22 May 2019

In our latest Meet the Member feature, we spoke with Huw Rowswell, a Nurse Consultant in Thrombosis at University Hospitals Plymouth NHS Trust. In April Huw's research work was recognised as he won the NIHR / BSH Researcher of the Year award at our Annual Scientific Meeting in Glasgow. Huw told us about the research that helped win this prestigious award, as well as more about his career in haematology.

Can you tell us about the research that you undertook that led to you winning the Nursing NIHR/BSH award at the ASM

My post coincided with the publication of the NICE guidance on reducing the risk of VTE in hospitalised patients back in 2010 which introduced mandatory VTE risk assessment for all patients. With such a change to inpatient management we felt it was important to look at whether this impacted on the number of hospital acquired thrombotic events seen. At the same time we started giving real time feedback to clinicians when VTE events were diagnosed as they were often treated by different specialties and the original team where not aware of the event. Our research looked at the number of hospital acquired VTE (HAT), the number of such events associated with inadequate prevention and looked at the rate compared with the number of admissions seen. Over the study period we say a significant reduction in total HAT, the number of events per 1000 admissions from 2.15 down to 1.5 and finally a significant reduction in those events associated with inadequate prevention from 50 annually down to 6.

Why do you think it is important for haematology nurses to participate in research projects?

The world of haematology is constantly changing and evolving with new treatments and new medications so it is really important to keep up to date with this changing environment. As part of this research projects allow us to look at the work and interventions that we are offering to patients to see if they make a difference or improve outcomes. This can be large multi-centre pharma sponsored trials down to small projects within a hospital comparing two interventions or retrospectively analysing data that is already captured to look at outcomes.

Can you give any advice to those nurses who wish to undertake research themselves, but are not sure where to begin?

In Plymouth we are lucky having a very active research department who are very supportive and able to help and fund research projects. In the first instance look at what your hospital offers and there are other sources of funding and help out there. Attending national conferences and listening to speakers and viewing posters is a great resource as it will show you that a lot of outcomes and results published could also be collected by you and would encourage anyone to submit abstracts. I was fortunate the haematologist I work with encouraged this and my first BSH abstract was submitted within a few months of starting my role and I have continued with this and encourage other colleagues to do the same.

Moving on to your career, what led you to a career in haematology, and your specialism itself?

My background was working in critical care and as a night practitioner and one of the main issues around the later role was the prescribing of warfarin which was a constant out of hours issue. Having looked into this in more detail I realised the importance of getting this prescribed on time and keeping the INR within the desired levels. When the NICE guidelines were being introduced and Plymouth was trying to become an exemplar site the CNS job was advertised. This was a great opportunity to be part of a Trust wide change around risk assessment and appropriate prophylaxis and to help improve patient experience and reduce thrombotic events. I was fortunate to be in this role when there was so much national attention around VTE and able to work with other colleagues in the national exemplar centres to share good practice and work together.

Why is this role so important in the delivery of excellent patient care?

Thrombosis is a potential risk for all patients admitted to hospital so ensuring they receive appropriate preventative measures is vitally important. I identify all VTE cases diagnosed within the hospital to ascertain whether they are receiving appropriate treatment, that follow up has been organised to look at whether there is any need for long term treatment and for HAT events carry out a basic root cause analysis to ensure appropriate prevention took place. I try to speak to as many newly diagnosed VTE patients as possible to answer any questions as the initial diagnosis can be overwhelming and they may require reassurance after this time.

Can you give 3 practical pieces of advice for haematology nurses in delivering excellent patient care?

It is difficult to give specific advice as the world of haematology nursing covers such a diverse population but the basic advice around listen to your patients and be open and honest as you deal with them. One of the issues I see is when I review VTE patients at three months to make decisions about whether to stop anticoagulation is an acknowledgement that whatever decision is made there is either a risk of bleeding or a risk of thrombosis so using shared decision making is very important. Finally being aware that there will be questions that you cannot answer either because you don’t know the answer or there is no evidence or consensus on this but it is okay to state this and try to find out as much information as you can rather than trying to bluff your way.

What are the rewards and challenges of the role?

I am fortunate that I have been able to present data from Plymouth both nationally and internationally and this has enabled me to attend conferences listening to some of the world experts in thrombosis. By picking up issues in prescribing I feel I have improved patient safety and reduced the risk of harm going forward. There are issues with supply of certain medications and cost pressures in looking at treatments as well as trying to keep yourself up to date as new trials are published and new medications come to market.

What does BSH membership mean to you?

I really like the changes to the membership structure so now have access to the journal and encourage other colleagues to take advantage of the free associate membership. The conference continues to grow from strength to strength and I have been fortunate to be part of the programme committee for the conference which has been a great opportunity in looking at the amount of work involved in this but also to be able to meet and network with other haematology professionals. The increased focus on nursing and allied health professionals in the BSH is practically pleasing and it is great to see nursing sessions as part of the ASM.