Improving patients' quality of life with liver disease.
Nurse Recognition Award for Improvement in Patient Care
“Implementing a Long Term Indwelling Abdominal Drain service to support patients with advanced liver disease to have an improved quality of life.”
With the support of the hepatology consultant, Laura developed a pilot project to review four key areas; the effectiveness of LTADs in managing non-malignant diuretic refractory ascites in near end of life patients, the impact on LTADs on the quality of life for this patient cohort, whether patients with LTADs have a reduced burden of hospital visits and finally whether patients with LTADs die in their preferred place of care. Additionally, she engaged with key professionals including the radiology team, community nursing and palliative teams and the drain manufacturer representative.
Although recruitment for the project was affected by Covid, since December 2019, 11 patients had LTADs fitted, of whom eight have since died and three still have a drain in place. All 11 participants have benefitted from at least weekly visits from the community nursing service, and they or their careers also received weekly calls from Laura during their LTAD care.
Patients reported an optimised quality of life, reduced pain and discomfort and high levels of satisfaction with the LTAD. They also benefitted from being able to remain at home for their care and treatment and crucially perhaps, each of the eight who died was able to do so in the place of their choice.
“As the project moves forward, I have identified new areas for development, include plans for an advanced liver disease MDT meetings to select patients who may benefit from LTAD, the development of a QoL outcome measurement tool and hepatology nurse community visits for complex LTAD patients. In addition, training has been implemented both for community staff and GPs in the use of LTADs in non-malignant ascites.”
Why did you choose this project?
‘In my role as a hepatology nurse, I often care for patients living with advanced liver disease. These patients can endure serious complications of their disease, including ascites. Ascites can cause huge physical discomfort and distress to the patient. To manage their condition, they may need to make frequent hospital visits, spending several hours or overnight whilst the fluid is drained. This becomes burdensome or even physically impossible due to their deteriorating conditions. Previously I worked in specialist palliative care, where long term indwelling abdominal drains (LTAD) were used to manage ascites in cancer patients. These drains are placed permanently under the skin and enable either community nurses, carers or patients to drain ascites at home. This care enhanced patient quality of life and meant that patients were often able to die outside of a hospital environment. I was therefore keen to understand if implementing LTAD into our hepatology provision would be appropriate for patients with advanced liver disease.”
‘I am delighted to have won the nurse recognition prize for this project. I am hugely passionate about supporting the care of patients with advanced liver disease. I have previously had a long career in specialist palliative care and this combined with my current role as a hepatology specialist nurse has motivated me to undertake this project to improve the quality of life for patients. I am the first (and only) hepatology nurse to work in the Great Western Hospital in Swindon, I have huge ambition and motivation to grow the service and deliver improved outcomes to patients with liver disease. This award will support me in raising the profile of hepatology and demonstrating what can be achieved. I am very excited to build on this project and develop the service further.’- Laura Kent