The ‘Patient Safety Improvement’ category sought nominations of initiatives which could show how they have addressed factors known to place patients at risk with clear demonstrations of improvements in patient safety.
The atypical haemolytic uraemic syndrome (aHUS) Clinical Nurse Specialists – who lead the nursing service for the National aHUS Service based at the RVI – were named as Finalists for their initiative ‘A Collaborative model of meningococcal vaccination response monitoring for patients receiving complement inhibition.’
Introduced by CNSs Christine Maville and Gemma Allen the aim of their work is to help prevent potentially life-threatening infections caused by a known side effect of the life-saving treatment aHUS patients receive.
On discovering they were Finalists, Christine and Gemma said “We are delighted to be shortlisted for this award as it is recognition of how collaborative working can successfully lead to improvements in patient care.”
Expertise in this rare specialism
aHUS is an extremely rare disease with an incidence in the UK of only 0.4-0.5 per million population. It is caused by a fault in the complement system – part of the body’s immune system which acts as our first line of defence against infections.
The human body has an in-built system of protector proteins that stop the complement system from attacking its own cells. However for those affected by aHUS, complement attacks the body’s own cells, especially those lining the blood vessels. This can cause clots to form in the body’s smallest blood vessels leading to problems such as aHUS and other similar conditions known as thrombotic microangiopathies (TMAs).
Whilst all organs can be affected the most commonly affected organ is the kidney. If left untreated it can become a life-threatening illness with the majority of patients developing end stage kidney failure requiring long-term dialysis/ kidney transplant.
The National aHUS Service in Newcastle was commissioned by NHS England in May 2016 to diagnose and co-ordinate the management of patients with aHUS.
The patient safety risk
aHUS typically presents with symptoms of:
- thrombocytopenia (low platelet count),
- microangiopathic haemolytic anaemia (destruction of red blood cells)
- acute kidney injury (when the kidneys suddenly stop working).
Patients are treated using complement inhibition (Eculizumab/Ravulizumab) which works by blocking the action of complement and therefore preventing it from damaging the body’s own cells.
However, the treatment makes patients susceptible to infection, particularly meningococcal infection, which can be life-threatening.
Responding to the risk factor
The project, that was designed, led, implemented, and audited by the aHUS nurses, was intended to improve the percentage of patients having their annual blood test taken to measure protection against meningitis.
This was achieved through stakeholder engagement and the implementation of a centralised monitoring system to reduce the healthcare burden for patients and ultimately ensuring patient safety is prioritised.
Clinical nurse specialist Gemma Allen explains “Our patients receive the C5 inhibitor, Eculizumab which leads to a >600x risk of meningococcal sepsis with mitigation through vaccination and antibiotic prophylaxis.
“With a geographically disparate patient group, we identified a deficiency of local monitoring, potentially placing patients at risk.”
Gemma continues “By working collaboratively with stakeholders including patients, local clinicians, homecare companies and Alexion (the pharmaceutical company who developed eculizumab, and who fund homecare services for aHUS), new service level agreements across all Trusts were negotiated and implemented – resulting in an innovative system to increase monitoring of meningococcal titres and revaccination.”
Colleague Christine Maville adds: “A review of compliance with best practice was undertaken. This was verified by comparing our own records with those of the Meningococcal Reference Unit (MRU), UK Health Security Agency. Following this audit, change was implemented with a central monitoring strategy.
“This centralised monitoring strategy involved the development of a patient pathway whereby a blood sample for titres could be taken alongside a patient’s infusion at home. We provided patients with a kit, letter and safebox for posting the sample direct to the Manchester reference lab.
“Results were reported directly to our service for clinical review and recommendation for further management”.
In the time period 2017-2018 annual meningococcal titres were undertaken predominately in the primary care setting. An initial audit demonstrated compliance of 57%. A repeat audit following implementation of this new strategy demonstrated 97.6% compliance.
A national exemplar
The success of this scheme has led to a wider rollout for all distant monitoring and has now been implemented for monitoring of anti factor-H autoantibodies, a cause of aHUS, which has resulted in patients being able to stop treatment and reduce meningococcal risk to a baseline.
Christine says “As part of the initial audit, where patients were monitored largely within primary care or via their local managing team in secondary care, it was noted that patients did not receive a copy of their titre results and therefore were not included in this aspect of their care.
“As part of the centralised monitoring process, patients are involved in each step of the process and receive a copy of their results and our recommendation for further vaccination and monitoring.”
Of the successful results Gemma says “We have found that using a collaborative approach with relevant stakeholders strengthens partnership working which has resulted in improved working relationships which has enabled other projects with these stakeholders to be more streamlined and effective.
“We would be keen to explore further whether this initiative could be utilised by other highly specialised services, using our model as an exemplar.”
Cheryl Teasdale, Associate Director of Nursing said “A well deserved nomination for the atypical haemolytic uraemic syndrome (aHUS) Clinical Nurse Specialists, this project is innovative, patient centred and collaborative making a difference to this vulnerable patient group. Well done and best of luck at the awards.”
More information about the National aHUS service can be found on their website: http://www.atypicalhus.co.uk
Nursing Times Award – ‘Patient Safety Improvement’ category criteria:
As the professionals with the greatest amount of patient contact, nurses play a vital role in ensuring patients’ safety at every stage in their care.
This category was open to individuals or teams from the NHS or independent sector who have undertaken an initiative to address factors that place patients at risk and promote safety as an essential part of healthcare with clear outcomes demonstrating improvements in patient safety.
Nursing Times Awards 2023
These awards bring together the nursing community to shine a light on the brightest talent in the profession and recognise those of you making nursing innovative, patient-focused and inclusive.
There are 23 categories covering a wide range of nursing specialities, all open to entries from individuals and teams, or nominations from those who wish to highlight a nurse or team who they believe deserves recognition.
The awards ceremony will take place in London on Wednesday 25 October 2023 – we wish all of our Finalists the very best of luck.