The DREEAM Research team has changed a lot since I started working here.
The main clinical areas of focus have always been ED and AICU but we now also deliver studies to patients in places such as the Elective Admissions Lounge (EAL), Children’s ED and on the Orthopaedic and Trauma wards.
A typical day for a DREEAM research nurse is never typical; it usually starts with a list of jobs I would like to achieve and ends with a complicated recruitment process and an even longer list of new jobs to complete ☺
07:00: There are only two of us on shift today. I screen all the critical care areas for suitable patients for all of our intensive care studies; we work across both campuses of the hospital (City and QMC) so I use Nervecentre, one of our digital patient records systems, to update our screening log of patients currently on critical care. This document is big and for anyone outside of our team looks insanely complicated but it allows us to keep track of who we have approached and our way of keeping a record of the all critical care patients and identifying which studies they might be eligible for. My colleague focusses on screening for ED that day in the same way. These processes help our team coordinate from day to day ensuring no patients are missed but also that we don’t duplicate our efforts. We don’t have as many ED studies at the moment but we hope to pick up the pace there soon.
08:00: We attend the critical care medical handover. This is a great opportunity for us to review the patients on AICU with the medical team who can help us identify and agree to approach all the patients who could benefit from our studies. We are there to answer any questions about the research studies they might have so they can also inform patients and their families about our work and fit our research activities around existing treatment plans.
09:10: After the handover I walk round the patients to screen them for the plethora of studies we currently have running. This is a great opportunity for us to chat with the bedside nurses, as well as check up on any patients we have already in clinical trials.
09:50: I get back to the office and eat some cereal whilst updating the screening log with the latest information. We have recently been given a Microsoft surface Pro so that we can screen patients at their bedside but I’m still getting to grips with it so have opted to use paper today! (training need noted: The Boss)
10:00: During the screening on AICU we have identified a patient who may be eligible for the ADAPT-Sepsis study. We head back up to AICU to speak to the clinician who is looking after the patient to ask if they would be happy for us to approach the patient about joining the trial. This study uses daily blood sampling to understand if using PCT/CRP tests could help in deciding the best duration of antibiotics to treat sepsis. It doesn’t have a huge impact on patient care so clinical staff are normally happy for us to proceed if the patient agrees too.
10:30: In this case we have the go ahead from the clinician but the patient is sedated. Their family are coming in later so we can speak to them but for the meantime we obtain nominated consent from the clinician and begin the process of randomisation. Randomisation is important for most clinical research and ensures a number of things. It means that patients have an equal chance of being in the active or control groups in any study so the results are unbiased. We are also “blinded” to this allocation and won’t ever know which arm of the study the patient is in meaning we collect unbiased outcome data.
Once we have randomised the patient we take some blood samples with the help of the AICU nurses and take them for testing. The Lab staff are also involved in the study staff so know exactly which tests to perform and input this into the database online. Once the result is in we receive an email saying to continue or stop antibiotics. This is shared with the clinicians during a micro ward round. When the family arrive we explain the study and they agree that we can continue once they understand what is involved. It’s as simple as that!
11:30: I have to phone one of the study centres today who are supervising the study at a number of NHS hospitals. I did a follow up conversation with a family member of a patient on Saturday. A patient had given verbal consent for their relative to be in one of the AICU studies, so the team got Nominated Consultee Consent from one of the consultants, until the family member felt able to supply written consent. However by Saturday they had changed their minds. I knew I would need to withdraw the patient from the study and destroy all samples but I did not have the documents I needed for this. I had a good chat with ‘Helen’ at the trial centre and she talked me through what I needed to do sending me all the documents I needed to use.
11:50: Now I need to go back up to AICU to ask the Consultant to complete the patient withdrawal form, document all this in the patients notes and feedback to the staff about what has happened.
12:30: Back in the office again, I document everything that has just occurred in the patient recruitment pack. Clinical studies are monitored internally and externally to ensure that all our processes are performed as stated in the study “protocol”. For every patient we include there is a complete audit trail of everything we have done. This ensures safety but also creates high quality data which is essential so the results can help patients in future.
13:00: My ‘to do’ list is not getting any shorter and I am now thinking about the patient follow-ups that need to be done. There are only two but they must be done today to ensure we have accurate data. I discuss them with my colleague and we take one each. In between all the running around we are both intermittently screening the emergency department for potential recruits and have admin to do for our other studies.
14:00: We have received email feedback about another patient for the ADAPT-Sepsis study. I print this out and take it upstairs to file in the patient’s notes. Their treating clinician reviews the guidance and signs to confirm this. This time ‘usual care’ is recommended so there aren’t any changes to document!
14:20: We have a couple more follow-ups to do this afternoon and once patients regain capacity we return to speak to them about the study they are in and obtain retrospective consent. This can take quite a few trips as patients want time to think about what has happened and they and their families usually have lots of questions. It’s one of my favourite parts of the job as you get to see patients once they are better. We always make time for these conversations and sometimes just a general natter!
17:00: My shift ends at 5pm. We work a mixture of ‘earlies’ and ‘lates’ so that we always have cover until 7pm. I haven’t managed to get everything done but know that my colleagues will always continue where I left off……………..