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The NiP Awards 2008: down to the final few

It hasn't been easy, as the standard of entry has been so high, but after much debate and deliberation, the final entrants in each category for the NiP Awards 2008 have been chosen. The winners will be announced at the NiP Event in Birmingham on 19 November, but until then, here's a taster of some of those on the shortlist

The Nursing in Practice Awards 2008 were designed to recognise best practice in a range of clinical areas. We invited applications from individual nurses or teams of healthcare professionals working in primary care and in the community, who had undertaken projects to improve their practice and the delivery of care to their patients.
And what a selection of entrants we received. From setting up a travel health clinic in Warwickshire, or a postnatal depression group in Bedfordshire, to increasing uptake of flu vaccine in children with special needs in Trafford, or reducing teenage pregnancies in Northumberland, our judges had a very difficult time whittling all the applications down to just a few in each category.
We would like to thank everyone who entered the Awards - the work you have done and are doing was truly inspiring. We don't have too much longer to wait for the winners to be announced, but in the meantime, here are some examples of those projects that made the shortlists.

Breathing easier in Blackburn
Blackburn with Darwen tPCT (BwD) has some of the worst health statistics both regionally and nationally. It is the 17th most deprived local authority area and life expectancy is on average eight years lower than anywhere else in the country.
Evidence suggests that smokers from disadvantaged areas are more likely to start smoking as a coping mechanism and therefore find it harder to quit. Smoking contributes towards 80% of all cases of COPD. BwD tPCT has a registered population of 164,500 and, before April 2007, 3,148 patients on the COPD register, which equated to 1.91% (the national average being 1.4%). COPD needed to be tackled head on.
In April 2007 it was decided to set up a COPD care programme, with the aim of improving healthcare for COPD patients.
One aspect of the programme was education for practice nurses (PNs) and healthcare assistants (HCAs), with the aim of extending the role of the HCA to see mild patients, creating more capacity for PNs to see moderate and severe patients. Before the programme BwD tPCT had no structured education programme for PNs and HCAs - training offered in the area of COPD was through the COPD Local Enhanced Service (LES) launched in 2006, which consisted of academic courses at diploma level. Sign-up to the COPD LES was only 55% due to many of the PNs not being in a position to undertake this level of education and wanting a more "hands-on" approach.
To tackle this BwD tPCT employed an independent training provider and respiratory nurse consultant, who could provide RCN-accredited education. A proposal was submitted to the PBC Board and PEC for approval to commence a specific competency-based pilot with this training provider and one pharmaceutical company. The components of the project were already there, it met the strategic needs of the tPCT, and ensured that equity and a consistent message would be given to all practices.
Since implementation of the programme the COPD register has increased from 3,148 to 3,257, 1.91% to 1.98%, an increase of 3.7%. However, the local acute trust has reported a decrease in referrals, exacerbations and admissions.
In addition a practice nurse forum has been formed along with a COPD patient group run by one of the PNs. There have been reports of more robust working relationships between primary and secondary care, resulting in the respiratory team based within the acute trust offering job shadowing to the local PNs.
Five HCAs have started undertaking patient reviews for mild COPD patients to increase the capacity of the PN appointments to undertake patient reviews for those categorised as moderate and severe.
In fact overall the programme has proved such a success that it has been shared with other PCTS, the LHB in North Wales and students at Bolton University through presentations, teleconferences and meetings.
The PNs involved have found the process very satisfying. As one put it: "Since starting this course the practice has gone from 82 patients on the register to 98, all diagnosed or picked up by me through opportunistic cases or asthmatics that are wrongly diagnosed. I also feel much more confident educating them and evaluating their care and treatment."
Project Lead, Ruth Rollings, sums up the team's success: "This programme has demonstrated that by working as a cohesive group it has been possible to make significant changes to the healthcare provided to patients with COPD. It has also provided the evidence to obtain funding for future training programmes for other long-term conditions."

Initiating insulin in West Norfolk
Back in April 2005, any patients needing insulin conversion in West Norfolk were referred into secondary care, to diabetes specialist nurses (DSNs) or to Julie Widdowson, a diabetes educator/facilitator and practitioner. This meant that patients had to travel to unfamiliar surroundings, and meet with new professionals at what is a difficult and confusing time.
To make this process easier it was decided to educate practice nurses to initiate insulin in primary care.
The programme used was the "Intensive Management in Type 2 Diabetes", accredited by Warwick University and delivered by trained educators. To undertake this programme nurses have to be running diabetes clinics and have a diploma qualification in diabetes, and the support of the practice. The course runs for nine months and within this time the student has to have started at least six patients on insulin. A formal write-up of reflective practice is also submitted.
Norfolk Community Health Care now has 17 trained nurses who initiate insulin in 15 practices. In the last year only two patients have been referred to secondary care for insulin initiation.
Julie Widdowson explains: "This has enabled practice nurses to feel empowered to continue their patients' management, and support them to the next step in treatment. Equally patients can be started at an earlier point in their disease journey, when HbA1c levels are starting to decline."
Julie now runs update sessions every six months for the nurses and GPs who have qualified in insulin initiation. These sessions include new therapies, insulin devices, carbohydrate counting and case studies. It gives the chance for sharing of experience and support of practice.

Don't miss the NiP Awards ceremony!
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There's more to Birmingham than the NiP 2008 Awards!

Nursing in Practice Birmingham is an unmissable event for all primary care nurses and public health professionals. This free event is specifically designed to meet your educational needs and brings best practice straight to your door. Across the UK, these events have gained a reputation that brings delegates back year after year and our 2008 Birmingham event promises to be no different. Nursing in Practice Birmingham delivers everything you want from a professional conference.

This year we continue to provide great speakers with national profiles. With great pleasure, we host Ann Close, a national clinical adviser for the Healthcare Commission as our keynote speaker. Ann will discuss methods for improving quality in healthcare, the value of teamwork and the importance of keeping up-to-date through professional and practice development. In addition, we present clinical and policy updates on wound care, smoking cessation, childhood asthma, pain management in primary care and sexual health, among others. Gilly Andrews, a clinical nurse specialist in reproductive and sexual health will deliver an informative presentation on contraception in the perimenopause, while Mark Peters, a neurolinguistic programming (NLP) trainer will provide advice on dealing with patients that present with symptoms of depression. We will also provide the opportunity to take an indepth look at topics such as telephone triage and assessment and the NHS Knowledge and Skills Framework and how these impact on the way you practise healthcare.

On a softer note, Jane Davis, a lecturer at Liverpool University, will deliver an insightful workshop on patient reading groups as part of our motivational session, showing how nurses can "go that extra mile" in delivering healthcare and improving patient experience through alternative methods.

You have the chance to question and debate with key opinion leaders, network with numerous nursing colleagues from community settings, and meet a vast range of exhibitors, from pharmaceutical and equipment companies to charities and colleges. Most of all this will be a truly stimulating day that will make you forget the pressures at work. So don't miss out and register today!
Shivani Pala
Programme Manager, Nursing in Practice Events