Guidance

AAA screening programme nurse specialist guidelines

Updated 21 July 2020

This guidance provides a standardised framework and guidelines for the role of the abdominal aortic aneurysm (AAA) screening nurse specialist across England to ensure that individuals with screen detected aneurysms receive the same level of support and guidance.

The nurse specialist appointment provides health and lifestyle advice to individuals with screen detected aneurysms at specific points in the screening process.

Individuals with aneurysms require close monitoring, support and secondary prevention to reduce their overall vascular risk and improve outcomes.

1. Qualifications and experience

The nurse specialist must be a registered general nurse (RGN) with a minimum 3 years’ post registration experience, one of which must be in vascular services. This must include the management, surveillance and treatment of individuals with abdominal aortic aneurysms.

The nurse specialist:

• should have a job description that includes their role in the NHS AAA screening programme and shows the clinical responsibility and accountability structures within the local provider
• must be able to demonstrate links with key clinicians involved with providing care to individuals with cardio-vascular disease, including smoking cessation, vascular surgery and radiology
• must demonstrate knowledge of the NHS AAA screening programme and population screening or be willing to develop this knowledge
• is expected to be working within the Society of Vascular Nurses’ vascular staff nurse competencies document, which sets out the minimum standard required to deliver advanced nurse roles in the vascular field while bringing together the skills, knowledge and understanding needed to be effective in the role; they can be used to identify training requirements

2. Nurse specialist role requirements

The minimum initial recommended whole time equivalent (WTE) required for the nurse specialist is 0.1 WTE for a screening programme undertaking 7000 scans per year. Therefore, larger screening programmes may require additional WTE to effectively undertake the role.

The nurse specialist:

• must have protected time to undertake their role within the screening programme
• must be integrated within the screening programme; this includes regular contact with the programme manager or co-ordinator and invitations to AAA screening staff meetings and programme board meetings as appropriate
• should be supported in linking with key clinicians involved with providing care to men with cardiovascular disease, including smoking cessation, vascular surgery and radiology

3. Nurse specialist responsibilities

As clinical experts in the management and surveillance of individuals with abdominal aortic aneurysms, the nurse specialist should:

• provide education, training and professional development to screening technicians where appropriate
• offer all individuals the opportunity for a face-to-face nurse assessment appointment
• ensure individuals who screen positive for an AAA understand the issues and consequences associated with AAA management and surveillance (specifically, providing support, advice, secondary prevention and referrals if appropriate)
• liaise with the local programme manager or co-ordinator to ensure accessible and equitable clinics are booked appropriately and regularly monitored
• use the national IT Screening Management and Referrals Tracking (SMaRT) system appropriately and record all individual’s contacts within 5 working days (this task must not be delegated)
• attend the education and networking events hosted by NHS AAA screening programme
• maintain a continuing professional development record and registration with the appropriate professional bodies

The nurse specialist MUST not:

• undertake screening unless they have successfully completed the NHS AAA screening programme accredited training course
• clinically sign off screening technician scans or assessments as competent unless they have an appropriate ultrasound qualification and have attended the appropriate NHS AAA screening programme training course

4. Operational requirements

To ensure the effectiveness of the nurse specialist role, all screen positive individuals should be contacted and offered a face-to-face appointment with the nurse specialist. The appointment should be within 12 weeks of the initial scan.

If an individual is unable or unwilling to attend a face-to-face consultation, they must be offered a telephone consultation with the nurse specialist within 12 weeks of the initial scan.

The timeliness of the nurse consultation is an NHS AAA screening programme screening standard (effective from April 2020).

Individuals should be offered a second opportunity for a face-to-face appointment if they do not accept their first invite.

If an individual declines a face-to-face and telephone assessment this should be recorded by selecting the ‘Declined’ option in SMaRT.

Appointment ‘Not Required’ is only used for anything outside of the normal pathway, for example if an individual specifically requested an additional appointment but then changed their mind. This can be selected at the time of being scanned or afterwards.

A screenshot showing the selection of ‘Not Required’ for a nurse appointment

‘Declined’ must be used to reflect an individual’s decision for audit purposes. This will then show on subject status.

SMaRT users are then able to undertake a search and report how many followed the pathway and were marked ‘Not Required’ or ‘Declined’.

A screenshot showing how to include 'Not Required' or 'Declined' in a search

Once an individual’s AAA diameter reaches 4.5cm or more and requires 3-monthly surveillance, they must be offered an additional appointment with the nurse specialist before the next 3-monthly surveillance appointment.

An individual can request additional appointments if they wish to discuss specific issues or are anxious about their AAA.

A minimum 30-minute time slot is recommended for each individual.

5. Nurse assessment

During the assessment the nurse specialist should:

• measure and record height
• measure and record weight
• calculate and record body mass index
• determine smoking status (current smoker, ex-smoker or non-smoker)
• measure and record resting blood pressure using National Institute for Health and Care Excellence NICE guidelines
• review current medical and medication status, including statins and antiplatelet therapy
• discuss current diet, exercise and alcohol consumption if appropriate
• discuss familial AAA history

Following the assessment, the nurse specialist should:

• provide a full explanation of the individual’s condition and brief overview of the possible treatment options
• give details of the surveillance programme and a contact number for the local AAA screening office
• advise on blood pressure optimisation (urgent or routine) as per NICE guidelines
• initiate smoking cessation guidance or referral if required
• advise/recommend any interventions required by an individual’s GP
• give healthy eating or drinking and exercise advice in line with NICE guidelines
• address any concerns individuals may have, such as working, driving, contacting the Driver and Vehicle Licensing Agency (DVLA), travel and travel insurance
• discuss familial AAA risks

6. Communications

A letter generated from SMaRT should be sent to the individual’s GP communicating the nurse specialist assessment findings, advice given and any recommendations that the GP may wish to consider.

A copy of the SMaRT generated letter should also be sent to the individual.

7. Role of the screening technician in nurse assessment

Screening technicians should encourage the individual to attend a nurse assessment following a positive screen for AAA. The screening technician should advise that the appointment will be within 12 weeks of the scan and explain why it is important to attend.

The scope of practice for screening technicians in the NHS AAA screening programme does not include physiological measurements, including height, weight and blood pressure.

If local services incorporate physiological measurements as extended roles for screening technicians, they are responsible for ensuring competency. This includes initial training and annual competency review of screening technicians, adhering to relevant NHS and NICE guidance.

The local service is fully responsible for the clinical governance of individuals working outside of their scope of practice. Detailed standard operating procedures should be in place within the service to document pathways and responsibilities.