ADVANCING NURSING PRACTICE IN THE FIELD OF HEPATOLOGY THROUGH A PROSPECTIVE OBSERVATIONAL RESEARCH STUDY IMPLEMENTING INNOVATIVE SCREENING FOR LIVER DISEASE IN A COMMUNITY ALCOHOL SERVICE WITH A PORTABLE FIBROSCAN® DEVICE
Background Alcohol related liver disease, including cirrhosis, is a major cause of death in the UK (Williams et al 2014). Liver disease is silent and usually presents late. FibroScan® is a non-invasive tool for measuring liver stiffness; an indicator for fibrosis/cirrhosis. Socially deprived patients with alcohol related liver disease are a “hard to engage” population (Watt 2013) therefore, simple screening methods may help early identification of liver disease. Aims 1. Monitor uptake of FibroScan® in individuals accessing one community alcohol support service in a deprived area. 2. Determine prevalence of undiagnosed fibrosis/cirrhosis in study sample. 3. Monitor engagement following referral to specialist liver services. Method A prospective observational study recruited self-identified harmful drinkers between November 2014 and April 2015 for a liver FibroScan®. Participants with a FibroScan® reading of ≥7.1kPa were referred to a nurse-led liver clinic for further investigations, results of which determined referral to a liver specialist in secondary care. Participants referred were monitored for engagement over 6 months. Descriptive statistics were used to determine prevalence of undiagnosed cirrhosis and to determine engagement. Results Seventy-nine consented individuals participated, an uptake of 67% of those informed of the study (n=118). Of the 79 scans performed, three were unreliable leaving 76 participants. After scanning, 20/76 (26%) had a FibroScan® reading ≥7.1kPa requiring referral on to the nurse led clinic. All 20 (100%) engaged in further assessment. Of those, 12 required onward referral to specialist services. Subsequent compliance with specialist services in this sample (n=12) was ≥ 90%. Conclusion This nurse-led intervention advances nursing practice in the field of Hepatology. It demonstrates high uptake and subsequent engagement in liver services, giving potential for early intervention and improved health outcomes in a previously considered hard to engage population (Watt 2013). Keywords: Alcoholic, FibroScan®, liver cirrhosis, nursing assessment, transient elastography, screening.