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Planning for care outside the hospital

Planning for care outside the hospital. Jean Buchanan, community liaison sister, Weston Park Hospital. NICE clinical guideline 75 (2008).

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Planning for care outside the hospital

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  1. Planning for care outside the hospital Jean Buchanan, community liaison sister, Weston Park Hospital

  2. NICE clinical guideline 75 (2008) • Discharge planning and ongoing care, including rehabilitation for patients with MSCC, should start on admission…….It should involve the patient and their families and carers…….

  3. Holistic assessment takes time • diagnosis of spinal cord compression is a life changing event. “With a one year survival rate of less than 20% ,the majority of patients with MSCC must manage both disability and the implications of life limiting illness” • Eva G. Paley J, Miller M, Wee B; Palliative Medicine 2009: 23 “Patient’s constructions of disability in metastatic spinal cord compression” • It may be the presenting symptom of cancer. • Balancing patient’s need for time to adjust to their situation against pressure on inpatient beds.

  4. ?????????????? Will I walk again? Will I be able to go home? What happensif I can’t?

  5. What options are available on discharge? • Transfer back to local hospital • Admission to a specialist rehabilitation unit for people who are most likely to benefit (NICE clinical guideline 75) • Hospice • Nursing home • Return home

  6. What support may be available at home? • Informal carers • Social services home care, equipment & adaptations • Health services Community & palliative care nurses, night care, “hospice at home”, nursing equipment, home care • Third (voluntary) sector services • Charities e.g Macmillan, welfare rights advice, day care Services differ between areas –postcode lottery?

  7. Will I have to pay for my care? • Patients should be assessed against continuing healthcare criteria Depending on level of need either social services, health service or a joint package however • The WPH spinal cord compression audit indicates that patients with little or no mobility post treatment are likely to have a poor prognosis and should therefore meet the continuing health care fast track criterion: “A primary health need arising from a rapidly deteriorating condition which may be entering a terminal phase, with an increasing level of dependency” thisshould help meet the NICE guidelines that “care and equipment is provided in a timely fashion”

  8. In conclusion • “good communication with the patient cannot happen unless it exists between all members of the MDT” • Purdue C. (2004) Nursing Times 21/09/04 “Diagnosis and treatment of malignant spinal cord compression”

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