Barts and The London NHS Trust

Name of Contact: Dr Angela Grange
Phone: 020 7882 7275
E-mail: angela.grange@bartsandthelondon.nhs.uk

Description of Trust

Barts and the London NHS Trust is one of the largest employers in east London with over 6,600 staff providing services to more than half a million patients each year. There are nearly 1,000 doctors and dentists, 1,948 qualified nurses, 107 qualified midwives and 197 qualified AHPs working with Barts and the London patients at The Royal London, St Bartholomew’s and The London Chest Hospitals. The Trust provides the capital’s largest trauma service, and is one of five cancer centres serving London and the Home Counties. The renal service is the largest in Europe, and the Trust is a national centre for specialities such as retinoblastoma and colo-rectal surgery. There are seven clinical directorates with over 40 medical, surgical and emergency specialities, many of which are at the leading edge.

Infrastructure to support R&D

A draft nursing and midwifery strategy has been written and is awaiting approval by the Trust Nursing Policy and Maternity Governance Boards (a system of nursing and midwifery shared governance is in operation in the Trust). It is hoped that this strategy will be combined with the therapy R&D strategy in the near future to form a joint strategy as the aims and objectives are similar. Collaborative working between nursing, midwifery and AHPs is already underway to develop a joint strategy.

An interprofessional research team has been approved by the Nursing Policy Board and Therapy Evidence-Based Practice Group, to support the implementation of the R&D strategy; approval is being sought from the Maternity Governance Board in October 2003. The interprofessional team will comprise nursing, midwifery and AHP representation as well as research experts and academics from partner institutions, and will be key to putting aspects of the R&D strategy into operation.

A research facilitator for nurses, midwives and AHPs was appointed by City University in September 2003, based in the Trust R&D Department. The main aim of the research facilitator project is to build research capacity within nursing, midwifery and AHPs. This is being approached by developing a caseload of nurses, midwives and AHPs to support in three areas: 1) getting started in research, 2) acquiring funding for research, and 3) disseminating research results. An interprofessional researcher network is also being established in the Trust to support novice researchers.

There are 4 consultant nurses and one consultant midwife in the Trust. There are several lecturer practitioner posts and newly emerging research practitioner posts. These posts are joint appointments with City University.

Access to IT needs improving but all wards have a PC for staff to access evidence. There are good training facilities provided by the Medical and Dental Library and School of Nursing Libraries in searching for evidence. An Electronic Information Liaison Officer has been in post for 10 months to support staff at the London Chest Hospital to find evidence to support their practice.

There are many clinical nurse specialists and practice development nurses in the Trust and these nurses work closely with the Senior Nurse for Practice Development, and the Clinical Effectiveness Unit to evaluate outcomes of their care. The Essence of Care Benchmarks have been implemented Trust-wide, and are being continuously monitored via the Practice Development Unit (PDU). The PDU has close links with the RCN who are involved in the implementation of the PD strategy in the Trust, and the RCN Leadership programme is well established.

The Trust has close links with the Workforce Development Confederation in developing training programmes and career pathways.

Examples of clinically based research and development projects / activity that have made a difference to patients experiences / outcomes

There is a strong research culture within nursing in a few departments within the Trust, namely renal, cardiac, cancer and infection and immunity. Nurses working within these directorates regularly present their research at national and international conferences. There are many nurses working with medical colleagues on clinical trials research; the Trust has its own Clinical Research Centre.

Rather than list all projects recently conducted by nurses, some specific projects led by nurses that have impacted upon/or have the potential to impact upon clinical practice are described below: e.g.

A research project was conducted in conjunction with City University, which explored the care of older people in relation to reasons for delayed discharges. The results of this research led to the implementation of a new role – care co-ordinator, with improved length of stay outcomes.
A research study piloted the introduction of a new way of working within medical teams on general medical wards, from medical firms visiting wards to ward-based medical teams. Improvements in communication and co-ordination of care between medical and other colleagues were observed.
A research study investigating cardiovascular disease risk has the potential to challenge the basis of the CHD National Service Framework. Preliminary results suggest that the current policy on the use of lipid lowering drugs for patients with or at risk from heart disease needs to be reviewed if expensive drug treatment is to be most appropriately targeted.
An evaluation of the mental health services in A&E revealed a whole series of problems faced by Trust staff caring for people with complex physical and mental health needs, which resulted in the development of a further research proposal focusing on the mental health needs of general medical patients. The project also mapped out the training needs of staff involved in liaison nursing, and an MSc course has been validated by City University to meet these needs.
A research study investigated the conditions, human and environmental, that make drug errors more likely to occur, and the checking procedures that are most effective in preventing errors. The results led to the implementation of a Medicines Nurses Forum, which meets monthly and is attended by ward nurses to discuss problems and identify solutions. A nurse is also working with the Clinical Physics Department to establish an Equipment Library.
A research study to compare hospital and home IV antibiotic therapy in adults with cystic fibrosis.

Any internet links

R&D information is accessible via the Trust intranet pages with information on funding and training opportunities, research ethics application process, research governance issues, dissemination, finance, research support for nurses, midwives and AHPs, etc. Information on the research facilitator project for nurses, midwives and AHPs is available via the Trust intranet and City University web-pages (www.city.ac.uk/barts/research/depts/hcru/researchers/grange_a.htm).

Once approved the nursing and midwifery R&D strategy will be available on the Trust intranet pages. Unfortunately the Trust R&D department does not have an external web address to advertise the strategy, but it will be freely supplied upon request.