MEMBERSHIP INFORMATIONMembership of the

Haematology Association ofIreland Nurses and Allied

Health Professionals Group canbe arranged by contacting:-

Sinead Cassidy (HAI Administrator)9a Coolkill, Sandyford, Dublin 18

Tel: 00353 12958859Fax: 00353 12958869

Email: sinead@sineadcassidy.com

Web: www.haematologyireland.org/

BURSARY INFORMATIONDetails of bursaries aimed at

supporting innovations inhaematology practice and

educational development canbe found on our website:

www.haematologyireland.org

H A E M A T O L O G Y A S S O C I A T I O N O F I R E L A N D

On behalf of the HAI Nurses /AHP committee we wouldlike to thank Claire for herdedication and invaluablecontribution not only toBlood Matters but to ourgroup over the last numberof years.

In this issue we have an in-depth introduction to theNorthern Ireland Biobankand Dr Claire Lewisdiscusses the importance ofbiobanks in cancer researchand cancer care.

Ger Walpole providesfeedback on her recent tripto the 5th AnnualAmyloidosis meeting in theRoyal Free Hospital whichwas made possible by aneducational bursary fromJansen Cilag.

The experience of aHaematology Midwifeundertaking theNurse/Midwife Prescribingcourse is outlined by JacintaByrne.

Inside you will also readhow Laura Croan fromBelfast City Hospitaldeveloped the Haematologyoutreach nurse role andLaura explains her plans forfurther expansion of the role.

As usual we have our wordsearch competition, up-coming events and a reportfrom our Spring Study Day.

We look forward to seeingyou all at the annualconference on 18th and 19thOctober in Belfast.

Yours on behalf of theNurses’ and AHP’sCommittee.

Lorna StoreyActing Newsletter Editor and Chair

of the HAI Nurses/AHP Group

Welcome to the autumn edition ofBloodmatters. We have reluctantlysaid goodbye to our previous editorClaire Naughton and wish her everysuccess and happiness in her newposition in Saudi Arabia.

BLOODmatters

October 2013

BLOODmatters | 1

contents1. A word from the Editor

3. The Northern IrelandBiobank

6. HAI Spring Study Day2013

6. Forthcoming Events

7. Amyloidosis Meeting

8. Nurse/Midwife -prescribing theexperience of aHaematology Midwife

9. Development of theHaematology OutreachNurse Role

11. Last Issue CompetitionWinner

12.Wordsearch Competition

INTRODUCTIONBiobanking has gained momentumin recent years in response to thedemand for access to large numbersof high quality human biosampleswhich are required for biomarkerdiscovery programmes. In an erawhen drug discovery anddiagnostics in cancer care arerapidly evolving, biobanks providethe mechanism for the standardisedcollection of human biosamples tounderpin translational cancerresearch programmes and deliveron the promise of personalisedmedicine for patients with cancer.In August 2011, the Northern IrelandBiobank (NIB) was granted ethicalapproval for the collection,processing and storage of humantissue and associated biosamplesfrom patients in Northern Irelandwith a suspected or confirmeddiagnosis of cancer. The first of itskind in Northern Ireland, the NIB is ajoint venture between the BelfastHealth and Social Care Trust (BHSCT)and Queen’s University Belfast (QUB)and is integrated into the newlyrestructured Northern IrelandMolecular Pathology Laboratory inQUB’s Centre for Cancer Researchand Cell Biology (CCRCB). Thisarticle outlines the importance ofbiobanks to the future of caredelivery for patients with cancer,along with an overview of the NIBand its activity to date.

WHAT ARE BIOBANKS AND WHYARE THEY IMPORTANT?In their simplest, biobanks are largecollections of human tissue andbiospecimens for use by researchers.They are generally categorised intotwo main types: population basedbiobanks and disease specificbiobanks. Population basedbiobanks collect biosamples

(blood, urine, saliva) from thegeneral population along with datasuch as health and medical historyand lifestyle information. Thebenefit of population basedbiobanks is that researchers canstudy the onset and progression ofdisease in previously healthypopulations and investigatebiomarkers (See Biomarkers andPersonalised Medicine - next page)which may predict diseaseoccurrence (Asslaber and Zatloukal,2007). Disease specific biobanks onthe other hand collect biosamplesfrom individuals with a particulardisease, such as cancer. This type ofbiobank offers access to diseasespecific samples or to samples fromdifferent stages of certain disease,for example pre-cancerous lesionsor metastatic lesions. Often they willcollect the diseased tissue or blood,along with matched normal samplesfrom the same individual. Thisallows researchers to investigate themolecular alterations which havecaused the disease within thecontext of the individual’s owngenetic background (Asslaber andZatloukal, 2007).

As a concept, biobanking is not newas collections of human tissues have

existed for years in various differentorganisations, in different sizes andof varying quality (Beishon, 2008).However, it is only recently thatefforts have been made tostandardise the collection of humantissue and biosamples for researchpurposes given advances in thefields of biomarker sciences andmolecular diagnostics. Biomarkerstudies require access to largenumbers of human samples whichare of high quality and haveassociated clinical and pathologicaldata. It has been suggested thatresearch in this area has beenlimited by the lack of availability ofsuch high quality samples (Beishon,2008), as traditional archives maynot have been able to provide thequality controls required for suchstudies. Modern biobanks howeverhave standardised protocols inplace for sample procurement,processing and storage whichprovide researchers with anassurance of sample quality.Today’s biobanks therefore providethe mechanisms needed for thestandardised collection of largenumbers of quality assured humantissue and associated biosampleswhich are linked to robustpathological and clinical data.

BLOODmatters | 3

- by Dr Claire Lewis, (Lecturer, School of Nursing and Midwifery, Queen’s University Belfast)

and Dr Jacqueline James, (Consultant Pathologist/Senior Lecturer & Scientific Director,Northern Ireland Biobank, Queen’s University Belfast)

The Northern Ireland Biobank:changing the future of care deliveryfor patients with cancer in NorthernIreland and beyond.

4 | BLOODmatters

THE NORTHERN IRELANDBIOBANKThe Northern Ireland Biobank (NIB)is a disease specific biobank,established as a joint initiativebetween QUB and BHSCT to supportlocal cancer research. It wasawarded full ethical approval inAugust 2011 for the prospectivecollection of tumour and non-tumourcontrol tissues and matched bloodsamples, along with urine andsaliva where appropriate, fromconsented patients with a suspectedor confirmed diagnosis of cancer. Italso has full ethical approval for thecollection of blood samples fromindividuals with haematologicalmalignancies, as well as approval toaccess paraffin embedded formalinfixed (FFPE) tumour samples whichare held in the BHSCT tissue archive.The NIB is funded generously by theHealth and Social Care Researchand Development Office of thePublic Health Agency, along withcontribution from CR-UK and Friendsof the Cancer Centre charities. TheNIB is fully integrated into the newlyrestructured Northern IrelandMolecular Pathology Laboratory (NI-MPL).

This hybrid facility, the first of its kindin the UK, has been purposelydesigned to bring two worldstogether by combining moleculardiagnostics with moleculartranslational research. The NI-MPLprovides molecular diagnostictesting which allows clinicians totailor the treatments they offer tolocal patients, thereby providing amore individualised approach tocare. This ensures that cancertreatment for patients in NorthernIreland is at the cutting edge ofmodern medicine.

The NIB and NI-MPL is alsounderpinned by a comprehensivedigital pathology service. Digitalpathology supports digital viewing‘worldwide’ of images associatedwith banked samples including

histological images of the tissuemicroarrays that have been createdto facilitate biomarkerinvestigations. The NIB is now ableto host digital images of bothmacroscopic and microscopicsamples for viewing remotelyanywhere in the world at anytime.

NIB PROSPECTIVE SOLID TUMOURCOLLECTIONThe NIB prospective solid tumourcollection is focused on colorectal,breast, prostate, gynaecological,lung and head and neckmalignancies to complement localcancer research activity in CCRCB.Tissue collected for donation to theNIB is always surplus to clinicalneed, ensuring that patientdiagnostics are not compromised.Donation is also voluntary andrequires written, informed consentfrom patients in accordance with theHuman Tissue Act (Human TissueAuthority, 2004).

Since the NIB prospective collectionopened in November 2011, over 360patients undergoing surgery forcolorectal, breast, prostate andgynaecological cancers in BHSCT

BIOMARKERS ANDPERSONALISED MEDICINEBiomarkers are substances suchas proteins or genes found inblood, body fluids, or tissueswhich can be a sign of acondition or disease such ascancer (The National CancerInstitute, 2013). Advances in ourability to understand cancer at agenetic and molecular level hasenabled researchers to developbiomarkers which can be usedfor cancer prediction, prognosisand response to treatment.Examples of biomarkers includethe protein CA-125 which is usedas a tumour marker to detectovarian cancer, and the BRCAgene mutations which canpredict the risk of developingbreast cancer.

The use of biomarkers hasrevolutionised cancer care,particularly in field of cancertreatment. They have enabled

clinicians to tailor therapies theyoffer to patients based on thepresence or absence of abiomarker which can predicthow a patient will respond to agiven treatment. For a givengroup of patients with the samecancer diagnosis, treated with thesame drug regime, some willrespond to treatment, some willpartially respond and some willhave no response at all. This canbe explained by looking at themolecular signature of anindividual’s tumour, as eachcancer is different. Mutationalgenetic biomarkers candetermine whether a patient willrespond to certain therapies. Forexample, if a patient withmelanoma has a BRAF geneticmutation, they will be offered atreatment which is effective onlyfor BRAF positive melanomas (Suhet al, 2013). Such an approachhas been termed personalisedmedicine as it allows clinicians to

select treatments based on theirpatient’s individual biologicalprofile. This individualisedapproach replaces the previous‘one size fits all’ treatment optionfor patients, thereby limitingunnecessary side effects andtoxicities. Other examples ofestablished targeted therapiesinclude Imatinib for CML andHerceptin for breast cancerwhich have revolutionised themanagement of these conditions.

The increased emphasis on theuse of biomarkers in cancer carehas placed a greater demand onthe need for researchers to haveaccess to large numbers of highquality human samples fordiscovery and validation studies.Biobanking has subsequentlybeen recognised as thecornerstone of biomarkerdiscovery and personalisedmedicine in cancer (Hewitt, 2011).

BLOODmatters | 5

have been consented for tissuedonation. From consented cases sofar, 369 fresh tumour and non-tumour control samples have beencollected, along with 845 formalinfixed, paraffin embedded tissueblocks and 1,255 blood samples(serum, buffy coat, plasma andwhole blood). It is anticipated thatlung and head and neck collectionswill open in the near future.

Sample collection, processing,storage and distribution in the NIBprospective collection is governedby a rigorous set of standardoperating procedures based on bestpractice guidelines and/or bestevidence available to ensuremaximum sample quality.Additionally, researchers also haveaccess to linked clinical andpathological data from consentedcases via the NIB’s secureinformation management system.This system manages the entireworkflow from patient consent tosample tracking and storage;together with informationintegration, case search andretrieval, digital imaging of samplesand Biobank sample applications.

NIB RETROSPECTIVE COLLECTIONThe NIB has been granted ethicalapproval to access FFPE tissueblocks from the archives of theBHSCT Tissue Pathology Department.Retrieval of large cohorts of cancertissues from this archive hasfacilitated the creation of a uniqueset of resources for the NIB referredto as the ‘NIB retrospectivecollection’.

With over 1700 samples pulled fromthe BHSCT archives to date, thesesamples have been used to custombuild tissue microarrays (TMAs) andcreate DNA libraries to support localtranslational research.

HAEMATOLOGY PROSPECTIVECOLLECTIONHistorically biobanking ofhaematological disorders has beenfunded, in part, by the NorthernIreland Leukaemia Research Fund.Although the NIB has only recentlytaken formal responsibility forhaematological collections, alreadyover 150 patients have beenrecruited to the NIB collection andtheir samples relocated to the NIBstorage facility for future research. NIB collections are available forrequests from researchers basedwithin the Northern Ireland Healthand Social Care Trusts or either ofthe two Universities (QUB orUniversity of Ulster). Access to the NIBis also available to researchersoutside Northern Ireland andcommercial institutions if theScientific Review Committee of theNIB considers the research to fallwithin the remit of the bank’s ethicalapproval. To date, the NIB hasfacilitated more than 70 applicationsfor tissue samples from both localresearchers and further afield.

CONCLUSIONThe Northern Ireland Biobank is thefirst of its kind in Northern Irelandand its integration within the hybridNIMPL makes it unique in the UK.With the increasing incidence ofcancer and demand for efficienthigh quality care delivery,biobanking is set to become anintegral part of cancer servicedelivery. Whilst presently the NIB isonly operational in BHSCT, it isanticipated that activity will berolled out across the province in thefuture to allow all patients receivingcancer treatment in NorthernIreland the opportunity to becomeinvolved.

In 2009, biobanking appeared inTime magazine’s “10 ideas changingthe world right now”. Certainly, theNIB is changing the future of cancercare in Northern Ireland as localpatients are now benefiting frommolecular diagnostics andmolecular translational researchusing samples acquired from theNIB. As a result, the delivery ofpersonalised medicine for patientswith cancer in Northern Ireland is nolonger a promise but a reality.

For further information pleaseaccess our websitewww.nibiobank.org

1. Asslaber, M., Zatloukal, K. (2007)Biobanks: translational, Europeanand global networks. Briefings inFunctional Genomics and Proteomics,6(3), pp. 193-201.

2. Beishon, M., (2008) How Europe istaking on the big biobank challenge.Cancer World, May/June, pp. 20-24.

3. Hewitt, R. (2011) Biobanking: thefoundation of personalised medicine.Current Opinion in Oncology, 23, pp.112-119.

4. Human Tissue Authority (2004) TheHuman Tissue Act. London: TheStationary Office.

5. National Cancer Institute (2013)http://www.cancer.gov/dictionary?cdrid=45618 Accessed 09/08/2013.

6. Shu, S.K., Sarojini, S., Youssif, M.,Nalley, K., Milinovikj, N., Elloumi, F.,Russell, S., Pecora, A., Schecter, E.,Goy, A. (2013) Tissue banking,bioinformatics and electronicmedical records: the front endrequirements for personalisedmedicine. Journal of Oncology,Article in Press. DOI:10.1155/2013/368751

7. Time Magazine (2009)http://www.time.com/time/specials/packages/article/0,28804,1884779_1884782_1884766,00.html Accessed09/08/2013.

REFERENCES

FORTHCOMINGEVENTS 2013/421st November 2013CURRENT TREATMENT OPTIONS IN HAEMATOLOGICALMALIGNANCIES AND SUPPORT THERAPYHilton Hotel, Bristol, England.www.hartleytaylor.co.uk

25th November 2013MANAGEMENT ISSUES IN HAEMATOLOGICAL DISORDERSIN ADULTSRoyal Marsden Education and Conference Centre,London, England.www.royalmarsden.nhs.uk/haemmanagement

29th November 20132ND UK MYELOMA SPINAL MEETINGRoyal College of Surgeons, London, Englandwww.rnoh.nhs.uk/courses

7th - 10th December 2013AMERICAN SOCIETY OF HAEMATOLOGY ANNUALMEETING AND EXPOSIUMErnest N. Morial Convention Center, New Orleans, USA.www.haematology.org/meetings/annual-meeting______________________________________________________________________________

30th March - 2nd April 201440TH ANNUAL MEETING OF EUROPEAN SOCIETY FORBLOOD AND MARROW TRANSPLANTATION (EBMT)MiCo: Milano Congressi, Milan, Italy.www.ebmt2014.org

1st & 2nd May 201414TH INTERNATIONAL PAEDIATRIC HAEMATOLOGY ANDONCOLOGY UPDATE MEETINGRoyal College of Physicians, Edinburgh.www.iphoum.com/index.asp

12th - 15th June 201419TH EUROPEAN HAEMATOLOGY ASSOCIATION MEETINGMiCo: Viale Eginardo, Milan, Italy.www.ehaweb.org

6 | BLOODmatters

After coffee and scones the daystarted with a presentation byClodagh O’Brien a physiotherapistand project manager for theimplementation of the NICEguidance on Metastatic Spinal CordCompression MSCC, Clodaghexplained how the aim of the projectis to promote best practice, ensuretimely access to investigation,diagnosis and treatment for peoplewith MSCC.

Our next presentation wassomething a little different with DrAndy Hodgson a consultantHaematologist from Sligo GeneralHospital presenting on “presentationtechniques”. Andy certainty openedour eyes to the do’s and don’ts ofeffective presenting and shared lotsof practical tips for this sometimesdaunting process. Andy gave us aglimpse new and excitingtechnology for presenting that maychallenge the reliable Power Pointthat we are all familiar with. Wehope that this will encouragedelegates rise to the challenge andsubmit oral abstracts to our annualmeeting in October.

Following coffee and mingling withour sponsors a more scientificpresentation followed with RichardHagan Chief Scientist from the HLAlab IBTS St James’ Hospital providingan overview of HLA typing and theprocess involved in selecting themost appropriate donor for HSCT.Ger Walpole a CNS from SligoGeneral Hospital and committeemember then discussed afascinating case study and providedinsight into the management of apatient with Waldenström’sMacroglobulinemia. Ger outlinedthe challenges for both the patientand haematology team in the longterm care of this difficult condition..Before we broke for lunch RosemaryWilson Barrister at Law and formernurse gave us plenty of food forthought as she presented a verythought provoking session on thelegal issues surroundingdocumentation, she succinctlyoutlined the responsibilities of nursesand AHP’s in relation to recordkeeping and professional issues.This was a most interesting talkwhich stimulated plenty of thoughtand discussion into lunchtime.

In the afternoon session Dr BeatriceNolan a Consultant Haematologistfrom Our Lady’s Children’s HospitalCrumlin gave a clear andcomprehensive presentation onbleeding disorders in childrenemphasising the importance of thenursing role to support and educatethis cohort of patients and theirfamilies.

Very many thanks to our finalspeaker of the day Eugene Beirnewho very kindly stepped in literallyat the last minute (due to familyillness with our scheduled speaker).Eugene who is a CNS inPsychological oncology in St James’Hospital outlined the uniquepsychosexual issues and needsassociated with haematologypatients.

Thank you to all our delegates onthe day who provided positivefeedback on all our speakers andmade valuable suggestions fortopics for our annual meeting in TheEuropa Hotel Belfast in October.

HAI Spring Study Day 2013- by Lorna Storey, Chair of HAI Nurses and AHPs Group.

The Haematology Association of Ireland Nurses and AHP’s Group held the annualSpring Study Day on Friday 26th April in The Red Cow Inn Dublin. We weresupported once again by a wide variety of sponsors.

BLOODmatters | 7

AMYLOIDOSIS- by Ger Walpole, Haematology Clinical NurseSpecialist, Sligo General Hospital.

We had met Dr Julian Gilmore at aMyeloma nurses meeting in Dublinand he encouraged some Irishnurses to attend this very worthwhilemeeting. We were also fortunate tomeet Clinical Research NursesDarren Foard and Lisa Rannigan atthe Royal Free and they very kindlyshowed us around the AmyloidosisCentre. The NHS NationalAmyloidosis Centre is the only centrein the UK specialising in Amyloidosisand is part of University CollegeLondon. The centre has “state of theart” clinical and research facilities,and a team of highly qualifiedclinical, research and support staff.

AMYLOIDOSISThe term amyloidosis describes agroup of disorders caused byabnormal folding, aggregation andaccumulation of certain proteins inthe tissues, in an abnormal formknown as amyloid deposits. Thesedeposits are composed of abnormalprotein fibres which progressivelyinterfere with the structure andfunction of affected organsthroughout the body.There are over 20 different types ofAmyloidosis, many of which areextremely rare.

The 3 main types of systemicamyloidosis are:1. AA Amyloidosis2. AL Amyloidosis3. Hereditary Amyloidosis

SYMPTOMSSymptoms are often very non-specific but can include tiredness,weight loss, weakness and loss ofappetite. More specific symptoms,related to particular organs include:1. Ankle oedema due to renal or

cardiac involvement2. Paraesthesiae secondary to

nerve involvement3. Breathlessness due to amyloid

deposits in the heart

DIAGNOSISDiagnosis is often delayed due to thevagueness and variety of symptoms.Ultimately the diagnosis is initiallymade on tissue biopsy of theaffected organ SAP scintigraphy or“the Amyloid Scan” (see pic) wasdeveloped in 1987 as a newdiagnostic test. It can show thedistribution and amount of amyloidwithin the body’s organs without theneed for biopsies. SAP is a normalhealthy protein which is purifiedand tagged with a trace ofradioactive iodine that can beimaged throughout the body by agamma camera scanner. Thepatient is injected with Radiolabelled SAP 6-24 hours prior to thescan. The SAP scanner identifiesother amyloid sites, other than thesite biopsied, even when suchorgans appear to be functioningnormally. The scan can be used tomonitor changes in the amount ofAmyloid and response to treatmentover months and years. Thedevelopment of SAP scans hasdramatically reduced the need forbiopsies and helps to tailorindividual treatment.

TREATMENTThe aim of treatment is to suppressthe underlying condition andsuppress the production of therespective amyloid forming protein.Treatments vary depending on thetype and extent of the Amyloidosis.They can include chemotherapy indifferent forms:1. Low Dose – Melphalan +/- Steroids2. Intermediate Dose –

Combination Chemotherapy e.g.CTD ( Cyclophosphamide,Thalidomide andDexamethasone) or CVD(Cyclophosphamide, Velcadeand Dexamethasone)

3. High Dose – melphalan withstem cell collection andsubsequent transplant.

It is critically important to protectand support the organs affected byamyloid even when things are goingwell. Solid organ transplants can bean option for some patients.

IRISH PATIENTSAll Irish patients diagnosed withAmyloidosis should now be referredto The Royal Free NationalAmyloidosis Centre. Patients thenattend the centre for acomprehensive diagnosticassessment. This process takes 1-2days during which hospital or hotelaccommodation is provided by thecentre. A SAP scan is a vital part ofthe work up. A treatment plan isestablished and the patient returnsto their referring hospital for thetreatment. Patients are then seen sixmonthly or annually at the RoyalFree and are reassessed. Irishpatients are covered for this processunder the EU 112 form.

SUMMARYThe National Amyloidosis Centre isthe only centre in the UK and Irelanddedicated to the needs of patientswith Amyloidosis. Accuratediagnosis is necessary andtreatment is based on this. SAPscans measure the amyloid loadand enables the disease to bemonitored optimally. Regular andcomprehensive assessments guideeach patient’s management andtheir ongoing treatment.

We would like to thank Dr JulianGilmore, Darren, Lisa and all theteam for a really informative studyday and for their great hospitality.The tour of the unit was reallyinteresting.

This is an annual conference andwell worth attending.

With the support of an educational bursary from Jansen Cilag, Mary Kelly (ANPMidland Regional Hospitals), Teresa Meenaghan (ANP Galway University Hospital)and I attended the 5th Annual UKAN meeting in the Royal Free Hospital London inFebruary 2013.

I currently work as a HaematologyMidwife in The National MaternityHospital. There is a High RiskHaematology Maternal MedicineClinic running weekly with onaverage 25-30 women attending.These women are either antenatalor postnatal with a majority of themself administrating Low MolecularWeigh Heparin, taking Aspirin orPrednisalone. On occasions womenleave the clinic without theirprescriptions or need them changedor extended. I have to get theirchart, find a doctor, get aprescription and then get it to thepatient. This is not a problem whenthe clinic is on however it is verytime consuming. These situationslead me to do the Nurse/MidwifePrescribing course in the RoyalCollege of Surgeons. The course wasboth academic and clinical.

ACEDAMICThe programme as set out by AnBord Altranais, was delivered over asix month period and divided into 3modules; Professional Accountabilityin Nurse/Midwife Prescribing,Pharmacology and PrescribingScience and Systematic Assessmentand Evaluation in Patient Care. Theacademic sessions were given in

The Royal College of Surgeons andthe practical/clinical sessions weregiven in Beaumont hospital. Duringthe course we had face to facelectures, clinical and onlineteaching. We used E-portfolio for theelectronic submission ofassignments.

ASSESSMENTS My first academic assignment was aReflective Assignment (4000 words),this gave me the opportunity toreflect on a clinical situation where Ias a midwife prescriber would haveimproved patient care. My secondacademic submission was aCollaborative Practice AgreementAssignment This is a writtenagreement between myself,Consultant Haematologist. andhealth service employer whichoutlines the parameters of theprescriptive authority for me as amidwife. CPA defines the parametersof the Registered Nurse/MidwifePerscriber's scope of practice. Whilstrecognising the responsibility of theConsultant Haematologist to thepatient, I as midwife amaccountable for my own prescribingpractice. My CPA includes the typesof medication I proposed toprescribe and their indications for

use. Most drugs are not licenced foruse in pregnancy and some may becontraindicated for use inpregnancy and postpartum. Thehospital’s Chief Pharmacist and theDrugs and Therapeutic Committeeall received a copy of my CPA forreview. I must review this agreementyearly and submit to ABA. The finalacademic assessment was thepharmacy exam, including bothmultiple choice and long questions.This exam covered all medications.

CLINICAL INSTRUCTION ANDMENTORINGThe clinical element was providedin the High Risk Haematologyantenatal/postnatal clinic. Ireceived clinical instruction, one toone supervision, and support fromthe Consultant Haematologist. Therewere many learning opportunities ateach clinic. There were 3 ClinicalAssessments which were completedwith the mentor in the High RiskHaematology Clinic. Myparticipation in the medicationprescribing process graduallyincreased my knowledge andconfidence to a level where I canact as lead prescriber for thepatients attending the High RiskHaematology Clinic.

- by Jacinta Byrne, Midwife, The National Maternity Hospital, Dublin.

Nurse/Midwife PrescribingCourseThe experiences of a Haematology Midwife.

Update on the re-development of the Children’s HospitalHaematology/Oncology Ward, Crumlin.

8 | BLOODmatters

Re-development of the National Children’s Haematology/Oncology ward, St John’s Ward at Our Lady’s Children’sHospital Crumlin commenced end of last summer. This is a 3phase project, costing 4 million Euro to complete.

Phase 1 of the new build opened its doors on Thursday 21stFeb 2013. This new development offers state of the art facilitiesto all service users; each child is now cared for in their ownroom with en-suite facilities and rooming in for parents.

It also involved the construction of a new state of the art 4bedded Bone Marrow Transplant Unit.

Phase 2 of the project is due for completion early October2013.

THIS UPGRADE OF THE EXISTING WARD AREA AND INCLUDES;

• Creation of en-suite bedrooms;• New Play Zone;• Redesign school room;• Replacement of public toilet;• Redesign medication/treatment room;• Redesign drop-in area;• Conversion of existing staff base to meeting/conference

facilities, central station for nursing;• The inclusion of natural light & natural environment has

been included in the design.

The final phase includes an update of the main entrancearea to the unit and is expected to take a further 6 weeks.

Development of theHeamatology OutreachNurse Role (Belfast City Hospital)- by Laura Croan, Haematology Outreach Nurse, belfast City Hospital.

I was appointed HaematologyOutreach Nurse in May 2013. It is anew role developed from the‘Transforming Your Care’ NHS projectand is aimed at reducing patienthospital stay, facilitate earlydischarge from hospital, move careinto the community whereappropriate, and improve patientexperience. This post was designedto address the psychological andeducational needs of patients onoutlying wards and improve patientexperience. I ensure that patientsand carers’ on outlying wards havebetter understanding of their illness,treatment and its prognosis, whichcan facilitate open and honestdiscussions about treatmentdecisions from new diagnosis toterminal care and throughunexpected admissions to hospital.This role has also provided support,advice and education to the staffcaring for haematology patients toensure that they receive the bestcare possible.

To establish myself within this role Ihave developed workingrelationships with staff on outlyingwards, with the multidisciplinaryteam and allied healthprofessionals, and with members ofthe community team. This allowsme to work within other teams andwhere possible move care into thecommunity.

I have collected data onunscheduled haematologyadmissions, highlighting commonreasons for admission, the usualtimes and routes of admission, and I

found that some patients are beingtreated unnecessarily within theBelfast Health and Social Care Trust(BHSCT) when their treatments couldpotentially be local to other trusts.From this data collection I amreviewing how some of the patientsfrom outside the BHSCT catchmentarea came to be treated forpotentially local treatment regimensand I aim to collect further data onpatient demographics and whetherpatients can be treated locally toreduce pressures on the BHSCThaematology unit and also reducestress and travelling time forpatients.

I have developed and am in theprocess of completing a trainingprogram on Neutropenic Sepsis forstaff on outlying wards, I amimplementing Estimated Date ofDischarge to assist in reducinglength of stay and prevent delayeddischarges, I aim to develop a nursefacilitated discharge system, dofurther training in hematologicalconditions on outlying wards and Iwill develop ‘HaematologyInformation Packs’ for each ward.

I recently completed a trainingprogram on performing bonemarrow biopsies and in will bedoing these to assist in promptdiagnosis and will go to otherhospitals to prevent patients havingto travel for this procedure. I will becommencing the nurse prescribingand health assessment course thisSeptember in Queen’s University tofurther expand my role.

BLOODmatters | 9

CONGRATULATIONSTO LAURA

This year Laura Croan won theprestigious Royal College ofNursing Nurse of the Year PatientChoice award. She was nominated(by the patient) for the outstandingcare she provided to a young manwho was receiving chemotherapytreatment for leukaemia. Thepatient described how Laura tookthe time to get to know him,allowing him to share his concernsand fears.

He said: “She helped me tounderstand why things were beingdone and what was going tohappen”. The patient also explainshow Laura treated him as “a 19year old with issues” and not as“just another patient”. He describedhow she would often sit with him for30 minutes or so after the end ofeach shift and how this helped toalleviate his depression andencouraged him to take hismedication.

He continued: “If it weren’t forLaura, I wouldn’t have been able tostay in hospital to take mytreatment. I probably would havedied at home months ago. I hopeshe knows how much she did forme.”

The judging panel praised Laura’scapacity to look beyond theparticular condition that had led tothe patient being admitted and totake the time to understand andmeet his broader physical andmental health needs.

BLOODmatters | 11

HAEMATOLOGIC EMERGENCIES€100 Wordsearch Competition

WINNERHAI extend their congratulations to Nichola Harten,

(Haematology CNS, Connolly Hospital) whose entry from the last edition of

Blood Matters was the first correct entry drawn, winning her €100.

WOULD YOU LIKE TO WIN €100?Blood Matters have another wordsearch competition where you can win€100. Interested? The competition is on the next page - GOOD LUCK!

WORDS INCLUDED INTHE WORDSEARCH

ACUTE ANAEMIA

ACUTE HYPERVISCOSITYSYNDROME

APLASTIC CRISIS

COAGULOPATHY

DIC

FEBRILE NEUTROPENIA

HAEMORRHAGE

HYPERCALCAEMIA

HYPER LEUCOCYTOSIS

LEUCOSTASIS

MEDISTINAL MASS

PRIAPISM

SEPSIS

SHOCK

SPINAL CORDCOMPRESSION

SPLENIC SEQUESTRATION

STROKE

TRANSFUSION REACTION

TTP

TUMOUR LYSIS SYNDROME

€100.00WORDSEARCHcompetition

Find all the words listedbelow within the grid

which are all related to:

DRUGS USED INHAEMATOLOGY

Closing date forcompetition 6/12/2013.

The first correctrandomly selected entrydrawn after the closingdate will be eligible for

the €100 prize.

ASPARAGINASE

BISPHOSPHONATES

BORTEZOMIB

CYCLOPHOSPHAMIDE

CYTARABINE

DAUNORUBICIN

DEFERASIROX

ETOPOSIDE

FOLICACID

HYDROXYCARBAMIDE

IDARUBICIN

MELPHALAN

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METHOTREXATE

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PARACETAMOL

PHENOXYMETHYLPENICILLIN

THIOGUANINE

VESANOID

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WORDS INCLUDED IN THE WORDSEARCH

All completed entriesshould be sent to:

ROSENA GEOGHEGAN,

Dept. of Haematology,

3rd Floor Medical Tower,

Our Lady's Children'sHospital,

Crumlin, Dublin 12

NAME:

..............................................

JOB TITLE:

..............................................

WORK ADDRESS:

..............................................

..............................................

..............................................

..............................................

..............................................

TELEPHONE:

..............................................

MOBILE:

..............................................

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