Nurse Consultant Nutrition & Intestinal Failure
Department of Clinical Nutrition, St Mark’s Hospital
After qualifying as a Registered Nurse at St Thomas’ Hospital in the mid 80’s, Mia worked for a number of years in gastroenterology and colorectal surgery. She began working at St Mark’s Hospital; part of London North West Healthcare NHS Trust, first as a Staff Nurse, then Sister, and became a Clinical Nurse Specialist in Nutrition in 1999. She has subsequently held lead Nutrition Nurse Specialist posts at Barts and the London and Guy’s and St Thomas’. She returned to St Mark’s as Nurse Consultant in Nutrition and Intestinal Failure in 2008, and was an Honorary Lecturer at the Burdett Institute of Gastrointestinal Nursing until its closure in 2011. Mia holds a BSc (Hons) in Colorectal Nursing, a Diploma in Human Nutrition and an MSc in Nutrition Support.
Using Micrelcare with St Marks patients is a unique and first collaboration between St Marks and Industry.
When and why did you start using the Mini Rythmic PN+ Pump and Micrelcare?
We started the Micrelcare project in 2013, since then we have been able to analyse 6000 data points. From this information it has been possible to determine what the average line pressure is and subsequently what is abnormal. Although clinical benefits are in the infancy we are hopefully developing algarithims which will be able to predict if someone is going to get a line occlusion.
Is there anything else that has been highlighted since you started using Micrelcare?
From my perspective as a nurse it has provided me and my colleagues with an invaluable insight into life on HPN. ( Home Parenteral Nutrition ). Knowing how often people get an alarm may seem very trivial and they cannot tell you how many times the alarm has sounded, however other family members are very aware of the alarms. Some have clusters of alarms, others have alarms over a concentrated period of time up to 45 minutes.
How did you feel about using this technology?
To begin with I was sceptical and worried it may be viewed as an intrusion, however reviewing someone’s infusion history has often been the starting point of a conversation which would not normally taken place. Also it has revealed that sometimes people are not confident to reduce their prescription. Being able to reassure patients that the pump is not over or under infusing.
How have the patients felt about using the technology?
Patients have given very positive feedback to the monitoring as they are reassured that we are able to keep an eye on things. It is not for everybody and some patients have declined using it.
What is the Pamela Harris Award?
The Pamela Harris Award is sponsored by the Nightingale Trust. The Nightingale Trust is a charity whose objective is to educate healthcare professionals in providing good nutritional support through education and training. The award is named after Pamela Harris, one of the founders of the charity, and a patient who is reliant on artificial nutrition support.
I was genuinely surprised to win this award, because you don’t think what you are doing deserves the recognition as it is just your job. It made it extra special as I know the patient who the award is named after.
Harnessing innovative pump technology to improve the experience and outcomes of patients receiving home parenteral nutrition
Home parenteral nutrition (HPN) is a lifesaving therapy for severe intestinal failure. Infusion pumps play a key role in the life of these patients. They ensure the accurate delivery of fluid and alert patients to potential infusion or catheter related problems. Pumps have typically not permitted analysis of this information meaning that the nature and frequency of alarms is not known. In addition, infusion history is a vital part of HPN monitoring. This has traditionally relied on informal methods such as patient recall, measurement of stock used and/or stock ordered. Collaboration with industry (Micrelcare™) allowed information about alarms, infusion histories and pressures to be exported anonymously to a secure server using GPRS technology. This was achieved by attaching a special external battery pack to the pump and switching on the device prior to commencing an infusion. This presentation will present our experience with the technology and the potential clinical benefits. The data obtained established normal infusion pressures which alongside the nature of alarms facilitated early intervention for catheter occlusion, and also suggested pressure spikes might indicate an upcoming problem, such as thrombosis. Reviewing infusion histories assisted in the ongoing assessment of patient's requirements and permitted reduction in the number of nights feeding. Patients also reported feeling reassured by the technology and more involved in their ongoing care.
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