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Delivering a National Service – Impact on patients and families

Delivering a National Service – Impact on patients and families. Pam Green Senior Social worker Scottish Neurobehavioural Rehabilitation Service Neliss Baxter Outreach Nurse Scottish Brain Injury Rehabilitation Service. ABI NMCN. Standard 3d

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Delivering a National Service – Impact on patients and families

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  1. Delivering a National Service – Impact on patients and families Pam Green Senior Social worker Scottish Neurobehavioural Rehabilitation Service Neliss Baxter Outreach Nurse Scottish Brain Injury Rehabilitation Service

  2. ABI NMCN Standard 3d Effective discharge is facilitated by a comprehensive MDT approach.

  3. Rationale • Discharge is a process-not isolated event • Started at earliest opportunity • Comprehensive assessment of current and future needs. • Engagement of individual, family and carers.

  4. CBP and RFU • To provide a national brain injury and neurobehavioural service. • Assessment and rehabilitation for patients with complex care needs. • MDT – PT, OT, SALT, Neuropsych & SW. • CBP – 20 beds. • RFU – 19 beds within a locked unit. • Based in Morningside, Edinburgh

  5. Case Study - Brian • 18 – parents & 2 siblings 20 & 7. • 3 bedroom flat in rural location. • Employed full time as a builder. • Enjoyed going out with friends, computers and motorbikes.

  6. Rear seat passenger – RTA • GCS 3 at the scene • Diffuse axonal injury & frontal contusions • Multiple orthopaedic injuries • Required ventilation & induced coma

  7. Admission • Increased tone left UL and LL • Ataxic • Reduced coordination • Self propel wheel chair very short distances – fatigues easily • Assistance with personal activities of daily living

  8. Cognitive & Communication Issues • Poor insight • Reduced memory • Poor concentration • Distractibility • Poor planning & organising • Dysarthria

  9. Behaviour • Irritable • Frustration and anger • Physical & verbal aggression- family & staff • Impulsive • Disinhibited – sexual • Poor self monitoring

  10. Impact on the Patient • Isolated from friends & Family • Boredom • Lonely • Frightened • Grief/loss

  11. Impact on Family • Unfamiliar area/staff • Stigma • Grief/loss/anxiety • Emotional exhaustion • Distance & travelling • Hospital accommodation • Finances

  12. Support • Keep families in the loop • Positive relationships with patients & families • Involve patient & relatives in rehabilitation process • Provide information • Communication opportunities • Financial help

  13. Discharge Planning – Brian Challenges • Local care community assessment • Unsuitable housing • Will require personal care – 24/7 • Accessing Home - limited • Families expectations - high • Financial & Legal advice

  14. Geography & Distance • Out of sight out of mind • Communication • Assessment challenges – 2 way • Identifying resources for support plan

  15. Home - Brian • Limited opportunities • Lack of resources • Dependency on family/support • Loss of control

  16. Home - Family • Carer burden • Strain on relationships • New house – difficulties • Support from outreach team during transition • Adjustment & acceptance

  17. Support package post discharge • Making it work • Confidence • Information • Mentoring • Understanding

  18. ABI NMCN Standard 3d Effective discharge is facilitated by a comprehensive MDT approach.

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