The Vascular Team at St James’s Hospital’s Veins Unit hopes its Outpatient Ambulatory Care service will become a blueprint for varicose vein management nationwide, reports Gary Culliton
The Vascular Team at St James’s Hospital’s Veins Unit won in the Outpatient Initiative of the Year category at the 2015 IMT Irish Healthcare Awards for its project titled ‘Outpatient Ambulatory Care Management of Varicose Vein Surgery’.
This service continues to deliver high-quality outpatient surgery, and has doubled numbers availing of the service to date this year. Patient outcomes are excellent and over the next six months, it is hoped to formally measure patient satisfaction.
The vision and support of the hospital and staff has ensured the success of this project, the Team reported to IMT. In the near future, it is hoped to move to an upgraded department where there will be a purpose-built ambulatory care unit to provide the service.
It is also hoped that this service will become the blueprint for the future management of varicose veins throughout Ireland.
The Vascular Team in the Veins Unit at St James’s has successfully piloted a new model of outpatient Ambulatory Care Management, which has proved that consultant-delivered varicose veins treatment in an outpatient setting — under local anaesthetic — can result in significant cost savings without compromise to patient safety or quality or care.
The team hoped that three varicose vein procedures could be performed each morning in conjunction with a dedicated venous/varicose vein outpatient clinic. This would result in a significant increase in capacity and a resultant reduction in waiting times. Under the new model, all patients are treated in the outpatient setting and are given a mild oral sedative pre-operatively and local anaesthetic peri-operatively. All patients considered for varicose vein surgery are now listed for outpatient treatment unless they require pre- or peri-operative blood products.
At last year’s Awards, a commendation in this category went to the Five Steps to Living Well With Dementia in South Tipperary Consortium, for its ‘Memory Technology Library’. Located in South Tipperary General Hospital, the ‘library’ comprises five rooms showcasing an extensive range of dementia specific assistive technology products — such as furniture, sensors, modified radios and remote controls, orientation clocks, medication reminders etc — that may be useful for someone with dementia and that can be loaned out for use prior to a possible purchase.
University Hospital Waterford’s Cardiology Department was another winner at last year’s Awards, in the Nursing Project of the Year category, for its ‘Accuracy in precordial ECG lead placement project’.
An update on education needed to be given every six months on this matter, as recent re-auditing showed that this helped to maintain skills, according to Norma Caples, CNS at Waterford Regional.
As inaccurate precordial ECG lead placement may lead to erroneous ECG diagnosis, the team from the Cardiology Department at UHW first assessed the accuracy of lead placement amongst nursing staff, educated them regarding correct lead placement, and finally re-audited their accuracy to assess the impact of their intervention.
From their initial research, it was worryingly found that there was only a 10 per cent complete accuracy among the 63 nurses audited. The main errors made were not starting in the fourth intercostal space with V1 and V2 and ‘curving’ of V4, V5 and V6 instead of putting them in a straight line within the fifth intercostal space.
The subsequent programme involved providing a poster of the correct lead placement in all areas, followed by educational sessions on wards to demonstrate the correct placement. Further 30-minute presentations were also provided.
A second audit then showed 75 per cent accuracy — an improvement of 65 per cent.
There were two commendations in this category last year — including Naas General Hospital, HSE, for its prospective study on ‘The relationship between Nurses’ Assessment of Early Pressure Ulcer Damage and Sub-Epidermal Moisture Measurement’. Using a new point-of-care diagnostic tool to measure the levels of sub-epidermal moisture, the nurses found that the number of days it took to detect early pressure ulcer damage was reduced.
Knowing that early pressure ulcer damage is there, can now facilitate prevention strategies to avoid further extension, thus avoiding the associated patient morbidity and mortality.
A second commendation was awarded to the LauraLynn Children’s Hospice for its LauraLynn@Home scheme, the first dedicated hospice at home service for children in Ireland. Set up in June 2014, the programme provides support in the Dublin North East and Dublin Mid-Leinster regions.
Children with life-limiting conditions and their families have received support from the team of three staff nurses and three healthcare assistants — including the provision of short breaks, as well as crisis and end-of-life care.