1. 3 Girls, 3 Specialities, Unlimited skill set the impact of the clinical nurse specialist in haematology
Caroline KERR, LAURA CROAN, damian Finnegan, Lisa Houlihan, Oonagh Sheehy and Jackie Quinn

3. Introduction
Increasing numbers of patients living with haematological diseases requiring intensive monitoring.
CNS’s offer these patients continuity of care through individually tailored care plans to provide holistic support, education and advice to patients and their carers,
Point of contact back into the service if required.
NI has a shortage of CNS posts, there is however a CNS job plan to increase the numbers for cancer patients.

4. Objectives
In Belfast City Hospital a full ‘core’ team has been in place since April 2015.
Jackie Quinn- Myeloma and MGUS- in post 11 years. Funded by Trust.
Laura Croan- Lymphoma- in post since September Funded by Friends of the Cancer Centre.
Caroline Kerr- Myeloid- in post since April Funded by Macmillan.
We were keen to analyse the impact of a core team of CNS’s on the haematology service from a medical and patient perspective.

5. Methods
We conducted a retrospective analysis of the service from April 2015 – April 2017
We totalled the number of patients reviewed by the CNS team using clinic coding
We also reviewed all aspects of our workload such as telephone calls (> 15mins), referrals, health and well being events and service development using annual report data.
Staff and patient feedback was also included.

6. Results
We have saved 2,745 medical clinic hours based on each appointment being 10 mins.
The CNS team had 16,470 patient events, either inpatient or outpatient, face to face or telephone over the two years.
6,217 telephone queries were also answered during this time

7. CNS clinic activity
JQ – 2 velcade with 2 pre-assessment, MGUS tel r/v, 2 cons clinics
CK – 3 cons, HNA, MPN and long term leuk tel r/v, late effects, aza clinic development
LC – 2 cons r/v, 2 cons SACT, nrse led long term r/v, maintenance ritux, EOT HNA 7

8. Patient numbers

9. Other Activity Patient Health and Well Events Teaching
Patient Support Groups
Onward Referrals
Online Forums
Peer Review
Information Development for patients
Presentation at Conferences
NICaN
Teaching
Audit
Service Development
Mentorship
Professional Development
Charity Engagement
Policy writing
Support gp 3 monthly
Voluntary expert for macmillan
HWBE – 2 lymph/myeloma, myeloma UK days, LA pt and staff info days, 2 myeloid n coffee n cake, MPN days
Referrals – charities, other specialities (resp/GI etc) 9

10. Limitations
Figures are not fully representative of current activity as Myeloid CNS was not prescribing and was on induction for some of the evaluation period.
Myeloma CNS was not used to recording her figures as she was Trust not Charity funded.
Lymphoma CNS post was a new post and the service was being developed from scratch. Thus activity is not fully representative of current activity.

11. Education All educated to specialist degree level
All have a haematology qualification
All have blood authorisation training
All have health assessment and prescribing qualification
Radiology requesting
Bone Marrow Biopsies
All have advanced communication skills training
One has a masters level degree and two are losing their sanity this year, completing theirs!

12. Clinical Experience Ward based nursing Recruitment
Clinic – outpatient nursing
Apheresis
Research
Haematology Outreach Nursing

13. Other Skills not on the job description!!
Benefit forms!
Travel insurance/ agents!
Can arrange weddings and funerals.
Blood transfusions in foreign countries!
We do ‘Touchy feely stuff’ when the medical staff see tears!
We know random stuff such as humans can take DOG vitamins without dying!
We can turn water into wine… I wish!

14. Feedback from staff and patients
“Confident and reassuring. Seemed to have more time for me and I like being able to see someone familiar who knows me”
‘‘Whenever mum saw Caroline she always breathed a sigh of relief as she knew she was being well looked after’’
“We need more CNSs!!”
Haematology consultant
“Laura has been an amazing support to my mum and family. Bridgewater is blessed to have her”
“Jackie has been thoughtful and supportive to my husband and family.”

15. Conclusions
The impact of the CNS on the patient is well documented¹. The impact on doctor workload is less clear.
We have demonstrated the value of the CNS team, even in its infancy.
Nurse led clinics have led to a reduction in non – recurrent spend associated with ad-hoc review clinics, a reduction in the number of unscheduled admissions due to preventative measures and a reduction in length of stay of inpatients.
Such clinics and the contactable CNS has also had an impact on GP workload, reducing the need for GP intervention².
We intend to continue to document activity and re-evaluate now that the full team is fully functional.

16. Thank you for listening