Leading change

The Consultant Nurse at Buckinghamshire Healthcare Trust, Cardiac Day Unit and Catheter Laboratory, led on the development and introduction of a new nurse angiographer role within their Trust. The role reduced unwarranted variation seen in waits for catheter laboratory services and has led to improved experience and outcomes for patients using the service.

Where to look

The Consultant Nurse observed delays in catheter laboratory waiting lists due to increasing demands upon the Trusts cardiologists. They were often required elsewhere even when allocated to work within the catheter laboratory. Cardiologists were providing specialist advice as well as seeing other patients whilst also trying to manage waiting lists within the Catheter Laboratory. The consultant nurse identified that with specific training and development; nurses performing the angiograms would reduce waiting list times and support efficiencies within services.

What to change

Angiography is used to check the health of blood vessels and how blood flows through them. It also helps to diagnose or investigate a number of problems affecting the blood vessels including cardiac conditions that need ongoing treatment. Before the development of the new role, only Cardiologists were performing angiograms.

Nurses were identified as being able to safely perform some of the low risk procedures that cardiologists were undertaking. This would increase the doctor’s availability for the complex cases and enable more efficiency of the catheter lab service.

Research shows that nurses can safely perform procedures previously considered to be doctor’s roles. Registered nurses are increasingly extending and expanding their scope of practice beyond initial registration in all health care settings developing their skills, competence and confidence (RCN 2018). The development of a new nursing role within the Catheter Laboratory at Buckinghamshire Cardiac Unit meant that angiogram nurses could perform angiograms and manage their own caseloads within the department as overseen by the Nurse Consultant.

How to change

Within the Trust there was already an understanding that the Nurses were undertaking procedures with the support of the Consultants, however no formal process to recognise and support this work was in place.

When considering best practice, the nurse identified that there were no other nurse angiographer roles in the country. Training to fulfil the requirements of the role required two years of extended study on top of clinical registration.

The Nurse supported the organisation to develop and introduce a new substantive role for an Angiogram Nurse. This post was taken through formal review via: Indemnity, legal, creation of guidance and competences, Trust Board and HR approvals to create a recognised role within the team.

In order to evidence the impact of the role the nurse led on the introduction of an audit tool and benchmarking parameters which were used in practice. An audit of three hundred quality assured angiograms were undertaken in order to support the role becoming substantive.

Adding value

Better outcomes –The new nurse angiogram role has led to the Trust now having no waiting list for angiograms due to the successfully established nurse-led catheter laboratory clinics. Another positive outcome is that there is significantly lower levels of x-ray exposure and use of contrast being used with patients. The Nurse Consultant’s leadership has led to successful establishment of a safe nurse-led service.

Better experience – Patients are fully informed of the nurse-led service and procedures. They are supported to make an informed decision in their care. A patient survey undertaken by the Trust has shown that all patients using the service were happy with the nurse angiographer. 95% were happy to have a nurse-led angiogram with 94% rating the service as ‘very satisfied’ or above.

Better use of resources – The nursing angiograms service has led to improved efficiency within the catheter laboratory service as well as the removal of waiting lists within the Trust which is extremely positive. Cardiologists are now able to be released to perform complex procedures within the Trust.

Challenges and lessons learnt for implementation

It can take a long time to set up a new service and there can be lots of useful knowledge gained from our colleagues although the challenge of changing perceptions of traditional roles can be difficult.

Key stakeholders need to be engaged early in the process, having Consultant support is important as at times there can be resistance to nursing staff undertaking the role.

If changes to practice and services are to be made and successfully embedded, there are pathways to follow to make these changes safely.

Due to the success of the role, the nurse angiographers are in the process of sharing their learning with other organisations. Nursing staff within the Trust are encouraged to be trained and educated to support continued delivery of evidence-based high standards of care. For example, plans to develop Band 6 nurses to undertake femoral catheterisation are underway in order to support efficient preparation of patients for angiogram procedures.

Find out more

For more information contact:

• Ghazala Yasin, Nurse Consultant and Angiographer, ghazala.yasin@nhs.net