Impact of winning BSPED Nurse and AHP Award by Christine Desmond

As we plan to launch the 2025 Awards in April we asked Christine Desmond, (BSPED Nurse and AHP Award winner in 2022) to tell us how her project “Successful Integration of the Complex Excess Weight (CEW) nursing role into the Paediatric Endocrine Nursing Service” was impacted by winning the award. 

The development of services for CYP living with severe obesity has been a significant challenge due to the complexity of the medical and psychosocial complications affecting this vulnerable group, the rapid escalation in demand for these services, the lack of skilled specialist medical professionals to meet this rising demand, and the lack of ring-fenced commissioning. NHSE commissioned the Complications of Excess Weight (CEW) services in 21 locations nationally as part of a CYP transformation project which started in 2021. Although many endocrine and diabetes professionals had training and experience in managing patients with severe obesity, the detailed biopsychosocial model of holistic care required by the NHSE transformation project remained undefined but included safeguarding, behavioural support, social support and psychology skills. There was a challenge in recruiting the wide range of staff required to deliver this model. It was unclear whether CEW MDTs should be integrated with other stakeholder services such as diabetes and endocrinology teams, general paediatrics and community paediatrics or whether the CEW should be a stand alone specialist service. The CEW service at Southampton started in 2022 with the leadership and guidance of Dr Nikki Davis the clinical lead for Paediatric Endocrinology and the CEW South East Network. The vision was to integrate the CEW nursing role into the Paediatric Endocrine Nursing Service. 

Development of the new CEW nursing role-

Developing a learning pathway for CEW -  This involved attending clinics, completing online learning packages, and familiarising the team with medications and auxology requirements for CEW to empower PENS to manage this group of patients. There was also extra learning via the team psychologist around important aspects of understanding of CEW families including stigma, inequality, the importance of language, eating disorders, neurodiversity, poverty proofing and patient engagement

 Equipment and auxology - PENS were trained to measure waist circumference, neck circumference, calculate and understand the importance of bioimpedance measurements and calculate percentage excess weight.

 Novel therapies and prescribing - The development of patient information leaflets with the paediatric pharmacist for medications that could be used for CEW patients. I ensured that all PENS familiarised themselves with these to be able to advise on side effects and dosing regimens.

 Results of biochemical investigations - I ensured the team understood the various biochemical assessments needed for the CEW patient. This has supported PENS understanding and knowledge of the importance of a consistent approach to diagnosing and managing aspects of insulin resistance and metabolic syndrome which we can now also implemented across the endocrinology obesity cohort.

 Patient support information - We used our experience from producing endocrine information leaflets to develop structured patient information leaflets including the CEW fact sheet. Various aspects of the team communication and information was adapted to improve engagement and minimise anxiety.

 Safeguarding - This has been a steep learning curve for all nurses which has involved training on how to frame safeguarding queries , completing referrals and chronologies, attending safeguarding meetings and understanding the complexities for these families. We now have a designated safeguarding nurse in post for CEW who leads on this aspect of the role.

 Development of Nurse-led CEW clinics - I formulated detailed proformas to use for  CEW clinic including a semaglutide group start . I have been able to implement some of the strategies into the endocrine nurse led clinics, producing a structured weight management prescription using signposts to specialist websites .

CEW data - As CEW is a developing service, outcomes play a vital role in continued funding and patient management. I drew from the PENS team’s previous experience in data collection and management and allocated tasks to ensure that CEW data is uploaded.

Regional and national contributions - I was invited to attend both regional and national NHSE meetings which has supported a consistent approach to develop this service from its foundation. I provide advice and recommendations on how the nursing role can evolve and support the CEW service.

Impact

I have led and co-ordinated with the support of Dr Nikki Davis the successful implementation of the CEW role in the PENS team. I have made this a resilient role by identifying hours in more than one nurse for CEW to enable cross cover and ensure that with the high volume of patient contacts that all nurses are empowered to confidently support patient queries. I believe integration of endocrine and tertiary obesity services has fostered team cohesion and offered opportunities for the whole team to develop important generic skills to manage not only this patient population, but every child now affected by obesity. The award from the BSPED has enabled me to undertake a level 7 coaching qualification which I am currently completing. I would encourage other nurses and AHP to apply for the award as not only has this been an opportunity to reflect on the valuable nursing contributions to both services but also allows us to share practice with our nursing colleagues.