Like many people in the Department of Anaesthetics, Intensive Care and Critical Care Medicine, Gemma Ellis is juggling lots of hats. On the one hand, she’s a consultant nurse. On the other, a Senior Lecturer and also, on a third hand, she’s conducting research with Professor Judith Hall.
“I’m the only consultant nurse for critical care in Wales. There are about 30 consultant nurses in Wales but very few in acute care – probably three or four,” she says, sitting in the staff room having cut out a small slice of time from her schedule to speak about her work. “Over the last few years, I have led on work programmes focusing on quality and safety in healthcare. Most of my work involves the use of improvement methodology and a lot of the education and projects I am involved in is based on that methodology.”
Initially, Gemma trained in Belfast, where she is from. After that, she worked as a nurse in London and Aberystwyth before heading to Cardiff in 1986.
“I wasn’t ever really ambitious and didn’t really know what I wanted to do. When I applied to Cardiff for the job, I had also applied to University of Aberystwyth to do a degree in politics. But I stayed here in Cardiff because I loved it. I stayed on in critical care throughout the various mergers that occurred in Cardiff,” she says leaping forward a decade. “I became a ward sister in critical care the same day that I became a mother. They came down to tell me after the birth of my son that I had got the sister’s post. That was May 1996. Things happened quickly after that. I was senior nurse for critical care and then we had a really fantastic clinical director at the time and he developed the concept of a consultant nurse in partnership with Dr Ann Taylor who was a Senior Lecturer at that time. They developed a business case for a consultant nurse and then when it was approved, I applied for the position and got it.”
The idea of a consultant nurse did not exist when Gemma started her practice in the early 90s. But now, it is an established role.
“The role has evolved over time and I’ve been involved in a lot of national issues related to critical care,” she explains. “As a nurse, you’ll develop and become more and more senior. A consultant nurse will have a much more strategic role and work across organisational boundaries and with other departments / hospitals. You’re the most expert in your field and then you share that expertise.”
It’s in this role of closing the gap between academia and clinical practice that Gemma became involved in clinical improvement programmes.
“Cardiff was chosen to be part of the safer patient initiative. That was a national campaign in which I was one of the leads for the critical care work stream,” she explains. “During that time we eliminated central line infections by implementing care bundles: simple processes that will give you the desired outcome and improve patient experience and mortality in critical care. This is achieved through using improvement methodology which is applied to many different systems that we work in and this is now spread across the entire system. The WHO checklist pre surgery is an example of this; a systematic approach to patient care.”
Another part of Gemma’ work is the World Sepsis Day in Cardiff. Sepsis is a huge problem even in today’s medically advanced world. In Wales, mortality from sepsis in Wales is thought to be responsible for 1800 deaths per year and in the developed world sepsis is increasing annually by 8-13%.
“That’s only an estimate. What I can tell you is that a significant number of patients admitted to our critical care unit have a sepsis related illness and the mortality rate for these patients is high. It’s quite significant.”
Her involvement in World Sepsis Day was initially to do with the improvement work which she has undertaken in her consultant nurse role, but it has since blossomed into a branch of its own.
“One of the awards that I won was a Health Foundation Award for Leaders for Change. That was a 2 year long programme and my focus on that work was around sepsis and how to have it recognised much sooner on the general ward using a sepsis 6 pathway. I worked closely with Dr Ron Daniels to develop this. Ron is one of the founders of the UK Sepsis Trust and also CEO of the Global Sepsis Alliance,” she recalls. “We stayed in touch across various bits of work. He was one of the instigators of World Sepsis Day and in Wales we thought we would do something with 1000 Lives to mark the occasion. I also got to know Terence Canning who is the Welsh representative for UK Sepsis Trust.”
The first World Sepsis Day was in September 2012 and the team from the Department of Anaesthetics, Intensive Care and Pain Medicine took a localised approach.
“It was the first one we had done. We developed a network on twitter. The first one we tried to do like a ‘pass the baton’– tweeting about the event. We had people pass the baton from Australia to us and then to British Columbia,” Ellis continues. “Locally, we held a stall in concourse raising awareness which our Chief Exec attended. Last year was much bigger and we got more people involved. We were fortunate to have the Health Minister who came and spoke to sepsis survivors on the renal ward. There was a lot of media attention around that with several interviews taking place including television and Welsh radio. Our Welsh UK Sepsis Trustee, Terence Canning, was interviewed on TV and he told the story of how his brother died tragically from sepsis.”
This year, events leading up to World Sepsis Day in Cardiff will include a charity ball held in partnership with Mothers of Africa.
“We’re talking about a Senedd event. World Sepsis Day this year is on a Saturday and we’re looking to make use of that. There’s football on that day in the city. Do we do it much more for the public? We’re working quite hard with GP practices to have pre hospital sepsis identified early on. It’s little bits but every year we’re making progress. We were invited up to the Houses of Parliament last year to lobby ministers and to attend a parliamentary reception and we’re doing that again this year,” Gemma says.
In closing, Gemma has high hopes for the future of improvement work in relation to sepsis. Gemma has received NISCHR funding which she is utilising to work with Professor Hall for 3 years to assist with research into sepsis.
“We are working with Cardiff medical students across two Health Board to carry out a point prevalence survey to identify how many patients in hospital have signs of sepsis and if they have received timely treatment. It’s important work which we hope to roll out across Wales,” Gemma says concluding.