Rheumatology Nurses Research Articles

A national survey of rheumatology telephone advice line support in the United Kingdom: frontline perspectives.

Telephone advice lines are a key component of rheumatology services. A national survey of telephone advice line providers was undertaken to explore how this service is currently delivered and the impact on those delivering it to inform providers, policymakers and patients. We conducted an online survey between March and September 2023 collecting data on demographics, how advice lines function, governance and the impact on nurses' well-being. Data were analysed using descriptive statistics. A total of 123 health professionals completed the survey. The majority were rheumatology nurses [n = 118 (96%)], >45years of age [n = 112 (91%)], band ≥7 [n = 92 (76%)], with 77 (65%) reporting >10 years of experience within rheumatology. Most advice lines operated weekdays only [n = 93 (79%)], with most calls returned within 2 days [n = 81 (66%)], although some callers waited >7 days [n = 19 (15%)]. The number of calls received monthly ranged from 100 to >800, with 46 (37%) responders reporting >500 calls/month. The most common reasons for contacting advice lines were disease activity, pain and medication concerns. For most responders, governance arrangements were unclear [n = 72 (61%)]. Providing advice lines impacted on the well-being of nurses providing the service: 89 (72%) felt anxious 'sometimes to mostly' and 79 (64%) found it 'mostly-always' stressful. A total of 85 (69%) nurses had not received any training to manage advice lines. Although telephone advice lines are provided by experienced rheumatology nurses, high demand is impacting on well-being. Having designated training could equip nurses with additional skills to manage increased capacity and monitor their own well-being.

Rheumatology nurses’ knowledge and practices on pain management

Objective: Nurses have important responsibilities in providing effective pain management. This study was conducted to determine the level of knowledge and practices of rheumatology nurses regarding pain management. Methods: A descriptive study sample was 64 nurses in the rheumatology clinic. Data were collected using the Nurse Introduction Form and Questionnaire on Knowledge and Practices Regarding Pain Management. The data were evaluated in the SPSS. Results: It was determined that 73.4% of the rheumatology nurses did not receive training on pain management. The pain management knowledge score was moderate, and the knowledge of non-pharmacological pain management was insufficient. The mean pain management self-confidence score was 6.03±2.01 (0-10), and a positive correlation was found between the graduation year, working years in rheumatology, and pain management knowledge score (P

OA32 A national survey of rheumatology telephone adviceline support in the United Kingdom: frontline perspectives

Abstract Background/Aims Telephone advicelines (TALs) are a core feature of rheumatology services and highly valued by patients for providing clinical advice and support. The demand for TALs has increased since the pandemic, placing pressure on current capacity. This study aimed to assess how TALs are currently provided and the impact on rheumatology nurses who routinely deliver this service. Methods An online questionnaire was developed and piloted with input from patients and stakeholders and advertised through the Royal College of Nursing Rheumatology Forum and the British Society for Rheumatology. The survey included health professional demographics, how TALs operate, reasons for contacting TALs, documentation recorded and the impact on provider wellbeing using closed and free text questions. The survey was available from March to September 2023 and had university ethics approval. Results 123 people completed the survey. The majority were rheumatology nurses (n = 118), over 45yrs (n = 96,81%), band 7 or above (n = 88;74%) with over 10 years experience (n = 77,65%), with a first degree or higher (n = 106, 90%). 45 (38%) nurses had a prescribing qualification. The majority of TALs provided a voicemail response (n = 90, 76%),with a triaging system (n = 75, 64%) conducted by clinical support workers (n = 44, 37%) and nurses (n = 29,25%). The number of calls received over a month ranged from 100 to over 800 with 68 (58%) respondents reporting between 500-700 calls. TALs were provided over 5 days (n = 93,79%) for 8 hours (n = 61, 52%), by rheumatology nurses (n = 118), with calls returned within 1-2 days (n = 96,81%) by 1-2 nurses (n = 72,61%), although some calls took over 7 days to respond to (n = 19). The three main reasons for contacting TALs included increased disease activity, managing pain, and concerns relating to DMARDs. There was often no standard operating procedure (n = 72, 61%) or provision for people whose first language is not English (n = 99,84%). Data were collected on the nature of the call (n = 74, 63%) and the response given (n = 47, 40%). Providing TALs negatively impacted on provider wellbeing; 89 (75%) felt anxious ‘sometimes to mostly’ and 79 (67%) found it ‘mostly-always’ stressful. 85 (72%) had not received any training to conduct TALs and 79 (67%) reported that cover was often not available for leave or sickness. The qualitative findings also confirmed that expert providers found delivering TALs stressful and felt underprepared. One respondent commented that “The adviceline is the most stressful aspect of the role but has the least support.” Many felt the adviceline had developed without adequate planning, contributing to the service being under resourced and under recognised. Conclusion TALs support patients with concerns about their symptoms and treatments on a daily basis, yet the increased demand for delivering TALs is impacting on nurse wellbeing. Consequently, national guidelines are required on optimal service requirements including resource allocation, training and health professional support. Disclosure S. Ryan: None. S. Hider: None. A. Hassell: None.

E036 Rheumatology nurses’ perceptions of undertaking a postgraduate education programme: a qualitative study

Abstract Background/Aims Rheumatology nurses practising at an advanced clinical level are encouraged to undertake postgraduate study to provide an evidence base to their role. This study explored the perceptions and experiences of clinical nurse specialists (CNS) undertaking a Master’s programme in Rheumatology Nursing, including perceptions of impact and future educational needs. Methods CNS, in the United Kingdom and Europe, who had completed a Masters programme in Rheumatology were recruited to take part in semi-structured telephone and video interviews between 17th March 2021 - 17th May 2021. Interviews were digitally-recorded and data was analysed by two researchers and two public contributors. Results 10 CNS participated in the study including 9 Females and 1 Male and worked in a variety of different geographical locations including England, Wales, Scotland and Malta. The duration of the interviews was 23-50 minutes. Four themes related to the experiences of CNS undertaking an MSc programme were identified: i) Increased confidence and the development of new skills, ii) Perceived impact on the CNS’ organisation, iii) Benefits of face-to-face learning, and iv) Future educational needs. All CNS reported increased confidence with physical examination skills and the interpretation of clinical symptoms. New skills gained included assessing the psychosocial impact of inflammatory arthritis in the clinical consultation and the ability to appraise research evidence. Undertaking postgraduate study not only had an identifiable impact on the CNS’ own practice, but also benefited members of their organisation with the sharing of clinical examination skills, evidence based practice and enhanced communications with team members including managers and commissioners. Implementing learning was dependent on time and managerial support. CNS found the ability to interact in person with other students increased engagement in learning and the creation of professional supportive clinical networks that continued after the course had finished. Modules which developed physical skills, including musculoskeletal examination, were perceived to be better suited to face-to-face teaching whilst those with a greater theoretical component such as critical appraisal could be delivered remotely. Some participants also valued the opportunity to be away from the workplace, which enhanced their learning experience by being able to focus solely on their studies. Future education needs identified by the CNS focused on developing diagnostic skills and greater involvement in supporting self-management. There was consensus that all CNS should be prescribers as this was a major component of providing a telephone advice line service. Conclusion CNS identified that completing a face-to-face Masters in Rheumatology increased their knowledge and confidence in delivering new clinical skills, fostered peer networks whilst also benefiting their employing organisations. Postgraduate provision may need to consider how the benefits of face-to-face learning can be transferred to remote learning to ensure that clinical confidence and new clinical skills can be obtained. Disclosure S. Ryan: None. A. Hassell: None. Z. Paskins: None. K. Rule: None. M. Brooks: None. G. Tajuria: None.

Evaluating a competency framework for rheumatology nurses.

The Royal College of Nursing (RCN) competency framework for rheumatology nurses was developed in 2020. As part of the framework proposal, a service evaluation was planned following the framework's roll-out to determine its usefulness and acceptability. The aim of this evaluation was to explore rheumatology nurse specialists' answers to the research question: 'What was your experience of using the RCN's rheumatology competency framework?' A total of 14 rheumatology nurse specialists were interviewed and shared their opinions regarding the competency framework. Five themes were identified: personal usage; benefits to managers; inequalities and inequity in nursing; ideas for improvement; and general properties. The findings of this evaluation demonstrated the value of the framework, which enabled rheumatology nurse specialists to document the competency level they were working at and to identify their future training needs.

Evaluation of nurse practitioners' roles and competencies among rheumatology nurses: Results of a national survey.

To investigate nurse practitioners' roles and competencies among rheumatology nurses in China, an online, cross-sectional survey was conducted between July 7 and 14, 2020 among the national cooperation group of nursing experts on management of rheumatic and immune diseases. A total of 796 valid questionnaires were returned and participants' mean total scores on the Nurse Practitioners' Roles and Competencies Scale (NPRCS) was 2.51 (SD = 0.55), indicating a medium level. Medical assistance, leadership reform, and clinical research had low scores in the six dimensions of the NPRCS. Nurse practitioners' roles and competencies in the area of rheumatology require improvement. Training should focus on medical assistance, leadership reform, and clinical research. The current study can provide a reference for an improved training framework of nursing practitioners in the rheumatology field.

Nailfold Capillaroscopy Performed by Rheumatology Nurse-reliable and Delivering Significant Impact on Clinical Diagnosis Revision and Subsequent Major Medication Changes

Introduction: Nailfold Capillaroscopy (NFC) is a microscopic examination equivalent of an in vivo assessment of microcirculation. It is an invaluable examination in patients presenting with Raynaud’s phenomenon (RP) (triphasic color changes of fingers commonly on cold exposure) which might underlie a spectrum of rheumatic diseases e.g. scleroderma and mixed connective tissue diseases (CTD). Early diagnosis of these disease can allow investigation of other internal organ involvement and starting appropriate drug therapy e.g. immunosuppressants for immune-related part, and vasodilatory therapy as a symptomatic treatment. Methodology NFC was performed by Optilia[Formula: see text]Digital Video microscopy with 200x lens with LED illumination. Rheumatologists had performed NFC from 6/2020-11/2022 for existing scleroderma and mixed CTD patients. Rheumatology nurses started to perform NFC on patients with RP since 11/2022 (study period till 4/2024) after undergoing certified workshop training and having direct supervision from in-house rheumatologists. 3 rheumatology nurses had been involved in acquiring video images from NFC and 1 of them, an APN, drafted the reports which would be finally authorized by rheumatologists. Clinical data, revised diagnosis and drug changed of performed NFC patients were analyzed. Result: 56 female and 15 male with average 51 years old were performed NFC. All had abnormal NFC findings. Crucially there were accompanying diagnosis revision and subsequent major medication changes (rheumatologists’ initiation or stepping-up of immunosuppressants and vasodilatory agents): Rheumatologists verified all images and agreed on the final conclusions, except 1 (1.5%) reported as non-specifics findings by nurse and edited as late-stage scleroderma by rheumatologist. Conclusion: Rheumatology nurses are competent and reliable in performing NFC and had expanded patients’ group from known scleroderma and CTD to patients with RP in a wider scope. Waiting time was reasonably around 1 month. The significant clinical impact is apparent with the findings helping the rheumatologists to revise diagnosis timely and to adjust drug treatment accordingly.

"The Simpler, the Better." A Qualitative Study on Digital Health Transformation in Early Adopter Rheumatology Outpatient Clinics.

Workforce shortage and the increasing burden of rheumatic and musculoskeletal diseases lead to extreme time constraints in rheumatology outpatient care. Digital services promise to facilitate care by relieving employees and unleash new capacities. This study aims to explore the perspectives of early adopter health care professionals (HCP) on digital transformation in outpatient rheumatology. In-depth qualitative interviews were conducted with rheumatology nurses and physicians in 3 German rheumatology outpatient clinics, each characterized by an advanced level of digital adaption. Qualitative data were subsequently analyzed using deductive-inductive qualitative content analysis. Interviews with 11 rheumatology nurses and 5 rheumatologists were completed. Three key themes emerged from the qualitative analysis: (i) Digital transformation of care; (ii) impact of digital transformation on health care delivery; and (iii) perceived drivers of successful digitalization. The interviews revealed that digital technologies are widely used throughout the complete patient pathway. Digitalization enables more continuity and flexibility in rheumatology care. Patient information can be electronically obtained in a standardized manner prior to planned visits, enabling an informed consultation and more time for in-depth patient discussion. Although digitalization restructures work, it can also increase the current workload. Improved accessibility for patient calls leads to more work for HCP. Important drivers of successful digital technology implementation are low-threshold and interoperable services, a medical team that is interested and educated in eHealth, and comprehensive patient information and onboarding. Digital transformation is increasingly redefining rheumatology care. While accelerating communication and workflows, improved service accessibility leads to more work for HCP.

Nurse-led care for people with early rheumatoid arthritis: Interview study with thematic analysis.

To develop an understanding of what comprises nurse-led care in early rheumatoid arthritis from the perspective of rheumatology nurse specialists in England. Qualitative study. Semi-structured telephone interviews with rheumatology nurse specialists in England were conducted in Summer 2020. Interviews were audio-recorded, transcribed verbatim and analysed using reflexive thematic analysis. Reporting follows the appropriate elements of consolidated criteria for reporting qualitative research. Sixteen nurses were recruited and interviews lasted 30-60min. Four themes with 14 subthemes were identified. A SPECIALIST SERVICE DELIVERED BY EXPERIENCED RHEUMATOLOGY NURSES: Specialist care is provided by experienced nurse specialists with a high degree of autonomy in the rheumatology multidisciplinary team context. Care is evidence-based and aims to start treatment, keep in treatment, educate and support. Access to psychology expertise is needed. CARE WITH COMPASSION USING PERSON-CENTRED, HOLISTIC AND EMPATHETIC APPROACHES: Nurses create patient relationships and a positive therapeutic environment. Nurse-led telephone advice lines are essential for treatment adjustment, patient support and empowerment. Consultations are reviewed,and patients are asked for feedback. The COVID-19 pandemic caused disruption, but changes streamlined procedures and improved documentation and communication. Nurse-led care in early rheumatoid arthritis is a specialist service delivered with compassion, addressing complex care needs and using person-centred approaches. This study identifies key aspects of care in early disease from the nurse perspective.

Rheumatology nurses' perceptions of undertaking a postgraduate education programme: A phenomenological study.

The expansion of the role of the rheumatology nurse specialist led to the instigation, in 1999, of the first Masters programme in rheumatology nursing, with the aim of supporting clinical advancement with evidence-based practice. This study explored the experience of rheumatology nurses undertaking postgraduate study at Masters level. (1) To explore the perceptions and experiences of clinical nurse specialists undertaking a Masters programme in Rheumatology Nursing, including perceptions of impact. (2) To identify future educational needs. Ten rheumatology nurses who had completed a Masters degree in rheumatology nursing participated in a semi-structured video link or telephone interview conducted between 17th March 2021-17th May 2021. Interpretive phenomenological analysis was undertaken by two researchers and two public contributors. Four themes were identified: (i) Increased confidence and the development of new clinical skills. (ii) The perceived impact on the organisation; (iii) Benefits of face-to-face learning; and (iv) Continuing evolution of the rheumatology nurse specialist role. Participants reported increased confidence in clinical skills and felt that their learning had benefited their employing organisation. However, lack of time and insufficient managerial support could impede the implementation of new skills. Learning examination techniques, engagement in learning and peer support were seen as advantages of face-to-face learning. Future educational needs focused on diagnostic and prescribing skills. Participant learners perceived that completing a face-to-face Masters in rheumatology increased confidence in delivering new clinical skills and fostered peer networks, whilst also benefiting their employing organisations. There is a need for organisational support to apply learning to the clinical setting.

Health Care Providers' Experiences of a Mandatory Nationwide Transition to an Adalimumab Biosimilar.

Transitioning patients to biosimilars has become common to reduce costs and improve access. However, it is unclear how the transition process impacts health care providers at the frontline of the brand change. This study explores health care providers' experiences of a mandatory brand change to an adalimumab biosimilar. A cross-sectional study was conducted in Aotearoa New Zealand with 164 providers involved in the nationwide adalimumab brand change. Rheumatologists (n=39), rheumatology nurses (n=16), and pharmacists (n=109) completed a survey that assessed their satisfaction with logistics and supply, information and education, support, and administrative workload and reported what did and did not go well during the transition. The mean satisfaction score (0-10) with the transition was 5.7 (SD=2.6). Providers were the least satisfied with training for the biosimilar device, information from government agencies, and administrative workload during the transition. Satisfaction with adalimumab safety, efficacy and device quality, and the availability of sharps bins, alcohol wipes, and patient support was lower following the transition. Satisfaction with administrative workload (B=0.37, P < 0.001) and training for the device (B=0.20, P = 0.020) predicted overall satisfaction. Providers reported that a poorly implemented initial authorization process, loss of a patient support program, and insufficient communication between providers complicated the transition. The citrate-free preservative and longer authorization duration after the transition were viewed positively. Providers experienced an increased workload and reported less satisfaction with the biosimilar following the transition. Experiences may be improved by ensuring training for the device, a high-quality patient support program, and functioning authorization processes throughout the transition.

Association between depression and pain, functional disability, disease activity and health-related quality of life in patients with systemic lupus erythematosus: a meta-analysis

ObjectiveThe aim of this study was to explore the effect of depression on pain, disease activity, functional disability and health-related quality of life measured by Visual Analogue Scale, Systemic Lupus...

Challenges faced by nurses engaged inrheumatology care inJapan.

This study aimed to identify the challenges faced by nurses engaged in rheumatology care in Japan. We conducted a questionnaire survey of nurses in Japan in 2020 on challenges experienced in rheumatology care. The participants were nurses certified by the Japan Rheumatism Foundation. Participants' answers were coded and categorized based on relevant phrases and words. Content analysis was performed on the findings. Responses were collected from 162 participants, and a total of 228 issues were identified. Eighteen categories with 56 subcategories emerged from the data analysis, which were grouped into five types of challenges: (1) communication, (2) understanding, (3) expertise, (4) system, and (5) collaboration. In particular, the results highlighted deficiencies in needs-based multidisciplinary team care. This study elucidated issues experienced by rheumatology nurses in clinical settings in Japan. Furthermore, this investigation revealed the necessity of patient-centred multidisciplinary team care, including health professionals, patients, and other relevant individuals. This study provided practical directions to facilitate the implementation of effective care focused on improving patients' quality of life.

“I’d like more options!”: Interviews to explore young people and family decision-making needs for pain management in juvenile idiopathic arthritis

BackgroundJuvenile idiopathic arthritis (JIA) is a common pediatric rheumatic condition and is associated with symptoms such as joint pain that can negatively impact health-related quality of life. To effectively manage pain in JIA, young people, their families, and health care providers (HCPs) should be supported to discuss pain management options and make a shared decision. However, pain is often under-recognized, and pain management discussions are not optimal. No studies have explored decision-making needs for pain management in JIA using a shared decision making (SDM) model. We sought to explore families’ decision-making needs with respect to pain management among young people with JIA, parents/caregivers, and HCPs.MethodsWe conducted semi-structured virtual or face-to-face individual interviews with young people with JIA 8–18 years of age, parents/caregivers and HCPs using a qualitative descriptive study design. We recruited participants online across Canada and the United States, from a hospital and from a quality improvement network. We used interview guides based on the Ottawa Decision Support Framework to assess decision-making needs. We audiotaped, transcribed verbatim and analyzed interviews using thematic analysis.ResultsA total of 12 young people (n = 6 children and n = 6 adolescents), 13 parents/caregivers and 11 HCPs participated in interviews. Pediatric HCPs were comprised of rheumatologists (n = 4), physical therapists (n = 3), rheumatology nurses (n = 2) and occupational therapists (n = 2). The following themes were identified: (1) need to assess pain in an accurate manner; (2) need to address pain in pediatric rheumatology consultations; (3) need for information on pain management options, especially nonpharmacological approaches; (4) importance of effectiveness, safety and ease of use of treatments; (5) need to discuss young people/families’ values and preferences for pain management options; and the (6) need for decision support. Themes were similar for young people, parents/caregivers and HCPs, although their respective importance varied.ConclusionsFindings suggest a need for evidence-based information and communication about pain management options, which would be addressed by decision support interventions and HCP training in pain and SDM. Work is underway to develop such interventions and implement them into practice to improve pain management in JIA and in turn lead to better health outcomes.

P120 What's driving this disease activity score? A support framework to aid your decision

Abstract Background/Aims NICE now enables patients with a DAS of &amp;gt; 3.1 to &amp;lt; 5.2 to be treated with advanced drug therapies. To ensure correct and cost-effective use of resources it is essential that we identify a moderate DAS that is driven by inflammatory joint disease as opposed to a differential diagnosis. A reference-based tool entitled “DAS drivers: A nursing decision-making algorithm“ was designed to support nurses in their clinical decision making around appropriate treatment for moderate disease. Clinical trials suggest that advanced therapy provides similar benefits for people with moderate disease as well as those with severe disease. After a pragmatic review of existing evidence. NICE guidance was introduced in 2021 to include patients with a moderate RA DAS (&amp;gt;3.1 - &amp;lt; 5.2) to be eligible for advanced therapies. This is a positive step to improving access to advanced treatment options for patients and will help stem the burden of disability associated with RA. The algorithm presented was initially developed to support nurses identify and navigate around management plans for patients with moderate RA disease and would be freely available for all of rheumatology community to use in their daily practice. It is recognised in the BSR report ‘Specialist Nursing in Rheumatology - The State of Play’ that there is a need for succession planning and an increase in appropriately skilled rheumatology nursing workforce. The authors are experienced, longstanding members of the rheumatology workforce and thus are sharing knowledge and experience with the next generation of nurses to allow for continued quality of patient care as part of the succession planning program that rheumatology services now face. The algorithm aims to address these challenges by supporting the identification of patients with active inflammation in moderate RA therefore ensuring that appropriate patients are given access to valuable limited resources within the NHS. Methods Round-table discussions between three advanced rheumatology nurse leaders (the authors) with a cumulative and varied rheumatology experience of 70+ years, lead to the development of an algorithm specifically around identifying active inflammation in moderate RA. The authors drew on relevant publications and clinical experience to develop the algorithm and refine over a 12-month period. The intention of the algorithm is to make it user friendly and support standardised decision making in a clinical setting for all nurses working within rheumatology, irrespective of experience. Results The algorithm provides a structured approach and promotes ideas to consider when assessing and treatment patients with rheumatoid arthritis. Conclusion To endorse and disseminate the algorithm as an education tool and develop a publication. An audit on the use of the algorithm amongst nurses in clinical practice with a pilot audit with nurses who have attended educational events delivered by the authors. Disclosure B. Rhys-Dillion: Honoraria; B.R.D. has received honoraria from Galapagos. A. Kent: Honoraria; A.K. has received honoraria from Galapagos, Roche, Pfizer, Gilead, BMS, Amgen, Chugai-Pharma, Sanofi Aventis and UCB Pharma. J. Painter: Honoraria; J.P. has received honoraria from Galapagos, Pfizer, Novartis and Roche/Chugai-Pharma.

P108 Exploring the Treatment Burden of Disease Modifying Anti-Rheumatic Drug Monitoring in People with Rheumatoid Arthritis: A Qualitative Study with Recommendations for Practice

Abstract Background/Aims People with rheumatoid arthritis (RA) taking disease-modifying anti-rheumatic drugs (DMARDs) require safety monitoring to identify potential side-effects. This study explored patients’ and family members’ perspectives on DMARD monitoring, and how associated treatment burden could be minimised to optimise concordance and safety. Methods Adults with RA on DMARDs and family members were recruited from 2 rheumatology departments in the West Midlands to take part in semi-structured telephone interviews between July 2021 and January 2022. Public contributors with RA helped to develop the topic guide and interpret the results. Interviews were digitally recorded and data analysed using a framework method. Findings were discussed with a group of stakeholders to develop implications for practice. Results Thirteen people with RA (10 females, age range 40-79yrs, seven retired, disease duration 1 month-21 years) and 3 family members (male, retired, aged 70 to 79 years) participated in an interview. Three main themes were identified: 1) DMARD monitoring took precedence over the work involved. 2) Inflexibility with appointment times and travel requirements increased the work for patients and families. 3) Drug Monitoring was more than safety surveillance. DMARDs were considered a necessity to treat active disease and maintain wellbeing. Consequently, the work associated with DMARDs monitoring was often accepted in return for control of symptoms. Treatment burden was not always recognised, as early appointment times increased the work for patients with physical care needs and those with co-morbidities, who required extra time for preparation. Inflexibility in drug monitor locations impacted on the personal, practical and financial costs associated with travelling and parking, with family members having to take time off work. Monitoring encompassed more that drug safety addressing symptom management, functional ability and emotional wellbeing. Three core recommendations for addressing treatment burden to optimize concordance and safety were co-designed by the stakeholders (3 rheumatology nurses, 3 clinical academics, 2 rheumatologists, 1 GP and 1 person with RA) and the research team: 1) Conceptualising monitoring: changing the emphasis of care from ‘drug’ monitoring to ‘person’ monitoring to facilitate a holistic assessment of the person and their condition. 2) Identifying treatment burden: being clear who within the healthcare team is identifying treatment burden and when. Proactively, assessing treatment burden when a DMARD is commenced, rather than waiting for burden to exceed capacity, resulting in non-concordance. 3) Minimising treatment burden: by negotiating how treatment burden can be managed including offering flexible and responsive options, in terms of appointment times and monitoring locations. Conclusion The work involved for people with RA in drug monitoring is significant and often unrecognised. Our findings have led to clear recommendations to promote a more person-centred approach, increase recognition of, and minimise the treatment burden associated with DMARD monitoring. Disclosure S.J. Ryan: Royalties; book royalties oxford handbook clinical rehabilitation 5600006372. Grants/research support; General Nursing Council Trust. Other; unpaid committee role with the haywood foundation. L. Bullock: None. F. Manning: Grants/research support; NIHR Applied Research Collaboration South West Peninsula. Other; Honorary lectureship in bone health Keele University. Z. Paskins: Consultancies; non paid consultancy for UCB. Grants/research support; versus arthritis, royal osteoporosis society, general nursing council trust, charted society for physiotherapy, british society for rheumatology. Other; unpaid committee roles with royal osteoporosis society, versus arthritis and haywood foundation. C. Chew-Graham: Royalties; for a book primary care mental health 9781911623021. Grants/research support; NIHR and other funding bodies for research.

E004 Inpatient admission pathway for patients with rheumatological disorders

Abstract Background/Aims Rheumatology is a complex specialty covering many conditions of varying severity, from muscle pain through inflammatory arthritis such as Rheumatoid arthritis (RA) and connective tissue diseases. Most of the conditions can be managed in an outpatient/day case setting. However, acutely ill patients require safe and prompt inpatient management including specific intravenous infusions. This need to be done urgently and cannot wait to be accommodated through the Infusion unit at our hospital. Historically Medicine Acute Admission Unit has been the route to bring in these patients. However, operational bed pressures faced challenges leading to instances of delayed treatment with complications including fatality. This led to creating a direct inpatient admission pathway to the specialist ward. Methods Ward Matron designed the following robust pathway for direct patient admission to our specialist Rheumatology ward, Jevington ward. This was implemented in February 2022 after discussion and agreement with Clinical Lead consultant, pharmacist, clinical site managers and other colleagues. Rheumatology team and nurses covered the ward during working hours and by the on-call team out of hours. The overall responsibility remained with the rheumatology team. The referrals accepted only after completing appropriate paperwork. Patients carried out Lateral Flow Test (LFT) at home prior to admission. We ensured negative results and followed the Trust COVID 19 screening protocols. Subsequent screenings were done according to the updated guidelines. The planned assessment and treatments were carried out by the ward team complying with BSR/EULAR Guidelines, infusion protocols such as standard and continuous Iloprost Infusion Protocols of the Trust. Results We assessed the delay in patient's admission, length of stay, patient outcome and experience after implementing the pathway. The significant change has been in the time to admit; from two weeks in 2018 &amp; 19 to two days this year. This is reflected in the patient feedback. All our acutely ill patients were assessed, treated and discharged promptly on this specialist ward. Conclusion This pathway allowed safe and prompt treatment, prognosis and excellent experience for acutely ill patients with rheumatological disorders. This additionally enabled reduced length of stay supporting financial sustainability of the Trust. Disclosure S. Panthakalam: None.

E008 I feel a bit happier about going on it now: exploring the information needs of people starting methotrexate

Abstract Background/Aims Methotrexate (MTX) is recommended as initial disease-modifying anti-rheumatic drug (DMARD) therapy for people with rheumatoid arthritis (RA). Rheumatology nurses provide information about benefits, risks and safety monitoring requirements for methotrexate during DMARD counselling, which may be provided in different formats. This study sought to explore the information needs and experiences of people with RA commencing MTX. Methods Seventy-six adults with RA referred for MTX DMARD counselling attending two rheumatology units in the West Midlands were invited to take part in qualitative semi-structured interviews (either by phone or video) before and after receiving information about MTX. Research partners with RA helped to develop interview topic guides. Interviews were digitally recorded, transcribed and analysed using reflexive thematic analysis. Results Nineteen participants, (11 male, 8 female, White British, age 45-76 years, disease duration 6 weeks - 35 years) took part in telephone (n17) or video (n2) interviews (duration 34-82 minutes). Three main themes were identified: information delivery, necessity of MTX and concerns about MTX. Information delivery: most participants received telephone DMARD counselling which was helpful for people with mobility issues or work commitments. However, most acknowledged a preference for, and the importance of face-to-face communication. Information tended to be provided in a generic manner, using a checklist, and could feel rushed. Written MTX leaflets were received but not used by all participants. Some participants felt well informed whilst others felt overwhelmed with information. Many had difficulty recalling important safety information. Unmet information needs about monitoring, prescribing and follow-up arrangements were frequently reported. Inconsistent information about MTX from different sources could increase concerns. Rheumatology helplines were valued as a direct route to information and care. Necessity of MTX: most participants wanted more information on why they should take MTX, how and when MTX would help them and how long they would be required to take MTX for. Some wanted to know about other drug treatment options. Concerns about MTX: all participants had concerns about the likelihood and severity of side-effects including mouth ulcers, nausea and hair loss. Worries about the use of MTX as a cancer treatment were frequently reported. Whilst concerns remained about MTX most participants accepted the risk of side-effects because of the need to improve their symptoms. Conclusion DMARD counselling was valued by people with RA when starting MTX but was not always responsive to information needs. Addressing individual concerns about the necessity for MTX, concerns about side-effects and prioritising essential safety information is recommended. Practical issues around obtaining supplies of MTX, monitoring, follow-up arrangements and a follow-up telephone call may help address unmet information needs for some. Disclosure S.J. Logan: None. S. Hider: None. J. Green: None. S. Ryan: None.

P006 A national patient-reported experience survey (PREM) of advanced nurse practitioners in rheumatology, Ireland

Abstract Background/Aims Data collection to assess the impact of rheumatology advanced nurse practitioners (RANPs) on service quality tends to prioritise the quantitative impact on waiting lists and hospital admissions. However, patients’ views on the quality of service experienced is fundamental and essential to achieve high quality of care. Recording patients experience of care has the potential to improve quality of care. The Irish Rheumatology Nursing Forum (IRNF) wanted to measure patients' experience of care by an RANP and highlight triggers for change to enhance the quality of care delivery nationally. Methods The IRNF conducted a service evaluation postal survey using patient reported experience measure (RA PREM), previously designed, and validated for use with rheumatology patients. This tool examines eight domains of care specific to patients with inflammatory arthritis (need and preferences; care coordination; information about care; daily living; emotional support; family and friends; access to care) and is proven to be effective in measuring and monitoring patient experience. Minor adjustments were made to the questionnaire specific to the role of the advanced nurse practitioner. Patients seen by an advanced nurse practitioner within the previous 12-months were supplied with a questionnaire and a stamped address envelope during a 6-week period, in early 2022. Patient participation was voluntary, postal return of a complete survey implied consent. Results Eleven eligible rheumatology centres with twenty advanced nurse practitioners participated nationally. A total 350 questionnaires were disseminated, 188 completed questionnaires were returned, (54% response rate). In the previous 12-month period 38% of respondents had at least 2 appointments. Appointments with the advance nurse practitioner were predominantly face-to-face (73%), and a further 26% were telephone consultations. Most patients reported involvement in their care decisions, being emotionally supported, and that communication and service access were timely. Patients endorsed a good experience of care for their inflammatory arthritis (67% strongly agreed, 25% agreed). Most patients (71%) reported good control of their arthritis which allowed them to get on with usually daily life activities. Results from the self-care domain demonstrated low levels of knowledge about patient organisations and self-management programmes. Conclusion Optimising the quality of care delivered by advance nurse practitioners is contingent on measuring patient experience. The self-management organisations/programme knowledge deficit among patients will be addressed by the IRNF in partnership with the patient organisation Arthritis Ireland. It is incumbent on advanced practice nurses to undertake service evaluations for quality improvement and further service development. Periodic use of PREMS is a feasible way to inform service evaluation for quality improvement. Disclosure U.E. Martin: None.

Nursing interventions for patients with rheumatic and musculoskeletal diseases on biological therapies: a systematic literature review.

Investigating unmet needs and identifying the necessary interventions for patients affected by rheumatic and musculoskeletal diseases (RMDs) may help significantly to ensure the continuity and quality of the chronic care pathway. To this aim, the contribution of rheumatology nurses requires further evidence. The aim of our systematic literature review (SLR) was to identify the nursing interventions directed towards patients with RMDs undergoing biological therapy. To retrieve data, a search was carried out in the MEDLINE database, the Cumulative Index to Nursing and Allied Health Literature (CINAHL database), the APA PsycINFO database and the Excerpta Medica Database (EMBASE) from 1990 to 2022. The systematic review was carried out in accordance with the relevant PRISMA guidelines. Inclusion criteria were as follows: (I) adult patients with RMDs, (II) undergoing therapy with Biological Disease-Modifying Anti-Rheumatic Drugs (bDMARDs), (III) original and quantitative research papers in English with available abstract, (IV) specific to nursing interventions and/or outcomes. Two independent reviewers screened the identified records for eligibility according to their title and abstract, full texts were subsequently assessed and, finally, data was extracted. Critical Appraisal Skills Programme (CASP) tools were used to evaluate the quality of the studies included. Among the 2348 records retrieved, 13 articles met the inclusion criteria. These consisted of six randomised controlled trials (RCTs), one pilot study and six observational studies on RMDs. In a total population of 2004 patients, 43% (862/2004) of the cases concerned rheumatoid arthritis (RA) and 56% (1122/2004) of the cases concerned spondyloarthritis (SpA). Three major nursing interventions were identified, namely education, patient-centred care and data collection/nurse monitoring, which were correlated with high satisfaction rates regarding care, increased self-care capacity and treatment adherence among patients. All interventions followed a protocol defined in collaboration with rheumatologists. The large degree of heterogeneity in the interventions did not allow the performance of a meta-analysis. Rheumatology nurses are part of a multidisciplinary team caring for patients with RMDs. Following an accurate initial nursing evaluation, rheumatology nurses can plan and standardise their interventions focusing primarily on patient education and personalised care based on actual needs, such as psychological well-being and disease control. However, the training for rheumatology nurses should define and standardise, as much as possible, the competencies required for the detection of disease parameters. Key Points • This SLR provides an overview of nursing interventions for patients with RMDs. • This SLR considers the specific population of patients on biological therapies. • Training for rheumatology nurses should standardise, as much as possible, the knowledge and methods required for detecting disease parameters. • This SLR highlights the various competencies of rheumatology nurses.