Case study: Learning identified by the Tuberculosis Nurse Peer Support Network, Public Health England.
Case study summary
- The Tuberculosis (TB) nurse peer support forum has been successful in providing a virtual real-time platform to bring colleagues together across regions and nationally during the COVID-19 pandemic.
- This approach has supported the widespread sharing of learning, best practice and has aided the reduction in duplication of effort.
- Regional virtual forums continue to be popular with attendance rates at c. 90%.
- Virtual forums are an important asset for teams considering how to further develop patient-centred care, backed by multi-disciplinary teams and enhancing specialist TB nursing skills.
Background to learning
The design of local TB services reflect local drivers such as the prevalence of TB. Some TB services are led by clinical nurse specialists, whereas others are delivered within a wider team i.e. respiratory or infection control teams. Whatever the make-up looks like, locally working across networks to share practice is important. The pandemic has highlighted the need to strengthen networks and, consequently, nurses have established virtual forums to support nursing teams to share issues and learning during this pandemic.
Learning and advice to be shared
As the impacts of the pandemic started to be felt, an initial TB nurse peer support forum meeting was established in the Yorkshire and Humber/North East region, supported by colleagues in Public Health England and the TB national programme. Offering virtual support meetings instead of face-to-face, the group agreed to meet every four to six weeks. This provided a regular space for clinical nurse specialists and their wider nursing teams to come together and discuss the impact on TB services e.g. redeployment, PPE, patient behaviour in response to COVID-19 and service response. The meetings were arranged at times that maximised attendance and agendas dictated by its members.
Following the early success of this forum the nurse peer support forum model was quickly rolled out to other regions in England to ensure others had access. Throughout the pandemic, the virtual forum continued to be popular and once expanded across all regions, attendance rates remained high at approximately 90%.
Members report the regional based TB nurse support forums, have provided an opportunity to exchange information on technology and clinical practice by connecting with national leads. They have also been able to enhance real-time additional support, identification of cross regional links and support rapid dissemination of information to TB services.
As part of this network, members have discussed clinical changes being considered during the pandemic including:
- Risk assessment of patients to determine the most appropriate method of follow-up and support. Some continue to need physical face-to-face consultation although, usually, once a patient commences treatment follow-up would largely be provided through telephone or virtual clinics to reduce visits and face-to-face contact between the patient and TB services.
- How to adapt services to maintain uninterrupted patient pathways supported by qualified nurse prescribers.
- Opportunities for upskilling of TB nurses to perform phlebotomy in acute and community settings.
- Move to Interferon Gamma Release Assay (IGRA) testing for contact tracing to streamline consultation processes and maximise infection prevention and control practices.
- Safe management of home visits for patient assessment and subsequent follow-up post diagnosis, including provision of medication, blood test, visual tests, dry blood spot LFTs and mobile ECG machines.
- Prescribing and dispensing opportunities including longer duration of the supply of TB medications prescribed, where appropriate.
- Collaboration with other specialist nurses within multi-professional teams to ensure holistic support of patients with TB.
- Infection Prevention Control (IPC) COVID-19 triage of patients and their contacts for COVID symptoms before community and clinic visits.
The forum also supported the development of guidance for restoration of services during the pandemic offering practical guidance to national leads and TB specialist nurses across England.
Would it be beneficial to retain these changes?
The TB nurse peer support forum has been successful in providing a virtual real-time platform to bring colleagues together across regions and nationally. This has supported the widespread sharing of learning, best practice and has aided the reduction in repetition of effort.
TB remains a health critical and a public health issue with a continued focus of TB services on ensuring good infection control practices, in addition to patient centred holistic care. The pandemic has provided a catalyst for consideration of new ways of working driving service transformation at pace and scale. The ability to bring services together in this way could present an important opportunity and asset for teams in how they further develop patient centred care backed by multi-disciplinary teams and enhancing specialist TB nursing skills.
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