presentation jan binusa course 2008v4
TRANSCRIPT
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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?