THU0746-HPR Rheumatology nurse specialists and dmard prescription - where are we now?
Authors: MK Nisar, J Begum
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> It is widely acknowledged that a multidisciplinary team approach is the best way to care for rheumatology patient group. The rheumatology nurse specialist (RNS) is an integral part of this multidisciplinary team. EULAR has published recommendations for their role in the management of chronic inflammatory arthritis (van Eijk-Hustings Y et al, 2012). The Department of Health also highlights the need for providing different models of care in a more cost effective way. It recognises that the nurse specialists9 role is the bedrock of an effective care providing team and can contribute to answering the challenge of health provision in a financially difficult environment (Department of Health, 2008). <h3>Objectives</h3> We undertook a pilot survey to understand the present climate of rheumatology practitioners9 prescribing of methotrexate in their practice. <h3>Methods</h3> "Learning Rheum" is a national initiative with an aim to establish a core curriculum for rheumatology nursing. Prior to its national meeting, the steering committee organised a focus group discussion of an ideal training structure to be able to successfully deliver DMARD education for patients. Methotrexate was accepted as index DMARD for the purpose of the exercise. A questionnaire was created based on the discussion and all participants of the meeting were surveyed. Replies were compiled to ascertain the current picture of service delivery and educational training. <h3>Results</h3> 25 rheumatology specialist nurses participated in the exercise. Their job experience ranged from one week to 25 years (median 7 years). 21/25 (84%) ran independent clinics. 16/25 (64%) were employed at band 6. Five (20%) did not feel confident in counseling patients initiating methotrexate. Apart from two, no one had any formal training in delivering DMARD education. 10/25 (40%) had never been supervised whilst undertaking an educational session for patients. Six (24%) did not feel confident to teach or supervise their peers. <h3>Conclusions</h3> This is a pioneering survey mapping the training of rheumatology practitioners and nurse specialists to service delivery. This initiative highlights a wide variation in the training structure of a key job provision. There is lack of formal induction programme. Despite most participants running independent clinics and providing DMARD education for years, they confessed to have no formal education and little supervision. Over a fifth did not feel confident in counseling patients commencing methotrexate despite being in the job for a median of 18 months. Though most centres are delivering contemporary services, these are not being used effectively for developing key team members. A quarter of the cohort felt unprepared to impart the skills to peers (median experience 1 year). In conclusion, there is wide variation in the training of rheumatology nurse specialists. This can potentially have a negative impact on a relatively young workforce. There is a need for improving training standards to help deliver good quality rheumatology professionals of the future. <h3>Disclosure of Interest</h3> None declared