Background In routine rheumatology clinics, return visits can account for 75% of a rheumatologists case load reducing the time available for new patients or patients who require urgent care (1) In a systematic review of the literature rheumatology nurse led clinics proved to be an invaluable addition to the effective running of rheumatology clinics (2).
Objectives 1)To Identify the feasibility of an independent nurse led rheumatology clinic, and 2) Assess nurse autonomy and barriers to same in the clinic setting.
Methods Over a 4 week period in October 2011, return patients with inflammatory arthritis on DMARD’s were allocated to the clinical nurse specialist (CNS) led clinic. Following the clinics patient review data was analysed to establish the number of patients that were managed autonomously by the CNSs and the barriers identified to same.
Results From a total of 118 patients, 22 patient’s (19%) were managed autonomously by the CNSs, 43 patients (37%) were managed by CNSs with medical sign off for renewal of prescriptions, x-ray and dexa scan requests, or referral to Occupational Therapy and Physiotherapy. Fifty three patient’s (45%) required medical consultation for intra-articular joint injections, medication review or general medical queries.
Conclusions There is the potential to expand the nurses scope of practice in the rheumatology clinic to include medication prescribing, x-ray, occupational therapy and physioth erapy prescribing along with the administration of intra-articular joint injections where appropriate. This could greatly alleviate the time pressures on rheumatologists in the clinic. A review of present local and national policies in consultation with local stakeholders is recommended
Kirwan JR, Snow SM, et al (1991)Which patients see a rheumatologist? British Journal Rheumatology. 30 pp 285-287.
Van Eijk-Hustings, Y et al (2012)Eular recommendations for the role of the nurse in the management of chronic inflammatory arthritis. Ann Rheum Disease; 71pp 13-19
Disclosure of Interest None Declared