Planning for care outside the hospital

Jean Buchanan, community liaison sister, Weston Park

Hospital

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…….

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.

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Will I walk again?

Will I be able to go home?

What happens if I can’t?

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

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 careServices differ between areas –postcode lottery?

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” this should help meet the NICE guidelines that “care and equipment is provided in a timely fashion”

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”