Presentation Jan BInusa Course 2008v4

8/14/2019 Presentation Jan BInusa Course 2008v4

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Nursing in the Community

Community Care for People with

Sickle Cell Disorders in Islington

Supporting Care at Different Levels

Lorna Bennett (September 2008)


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Improving SCD community care

Where were we before?Sickle Cell and Thalassaemia service with limited ability to

provide alternative to hospital care

Where are we heading?Working to improve access and quality of care

Where are we now?

First community nurse matron in UK in an integrated team

How do we get to where we are going?

Structures, strategies and priorities are now in place


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Our SCaT Centre team

Nkechi Anyanwu: - Senior haemoglobinopathy counsellor

Matty Asante Owusu: - Community nurse matron

Dr Lorna Bennett: - Clinical service manager/ hbthy counsellor

Michael Coker: - Centre administrative manager

Dr Michael Evangeli: - Clinical psychologist

Moira OLeary: - Administrator

Gary Kinnane: - Administrator /Database administrator

Solomon Osinde: - Social worker senior practitioner

Dr Jane Wai Ogosu: - Locum haemoglobinopathy counsellor


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The Structures Staff support

Sickle Cell andThalassaemia

Community Centre

Steering Group is in place for the SCaT

centre to achieve the improvement

SCaT centre established staff, new staff and

centre activities managed by a Clinical Service

Manager

Clinical/ psychological and social work

supervision is in place. Community

Matron gets peer support from a

network of other CMs

Consultant Haematologist providing

clinical leadership for the SCaT centre


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Genetics

Counselling and

Screening

Hbthy

Community

awareness and

Users Group

Hbthy

National

Education

Centre

PEGASUS

Hbthy

Care of people

with a disorder

All staff

SCAT

COMMUNITY

CENTRE

Structures

SCaTCentre

activities

Improving community carefor adults with SCD

CLANS Database

Sustained Users Forum from 1989

NHS ANC Standards


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Adult (SCD) NHS Standards -

Community Care Framework

Stroke

Prevention &

Education

Expert

PatientProgramme

Public &

Professional

Education

Outreach

ServicesWelfare

Services

NursePrescribing &

Home care

Research

Audit &

Evaluation

GeneticCounselling

Phlebotomy

Outpatients

& Day

Assessments

One Stop

Shop

Support

Specialist nurse manager &

Administrator

New or improved premises

Drug funding and free

prescriptions

Patient information

resources (handbooks)

Transition planning National SCD registerStandards Working Group 2008 Chap 2 pp 17-31

Areas to

improve are

crossed


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Care of people

with a sickle or

thalassaemia

disorder

IslingtonSCD Adults

For high level input

flaggedCM, SW and Psy

All other

referrals to

the SCaT Centre

Hbthy Couns

SCD children,

thalassaemia

adults & children

Hbthy Couns

Structures

Access to SCD &Thal care

It is made clear to the public, patients and professionals that we have an

inclusive service, that is accessible to all with (or at risk) of a

haemoglobin disorder.


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The Strategy -

Organise SCD care on 3 levels

(DH 2004 NHS

Improvement plan)

Level 3

Adults

with SCD

who are

unwell a lot of

time

(Islington)

Level 2

Adults with SCD

who are at risk of becoming unwell

a lot of time

Level I

Adults with SCD

who may need

support

from time to

time

Case Management

Disease Management

Supported Self Care70 80% patients

CM, SW & Psy

CM, SW, PSY &

Hbthy Coun

Hbthy Couns

Population wide prevention

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Level 3 patients pathway

Patients identified by

patients at risk for re-

hospitalisation tool (PARR)

Patients referred by

health and social care

professionals

Patients are

assessed by

(a) CM re suitability for

the service

(b) by other members

of the IntegratedSupport Team

following internal CM

referral or directly via

the patient or other

professionals

Team agree on

suitability of

placing patient on

caseload anddecide on who will

take lead role

Patientsself referring


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The strategy -

Continuity of care SCD ()

1. Interventions at different levels are joined up

as people with SCD will change levels ().

2. All team members make a contribution to careat the different levels via MDT meetings, drop

in sessions or in the users group.

3. There is regular communication betweenmembers of the team, to avoid duplication,

replication or confusion.

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The Strategy -

An alternative to hospital

Flag self

to Community

Matron

Flag to

Social Worker &

Psychologist

Improve

care at home

Unwell

at home

SCaT

Centre

services

Flagged

to Community

Matron

Flag to

Social Worker &

Psychologist

Improve

care at

home

SCaT

Centre

services

Unwell

in hospital

Reducing Reliance Preventing Reliance


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Alternative to hospital

1. Our emphasis is to improve community careand not to reduce hospital admissions.

2. Patients must not feel that if they are unwell,they cannot attend hospital as they are costly

to the hospital, PCT or NHS.3. Our key message is that the service is now

providing an alternative to hospital care, forthose clients that would benefit.

4. A community alternative is ultimately morebeneficial and less expensive for patients, thehospitals, PCTs and the NHS.


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Early days outcome

Number of avoided inappropriate secondary care attendances, using

1st October to 31st March 2008 data and extrapolated for the full year effect

15278110.426.463664611TOTAL

1238N/a14.4516N/a6

Outpatient

appointments

13865110.49.65777464

Inpatient

admissions

175N/a2.473N/a1

Emergency

Department

attendances

Cost

Savings

(full

year)

Number of

bed days

Saved

(full year)

Number of

attendances

avoided

(full year)

Cost

Savings

(Oct Feb)

Number

of bed

days

Saved

(Oct-Feb)

Number of

attendances

avoided

(Oct-Feb)

Type of

attendances


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A note of caution

(a) Avoidance was bereft of any probable cost of secondarycomplications

(b) Only the community matrons impact is estimated within

the 5 months period

(c) Avoidance of secondary care attendance pre the auditperiod is not included

(d) Whilst secondary care use may have been avoided,

costs and bed days saved does not take into account any

increased use of any other services as a result of the saved

admission(e) Lack of a costing exercise for the integrated teams non

clinical activities leading to hospital avoidance

Ref: M. Evangeli, L. Bennett et al (2008) Interim Report, SCaT Centre, Islington PCT


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How do we get there?

Prevent or address barriers to a successfuloutcome e.g.:

2. Good marketing of SCaT services reducinganxiety and confusion for users and HCPs.

3. Competent staff that can provide holistic care.4. Effective forum for discussing issues of concern

(Steering group and Support group).

5. Positive working culture is promoted for team

dynamics; valuing diversity; communication;professional boundaries to be respected.

6. No Lip service to users engagement.


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EXERCISE & DISCUSSION

Taking into account the two service

models..

What are the risks and benefits

of moving sickle cell care

closer to home?

Documents

Presentation Jan BInusa Course 2008v4