Tracy Earley, a nurse consultant for the Integrated Nutrition and Communication Teams based in Preston runs a rapid access clinic 7 days a week to ensure patients get the care they need, when they need it. A Paediatric Nurse by background, Tracy spent 10 years on the Paediatric Intensive Care Unit before going onto to do her inflight nursing in America. After setting up two retrieval teams in Lincoln and Nottingham with the RAF, a move to Lancashire was on the cards and the rest, as they say, is history…
We got the opportunity to talk to Tracy about her role, the challenges she faces and what the future of nutrition looks like:
What is the Integrated Nutrition and Communication Team?
The team is made up of nutrition nurses, speech and language therapists, dieticians and the central venous access team. We work together with the patients, avoiding where we can artificial feeding, but when patients do need to be artificially fed we make sure we get the best device and the best fit that is bespoke to the patient. Once that is agreed and placed, we work together to optimise the patients’ health and also be a port for when things go wrong.
We run a rapid access clinic 7 days a week, so patients can be seen by an expert group of nurses who can help replace their feeding device, without having to be admitted into hospital.
What are the challenges that you face?
My idea of quickly doesn’t necessarily match other people’s ideas and if you have a patient who’s feeding device has fallen out, this is time critical. So getting them into clinic quickly is important and can also be a challenge. This is something we are working on and the increase from a 5 day clinic to a 7 day clinic has helped.
It can also be a challenge checking the position of a device to make sure that the patient is safely feeding and safely receiving their medicines. Particularly with NG Tubes, as it’s not like taking blood out of a vein, sometimes you really have to work at it and this can prolong the time a patient can get there feed and it can get there medicines out of kilter.
We are working on a technology with NGPod Global Ltd that will revolutionise the way we look after patients with nasogastric tubes and this is really exciting. It will provide a quick and reliable response on whether it is safe for the patient to feed or not and that will be much better for the patient and will keep them in better health as well.
What would you like to see happen in the future for nutrition?
At the moment we have two separate services for the community and hospital and this is not good for the patients. So for me, I think I would like to see these two areas integrate better. Once a patient is discharged from us, they will be looked after in the community by a different set of nurses and dieticians. I want the same staff to work in and out of hospital, so the patients don’t have any kind of difference in the approach. Patients become very expert at their care very quickly and they notice the difference if anyone does things ever so slightly differently. So I want our nurses to be able to go in and out of the community and hospital to ease the passage for patients, so they have confidence in their care no matter where they are having that care delivered.
Is patient choice important?
Yes definitely, we have to make sure that no matter what we are doing it is the right thing for them and we try really hard to work within their lifestyles. We want to put the right device in for that patient, because we know that if you get it right then the patient is happy and they will stay out of hospital a lot longer and they will be healthier and happy for a lot longer too. If you just put a device in that looks good on paper, then they are going to be back because they are not happy.
We try to have good relationships with our patients in order to get the best fit for them that fits around their lifestyle. For example, one of our patients has a caravan in Thornton Cleveleys, but they live in Southport. We needed to see them twice a week for bloods and a magnesium infusion. To make it easier for them we agreed that on his way to the caravan on a Friday he should stop by and we would do his bloods and the infusion, that way he would know he was going to be well for the weekend. And on the way back home, he would call in again for more bloods to make sure he was ok. This way he gets to have his weekend away with his family.
It is clear from speaking to you that patient care is at the heart of everything you do. So how have you achieved this and what advice do you have for others?
Aim high and listen to your patients, you cannot deliver a service that is what you think it should be on paper, because it will never fit your patients or the organisation. When you know what the patients need, use their stores to go and speak to your exec teams to change the world, because that is what we have done.
I remember one of our patients had a PEG and he went to the A & E Department of another hospital because it had fallen out. They were unable to do anything and it was a weekend. The patient called me at home (at this time our clinic was only open 5 days a week), I came in and we sorted his tube out over the weekend. If we hadn’t of done this, he would have been in hospital for a few days until we managed to get him transferred over and then that gastrostomy sight would have healed over and he would have had to go through the whole process again.
I took this story to our execs, when we were looking at opening 7 days a week and when they could see the problem from the patient’s perspective, increase chance of illness because they are not getting their feed or medicines. And the impact that then has on the NHS, stay in hospital and an expensive procedure that is preformed when it doesn’t necessarily need to be. Then they can put into context what I was asking for and it was these stories that really helped make the change.
You have to want to take over the world and have a bit of passion. If you are passionate about what you want to do, then you can normally find a way of getting people on board with you. Believe in what you are doing and why you are doing it.