and infection rates among healthcare workers caring patients with COVID-19, and measurable improvements in glycemic control in patients utilizing CGM technology should be explored to further demonstrate the benefits of inpatient CGM use.Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.