Experience with accreditation of SCI Rehabilitation

Transcription

1 Experience with accreditation of SCI Rehabilitation Claire Guy Rehabilitation Programme Lead National Spinal Injuries Centre (NSIC) Stoke Mandeville Hospital, Aylesbury UK ESCIF Conference May 2011 De Rijp, the Netherlands

2 This session... History of the NSIC The NSIC today Involvement of service users in recent developments The impact of CARF accreditation at the NSIC Discussion around rehabilitation models in the UK before CARF Future Developments

3 Professor Sir Ludwig Guttmann A man with deep compassion and humanity that made his patients love and trust him: a man who could walk with kings nor lose the common touch: a man with humour and down to earthness : a man who saw things in terms of black and white, never afraid to condone or condemn (Scruton 1998)

4 History of the NSIC After the second world war Professor Sir Ludwig Guttmann was asked by the British government to found a dedicated SCI treatment facility. This was built between 1941 and 1942 by Canadian Soldiers. It was opened in 1944 with very little infrastructure. At it s maximum were Beds. In 1983 the current building was opened by Prince Charles and Princess Diana. First considered CARF accreditation 2003, and made changes within the centre around management of bed usage. Accredited in 2008, in 4 categories including the Spinal Cord System of care for adults and Paediatrics, due for reaccreditation 2011.

5 North and South Corridor Wards North and South Corridor Wards, built in by Canadian soldiers. The original location for both Spinal Injuries and Burns & Plastics.

6 Humble beginnings The Spinal unit began like this: In ward X Dr Guttmann was allotted 26 beds in a prefabricated wooden hut built by Canadian Servicemen as they prepared for the second front. The director had no office, his secretary was based in the bathroom, and the Xray cabinet was a wooden box on the floor. It was staffed by the young sister Miss Merchant, an auxiliary Miss Buller and 8 orderlies who were seconded from the army. The first patient was Harry Collier.

7 Guttman said, If ever I did one good thing in my medical career it was to introduce sport into the treatment and rehabilitation programme of spinal cord sufferers and other severely disabled This led him to found the Stoke Mandeville Games in In 1949 he spoke of his vision; One day the Stoke Mandeville Games would achieve world fame as the disabled men and women s equivalent of the Olympic Games.

8 Organisation of SCI rehabilitation 114 Beds Acute Admission ward: 20 Rehabilitation, 2 wards, 23 beds each Pre discharge ward 16 beds Readmission ward 23 beds Young people s Unit 9 beds

9 Rehabilitation We strive to admit patients as soon as they are medically stable but this may be affected by bed availability, infection control status and eligibility checks. Most patients do have surgical fixation and once mobilising for four hours will be transferred to a rehab ward. They have a meeting, a Rehabilitation Information Meeting, to inform them of the process within rehab, eg their functional outcome, goal planning, and what needs to be done for preparation prior to discharge.

10 Young people s Unit In 2008 this was accredited by CARF and is the first dedicated spinal injuries service for children in Europe. Four further beds were opened in Not only does it serve young people who are newly injured but the adolescent service will support people injured as children through this important stage in their life. Staff (often with their own young children)have an excellent working relationship with the young people which contributes to it s unique nature.

11 Key components of effective rehabilitation Using the ICF framework in all areas ensuring a patient centred approach An established goal planning process, and use of the Needs Assessment Checklist Rehabilitation Information Meeting A sound Clinical Governance Structure Integrated Electronic Notes User involvement and feedback A comprehensive teaching programme Having spinally injured people on the staff and involvement of ex patients in teaching initiatives

12 Potential pitfalls Goal planning Rehabilitation Information meeting Clinical Governance Teaching approach

13 Rehabilitation Information Programme This discussion was set up in 2010 to ensure the patient had information about the rehabilitation process early in their rehabilitation phase. Areas covered are: Medical information, clarification of diagnosis/intervention Expected functional outcome Discuss home situation and possible outcomes Explain the goal planning process Explain other facilities available; education, family counsellor, clinical psychology services Discuss what is important to them and expectations

14 Evaluation Evaluation is of particular importance to the CARF assessment process. The main tool for evaluation is the Needs Assessment Checklist and it s use during the goal planning process. The Client Centred Rehabilitation Questionnaire(Cheryl Cott). IMS reporting functions.

15 Why CARF accreditation The Centre recognised the need to have a baseline comparison for what it delivered. This is difficult in the UK as the NSIC is the largest Centre and comparisons are difficult. Senior staff had explored CARF accreditation were attracted to it s thorough approach and how it would establish a sound baseline to our work. There are other standards, currently in the UK; the UK rehabilitation council have just published a generic tool which covers a good base, but not with the specific detail found in the CARF standards.

16 How has accreditation changed our practice? A dog is not just for Christmas. We needed to really embed the standards into our day to day practice and not just start getting worried as we approached an accreditation, or dismiss them when we felt like it.

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19 How has accreditation changed our practice? I was concerned that staff might sit back once accreditation had been achieved. This is not the case. It has provided a robust structure for us to establish good practice and there have been a number of developments and initiatives since The CARF process really does encourage and seek to improve services; for the provider of services this encourages a facility to improve it s delivery of care to the service user.

20 How has accreditation changed our practice? Involvement of users of the service. Integral to the management is a close working relationship with the patient liaison officer who is a person who has a spinal cord injury. She provides a very balance representation from a patient perspective and there is also a weekly presence in the Centre from the SIA peer representative. The Client centred questionnaire provides an ongoing barometer of the feelings of the service users.

21 Current development Since 2008 the following areas have been further developed: A client satisfaction survey the CCRQ Electronic Multidisciplinary Notes An integrated discharge report The additional 4 beds in the young person s unit Better communication with the service users Involvement in activities promoting the NSIC Developing sport and recreation related activities Exploring a Rehabilitation Assistant structure SPIN (Spinal Patients Involved) user group Establishing a strong presence for the 2012 Paralympics Improving staff teaching skills using an accreditated course

22 SPIN (Spinal Patients Involved) The structure of the patient s forum was reviewed this year with involvement primarily from people who had sustained a SCI. There is now a thematic programme. It runs every 2 months. Initially is feedback from previous meetings and any actions taken forward. A general presentation, a short time for questions then the group splits into smaller discussion groups of 4-5. The group then comes together for feedback of the main points of discussion.

23 SPIN topics Current trends in research. Discussion around setting up outreach clinics. The Goal Planning Process. Fitness and active therapy during and after rehabilitation. Sex Drugs and Rock and Roll. The patient education programme Attendance is current patients, friends and relatives, ex patients and staff. Delivery of session could be from staff or ex patients. Patient perspective

24 Planned further development To take the Electronic Pt Record system to the next reporting stage. To work towards re establishing a sports facility at the NSIC including the organisation of community events. Having better transparent outcome reporting. In September 2011 to have the first cohort of students on the Management of Spinal Cord Injury MSc course. To continually improve the experience of our service users to be as well prepared as possible for the next stage of their life.

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26 In Summary The CARF accreditation process has revolutionised the culture within the staff group in outlook, understanding and relevance of what we are striving to do. This has impacted some staff groups more than others. As developments are discussed we now have a very robust framework to set our practice against, and I am sure there are still many years of improvement ahead. For information: claire.guy@buckshosp.nhs.uk

27 Further references Goal Planning Professor Paul Kennedy Psychological aspects of SCI Professor Paul Kennedy Neurogenic Bowel Management Maureen Coggrave Aging studies Gordana Savic Managing children through development Ebba Bergstrom Wheelchair provision and seating development Lone Rose Adolescent and young people s development Dr Allison Graham Goodman, Susan (1986). Spirit of Stoke Mandeville: The Story of Sir Ludwig Guttmann. London: Collins. ISBN Rogan, Matt (2010). Britain and the Olympic Games: Past, Present, Legacy. Matador. ISBN Scruton, Joan (1998). Stoke Mandeville: Road to the Paralympics. Aylesbury: The Peterhouse Press. ISBN Silver, John Russell (2003). History of the Treatment of Spinal Injuries. Springer. ISBN