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Nurse led service reduces hospital trips

nenagh lung clinic web

Pictured at Nenagh Hospital were patient Rose Sheary, seated centre between Olivia Quinn, Respiratory Clinical Nurse Specialist and Paula Ryan, Advanced Nurse Practitioner, Respiratory; and standing left to right Cathrina Ryan, Operational Director of Nursing, Nenagh Hospital,  Cristina Loureiro Falcao, Respiratory Physiologist and Caomhe Gilmore, Physiotherapist

A simple telephone service has been helping keep patients with lung disease out of hospital and able to manage their symptoms at home.

The telephone triage system is available for patients of Nenagh Hospital if they are feeling unwell.

“We call it the virtual clinic,” explained Olivia Quinn, Clinical Nurse Specialist (CNS), Respiratory, in Nenagh. “And that service we provide to patients over the phone is a crucial part of it. We are hours on the phone to patients every week, giving advice on how to prevent flare-ups, exacerbations and hospitalisations. They might want to know something simple around inhaler technique; whether they can have one puff or two, which can make a world of difference to some patients; whether we can help them with an oxygen delivery and so on.”

The virtual clinic is just one part of a nurse-led Respiratory Assessment Unit that has seen 732 attendances in its first year, taking people off an estimated two-year waiting list to be seen by a consultant.

The unit, led by Olivia and Paula Ryan, Advanced Nurse Practitioner (ANP), Respiratory, UL Hospitals Group, opened in Nenagh in early 2017.

 “The major benefit,” explained Ms Ryan “is that we now have an ANP and a CNS working together in an assessment unit that is available to patients in Nenagh five days a week. In my role as an ANP, I can see patients who are currently on a two-year waiting list to see a consultant and take them from initial assessment through their complete episode of care as an autonomous practitioner. I will of course confer with the consultants in UHL where we have any issues but it has meant improved access for patients in Nenagh. It also means that for patients who have been on waiting lists, their respiratory disease is optimised, which prevents antibiotics and steroids, and on occasion, even hospitalisation.”

As well as improved outcomes for Tipperary patients, it also means better access to respiratory services locally.

 “Patients prefer to be seen locally by Olivia or I in the respiratory unit. We can arrange a complete episode of care including a chest x-ray, bloods tests, and make appropriate interventions in their respiratory care,” said Paula. 

The clinic in Nenagh sees patients with COPD (chronic obstructive pulmonary disease), asthma, bronchiectasis and other conditions.

Rose Sheary, a respiratory patient from Nenagh, explained the enormous benefits the local services have brought to her life and the management of her condition.

“My experience here has been wonderful and I can get all the information and advice I need right here in Nenagh whether I come in person or I am on the other end of the phone. The nurses are always available to talk to me and provide that reassurance no matter what state of mind I might be in. I am delighted with the service in Nenagh now and very grateful for it.”

In addition, satellite clinics have opened in Nenagh and Ennis hospitals in 2018 specifically for the management of patients with one of the most serious respiratory conditions, Interstitial Lung Disease/Pulmonary Fibrosis (ILD). There is no cure or no known cause for pulmonary fibrosis and life expectancy upon diagnosis is typically three to five years.

The new service facilitates patients with this serious and debilitating condition and avoids the inconvenience of a long journey to UHL or another major centre.

Six patients currently attend the monthly ILD Clinic in Nenagh and approximately 20 in the corresponding clinic in Ennis.

“For this particular group of patients, having a service available locally makes a huge difference. For a patient with ILD to go to Limerick; to get parking; to walk from the reception to outpatients can be a huge ordeal. They have to carry an oxygen tank and can get very breathless.So the new clinic makes a huge difference to them. And it also makes a huge difference for us. When you hear a patient or a relative come in and speak positively about service improvements, it makes it all worthwhile. That is what keeps you going and that is what motivates you to continue improving.”

The ILD Clinic is nurse-led and comes under the clinical governance of Dr Brian Casserly and Dr Aidan O’Brien, respiratory consultants. Paula and Olivia emphasised that the service improvements in Nenagh were made possible through the support of their consultant colleagues and the whole multidisciplinary team.

Teamwork is also key to the success of the RAU. The physiotherapists in Nenagh are essential to the management and care of respiratory patients, and the respiratory physiologists from the Pulmonary Function Lab in Limerick attend Nenagh Monday to Friday to facilitate sleep studies – a diagnostic test for sleep apnoea and other sleep disorders.

“Due to the established respiratory assessment unit, patients are benefiting from a reduction in their respiratory symptoms, which results in a reduction in exacerbations, hospitalisations and reduced length of stay in hospital. The overall benefit implies improved quality of life,” said Paula.

“And that is important as the incidence of respiratory illness continues to rise. We have a significant problem with asthma in this country with one person per week dying of asthma and every a person with asthma presents to ED every 26 minutes. Asthma exacerbations have been more severe this year with the high pollen count. In respect of COPD, that will be the third leading cause of death in this country by 2020. Our numbers are growing in this region all the time and by developing nurse-led services, Olivia and I are helping to manage that increasing demand.”