Venetia Wynter-Blythe is the Lead Upper Gastro- Intestinal (UGI) Clinical Nurse specialist (CNS) at Imperial College NHS Trust. She qualified from the University of Southampton in 1999 and has since worked in the field of oncology, specifically UGI over the past 10 years. Venetia is the national CNS and AHP (Allied Health Professions) lead on the AUGIS council. Venetia was awarded a place on the CLAHRC NWL Improvement Leader Fellowship in 2015 with her project focussing on the development of a multidimensional programme to improve pre-operative assessment and optimisation prior to OG cancer surgery.
What is the Improvement Leader Fellowship?
The fellowship is a multi-disciplinary education and leadership development programme that is accessible to NHS partner organisation staff, people with a role in health and healthcare, and the public. The purpose of the fellowship is to build capacity in quality improvement and research by developing future leaders with the authority and ability to improve patient care across Northwest London and beyond.
The fellowship is essentially a one-year training programme, where fellows commit to a minimum of 1 day a month for training purposes. Each fellow receives a £7500 bursary and undertakes a self-initiated quality improvement project with support and mentoring from CLAHRC NWL.
For Venetia, involving patients in their care is key to improving outcomes.
Believing there was scope to improve the way patients were prepared for surgery following initial diagnosis and treatment of oesophago-gastric cancer, she set about seeking the support of her colleagues to develop a multimodal programme of “prehabilitation”.
“…to my mind Preoperative assessments were traditionally directed at co-morbidity, with little or no opportunity to optimise patients prior to their surgery” she says. “I would ask myself whether we had done everything we could to put them in the best possible position for their surgery”
Venetia initially applied to Imperial College Charity for funds to initiate a pre-operative optimisation programme.
“I just knew something had to change. We were simply addressing co-morbidities rather than looking at individuals and thinking how we could care for them holistically. We needed to do three things i. standardise, 2. optimise and 3. personalise the process of preparing patients for surgery.”
And so the PREPARE programme was born – a highly personalised approach aimed to equip and empower patients to improve their own physical and mental health, thereby enhancing their quality of life throughout treatment and beyond.
PREPARE stands for Physical activity, Remove bad habits, Eat well, Psychological wellbeing, Ask about medications, Respiratory exercises and Enhanced recovery. The programme is evaluated via validated screening tools relating to patients’ nutritional health, psychological wellbeing and functional status. These are taken at the point of diagnosis and then reassessed before and after chemotherapy, in advance of surgery and then six weeks post-surgery.
The patient’s progress is evaluated throughout their pathway and according to individual need and goals are set depending on progress and in partnership with the patient.
“It’s a multi-professional initiative that has patients at its heart,” says Venetia. “It’s about enabling people to feel in control and contribute to their overall outcome. It stands to reason that if you keep people in the dark and see them as a bystander in their care then they will, over time, feel a degree of apathy towards what’s happening to them. From my perspective, patient engagement is the next bastion of improving outcomes.”
In the two years since its launch more than 80 patients have benefited from taking part in the PREPARE programme. The number and severity of surgical complications has decreased, patients are recovering from surgery quicker and the number of days they spend in hospital has reduced.
However, it is the improved patient experience that really drives Venetia. “I saw someone in clinic yesterday who was six weeks post op,” she adds. “He said he felt fitter than he had ever done. This is about long-term behavioural change. When people get through and recover from surgery, they feel that they’ve been given a second chance. So it’s our job to give them strategies to move forward and resume control for lasing benefit and resume their quality of life.”
Nevertheless, the programme has not been without its challenges. In the early days, even Venetia herself was at times, doubtful as to its potential and there was some initial cynicism from colleagues about getting octogenarians into the gym.
Venetia was awarded a CLAHRC QI fellowship (Improvement Leader Fellowship) in 2015 and this played a key role in shaping the design, implementation and evaluation of the PREPARE programme. Gradually it began to gather pace and as evidence came back proving its effectiveness, minds began to change.
“The whole team started to see the benefits and gained confidence in what we were trying to achieve. Now everyone is on board and we’ve worked together to improve the programme. It’s been an iterative process that’s created unity among a wide range of multidimensional health care professionals.”
And what about patients? Have they embraced it with as much enthusiasm? “Don’t get me wrong,” Venetia admits, “they take part with varying degrees of gusto…but I haven’t yet met anyone who refused to do the programme. Many see it as an opportunity to minimise post-operative risk and get home quicker.”
The programme is now being trialled with urology and lung cancer patients. The PREPARE team are also starting to use remote monitoring through Fitbits and weighing scales so they are better able to track their progress. Receiving data in real time enabling a more proactive approach to their healthcare rather than a reactive model.
“There is a wide application and potential for PREPARE,” adds Venetia. “I hope it could be transferred to a number of healthcare settings. I’m not saying it’s the solution to everything but with the increase in survival rates cancer is becoming more aligned to a chronic condition. More people these days are surviving cancer and we need to give them the skillset to manage the long-term consequences of their treatment from the outset. We need to empower them with knowledge and the confidence so they’re able to navigate their way through the complexities of their treatment and beyond.
“The success of this programme shows that when we all work together as equals, with patients as equal partners in their care, there’s no limit to what can be achieved.”
The PREPARE for Surgery won the Royal College of Nursing (RCN) Innovation award at an awards ceremony on the 6th May 2016 and at the end of the evening Venetia was announced as the RCN nurse of the year for her holistic approach to getting patients both physically and psychologically fit for surgery.
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